Terminally Ill Adults (End of Life) Bill

Lord Shinkwin Excerpts

Friday 5th December 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I will speak briefly to Amendment 405 because the Equality Act is relevant to it. It provides a legal duty to provide reasonable adjustments for disabled people, which is defined quite broadly and I think would include a person who was terminally ill. The amendment is currently worded that the doctor must

“take all reasonable steps to ensure that there is effective communication”.

Will the noble and learned Lord consider changing his drafting to say that the doctor must “ensure reasonable adjustments are provided to ensure effective communication”?

[Lord Shinkwin (Con)]

My Lords, I rise to speak on Amendment 405. It is a pleasure to follow the noble Baroness, Lady Hollins, and to echo some of the points she touched on. I clarify that of course the amendment is in the name of the noble and learned Lord, Lord Falconer of Thoroton. I do so because, as a disabled person who was on the National Disability Council in the late 1990s developing codes of practice and advising the then Government on the importance of language—a point that the noble Baroness has just mentioned—I fail to see how changing the Bill’s wording from

“must first ensure the provision of adjustments for language and literacy barriers”,

which was the language of the amendment adopted by the other place, to “take all reasonable steps” can do anything other than weaken this Bill.

The noble and learned Lord would have us believe that this is just a drafting change; indeed, he said in his opening remarks that it makes it “clearer”. I contend that this is no drafting change because, yes, it changes the sense of meaning. The amendment would take us backwards because it would fundamentally weaken one of the Bill’s safeguards, such as they are, which was inserted as a result of Jack Abbott’s Committee amendment in the other place, and which the Bill’s sponsor in the other place described as “very sensible”—she was happy to support it.

I have a few questions for the noble and learned Lord that I would be grateful if he could answer in his closing remarks. Is this Committee being asked to believe that today the Bill’s sponsor in the other place is happy for the noble and learned Lord, in effect, to overrule her? Can he confirm in his closing remarks that she and Mr Abbott have been consulted, or is it that, together, the noble and learned Lord and Ms Leadbeater have decided to water down one of the few safeguards in the Bill because, well, it is only the House of Lords so no one is going to notice? The whole point of the Bill is to make it as easy as possible for people to have assisted dying, so let us minimise the constraints.

I began my career at the Royal National Institute for Deaf People during the first Blair Government. It was an exciting time. To the credit of Tony Blair and the noble Lord, Lord Hutton, who was Health Secretary, digital hearing aids were introduced on the NHS. The RNID, when I worked there, was listened to, and it should be now. So could the noble and learned Lord explain why this amendment implicitly ignores the finding made this year by the RNID and SignHealth in their report that some patients did not understand their diagnosis or treatment?

As a disabled person, I thank our Labour colleagues most sincerely. I know that I owe a debt to the Labour Party’s long-standing and noble—in the true sense of the word—commitment to advancing disability rights. However, this amendment underlines an inescapable but painful truth. The Bill makes a mockery of that fine, noble and honourable tradition. It shreds a tradition that deserves to be preserved, not sacrificed in such a profoundly cynical and misleading way as to make out, as the amendment does, that this is somehow only a drafting change.

There is a reason why not one organisation of or for disabled people supports the Bill; they know that disabled people need the Bill like a hole in the head. I marvel that the noble and learned Lord does not seem to realise that the Bill is dangerous enough already without the removal of provisions that would at least acknowledge the obligation to first ensure that communication adjustments were made; for example, for people with learning disabilities or users of British Sign Language.

The last thing that we as a House should be doing is endorsing an attempt to make the Bill an even poorer piece of proposed legislation than it already is. Noble Lords could be forgiven for thinking that that was not possible, but, as the noble and learned Lord’s Amendment 405 clearly states, he is perfectly capable of making his poorly drafted Bill even worse.

[Baroness O’Loan (CB)]

My Lords, could the noble and learned Lord, Lord Falconer, clarify for me the impact of Amendment 290 and whether it deals with matters of coercive control and economic abuse effectively for the purposes of the legislation? I ask this because Amendment 290 would remove

“including coercive control and financial abuse”

from the Bill. The same principle applies to Amendment 366, while Amendment 931 would remove the requirement for members of a panel to receive training on coercive control and financial abuse.

Even taking into account the Domestic Abuse Act, which I will come back to in a moment, there is a difference between coercion and pressure and coercive control and abuse. It is for that reason that I support the comments previously made about, for example, Kim Leadbeater in the Commons being pleased to support mandated training on domestic abuse, including coercive control and financial abuse, and the Health Minister in the Commons Committee noting that the amendment would require training regulations to include

“mandatory training relating to domestic abuse, including coercive control and financial abuse”,—[Official Report, Commons, 18/3/25; col. 1212.]

which clearly would ramp up the requirement.

However, the definition of domestic abuse in Section 1 of the Domestic Abuse Act 2021 refers to behaviour in the context of personal relationships—persons who are connected—and there is a list of the persons who are connected. Section 1(4) of the Act does not cover those who are not personally connected but who may be capable of having enormous influence upon people on behalf of those who are. I think, for example, of financial advisers, lawyers and even doctors, people like that, who may be able to put pressure on people, and we have seen situations in which such pressure has been brought to bear. Does the noble and learned Lord consider that the situations in which pressure may be brought to bear by someone not personally connected should be otherwise provided for?

This group also contains amendments to Clauses 10 and 13, the provisions in relation to the situation in which a doctor is unable or unwilling to act as the independent doctor. There are provisions in Amendments 332, 418 and 419 for a further referral if a doctor is unable or unwilling to continue. His reasons for unwillingness could include ethical concerns or suspicions of undue influence on the patient. Despite the fact that there is a provision that he can seek specialist advice on this issue, there may be a situation in which the doctor will simply withdraw from the process. The single additional referral was approved in the other place to protect the patient, but these amendments would enable doctor shopping to occur. We will come back to that in group 44. Moreover, if a doctor withdraws from completing the process because of suspicions of possible or undue influence, the reason must surely be recorded.

Amendment 405 would remove from the Bill the requirement to have regard to “language and literacy barriers”, replacing it with the new more general requirement to

“take all reasonable steps to ensure … effective communication”.

The noble Baroness, Lady Hollins, explained during the previous debate the extent to which people with a disability have complex needs, which must be satisfied to enable understanding. The inclusion of “all reasonable steps” et cetera introduces a far less specific test, and consideration must be given to setting standards for the level of communication which is required. I have to ask the noble and learned Lord: does this amendment inadvertently disadvantage those with specific learning difficulties and similar vulnerable groups?

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I do not accept that it is not a drafting point, but that may be dancing on the head of a pin. The point that both the noble Baroness, Lady Fox, and the noble Lord, Lord Deben, are making concerns making sure that if you are leaving for a reason that will give rise to problems, it is properly recorded. I completely accept that and we will make sure that that is the position, because it is a valid point.

In relation to Amendment 405, the noble Lord, Lord Shinkwin, said that it is a watering down. It is not a watering down at all, with respect. The current draft says:

“When carrying out an assessment in accordance with subsection (2), the assessing doctor must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters”.


The new draft says that the relevant doctor must

“take all reasonable steps to ensure that there is effective communication between the assessing doctor and the person being assessed (including, where appropriate, using an interpreter)”.

The noble Lord, Lord Shinkwin, is shaking his head; I am more than happy to talk to him about how that could be a change, and if there is some change that he would like in relation to it, let us put it in. But it is, in legal terms, to my eye, wider. It covers a much wider ambit without providing any inadequate protection. Maybe the right course is for me and the noble Lord, Lord Shinkwin, to sit down and for him to identify the changes that he would like. At the moment, I cannot see them.

[Lord Shinkwin (Con)]

I thank the noble and learned Lord, and I will be very brief. Would he consider withdrawing his amendment? The change I would simply write, and I imagine the House would find acceptable, is what the sponsor of the Bill in the other place also found acceptable, which is to accept Mr Abbott’s amendments.

[Lord Falconer of Thoroton (Lab)]

I do not need to withdraw the amendment, because if the noble Lord objects to it, I will not press it in Committee. It depends on what we get to when we get to Report. What I am saying is that, at the moment, I cannot see the difference. I am more than happy to talk to him before Report. If there are valid points, let us put them in. However, at the moment, it looks to me to offer just as good, if not better, protection.