Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, it has been a great privilege to sit here all day and listen to noble, and noble and learned, Members of this House. The problem is that when you are the penultimate speaker, most of the good ideas and suggestions have already been made. I pay tribute to my noble friend Lady May, the noble Baronesses, Lady Falkner and Lady Hunt, and indeed the noble Lord, Lord Stevens, on his very good point regarding palliative care in England and Wales, which is highly relevant to this debate.

I am concerned about the fundamental shift that the Bill will cause for our relationship with the medical profession. As legislators, we owe it to the public who will be impacted by the Bill to think through all consequences carefully, whether intended or not, and to think about who we will empower to pass legislation.

If this Bill passes, we will be moving from an NHS where doctors are focused solely on healing to an NHS where, when the conditions of the Bill are met, any individual doctor with no specific training can raise ending a terminally ill patient’s life with the state’s endorsement, no matter how vulnerable the patient. We place a lot of trust in our doctors and healthcare professionals to seek what is best for us, and the Bill risks the implication, if not outright declaration, that ending your life early is a suitable course of NHS treatment.

The honourable Member for Sleaford and North Hykeham in the other place, who is an NHS consultant doctor, reflected on this issue of how patients interact with their doctors during the debate on Report:

“As a doctor, I am very aware of the trust that the public place in doctors and the seriousness with which they take what we say. If a doctor gives somebody information about assisted dying, it is quite reasonable for that person to think that the doctor is suggesting that they should take part in that process, or is hinting that their death will be dreadful and trying to be kind. If doctors are allowed to say, ‘This is a good process,’ more people will take it up than would otherwise have wanted to”.—[Official Report, Commons, 16/5/25; col. 646.]


I know when I go to the doctors, I assume that the doctor before me will be there to help my health and recovery and nothing else. That should be our experience. Any threat to this kind of relationship between the medical profession and its patients must be rejected. We cannot afford to fundamentally rewire the NHS to the effect that the public will no longer be sure that their recovery is occupying the totality of the doctor’s thoughts, or will worry that in a cash-strapped NHS trust, somebody is calculating, as set out in the impact assessment, that £13,000 could be saved per patient for every four months of unused healthcare for the cost of a £14 prescription.

As this Bill passes into law and establishes assisted dying as a regulated and approved treatment, something commonplace, we will have to be sure not just that systems and process are beyond reproach; many professionals at all stages on their career will have the opportunity and ability to put patients on the route to an assisted death. This means that we will have to have faith in the competence and professionalism of every individual. I have no problem, having closely interacted with three NHS trusts as a Member of Parliament, in saying that some of the most dedicated people in our country work in the NHS. However, I would be delusional to pretend that that is universally true. I have seen deeply worrying cases where one bad apple was simply shunted from job to job. As with all institutions, doctors are fallible human beings. Mistakes will be made through exhaustion, misunderstanding and, yes, in some cases, malice.

Yet advocates for this Bill would have us reject common experience. When the Member for Vauxhall and Camberwell Green raised the point on Report that many constituents

“have grave concerns about the way in which they are treated, because they feel that they do not have a level of equality within our NHS”,

the Member for Solihull West and Shirley rejected it as

“rhetoric that engenders a fear around the medical profession”.—[Official Report, Commons, 16/5/25; col. 651.]

We must not underestimate how much power this will put into the hands of, potentially, very junior medical professionals, and the scope of impact that a very small cohort can have. That is evident in the international jurisdictions with similar regimes. According to an official report in 2021, a single doctor in Oregon wrote one-eighth of all assisted dying prescriptions. In Victoria, according to the Voluntary Assisted Dying Review Board, during 2023-24 10 doctors handled 55% of all cases. This Bill should not pass in this current form.

Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

I encourage the noble and learned Lord to say early in this debate—we have done it for nearly an hour already—that he is prepared to sit down after this Committee stage with others with the intention, the purpose, of adding the appropriate words to this Bill with the assistance that he has been lucky enough to have. We have had wonderful assistance from the Public Bill Office. He has had much more assistance from even more official channels. We can sit down, we can find the words, we can try to agree on them, and I hope that noble colleagues in this Committee would undertake to act in good faith to try to find those words and to ensure that on Report they were included. Let us not have another three-hour debate in which we feel as though the pin on which we are dancing is melting underneath us.

[Lord Evans of Rainow (Con)]

My Lords, I rise to speak to Amendment 50 in my name and that of my noble friend Lord Goodman. It is a pleasure to follow the noble Lord, Lord Carlile. I would not describe him as a nasty lawyer at all. The noble Lord is a Burnley fan. I do not know any nasty Burnley fans, but I do know a lot of Arsenal fans. There is one thing I would say about some phraseology the noble Lord used early in his speech. He used the words “final solution”. I encourage the noble Lord to think of other phraseology to describe that.

I agree with a lot of what the noble Lord, Lord Carlile, said. I am grateful to my noble friend Lord Deben for following the noble Lord, Lord Pannick, because I, too, am not a lawyer, but like my noble friend, as a former Member of Parliament, I experienced lots of constituents who were under coercive control. Lots of MPs do surgeries for their communities and take on these cases. Not being a lawyer, as a layperson trying to fathom out coercive behaviour is notoriously difficult, and that is why I have come up with Amendment 50.

The existing language limits the coercion pressure bar to cases where it causes the person to make a decision, which creates evidential difficulties. This amendment excludes all cases of coercion and pressure without requiring finding out whether in fact it causes the person to make the decision to end their life. It is easier to see whether someone is being coerced or pressured than to know whether the coercion or pressure is the operable cause that leads a person into making the decision. A doctor should exclude all cases where a person is being coerced or pressured to make a declaration rather than engage in causation analysis. Similarly, offences ought to be focused on the wrongful act of coercing or pressurising regardless of the outcome.

At trial, the Crown, with plenty of resources, would have trouble proving that the coercion or pressure resulted in someone making the decision. How is a doctor on their own supposed to find out? Asking a patient is no help given that the frail or vulnerable person may not even know that they are pressurised or may have been intimidated by coercion. Doctors can see pressure from, say, the person accompanying the patient but cannot read the patient’s mind. This amendment would stop doctors being required to be detectives.

The closest analogy in existing law to this rule against coercion or pressure to do a potentially fatal action is Section 2 of the Suicide Act 1961, “Criminal liability for complicity in another’s suicide”. It does not require any attempt at suicide or even a decision to commit suicide and provides that

“D may commit an offence under this section whether or not a suicide, or an attempt at suicide, occurs”.

Section 184 of the Online Safety Act 2023 titled, “Offence of encouraging or assisting serious self-harm”, provides in subsection (5) that

“D may commit an offence under this section whether or not serious self-harm occurs”.

Compare also Section 65 of the Serious Crime Act 2007, which refers to pressurising someone to commit an offence and does not require the outcome be causative.

In recent years, the Crown Prosecution Service has pursued manslaughter charges against men who subject women to domestic abuse that is believed to have driven their suicide. These are criminal offences where there is a much higher bar to action, given that a person’s liberty is at stake. However, Clause 1 is addressing when civil authorities and doctors should draw the line at a patient’s autonomy. Why does the Bill have a higher standard? There is no statutory precedent for “pressured into making it”. The Government have claimed that the Online Safety Act 2023 and the Serious Crime Act 2007 are analogous, but the distinction is making the pressure all that is needed for an offence. Meanwhile the threshold for excluding a person in Clause 1 requires more than is necessary for a criminal offence under these Acts.

Without this amendment it would be lawful to progress a person towards an assisted death even though the person is living in a household where family members are actively making it difficult to live. All that is needed is to see that the person is not pressured or coerced into making the decision. The leading cause of death in domestic abuse victims is now suicide. We work to stop this, but this Bill is opening a door to help perpetrators. It is estimated that three women a week take their own lives. The Government view addressing this as a priority, and the CPS will now prosecute for manslaughter men whose abuse is seen to have contributed to the suicide of a woman. Those men have not had directly to coerce their partners into death, the facts of the abuse are sufficient pressure, but with assisted deaths there will be no coroner’s inquest to address foul play.

The UK leads the world in now recognising coercive control in law, but a regime of total control is poorly understood and insidious. As Cherryl Henry-Leach of Standing Together Against Domestic Abuse told the Lords Committee:

“Coercion is an incredibly complex phenomenon and by its very nature it is difficult to identify and respond to. A perpetrator of coercion will ensure that a person is dependent on them by isolating them from support, exploiting them and depriving them of their independence and autonomy to make decisions freely. As a result of this, we are extremely concerned ... When I think about pressure, I also am mindful of a pattern of coercive control that can be insidious and subversive. Pressure can be a tactic by a perpetrator to enforce a regime of coercive control. That is very complex and I get that, but it is important to be mindful that pressure can be a tool that indicates a pattern of coercive control”.


Studied neglect and coercion are naturally notoriously difficult to detect, and as it stands now, this Bill is a suicide charter. My amendment is intended to improve the Bill.

[Baroness Hollins (CB)]

My Lords, I have amendments in this group, and I have added my name to other amendments. I start by adding my support to Amendment 460, tabled by my noble friend Lady Finlay. Safeguarding measures are not optional; they are essential. To ensure that each individual requesting assisted dying is properly safeguarded, it is essential that all relevant information is gathered so that a full and thorough picture of their circumstances can be formed. We know that poor mental health, inadequate care support or unaddressed social vulnerabilities can profoundly affect a person’s decision-making and ultimately their capacity and understanding of an assisted death. When safeguarding is insufficient or overlooked, the risks of coercion, subtle pressure or abuse increase, and these are risks that may be difficult to detect or are deliberately concealed. This amendment seeks to ensure that such dangers are neither under-estimated nor ignored.