Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, palliative care may not be the answer but it has to be part of the answer, and unfortunately that is just not the case across England and Wales as we speak today. It is estimated by my colleagues at King’s College London and the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care—some of the foremost experts in the country—that over 100,000 people die each year in this country without the palliative and end-of-life care that they would have benefited from. Two-thirds of people report being fearful that they will not have access to palliative care when they need it. So, to the extent that the Bill is about autonomy, you cannot have meaningful choice without having palliative care as part of that choice. By the way, I place high weight on the principle of individual autonomy. My question is, how autonomous can you be when you do not have a meaningful set of choices?

Advocates for the Bill make the point that in some countries that have introduced assisted dying legislation, palliative care services have improved. I have looked at those instances and that is because, when the legislation has been progressing, there has been a matched government effort specifically to increase funding for palliative care. I am not aware of any such effort on offer in this country. Although, as the noble and learned Lord, Lord Falconer said, the assisted dying service will, as per the estimates, be remarkably cheap at only £25 million, the cost of doing something in palliative care would be far greater. Therefore, it makes it far riskier to envisage that this will automatically come about.

Instead, we have in the Bill two reports on offer, in Clauses 47 and 50: one a year after the Bill is passed—if it is—and another, in effect, in nine years’ time. Frankly, those reports on the state of palliative care are not going to be worth the paper they are written on. It would be the Secretary of State at the time marking their own homework. It would be a one-off assessment. In any event, it would have no consequences, because the Act would have automatically commenced within four years anyway.

So, what could be done about this? There are some practical amendments that would improve the prospects. I would like to see a triple lock, as it were, for palliative care. First, I would like to see the attestation that the two doctors are being required to provide attest that there has been a comprehensive offer of palliative care and end-of-life support made available to any applicant to this scheme—not simply that they have had described to them the availability, or lack thereof, of any palliative care in their local area.

Secondly, we should see an attestation from the patient themselves that that genuine offer of palliative care has been made available. Thirdly, it would obviously be entirely perverse if the only way you guaranteed access to palliative care was by going through the assisted dying service. Therefore, we need to see an attestation, periodically independently verified by the Care Quality Commission, that everybody who might benefit from palliative and end-of-life care has access to it across the country. Absent safeguards such as that, we should take very seriously the warning from Hospice UK:

“The introduction of assisted dying, while palliative care is underfunded and inequitably delivered, as is currently the case, therefore brings evident and substantial risk”.

Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

My Lords, my noble friend Lord Birt was, of course, perfectly entitled to refuse my attempt to intervene in his speech. I am, however, disappointed that he chose to defy the determination of this House that we should not have repeated Second Reading speeches. Every one of us here can stand up and make a Second Reading speech on any of these amendments if we defy that determination, and I hope that he will not do it again. I am sure it was a misunderstanding on his part about the way in which he was able to move his amendment.

As to his amendment, I am afraid that I am suspicious about his group of amendments, and I think he gave the game away in the way in which he later turned to and referred to them. It is clear that he is very keen on there being a more extensive provision for assisted suicide—that people far beyond the scope of the noble and learned Lord’s Bill should be able to claim and achieve assisted suicide. Some of his amendments I agree with—I would love to see better care for people who are facing the end of their lives—but behind his amendments is a death service. As the noble Lords, Lord Deben and Lord Harper, said, what he is providing is a way to death, not a way to enjoy and make the most of the rest of your life. I would urge noble Lords not to support these amendments, because I regret that their motivation is not even consistent with that of the sponsor of the Bill.

[Lord Stevens of Birmingham (CB)]

My Lords, I speak specifically against Amendment 771, which would require the Secretary of State to establish an assisted dying help service as part of the National Health Service. I believe that that is a conceptually misplaced proposition in that, if we cast our minds back to last Friday, it was completely evident that the sponsor of the Bill does not intend that only in cases of unbearable pain or suffering would a person be eligible for the assisted dying service. Instead, concerns about your finances or being a burden on your family would be defined as legitimate bases for making the choice to opt for an assisted death.

It is not the proper function of a national health service to deal with financial burdens or pressures on people’s families in that way: that is a category mistake. Indeed, the founding charter for the NHS, the National Health Service Act 1946, is quite clear, and all successive health Acts have laid out the purpose of the NHS, which is

“to promote the establishment … of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”.

Assisted dying does not fall within the scope of that purpose. In fact, I think that must be evident indeed to the drafters of the Bill, because somewhat camouflaged at Clause 41(4) is the suggestion that, by regulations, that founding charter for the National Health Service could be amended to include assisted dying. They reference the fact that change is probably required to the most recent iteration, the 2006 Act, to bring that about. I do not think it can be said legitimately that this is a part of the purpose of the National Health Service, and it is unnecessary in practice, organisationally.

Just because doctors, like lawyers and social workers, are proposed to be involved in this, it does not mean it is inherently part of the National Health Service. Doctors do DWP assessments, but that does not mean the National Health Service runs the benefits system. Doctors are involved in driving licence assessments, but that does not mean the National Health Service runs the DVLA. Doctors are involved in the criminal justice system as forensic medical examiners, but that does not mean the NHS needs to run the court system.

[Lord Winston (Lab)]

Does the noble Lord agree that removing life support is not part of the health service?

[Lord Stevens of Birmingham (CB)]

As the noble Lord will well know, the ethical principle of the doctrine of double effect is in place there. There is no doctrine of double effect associated with assisted dying; it is a completely different ethical principle. In fact, part of the reason why it would be dangerous to include assisted dying in the National Health Service is because it risks undermining the very trust that people have in their clinicians.

It increases the risk of what you might call self-coercion in the name of altruism. People thinking that they are reducing not only the burden on their families but on the NHS from an earlier death is a genuine risk. We saw that, frankly, during Covid, when the slogan, “Protect the NHS”, was used. A number of us were opposed to that, fearing it would put people off coming forward for needed care, which is precisely what happened. The idea that an NHS-branded assisted dying service might, at least in people’s minds, come to be associated with helping to protect the NHS by virtue of choosing an earlier death blurs the lines, which we should be careful to avoid.

Fundamentally, it is unwise to include assisted dying in the National Health Service because it blurs the distinction between palliative care and what is proposed in the Bill. As we have just heard from the noble Lords, Lord Harper and Lord Deben, many of us have concerns that the choice on offer will not be a genuine choice if palliative care is not available, and I am afraid the Government have been less than forthcoming as to what they envisage palliative care services looking like over the coming years.

Two months ago, I asked the Government a very straightforward Written Question: can they tell us whether the palliative care and end-of-life care modern service framework, which they are going to publish, will quantify the incremental funding needed to make sure that everybody who would benefit from specialist palliative care would get it? I did not get an Answer to that straightforward Question before this House debated the palliative care elements of the Bill. This week, I received a two-sentence response—it was not an Answer —which said:

“The Government is developing a Palliative Care and End of Life Care Modern Service Framework for England. I refer the Noble Lord to the Written Ministerial Statement … on 24 November”.


That was the Answer to the Question: will the Government’s framework specify the funding gap, identify funding to meet it, and ensure that people have access to care? On that basis, we are entitled to conclude that they probably do not intend to move in that direction. Therefore, the concerns about having an assisted dying service as part of the National Health Service, when palliative care needs go unaddressed, are all the more acute.

For those three reasons—the fact that the proposal is conceptually misjudged, organisationally unnecessary and inherently risky—I oppose the proposition that assisted dying should be part of the NHS.

[Baroness Hollins (CB)]

My Lords, I support and have added my name to Amendment 771ZA, in the name of the noble Lord, Lord Mackinlay, which would prevent the assisted dying service being part of the NHS. I agree with the points made by my noble friend Lord Stevens.

Integration into mainstream healthcare appears to normalise the practice and lower barriers to the use of assisted dying. International evidence is instructive—where it is embedded within publicly funded healthcare systems, such as in Canada and the Netherlands, uptake rises steadily over time and eligibility criteria broaden. As we know, in some jurisdictions it is available to minors, people with non-terminal conditions, psychiatric diagnoses, and even people with learning disabilities and autism, as my own published research on the Netherlands has shown.

I agree with my noble friend Lord Stevens that assisted dying is not a treatment. That is a further reason why it should never become part of the National Health Service. The substances proposed to be used neither treat nor prevent disease; they fall outside the legal definition of a medicinal product. The drug regimens proposed are unlicensed, have not undergone appropriate clinical trials and lack international consensus. The drugs that have been used more widely and successfully to provide the much-lauded pain-free and quick death, such as in Switzerland, are not even available or licensed for human use in the United Kingdom.

My noble friend Lord Birt seems to seek to introduce similar criteria as are used in Switzerland, and not just for terminal illness—he spoke about suffering, pain, and conditions that are not eligible under the Bill. In Switzerland, non-profit organisations such as Dignitas operate within that narrow but deliberate legal space created by Article 115 of the Swiss Penal Code, which states that assisted suicide is punishable only when carried out for selfish motives. That means that if it is provided purely out of compassion, with no personal gain, it is not a criminal offence, enabling Dignitas and other similar non-profit organisations to function lawfully so long as they can demonstrate altruistic intent and ensure that the individual is acting autonomously.

Interestingly, Article 115 of the Swiss Penal Code, contained only one clause—I think just one sentence—when it became law in 1942. One wonders whether the smoke and mirrors of the 59 clauses in the Bill and the various proposed new clauses from my noble friend Lord Birt disguise a similar intent. The potential changes and development of the proposals before us today are concerning. Indeed, if something as straightforward as is provided in Switzerland is intended, I do not understand why it was not proposed in the first place. We do not want this in the National Health Service.

--- Later in debate ---

[Lord Kamall (Con)]

I thank my noble friend for that intervention. Before commenting on the content of the Bill, I was seeking, just to be fair to the Government, to lay out what they have told me.

[Lord Stevens of Birmingham (CB)]

May I pursue the important point that the noble Lord is making? The Minister for Care, Stephen Kinnock, was before a Commons Select Committee on this very point that the noble Lord, Lord Harper, has discussed. He declined to give any commitments about the content of the modern service framework for palliative care and declined to say that resources would be made available to fill the gap; the only specific commitment he gave was that a new 24/7 phone number would perhaps be put in place in 2027, I believe.

[Lord Kamall (Con)]

I thank the noble Lord for that intervention, as well. It reinforces the points I am going to come to—if that makes sense.

The Minister, the noble Baroness, Lady Merron, ends the letter by saying:

“Through these actions … we hope to ensure sustainable funding for palliative care and end-of-life care sector in the long term”.


This is the Government’s stated intention. The next bit says:

“I hope this letter has provided clarification on the queries you raised”.


I will let noble Lords be the judge of whether it provides clarification. To be fair, the Minister copied the letter to all Peers who tabled amendments, as my noble friend Lord Harper said, and put a copy in the Library. I urge all noble Lords to read that letter to see whether they believe that it provides the clarification that many are seeking. If we feel that it does not, we should come back to this point in future weeks and raise these issues with the Government again.

I hope the Minister, the noble Baroness, Lady Blake, will take that on board when she answers. If she does not have the answer to many of these questions, we should wait for other noble Lords to read that letter, then maybe raise the questions again and ask whichever noble Baroness is on duty as the Minister in future weeks to answer questions on areas where we still believe there are gaps.

--- Later in debate ---

On the broad principle, I take the view that an assisted death is well within the founding principles of the NHS. There is a separate legal question, which I do not think is really the question that the noble Lord, Lord Stevens, is raising, but it needs to be addressed: does that require some amendment to Section 1 of the NHS Act? That is a strict legal question; government lawyers have to answer that one.

[Lord Stevens of Birmingham (CB)]

On that very point, the noble and learned Lord’s Bill, at Clause 41(4), does indeed propose that an interpretation will be imposed on Section 1(1) of the 2006 Act, suggesting that he thinks there is some ambiguity on that point. As to the question about withdrawing care from an MND patient, surely the distinction between an act and an omission—the ability for somebody to choose to decline treatment—is a well-understood principle that has no bearing on the question of an assisted death.

[Lord Falconer of Thoroton (Lab)]

They are fundamentally different, but the idea that removing the respiratory equipment does not involve some acts is not realistic. But I completely accept the proposition that they are different. On the legal point, there is some ambiguity about what the section means and whether it needs to be changed, but I am making it absolutely clear that, from my point of view and that of the promoters of the Bill, it is most certainly not outside the broader founding principles of the NHS.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

My answer to that—because the answer I gave in my long and tedious speech was obviously inadequate—was that to be properly informed, you would have to say what the effect of the drugs and what the complications would be. That comes from the word “informed”. If there could be any doubt about that, the fact that you have to discuss how, physiologically, it brings about the death and you need to discuss what happens in relation to the complications puts that beyond doubt.

I will just go back to the question from the noble Baroness, Lady Berridge. It is Clause 33, not Clause 32, which is the civil liability for providing assistance. That provides that if it is done in accordance with the Act then there is no civil liability, but it needs to be done in accordance with the Act, which means it has to be the informed wish.

[Lord Stevens of Birmingham (CB)]

Could I pursue that point and connect it with the question from the noble Baroness, Lady Finlay? It is very important that we clarify this for the benefit of the medical profession. Clause 33(2)(b), which covers civil liability, says that the civil liability exemptions are not available to a doctor

“in tort arising from a breach of a duty of care owed to a person”.

In the scenario described by the noble Baroness, Lady Finlay, what is the duty of care that the doctor owes the patient who has just not died?

[Lord Falconer of Thoroton (Lab)]

I am not sure whether the noble Lord is asking that in the context of giving information or of doing it negligently. The effect of Clause 33(2) is that nothing prevents the obligation on the doctor to act with reasonable care towards the patient. If, carelessly, the doctor failed to set out all the risks or maladministered the assistance, either the patient or the estate of the patient would have a claim against that doctor for negligence. There might be a dependency claim as well.

[Lord Falconer of Thoroton (Lab)]

In response to the question from the noble Baroness, Lady Finlay, regarding the complications, that has to be agreed in advance. I did not think that that was the question from the noble Lord, Lord Stevens.

[Lord Stevens of Birmingham (CB)]

That was indeed my question.

[Lord Falconer of Thoroton (Lab)]

The doctor has to take reasonable care at that point. They cannot do anything to kill the patient, so they have to provide reasonable treatment to save the patient’s life at that point.

Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

I hope the sponsors of this amendment might consider a redrafting that takes account of these fundamental differences, retaining access to helpful diagnostic tools while excluding a general-purpose superintelligent AI, still to be developed, from a decision-making process that properly resides in human agency.

[Lord Stevens of Birmingham (CB)]

Essentially, I agree with the right reverend Prelate the Bishop of Hereford. I could almost leave it there, but I will briefly say, in the spirit of the amendments, that the tablers are right to raise general concerns about the possibility of abuse through bias—as we heard from the noble Baroness, Lady O’Loan—and hallucination. After all, we have had the first high-profile resignation of a public sector leader in the form of the chief constable of the West Midlands praying in aid the fabrication of a non-existent football match as the reason why Parliament was misled.

In addition to bias and hallucination, there is the risk of what is called scheming. The results from some of the LLMs—published, for example, in the journal Nature in October—show some pretty disturbing examples. In the article, headed “AI Models that Lie, Cheat, and Plot Murder”, there are examples where models have attempted to write self-propagating worms, fabricate legal documentation and leave hidden notes to future instances of themselves. The punchline, essentially, is that, in regard to some of these technologies,

“the world is in a lucky period in which models are smart enough to scheme but not smart enough to escape monitoring”.

That is scary because, in five years’ time, that may no longer be true. So there are good reasons for generalised concerns about AI and wanting to circumscribe the role it might play in this legislation.

However, for the reasons that others have mentioned— I suspect the noble Baroness, Lady Coffey, herself would accept this—this probing amendment is written too broadly. It says:

“Artificial intelligence must not be used to carry out any functions in any section or schedule of this Act”.


Given that, for example, under Clauses 5(5) and 12(2), a doctor has to discuss with a person their diagnosis, their prognosis, any treatments available, the likely effects of them, and palliative, hospice and other care, it is highly likely that those will be informed by machine learning. It will interpret, for example, CT scans or MRIs, and AI tools will personalise and optimise therapies, potentially with predictive AI for better prognosis. So, were this to come back on Report, there would be a good case for ensuring greater precision in the firepower that is aimed at this particular concern.

However, all that should not in any way excuse or divert us from an equivalent worry: we must not kid ourselves that the gold standard is human expert judgment on many of the questions posed by the Bill. As we discussed, Clause 2(1)(b) requires an assessment of whether somebody with a terminal illness will live longer than six months. Unfortunately, as we have heard, that turns out to be a clinically irrelevant threshold that is very hard for expert judgment to get right.

I have just pulled the data from a large study looking at 98,000 people across London over the last decade and at prognostic accuracy, and the answer was that clinicians were able to be accurate about whether somebody was going to live for two weeks with about 74% accuracy, and they were able to be accurate about whether somebody was going to live more than a year with 83% accuracy, but, in terms of being able to predict whether somebody is going to survive for weeks or months, accuracy was only 32%. So, whatever our concerns about AI, human expert judgment, which underpins the Bill, is itself highly fallible.

[Lord Markham (Con)]

To follow on from that, as my noble friend said right at the beginning, the amendment was put down in such a blunt fashion absolutely to stimulate this sort of debate. What has been really useful in this debate is finding that there is a broad degree of consensus that AI can be valuable as an input to decision-making, but it should not be used as the output: as the final decision-maker. As mentioned, AI can detect the progression of cancers and can probably do better prognosis or improve, especially over the time that we are looking at here, so that you can get better assessments of how long someone is likely to live.

On the AI in the chat box, there are very many instances where it could be very useful in terms of detecting coercion if it is talking to someone over quite a long period of time. Therefore, in all of this we see that, with inputs to the decision-making process, AI has a valuable part to play, but I think we would also absolutely agree that the final decision-maker in terms of an output clearly has to be a human; obviously they will be armed with the inputs from AI, but the human will make the final decision. I think that is what the Bill does, if I am correct, in that it is very clear that the decision-makers, the panels, the doctors and everything are those people, but at the same time—although I guess the Bill is silent on this—obviously it enables AI as an input.

I hope this debate is useful in that it shows a degree of consensus and that in this instance we probably have the right balance, but, again, I would be interested to hear from the Bill sponsor in his response whether that is the case.

Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Maclean of Redditch (Con)]

My Lords, I will speak to Amendments 145 and 439 standing in my name. It is good that I previously gave way to the noble Baroness, Lady O’Loan, who is no longer in her place, because she covered a lot of the points that I was going to make about care homes.

This is the first time I have spoken in Committee, even though I have attended virtually every day of the proceedings. Lots of people spoke earlier about their personal experiences. I do not intend to go into extensive detail, but I want the Committee to know that I have, for the past eight years, had power of attorney for my 88 year-old mother, who has been in a care home for that time. She has advanced dementia. She cannot speak, read or write. She does not know who I am. So, I have first-hand, practical experience of fluctuations in capacity and how that can be dramatic, from one day to the next. I come at this from a very practical, family-based perspective as well. Those of us who are former MPs have seen those family situations in our surgeries. That is where I am coming from. We need to make sure that family and care home staff always have the best interests of patients, such as my mother, at heart, as I know that they would wish to—but we just do not know what those interests are in my mother’s case, given that she simply cannot communicate.

My Amendment 145 is very much in line with what has already been said about the appointment of the very important role of the voluntary assisted dying commissioner. The noble and learned Lord, Lord Garnier, the noble Baroness, Lady Finlay, and others have already mentioned ways in which we can ensure that public trust is commanded by the appointment of this person. It may well be that there are better ways of achieving this than my amendment. I urge the sponsor of the Bill, the noble and learned Lord, Lord Falconer, to come back to the points raised by a good number of us.

I suggest that the Cabinet Office should create and maintain a register of interest for the commissioner’s office and the panel members. This appointment is solely in the authority of the Prime Minister, as the noble Baroness, Lady Fox, remarked. This is very important for public trust. It does not matter which Government are in office; we must have transparency and confidence when this person is appointed. The noble and learned Lord, Lord Garnier, suggested that this should be an appointment by His Majesty. It may be that that is a more effective way of achieving the end result.

My Amendment 439 has not been discussed in detail so far in this group. It would require the commissioner to notify specified and interested parties of a person’s referral to an assisted dying panel. Here, the noble and learned Lord, Lord Falconer, will be aware of practice direction 9B in the Court of Protection Rules. That is where we are coming from with the amendment. It states:

“The applicant must seek to identify at least three persons who are likely to have an interest in being notified that an application form has been issued”.


The direction goes on to make clear it that ordinarily, although there are some exceptions, close family are

“likely to have an interest in being notified”.

This can then enable them, if appropriate, to submit a formal witness statement to the court.

I cannot understand why it should be any different here. Assisted dying panels are given extensive powers to make judgments under the Mental Capacity Act 2005, just like the Court of Protection. Surely the same powers of notification and, for that matter, summoning witnesses should apply. If the sponsor does not agree with this or cannot accept it, perhaps he can explain why he thinks that the panel process should be more secretive than the Court of Protection proceedings.

This brings me to the importance of emphasising how important it is to involve families in these significant decisions. One of the problems with the Bill is that it seems to treat assisted suicide as an entirely autonomous decision that can be considered in isolation from the context of other complex care needs. Those of us who have first-hand experience with loved ones will know that this could well be a patient crying out for further support in some way—with their care needs, how they feel or their emotions in that moment. I raise this because the NHS guidance on complex care planning repeatedly emphasises the involvement of family and how important that is. I quote NHS England’s guidance:

“It is important to involve families and carers in decisions about … someone’s care and support (with permission of the person being cared for) … It is important to be led by the person, with their family, carers or supporters, to make sure they can be involved in decision making”.


Similarly, the statutory guidance under the Care Act promotes a whole-family approach to assessment. That is a principle that I am sure we all recognise—that the provision of care involves several parties, including the family, who also need to be supported. This is significant, because many people who request assisted suicide express the concern that they feel a burden. We have heard that expressed time and again in these proceedings. It may well be that if discussions involved family or carers, which then allowed further support to be offered, that motivation would disappear.

Before I sit down, I will address the objection that there might be circumstances when, it is argued, the family should not be notified, perhaps most obviously in an instance when they express the view that they do not want that. I accept that the Court of Protection Rules I referred to provide a certain degree of discretion as to which relatives are notified, considering who is practically closest to the person. The rules also include a provision that is entirely absent in the Bill:

“Where the applicant chooses not to notify a person listed in paragraph 7 … the evidence in support of the application form must also set out why that person was not notified”.


That same exploration and recording requirement on this point is set out for social workers in the NICE guideline on social work with adults experiencing complex needs, and there are good reasons for this. When a person does not want their next of kin to be involved, it might be a red flag that could indicate coercion, an inheritance dispute or some other significant issue. That should be a material fact that is taken into account by the panel.

This somewhat anticipates Amendment 389 in the name of the noble Baroness, Lady Gray of Tottenham, in another group, which would require the assessing doctor to discuss—although not record—the reasons why a person does not want to notify their family. As it connects to my amendment in this group, I ask the sponsor, if he is not minded to accept my amendment because it does not allow the person to decide whether they want their family involved, why the Bill does not include an explicit recording requirement on their exclusion in line with the usual practice.

[Lord Stevens of Birmingham (CB)]

My Lords, contrary to Amendment 129, I think that the Bill gets it right in requiring, at Clause 4(3), that the voluntary assisted dying commissioner must hold or have held office as a judge of the High Court, the Court of Appeal or the Supreme Court. This is quite clearly not a medical role. Its principal functions are to ensure that the statutory processes and safeguards that Parliament would have established are being adhered to.

However, we have to accept that a postholder having been a judge does not automatically mean that they will not come with personal views about the scope of the law that Parliament has passed. Therefore, the debate that the Committee has just had on how to make sure that there is transparency about the views that such an individual might hold before their appointment is ratified has merit.

For example, I was very struck by an important interview that the noble and learned Baroness, Lady Hale of Richmond, the former President of the Supreme Court, gave in Prospect magazine in December 2024. She recorded that, in the case, for example, of Tony Nicklinson back in 2014, who wanted it to be declared that it was lawful for people to assist him to take his own life because he had a disabling illness but was not terminally ill, two Justices of the Supreme Court

“would have been prepared to make a declaration that the current law on assisting suicide was incompatible with the Human Rights Convention”.

She went on to say:

“There were nine of us on the court. Of that, five of us took the view that when the time was right, the court might make such a declaration of incompatibility. But three of those five thought the time was not yet right”.


I infer from that that—at that particular point in time, anyway—five Justices of the Supreme Court would have taken the view that the Bill before us, if passed by Parliament, would fall foul of their reading of the European convention.

It is helpful to think about the mechanisms by which Parliament could know the views of such judges, were they to be put forward for appointment as the voluntary assisted dying commissioner. The thrust of Amendment 127 in the name of the noble Lord, Lord Beith, therefore has merit. It would require, for example, pre-appointment hearings by one or more Select Committees in the House of Commons, which would give us an opportunity to probe these questions and make sure that a nominee was going to stick to the faithful implementation of the legislation that Parliament, after such careful deliberation, would have produced, rather than, for example, interpreting the role of the voluntary assisted dying commissioner as in some way akin to that of the Children’s Commissioner, which is clearly an advocacy role for the rights of children.

[Baroness Coffey (Con)]

My Lords, this is a really important clause and a really important schedule. This is the one time when a judge, whether they are current or retired, will be involved in any of this process after the Commons chose to strip judges away from the original proposal. I have tabled stand part notices opposing Clause 1 and Schedule 4 because I would prefer a judge-led process; I have a lot of sympathy with what the noble Lord, Lord Carlile, articulated several weeks ago.

Let me say at the start that I disagree completely with the idea from the noble Baroness, Lady Cass, that this role should start to become like that of the Children’s Commissioner, the Victims’ Commissioner or similar. That is simply not the case, and not only because the legal powers in the Bill—in Clause 18, in particular— are where they must make judgments on whether there have been errors of law in the panellists’ determination. I am very keen, which is why I have tabled Amendment 913ZD, for us to get this back in focus, particularly in terms of the commissioner’s role, and to think about this person being a judge, not the Secretary of State.

I agree that it should be the Lord Chancellor so, to some extent, I agree with the noble Lord, Lord Beith, that Select Committees of Parliament should be able to go through this process as well; it should be the Ministry of Justice and the relevant committee in the Commons. There is precedent here. I think it was the noble Lord, Lord Tyrie, who managed to get a determination role for the Treasury Committee so that it had, in law, a power of veto on the appointment of the chair of a body; I think it was the CMA, but I cannot quite recall it right now. So there is a precedent in this regard.

I agree with what the noble Lord, Lord Stevens, just said. The Bill is right, in that it should be a retired judge. There are a lot of views and a variety of opinions on this. So far, only one retired judge, as far as I have been able to ascertain, has come out publicly against the Bill. Those who have expressed views are, as has just been articulated, very much in favour of the Bill; in fact, they think it should go a lot further. So some sensitivity will be required by whoever gets to make the decision on who the commissioner should be.

My noble and learned friend Lord Garnier would like this role to be done by His Majesty. There is a certain irony there. It is good to see so many Lords Spiritual here. I did try to see whether I could table an amendment to strip out, at the very beginning of the Bill,

“with the advice and consent of the Lords Spiritual and Temporal”,

but the Lords Spiritual have already been very clear that they do not, and will not, consent to the Bill. Why, then, should we put the onus to make this appointment on the Supreme Governor of the Church of England? I appreciate that there have been some difficulties with the current Prime Minister and his appointments recently, but I would be surprised if anything quite so careless happened again with future appointments concerning this or other approaches. More broadly, I support their proposals to get this into the public appointments process.

On Amendment 134, I support my noble friend Lord Moylan completely in trying to prevent mission creep. That is a risk, which is why I have tabled Amendments 913ZA to 913ZD and 914A to 914C as probing amendments. Schedule 1 to the Bill says that, basically, the Secretary of State will hand over as much money as they see fit. They will decide on pay and pension arrangements and will give people offices—all the things one might expect of a sole corporation. As far as I can tell, none of the employees will be civil servants, unless they are seconded civil servants.

Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, I will speak briefly to two amendments in this group, the first being Amendment 334. In particular, I hope to draw the attention of the noble and learned Lord, Lord Falconer, the sponsor of the Bill, to subsection (6)(m) of the proposed new clause and ask him whether he might be inclined to look sympathetically at the proposal there, which relates to palliative care.

We have had the discussion many times in Committee about the importance of palliative care, which is a shared sense from all sides of this wider debate. Proposed new subsection (6)(m) would require that the assisted dying panel in its assessment must ascertain whether a person considering seeking an assisted death

“has experienced the involvement of a specialist palliative care team and, if not, whether this was because of availability, unsatisfactory care or patient choice”.

I would have thought that this should be acceptable to the sponsor of the Bill. Why would you not want to know whether somebody coming before an assessment panel has had access to specialist palliative care, and, if they have not, whether it is because of the concern that a lot of us have, that palliative care gaps exist right across the country? That will bring about a degree of transparency as to what is actually going on.

In a sense, the difference perhaps between those who are more optimistic and those of us who are less sanguine about the availability of palliative care just comes from the lack of transparency and the lack of a firm government commitment at this stage to funding unmet need in palliative care. Perhaps by way of analogy, we should look at what is happening in mental health services and the health professionals within it, some of whom are going to be required to support the processes set out in the Bill. We have line of sight as to what is happening on mental health spending only because of an amendment that the House of Lords inserted into the Health and Care Act 2022, which requires the Secretary of State to declare his or her hand for the upcoming year, as to what they plan on doing about the share of NHS funding going to mental health.

We found out yesterday from a Written Statement by the Health and Social Care Secretary that his plan is that the share of NHS funding going to mental health services next year should be cut, which is a pretty significant departure from the arrangement that had existed since 2015 onwards. Obviously, that has provoked a degree of concern across the NHS. We have that degree of transparency on mental health but we do not have it in respect of palliative care, and proposed new subsection (6)(m) just provides one little ray of light as to what would actually be going on in this scheme, were it to come into effect.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

May I just finish? The noble Lord, Lord Stevens, refers to proposed new paragraph (m) in the scheme. Under the scheme proposal, the panel of up to seven persons has to be satisfied, or the “assessment must ascertain”, that the person

“has experienced the involvement of a specialist palliative care team and, if not, whether this was because of availability, unsatisfactory care or patient choice”.

I am very supportive of the idea—and I think this was in the noble Lord’s mind—that as much information is available as possible. As I understood the noble Lord, the more we know about the shortcomings of palliative care, the better.

However, I wonder whether the best way to deal with that is not to make a requirement in proposed new paragraph (m) for what a seven-person panel must investigate but to make that the sort of issue that the voluntary assisted dying commissioner should be looking at in his monitoring, which is required specifically by the statute. That is just the sort of thing that might help him.

We all support the point that the noble Lord, Lord Stevens, made that the more we know about palliative care—its funding, where it is good and where it is bad—the better. But is the assisted dying Bill the right place to try to lever in a whole range of informational requirements, of the sort that he referred to from the Mental Health Act, which we would all support?

[Lord Stevens of Birmingham (CB)]

Even if the noble and learned Lord does not adopt the scheme put forward by the noble Baroness, Lady Finlay, would he nevertheless accept that, for the co-ordinating doctors, it would be valuable to ascertain the information contained in proposed new paragraph (m) in this amendment? We would therefore be accumulating real-world evidence from every case and not looking at just the aggregate national position that the voluntary assisted dying commissioner might be able to adduce.

[Lord Falconer of Thoroton (Lab)]

Yes, and I cannot imagine a situation, in particular because it is specifically required under the Bill, in which the co-ordinating doctor does not raise the question of what palliative care the patient has had and what is available. Indeed, the Bill requires him or her to do that. Whether the co-ordinating doctor should then provide that information to the voluntary assisted dying commissioner is a matter for the commissioner, as it is up to him or her to decide what information to collect. In principle, it seems a good thing, but the noble Lord has referred to vastly bigger issues that we might need to consider, not in the context of the assisted dying Bill but in relation to how proper information is available about the availability of palliative care. We are all supportive of that.

Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Pannick (CB)]

My Lords, it is a great pleasure to see the noble and learned Baroness, Lady Prentis of Banbury, back in her place. She has been very much missed, and I hope this is the first stage on the road to full recovery. She, like me, may have a feeling of Groundhog Day because we have made lamentably slow progress on the Bill since she was last with us. We are on day 12 in Committee and we are still on Clause 5 of 59.

As the noble Baroness, Lady Coffey, mentioned, she began our Committee proceedings on 14 November when she moved the first of her 111 amendments in relation to Wales, and here we are again. I say simply to the Committee that of course the Bill should apply to Wales. The Bill seeks to create an exception to the prohibition on assisted suicide and that is an aspect of the criminal law of England and Wales. We all agree that criminal justice is a matter reserved to Westminster. It would be bizarre were this House or Parliament to approve the Bill but not approve it in relation to Wales. There is simply no sensible reason why people living in Wales should be denied the same options as people living across the border in England.

I listened carefully to what the noble Baroness, Lady Smith, said, and she suggested that there has been some parliamentary mischief, and that the people of Wales have not been listened to. But it is the case that the people of Wales have a number of representatives in the House of Commons. My understanding is that they all voted for the Bill.

[Lord Stevens of Birmingham (CB)]

Most of the amendments in this group relate to Wales, but some of them also relate to Scotland. Notwithstanding the noble Lord’s sensation of Groundhog Day, there has been an important development since we met last Friday, which is that the Scottish Parliament, by a decisive majority of 69 to 57, has chosen against assisted dying. In that context, therefore, a number of the provisions in the Bill need a significant rethink; in particular, references to Scotland in Clause 57(2) and (3), which would extend the provisions to Scotland, surely should no longer apply.

[Baroness Whitaker (Lab)]

I thank the noble Lord for giving way. There is a substantial difference between the Bill that was not accepted in Scotland and the Bill that we are debating now. The Bill that was debated in Scotland had fewer safeguards; it is not the same Bill and therefore the noble Lord’s premise is not quite as he said.

[Lord Stevens of Birmingham (CB)]

The noble Baroness brings me neatly on to the second point I was going to make, which is that the lack of safeguards in Scotland precisely demonstrates the constitutional and practical difficulty of trying to legislate in Scotland while a number of those key safeguards are reserved matters to Westminster. Part of the reason the Royal College of Psychiatrists and the pharmacists came out decisively this week against the Scottish Bill was because it was not able to include enforceable conscience protections for health professionals that would, for example, have enabled them to refuse an instruction from their employer to participate in assisted dying. Instead, the mechanism that was forced, as it were, on the Scottish legislation was a Section 104 order, which would be subject to a future Westminster Government changing their mind.

The Scottish Parliament was being asked to legislate for assisted dying, absent any Scottish safeguards for conscience and dependent on the future decisions of a Westminster Parliament. The noble Baroness neatly illustrates the point that there is a fundamental problem when one part of the United Kingdom seeks to go its own way. It is incapable of getting the necessary protections and that is one of the reasons why the measure was defeated. Amendment 887 in this group, which would withdraw the reference to Scotland from some of the measures, clearly makes sense given that the Scottish Parliament has just decided that it will not go down this path.

[Lord Falconer of Thoroton (Lab)]

The three reasons why it extends to Scotland are so that people cannot advertise in Scotland to England and Wales, so that people in England and Wales get proper protections if they want to use the conscience clause, and so that substances are dealt with by the United Kingdom. That is why Scotland is included. Is the noble Lord saying that he wants those removed if the Bill goes through?

[Lord Stevens of Birmingham (CB)]

Can the noble and learned Lord elaborate on his second reason?

[Lord Falconer of Thoroton (Lab)]

The second reason is that if, for example, you want the protection of employment law, that employment law which extends to the whole of the United Kingdom should protect you in Scotland as much as in England. You should never be prejudiced. That is why it is included.

[Lord Stevens of Birmingham (CB)]

Is the noble and learned Lord suggesting that Scottish health professionals will be travelling south to undertake assisted dying? Is it a sort of Berwick-upon-Tweed provision?

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[Lord Stevens of Birmingham (CB)]

It is not so much a matter of prejudice because, as I understand it, this provision was inserted in the House of Commons in the anticipation that the Scottish Parliament was going to have before it a Bill on assisted suicide, which it would at that point have passed. This was trying to do a belt and braces on a Section 104 order which everybody could see was likely to be deficient.

[Lord Falconer of Thoroton (Lab)]

No, that is not right. The reference to Scotland was included to provide protection for people in England and Wales who, under employment law, wanted to exercise the conscience clause. If I am right about that, I am sure the noble Lord would not wish it removed.

[Lord Stevens of Birmingham (CB)]

I would be interested to come back to that on Report when we have had a chance to investigate that point further.

Fundamentally, this shows that there is a great problem, a structural problem, in trying to do these types of big social changes through Private Members’ Bills, be they in Scotland or England. The reason for that is that it requires concurrent action by the Governments of both nations. We have seen time and again that when these sorts of questions have arisen and we have posed these questions, we have been told by the Front Bench, for reasons we all understand, that amendments to try to deal with these problems pose workability concerns. Then we ask, “How would you address those workability concerns?” and answer comes there none, because the Government are officially neutral on the question. Dealing with these sorts of questions cannot be left to Private Members’ Bills when you cannot get to the bottom of the workability concerns or deal with the fact that, in order for the narrowly drawn legislation to work, there are a whole set of other things that have to be in place that only the Government can provide.

I conclude on that point by noting that this past week we have seen a report from the House of Commons Public Accounts Committee, once again on hospice and palliative care. It says:

“There is an urgent need for reform to address the financial challenges that the independent adult hospice sector faces … The Department’s solution—the Modern Service Framework—is in the early stages of development, details are sketchy, and it is at least a year from being introduced. This is not good enough when so many hospices are announcing service cuts”.


The idea that we should legislate when that is the context right now seems to me utterly ridiculous.

[Lord Deben (Con)]

My Lords, as a Welsh-speaking Welshman, who has, in this House, consistently supported Plaid’s perfectly right demand that there should be fairer funding for Wales—I am not a Plaid supporter, but I support that aspect—I hope that the House will have listened carefully to the fundamental comments made by the noble Baroness, Lady Smith. If the Bill is passed, the Welsh Government will have to make arrangements for its implementation in Wales. In Wales, the provision of palliative care is not as good as it ought to be—this is widely understood. Yet we would be imposing on the Welsh Government the necessity to make particular decisions about health in Wales, when they have no powers to make those decisions for themselves.

That is a very simple issue, and I recognise the problems stated by the noble and learned Lord. But the truth is that we have an underfunded Welsh Government who spend half their money on health and know that there are real gaps in the provision. Last week, the noble Baroness, Lady Murphy, told us that assisted suicide was part of palliative care. That, of course, has solved the case—we now know that it is just part of palliative care. But those of us who do not think that it is part of palliative care recognise that, in Wales, the issue is sharper than anywhere else because of the lack of funding, which is about the misuse of the way that funding from the centre is put out.

I beg this House to take very seriously what the noble Baroness, Lady Smith, has said. If we were to ignore the amendments we are talking about here, we would be saying to the Welsh, “You just stuff it because we are going to decide”. We have had that issue before on abortion in Northern Ireland: they decided what they thought and we chose a moment when we had the power to decide they could stuff it. I believe in devolution, and I do not believe that this House should tell the Welsh people to stuff it; we should let them make their own decisions.

Finally, I will turn to what the noble Lord said. I know perfectly well—

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[Lord Falconer of Thoroton (Lab)]

The health service could determine who it is going to make it available to free, but it could not prevent other people—for example, private providers—having different provisions in relation to it.

The next category of amendments was in relation to removing Scotland. I gave an answer to the noble Lord, Lord Stevens, in relation to that in the course of the debate.

[Lord Stevens of Birmingham (CB)]

Perhaps the noble and learned Lord will clarify the answer he gave on Scotland. I think he is saying that even though the Scottish Parliament has decided that assisted dying should not be lawful in Scotland, a Scottish hospice could nevertheless not prevent its employees doing something that would be unlawful in Scotland if they travelled across the border to perform that act in England. Is that the consequence of what he is suggesting?

[Lord Falconer of Thoroton (Lab)]

This was picked up by the noble Baroness, Lady Merron. She focused, rightly, on what would happen in the case of a doctor who lived in Scotland but worked in England. The question was: could they be prejudiced? The answer is no—employment law would apply, and employment law is right across the country. On what is not being done in relation to the Bill, it does not refer to Scotland, because in Scotland they are awaiting the Scottish Bill. It is entirely focused on the protection of people working in England. That is why it is there. It is also focused on advertising coming from Scotland into England. So it is not in any way dependent upon what might happen in Scotland.

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[Lord Rooker (Lab)]

My Lords, as usual, I came to listen and not to speak, but there are a couple of things that have been said to which I want to react. I agree entirely with my noble friend Lady Hayter, to be honest.

I will not go into the details, but I lost my first wife before the internet. There were no internet searches at all, because it was so long ago. We could work it out. It kept coming back in half the time—three years, 18 months. She was still at work—no problem there—managing a college in south London. It was coming back in half the time, so it was fairly obvious that you could measure it. We did not do it like that, and it was only later that we worked out that it came back in half the time.

When I went through it, I had no warning at all. I say to the noble Lord, Lord Moylan, that there was a consultant who had looked after me since the beginning, when I had no warning. About four years after I finished chemo—she was going off somewhere else to do research, so I was not going to see her again—she said to me, “You have to remember that the drugs deal with only half the problem”. That made me very satisfied. On the other hand, I have gone through cases involving people who were as positive or more positive than I was, but it got them in the end. That is what I remember. The drugs deal with only half the problem.

[Lord Stevens of Birmingham (CB)]

On the thrust of the argument, I agree with the noble Lord, Lord Moylan, that approaching this probabilistically, rather than with a single number, clearly makes sense. It is wonderful to hear the impact that these new immunotherapies have had in his own personal case as well as for oesophageal cancer.

Just for the record, I want to associate myself with the comments of the noble Baroness, Lady Royall, because the evidence is pretty clear that there is not an association between positive thinking and cancer survival. There may be a link with quality of life, but frankly, it is perfectly normal, having had a cancer diagnosis, for people to feel depressed or anxious.

The only reason for raising this very briefly at this point is that we need to be very sensitive. When somebody’s cancer progresses and ultimately kills them, we should not be leaving the impression that we think that is because they lacked the positive attitude that would in some way have enabled them to survive. I know that is not what the noble Lord was suggesting, but just for the record, I think that the noble Baroness, Lady Royall, was right to draw that to our attention, and we should be clear about that.

[Baroness Jay of Paddington (Lab)]

To add to what the noble Lord, Lord Stevens, said, I very much dislike the death notices, for example, which refer to people having put up a great fight or having failed to deal with the battle, or whatever expression is used, which suggests precisely what the noble Lord said—that they have somehow failed in a mortal combat.

Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Committee stage
Friday 27th March 2026 Lords Chamber

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I accept the spirit of the noble and learned Baroness, Lady Butler-Sloss, so I shall be very brief. I support the noble Baroness, Lady Fraser of Craigmaddie, in her amendment on the register. I understand that one of the things that we are trying to do in this group is to protect professionals. Therefore, many of us will be very sympathetic to what the noble Baroness, Lady Gerada, said about receiving hate mail if there were a register. However, in modern times, I am afraid that everyone in a public position has to face the disagreeable fact of hate mail; it is a feature of social media. We therefore cannot close down the openness that we want to have on many aspects.

I am thinking about the benefit of this register to the patient. It is important for the medical profession as well, but it is very important for the patient for a wider reason. First, obviously you want to find someone who will assist you to take your own life, but also, as these debates so often show, there is unfortunately a big moral gulf between those who support and those who oppose the Bill. If you think of a patient, particularly an elderly patient with a serious illness who is therefore eligible under the Bill, it is important that they know the type of doctor they are dealing with in a wider field of care.

For example, suppose I had to find a doctor for my aged mother, who is absolutely determined to live to be 100, and is, in fact, the only woman I know who lies upwards about her age. I know that she would not want to go to a doctor who provided assisted dying, which is understandable. Behind all this is a very different view about life and death and what they are, and a patient would therefore need to know. That is a very good reason for supporting the noble Baroness’s amendment.

[Lord Stevens of Birmingham (CB)]

I will be equivalently concise. It is important to connect Amendment 657, which specifies that assisted dying

“is not to be regarded as medical treatment”,

with our debate on the broader conscience protections that the Bill needs to include. The reason is not just that regarding assisted dying as a treatment is a conceptual error. As Wittgenstein pointed out:

“Death is not an event in life”.


We are talking about a personal existential choice. It is in no sense a treatment, but the Bill is silent on that question. As the noble Baroness, Lady Fox, and others have pointed out, that matters in the real world because, notwithstanding the employment protections included in the Bill, the professional duties on a doctor are potentially in play if assisted dying is determined to be a treatment. That will give rise to questions on the obligations of a doctor to raise assisted dying as a possibility, even if that doctor’s conscience is against participating. It will give rise to consent questions—we talked previously about the McCulloch test—and negligence questions from surviving members of the family. It is therefore important that we put this beyond doubt.

Given the understandable desire of the House to move on to the next group, I will just commend to fellow noble Lords an article in the BMJ from 9 June last year, written by Professors Gareth Owen, Alex Ruck Keene and Katherine Sleeman, which sets this all out beautifully. Their conclusion was:

“Statutory ambiguity serves neither professionals providing assisted dying, nor patients requesting it. Parliamentarians must consider this question”.


That is what we are doing. Amendment 657 would put it beyond doubt, and I hope that the noble and learned Lord the sponsor will accept it.

[Baroness Grey-Thompson (CB)]

My Lords, I have Amendments 673A and 679 in this group. Amendment 673A would provide that a medical practitioner who had opted into the process could choose to opt out at any time, and Amendment 679 would insert a new clause.

I will start with a number of questions for the noble and learned Lord. In a letter to Peers on 28 January, the noble and learned Lord said that he had had very productive discussions with Hospice UK on institutional protections, and that he would table amendments as soon as possible. I think that three amendments have been tabled, but I am not sure that they solve the problem that we are trying to solve. There is nothing in those amendments that requires any training to be kept up to date, there nothing about revalidation, and there is no requirement to be trained and up to date to enter the assisted suicide process.

Can the noble and learned Lord provide an update on his statement that he is working with officials to address Hospice UK’s concerns? Does he accept that the red line for many care homes is that they are not willing to tolerate this process on their premises? In the other place, the honourable Member for Spen Valley resisted a blanket institutional opt-out, arguing that it could lead to “stress and distress” for terminally ill patients if they are forced to move out of their “so-called home” on their final day. But what about the stress and distress of those who share that home, should the process take place on the premises?

Does the noble and learned Lord accept that it will be very difficult to extricate care home staff from involvement—such as organising appointments connected to the provision of assisted dying, assisting in the organisation and sending of documentation connected to its provision, or accommodating the doctor who must remain with, although not necessarily in the same room as, the resident until they die—were assisted suicide to take place on the premises? Do the noble and learned Lord and the Minister recognise the seriousness of a situation where hospices feel forced to close, which could cost around £8.4 billion a year to the public purse?

It has been very interesting to talk about the number of people who may be trained. However, if the equality impact assessment is anywhere near correct, the estimated number of patients in year 1 will be somewhere between “273 and 1,078”, and in year 10 it could be between “1,737 and 7,598”. This does not sit alongside the 310,000 people who accessed hospice care last year. Therefore, if there is no expectation of overwhelming demand from people wishing to end their life, why is there need for mass enrolment?

There might be a number of different reasons why organisations with principled opposition might want to be exempted: freedom of association in law for charities, legal rights guaranteeing patients a choice of their place of care, the cost to the public purse, freedom of religion and belief in law, and the public benefit of faith-based charities.

We currently have a fragile workforce. In 2024, the Royal College of General Practitioners surveyed GPs, 42% of whom said that they were unlikely to be working as a GP in the next five years. This brings us back to the number of people who we may need to have trained. Whatever we think the Bill says, I am concerned that it is not clear enough. We also cannot underestimate the pressure on doctors and medical practitioners who may choose to opt out. If they work in an organisation that feels very strongly that this process should take place on its premises, someone’s career might be in jeopardy if they are not willing to sign up to it.

The noble Baroness, Lady Fox, raised issues around porters. Although we have discussed prisoners in previous groups, we have not discussed prison officers in this group. There is another group of individuals—not just doctors—who might want to exercise a conscience clause. It might include administrators as much as anybody else who works in the system.

My noble friend Lady Watkins of Tavistock rightly said that many people would choose to have excellent palliative care. The reality, as we have discussed, is that it is a postcode lottery. It is a great shame that as part of this Bill we were not able to discuss the provision of palliative care—it was ruled out of scope—because I think it would have given many of us a level of reassurance if we could have debated that at the same time.

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[Lord Falconer of Thoroton (Lab)]

There is a specific provision for opting in. I am not quite sure what the noble Baroness is saying. It is absolutely clear that that is the provision.

I move on to the amendments to Clauses 5 and 31 on the width of the opt-out. As far as Clause 5 is concerned, as I indicated to the noble Lord, Lord Harper:

“No registered medical practitioner is under any duty to raise the subject of the provision of assistance in accordance with this Act with a person”.


A number of noble Lords, including the noble Lord, Lord Stevens, made the point, and he referred to Professor Ruck Keene and others’ articles on the problem. We have approached the question of whether it is a treatment or not on the basis of what provides a practical answer to doctors and medical professionals. If you say that it is not a treatment, I do not see why that would necessarily obviate the need, if you are worried about doctors or health professionals having, in particular circumstances, to raise it. The key thing for the doctor to know is there can never be a legal duty on him or her to raise it or to become a participant in the system.

What more could—

[Lord Stevens of Birmingham (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

Let me finish.

What more could one do to give protection to doctors? Beyond saying that there will never be a duty to raise it or to participate, I cannot think of what wording there could be.

[Lord Stevens of Birmingham (CB)]

I thank the noble and learned Lord for giving away. One answer would be to simply put in the Bill that this is not a treatment, in which case all the other consequences would not arise. The question, just to clarify, is: is he saying that assisted dying is deemed to be a treatment? Nevertheless, his Bill overrides the duties on a doctor affirmed by the Supreme Court in July 2023 in the McCulloch case.

[Lord Falconer of Thoroton (Lab)]

Yes, there can be no duty to raise a question of assisted dying if an Act of Parliament says that there is no duty to raise it. That case, the Montgomery case and the normal negligence cases do not in any way lurk in the background waiting to, as it were, stop this. It is absolutely plain that the effect of this provision and the provision in Clause 31 is that if you did not raise it, there can be no legal kickback of any sort. That is why it was phrased like that, and that is why putting in the words “it is not a treatment” would not be sufficient.

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[Lord Falconer of Thoroton (Lab)]

The only organisational exceptions that I am contemplating—the exceptions in Clause 31 are for individuals—are in relation to hospices, not care homes.

[Lord Stevens of Birmingham (CB)]

I think the noble and learned Lord has just made a very important point. To clarify: he is saying that Clause 31(8)(b) would not apply in hospices; in other words, as drafted, the Bill would prevent a hospice as an employer from restricting doctors who were working for that hospice from also participating in assisted dying. If the hospice wanted, as a matter of philosophy or ethos, to say, “We do not want to be part of that”, is the noble and learned Lord saying that it would have an opt-out from Clause 31(8)(b)?

[Lord Falconer of Thoroton (Lab)]

I am not sure I have understood the question. If the question is, “Can a hospice opt out from the opt-out?”, the answer is no. Can the hospice have a separate opt-out? That may be the position, but I need to consider how to deal with that.

[Lord Stevens of Birmingham (CB)]

To clarify, I think Clause 31(8)(b) prevents a hospice as an employer restricting its employees from participating in assisted dying if they do it somewhere else. Is the noble and learned Lord saying that he is willing to change that?

[Lord Falconer of Thoroton (Lab)]

What I am thinking about is a provision that says if, as a hospice, you say you do not want to provide it, you should not suffer various sorts of institutional detriment. That is what I am interested in. I am not saying anything about Clause 31, because I am not understanding the noble Lord’s question, but that is what I am thinking about, to be clear.

[Lord Stevens of Birmingham (CB)]

I think what follows from that is that the noble and learned Lord is accepting the position that hospices will not be in a position to restrict their employees from participating in assisted dying, if they are doing that somewhere other than in the hospice.

[Lord Falconer of Thoroton (Lab)]

That is correct.