Terminally Ill Adults (End of Life) Bill

Baroness Berger Excerpts

Friday 27th February 2026 Lords Chamber

[Baroness Lawlor (Con)]

We are proposing and debating a piece of legislation at this moment. We are concerned about the safeguards in the current proposed piece of legislation. The noble Baroness, Lady Gray of Tottenham, has proposed that the reviewing panel must raise with the person considering assisted suicide whether they have discussed it with their nearest and dearest. That is a different matter from what the noble and learned Lord has raised. We are discussing a piece of proposed legislation and I am discussing an amendment proposed by another noble Lord.

It is very important for those on whom we have depended and may still depend that we form a society and, as human beings, give support and love to one another—a mother or father who wishes only to support their child, perhaps terminally ill, to live their life as best they can; a daughter, son or sibling supporting their loved parents, sister or brother; or a spouse or best friend.

I do not agree with the premise of the Bill that we are autonomous human beings to dispose of ourselves just as we wish. Whatever freedom we have as human beings is rooted in a network of social relations and responsibilities, especially to our kith and kin. We therefore need to do whatever is possible to ensure that a person’s ultimate decision to end their own life is taken within a familial and social context. This amendment, which I support, promotes that end.

[Baroness Berger (Lab)]

My Lords, I will speak to my Amendments 466, 471 and 474, as well as to Amendments 472 and 485 in the name of my noble friend Lady Gray of Tottenham; I will make different points on those. These are all forms of amendments that were tabled but not debated in the other place. They all seek to strengthen the effectiveness of the voluntary assisted dying panels as a safeguard, because that is what we have been told they have been put forward to provide.

My first two amendments would mean that questioning both the co-ordinating or independent doctor and the person seeking an assisted death is mandatory and not at the panel’s discretion. It is extraordinary that, in light of all the evidence that we heard across the 13 panel sessions of the Select Committee, the Bill currently does not ensure that the panel asks questions of every person seeking an assisted death.

Noble Lords will be aware that, as we have heard, the panels were added to the Bill in the other place two-thirds of the way through Committee in order to replace the High Court, which we were originally told was part of a judge-led process. The panel process has never been piloted or consulted on, and it appears to have been based on the Spanish system—a system of guarantee and evaluation commissions—but of course the Spanish law is very different from the Bill that we are scrutinising, which we have been assured is narrower and safer. The Spanish system, which allows for both assisted dying and euthanasia, does not require a terminal illness from which a person is likely to die within six months, as the Bill that we are scrutinising does; it requires only—in translation—a serious and incurable illness or a serious chronic and impossible condition. The Spanish legislation provides for considerably wider categories. I am sure that those of us concerned about vulnerable people being made to feel that they are a burden are very glad that the sponsor has not proposed them here.

The requirement for a terminal illness with a six-month diagnosis is a meaningful safeguard only if it is properly tested. How can it be said that a panel has done its job if it has not asked a single question of the doctors? How can it establish that the person has not been pressured or coerced just by passively hearing their prepared statement, which may have been drafted under the eye of their abuser? In what way is any of this a suitable alternative for the rigour set out in the first iteration of the Bill, which included the High Court? That is why I believe that these amendments are necessary.

This concern was expressed very well to the Lords Select Committee by Dr Luke Geoghegan, who represents the British Association of Social Workers. He set out the following about how safeguarding usually works in this country and how it differs from the approach of the panels that is currently set out in the Bill:

“An allegation is made or a concern is raised and that concern is investigated, and then that allegation or concern is either upheld or it is not. The challenge for the panel”—


the voluntary assisted death panel—

“is that here this model is flipped. Can we be sure that this person is not affected by safeguarding or coercion issues? It is often impossible to prove a negative, but we can make reasonable assessments on the balance of probabilities”.

The real issue here is that the panel system means there is no other side seeking to show that the test for eligibility has not been met, and there is no cross-examining of the witnesses who say that it has. In the absence of such a legal process—usually the hallmark of our British system—having the panel at least ask some questions of every applicant for an assisted death is surely the absolute minimum that must happen if we are to have confidence in it as a safeguard.

Amendment 474 would make a more discretionary change. It would add a requirement to “consider hearing from” a person’s family and other treatment and care providers. I reiterate that, in the amendment as set out, it is not mandatory. In advance of explaining the amendment, I will provide a counterview to some of the things that we have heard so far. We have heard the discussion about family members in the context of agency. I will talk about it in the context of the variety of autonomy and the context of establishing coercion.

Family members and those who have provided care for the person are likely to be privy to information that has a significant bearing on the panel’s deliberations and decision. Perhaps a son or daughter knows that someone new has recently entered the life of their vulnerable parent, has slowly taken control of their finances and has encouraged them to cut contact with others.

I set out this point reminded by the evidence that we heard from Age UK and the existence of different types of abuse, but particularly romance fraud. In the Select Committee, we heard that Age UK had been contacted

“by families who say, ‘Hang on, I’m really worried that there is this person in my mother’s or father’s life and I’m not sure what their intentions are’”.

The evidence talked about

“the moral hazard for people who stand to gain from older people after their death”.

An example of this could be a carer who knows that the person has struggled with suicidal feelings long before their illness worsened or knows the reason behind the source of their despair. Perhaps, while quietly attending to the needs of the patients they are responsible for, a carer has overheard a friend or family member suggest to the patient that it really would be easier all round if they were to end things sooner rather than later with the help of trusted professionals. I know that we would like to think that this does not happen, but I have spoken already in this Chamber about the first-hand experience of hearing how that is unfortunately the case in some instances.

I am aware that there is a power in the Bill to hear from “any other person”, but this is left so open as to add little in the way of assistance or direction to the panel. My amendment, therefore, responds to the evidence we heard from the professional bodies and provides an explicit steer while still allowing for the panel to conclude that additional evidence is not likely to be helpful or that the process of seeking it would be too onerous.

I also support Amendments 472 and 485 in the name of my noble friend Lady Gray, who unfortunately is unable to attend today. Amendment 472 would require the panel to ask the person whether they have discussed their requests for an assisted death with their closest relatives and to discuss the reasons if they have not. Amendment 485 would provide that this requirement would not apply in the exceptional circumstances where a panel chooses not to hear from the person. These amendments, like mine, seek to highlight the vital insight that family members may have into the person’s wishes or eligibility. If the panel is able to place the person’s request for an assisted death in the context of their relationships, they are more likely to be able both to understand an undeclared motivation behind the request and to detect any coercion or undue influence.

As the Bill has progressed, it has frequently been noted that doctors rarely make serious decisions on their own. The sponsor, my noble and learned friend Lord Falconer, has acknowledged this, which is why the panel itself is so often referred to as multidisciplinary. Here, I note the expertise of the noble Baronesses, Lady Finlay and Lady Cass, and others, who have rightly pointed out that the medical assessments themselves should also be multidisciplinary. However, it is also true, as we heard at the Lord’s Select Committee, that patients rarely make decisions on their own. We heard from the Royal College of Psychiatrists that there is very pure personal autonomy, where somebody makes a decision uninfluenced by anybody else, but that does not reflect the way that people usually make decisions, which is as part of their relationships with others, and that is very normal.

Professor Charles Foster told us that, in the real world,

“decisions about how we exercise our autonomy are made in the context of our relationality”.

We discuss with our relatives what should happen. If someone chooses not to tell their immediate relatives or loved ones about such a momentous decision as ending their life prematurely, that is noteworthy. There may be good reasons for it, as set out by my noble friend Lady Hayter, but that should be for the panel to establish. These amendments do not offend against autonomy and they would not oblige a person to tell their family or friends anything, but they would enhance the information available to the panel and move it further towards being an effective safeguard against coercion and undue influence or an otherwise unwanted assisted death.

A secondary point to these amendments is to make it at least a little less likely that families will have to go through the trauma of finding out about the death after it has happened. Our Select Committee was told by the Royal College of Pathologists that in cases where death is unexpected, families often find out about the death of a loved one when they receive a call from the medical examiner. If passed, the Bill is likely to increase the number of cases where that happens and will put a great strain not only on families themselves but on the professionals who find themselves in that position. I am conscious of time, but it is worth reflecting on, and I ask noble Lords to look at the comments from the Royal College of Pathologists, as that was explained to us.

Amendments 472 and 485 seek to minimise these impacts as far as possible. They would not create an obligation on the person to involve their next of kin, but they might encourage them to have that conversation if they feel able to do so. Ultimately, the more information that is available to the panel about a patient’s circumstances and relationships, the more confident we can be in the panel’s decisions and the regime it would create.