Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Friday 16th January 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I tabled Amendments 56 and 57. Amendment 57 is to do with

“acting for the primary purpose of avoiding physical pain”,

while Amendment 56 is about someone

“acting for their own sake rather than for the benefit of others”.

The two amendments are distinct, although they are linked somewhat because, to some extent, the issue of physical pain—or avoiding it—is a clear-cut way of limiting the scope. I accept that my noble friend Lord Markham does not think that the scope should be limited in this way; indeed, many others may well think the same. I also bear in mind what the noble Baroness, Lady Royall, said about the fact that people are dying anyway. However, this is about a new way of accelerating death rather than the situation that we have at the moment, including, for example, “Do not resuscitate”; as I say, I am relieved that we no longer have the Liverpool care pathway.

Without revisiting the entire palliative care debate, one thing I was struck by in the words of noble Lord, Lord Stevens of Birmingham, is that element of choice—that is, whether this is a real choice and can be considered objectively, in terms of the primary purpose being avoidance of pain. If palliative care were widely available—I know that there are people who feel that palliative care may still not be enough—Amendment 57 would still allow for that.

Where the second element comes in—I appreciate that noble Lords may feel, “We’re back here again talking about coercion”—is in relation to motivation. I was struck somewhat by what the noble Baroness, Lady Whitaker, said, which was almost, “I don’t want to be a burden—my children know this—so let’s just get on with it”. However, this issue keeps coming back, I am afraid.

I thank the noble Lords who signed my amendments; one of them, the noble and right reverend Lord, Lord Harries of Pentregarth, has left because we have gone past 3 pm. I was motivated to table them by the debate in the name of the noble and learned Lord, Lord Falconer of Thoroton, in this Chamber on 7 November 2014, with the same Peer, going back to this understanding of what “voluntary” is. Back then, the noble and learned Lord referred to the aspect of people not wanting to be a burden. I intend to quote him, if that is okay; I appreciate that he may not have the Hansard to hand. Another Peer asked the noble and learned Lord, “How do you know?” The key thing is that, although that Bill was admittedly about a judge-led process, it was also about conducting

“in-depth discussions with the patient and the other doctors”

where the voluntary bit had to be voluntary, with

“he or she … not being forced into it either by coercion or by the sort of guilt that we referred to earlier”.—[Official Report, 7/11/14; cols. 1955-56.]

The “earlier” was that feeling of being a burden. So, my question for the noble and learned Lord, I guess, is: has something changed? Is it just that society has moved on and that autonomy is now more important than our concerns, which are still there, around why people want to accelerate the end of their life even though they know that it may come quite soon?

I am still concerned with making this issue clearer. Most of the stories that have led to the debates and Bills that we have had have been about pain and suffering; that is why, to be candid, I prefer Amendment 57, to avoid the issue highlighted in Amendment 56.

[Lord Kamall (Con)]

My Lords, this has been another rather long but interesting debate. It is important that noble Lords who wanted to speak had their voices heard. It touches on something we touched on very early. Noble Lords will remember when we debated another version of motivation and talked about coercion. A number of noble Lords put forward amendments to talk about encouragement. In that debate, we saw how difficult it was to distinguish between encouragement and coercion, to say whether encouragement is a form of coercion, and to legally define something such as encouragement.

Now we have the very same issue with motivation. In some ways, as the noble Baroness, Lady Cass, said, motivation is the internal version: it is self-encouragement or self-coercion, not wanting to feel a burden. We have debated what it means to feel like a burden. It is important that we understand the motivation. As the noble Baroness said, professionally, doctors need to do that to understand what help or assistance that patient could be given. It could be, if this Bill passes, that they are allowed or helped to progress to assisted dying, but it could be that they are offered something else that they feel very comfortable with that gives them a bit longer to live and to have that quality time that the noble Baroness, Lady Fox, talked about having with her family. When I was a Health Minister, one of the things that I learned about palliative care from the noble Baroness, Lady Finlay, when I first spoke to her was that people who live longer, even though they may have wanted their life to end “now”, appreciated that extra time with their family, once they entered palliative care, to close those unclosed things, to make up with friends and family they may have fallen out with, and to bring closure to their life before they went. It is important that we recognise that. I do not want to go back into the whole debate about palliative care, but it is important that it is seen as an option to give that closure to people, even if they do not want it and they decide, “I’ve made my mind up”. That is probably a more informed choice.

We need to be very careful about trying to define exactly what the one word that sums up the debate is. If it is about choice and only choice, pretty soon after the Bill reaches the statute book, people will say, “I only have 12 months to live. Why can’t I have the same choice as people who have six months?” Surely it is about not just choice or suffering but a combination of factors. That makes it incredibly difficult for the lawyers, but also for the medical people, to determine. We need to unpick some of that.

Noble Lords who have spoken on this group have picked up a number of issues: people feeling like a burden, mental health disorders, disabilities, and remembering that not all disabilities are visible. On that point, I welcome back the noble Baroness, Lady Campbell of Surbiton—I should know her title because she lives down the road from me; next time she sees me on the high street, she will probably prod me on that. There are also financial considerations, self-motivation and avoiding physical pain. The Bill does not require a specific motive as part of the eligibility criteria. Obviously, the whole Bill is about eligibility—the first few words are about who is eligible to seek assisted death services or terminally ill adult services—but it would be helpful if the noble and learned Lord, Lord Falconer of Thoroton, could expand on the thought process behind his very tight definition of “eligibility”.

I must say to noble Lords who have teased the noble and learned Lord a little bit about things that he may have said in the past that we are all entitled to change our mind when we learn new facts or hear a different view. I do not see it as a weakness in an argument if someone changes their mind when they have heard new facts. I find myself defending the noble and learned Lord, but I do not think we should be too harsh. I should remind people that I am personally very torn on this Bill, and I have not made up my mind. I am waiting to see the outcome of this debate before I make up my own mind about how I vote on this.

We also heard about dignity. I teach at a Catholic university, and dignity is a very important concept in Catholic social teaching. But what is dignity? It can be subjective. One person could be told that they have to wear incontinence pads for the rest of their life, and someone else could be told, “I’m sorry, you can’t walk for the rest of your life”, but other people have quite a full life even if they face those challenges or find themselves disabled. It is really difficult to define dignity; in many ways, it is subjective.

I have read many of the papal encyclicals about all this. By the way, I am a Muslim teaching at a Catholic University; in many ways I am the diversity, if you like. It is important that we consider what we really mean by dignity. We all think we know what it means, but we all have a different perspective on what it is.

A point that has come up many times in the debate is that we hear the words “pain” and “suffering”, but they are not in the Bill. We have to ask the noble and learned Lord, the sponsor of the Bill, about the thought process behind why he decided not to put “pain” and “suffering” in the Bill so that we can all understand, given that many noble Lords have asked that question about pain and suffering, why they are not explicitly there.

I ask the Minister this very carefully. A number of times during Committee, we have put questions to the Government but they have constrained themselves as to what they answer. It is important that the Government tell us what the implications would be if the Bill were to pass into law and what that would mean for resources in the department and for decisions that the Department of Health may have to make, as well as what it might mean for other departments of government. That is important. We cannot just say, “I’m going to confine myself to these few clauses”, because this will have implications. Some will say that it may have implications for wider society—a society that allows people to take their lives earlier or encourages death. It changes the sort of society we live in. Many people will welcome that and will say it is a society of choice, while others will say, “No, we don’t want to live in that sort of society”. We have to remember the implications of this Bill.

I ask the Minister to set out the Government’s considered view. I know that the Minister will say that some of these amendments as drafted are not legally sound—we understand all that—but these are probing amendments. This is a Committee stage and the amendments are not meant to be completely technically sound. We need to know, if they were to pass and were to be tidied up by the government lawyers or the officials, what that would mean for the workability of the wider health and care system and not just in respect of these issues that we are debating or the individual clauses in the Bill. We need to have a clear view of how this will change things and of the challenges that any Government will face when a new Bill comes in. That would be helpful.

I will stop there. I have asked a few questions to the noble and learned Lord, Lord Falconer of Thoroton, about the motivations for some of the decisions that he made in drafting the Bill, but also to the Minister speaking on behalf of the Government to answer the very real implications for resources, et cetera, not only in the Department of Health and Social Care but more widely across government.

[Baroness Merron (Lab)]

My Lords, I, too, welcome back to the Chamber and to this House the noble Baroness, Lady Campbell. It is a pleasure to see her back with us and I thank her and other noble Lords for their contributions in this group of amendments.

I once again make it clear that I will keep any detailed comments limited to amendments on which the Government have major legal, technical or operational workability concerns. It is important to remind your Lordships’ House of that. I say to the noble Lord, Lord Kamall, that the Government are doing only what any Government would do, which is to be scrupulously neutral, as your Lordships would expect us to be, and to handle it in that way. If Parliament passes the Bill into law, of course we will ensure its safe and effective implementation, but until that point I am afraid that I will be sticking scrupulously to what the role of any Government would be. I am sure that the noble Lord understands.

Amendment 30, tabled by the noble Baroness, Lady Foster, was spoken to by the noble Lord, Lord Weir, and Amendment 30ZA, in the name of the noble Baroness, Lady Lawlor, seek to prevent a terminally ill person in England or Wales from being eligible for an assisted death if they are motivated by certain specified factors. These amendments would introduce uncertainty around definitions and concepts, such as what constitutes “adequate housing”. They would also create an internal inconsistency in the Bill, as they are not reflected in later provisions that set out the assessment process. Drafting difficulties and internal inconsistencies are likely to result in confusion on eligibility, and significant further consequential amendments and policy development would be needed to produce predictable legal effects.

The Government also have some further practical operational concerns, which I will note for the Committee’s consideration. The amendment’s exclusion of those

“substantially motivated by… a disability”,

while excluding terminal illness from “disability”, would be potentially complex to operationalise. It may also be that somebody has multiple motivations. It is unclear how these could be separated or who would be able to make a final judgement.

--- Later in debate ---

[Noble Lords]

Front Bench!

[Lord Kamall (Con)]

My Lords, I have been very clear throughout this debate that any noble Lord who wants to speak and participate should be allowed to do so.

[Lord Kennedy of Southwark (Lab Co-op)]

As I said earlier, it is absolutely fine to break mid-group on these amendments.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

While that is absolutely a legitimate thing to discuss, and I would always defer to doctors on that, it makes no difference to this part of the argument of whether we call it dying. The noble Lord may well want to raise the question of whether we can ever be sure that someone is dying, although I have to say that I cannot be the only one who has been with someone where it is jolly clear that they are not going to live till the end of the week. There are times when you absolutely know that someone is going to die. While he may well be right that there are other cases, that is not the issue of this word. This word in the Bill is to give to the public the understanding that we are talking about whether there is a way of helping either the final timing or the way of those final days. We are not talking about someone who just decides to commit suicide for some other reason; we are talking about people who are dying from some sort of terminal illness.

[Lord Kamall (Con)]

My Lords, I remind the Committee that I am one of those who are still balancing the arguments on the overall Bill, and where I get put off some arguments is when people heckle those who are trying to make a point. I do not think it helps their cause. On the other side of the argument—I am trying not to sound as if I spend my life sitting on the fence—those who speak much longer than they need to in making a point also make it difficult to support some of the points that are being made. On future Committee days, I would like to see a bit more mutual respect between the different sides of the debate, with shorter points made but also less heckling of those who want to make a point. It is important, if we are going to say that we are doing our job in scrutinising the Bill, that everyone who wants to make a valid point, relevant to the amendments, is allowed to make it.

I thank my noble friend Lord Frost for tabling the amendments in this group. I recall that at Second Reading my noble friend Lord Moylan spoke about the importance of language. Language is important, especially clarity of language, so I understand my noble friend’s intentions in tabling these amendments. One could argue that there is a distinction to be made between the terms “assisted dying” and “assisted suicide”. “Assisted dying” on its own, before you even consider the Bill, does not necessarily mean consent on the part of the person whose life is being ended. The Bill introduces that element of consent, but “assisted dying” on its own does not mean consent, whereas it could be argued that the term “assisted suicide” conveys some form of intent—that it is a person seeking to end their own life, they want to do so and are not being assisted to die, regardless of whether or not they want to die. That may seem to be a philosophical point, but it is important that there is a distinction between assisted dying and assisted suicide. As the Official Opposition, we have no collective view, but it is a legitimate challenge by my noble friend to the language of the Bill, seeking clarity or, as the noble Baroness, Lady Fox, said, transparency.

Noble Lords have argued that people in this country should be able to access the services that people can access from Dignitas in Switzerland. However, Dignitas is described as offering physician-assisted suicide. Looking at the Dignitas website—not because I have lost the will to live after trying to get through a day of debates, but to look at the language—I see that it uses the phrase:

“Legal assistance for suicide with DIGNITAS”.


So we have to ask ourselves: if we are trying to be consistent with Dignitas, why is it okay for Dignitas to use the language of “suicide” but, when people want that same service in this country, we cannot use that language?

[Baroness Hayter of Kentish Town (Lab)]

That is exactly because it will take people who are not dying. This is not what this Bill does.

[Lord Kamall (Con)]

That is a fair point to be made. It is why the question was asked, and I thank the noble Baroness for answering it.

I thank my noble friend Lord Frost for provoking this debate, because there are still other arguments for using the phrase “assisted suicide”, particularly in terms of clarity. I look forward to the consideration of the arguments made by my noble friend Lord Frost from the noble and learned Lord, Lord Falconer, and the Minister.

[Baroness Merron (Lab)]

My Lords, I will be very brief. The amendments tabled by the noble Lord, Lord Frost, do not present significant workability concerns. As noble Lords will be aware, the amendments have not had technical drafting support from officials. Therefore, further revision and corresponding amendments would be needed to provide consistent and coherent terminology throughout the Bill.