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.