Terminally Ill Adults (End of Life) Bill

Lord Pannick Excerpts

Friday 12th December 2025 Lords Chamber

[Baroness Merron (Lab)]

I am sure that my noble and learned friend will comment on the noble Lord’s points, but the point I wished to make, which might be helpful, is that it is usual practice for the Government to consider and address these matters. Noble Lords are aware that there is a range of ways of dealing with that: by amending primary legislation, through a remedial order or by a declaration of incompatibility. That is the usual practice.

[Lord Pannick (CB)]

On human rights law, does the Minister agree that, if Parliament forms a considered judgment that there is a basis for a differentiation in this context or any other, it is most unlikely that a court is going to intervene on the sensitive subjects of social policy that we are concerned with here?

[Baroness Merron (Lab)]

I hear the noble Lord, but my role today, as I am sure he understands, is to advise your Lordships on the risks as we see them and for noble Lords to decide how they wish to interpret them with regard to these amendments. But I am grateful for the point that the noble Lord makes.

Noble Lords may wish to note that these amendments would lead to different treatments for those detained under the Mental Health Act from those detained under the Mental Capacity Act. Only those detained under the Mental Capacity Act would be excluded from assisted dying. Noble Lords may wish to consider whether this is justifiable, given that the criteria for detention under both Acts are similar. The decision on which Act to use is largely a matter of professional discretion. Operationally, these amendments could also create confusion for practitioners, because they depart from the principle that capacity assessments are decision- and time-specific, so additional guidance and training would be needed.

Finally, as noble Lords will be aware, these amendments have not had technical drafting support from officials, which means that they may not be fully workable, effective or enforceable in the way that they are currently drafted. However, the issues raised are rightly a matter for noble Lords to consider and decide.

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[Baroness Lawlor (Con)]

My Lords, I will speak to Amendments 30B, 220 and 265A in my name. They share the aim of other amendments in this group to ensure that the GP knows and has looked after the person who wants to end his or her life, but go beyond them in proposing the extent and length of the relationship needed and in requiring a letter from the GP to provide important additional safeguards. I will explain the amendments.

First, I propose that the patient be known personally to a doctor for two years through having been seen for at least six appointments. Secondly, I propose that the doctor submits a letter to the assessment panel on the patient’s physical and mental health during that period, and a prognosis. Thirdly, I stress that the doctor, as we see their involvement in this Bill, may be the patient’s GP, but that is not required; the doctor may be the first doctor, but, given Clause 11(8), this is unlikely, and it will probably not be the second doctor. The important point is that a medically qualified practitioner knows the patient over time and can write an assessment for them.

Why does this matter? Advocates of and those concerned about the current arrangements in the Bill want adequate safeguards. We all do. We want to protect the weak, the elderly and people with physical or mental health conditions from being influenced, pressured or coerced into wanting to end their own life. But if the request for assisted suicide can be accepted without a doctor who knows the patient personally over time, there will be no such safeguards. “Knows” does not mean a fleeting acquaintance but a professional knowledge of the patient built up over years. That is the aim of my amendments. By contrast—

[Lord Pannick (CB)]

What happens if my doctor retires and I therefore have not had a doctor who knows me for two years? Am I to be denied access to the provisions under this Bill?

[Baroness Lawlor (Con)]

I thank the noble Lord. I hope to come to deal with that question.

By contrast, all the Bill requires is the involvement of two doctors, neither of whom needs to be at the practice where the patient is registered or even has to have had prior knowledge of them before the process begins. Under the Bill as it stands, there is no connection between a doctor who knows the patient well and the process that leads to the assisted suicide. The other amendments in this group go some way to mitigating this, but it matters that there is a guaranteed role in the process for the doctor who may have known the patient.

The Bill recognises that the patient’s GP may not wish, as a matter of conscience, to be involved in the process, but that does not mean that they or another doctor who knows the patient should not submit a letter to the process of the assessment panel as one of a number of documents seen by the multidisciplinary panel, which would be part of the public record of the assisted suicide. It will be in a different format—neither a checklist nor compiled from the hasty notes that GPs are obliged to write that they squeeze in between their 10-minute appointments.

I turn to possible objections to these two-pronged amendments. First, the requirement that the same doctor has seen the patient six times over two years to allow adequate safeguards may be thought too much. Anything less would hardly amount to knowing the patient, the condition and their state of physical and mental health. It is feasible. Some evidence suggests that, on average, in 2018-19 patients had 3.3 face-to-face consultations per year with their GP, and 8.7 when every sort of consultation was taken into account. This data has not necessarily changed over the 20-year period of the study. Other data puts the face-to-face consultations lower, at 2.6, but these are averages. Very seriously ill people will have had far more consultations.

Moreover, only face-to-face consultations, when the patient is physically with the doctor, give a good idea of physical and mental conditions as they develop. If the Bill is so amended, in answer to some problems that have been raised, it might encourage more face-to-face GP consultations with seriously ill patients. If there is a seriously ill patient and the GP retires, they might like to leave a letter providing the evidence over the period they saw them before they retire. But there will always be objections—

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[Lord Pannick (CB)]

The GP might have died 18 months ago; what happens then?

[Baroness Lawlor (Con)]

These things can happen, but we should have a process or an alternative mechanism. I am not going to deal with exceptional cases. My GP is still in situ, and I can see my GP when I want to; other practices could aim to do the same thing. We have very great demands on the practice in Cambridge, with many students registering.