Terminally Ill Adults (End of Life) Bill

Lord Rook Excerpts

Friday 12th December 2025 Lords Chamber

Moved by

[Lord Rook]

19: Clause 1, page 1, line 12, at end insert “and has been so registered for at least 12 months ending with the date of the first declaration, during which time the person has been seen by a general practitioner at said practice (in appointment, consultation, or home visit) at least twice”
Member’s explanatory statement
This provides a simple way to check one of the aspects of ordinary residency required in paragraph (c), and ensures the person in question has been receiving medical care within the jurisdiction prior to making the request.

[Lord Rook (Lab)]

My Lords, my Amendment 19 would add a modest but important safeguard to Clause 1 by ensuring that a person seeking an assisted death has been registered with a GP practice in England or Wales for at least 12 months and has had at least two contacts with that practice in that period, whether in person, remotely or through a home visit. These are minimal thresholds. They do not obstruct genuine applicants. They would simply ensure that before someone seeks the assistance of the state in ending their life, there is at least some continuity of care—the importance of which the right revered Prelate the Bishop of Norwich has already stressed this morning.

To this end, a real relationship with the primary care system is important and prevents a terminal decision becoming subject only to a paper exercise. The Bill already requires 12 months of ordinary residence, but ordinary residence, as we discussed on the last day in Committee, can be, legally speaking, a somewhat elastic concept. A single GP registration can in practice be little more than having your name down on a list. The Government’s own equality impact assessment notes that access to GP services is uneven, that continuity of care is declining, and that patients in deprived or rural areas often struggle to obtain timely appointments.

The independent investigation into the NHS by the noble Lord, Lord Darzi, discovered that more than 1,300 GP practices have closed since 2015, while the average full-time GP now has responsibility for more than 2,200 patients. In such a landscape, it is simply unrealistic to assume that every person approaching the end of life will have a meaningful GP relationship, without a safeguard such as the one I propose in this amendment.

This amendment would give the residency requirement real substance. Twelve months of registration and two GP contacts would not create a barrier but would provide a more objective basis for assessing doctors to know that the person has not merely appeared in the system at a moment of crisis. The amendment would also increase the chance that some medical history exists. Notes of previous consultations, indications of distress, relevant family context and prior diagnoses are all crucial in understanding whether a wish to die is stable or situational.

This matters because, as we have discussed already and at some length, the Bill places extraordinary weight on two clinicians making difficult judgments about a prognosis, about mental state and about possible coercion. Clause 12 allows them to seek information from the person’s GP, but this safeguard works only if a relationship with that GP actually exists.

As a number of noble Lords have mentioned, this House has been served well by the Bill’s own Select Committee. In that, your Lordships heard repeatedly that continuity of care is one of the most reliable protections against misjudging capacity or missing signs of procedure. Dr Michael Mulholland of the RCGP stressed that continuity is not a luxury but central to safe clinical judgment. Professor Katherine Sleeman explained that earlier access to palliative care often changes patients’ perception of their suffering, which again relies on a clinician who knows the patient. Without any medical history or any prior interactions with clinicians, life and death decisions are being made without the proper safeguards. This is not safe for patients, and it is not safe for, or fair to, doctors.

We also heard extensive evidence on access difficulties. Caroline Abrahams of Age UK told the Select Committee that the single biggest practical improvement that older people want is simply being able to see their GP. Many cannot. She noted that significant numbers of older people near the end of life have no contact at all with their GP, not because they do not want it but because the system does not provide it. A report cited in the equality impact assessment on the Bill found that two in three older people in Wales struggle even to make suitable appointments. If access to GP care is already fragile, the Bill must not assume a relationship that does not exist.

There is also the risk, recognised multiple times already in Committee, of doctor shopping. We see it in pain management, in cosmetic procedures, even in end-of-life discussions. When someone is desperate, frightened or grieving, they will simply go from clinician to clinician until they find the answer that they feel they want and need. Expert witnesses, including psychiatrists and geriatricians, told the Select Committee that major emotional shifts commonly occur around diagnosis, around transitions in care or around family crises. These are precisely the moments when a single assessment by an unfamiliar doctor is most likely to misread a temporary situational wish to die as a settled and autonomous choice.

International evidence reinforces the point. Australian states, often cited as models, have tightened their systems after discovering patterns of people travelling to access assisted dying without any real connection to local health services. Canadian doctors regularly highlight the difficulty of assessing capacity and voluntariness when clinicians had no longitudinal knowledge of the patient, contributing to public concern over several high-profile cases.

We need not make those mistakes. The DHSC and MoJ impact assessments underline that assisted deaths must be documented and monitored and that clinicians require access to historical records to make safe judgments. But the true quality and veracity of these records relies on real and consistent engagement with a primary care provider. The Select Committee also heard from social workers and safeguarding experts, who emphasised that subtle coercion is almost impossible to detect in a single clinical encounter.

[Lord Winston (Lab)]

I am grateful to the noble Lord for giving way. I just wonder what he feels a GP should do in the circumstance in which he does not approve of assisted dying? Does the noble Lord feel that that is a problem?

[Lord Rook (Lab)]

With the greatest respect, that is not the conversation I am trying to have here. The conversation is about the necessity that someone who is going through the process has continuity of care and a relationship with that GP. We are suggesting that someone who is after a state-assisted end-of-life process should have the opportunity to see that GP on a number of occasions so that their judgment can be made in the context of continuity of care, not in one appointment.

To pick up the noble Lord’s questions, this amendment would not block access. It would not frustrate autonomy. It would simply ensure that assisted dying does not begin from nowhere. It grounds a grave decision in a minimal but essential relationship with the health service that is charged with safeguarding the person in question. Supporting autonomy requires a supportive context. It requires knowing whether a request reflects a settled conviction, a moment of despair, untreated depression or pressure that the patient feels unable to articulate. These things cannot be reliably assessed in isolation. Above all, care is relational. If Parliament is to contemplate legislation under which the state may participate in deliberately ending life, the very least we must insist on is that such decisions take place within the context of real and primary medical relationships, not on the periphery of the system.

This amendment would strengthen residency safeguards, improve the evidential foundation for clinicians, reduce the risk of doctor shopping and respect the seriousness of what the Bill proposes by rooting it in genuine and consistent care. I commend the amendment to the Committee.

[Baroness Jay of Paddington (Lab)]

Can I ask the noble Lord, having cited the doctor Michael Mulholland as a great authority in relation to his evidence to the Select Committee, whether he also accepts what Dr Mulholland said to the Select Committee? He said:

“As GPs, we are very used to providing holistic care and trying to understand where the patient is coming to us from in lots of situations”.

[Lord Rook (Lab)]

I absolutely agree with that. The reason why the doctor is able to do that is because he gives consistency and continuity of care. He does not see patients on one occasion on one big issue, but is able to travel with them in a longitudinal relationship, and that gives him the ability to make those decisions.

[Baroness Gerada (CB)]

As a GP, I understand the sentiment behind this amendment and the power of continuity; in fact, it was what my maiden speech was about yesterday. But modern general practice works in multidisciplinary teams. We have nurse prescribers, pharmacists and physician associates. We also work with other team members, especially with those at the end of their life, such as palliative care teams and oncology teams. While I understand the need to have a GP involved, I think it is rather reductive. We deliver continuity in today’s world through our medical record, which is a complete record of the individual from cradle to grave. I would say it is with the primary healthcare team that the individual has a relationship rather than with an individual.

On a point of clarification, the average patient over the age of 75 consults their GP team—the primary healthcare team—around 10 times per year, so I do not recognise the figure that most elderly people at the end of their life have no access to the GP. We reach out to our elderly patients and we try to deliver the best possible care we can to them, especially when they are approaching the end of their life.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

My Lords, I indicated my position in my intervention. I will summarise my understanding of the amendment, what my response is and next steps. All the amendments in this group seek a requirement in addition to having a GP before you can have an assisted death. My noble friend Lord Rook suggests having a GP for at least 12 months and having seen him twice before the first declaration. The noble Baronesses, Lady O’Loan and Lady Grey-Thompson, refer to having an “established relationship” with a GP. The noble Baroness, Lady Finlay, refers to one consultation and a home visit before the application. The noble Baroness, Lady Lawlor, refers to a two-year relationship, an average number of visits face to face and then a letter that relates to the medical condition, the treatment and the state of mind of the patient.

As I have indicated, the GP, in the structure of the Bill, is not somebody who has to be involved. The noble Earl, Lord Howe, encapsulated perfectly that the GP is somebody who is receiving information. All these provisions for making it necessary to have a better relationship with your GP than just having a GP do not touch the safeguards. Quite separately from that, I support what the noble Lord, Lord Deben, and the noble and learned Baroness, Lady Butler-Sloss, said. These provisions have an air of utter unreality if you are saying that a condition of an assisted death is a particular relationship with a particular GP. I do not think that any of these safeguards work or reflect the current drafting of the Bill.

It is clear from listening to the debate that people who are concerned with the care should form a basis for the decision. It may not necessarily be making the decision—a lot of people would say that they should not be making the approval—but their input is vital. That was the insight of the noble Baroness, Lady Gerada, which was very much reflected around the Committee. I am willing and keen to reflect that insight in the Bill. But the route is not through newness in relation to the GP. It is reflecting the proposition that the multidisciplinary team dealing with the patient must have some input. I do not know whether that satisfies the question asked by the noble Earl, Lord Howe, but that is the purpose of what I am taking away from this very valuable debate.

As for the right reverend Prelate the Bishop of Gloucester, we are going to speak about prisoners on the next group. Can I reserve my position in relation to prisoners to avoid there being too much duplication?

In those circumstances, I invite the noble Lords not to press their amendments.

[Lord Rook (Lab)]

I thank noble Lords for their patience, passion and seriousness in scrutinising this part of the Bill.

My Amendment 19, which started this debate, possibly needs some clarification. Forgive me, as one who is still becoming accustomed to your Lordships’ House, if I should have intervened earlier on this. I am very grateful to the noble Baroness, Lady Gerada, for her remarks. I had the privilege of working with her in a previous life and saw her brilliant healthcare and the provision of many experts—not just healthcare professionals but the wider community—in seeking people’s health and well-being. Her best-case scenario is what we would like to see in all end-of-life care and in assisted dying.

However, to speak to the comments by the noble and learned Baroness, Lady Butler-Sloss, and the noble Lord, Lord Pannick, my amendment is not seeking for a patient to have to see the same GP twice. That is not the amendment that we are trying to make here. We are asking that someone should be registered in a practice for a year and see a GP twice in that year.

I am very grateful to the noble Baroness, Lady Hollins, for her view that this could mean a wider team engagement—it might not be just the GP. I am saying not that it has to be the same GP twice but that a person has to engage with a GP twice in that stage. If any one of us in this Committee, or any one of our loved ones, were facing a serious medical condition right now, I think we would all have the reasonable expectation that in the next 12 months we might see a GP at our practice. Given the importance of this legislation and just what it will do for the state’s relationship to life and the NHS’s relationship to life, someone who is critically facing the end of life and requesting an assisted death should also be afforded the opportunity to see a GP twice in that period.

Dr Michael Mulholland has been quoted a number of times from his remarks to the Select Committee. I will finish with a quote from him. He said:

“We need to be sure that these things are checked on many levels. It is not at a single time and point where you tick something”.


I am grateful to the noble and learned Lord, Lord Falconer of Thoroton, for his willingness to consider this issue. I look forward to seeing how these concerns and conversations might be expressed and reflected in the Bill. With that, I beg leave to withdraw the amendment in my name.

Amendment 19 withdrawn.