Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, 60 years ago Parliament passed what I think would be by common consensus one of the most significant pieces of legislation of the 20th century—namely, the abolition of capital punishment. The rationale for that decision was largely based on three principles that are difficult to argue against: first, that in a modern civilised country it was barbaric for the state to decide to kill its own citizens, even after a judicial process; secondly, that whatever protections or procedures were put in place with a judge, jury, tribunal or panel, it is made up of human beings who ultimately from time to time will make mistakes; and, thirdly, that when we are dealing with a situation involving the death of a person, the consequence of a mistake in those circumstances is irreversible. The clock cannot be turned back six months later when new evidence emerges, if that person is dead.

Those principles have held firm throughout the decades, which is perhaps why, in the 60 years since then, there has never been a realistic prospect of that law ever being revoked. But I contend that the legislation before us today reverses and repudiates all three of those principles, with the added expense of offering in return a false prospectus of a painless, easy death.

If this legislation passes, the state will have control over who is eligible for assisted suicide and control over how that is done, and it will ultimately be administering the killing of the individual. Whatever procedures we put in place, the panels will make mistakes. We know that the prognoses that doctors make, no matter how qualified or specialist they are, cannot be got right all the time. But what worries me most is the issue of coercion. This is not simply an academic or hypothetical question. Sadly, we have seen too many cases over the years, particularly those resulting in the tragic deaths of partners or children, in which it has then emerged at a later stage that there were years of abuse and coercion. The reality is that coercion is not easy to spot because it happens behind closed doors. It can be blunt and aggressive, but it can also be sophisticated and subtle—a drip-drip message to a person that they are a burden on their family.

The reality is that even beyond the coercion that comes from others, there is a risk in this legislation of what I would call self-imposed coercion, whereby a person decides or convinces themselves that the burden that they place in terms of caring and financial responsibilities means that they feel compelled to make the supreme sacrifice for their family. As with capital punishment, if we get it wrong on an issue of coercion, we cannot look back six months or a year down the line and reverse that decision.

Finally, to use a classical analogy, today we cross over not only the River Styx but the Rubicon if we accept this legislation. Some of the proponents of this legislation are already saying that it is the first step. We have seen that happen in country after country, perhaps less in a direct change of the law and more in change of practice. While I am sure that we have great faith in this country, we cannot be that uniquely arrogant to believe that we will be the one country where there is not an expansion of the issue of assisted dying.

This Bill, rather than being progressive and permissive, is cruel and regressive. This House should do the mature thing and reject it.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Coffey (Con)]

My Lords, group 1 is perhaps not the ordinary place to start when we are considering the issue of Wales, but I have tabled 40 amendments with specific reference to Wales for a reason. We will get into aspects of this in more detail and I am grateful to the noble Baroness, Lady Smith, and the noble and learned Lord, Lord Thomas, for degrouping some of their amendments, because I think it is important that we have a considered debate about how the Bill could potentially apply in Wales. I am also conscious that the Committee will want to get on to the key principles that we will cover in later groups.

My reason for raising this is that the Bill started as a judge-led process, with quite a focus on, in effect, decriminalising parts of the Suicide Act. I am in no doubt that that is a reserved competence: having the one judicial system. I completely accept that. That is not what I am seeking to get into. However, what has happened in the Commons, and even more now in Committee in your Lordships’ House, with the amendments that have been tabled, has basically flipped the Bill into being a Bill on NHS-provided assisted dying—or “assisted suicide”, or “assisted help”; I have forgotten the varieties that are now being proposed on what it is going to be called—and without doubt, health is devolved to the Welsh Government, and therefore the Welsh Senedd.

There have been a number of debates in the Welsh Senedd, and the Welsh Senedd has consistently said that it does not want assisted suicide to go ahead, particularly in Wales, under its devolved elements. That vote was actually taken fairly recently and, as a consequence, I am concerned that aspects of the Bill will, in effect, potentially be breaking the Sewel convention, although I accept that the Welsh Government are now on to their second legislative consent Motion and will have more.

When I have asked the Government questions, I have tried to do it through freedom of information requests, just trying to understand what concerns the Government have had about the Bill and why it has needed, I think, 11.7 full-time equivalent civil servants working in the Department of Health and more than three in the Ministry of Justice to work through and understand the issues that have made the Government decide, “That’s not workable”, “That’s not practical”, “Let’s think about the legal element”. I have been blocked at pretty much every turn. I have been told, on FoI elements, “It’s going to take too long to answer you”. Indeed, I am still waiting for an answer from the Department of Health, but I got another one just saying, in effect, “Well, the Minister mentioned it basically in Committee in the other place, you can look it up yourself”. I am not sure that that is the attitude that is going to help us get through this detailed understanding of where we are.

Returning to Wales, the Government have been having weekly technical meetings with Welsh Government officials. It has not been possible to get information about what has been discussed. Recognising that both Governments are supposed to be neutral on this, this is not a case of government policy formation, which is protected under the Freedom of Information Act, but nor do I feel it is in the spirit of considering the most important Bill of this entire parliamentary Session, indeed of this entire Parliament.

The other aspect I am concerned about is what is happening in the Welsh Senedd. There is clearly a difference of view between the Welsh Senedd and the Welsh Government, and information is not currently being released. I am not trying to get into a whole debate on Wales, but can the Minister give us an understanding of what is happening? I appreciate that the sponsor of the Bill may have the answers, but let us be candid: it is the civil servants who have been doing all the technical work and the sponsor has been doing the more general policy ideation—at least, that is what Ministers told the Select Committee. I know the Select Committee had limited time and I tried to get a discussion about Wales during it, but it was not possible.

I am not going to delay debate on the first group, but it needs some careful consideration. I could make lots of references to reports, which are online, but there is a huge difference in what the Welsh Senedd believes should be devolved and what needs a legislative consent Motion. I am still awaiting an answer from the Government about whether they have requested the legislative consent Motion.

There are many more clauses the Welsh Senedd believes should be in here, and I am looking for a straightforward response from both Ministers on the clauses that they believe are not devolved and why. Ideally, I would like to hear it on the Floor of the House but if the information is not available today, I would be grateful if it could be responded to in a letter to be laid in the Library so that everyone has a proper understanding of what is the responsibility of this House and what is the responsibility of another Parliament. We need to be transparent about what that means, because we should not assume that we have the opportunity to ride roughshod over what other devolved Administrations and Parliaments believe. I beg to move.

[Lord Weir of Ballyholme (DUP)]

My Lords, I rise to support the amendment standing in the name of the noble Baroness, Lady Coffey. Some people may detect from my accent that, although I hail from the great city of Bangor, it is not the great city of Bangor in north Wales but the great city of Bangor in Northern Ireland. I have particular empathy with the amendments that have been put forward by the noble Baroness due to my experience as a Minister in a devolved Administration. The clarity the noble Baroness seeks goes to the heart of the relationship between the devolved Administrations and Westminster, and it is of particular relevance to this Bill.

Generally speaking, a Minister in a devolved institution will face three categories of legislation. First, there will be reserved matters, which are entirely within the purview of Westminster—national issues, which I think everyone would accept. Secondly, there will be a range of issues which, although not strictly reserved, are of such obvious applicability across the United Kingdom that a legislative consent Motion should be applied. I do not see the noble Lord, Lord Foulkes, in his place, but on occasions even the SNP Government in Scotland have been prepared to sign up to legislative consent Motions. The third category—the bulk of legislation—is situations that should be decided locally, where a devolved Government and a devolved Parliament can choose whether to follow what is happening at Westminster and in England, to take a different path in seeking either to virtually replicate or to amend, or to go in a tangentially very different direction. That is at the heart of democratic accountability in devolution.

I believe that this is an issue that should be decided in Wales. It is an issue that should clearly fall into category three. We all know that we have a very unusual constitutional set-up in the United Kingdom, where devolution to Wales, Scotland and Northern Ireland is on a slightly different basis in each case. That can produce some unusual aspects. What we have today is a certain level of anomaly, because this legislation falls into what may be described as a fourth, hybrid category. As the noble Baroness, Lady Coffey, highlighted, the distinction is between the aspects that deal with criminal justice and criminal responsibility, and those that deal with health and social policy, with the former being reserved and the latter being devolved.

It is very clear that the heart of the Bill makes major decisions that impact on health and social policy. However, we are left with a situation for Wales that means, if this goes through unaltered, that the criminal responsibility will be lifted but there will be no regulations coming from this House as to how that will actually be brought about. It is the equivalent of this House saying that we are going to bring in new road safety measures, which will not apply to Wales, but if you are caught speeding on the motorway there could be no criminal sanction against you. What we have potentially arrived at for Wales is the worst of all worlds.

We need to take a step back. We need to ensure that the wishes of the Welsh people, as exercised by the Senedd—they may change over time—are respected. Rather than, in effect, imposing something that then has to be more or less corrected in Wales by way of changes to their health and social policy, we should be allowing the issue of assisted dying to be decided by the Welsh Senedd. If they decide to make those changes, this Parliament should then reflect them by way of changes to the criminal justice system, which I think would be relatively easy to do.

In the absence of that, the importance of these amendments, as outlined by the noble Baroness, Lady Coffey, is that if we cannot get things definitively the right way round, we can at least get a level of clarity over what aspects apply to Wales, rather than a potential wall of obfuscation. This is an ideal opportunity for the Government and the sponsors to highlight where exactly the demarcation is, which will be very helpful as we move through the rest of this Bill.

[Lord Blencathra (Con)]

My Lords, I support my noble friend Lady Coffey’s amendments in this group. As I looked at the title of the Bill, “terminally ill”, and then saw clause after clause talking about the patient and the doctor’s involvement, I was clear that this was a medical Bill. We had the Secretary of State for Health saying that he was in charge of it, and the Department of Health and Social Care, which seconded about 30 officials to help rewrite it, in a way taking ownership of it. Then I asked myself: why on earth are we legislating for Wales when health is a devolved matter in Wales and the Senedd is in charge of health matters? This is where it is really Pythonesque, because although this is a medical Bill in England, it is a criminal Bill in Wales, and criminal matters are not devolved to Wales. How on earth can the same Bill be a health Bill in one country of the union and a criminal Bill in another?

On 23 October last year, Senedd Members, including the First Minister, Eluned Morgan—the noble Baroness, Lady Morgan—and the Health Minister, Jeremy Miles, voted against a Motion calling for a new law to allow assisted dying in Wales and England. Miles had earlier warned of “huge ramifications” for Wales if the law changed. In total, 19 Senedd Members voted in favour of the Motion, with 26 against and nine abstentions. However, the Senedd does not have the power to change the law on assisted dying in Wales, so the vote was symbolic. The Senedd does not have the power to legalise assisted dying, but the Health Minister indicated that it is likely that future legislation will require another vote to give Parliament consent.

The Welsh NHS, which is almost totally devolved and overseen by Cardiff politicians, would be responsible for implementing the law. However, I understand that the Senedd can still vote on whether to implement the legislation, as parts of the Bill touch on devolved areas, so the Welsh Government would need to pass specific regulations and gain an affirmative vote from the Senedd before the Welsh NHS could provide the service. I am not a great fan of the devolved Administrations, but they exist and they have a genuine job to do. In Wales, this would mean that their NHS and its doctors would have implemented all the provisions of an English law, which they had no power to change. That does not seem right. If the Senedd in Wales can be trusted to run the NHS in all medical facilities in Wales, it should be trusted to make its own terminally ill end-of-life Bill.

Next year there will be Senedd elections, and on current polling there may be a large majority of Plaid Cymru and Reform Members elected. It cannot be right that they inherit a Bill relating to the deaths of about 35,000 people in Wales each year and that they have no say over how their constituents die.

Of course, the Senedd could refuse to give consent to the legislation, but I suspect it will be threatened and blackmailed into doing so. It will be told that it is the English Bill or nothing and that Wales has no power to do its own law, so the Senedd had better approve it or else. But the Senedd could do its own law; all we have to do is grant it the constitutional power to do so.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 4, in the name of the noble Baroness, Lady Berger, to which I added my name.

As well as this Bill, the Private Member’s Bill in the name of the noble and learned Lord has, as a requirement, the safeguard of a six-month prognosis. When one looks at this in relation to those over 18, I am interested in what pre-legislative scrutiny or consultation the noble and learned Lord, or the other Bill’s sponsor in the other place, had on the science. I am not a scientist, but I have a researcher who is a scientist, so I took advice on how to treat the science when one speaks in a debate with those who have great eminence, such as the noble Lord, Lord Winston. Having looked at that, I believe it is relevant to the age limit in the Bill. There will be specific types of vulnerability for certain groups of young people—as the noble Baroness, Lady Fox, outlined—but those will be discussed in later groups.

According to peer-reviewed studies—which, I am told, are the best way to begin to treat the science—the brain reaches its full size physically at the age of 14, but the neural circuitry does not develop to enable enhanced decision-making and cognitive function until the age of 25. I am also informed—I am sorry to disagree with my noble friend Lord Sandhurst—that the study that was quoted by the BBC is viewed as an outlier from the peer-reviewed studies that we have in this regard.

When looking at terminally ill adolescents—I am grateful to the noble Lady, Lady Hayter, for reminding us of that—we also need to consider that there are psychological reports that they may have an unrealised concept of the finality of death, which I think is relevant to what the noble Lord, Lord Moore, said. As the Children’s Commissioner stated in her letter of evidence to the Select Committee:

“Compelling arguments have … been made about the additional difficulties present in diagnosing young people in this age group, and predicting with certainty the chance of living for six months”.


Of course, if that is wrong, it could lead to an earlier, untimely death, if assisted dying is made available to them.

I was really intrigued by that statement and sought to look at the scientific evidence. I have found peer-reviewed papers, in particular one from the University of Manchester reporting historical data that finds that, even with advanced diseases such as thyroid cancer, this group has a better rate of survival than adults over the age of 25. The report outlines that that may be because a more efficacious response to treatment, as a younger body may be better able to receive it; it may be due to an elevated sense of hope, which is often reported in young adults; or it might be because such a devastating diagnosis at that age is hard to fathom, as it is not a disease they think would ever happen to them. That sense of hope possibly contributes to a positive impact on the immune system, thus resulting in a better response to the administered medication.

The second reason I outline is that—as the noble Lady, Lady Hollins, briefly alluded to—there is a significantly increasing life expectancy in terminally ill young adults due to the incredible advances that we are beginning to see in treatments such as advanced immune therapies and personalised genotype-directed treatment. Both have seen increased survival rates of up to five years in up to 80% of patients with terminal cancers. Although we will come to the matter of young people and the EHCP in a later group, I think it is right to reiterate that we have policies that treat those between 18 and 25 differently in certain situations.

The Children’s Commissioner also brought to our attention that young people already often fall into a gap at the ages of 16 and 17. Some community palliative care services end at 16, and then others do not begin at 18. That makes me wonder whether we need to think more about their access to specialist palliative care in this Bill in later groups.

Can the noble and learned Lord outline what process there was, before both Bills were put together, to look into the scientific evidence? It seems to me that the assumption in both Bills is that a six-month prognosis affects or applies to all groups of the population in the same way. Is that indeed the case? We know from evidence from the European Society for Medical Oncology’s Professor Stone that a six-month prognosis is inaccurate in over half of cases. Is six months the right level to use—that might be a connected change—or is 18 too young an age? I would be grateful to know whether the noble and learned Lord has already engaged with this science. Perhaps with the assistance of the noble Lord, Lord Winston, this, I think, would be a valuable way of looking at the evidence behind Amendment 4.

[Lord Weir of Ballyholme (DUP)]

My Lords, this is an important group of amendments, particularly to those of us who have an interest in young people. It is very important that we have heard today a range of opinions on where age eligibility should lie. When dealing with age eligibility in this Bill, it seems that there are three critical questions. First, at the lower end of eligibility, should there be an age limit below which it is impossible to access assisted dying? Secondly, if it is agreed that there should be an age limit, is 18 the appropriate age? Thirdly, as has been posed by the two sets of amendments in this group, if we feel that 18 is too young an age, what is the appropriate age that we should set?

On the first issue, I am glad to say that at least the proponents of this Bill have not gone down the line—as has been argued, I think, by some lobbyists and has been the case, for example, in Belgium and the Netherlands—that there should be no lower age limit. I welcome the fact that this seems to be accepted by the proponents of this Bill. However, I reiterate the question that has been asked—I look forward to the noble and learned Lord, Lord Falconer, summing up in relation to this—about what assurances we could have if we ended up in the position where the eligibility is at 18. What confidence could we have that that will be stuck to?

On the second issue of whether 18 is the appropriate level, I cannot claim any particular knowledge or expertise on neuroscience, but I have a lot of experience having served twice as Education Minister in Northern Ireland. I am sure that, if you speak to anyone who has served in that sort of role in any of the jurisdictions, they will say that the greatest privilege you have in that ministerial capacity is meeting young people on a day-to-day basis and talking to them about their lived experiences. It is a great joy to meet the many very healthy, confident young people who can look forward to a lifetime ahead of them. However, it is also the case that you come across a number of young people who are very vulnerable, who have extremely life-limiting conditions and who have a terminal illness.

In my experience, the families of those young people reorientate themselves through their love, so that the focus of almost all family activity is on that young person. The by-product of that, at times, can be that some of those young people feel themselves to be a burden on their family: that they are disrupting everything that their family does and not allowing their family to lead a normal life. They sometimes feel a sense of guilt.

While I am sure that we will come on to this in later stages, I note the concern about what might be described as “self-imposed coercion”: people coming to the conclusion that they will be doing a service to their loved ones by going down the route of assisted suicide. We know that concerns have been raised in relation to the disabled and the elderly feeling under a particular level of pressure, but it would be naive to believe that young people in that position do not also feel themselves to be pressurised. I do not want us to create a situation where a young person, in the run-up to their 18th birthday, asks, “How can I facilitate my family by taking that ultimate step?” So, on the issue of maturity, I contend that 18 is perhaps not the right boundary point in this case.

Finally, there are competing amendments about whether it should be 21 or 25. While I came to this in a fairly agnostic manner, I have been persuaded much more towards the position of the noble Baroness, Lady Berger. I am also persuaded in many ways by the words of the Children’s Commissioner. I have considerable experience of dealing with both the Children’s Commissioner in England and her opposite number in Northern Ireland, and I believe that the commissioners tend to have a particular worldview: when they look towards young people, they want the world to be permissive towards them. They are progressive in their nature—and sometimes, I have to confess, they may be a little too progressive on certain subjects for my own liking. But they always look, where possible, to extend rights to children that are normally given to adults. So, when we see a situation such as this, where a Children’s Commissioner is, in effect, saying, “Be very careful in relation to the law. Do not extend this to younger people between 18 and 25”, we need to pay cognisance to that.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

Moved by

[Lord Weir of Ballyholme]

30: Clause 1, page 1, line 12, at end insert—
“(e) is not substantially motivated by—(i) not wanting to be a burden on others or on public services,(ii) a mental disorder (including depression),(iii) a disability (other than the terminal illness),(iv) financial considerations, including a lack of adequate housing,(v) lack of access, or delayed access, to treatment or other service which a public authority is required (or can reasonably be expected) to provide, or(vi) suicidal ideation,”

[Lord Weir of Ballyholme (DUP)]

My Lords, I have notified the Lord Speaker’s office and the Whips that I shall be moving Amendment 30, which stands in my name and those of the noble Baronesses, Lady Foster—who is unable to be with us today—and Lady Fox, and the noble Lord, Lord Empey. This group of amendments deals with the issue of motivation, and there is a level of link with the previous group, which dealt with eligibility. In the interests of time, I will allow the proposers of the other amendments to speak to those and will concentrate entirely on Amendment 30.

The purpose of Amendment 30 is largely to ensure that the Bill remains true to what I think is one of its key underlying principles: that when dealing with the substantial motivation of anyone applying for the assisted dying service, there is a critical, causal and direct link between that desire to have an assisted death and the terminal illness, and the application for an assisted death does not arise from a range of other motivations. Also linked to this is an attempt, at least, to ease the gap between two tensions that will lie within public policy should the Bill become law. Should it become law, the state will play a role in assisting the death of members of the public, while at the same time there is a public policy commitment and priority to try to prevent suicide. In many ways, those two objectives are pulling in opposite directions. Amendment 30 at least tries to create a little bit of clear blue water between the two; it cannot square that circle, but it goes some way towards dealing with the issue.

Sticking to the original principles of the Bill is all the more important because one of the most fundamental motivations behind it had to be abandoned from the face of the Bill. We know that the proposer of the Bill in another place, Kim Leadbeater, has said on numerous occasions—both before the Bill was proposed and during the debate on it—that it is principally about pain and suffering. Indeed, on one occasion, she made the comment to the then Archbishop of Canterbury:

“My proposed legislation is less about ending life, but very much about easing suffering and shortening death”.


I am sure that the noble and learned Lord, Lord Falconer, will give us very good reasons as to why this is the case, but nowhere do pain and suffering appear as part of the Bill. That issue will be probed particularly by the amendments in this group tabled by the noble Baroness, Lady Coffey.

To ensure that there is that strong, critical, causal link between the termination of life being the motivator and the assisted death, Amendment 30 seeks to exclude six other areas that could be considered as substantial motivation for an assisted death. The first is a lack of access, or delayed access, to alternative medical treatments. I do not wish to reiterate the earlier debates we have had—for instance, on palliative care, or the question marks that are sometimes there about a certain level of postcode lottery in the NHS. Those issues have been debated already, but if we are to fulfil what I think is one of the key arguments for the Bill—that of bodily autonomy—and if there is to be autonomy, autonomy has to be real choice. If there is no reasonable opportunity for access to any alternative medications, it is not really a choice, and that should not be the motivation for an application.

Secondly—again, this was touched on during the debate on the last group—the substantial motivation should not be lack of resources. I agree on one thing with the noble and learned Lord, Lord Falconer: this should not discriminate against people on the basis of socioeconomic background. Therefore, lack of resources should not become a driver for the poor to go down this route because they do not have any other opportunity. This is not simply a hypothetical concern; we have seen it happen time and again, particularly in the Canadian example, in which people—particularly those with mounting debts, which are quite commonplace among those who are debilitated by illnesses—feel under massive financial pressure, and that the only route through is to have an assisted death. That should not be the principal motivator.

Thirdly, it should not be because someone feels themselves to be a burden. We have mentioned before that we will want to put in all the provisions that we can on the issue of coercion. However, what might be described as “soft coercion” is a feeling among those who are terminally ill that they are a burden on their family and loved ones, and perhaps on society as a whole, which acts as a driver towards assisted dying. Again, there is plenty of evidence that this is a major factor in other jurisdictions. For example, among those persons who applied for assisted dying in Oregon in 1997, around 13% indicated that feeling a burden was a substantial part of their motivation. That figure has now risen to 42% of those applying, and in other jurisdictions it can be even higher. We want to safeguard against that.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

We really must be told, by the promoter and by the Minister, which Secretary of State will be responsible for choosing the panel, because there are a lot of references to the Secretary of State in the Bill. Will it be the Secretary of State for Health, or whatever the relevant one is at the time, or will it be the Ministry of Justice?

[Lord Weir of Ballyholme (DUP)]

Is it not also the case, if we are looking at assisted dying much more from a justice prism, that one of the broader, important elements to establish, where death has occurred, is whether there has been any criminal action or intent, in terms of the administration but also in a situation where people coerce somebody to die? That is another reason why, if this is to happen, it should sit much more with the justice side of things than with the health side.

[Lord Sandhurst (Con)]

I agree entirely with the noble Lord. That is why at the start, perhaps briefly and elliptically, I talked about bad agencies and people. That is not the health service’s primary role. It will happen from time to time. I know a medical professional —I mentioned this at Second Reading—who has a relative in charge of safeguarding in a major London trust. One of the concerns they have, and what they have to deal with from day to day, is families who are not all united in their support for an elderly and tiresome relative and would often, in fact, like them helped on their way. I will not say more, but I think the point is clear that this structural point is a major failing in the Bill.

--- Later in debate ---

[Baroness Berridge (Con)]

Well, I hope that he will write to me personally about this.

In relation to the evidence on which the noble Lord, Lord Birt, is basing his argument, I was surprised that the right reverend Prelate mentioned the Australian non-comparable. Paragraph 8.4 of the impact assessment, on the delivery model, states that

“in most jurisdictions where assisted dying is legal it is provided through the healthcare system”,

so looking for international comparators is an unusual approach. The 30 jurisdictions that we keep hearing about include the Isle of Man, Tuscany in Italy, and only 13 of the 50 United States. This is not a wave that we must get with, as many progressive politicians like to say it is. Denmark considered this in 2024, and 16 out of 17 members of the Danish Council of Ethics voted against introducing assisted dying into their jurisdiction. Only yesterday, the French Senate decided not to go forward with legislation. This is in no way a progressive train that we need to get on.

My second point relates to the speed of these decisions for families. We know that the Bill is philosophically based on individual autonomy, which is anathema to many communities. For families to know that this was done within 18 days will only compound what we believe will be complicated grief. I am particularly concerned about how the speed of service will fit in with the increasing uncertainty of diagnoses for 18 to 25 year-olds because of the various positive effects of treatments for them. The noble and learned Lord, Lord Falconer, has admitted that there are, sadly, deficiencies in Clause 43 in relation to advertising. I do not think I am a cynic, but I am sorry to say that I can see a competition: “Can I get to 18 years and 18 days and be the first young person to meet that milestone?” We do not want a culture of speed in this process, limiting reflection.

Finally, maybe I am the only noble Lord sitting here without the benefits of the pre-legislative scrutiny of a consultation White Paper but, with many amendments, I am wondering how this service will fit together with a panel—or will it be a judge, or a judge with a couple of other members? That is the deficiency: in Committee, we are still trying to put right the lack of pre-legislative scrutiny, and I do not know whether that is possible.

[Lord Weir of Ballyholme (DUP)]

The noble Baroness raised the issue of speed. It comes back to a point raised by the noble Baroness, Lady Fox. Often in public policy issues, there is a trade-off between the speed of a decision and its quality. Sometimes when we short-circuit or fast-track decisions it can inevitably lead to a greater level of mistakes being made. But in a wide range of other public administration or public policy decisions, there is at least the advantage that if a mistake is made, there is the opportunity at a later stage to come back and correct it—to perhaps appeal, review or reverse it. Of course, the major problem with this is that if we fast-track things and it leads to a death that should not have occurred, we cannot bring the person back to life.

I agree with the noble Lord, Lord Markham, who said in response to an intervention from the noble Baroness, Lady Berger, that he perfectly acknowledged that we should have the safest possible system—I see that he is nodding now. I therefore find it very difficult to see how we get the safest possible system if these amendments go through and decisions are fast-tracked, inevitably leading to greater numbers of mistakes and shortcuts.

[Baroness Finlay of Llandaff (CB)]

My Lords, in introducing this group of amendments, the noble Lord, Lord Birt, said that one of the reasons he tabled them was that the proposals in the Bill are potentially chaotic and prolonged. This group is in some ways something and nothing. The proposals make the case for a profound imbalance, with assisted death actively facilitated, accelerated and led through the dedicated service with speed. As my noble friend Lord Stevens said, this is not in scope for the NHS and NHS services, and we have to look at the NHS constitution. I ask the Minister whether, in the light of some of the proposals, there is a plan to rewrite the NHS constitution as well as the fundamental principles of the NHS, as read out by my noble friend.

The amendment’s structural conflict is between efficiency and caution. In responding, can the noble Lord, Lord Birt, explain how the clock will be stopped and by whom, and whether a request to shorten the process will trigger enhanced scrutiny? If so, how that will be done? Will all the assessments be face to face to improve the chances of detecting coercion to death? Will all the contacts with the navigator be recorded and audited so that one can be sure that the auditor is not acting in a profoundly subtle and coercive way?

The navigator seems to bypass a search for many things and, without the amendments in the names of the noble Lord, Lord Mackinlay, and others, I cannot see how that imbalance would be corrected. At least the imbalance is there, but Amendment 771 gets to the heart of the problem: it tries to make all of this a profound NHS responsibility. As we have heard, the NHS cannot cope. We have patients on extra beds in the middle of wards, seriously ill patients being looked after in corridors and patients sitting on plastic chairs waiting for a bed, sometimes dying on those plastic chairs.

The NHS is not the place to have a dignified death in a hospital setting in the lovely planned way that seems to be described and desired by some people. People are working themselves into the ground trying to manage their current workloads. As has been said, the workforce itself is completely on its knees. GPs are already overstretched. Evidence suggests that assisted dying would require around 30 hours for an individual case, yet many palliative care doctors and psychiatrists would opt out, therefore decreasing the pool. That is relevant to the way these amendments are put together.

I will respond to some of the points raised about whether the public want this. When the public are asked in polls what they understand about assisted dying, 52% say that it is a right to stop treatment. They already have that right. Nobody should be treated against their will, and they should be supported in that decision. Some 17% of people think that assisted dying is hospice care.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Garnier (Con)]

My Lords, I am grateful that the noble Lord was able to introduce his remarks before he has to go and perform his functions as chairman of the Committee. I have only a few things to say, and my amendment is discrete, in the sense that it does not really affect much of the rest of the Bill. It can be taken quite briefly, and I hope that the noble and learned Lord, Lord Falconer, will be able to agree to it, not least because it bolsters the job that he once held.

With respect, I disagree with only one point that the noble Baroness, Lady Cass, made. The function of the commissioner is not simply administrative; there is a judicial element to their work, which is found in Clause 4(4)(d). One of the principal functions of the commissioner is

“determining applications for reconsideration of panel decisions under section 18”.

That said, I fully accept that it is a mixed-function job: it is partly administrative and partly judicial—but then so are quite a lot of senior judicial jobs. The Lord Chief Justice and the Master of the Rolls all have heavy administrative burdens as well as having to perform a judicial function, and no one would suggest, I venture to say, that those people should be appointed directly by the Prime Minister.

It is more constitutionally appropriate for the voluntary assisted dying commissioner to be appointed, as so many other judicial and quasi-judicial posts are, by the sovereign on the recommendation of the Lord Chancellor. I appreciate that the office of the Lord Chancellor has changed a lot since the 2005 Act—more’s the pity, in my view, but there we are. That was a long time ago. When I become Prime Minister, of course, I shall have it changed.

There is a nice distinction to be drawn with the appointments made in the way that I suggest. If my amendment is accepted by the Committee or by the House as a whole, it will obviously have a knock-on effect on the appointment of the deputy commissioner under paragraph 3(1) of Schedule 1—but let us not delay ourselves with that. All I am saying is that it is more appropriate for this particular function to be appointed by the sovereign on the advice of the Lord Chancellor, as so many similar posts are.

A Minister responding for the Government in the other place said that the investigatory powers commissioner is appointed by the Prime Minister, and he, like the assisted dying commissioner, has to be a sitting or retired member of the senior judiciary. But that is a false point. The distinction between this job and the investigatory powers commissioner is that the investigatory powers commissioner deals with matters of national security—which are essentially a matter for the Prime Minister—whereas this assisted dying commissioner will deal not with matters of national security, foreign policy or anything of that nature but simply with the workings of this Bill, or this Act as it may yet become.

This a very short and simple point that I am sure the noble and learned Lord can easily agree with, because it does not damage the Bill. It is simply a technical adjustment of the route to appointment, and I urge the Committee to support it.

[Lord Weir of Ballyholme (DUP)]

My Lords, I will speak to three amendments in this group, two of which stand in my name. The third is Amendment 128 in the name of the noble Baroness, Lady Foster, which I have co-signed and will touch on briefly now.

Amendment 128 is essentially probing in nature. The Bill lists the principal functions of the commissioner—we do not take particular exception to that—but does not outline their specific duties, so we feel that there is a bit of a gap at present and are probing whether the duties are correct and whether the commissioner has a role in ensuring effective oversight. I look forward to hearing the response of the Bill’s sponsor on that.

I move on to Amendment 129, following on from the remarks of the noble Baroness, Lady Cass. When I arrived today I did not anticipate that she would be my warm-up act in relation to the amendment—I thank her for her remarks. The amendment essentially deals with whether the commissioner should be required to be either a senior judge or a retired judge. In part it also has a slightly probing quality, and again I will listen to the remarks of the Bill’s sponsor. Given where the passage of the Bill has gone so far and where it might land—the situation is slightly fluid—and although I appreciate that, for instance, the noble Lord, Lord Carlile, has made suggestions on how we could inject a level of judicial introduction to the panels, we will probably be keen to press this on Report if the issue is not resolved and we are left with the current situation.

The reason for that is that when the Bill was introduced in the Commons, one of its core elements was the judicial function and, indeed, judges on the panels. That was one of the great selling points of the supposed—and slightly self-proclaimed, I have to say—safest Bill in the world. But that position has been resiled from and, although I am sure that the Bill’s sponsor will give reasons for it, we have moved away from that core element. If we do not have that core element of a judge on the panel, do we leave a situation in which the commissioner has to be either a senior serving judge or a retired judge? Would that create a veneer of judicial impact when the core element has been taken out?

That is all the more appropriate when we look at the functions that have been listed for the commissioner, of which there are five under Clause 4(4). Paragraphs (a) and (b) relate to “receiving documents” and compiling a list of eligible panel members. It is hard to see why those functions, which are essentially administrative in nature, would require a level of judicial input. Similarly, paragraph (c) relates to

“making arrangements in relation to such panels”.

Again, that function lies largely within administrative competence rather than requiring any element of judicial quality.

The one area that does touch on that, as has been highlighted, is paragraph (d), which talks about the reconsideration of cases, but cases are not to be reconsidered on their own merits. The Bill’s sponsor in the other place, Kim Leadbeater, said that the commissioner is

“not acting as a judge”,

so there is a query about the level of judicial impact even of paragraph (d). Finally, under paragraph (e) there will be a monitoring role, particularly as regards medical statistics. There is a question mark in relation to that. If we are looking for somebody to undertake that role, which I think was initially put within the remit of the Chief Medical Officer, it seems to me that a medical professional is much better suited to it. There are queries about the applicability and whether we are simply creating a façade of judicial involvement by having the requirements currently in the Bill.

My Amendment 496C would afford a person, if they desire it, the opportunity of a hearing before the commissioner, rather than their case being decided by a paper hearing. That would cover aspects such as someone being registered disabled under the Act, the availability of communication, cognitive impairment and mental distress, in the interests of justice.

--- Later in debate ---

[Lord Sandhurst (Con)]

That is what I am hoping. Thank you very much.

[Lord Weir of Ballyholme (DUP)]

I rise to speak to two amendments in my name in this group, Amendments 496A and 496F. At the outset, I want to give an apology to the sponsor and to the Committee as a whole, in line with the Chief Whip’s procedural recommendations. Given that I suspect that this will carry on at least until 6 pm, I will unfortunately have to leave almost certainly before the end of this debate to catch the last flight home to Northern Ireland.

Both these amendments, like a number of the amendments that I have submitted, deal with concerns that have been raised with me by disability groups. We are aware, again without reiterating the detail of this, that a wide range of concerns has been raised by a large number of groups representing the disabled, which vary between having some concerns and total opposition to the Bill. As we know, no disabled group has expressed support for the Bill. Where concerns are being raised, it is important and incumbent that, where we can try to improve the Bill by trying to take on those concerns, we listen to them.

I will deal with the two amendments briefly, Amendment 496A would add an additional ground to the grounds for reconsideration: failure to adequately consider or to be inconsistent with evidence of disability-related vulnerabilities. I suppose the aim of this is to provoke an examination of the extent to which reconsideration focuses on the particular needs of the disabled. It may not necessarily be the route that I would pursue on Report, but the purpose of this is to ensure that the commissioner, when looking at this, focuses explicitly on the impact on disability and vulnerability.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, the purpose of my amendments in this group is to ensure that all patients’ needs are taken into account and support is given so that people have a genuine choice. I am delighted that my noble friend Lady Campbell of Surbiton will speak to this group. Amendment 149 would ensure that the subject of assisted suicide is not raised within 48 hours of a terminal diagnosis. Perhaps this should be considered a cooling-off period. I have been with someone when they received a devastating diagnosis that they were dreading. They had not considered assisted suicide, but neither of us heard much after initially being told.

This is about a timing issue that could be seen to be a power imbalance or an implied endorsement. Options need to be very carefully discussed. If discussed straight away, treatments might seem so awful that assisted suicide is considered the best option. It might be quicker or easier to talk about this than a complex set of treatment options. To give patients choice, a multi-agency team assessment should take place to identify current support needs and ensure that steps are being taken to meet those needs.

This amendment would also offer some protection to doctors. If the conversation is discretionary, there may be a difficult legal dilemma: if it is raised at the initial consultation, it might be seen to be implicit coercion, but if doctors fail to raise it, that might be considered blocking access. There was a case in South Australia, mentioned in the Voluntary Assisted Dying (Voluntary Assisted Dying Board Annual Report 2022-23). Siblings said that, when they were with their relation, who was given VAD, it was the only time that doctors had shown empathy or understanding. The Medical Defence Union, which supports 200,000 healthcare professionals, is deeply concerned about the appropriate time to raise the subject.

This leads us into a grey area of suicide ideation. We fund suicide prevention; we do as much as we can to prevent someone dying by suicide. This Bill could lead to unforeseen consequences. As previously debated, it does not guarantee a quick or painless death, and if this process exists, the rate of suicide may even rise, as has happened in Australia in the over-65 age group.

There is also an assumption that if a terminal diagnosis is given, the process will be entered into, which might not be the case. ONS data from 2022 shows that people with terminal conditions can feel suicidal. One year after diagnosis for low-survival cancers or COPD, the suicide rate for patients was 2.4 times higher than the suicide rate for the matched controls. One year after diagnosis for chronic ischemic heart conditions, the suicide rate for patients was nearly two times higher than for the matched controls.

In oral evidence, Dr Price said that, of those who would qualify under the Bill,

“around 20% will have diagnosable depression, around 10% will have a wish to hasten death, and around 4% will have a more persistent wish to hasten death”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 270.]

She added:

“Those who had a wish to hasten death were 18 times more likely to also feel suicidal”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 276.]


The Royal College of Psychiatrists has raised issues, stating that doctors do not know how to assess the presence of depression. In a large-scale survey of professionals in England and Wales, co-authored by Professor Gareth Owen in 2021, only 6.9% of non-psychiatric doctors rated themselves as assessing capacity “very well”. When Fazilet Hadi from Disability Rights UK gave evidence, she said:

“We often find that doctors, because they cannot treat or cure us, do devalue our lives”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 29/1/25; col. 180.]


She was referring to disabled people.

The VAD review board of the Australian state of Victoria says that doctor initiation might be the reason for increased take-up. Previously, there was a prohibition on doctors raising it, but that gagging clause has now been removed. A JAMA Psychiatry paper from 2019 also highlighted the heightened risk during the first week after diagnosis. It said:

“Clinically, our results identify specific cancers associated with significantly elevated risk of suicide”.


The combined literature suggests that the first week after diagnosis has the highest risk for suicide, and it falls thereafter. It therefore makes sense that those who have received a shock terminal diagnosis are most vulnerable and suggestible and may have low self-worth. Macmillan Cancer Support recommends a holistic needs assessment as part of cancer care. The Bill will be better for having this assessment built in and will lead to more patient-centred care. It is impossible to have true agency when only one realistic choice is offered. That is why it is crucial that the patient’s current support needs are identified after diagnosis.

I strongly support Amendment 155 in the name of the noble Baroness, Lady Keeley. I feel very strongly that patients should be able to discuss their diagnosis and treatment with no fear of potentially being encouraged or having this process suggested to them.

On Amendment 176, we have covered complications before. The noble and learned Lord said in the Chamber that a discussion should take place before the first set of drugs are taken, and, if they do not work, the patient can choose to take a second dose of poison. But what is there to protect the doctor? Will the wishes be written down or witnessed? What should the doctors do if the drugs do not work? Should the doctor have a second dose with them? Will it be a doctor or, perhaps, a physician assistant? Is euthanasia the next step? It could be seen to be the next logical step in expansion. If one or two bad deaths are recorded, we might be told that we need to be more compassionate, and this is the best way to go.

In Hawaii, a doctor allegedly completed the death of a patient after the woman began choking; it was reported in the Honolulu Star-Advertiser. That doctor was charged with second-degree murder. Legally, a patient needs to know the effect of the drugs. Clause 12(2) refers to the need to discuss the complications, but we cannot play down the risks. Data from Oregon from between 2012 and 2022 showed a complication rate of 11%. In the Netherlands, in one-third of cases it takes up to 30 hours for a patient to die. As I have said before, assisted suicide is often represented as painless and quick, allowing for a calm and meaningful goodbye, but the reality from cases around the world shows that it can be far from this. The case of Kurt from Colorado has been raised previously by my noble friend Lady Finlay.

There has been much said in this Chamber about the importance of words, and I strongly believe that the word treatment does not cover what we are talking about. Using “treatment” to mean a lethal mixture of drugs intended to end life is clearly an attempt to soften the blow of reality. That is why people are not aware of the frequency of complications, and of the need to know the wishes of the patient in the event of complications.

My Amendment 200 is very similar to Amendment 149— it just seeks to amend a different part of the Bill. Briefly, I will talk to Amendment 200A and the unique context around the preliminary discussion, because failure to comply with regulations is appropriately treated as misconduct and subject to existing disciplinary procedures. I know that the noble and learned Lord is not keen to ask someone why they would want an assisted suicide, but I think the question should be asked. People do not need to answer, but we need to ask, to understand the process and look at whether there are other ways that we can improve our health service.

In Victoria, in 2023, the reasons for accessing VAD were not recorded, so the nature and source of the suffering—which is a clear criterion for access to VAD—is not known. This information could help us improve legislation in the future, or close gaps. The impact evaluation of VAD is undertaken by researchers funded by time-competitive grants, which means the results can be piecemeal and the data not always accurate. In 2023-24, 10 doctors with the highest VAD caseloads consulted on 55% of all VAD cases. In Australia, the VAD substance is often taken in the absence of a health professional, and there are no specific requirements or procedures for gathering or publishing information, including on whether complications have occurred.

Turning to my Amendments 207 and 207A, I have previously quoted Tommy Jessop and his concerns for people with Down syndrome. People with Down syndrome put great store in people in positions of trust around them, and the Learning From Lives and Deaths report that was published in January 2026 discussed some of the challenges. The proportion of deaths of people with learning disabilities classified as avoidable was 40.2% in 2023; it was 21.8% for the general population in 2022, so the figure is almost double. That demonstrates that there are problems in healthcare for people with learning disabilities. Some 72.7% of adults with learning disabilities who died in 2023 were reported to have received the reasonable adjustments they required when they accessed care, but conversely, 27.3% were reported to have needed at least one reasonable adjustment that they were not provided with.

There are already deficiencies in our system, and disabled people are discouraged by ableist attitudes in our culture. In 2024, Autism Alliance UK reported that 91% of autistic people feel that society does not accept them, or only sometimes accepts them. That is the reason why my amendments would widen the definition, so that we should be looking to support from a “guardian, or independent person”. Many families are loving and caring, but we have to recognise that some are not, and we should ensure that people have the right protection and support around them. I beg to move.

[Lord Weir of Ballyholme (DUP)]

My Lords, I will speak to my amendment in this group, Amendment 200B. It would insert a new clause to say that care professionals are not permitted to raise the subject of assistance. For the avoidance of doubt, the proposed new clause says that anyone who is engaged in patient care may not

“raise, suggest, encourage or initiate consideration of the subject of the provision of assistance under this Act”.

There are four main reasons why I have tabled this amendment. First, it would give clarity and absolute legal certainty to those in the medical profession and to care professionals regarding the initiation of discussion of the subject. We know that other parts of the Bill set out a clear position on what actions will be taken by medical professionals when it comes to the administration of the assisted death, but it is important that we have a clear legal position when it comes to the front end of the process. That is not simply to give assurance that there is clarity in the law; I think it would give comfort and certainty to anyone who is involved in the care profession. If I were a care professional, I would want to know with certainty what I am entitled to do and not entitled to do. My amendment would give a level of support to those people.

Secondly, the amendment is very much in the spirit of trying to create a distinction between healthcare and the provision of assisted death. A concern has been raised on a number of occasions in this Committee about the extent to which assisted death will alter the perception of the National Health Service and its mission statement. This amendment in and of itself would not solve all those problems, but at least it would go some way to having a level of protection for the National Health Service, which is very much the jewel in the crown of this society. It was created through probably the most significant legislation that a Labour Government ever put through, and it is important that we look at the implications of this.

Terminally Ill Adults (End of Life) Bill

Lord Weir of Ballyholme Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

I suggest to your Lordships that we should get on with deciding whether or not this Bill should be passed. As I have said, I am not in favour of this Bill, but let us get on with the parliamentary procedures that are placed upon us. If the Bill is passed, adjustments may have to be made to enable Wales to have the funding, which would be administered by the Government in Cardiff.

[Lord Weir of Ballyholme (DUP)]

My Lords, it is good to see the noble Baroness, Lady Prentis, back in her place, and I am sure the whole Committee welcomes her back.

Unlike the noble Lord, Lord Carlile, I cannot claim to have a background in representing Wales—the closest I have been is on a few childhood holidays—but I have experience in one of the three main devolved Parliaments in the United Kingdom. We have a unique constitutional settlement in the United Kingdom, part of which is the slight irregularity and rough edges so that in Northern Ireland, Scotland and Wales devolution does not happen in exactly the same format.

I find myself in complete agreement with the noble Baroness, Lady Smith, who made an excellent speech. I do not know whether she should be more worried that I agree with her or I should be more worried that I find myself in full agreement. The reality is that her speech clearly indicates that the amendments in this group, which are worthy of support, go to the heart of important issues relating to the constitutional settlement that we have in the United Kingdom. They are worthy of support, regardless of whether you are the strongest supporter of this Bill and the principle behind it or you are the most fervent opponent.

It is important that the will of the Parliaments of Northern Ireland, Scotland and Wales is fully respected. On occasion, there is a danger that the Parliament in Westminster shows a bit of a tin ear to the desires of the Parliaments in the devolved nations. As has been alluded to, we have at times seen—I will not go into the details—things imposed on Northern Ireland against the wishes of the Northern Ireland Assembly. Similarly, we need to be sensitive to the wishes of the Welsh Senedd. On the consent Motion, the Senedd was left in a virtually impossible situation. It is concerning that that has been misrepresented by some as the Welsh Senedd embracing a Bill on assisted dying. That has been the spin, but we know that the one vote that has taken place on the principle saw the Senedd say that it did not support legislation of this nature.

Clearly, there are health service implications of assisted dying. As such, we should respect the positions of the devolved Parliaments in Wales, Scotland and Northern Ireland. This week, Scotland has looked at its legislation, which I agree is not the same as the Bill before this Committee. We were told by supporters of the legislation in Scotland that it was “bulletproof”, but then we were told that it did not have the same level of safeguards. That slightly calls into question the oft-repeated phrase that this Bill is “the safest in the world”—those phrases seem very similar. It is important that we respect the wishes of the devolved institutions.

The noble Lord, Lord Pannick, is right on one particular point. On the very first day in Committee, a number of amendments touched on this area, particularly those tabled by the noble Baroness, Lady Coffey. One of the disappointments, which is symptomatic of the way that this Bill has been dealt with, is that concerns were raised on day one, yet they have not been properly addressed. It seems to me that, rather than Wales falling into line with what is brought forward in Westminster, we should be taking action that enables this place to retrofit whatever decisions are made in Wales for the Welsh people.

I conclude by slightly oddly agreeing with one point that was made in an intervention. One noble Lord said that, essentially, we have had enough talk about the lack of funding for palliative care. In one sense, he is right. It is important that we have less talk about funding palliative care and more action on funding palliative care.

[Lord Harper (Con)]

My Lords, I want to touch on a number of points. First, I join the noble Lord, Lord Pannick, in welcoming my noble and learned friend Lady Prentis back to these Benches. I do not think she will mind my saying that she has been following our debates assiduously from home—she cannot get enough of them. It is a delight to see her come back to hear them in person.

The noble Lord, Lord Pannick, put his finger on one of the issues by asking what reason there could be for us not legislating for Wales. Well, the rather obvious reason was set out clearly by the noble Baroness, Lady Smith of Llanfaes: the Welsh Senedd has debated the principle of assisted suicide and has decided that it does not want it to apply in Wales. I think we should respect that.

--- Later in debate ---

[Baroness Cass (CB)]

Not at all. When I first saw the term “independent advocates” in the Bill, I worried because, in my clinical career as a neurodisability consultant, I have had some very negative experiences of advocates who allegedly were speaking on behalf of people with a range of disabilities but who, we were fairly clear, were not accurately doing so. Some of their behaviours were, frankly, coercive. I know that my noble friend Lady Hollins will have similar experiences and stories to tell.

“Advocate” means different things to different people. Under the Mental Capacity Act, the role is to support people to have capacity, often in the context of the need to make decisions on life-saving treatments. That is clearly not what we are talking about here.

My amendment to Clause 22(4)(b)—which might now be academic, as the clause is to disappear—tries to frame it as people having difficulty accessing information about decisions they need to make for the purposes of requesting assistance and communicating relevant matters. It narrows it down to a communication problem, in the widest sense of the word.

I am slightly concerned that Amendment 548A, from the noble and learned Lord, Lord Falconer, includes “retaining that information” and

“using or weighing that information”

as part of the process. It is very hard, if someone is not retaining information, for anyone to help them to do so; people who are suffering from dementia or memory loss would otherwise be able to be facilitated to remember things, which they cannot possibly be. If somebody does not have capacity, it is hard to see how an independent advocate can facilitate them to have that. That is certainly not what we want them to do, so I am slightly concerned about that line in the new clause.

As for what that independent advocate should do, the noble and learned Lord, Lord Falconer, and I are on the same page, in that it should very much be about facilitating the effective participation of the qualifying person in relation to the provisions of the Act, where their communication needs would otherwise impede such participation. It is about acting to support communication—both understanding and communicating—but not deciding, representing or driving a particular view.

The noble Lord, Lord Sandhurst, who is not able to be here today, and I have put our names to an amendment that seeks that the independent advocate should not be a relative, carer or someone with professional responsibility, for obvious reasons, because, de facto, the individual should be independent and should have had training. Within that training, it is important that they are able to recognise coercion, domestic violence and many of the other issues that we have recurrently discussed in this Committee.

In summary, certainly, my amendments on the role of the independent advocate are subsumed in the new replacement for Clause 22. However, I still have some concerns about who qualifies.

[Lord Weir of Ballyholme (DUP)]

My Lords, I will speak to my Amendment 553B. It is one of a range of amendments I have tabled, which have been put into a number of groups, to try to deal with some of the concerns that have been raised by disabled people and to provide high levels of safeguards. The amendment overlaps with other amendments in this group, as a lot of us are coming from a similar position, irrespective of our broader attitudes towards the Bill as a whole. As such, I am not suggesting that my amendment would cover all aspects.

There is reference in this amendment to one area that we need to get our heads around: how the independent advocate is selected and from where they can be drawn. In the interest of time, I will restrict my remarks purely to my amendment and let others make the case for theirs. My amendment would ensure that there is the availability of an independent disability advocate with “appropriate expertise”—that is as close as I was able to get to defining this—which must be provided by the commissioner for any disabled person within the definition of Section 6 of the Equality Act 2010.

[Lord Falconer of Thoroton (Lab)]

Could the noble Lord indicate which amendment he is talking to?

[Lord Weir of Ballyholme (DUP)]

It is Amendment 553B.

As part of that, the commissioner should offer a reasonable opportunity for the person to consult the advocate before a decision is made. Flowing from that, there would then be recorded written reasons for whether that meeting has taken place, whether the offer has been taken up and, arising from that, whether any concerns have arisen from that contact.

The point is that those who qualify for this advocate should be disabled, and it should not be a question of a commissioner simply picking and choosing who they feel falls into that category. Even advocates of the Bill would say that this is based upon the idea of autonomy, and autonomy is very much at the heart of this amendment. There must be the opportunity for a disabled person to say that they want to meet or have an advocate. It is a matter of choice for them. Therefore, it would not be forced upon anyone, but the availability of it would be guaranteed.

This is important, because we know that an independent advocate can do a number of things. Mention has been made already of the dangers for people with communication difficulties. If we are dealing with a sensitive subject, getting the communication wrong can be critical. For many disabled people, there can be issues around misunderstanding. It is important that we have a situation in which people realise that there are other options, and to have that independent advocate is critical. It can provide a safeguard, because those discussions can be, to a degree, a fail-safe to try to detect whether any level of coercion has taken place. That is explicitly mentioned in the amendment.

This is a position endorsed by the UN Committee on the Rights of Persons with Disabilities. The committee has spoken of the fact that, in navigating a high-stakes situation for a disabled person—deciding whether or not a life should end is about as high-stakes as you can get—where there are complex legal and medical processes, no matter how much there are attempts to try to insulate those, if there is the denial of support to that person then that can lead to a form of discrimination against them and leave them vulnerable. Similarly, the Equality and Human Rights Commission has indicated that, for disabled people, where there is an opportunity for that additional level of support, it can be deeply empowering to the individual.

The case for an independent advocate is one which I hope the Committee will endorse strongly, because it is a very major concern of disabled groups. Demos has done a number of focus groups among disabled people. One of the concerns that keeps coming back is a worry not simply about coercion itself but that family or the medical experts dealing with this will put forward assisted death as simply being the sensible option and so will be advocating for that. To have someone who is completely independent, and who does not have any particular views or an axe to grind, but who is there to simply talk through the issues with the disabled person, is critical.

In conclusion, this is part of a wider concern. This amendment has been drafted by disabled people. One of the issues, and a frustration among many disabled people out there, is that this Bill is being done to them, not with them. As such, while we in this Committee try to channel those voices, there is at times a danger that we take away those voices. It is important with this amendment, and many other amendments that are motivated by disabled groups and disabled people themselves, that we do not turn a deaf ear to their concerns. We should listen to the concerns that are there and act on that basis.

[Baroness O’Loan (CB)]

I have put my name to Amendments 300, 538 to 540, 541 to 543 and 544B in this group because of the importance of independent advocates and the definition of who they may—or should—be made available to. As has already been alluded to, the fact that the Bill provides for somebody with a disability is compounded by the fact that people with a learning disability in particular can want to please those whom they perceive to be in authority over or looking after them. They can think that people will act in their best interests, and they will very often comply with what is proposed to them. That is one of the things that make this issue profoundly important. What is so lacking in Clause 22 is the specificity that would enable one to articulate what an independent advocate is. In a minute, I will come to the amendments proposing a new Clause 22.

Amendment 300, tabled by the noble Baroness, Lady Grey-Thompson, proposes a new clause requiring the appointment of special independent advocates for disabled people as defined by the Equality Act. That is a wider definition of those for whom independent advocates should be provided. However, it recognises that, in those moments of considering a choice between life and death, a person needs to be cared for, so that the stresses that they will inevitably experience do not prevent them making an informed decision under the Bill. It is very important for such advocates to be trained specifically in disability rights and the identification of coercion. Amendment 300 is specific in identifying the range of support and advice that must be made available. Amendment 539 similarly requires specific communication training, which is essential for someone to act for a person with a profound disability, as we heard in an earlier group today.

Amendment 541 in the name of the noble Lord, Lord Sandhurst, specifies conflicts of interest that would preclude someone from acting as an independent advocate, and I agree that it is important that these be spelled out in the Bill.

Amendment 542 states what the independent advocate cannot do. In particular, they should not be there to support a person to have capacity to end their own life; nor should they advocate for someone, as under the MCA arrangements. Rather, they should ensure that the person seeking to end their own life understands what is being offered to them and understands the consequences of complying with the suggestions, thereby enabling them to respond to the options made available to them.

Amendment 548 seeks to amend Clause 22(4)(b) by making more specific the difficulties that may be faced by a qualifying person.

In responding to the DPRRC report, the noble and learned Lord, Lord Falconer, has tabled the amendments to which he has already spoken. However, I have concerns. The changes proposed by the noble and learned Lord no longer provide an obligation on persons performing functions under the Act to ensure the presence of an independent advocate for a qualifying person. Subsection (9) of the proposed new clause in Amendment 548A says that someone

“‘has’ an independent advocate if an independent advocate is instructed to represent and support them”—

it is not that they need to be present or involved; they merely have to be instructed.

At this point, it is important to remember why the independent advocate is there in the first place: to provide support to someone who has difficulty understanding and who may very quickly forget, after the conversation, anything that has been said to them. That is why the independent advocate must be present. Can the noble and learned Lord tell us why he removed that requirement? Does he think that an independent advocate could support someone if they are not present for the discussions and consultations?

More chillingly, subsection (3)(c) of the proposed new clause in Amendment 548A says that a “preliminary discussion” can proceed even where

“the person seeking assistance informs the relevant person that they are content for the preliminary discussion to be conducted without them having an independent advocate”.

It is not difficult to imagine a situation in which a registered medical practitioner asks, “Are you happy to go ahead without an independent advocate?”, and the qualifying person, possibly wanting not to annoy or even to please, says yes—and so the preliminary discussion goes ahead.

Subsection (3)(b) of the proposed new clause provides that the disabled person can say that they do not want an advocate, but how can we be sure that the person understands what an independent advocate is—we are having quite a discussion ourselves this afternoon about that—and what they might bring to them? Is it possible that a tendency towards needing privacy, and perhaps a tendency to not engage with strangers, might lead someone in this situation to decline an independent advocate without really knowing what they are doing? It would be helpful if the noble and learned Lord could explain how he intends to prevent this happening or to safeguard the person.

It would, of course, save quite a lot of money if the IA were declined. The noble Baroness, Lady Grey-Thompson, has referred to the £2,333 per case. I have a notion that it might be more, because some of these assisted dying cases are going to take quite a long time as they go through all the processes, particularly the process in the house, the hospital or wherever it is that the lethal drugs are to be administered. Assisted dying could take some time. If a disabled person says they do not want an independent advocate, things could move more quickly. There is significant risk here and the noble and learned Lord needs to help us understand the safeguards.

Subsection (8) of the proposed new clause provides a really important definition of an independent advocate, by saying that it is someone who represents and supports a qualifying person

“in connection with … anything done under this Act, by or in relation to the qualifying person”.

My questions for the noble and learned Lord are: what support is envisaged here and what is meant by that phrase? What support is the independent advocate going to provide when the doctor is providing the lethal drug under Clause 25(8)(b)? Is it assisting the person to ingest or otherwise self-administer the lethal drug? What is “support” in this context and that place? Is it possible that the person seeking to die might expect their independent advocate to hold the cup for them or press the syringe with them? Is the clause clear that support cannot include any active role? That would be vital.

Surely this could open the door to an interpretation by those who perhaps have malign intent—I am thinking about coercion here—that the independent advocate can do more than listen, explain and communicate. I wonder what is meant by Clause 25(8)(b) in any event. How far can the doctor go in helping the

“person to ingest or otherwise self-administer”

a lethal drug? We will get to that later, but what does it actually mean?

There is a massive difference between helping with communication and support and being present when someone takes lethal drugs to end their own life, or is assisted to do so by a doctor, and supporting that process. Amendment 549A does not add the kind of clarity required, but it does allow the independent advocate to access the person’s medical records or require information from those records. That seems to suggest that this independent advocate would require some kind of medical expertise, which has not been previously suggested. I do not know what the actual purpose of subsection (3)(d) of the proposed new clause in Amendment 549A is. It would be helpful if the noble and learned Lord could explain it to me.

There is a massive danger inherent in the terribly loose drafting of both Clause 22 and the noble and learned Lord’s proposed new clause in Amendment 548A, and some of the additional material contained in Amendment 549A. Can the noble and learned Lord explain why he has drafted an amended clause which seems even more deficient than the original Clause 22? Needless to say, I also support Amendment 549C, in the name of the noble Baroness, Lady Coffey, which would apply if Amendment 549A were passed.