Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Harper (Con)]

My Lords, it is a great pleasure to follow the noble Baroness. At the end of her speech, it was very clear that she should have had no concerns about the contribution she would make to the debate—it was a very powerful speech.

We are all the product of our experiences. One of the most profound and shaping that I had in public life was being shadow Minister and then Minister for disabled people. The reason for that was the opportunity I had over the four years or so in those two roles to meet people of all ages who had thrown in front of them, sometimes over the whole of their life and sometimes as a result of circumstances, challenges and difficulties that they faced doing the things that we all take for granted: living an independent life, working, bringing up a family, contributing to society and making the best of what they had in front of them. Many of those people are profoundly concerned by what the Bill will do to society’s view of people who have challenges thrown in front of them.

I know that is not the intention of the promoters of the Bill, but it does say something fundamental about society’s view of life, particularly life lived by people who have profound challenges. That is why the Bill is not supported by a single organisation in this country that represents disabled people—not a single one—and we should listen to their views and take them very seriously.

The second very powerful argument we have heard in this debate, referred to by the noble Baroness, Lady Fox of Buckley, is the one about choice and autonomy. The reason why that argument fails in this case is that you are taking a decision that impacts only upon yourself and has no consequences for others. The problem is that in delivering rights and choices for those who will be the beneficiaries—if that is the right word—of the Bill, you are effectively taking away choices and opportunities from others. There are competing rights, and when we have competing rights, we always have the most difficult decisions to make, and they are always the most charged political conversations we have.

The second reason why that argument fails is that, for choice to mean anything, it has to be a meaningful choice, and we do not have that in this country. We have some excellent palliative care, but it is not universally available to everybody; and in the Government’s 10-year plan for the NHS, there is no plan and no ambition to make it so, not even at the end of that 10-year period. I am afraid that a choice for assisted suicide without access to good quality palliative care is no choice at all.

My final point is about being clear about what we are doing here. As the noble Baroness, Lady Fox, said, and my noble friend Lady May of Maidenhead said last week, this is about assisted suicide. We are amending the Suicide Act to provide a defence for people taking their life. If the promoters of the Bill and those who support it find plain and clear language uncomfortable, rather than attacking those that use that plain and clear language, as they have done with my noble friend Lady May, they should perhaps reflect upon what it is they wish to do.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

As the Delegated Powers Committee has pointed out, there are already extensive Henry VIII powers in the Bill, and it should be an easy matter to draft a new clause that removes all references to Wales in the Bill but grants a power to the Senedd to do its own Bill. Wales wants control of its own death regime and cannot do it since the Bill is nonsensically regarded as a criminal law Bill in Wales. We have the power to give the Senedd the power it needs to determine its own laws on this matter.

[Lord Harper (Con)]

My Lords, I support my noble friend Lady Coffey’s amendments. I will raise two issues, one on the principle of how we are dealing with devolution. I also want to bring to the Committee what I hope is some valuable experience from my time in the House of Commons about the detail of how these services are delivered on the ground, particularly for people who live close to the border. Given that these are life and death issues, the detail of how these services are delivered is very important.

One lesson from the way in which the 1999 devolution settlement was delivered was that there was literally no thinking done about some of the complexity of the cross-border issues. It took the best part of a decade of hard campaigning work to get this right. In the interim, many of my former constituents sadly did not get the life-saving medical treatment that they deserved as residents in England. This is incredibly important. It is an issue that I suspect will be known only by those of us who have had some responsibility for this. I am sure the Minister will be well aware of it and, if she is not, she will be able to ask her officials to dig out all the background and history for the cross-border delivery of healthcare and the protocols that are now in place, because they will be very relevant to how these services are delivered.

In the first part of my remarks, I will touch particularly on the aspect that my noble friend Lord Blencathra raised. This is partly about my fundamental view that I do not think that delivering this legislative outcome through a Private Member’s Bill is very satisfactory. This issue is one of the reasons why. We have a very uncomfortable situation in which we accept that this is devolved in Scotland—and the Scottish Parliament is busy legislating to deliver assisted suicide in Scotland according to how it wants to deliver it.

I personally do not believe that assisted suicide is a healthcare intervention, actually, but it is clear from what Health Ministers have said that they think this will be delivered by the National Health Service. If it is to be delivered by the National Health Service, you would logically expect it to be done, as my noble friend said, in accordance with the devolution framework. But because what is actually happening here is the amendment of the Suicide Act to put in place the ability for people to help someone take their own life and not be caught by the Suicide Act, that effectively makes it a criminal justice matter. That is not devolved, which is why we are having to legislate for England and Wales. I do not think that makes any sense.

It would have been much better if the UK Government had had some sensible conversations at the beginning of this process with the Welsh Government and come to an agreement about how this was going to be dealt with, either—as my noble friend said—by devolving the power to the criminal law in Wales and allowing a fully devolved solution, or by the Welsh Government and Senedd agreeing that we could legislate at Westminster for both the principle and the operational delivery mechanisms on an agreed basis. We have ended up with a very uncomfortable halfway house, which I do not think will be at all satisfactory, where we will be making decisions here for a service being delivered in Wales, not doing it in line with the wishes of those elected by the people of Wales. We are not really having that proper, sensible conversation.

I turn now to the operational issues. I have looked at the Bill, and because it says almost nothing about how this will be delivered in practice, I will flag up a couple of issues. The Bill applies to people ordinarily resident in England and Wales and registered with a GP practice. For those who do not know, my former constituency is the Forest of Dean. One of the complexities if you live in the Forest of Dean is that there are parts of it where you live in England, so will be covered by the law and the NHS in England, but you will be registered with a GP practice either physically located in Wales and governed by Welsh laws or physically in England but part of a wider practice in Wales. That matters because you will get your primary care delivered according to the rules of that practice. Some of my former constituents have primary care delivered according to Welsh rules, even though they are resident in England. People will be familiar with the fact that there are differences there—about whether you pay for prescriptions, for example.

The really important issue, on which the Bill is silent, is that when you receive secondary care—when you are referred to hospital for treatment—it was the case before we put in place the protocols that now exist that my former constituents in England, entitled according to the law to get services in England, were being referred to secondary care in Wales. There, waiting lists were longer and there were not the same provisions about choice. Therefore, those residents of England were not getting the services to which they are entitled. The Bill does not distinguish between whether you are resident in England or Wales.

The concern is that if the health service in England delivers the service in a particular way but Welsh Ministers decide to deliver the service in a different way, with different checks and balances and different professionals delivering that service, it is not clear in the Bill whether someone who lives in England but is registered with a GP practice in Wales would be entitled to the English or the Welsh provisions. Given that this is about life and death situations, that matters. I, for one, am not content to leave it to secondary legislation. The Bill should spell out the rights you have as a resident of England to the services you get, and if you live in Wales the rights should be according to the provisions of the Senedd.

I see Ministers chatting to each other. This matters. If this is not got right, there will be people in England facing life or death situations who do not get the health professionals involved in this. There will be people potentially coming under the ambit of the Bill who get social care. Social care is devolved, so the level you get, the rules about it and the entitlements to it are different in England and Wales. There has been a lot of talk about the necessary provision of psychiatric services. The provision of secondary care—psychiatrists, for example—is devolved, so it will not be the same in England and Wales. Getting this right matters.

The legislation says nothing about delivering services accurately to people based on their residence. At the moment, we have lumped together whether someone is ordinarily resident in England and in Wales; I do not think that that is satisfactory. You should get the services in England that this House and the other place decide are appropriate, and English Ministers—namely, Ministers in the UK Government responsible for the health services in England—decide that. If you live in Wales, you should get the services that Health Ministers in Wales decide you get. We need to make that very clear in the legislation.

My noble friend’s amendments raise some important issues that go to the heart of the legislation. They have not been thought through by the promoter and sponsor of the Bill. Having raised them today, I hope that Ministers will start thinking about them and will come back to the House with amendments themselves. Otherwise, I will put down amendments—and I suspect other noble Lords will, too—to correct this on Report. It is a massive gap, and it will be an issue for residents in England and Wales, particularly those close to the border, who make up one-quarter of the Welsh population. It will be raised by Members of Parliament up and down the border. My experience as a former Member of Parliament is that it is better to get these things right—

[A noble Baroness]

You have made your point.

[Lord Harper (Con)]

I am going to finish very quickly if you do not interrupt me. The time limit is very clear, and I am going to stick to it, but I am finishing my point. I was coming to the end of my point, and that was not necessary. The Government Chief Whip made it clear that these are incredibly important issues, and we will debate them with courtesy and respect. I will treat people whom I do not agree with on this issue with courtesy and respect. As I have not exceeded the time limit, I do not expect to be yelled at. Let me just finish my point and then I will sit down.

My experience—I am going to go over the time limit only because I was interrupted—as a former constituency MP is that it is better to get these things right in advance, when you draft the legislation, and not spend years trying to fix them afterwards.

[Lord Markham (Con)]

My Lords, I am not an expert on delegated powers, so I must admit to a bit of confusion. I hope that either the Minister or the Bill’s sponsor, the noble and learned Lord, Lord Falconer—or maybe both—can help clear this up.

My understanding of what the Bill is trying to do is to enable the Welsh Senedd to make a choice. If the amendments were to go through as drafted, they would deny that choice, because they would rule out people living in Wales from being able to choose whether they have assisted dying, whereas what I think the Bill is trying to do—I hope that can be clarified in the response—is state that the legislation will enable the Welsh Senedd to decide whether and how it wants to implement the Bill. When the Senedd does that, it can take into account the points that the noble Lord, Lord Harper, made about how the two services could sit alongside each other.

If we were to pass this amendment, we would deny the people of Wales that choice. That cuts right across the principles that the noble Lord, Lord Weir, set out when he said that the decision should be taken in Wales. The amendment would mean that the decision was taken here, which would deny the people of Wales that choice.

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[Lord Harper (Con)]

The Minister has said very carefully today and in answer to some Written Questions that there are officials, rightly, working on the legislative drafting of this Bill to make sure that it is workable. It is completely proper for Ministers and officials to be doing that. I want to probe the Minister on a point raised by the noble Baroness, Lady Grey-Thompson. Does she have officials, in her department or elsewhere, who have gone further than that and who are working on implementing the legislation if it were to pass both Houses of Parliament?

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[Lord Falconer of Thoroton (Lab)]

My Lords, I make a declaration of interest: I have an assistant who is funded by Mr Bernard Lewis and who helps me on this Bill. I make a declaration that Dignity in Dying paid for the printing of the material that was circulated to Peers in my name before this process commenced.

I compliment the noble Baroness, Lady Coffey, on the short way that she introduced the important issue. I very much hope that I can put to rest most of the misconceptions that were expressed during this debate.

As everybody agrees, criminal law is not devolved to the Welsh Senedd. Therefore, any change in criminal law has to come from the UK Parliament. You cannot proceed with assisted dying without changing the criminal law. Therefore, the UK Parliament has to provide a legislative change for that.

Healthcare is rightly devolved to the Welsh Ministers and the Senedd. The Bill makes provision in England for Ministers to produce regulations on how assisted dying will be implemented and regulated in England. Clause 42 requires Ministers to produce such regulations. It is wrong, as part of the devolution settlement, to require Welsh Ministers who are responsible for health in Wales to do that. It is for the Welsh Government to decide what provision to make. Unlike Clause 41, which relates to England, Welsh Ministers are given the option to introduce such regulations as they see fit. Those regulations will permit the assisted dying process to be introduced in Wales, in the National Health Service, and for Welsh Ministers and the Welsh Government to provide whatever provision for it in regulations that they see fit.

The noble Lord, Lord Wolfson, asked why we are legislating for England and Wales but not Scotland at the same time. It is because we are doing exactly what the noble Lord, Lord Gove, asked me to do—and I am so glad he did—which is to respect the devolution settlement. Will the noble Lord let me finish? Then I will come back to him.

The way this structure works is that, first, we in this Parliament determine whether the criminal law should be changed. Secondly, the Welsh Government are given the power to introduce regulations. That power should normally be given to Welsh Ministers by an Act of the Senedd. Therefore, a legislative consent Motion has been proffered by the Welsh Government for the Senedd to decide whether it would be willing to give us consent to legislate in an area that would normally be legislated for in the Senedd.

The LCM—legislative consent Motion—in the Welsh Senedd covers the following. I give these details for noble Lords to consider them at their leisure: Clause 40, which gives Welsh Ministers power to issue guidance; Clause 42, which gives Welsh Ministers power to regulate how this is to be introduced in the health service in Wales and with what regulations; Clause 51, which gives the Welsh Government power to talk about and make regulations about the Welsh language; Clause 54, which gives them a general power to make regulations; and Clause 58, which gives the Welsh Ministers and the Welsh Government power to introduce certain of the provisions.

The sponsor in the other place and I have discussed this arrangement with the Welsh Government, and by that I mean Welsh Ministers and Welsh officials. We have done what the Welsh Government would wish us to do to respect devolution. We have taken these powers in the Bill, subject to Parliament, so that there is not a position where, after this Bill is passed, Welsh Ministers lack the power to introduce regulations if they choose to do so.

I have listened to this torrent of points about Wales saying it has not been thought out. I say with suitable humility that we have thought it out and sought to reflect what good devolution practice would require. I do not invite people to come back, but please think about what I have said and consider—

[Lord Harper (Con)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

Hold on. Consider whether it represents the right position.

Can I just deal with two other points? First, the noble Baroness, Lady Smith, in a very clear speech, said maybe one should amend the Bill to give the Welsh Senedd the power to make a decision about the criminal law in relation to assisted dying. It was a point I thought the noble and learned Lord, Lord Thomas of Cwmgiedd, was sort of flirting with. We have not taken that view. We have taken the view that the right way to deal with this is in accordance with the existing devolution settlement.

If the noble Lord, Lord Gove, has not been satisfied with my answer so far, he may continue with his question.

[Lord Falconer of Thoroton (Lab)]

In relation to the noble Lord’s first point, the Legislation, Justice and Constitution Committee’s point about the width of the legislative consent Motion is that it wants the LCM to extend not just to the health provisions but also to those that relate to the change in the criminal law and the safeguards. It argues that those changes in the criminal law should also be subject to it. My view—and it is a view I think shared by the Welsh Government—is that, no, you do not need a legislative consent Motion for the UK Parliament to do that which it is entitled to do, which is to change the criminal law. I give way to the noble Lord, Lord Harper.

[Lord Harper (Con)]

I am very grateful—

[Lord Falconer of Thoroton (Lab)]

Sorry, the noble Lord, Lord Gove, asked a second question which I did not answer.

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[Lord Harper (Con)]

I am grateful to the noble and learned Lord. I have listened very carefully to what he said, and I absolutely accept that he has conducted extensive engagement with Welsh Ministers based, perfectly understandably, on the framework of the Bill as he and the sponsor in the Commons have drafted it.

The noble and learned Lord will know that one of the concerns of many in your Lordships’ House is the extent of Ministers’ powers and the extent to which some of the regulations should be put in the legislation. I am sure, as Committee progresses, we will have those debates. If it ends up being the wish of this Parliament that more of the detail about how the legislation will be implemented is put in primary legislation, how will we do that in a way that satisfies the desires perhaps of this Parliament but does not trespass, given the way he has chosen to set out the framework, over the devolution framework? Therefore, did he consider just devolving the power to the Welsh Senedd to change the criminal law in this narrow case? Then the Senedd, as the noble Baroness said, would have the full power to change the law and implement it. I accept that what he has done makes sense in the way he has drafted the Bill, but if we significantly change the Bill, I think that will cause a real problem with how it is implemented.

[Lord Falconer of Thoroton (Lab)]

I am not sure I understood the question. As far as devolution is concerned, I do not think the question of regulations on the face of the Bill is the right issue. The right issue is who has power to produce those regulations and does that offend against the devolution settlement. If he has a question about there being not enough detail in relation to other areas, I am happy to answer that, but this is not for this group. Those are my submissions.

[Lord Harper (Con)]

Let me ask him the question.

[Noble Lords]

No!

[Noble Lords]

Yes!

[Lord Harper (Con)]

He said he did not really understand my question. If we set out in the Bill some of the details he currently envisages are in regulations and therefore the House decides on them as opposed to them being for Ministers in either the UK Government or the Welsh Government, that will cause a problem for the approach to devolution that he has conducted. I just wondered whether he had thought about that. That was my question, and I am sorry for not expressing it clearly.

[Lord Falconer of Thoroton (Lab)]

I am not sure the noble Lord has quite understood what I have said. It is for the regulations in so far as they deal with the Welsh health service to be delivered by Welsh Ministers, so it is quite inappropriate for us to put them in this Bill.

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[Lord Rook (Lab)]

My Lords, I will keep this brief. I was not going to share this at this point because it is quite personal and because it takes a lot for me to counter the noble Baroness, Lady Andrews, for whom I have huge respect. She was the first person to invite me to the House of Lords for tea, many years ago. I do not doubt that the Mental Capacity Act has been a huge advance in how we deal with these issues.

I accept that the noble and learned Baroness, Lady Butler-Sloss, is probably one of the few people in this place to make judgments in the courts and the Court of Appeal on mental capacity. I suspect that more of us have had to go through the process of helping a loved one through a mental capacity assessment, although I suspect that number is also still low. My father has dementia. I have had to support him through a mental capacity assessment. No matter how clear the Act or various legislations or definitions may be on paper, it is extremely difficult at times to take someone through that process. All he had to do was prove that he had capacity to instruct a solicitor, a decision far less serious and far less terminal than the one we are discussing today.

If you assessed my father’s capacity, you would find—on the comments made by the noble Baroness, Lady Hollins, about literacy and numeracy—that my father has near-perfect literacy and numeracy. We have had comments about executive function. You would find that he has near-perfect capacity for executive function to make important decisions. You would also find that he has virtually no short-term memory. He is more than capable of making a decision, but that decision is gone in 30 seconds—sometimes sooner. If you apply that to this situation, he would be able to make a decision but would not know about it at the point that decision was acted upon.

Returning to the comment from the noble and learned Baroness, Lady Butler-Sloss, about whether it is capacity or ability, I pick up on the comments from the other side of the Committee recently. There is not enough, in the way we judge capacity at the moment, to make this practicable and desirable. We certainly need more. I am not sure whether it is “ability”, but what we have at the moment is not enough to deal with this in practice.

[Lord Harper (Con)]

My Lords, I have listened carefully to the debate. The noble Baroness, Lady Finlay, has done the Committee a service in tabling this amendment. It has enabled us to think in advance of the debate that we will have when we get to Clause 3 on the existing wording in the Bill about the Mental Capacity Act. Some of those issues came out in the debate that we have just had. It has been helpful to cue that up.

I want to comment on a couple of issues following on from the comments made by the noble Lord, Lord Deben. Two different things are being talked about with capacity and ability. I listened carefully to the comments of the noble Lords, Lord Pannick and Lord Scriven. There is a clear mental capacity test. But as others have said—I will not repeat the quote—experts in assessing capacity from the Royal College of Psychiatrists think that this decision was not thought about when the test was designed and that it is not an adequate test. I will not labour the point now, but we should think about whether we need a new test or, as the noble Lord, Lord Deben, said, an additive process where we take the Mental Capacity Act test and add something to it. There are amendments on both of those—a new test or adding things to it.

That comes to the point that the noble Lord, Lord Scriven, made. Of course, it is true that people make life and death decisions about medical treatment and about whether to refuse medical treatment. But there is a qualitative difference between refusing medical treatment, even if the consequence of refusing that medical treatment will be to hasten the end of your life, and to make a decision for active steps to be taken to administer substances to you which will end your life. They are very different things, and they are treated differently in the law. Perhaps that is the reason why we have had that slight cross-purpose. We need to be very precise about our language when we come to have that debate on capacity. I think that that would be helpful. That is all I will say about that at this point. I suspect that we will have a very extensive debate on Clause 3.

I think that the noble Baroness, Lady Finlay, was getting at something a little wider, which was not just about the capability of the individual to make a decision—that is the capacity piece. It was also about both the information they are furnished with and whether they have all the information at their disposal to be able to exercise their capacity to make a decision. It is not just about whether the information is available but whether the services are available that make that a truly proper, informed decision. Clearly, she has enormous expertise in palliative care.

Whether that palliative care is available in practice is incredibly important. Somebody could have capacity, and we could judge that they do. I listened very carefully to what the noble Baroness, Lady Andrews, said, with her expertise on the Mental Capacity Act, and I listened carefully to my noble friend Lady Browning about the importance of recognising how it works in practice, but it is also about whether those services are available. You could have the capacity and a lot of information provided to you, but if the palliative care services are not available to you, you do not have the ability to make a meaningful choice about whether you wish to end your life. I think that is what the noble Baroness, Lady Finlay, was getting at in that wider use of the word “ability” on top of capacity.

When we get to Clause 3 and the amendments to it, one of the things we should think about is whether we accept that the Mental Capacity Act is a good basis. As people on both sides of the argument have said, it is a tried and tested situation. As we heard earlier, it has been tested in court, up to and including the Supreme Court. We should think about whether we want to replace that with a completely new test or whether we actually stick with the Mental Capacity Act and perhaps have some additions to it, which recognise that it is a qualitatively different decision from whether you are having medical treatment or not. That is the essence of it.

In the place it is in the Bill, just accepting the word “ability” probably is not the right thing to do. We want that wider debate. But the noble Baroness, Lady Finlay, has done us a service in flagging up some of the issues that we can now think about in advance of the debate on Clause 3.

[Lord Winston (Lab)]

Before the noble Lord sits down, perhaps he could just clarify a point. Medical royal colleges are often quoted as having a view, but they are very seldom unanimous. I wonder whether he could tell us not just the percentage of psychiatrists but how many psychiatrists who are members of the royal college specifically had this view and how may did not. That is really important. There were a number of people who just did not respond to a question.

[Lord Harper (Con)]

I am happy to answer. I do not know how many did. My understanding is that the royal college, whatever its decision-making processes are, has publicly said that it does not think this is adequate. As I said, I did not quote it, because it had been quoted at length. I put some weight on that.

As a relatively new Member of your Lordships’ House, I am also very struck that this House is blessed with those who have enormous experience in the law, who have to make some of these decisions in practice, and experienced legislators, such as myself, who have looked carefully at the operation of the legislation, both in taking it and post-legislative scrutiny. Many Members have personal experience, either themselves or through family members, of the exercise of these laws in practice. I will listen very carefully to them.

Therefore, the view of the Royal College of Psychiatrists is clearly an important one that I will put some weight on, but I will also listen very carefully to others in the House, who I think will add enormously to this debate as we weigh up this important piece of legislation. I thank the noble Lord for his question.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank the noble Baroness, Lady Finlay, for bringing this debate to the Floor. I declare my interests as chief executive of Cerebral Palsy Scotland, and I have been involved with the Scottish Government on neurological conditions and policies for many years.

What has struck me in the debate so far is something that the noble Baroness, Lady Hayter, said about concentrating on the interests of the person. This is what I see every day when I deal with vulnerable people and they are dealing with service providers, whether in health, education, housing or whatever. I take the point your Lordships have made that this debate is about the difference between “capacity” and “ability”; capacity, as we define it in the Mental Capacity Act, is something that professionals will assess. They have lots of experience of doing that, and that is great. However, if we come back to concentrating on the interests of the person, the person is quite often in this difficult, complex situation for the very first time. Therefore, as my noble friend Lord Deben said, their ability to take on complex information, potentially when there might be multiple comorbidities and issues going on, is very different.

We see it in children in education and in people with communication difficulties—I have an amendment later on about how we support people with communication difficulties to navigate this. But we see it every day with the ability of people to take on something really profound that professionals are used to talking about—and we are professionals in here; we can talk about definitions and how we define things in legislation. I wanted to question whether people in the street that will be dealing with this have the ability to understand all the options, the prognoses and everything in front of them.

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[Baroness Hayman (CB)]

I cannot accept that. I am talking about the Bill that we have before us. The noble Lord, Lord Harper, asked: should we have a novel approach to this? My answer is no; it is safer to continue with the approach that we have.

I want to say one other thing to the Committee. I hope the Committee will accept that, given the experience that I have had here and the honour I had of being Lord Speaker, no one respects more the contribution that this House can make to improving legislation and the commitment that it should do its work properly. The noble Lord, Lord Harper, said that we were blessed in this House with many experts, and that their opinions should be listened to. The noble Lord, Lord Shinkwin, said that we should listen to the voices of those with lived experience. I am sad that the Select Committee did not do that, but I think that that is absolutely correct.

The one thing that we are not is what was said to me in 1974: “You have now been anointed by the popular vote”. I was then a Member of Parliament. It was a long time ago—in ancient times—but it was true. What has worried me slightly about the tone of this debate is that there has been a sense that this was a Private Member’s Bill introduced in the House of Lords, and that we were having the first go at any scrutiny of it. That is not true; it is not true at all. We do often get legislation from the other place that has not been scrutinised, but that is not true of this Bill. It has had much more scrutiny and I think we should have some respect for the fact that that has happened.

People say that we should not have an arbitrary timetable. Of course we do not want an arbitrary timetable. We have to do our job properly, but we should not be forced into a position where we are incapable of completing that job due to having an enormous number of amendments. We should concentrate on the important issues that we want the other place to take our views on seriously. I really think we are in danger of demeaning that process if we allow so much debate that we do not allow the other place to hear considered views on the important issues.

[Lord Harper (Con)]

I have an enormous degree of respect for the noble Baroness, particularly given her position as a former Lord Speaker. I am a relatively new Member of your Lordships’ House, but I have interacted with it. I look around and there are a number of noble Lords here—such as the noble Lord, Lord Pannick—with whom I had a number of interactions on previous matters. So I am familiar with the different role of the two Houses, and I believe it is absolutely our job to get legislation right.

In the end, this is a Private Member’s Bill. It was not in the Government’s manifesto, so it has not been, to use the noble Baroness’s words, anointed by the popular will. This is our job. If in the end this House decides that this Bill is not fit for purpose and cannot be adequately put into law, it is our role to say to the House of Commons, “It isn’t good enough; we need to do this again”. It is our job to say to the Government that this is of such import that, as the noble Lord, Lord Tyrie, said, the Government should do their job and bring forward a better-drafted piece of legislation. That is our right, and we should reserve that right for later stages.

[Baroness Hayman (CB)]

I follow the noble Lord’s argument, but he said that we should say, “We should do this again”. I think that if we reach that situation, the proper formulation is, “You should do this again”, and the other place could consider that. But the way we undertake that scrutiny should be responsible and reasonable and it should not deny the process of doing our job and putting those views and doing that—frankly, we have to be grown up about this and we have to behave responsibly about it.

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[Baroness Coffey (Con)]

I will respond to that. I do not know the answer about the noble Baroness, Lady Murphy. However, I say to the Committee and to the noble Lord, Lord Bassam, that amendments have been made to the Mental Capacity Act 2005 that have not been enacted by this Government. Therefore, we are not even sure exactly which version of the Mental Capacity Act we will be dealing with in the future. The noble Lord, Lord Bassam, is babbling away, but this happened. Amendments were made in 2023. That was on slightly different matter, but it is something I will come to in Clause 3.

I come back to the attack on Dr Price. Perhaps the noble Baroness could be brave. She has used parliamentary privilege to do that. If she really believed it, she might say those words outside the Chamber and see if she gets a legal letter. I thought it was really poor to attack somebody who had been invited and to try to suggest that, somehow, for such a distinguished royal college, she was manipulating a particular report. That was unfair.

I will make one minor observation about the Select Committee. In my view, it was noticeable how distressed Dr Price started to become during that oral evidence session. I am not a clinician or a psychiatrist; frankly, I am just another woman who could see how distressed she started to become. I also spoke to her outside afterwards. We have to bear in mind that we are used to this bear pit—which is much gentler at this end than at the other end—but that is not true of the others.

I will come back to the discussion and one of the questions I wanted to understand when going through ability versus capacity. We have already heard that things such as depression and mental illness are not a disabler. We already know that having dementia is not a reason to be denied, certainly in the Mental Capacity Act 2005. We know that capacity can fluctuate, and I certainly will not repeat what others have said.

What I have not yet understood is how things such as the power of attorney might work, which can be given over for health reasons. I want to get an understanding of the view of the sponsor and the Government Minister about the application of this, before potentially laying further amendments to discuss this.

We know that the Government do not believe that the Bill is in a fit state. They would not have 16 people working on it and the amount of work that has been going on if they did. By the way, that does not include the Government Legal Department in any way.

I thank the noble Baroness for having introduced this, but there is still quite a lot of debate to be had once we get to Clause 3, if we are allowed to see that it is in scope.

[Lord Harper (Con)]

In case I am not understanding it and it would be helpful for the Minister, is the question my noble friend wants the Minister to answer on lasting of powers of attorney whether it the Government’s understanding that somebody in possession of a lasting power of attorney for health and social care would be able to use that lasting power of attorney to seek an assisted suicide for the person on behalf of whom they hold the lasting power? Is that the question she is asking? I was not entirely certain.

[Baroness Coffey (Con)]

My noble friend has put it more accurately—that is precisely the question I am trying to understand. I am trying to be a legislator rather than somebody who argues in court, but the very fact that somebody can make health decisions on behalf of somebody else is important to consider in this matter, and I am not clear that it is explicit in the Bill—yet—that that power of attorney could not apply. We know that the Mental Capacity Act 2005 does not apply to Section 2 of the Suicide Act 1961. I will not go into a history lesson about the Suicide Act at Clause 1, but at the moment everything seems silent on the use of that lasting power of attorney.

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[Baroness Williams of Trafford (Con)]

It might be convenient to concur with what the Government Chief Whip has just said. We could finish in the normal run of things if there were fewer interventions and perhaps if the Front Benches could be allowed to sum up.

[Lord Harper (Con)]

Since I was standing, I will be very brief. I support what the Chief Whip said. I agree with what the noble Baroness, Lady Hayman, said earlier. I agree with the Government Chief Whip about not giving government time, but we need more time to deal with this as a Private Member’s Bill. I do not think that any reasonable person listening to the debate and the expertise contributed from these Benches could have concluded anything other than that this was a debate that reflected well on the House and that we are doing our job seriously and conscientiously. We need to continue to do that. That is all I would say to the Chief Whip.

[Lord Kennedy of Southwark (Lab Co-op)]

As a final point, I agree with the noble Lord. As Government Chief Whip, I take my job very seriously. I love the House, and I want to do this properly. I assure the Committee that I hear noble Lords’ sentiments. I know how long it has taken on the Bill. I know that views are sincerely held on both sides. I will work in the usual channels to deal with these matters.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

I just remind the noble Lord, Lord Empey, that of course I did vote for the Brexit legislation and in fact led the Labour Party into the Lobby to support the final agreement on Brexit.

[Lord Harper (Con)]

My Lords, I support the thrust of the amendments in this group, but first, I want to say a word or two on one of the issues that has come up in this morning’s debate. I hope the Committee will indulge me if I just quote a few lines from yesterday’s maiden speech by the right reverend Prelate the Bishop of Chester. The House was a little less well-attended for the debate on the Sustainable Aviation Fuel Bill in which he spoke, but I thought his words yesterday, the ones I am going to read, are very relevant to the debate and the tone of it, so I hope the Committee will forgive me. He said that

“communication is a vital gift for those of us who nurture and curate community. In communication, we need to learn to speak and to listen. This is almost always done in person and directly. Indeed, I argue that one of our primary vocations in this noble House is to be with and to listen, for few disciplines are more vital in the search for wisdom—the search I so often witness in your Lordships’ House. The question for me is not so much how we can be great again, but how we can be kindly present. Greatness is great, but grace is greater”.—[Official Report, 20/11/25; col. 965.]

I think those were wise words. They moved me and I think they are relevant to how we conduct ourselves in this debate on these vital issues.

The noble Lord, Lord Carlile, referred to how useful this debate was, and I believe that it is vital. That is why I quoted those words from the right reverend Prelate. We have raised a range of issues, all connected to people’s capacity to make an informed choice. The point of the debate is for us all—but especially the Bill’s sponsor, the noble and learned Lord, Lord Falconer of Thoroton—to listen to the concerns that have been expressed. I agree with the noble Lord, Lord Carlile, that the noble and learned Lord will then have the opportunity to talk to noble Lords and to bring forward on Report amendments that deal with these issues.

Part of the problem here, and the reason there are many amendments on the Marshalled List and the debate will be lengthy—the noble Lord, Lord Watts, referred to that—is that the House of Commons spent, I think, 17 hours in Committee, focusing on just the first three clauses of this legislation because they are very important. That involved just 23 Members of Parliament. Almost all the proposals that we are discussing were brought up in the House of Commons, but almost all were rejected or disposed of. If some had been accepted and dealt with in the House of Commons, all we may have been doing here is tidying up some of the wording or improving the amendments. However, we have to address them from scratch because they were not dealt with in the House of Commons.

It is our job in the House of Lords to scrutinise legislation and to deal with the things that have not been dealt with. We do that on behalf of people— a number of today’s amendments deal with vulnerable people who do not have the same opportunities that we have. The one thing that we all have in common in this House is that we are all privileged. I am referring not to our material circumstances but to the fact that we have a voice. Many people in this country do not have a voice. Many of the people who have been touched on in these amendments—people of poor material circumstances; people undergoing coercive control, as my noble friend Lord Gove suggested; and people who have severe disabilities—have no one to speak for them. It is our responsibility and duty to make sure that we test these issues and make sure the Bill is as good as it can be.

The noble Baroness, Lady Hayter of Kentish Town, asked whether the noble Lord, Lord Carlile, would support the Bill if some of these things were dealt with. That is not really the question. I have been very clear that I do not support the change, and I will set out why in a moment in relation to one of the amendments. However, I have to confront the possibility that the Bill may become law; I will not find that welcome, but the noble Baroness will. If it becomes law, it is absolutely my responsibility—and the responsibility of everyone in this House—to make sure that the Bill has in it all the protections for vulnerable people. If we were to fail to do that, we would have failed the people of this country, whom we are supposed to support—that is our duty. There will be some people in this House who will, if the Bill is improved, support it; there are some who will not, but that is not the point. The point is to get the Bill in as good a shape as possible.

Let me now turn to the amendments. I will deal first with Amendment 45 on encouragement, so powerfully spoken to by the noble Baroness, Lady Fox of Buckley. The reason that word is important was demonstrated in the short debate between the noble Lords, Lord Pannick and Lord Carlile, on the present position. I hesitate, as a humble accountant, to trespass in the debate between those learned noble Lords, but I will make two points. First, there is a fundamental difference between someone refusing treatment or not having treatment and someone taking deliberate steps to kill themselves. Those are fundamentally different things, and trying to elide them is not helpful to the debate.

The noble Lord, Lord Pannick, talked about the status quo. As I understand it, the current position if you assist somebody to take their own life and the DPP investigates is that the guidance contains the concept of encouragement. There is a specific point, when the DPP is considering whether to prosecute you, about whether you have encouraged somebody to take their own life or tried to talk them out of it. If you have encouraged them not to take their own life but you have, none the less, assisted them, the current position is that that is treated much more favourably than if you had not tried to discourage them. That subtle position in the status quo is something we should maintain, because something very important will happen if this legislation passes, which is why I do not support it: it will, effectively, change society’s view of suicide. In some circumstances it will, effectively, support suicide where currently we do not. In those circumstances, the use of “encouraged” is vital. That is why I support the amendment.

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[Lord Falconer of Thoroton (Lab)]

That will very much depend upon the number of people who apply from particular groups, and I think one can be pretty sure, on the basis of the impact assessment, that there will be sufficient numbers.

[Lord Harper (Con)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

I think it would probably be sensible, unless the noble Lord has something to raise that we have not already dealt with, for me to make a bit of progress.

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[Lord Harper (Con)]

It is directly relevant to the amendment that we are discussing, if the noble and learned Lord will forgive me. I am coming back to what the noble Lord, Lord Carlile, said about the point of the debate. I absolutely get that the noble and learned Lord is very certain about the quality of the Bill. He has set that out in his usual eloquent way. However, if he followed my injunction from the words of the right reverend Prelate the Bishop of Chester yesterday and if he has listened to this debate, he must recognise that that certainty is not shared by many Members of this Committee.

I hope the noble and learned Lord will forgive me if he was coming to this on later amendments, but he has in effect said that he is not persuaded by most of the amendments. If he does not accept that many noble Lords have concerns about the Bill and thinks it is basically fine as it is, I fear that—picking up the point made by the noble Baroness, Lady Hayter—many noble Lords who might have been persuaded to support it had it been improved will not now be persuaded. Is he prepared to listen and amend the Bill in any way at all?

[Lord Falconer of Thoroton (Lab)]

My Lords, first, I am sure that I will not be able to reach the high standard of the right reverend Prelate the Bishop of Chester, but I will try.

Secondly, I do not think I am rejecting the principle of many of the amendments. I am saying that—for example, in relation to an independent decision and to encouragement—the protection is there in practice. I also say to the noble Baroness, Lady Coffey, that her reference to organisations is something we could discuss. I think it may already be covered but let us discuss it.

The noble Lord, Lord Harper, is right: I am saying no to quite a lot of the amendments because, in my opinion, I do not think they are necessary and there is adequate protection. It does not mean I am not listening; but painful as it is, because I respect so many people who disagree with me, I do disagree with some people.

I am very conscious as well of what the Chief Medical Officer, Sir Chris Whitty, said, which is not to over-engineer this and make it a thicket people cannot get through. If you are serious about assisted dying, make sure it is genuinely accessible to people. I am trying to strike that balance.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, up to the age of 25, people often struggle to grasp that death is irreversible. They understand in notional terms the point that death ends a person’s life on earth, but they do not really grasp the sense—both those who accept and those who deny the afterlife know this—that life as we know it ends.

Somebody who has not been mentioned is Professor Leah Somerville, a Harvard academic who specialises in psychology and is the director of the Affective Neuroscience and Development Lab. An article on her research says:

“Adolescents do about as well as adults on cognition tests, for instance. But if they’re feeling strong emotions, those scores can plummet. The problem seems to be that teenagers have not yet developed a strong brain system that keeps emotions under control”.


I have suggested the age of 21, not 25, as the lower limit. I regard this as a compromise, and I proposed it at the outset. As I say, the medical evidence points to 25; I am happy to support that.

In conclusion, opponents might say that the seven-year gap between the age at which a person is thought to be an adult for legal purposes and the age at which they become eligible for assisted suicide is simply too long, but no young person should be presented with the option of taking their own life—certainly not those who have been diagnosed as having a terminal illness. They are not physically, psychologically or emotionally developed to the maturity needed to make a judgment devoid of emotion. Although my moderate amendment places the age of eligibility at 21—I stress that it is a compromise—I would be prepared to support other noble Lords on the age of 25.

[Lord Harper (Con)]

My Lords, I want briefly to respond to a point made earlier in the debate by the noble Lord, Lord Winston, whose medical expertise I respect greatly. He quoted a comment from Sarah-Jayne Blakemore, which has not been said already in this debate, and talked about the context in which decisions are made. In a paper, she said:

“Adolescence is characterized by making risky decisions … This suggests that decision-making in adolescence may be particularly modulated by emotion and social factors, for example, when adolescents are with peers or in other affective (‘hot’) contexts”.


That tells me—it is relevant to an earlier discussion—that it is not just the age of the person that is relevant, which is why Amendment 4 from the noble Baroness, Lady Berger, is very helpful. It is about context in decision-making.

I listened carefully to what the noble and learned Lord, Lord Falconer, said about the thought process that he was going to undertake, having listened carefully to some experts. Like him, I am torn on the age issue. The amendment from the noble Baroness, Lady Berger, is very helpful in setting out some of the issues, but I was also struck by what the noble Baroness, Lady Fox, said, so I am slightly torn on whether age is the right way of doing it. I do not know whether it is an assessment.

My final point is that I was struck by what the noble Baroness, Lady Berridge, said—

[Lord Birt (CB)]

I just want to ask: does the noble Lord think that we should try to reach the 10th group of amendments in the course of today?

[Lord Harper (Con)]

I am trying to make a brief remark. I have been speaking for only one minute and 45 seconds; if I keep getting interrupted, I will not be able to sit down. I was going to make literally one more point, having listened to the debate. After all, this is supposed to be a debate where we listen to what noble Lords say and respond—

[Lord Birt (CB)]

Could the noble Lord please answer my question: should we try to reach the 10th group of amendments today?

[Lord Harper (Con)]

I want to try to make progress, which is why I was trying to keep my remarks very brief; if the noble Lord keeps interrupting me, they will necessarily take longer. All I was going to do was make one further point.

I was very struck by what the noble Baroness, Lady Berridge, said about the differences in the medical prognosis for a number of conditions among younger people. I suggest to the noble and learned Lord, Lord Falconer, that as well as looking at the assessment process, he should look at the extent to which clinical advice and evidence can be brought in to see whether a terminal diagnosis for a younger person is qualitatively different; from listening to the noble Baroness, Lady Berridge, that appears to be the case. That may be the appropriate way to pick up the concerns, which are widely shared. But I also accept—the noble Baroness, Lady Fox, made this point—that the law has to have some clarity to it. Like the noble Baroness, I think that having lots of different ages would be very difficult.

From listening to the points made by the noble Baroness, Lady Berridge, I think that may be a way forward; I commend it to the noble and learned Lord when he undertakes his thought process for what he may bring forward on Report.

[Baroness Spielman (Con)]

My Lords, I have not spoken previously on the Bill, nor tabled any amendments. But as the chief inspector responsible for inspecting children’s social care, as well as education in mainstream and special schools, I have visited many institutions with children with life-limiting conditions. I recognise that the Bill has profound implications for many children and young adults.

I support the amendments to raise the minimum age of eligibility—in particular, the amendments from the noble Baroness, Lady Berger, to amend the minimum age limit to 25 throughout the Bill. There are, and always will be, children in their teens with terminal illnesses who are thinking about their own futures, in the context of the choice that they would be empowered to make from their very first day as adults, before they have any experience of adult palliative care.

Even though the provisions now rightly prevent medical practitioners initiating the subject of assisted dying with children, we know that young people seek out and are influenced by all kinds of information freely available online—and we have plenty of precedents. Consider what young people can already see on suicide, eating disorders, puberty blockers, cross-sex hormones and, indeed, claiming invalidity benefits. These precedents show that no matter what constraints are placed, there will be freely available video content promoting assisted dying and some of it will coach viewers in how to pass mental capacity tests. That reveals the unpalatable prospect of children reaching their 18th birthday and immediately demanding their right to a state-delivered death, with little or no opportunity for adult services to be deployed to offer supportive alternatives.

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[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am grateful to noble Lords for their contributions to this debate on the age of eligibility for those who are provided with assistance under the Bill. I have made it clear previously, and reiterate, that I will keep my comments limited to the issues on which the Government have major legal, technical or operational workability concerns.

The amendments tabled by the noble Baronesses, Lady Berger, Lady Lawlor and Lady Hollins, seek to raise the age at which an individual would be eligible for the provision of assistance under the Bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the decision-making of noble Lords, but the underlying policies are rightly a matter for Parliament. Under the convention, the amendments in this group could give rise to legal challenge; for example, that excluding people who are under 21 or 25 from accessing assisting dying may not be justified under Articles 2 or 8 of the EHCR, or that this amounts to unjustified discrimination under Article 14.

Noble Lords will be aware that differential treatments, such as raising the age of eligibility, may be lawful if it is possible to persuade the courts to agree that the age limit is justified, necessary and proportionate. There would need to be a reasonable justification for restricting access to assisted dying to people aged either 21 and over or 25 and over. Noble Lords will want to consider this in relation to these amendments.

[Lord Harper (Con)]

Can the Minister be clear? If we decided to limit—whether by age or in some other way that the noble and learned Lord, Lord Falconer, might decide—and put that into primary legislation, is that then not the law of the country? All that the European court could then do is say that it is not compatible but remains the law—or is the Minister saying something different? If we pass primary legislation, that is the law of the land, is it not?

--- Later in debate ---

[Baroness Whitaker (Lab)]

My Lords, when considering this group, in particular, perhaps, Amendments 300A and 306A, I realised that the small number of noble Lords who have tabled most of the very large number of amendments to the Bill recognise compassion as their guiding intention. I hope they are being reassured by my noble and learned friend Lord Falconer’s comprehensive and expert reassurance on the many safeguards now inserted into the Bill—more safeguards, I believe, than in the legislation of any other country.

However, I am concerned that very extended delays will betray the hope of the woman who nursed both her parents through agonising and protracted deaths, and who now faces the same fate herself. She mourns the fact that her parents were never given the choice this Bill provides. Her words to me as a legislator were: “Have mercy”. Mercy is what this Bill is about, and noble Lords will surely seek the path to mercy. Surely only those whose motives are ideological would want to prevent this Bill from passing, rather than working out the best amendments on a reasonable timetable.

I remain profoundly uneasy at the prospect of Members of this House abrogating to themselves the right to deny the choice of mercy to that large majority of our fellow citizens who want this choice to be available, as reflected in the decisions of our elected representatives. “Have mercy” should be our watchwords.

[Lord Harper (Con)]

The noble Baroness referred to the two amendments that I have on the Marshalled List that I have not yet spoken to. She seemed to be ascribing motives to the amendments. She referred only to two amendments—the two amendments I have tabled—and she seemed to be suggesting they were designed to stop people accessing this service. I hope she will stay and listen to me when I explain what my amendments are about, and she will see that is entirely the opposite of what they are designed to do.

[Lord Pannick (CB)]

I say to the noble Lord, Lord Moylan, that nothing is impossible in human rights law. But it would be exceptionally surprising if the courts were to say that a criterion as well established as ordinary residence were not a justifiable criterion to address the difficult problem of which people ought to benefit from the advantages that this Bill, if enacted, would confer. One other point—

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[Lord Goodman of Wycombe (Con)]

My Lords, I will speak very briefly in support of Amendment 23, which was spoken to by the noble Lord, Lord Frost, bearing in mind that amendments in Committee very often are probing amendments to test the view of the sponsor.

It is important to recognise at the start that it is, in fact, not clear from the Bill whether the NHS will provide voluntary assisted dying services. This was a point in relation to which the Bill was criticised very heavily by the Delegated Powers Committee, on which I sit. But it clearly is the intention of the noble and learned Lord, Lord Falconer, that it should, and I want to assume for the purposes of this debate, very briefly, that it will.

My noble friend Lady Coffey raised at the start of this debate a problem, which was the question of whether someone might seek to obtain residency under the terms of the Bill in order to obtain what has been referred to as death shopping. This is clearly a problem. The virtue of the amendment from the noble Lord, Lord Frost, is that it would deal with this, imperfect though the amendment may be. I would like to hear from the sponsor of the Bill, the noble and learned Lord, Lord Falconer, what his view is of the problem raised by my noble friend Lady Coffey. I think he accepts that death tourism is a problem. Is his view, like that of my noble friend Lord Lansley, that residency remains the only sensible way of determining these matters? If it is, why has he put the additional safeguard into Clause 1 of the Bill? Or, if he thinks residency is not sufficient, what additional safeguards might he be able to offer? I look forward to hearing from him when he responds to this debate.

[Lord Harper (Con)]

My Lords, before I speak to my Amendments 300A and 306A, let me just pick up, briefly, a couple of issues that have been raised in the debate.

First, I was very pleased that the noble and learned Lord, Lord Falconer, said it was very important, in response to the noble Lord, Lord Beith, that we dealt with these border issues. He will remember that I spoke on that on the first day of debate, using my experience as a former Member of Parliament for a border constituency and I raised some of the very practical issues that there will be if we do not get that right. The noble and learned Lord will remember that when I was raising these issues, there were people on the other side of the argument who tried to shout me down before I had even finished. I am pleased, therefore, that he recognises that the issues I was raising are important and valid ones. To make sure these issues work properly, we have to worry about both the England-Scotland border and the England-Wales border.

Secondly, I am very grateful to the noble Lord, Lord Pannick, for the free legal advice he provided to me in answering the question about what the courts could do about a human rights challenge. I did not get an answer from the Minister, so I am grateful to have had it from him.

Thirdly, on the point that came up in the debate about Crown servants, if you are a Crown servant, you can retain your ordinary residence status when you are posted overseas—that applies to diplomats, members of the Armed Forces and civil servants. It does not usually apply, though, to people who work for the NHS, local government and so forth, but we do not have to worry about people who work in embassies.

Let me deal with the issues raised by the amendments from the noble Lord, Lord Lansley, because they are relevant to the nature of this service. He is absolutely right that, for primary care, we do not have the same test on residence that we do for secondary care. There is a reason for that. When we were putting in place the changes for secondary care in the Immigration Act, we considered whether we should implement similar changes for primary care—that was after he was Secretary of State for Health. We did not change that position because there is a very significant community benefit for allowing people, who are physically in the United Kingdom, to have access to primary care, so that they can access all sorts of services, particularly if they have a communicable disease or illness. We absolutely want them to seek early treatment, not just for their own benefit but for the benefit of everyone else. That is why we have wider access for primary care than we do for secondary care, which we limit to people who are ordinarily resident. We allow others to access it, but only if they pay for it.

I argue that, if this is to be provided on the NHS, this service should be treated more like how we provide secondary care, rather than how we provide primary care. It is more akin to that sort of treatment than primary care. That is where I respectfully disagree with the noble Lord.

[Lord Lansley (Con)]

I do not think that we are disagreeing, because my amendments would have the effect of applying an ordinary residence test. That ordinary residence test for the assisted dying service would be exactly the same as the one for planned secondary care.

[Lord Harper (Con)]

In that case, I now understand the noble Lord. When he was talking about primary care, I thought he was suggesting that we had a wider remit, so I am very pleased to hear that.

I will now address my amendments and their purpose. They are intended to deal with the fact that under the Bill, as I understand it, it would be the job of the co-ordinating doctor—a clinician—to make the determination about somebody’s ordinary residence. The Medical Defence Union has expressed concern that requiring medical professionals to do that could put them at legal risk. Indeed, as my noble friend suggested, it sort of turns them into immigration officers. That concern was pointed out when we were making the changes to the then Immigration Bill, which is why the people who make those decisions are not clinicians; they are overseas visitor managers and administrators in the health service.

Therefore, my amendments would shift the responsibility for assessing residency from clinicians back to administrators. If NHS trusts were providing this service, they would use their overseas visitor managers to do it. That is an existing structure: they are people who know how these rules work. As I think the noble Lord, Lord Carlile, mentioned, a tool already exists, which is well understood, to enable people to check people’s eligibility. I think this has already come up in the debate, so I will not dwell on it at length, but I note that ordinary residence is not that straightforward; it is designed in case law, not in statute. When we were bringing forward the Immigration Act, the overseas visitors charging review took place in 2012, which concluded that the vagueness of the definition means that ordinary residence is difficult to interpret and apply on an individual case basis.

I have already been quoted by the noble Baroness, Lady Finlay, and now I am in danger of quoting myself. When I was taking through that legislation, I said that the existing rules were complex. One of the things that came through from the audit was that front-line health professionals find them complex. The evidence we got was not just that this was the opinion of front-line professionals—they were actually complex. We tried to make them more straightforward. It was one of the reasons why we introduced the health surcharge. Rather than try to make it more complex for the health service not to treat people, or to test whether they were treating people, we charged people coming into the country and then let them have access to the health service. That seemed to be a more sensible way of doing it.

That is the essence of my amendment, and I suggest to the noble and learned Lord, Lord Falconer, that he looks at it. On Report, it would be helpful if the Bill was amended to take the test for ordinary residence away from the doctor in charge of this and give it to the organisation that is providing it, so that it can be done as part of an administrative function. From the conversations we had at the time, I know that clinicians and medical professionals feel that it is not for them to gatekeep access to these services, both for legal reasons—as set out by the Medical Defence Union—and, as my noble friend Lord Lansley said, because that is not their job. We already have professionals in the health service whose job is to do that, and it would be better if they were given that task rather than clinicians. That is the purpose of my amendment.

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[Lord Falconer of Thoroton (Lab)]

I accept that completely. The reason the 12 months is here is to give some degree of assurance that the reason you are living here is not because of an assisted death but because it is your genuine home.

I come to the proposal from the noble Lord, Lord Frost. The way it is drafted, although I cannot believe he meant this in the way that he put it, you have to be ordinarily resident in England or Wales, you have to be a British citizen and you need indefinite leave to remain. I was surprised he was saying it would be an easier test to apply. It would not be an easier test to apply, because you would have to apply both ordinary residence and whether you are a citizen or have indefinite leave to remain. Even assuming the proposal is the more limited one, namely, that you only have to be a British citizen or have indefinite leave to remain and you do not have to be ordinarily resident here, that would not be appropriate, for two reasons.

First, the policy choice that the sponsors of the Bill, myself and Kim Leadbeater, have made is that, if you live here—if you are ordinarily resident here—whatever your citizenship or status, you should be entitled to it. Secondly, and separately, I do not think it is appropriate to make it available for people who, for example, have not lived in this country for 50 or 60 years and have no intention of returning. That would invite death tourism, to use the phrase.

The noble Lord, Lord Harper, said that doctors should not be required to make the assessment. If the position is that there has to be some residence requirement, it is perfectly okay for the two doctors who are concerned with this to make inquiries about where someone lives and how long they have lived here. That is not difficult, and in 99.99% of cases it will not give rise to any problems. Let us assume that most people are honest, and say to the doctor, “I actually live in France but I’m coming here because I want this”. The doctor will say that it is not available. I hear what the noble Lord says, but I do not think it gives rise to particular problems. If there are particular problematic cases, these can ultimately be resolved by the panel.

[Lord Harper (Con)]

I do not think that is the experience of the National Health Service. There is a whole cadre of staff—the overseas visitors managers—who deal with people who are trying to access a service. I do not think it is the case that this is straightforward and that in the vast majority of cases there will not be an issue. That is not the NHS’s experience and I do not think it will be the experience of this service either.

[Lord Falconer of Thoroton (Lab)]

I am surprised to hear that. I will make inquiries, but I am almost sure that that will not be the case with this.

The noble Lord, Lord Mackinlay, gave us an interesting tour d’horizon of the law and said how “ordinarily resident” applies in various areas. “Ordinarily resident” means the same thing in all those areas. For the reasons I have already given, I do not think it will prove a difficult thing to apply in practice. I am grateful to the noble Lord, Lord Meston, for his endorsement of the approach to “ordinarily resident”.

The noble Lord, Lord Wolfson, asked me a number of questions, such as about the citizen who was ordinarily resident here and then went to live abroad—I think that was the case raised by the noble Lord, Lord Moylan. If a person decided that they were going to move to Spain and live the rest of their days there, then when they become ill they wanted to come back and have an assisted death, under the terms of this Bill they would not be eligible because they would not have been ordinarily resident in this country for 12 months—this country being England and Wales.

The noble Lord’s second question was about somebody from Northern Ireland who comes here and asks for an assisted death. Again, they would not be eligible because the assumption under his question was that that person’s ordinary residence was in Northern Ireland. His third question was about why opinion is not satisfied. It seemed to us that opinion is enough in relation to this because it would be done basically by asking a number of questions and you would assume that the answers that you had would be honest.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I will speak to the amendments in this group. I did not table one in my name about a group of people who are also subject to deprivation of liberty safeguards. I am pleased to hear the noble and learned Lord repeat his offer of a meeting, which was made last Friday. I was disappointed not to receive an invitation to a group meeting to discuss the various groups of vulnerable people who may need additional conditions. Had there been such a meeting, I would not be taking up time today or on the later group, where I had offered to withdraw amendments had a meeting taken place.

There is another group of people under deprivation of liberty safeguards who are not under the Mental Capacity Act. These are young people who are under the High Court jurisdiction of deprivation of liberty safeguards—called High Court DoLS. I thank the President of the Family Division for ensuring that there is research available on this group and the Children’s Commissioner, who has visited very many of them. Those young people are so troubled that their liberty needs to be restricted, but they cannot currently be detained under Section 25 of the Children Act in a secure children’s home. That was for a variety of reasons. One was that we ran out of places, but another was that some of them were in such a situation that they could not even bear a communal secure environment like that.

I did not table an amendment also because under the Children’s Wellbeing and Schools Bill these young people will possibly be brought under the statutory jurisdiction of the Children Act, though it would not be all of them. There were 1,280 applications made last year, and around 90% of them were granted, so this is not, as was originally envisaged, a handful of young people. Are any of those young people also ill? Are noble Lords content that at 18 years and one day old they should have assisted suicide raised with them? Are they also happy that if a child has been under mental health treatment but is also physically ill, at 18 years and one day they come under the jurisdiction of this Bill? The same applies to those detained in a young offender institution. Sadly, due to the Private Member’s Bill process, I do not believe that there has been any consultation, a White Paper or pre-legislative scrutiny to flush out the details and data that we need to properly legislate.

I am grateful to the Children’s Commissioner for attending the Select Committee, but I was surprised that the Public Bill Committee in the House of Commons did not hear from her.

In addition to the issue of those who are 18 years old and one day, some of whom are still under the jurisdiction of the Children’s Commissioner until they are 25 and under the jurisdiction of the local authority, it is not wrong to say that there will be enormous societal change that affects children. I would be grateful to know, whether now or in the meeting that the noble and learned Lord has promised, whether he is aware of this group of children and what meetings he has had to establish how many would be affected at 18 years old, how many are in this group and how they can be protected by additional conditions and safeguards.

[Lord Harper (Con)]

My Lords, the noble and learned Lord, Lord Falconer, gave a very welcome response to the opening speech of the noble Baroness, Lady Finlay. He set out a range of protections that there may be. Once he has had those conversations, if he is persuaded that there need to be some protections, will he be prepared to table his own amendments on Report to put those protections and assurances in the legislation, or will he do what the Delegated Powers Committee referred to as disguise legislation, which is only putting it in codes of practice and guidance?

I think it would be widely agreed that if we are going to have those protections, it is better that they are in the Bill. They then cannot be watered down and can be properly enforced. Could he indicate that to all noble Lords after he has had those conversations with those who are interested? The disadvantage of having private meetings is that you are not able to tell other people. If the noble and learned Lord wants proceedings to go faster and to table his own amendments on Report and prevent the need for other people to do so, can he indicate that, once he has had those conversations, he would be willing bring forward those amendments and put those protections in the legislation. I am sure that would be most welcome. If he could indicate his thinking on that today, that would be of help to the House.

--- Later in debate ---

[Lord Harper (Con)]

I am grateful to the Minister for making that point, which I think was the question I asked last time. This is very relevant to the question that I posed to the noble and learned Lord, Lord Falconer. It is very important that we put protections in the legislation, so that they are not subsequently unpicked, whether by domestic courts or the European Court of Human Rights. If they are only in a code of practice or guidance, it would not provide protection against those legal challenges. Will the Minister just confirm that what I have said is correct?

[Baroness Merron (Lab)]

I am sure that my noble and learned friend will comment on the noble Lord’s points, but the point I wished to make, which might be helpful, is that it is usual practice for the Government to consider and address these matters. Noble Lords are aware that there is a range of ways of dealing with that: by amending primary legislation, through a remedial order or by a declaration of incompatibility. That is the usual practice.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I will just pick up what the noble Lord, Lord Kamall, is saying. I think he is saying that the Act has been updated over the years and that people have taken account of improvements. He is absolutely right; from my own knowledge of the working of the Act, he makes an absolutely valid point.

I repeat what I said earlier—that we need to discuss this. I will deal with the interventions after I have given my response.

First, the noble Baroness, Lady O’Loan, is right in identifying the risks that arise. That is why I think that the noble Baroness, Lady Finlay, is right that we need to build in some form of enhanced protection.

As far as the intervention from the noble Baroness, Lady Berridge, is concerned, this amendment is limited to DoLS under the Mental Capacity Act; it does not include any exercise of the inherent jurisdiction of the courts on somebody whose liberty has been taken away. The noble Baroness is very welcome to come and discuss that with us, and I will give her notice of any meeting that we have.

As far as the noble Lord, Lord Harper, is concerned, how one provides effective protection depends first on the discussions that take place. I would envisage tabling an amendment on this or maybe agreeing that somebody else tables one. I cannot tell noble Lords the extent to which it will involve the Minister having powers, but it is something that we will discuss.

The points that the Minister, my noble friend Lady Merron, made about discrimination relate to people who have had a deprivation of liberty order in the past, or even those who have one now, who will be excluded altogether from the right to assisted dying. The nature of the Mental Capacity Act is that this should be done on a case-by-case basis. I am proposing that we discuss how to provide enhanced protection rather than excluding.

In the light of what I have said, I hope that the noble Baroness, Lady Finlay, and the noble Baroness, Baroness Berger, on behalf of the noble Baroness, Lady Keeley, feel able to withdraw their amendments.

[Lord Harper (Con)]

I agree with the noble Lord, Lord Pannick, that a court is unlikely to interfere with important social and economic policy that has been decided by Parliament. That rather reinforces the point that I made about why it is important that these protections are included in the legislation.

--- Later in debate ---

People living in remote parts of the borders, faced with a long drive when they are not feeling well and needing to attend an appointment 55 miles away in Cramlington, for example, could have a greater sense of wanting to seek to end their life because of the stress and sheer exhaustion that comes with travelling such distances for cancer or other terminal illness treatments. I therefore ask the noble and learned Lord, what consideration has been given to those living in remote parts along the England-Scotland border?

[Lord Harper (Con)]

My Lords, this is a very sensible group of probing amendments, and it is a pleasure to follow the right reverend Prelate. I will speak to them because the issues raised in this group concerning the difference between where somebody resides and where their GP is registered are exactly analogous to the situation regarding England and Wales, which I raised in an earlier group but have not received a satisfactory answer to.

I will remind the noble and learned Lord of the situation and he can, I hope, respond in a positive way. There are two issues, one of which is the difference between where you reside and where your GP is registered. There are a significant number of people living along the England-Scotland border and the England-Wales border whose place of residence is not the same as where their GP is registered. Therefore, it is very important that the legislation makes it clear that the rules through which you access assisted suicide are governed by where you live, not where your GP is registered. That is important for the reasons my noble friend Lady Fraser set out—in England and Scotland there will potentially be very different legal situations.

As we know from the earlier debate, although the Bill covers England and Wales, the rules governing the detail of how an assisted suicide service will work in Wales will be set by the Welsh Senedd, not the UK Parliament. Therefore, it is important that the Welsh rules apply only to people in Wales, who are governed by a body that is democratically accountable to them, not to people who live in England; otherwise, there would be a massive democratic deficit. It is very important that the noble and learned Lord is clear about how that is going to work.

Secondly, I think the noble and learned Lord said in response to our debate on England and Wales that he and the honourable Member for Spen Valley had had some detailed discussions with the devolved Governments. However, I was not clear from his responses whether those discussions had covered this point. Obviously, they need to take account of the views of not only the devolved Governments but the UK Government—which, for these purposes is actually only the English Government. We need to understand how this is going to work in practice.

As I have said, and in conclusion, this must be got right now, in primary legislation. If we do not get it right now, somebody will have to spend months and years clearing up the mess afterwards, which is one of the things that I had to do when I was the Member of Parliament for the Forest of Dean to deal with the cross-border issues that had not been properly thought through then. This is a valuable set of amendments. I was pleased that that the noble and learned Lord acknowledged, I think last week when the noble Lord, Lord Beith, spoke about this briefly, that these are valid issues that need proper answers. I look forward to hearing them now.

[Lord Deben (Con)]

Could I be vulgarly practical about this, because of a point the noble Baroness mentioned, which is the parallelism with the deposit return scheme that got into terrible trouble? I declare an interest as chairman of Valpak. We had to work through that, so it is burnt into me how extremely damaging it was because it was not decided beforehand. I know that we are talking about much greater issues here but, as I hope the noble and learned Lord will accept, this is a really serious issue; it brought about enormous cost and a vast misunderstanding, and it ended up destroying what the Scottish Government wanted to do. It is a very dangerous precedent. I am sure that the noble and learned Lord will want to make absolutely sure that we do not have a repetition of something that cost vast sums of money, in both the private and public sectors, and that has undermined an important measure ever since.

--- Later in debate ---

[Baroness Blackstone (Lab)]

My Lords, I wonder whether we can now hear from the Front Benches. We have had a long discussion about these issues and have moved into the danger of repetition. We have already had a response from the sponsor of the Bill too, so I think it is now the turn of the Front Benches.

[Lord Harper (Con)]

My Lords—

[A noble Lord]

No—Front Benches.

[Lord Harper (Con)]

My Lords, I will raise some new points that have not yet been raised in the debate—looking at the Companion, as the Government Chief Whip instructed, I have every right to do so. My noble friend Lord Blencathra made some very good points. I have been here for every minute of the debate on the Bill, and I have listened with care and courtesy to every noble Lord, whether they were making points I agreed with or disagreed with, and I expect the same courtesy to be afforded to every Member of this House.

I agree with the sentiment of these amendments. It has been a very valuable debate, because there has been a general sense in the Committee about the importance—

[Baroness Winterton of Doncaster (Lab)]

My Lords, the noble Lord and I go back a long way. I certainly appreciate what he just said, but I ask him whether he agrees with the noble and learned Baroness, Lady Butler-Sloss, that it is important that the Bill gets to Report and that the House has the time to consider it then and not only in Committee.

[Lord Harper (Con)]

I am trying to make some comments on the amendments. Let me do that and then, if I have time—I am very careful to keep my remarks to less than 10 minutes, which is the guidance in the Companion—I will address the noble Baroness’s points. She is right that, when I was Government Chief Whip, she was my opposition and we had a very good working relationship, which I want to continue in this House.

What has come out of the debate is a general view from everybody, whatever their view on the Bill, about the importance of the relationship that people have with their general practitioner, whether it is an individual or, as the noble Baroness, Lady Gerada, said, a multidisciplinary practice. That is a very important point. The amendments that have been tabled to Clause 1 are about the eligibility criteria for whether someone is able to make a request for an assisted death.

The flaw in the amendments—I support the idea behind them, but I do not support them—is that they do not make an appreciable difference to the safeguards in the Bill. When the noble and learned Lord, Lord Falconer of Thoroton, made some remarks in this debate, he put his finger on it: there is no requirement in the Bill for the GP or the team at the GP practice to be the doctor who makes the assessment about whether the person has the capability to make this decision or not. That, as was said by the noble Lord, Lord Scriven, is the role of the co-ordinating doctor, who does not need to have any relationship with the patient at all.

When the noble and learned Lord, Lord Falconer, looked at this issue before, there was a report from the Demos assisted dying commission, which the noble and learned Lord chaired. Its recommendations recognised the need for

“a doctor who … knows the person well and supports the person and their family”.

The report also said that that doctor who knows the person can better assess whether the request to die is a cry for help, a sign of poor care or a result of coercion, and that

“if an assisted death was to go ahead, the first doctor should be responsible for arranging support for the patient and their family during and after the assisted death”.

It envisaged that

“the first doctor would have a greater level of involvement”

and

“an established relationship with the person requesting this assistance, and be familiar with their personal history and family context”.

That seemed to be the general view of all of the noble Lords who have spoken.

The problem is that there is no requirement in the Bill before us for the GP or multidisciplinary practice to be the co-ordinating doctor or even to be consulted before the co-ordinating doctor makes the first assessment. It is absolutely true, as the noble Lord, Lord Scriven, said, that, when the co-ordinating doctor has made the assessment, he or she has to send that to the GP practice. However, as the Bill is drafted at the moment, the role of the GP practice is to act as a postbox, log the report—I see the noble and learned Lord, Lord Falconer of Thoroton, nodding—and pop it on somebody’s medical records. There is no requirement or duty on that GP practice to read the report, to make an assessment of the decision of the person with whom they have a relationship to die or to do anything about it at all. That is the flaw in this.

The problem with the amendments on the eligibility criteria that we are considering is that, if they were all adopted—this is an administrative point—they would not ensure that that knowledgeable individual or practice with whom the patient has a relationship has any role whatever in making this important decision, involving the family or consulting anybody at all. That is the flaw.

This has been a valuable debate because I think it has demonstrated—and I think the noble and learned Lord, Lord Falconer, recognised in his earlier comments —that there was value in that relationship, and I am not surprised by that, given the conclusions that the commission he chaired came to, but the problem is that that is not reflected in the Bill at all.

If I may, I will conclude on this point before I address the remarks of the noble Baroness, Lady Winterton. Why we have these debates, and the reason for hearing from noble Lords with opinions, is because it highlights the flaws that exist in the Bill. The point of this process is that that then enables the sponsor of the Bill and all noble Lords to listen carefully to the debate and to bring forward improvements on Report.

I hope that, in his response, the noble and learned Lord, Lord Falconer, will draw on the concerns that have been highlighted and can indicate his approach. If he is minded to bring forward amendments that deal with some of these things, that clearly means that other people do not need to. If he indicates he is not minded to do that, then other noble Lords can bring forward amendments to deal with it, which can then be debated and voted on at Report stage. That is the point of our process and why we debate these things in the Chamber: so that everybody can hear the debate and the points. It is a better way of improving the legislation than having lots of private discussions to which most of us are not party.

What I would say to the noble Baroness, Lady Winterton—

[Lord Scriven (LD)]

My Lords, I think there is a misconception by the noble Lord on how modern general practice works through the electronic patient record. If the report goes to a GP, like any report does, it is clinically coded, and there would be a flag on the patient’s electronic patient record that would indicate to the GP and anyone in that practice that an assisted death had been requested through the co-ordinating doctor. It would not, to use the noble Lord’s words, just be postboxed; it would be automatically registered on the electronic patient record, and a flag would come up for anyone in the GP practice to see what was happening.

[Lord Harper (Con)]

That is a very helpful intervention, and I absolutely accept that. I understand that that is the way it works. Certainly, with the way the NHS works now, you can go on to the NHS app, which many noble Lords may use, access your own patient record and see all those various notifications registered. He is absolutely right that a flag would be raised; the problem is that there is no requirement in the way the Bill is drafted at the moment for that GP practice to do anything as a result of that flag being raised—none at all. I think there should be. We can come on to that, as we progress through the Bill, when we get to Clause 10. That is the point I was trying to raise.

I do not want to go over my time, but I will deal briefly with the points by the noble Baroness, Lady Winterton. I agree with her. It is right that the House scrutinises the Bill properly. If you look at the number of days of debate in the House of Commons, I think there were 11 days in Committee. If you look at the normal way this House conducts itself—because we tend to do a more detailed level of scrutiny than the House of Commons—you would expect, as a rule of thumb, about 16 days of debate in Committee; then we normally have 50% of that on Report and at Third Reading. I do not disagree with her. It may be that this Bill requires more time, and that is clearly a discussion for the sponsor to have with the Government Chief Whip about making that time available. But I think the wrong response is for us to not do our jobs properly, not scrutinise the Bill and not make sure that it is a properly fit piece of legislation to get on to the statute book. That would be the wrong response. If we were to do that, we would be failing in our duty to legislate properly for the people of this country.

[The Lord Bishop of Gloucester]

My Lords, I will speak to these amendments because I want to make a new point. A very vulnerable population that we must continue to remember is the prison population. Although we will deal with the prison population more fully in the group coming up, we must remember that this Bill currently does not exclude prisoners from being eligible. That means we must consider how each issue is likely to play out in a prison setting.

As we have heard extensively, these amendments deal with two main issues: first, access to primary care; and, secondly, how well that primary care physician knows the details of your medical history. The first is very closely related to inequalities and making sure that those who have worse access to care are not more likely to choose assisted dying. The prison population are therefore a key group that must be considered, since their health and access to healthcare are worse than that of the general population. That is evidenced by the recently published report by the Chief Medical Officer.

That report also highlights access to healthcare for those in prison. There is no automatic or compulsory enrolment of prisoners into primary care on the prison estate. Over 20% of the prison population do not complete registration on arrival. For those who do, the service is often slow or inaccessible. According to the Nacro report on physical health in prison, two in five prisoners waited for a month or longer for a GP appointment and one in 13 never got one. According to the Chief Medical Officer’s report, one in three prisoners does not have their full electronic health record available to prison healthcare staff. These are not just statistics. When I visit and talk with prisoners about their well-being and purpose, access to healthcare is always spoken about.

Briefly, I do not believe that the issue of how well a primary care physician knows your medical history has been sufficiently considered from a prison context. If a GP may be the person to conduct a preliminary discussion to consider a person’s application for an assisted death, how will they do that safely with incomplete information about their patient’s health record? We must question eligibility along these lines. Before we talk about the next group of amendments, I hope that there will be important safeguards for prisoners on the issues raised in this group.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Harper (Con)]

My Lords, the flaw in that argument is that not all of the questions for the noble and learned Lord, Lord Falconer, and the Minister have been asked. If they answered some of them now and more were then asked, we would need to hear from them again. That would not help the Committee make progress. It is better that the noble and learned Lord and the Minister hear all of the questions then respond to them.

I listened carefully to the procedural debate yesterday. There was a great deal of concern that one of the reasons for the slow progress of the debate was the fact that many of the questions asked in the debate have not been answered by the Bill’s sponsor; indeed, the sponsor himself recognised that he needed to do better. That is welcome, and we look forward to hearing that later.

--- Later in debate ---

[Lord in Waiting/Government Whip (Lord Lemos) (Lab)]

I do not want to interrupt the noble Lord but I am sure that it will be useful for him to know that the Minister will respond on the question of resources when the time comes.

[Lord Harper (Con)]

That is very good. I am glad that the noble Lord has confirmed that the Minister will respond; I look forward to her doing so.

My final point concerns whether the Bill’s sponsors have carried out the modelling and costings that their proposals will require. Have those been put before this House so that we can make the appropriate decisions?

[Lord Falconer of Thoroton (Lab)]

I am sure that the noble Lord will have read the impact assessment; it is based on the current Bill, which includes the panel, and contains detailed costings for the panel.

[Lord Harper (Con)]

I am aware of that. I want to know whether it will contain detailed costings for the court process. Obviously, I do not know what the noble and learned Lord, Lord Falconer, is going to say, but one of the things discussed yesterday was whether he will accept any of the amendments that have been tabled. The point I am making is that, if he were minded to accept the amendments from the noble Lord, Lord Carlile, which obviously have a cost implication, there is a role for the Government in assessing those costs as well as a role for the sponsors. I am simply asking whether, if the noble and learned Lord were to accept them—he may not, of course—he would also provide the costs to the Committee. At that point, I draw my remarks to a conclusion.

[Lord Hamilton of Epsom (Con)]

My Lords, I will not detain the Committee for very long; the noble Baroness, Lady Hayter, can be reassured that I am not in the business of making a long speech.

I have in the past expressed my concerns to the noble Lord, Lord Carlile, as to whether judges are the best people to make these decisions and whether they can do so against the advice of the contracting doctor. The problem is that the doctor will be absolutely adamant that he is right in his case; I do not see why a judge should be able to overrule that, and I am not at all certain that a panel makes it much better. We should concentrate very much on the question of the contracting doctor; my forthcoming amendments will, I hope, address that point.

The problem is that doctors are sometimes malevolent. I accept that the doctors in this House are dedicated to looking after their patients and the public good, but that is not always the case. There are occasions—the noble Lord, Lord McCrea, referred to them—when doctors get it completely wrong.

I am very pleased that although Esther Rantzen was given six months to live, that was two and a half years ago. She wrote an article in the newspaper saying how much she has enjoyed the extra time that she has been given, although she is an advocate of this Bill. We must accept that doctors get these things wrong, and I think we should be concentrating on the contracting doctor rather than on the process of review.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)]

My Lords, I shall respond to the amendments in the names of the noble Lord, Lord Carlile of Berriew, and the noble Baronesses, Lady Grey-Thompson and Lady Coffey. Some of your Lordships may be aware that I know the noble Lord, Lord Carlile, very well. Indeed, the convention of this House is that I refer to him as “my noble kinsman”. This has given rise to a number of jokes outside this Chamber, but there is a serious point to be made here. I reassure your Lordships that this has no effect on the Government’s neutral analysis of the workability of the amendments in question, and although I have the advantage of having advance notice of my noble kinsman’s position, I have engaged with him as to the Government’s response in no different a way from the way I would with any of your Lordships.

As this is the first time a Minister from the Ministry of Justice has spoken in this debate, I reiterate what has been said on many occasions by my noble friend Lady Merron: the Government’s position is that it is a matter for Parliament to decide the policy which underpins this Bill. It follows that I will not be providing a government view on the merits of any of the amendments, nor will I make any observations in a personal capacity.

I will, however, deal with the question asked by a number of your Lordships as to whether the Government would deliver this, were the will of Parliament to be that the general principle contained in the amendments of the noble Lord, Lord Carlile, were to be adopted. The answer is that, given our current workload, it would of course be challenging; I say this because I am in fact the Family Justice Minister, as well as the Lords Minister. But if it is the will of Parliament, then we will work with the judiciary to make sure that we have the resources in place to deliver what Parliament has decided.

This is a large group of amendments, and it is the Government’s view that—

[Lord Harper (Con)]

On that point, briefly, the Minister made the point about making available the resources to deliver what would be in the Bill. The question I asked her, which the Whip on the Front Bench confirmed she would answer, is: would that have an impact on other users of the court system, or would the Government make available extra resources to deliver what is in the Bill, but without disadvantaging other users of the court system? He did say she would answer.

[Baroness Levitt (Lab)]

He did not intend to say that he would go further than I have just gone. That is confirmed. I would be surprised if he had intended to go further than I intended to go.

With respect to the noble Lord, we are not here to debate what is going on in the family justice system. We are here to debate these amendments, and I am going to stick to that. I am also anxious not to take too many interventions because this is a large group, and there are things the Government want to say about workability. I need to get through them in the time allotted to me.

--- Later in debate ---

[Baroness Levitt (Lab)]

I am sure the Committee entirely endorses what the noble Baroness said in relation to the importance of those who are hearing impaired. I think that, in these circumstances, this is not a matter for the Government; it is a matter for the proposer of the amendment and for the sponsor of the Bill should it be passed. However, the point remains an important one.

[Lord Harper (Con)]

Before the Minister concludes, she has obviously inadvertently omitted to answer the important question that both my noble friend Lord Gove and I asked. This is a resources question and the Whip, of course, confirmed that she would answer it. The Bill, as introduced, had a court system in it. It was reported that the sponsor of the Bill was advised by the Government and the judiciary that it was not possible to deliver that for capacity reasons. Did the Government provide that advice, and if they did, will the Minister publish it?

[Baroness Levitt (Lab)]

I am going to repeat the words that were used by my honourable friend the Minister for Courts in the other place. The decision as to the introduction of the panel was made by the sponsor.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords—

[Lord Harper (Con)]

My Lords, I just want to make one point—

[Noble Lords]

No!

--- Later in debate ---

[Lord Harper (Con)]

No, I am sorry, there is no requirement in the Companion that you can speak in a debate only if you have tabled an amendment. If we want to finish at 3 o’clock, we can either go slightly past 3 o’clock or we can stop at 3 o’clock and resume this group next week. I wish to make one point that has not yet been made and which I think is pertinent to the debate, and I believe I am perfectly in order doing so.

The point is this. Two Members have raised the valuable contribution made in yesterday’s procedural debate by the noble Lord, Lord Stevens of Birmingham—a man who knows what he is talking about on the NHS, as he ran it for a number of years—about the timetable for the Government to publish their modern framework for palliative medicine. He said that, at the moment, that framework is likely to be published after Parliament has considered the Bill, and he felt that that was the wrong way around. The reason that matters is that the Government have published a 10-year plan for the NHS, and nothing in that plan will significantly change the provision of palliative care in England.

We know that only about half the people who require specialist palliative care are able to get it, and that the Bill’s sponsor, the noble and learned Lord, Lord Falconer of Thoroton, believes—or believed and still believes—that good palliative care is a prerequisite for there to be assisted suicide, so I think it very important that the Minister answers the question and confirms that the Government will at least think about publishing the modern framework for palliative care before we get to Report on the Bill, so that this House can make a properly informed decision about the amendments before it on palliative care.

[Lord Blencathra (Con)]

My Lords, this is a self-regulating House, and that does not mean that a Government Whip can regulate who can speak and who cannot. I echo the point made by my noble friend. If the only way one can speak in these debates is to sign amendments, I know what to do in future.

I spoke for five minutes on the Friday before Christmas and said not a peep in the debate earlier today because it was not my speciality. I have been waiting here for two hours to make a speech on palliative care, and we seem to have been refused the right to do so because the Government Whip wants us not to say anything so that we can finish at 3 o’clock. I agree that we can finish at 3 o’clock—it is a simple matter for the House to adjourn and come back to polish off this matter next Friday morning—but it would be absolutely outrageous for noble Lords who have not had a chance to speak at all on palliative care to be refused the right to do so because the Government have imposed an arbitrary timetable on us.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Deben (Con)]

I hope that it was an intervention, because, if so, I am able to comment on it. If we start talking about paternalism, we will go backwards in time. We are not really talking about that at all; we are talking about the legislation of this House and the House of Commons. We are talking about how we produce legislation that works. What worries me is that there are a lot of words being used, such as “paternalism”, “kindness” and others, that are making us less precise. Law has to be precise enough for it to be properly implemented.

Frankly, the intervention of the noble Baroness sums up something else. There is a paternalism among some in this Committee who feel that they are so right about the Bill and that they can therefore ignore the comments of people who are trying very hard to overcome their own prejudices—if that is the right word—to get the Bill right. I find it a bit discomfiting to be lectured to, from time to time, as if I should not be making any of these comments because I do not seem to understand the higher views that are being presented. After being a Member of Parliament for 40 years and knowing what goes on in families in terrible circumstances, all I am trying to do is protect people. That is my job; it has been my job all my life. In response to the noble Baroness shaking her head, I say: that is not paternalism; that is the role of leadership in any circumstances. It is what decent people do, and, above all, it is what kindness demands.

[Lord Harper (Con)]

My Lords, I will speak to two blocks of amendments in this group. Before I turn to that, I just want to pick up on the points that my noble friend Lord Deben made. I strongly agree with the thrust of his speech, and I look forward to the response of the noble and learned Lord, Lord Falconer of Thoroton, to this group, not just to the specific amendments. Perhaps it will give us a sign of how he intends to respond.

I agree that if the noble and learned Lord listens to the concerns of the Committee and sets out clearly on the Floor of the House on the public record what he intends to do about some of them, that is the best way, from his point of view, to make progress. It is important that those commitments are made on the Floor of the House in public, rather than in private meetings. That is how Ministers generally conduct themselves when they discuss concerns with Back-Benchers. They might have meetings to discuss those concern, but, certainly when I was a Minister, I was always expected to set out at the Dispatch Box what I was committing to do on behalf of the Government so that people were confident that we all had an agreement and that it could not be walked back. Given that we are in a slightly different situation here, because it is a Private Member’s Bill and the noble and learned Lord is the sponsor, I would expect him to behave in the same way as a Minister piloting a Bill to give that level of public transparency, and I hope he will be able to do so.

I will pick up on what my noble friend Lord Deben said in response to the noble Baroness, Lady Jay of Paddington. I agree with her that we should not be paternalistic, but I do not agree that that is what we are in danger of doing. This group of amendments is about making sure that other people are not making decisions on behalf of the individual who is going to end up losing their life. This is about making sure it is actually their decision, that they are not being pressured into it and that someone is not making it on their behalf. Allowing somebody else to allow someone to be killed is the paternalistic thing—to turn a blind eye to it and do nothing about it. To make sure that it is genuinely that individual’s settled will is the opposite of paternalism. That is what we are trying to do in this group of amendments.

The first amendment I want briefly to refer to is Amendment 28 in the name of the noble Baroness, Lady Finlay of Llandaff. It is about setting out in the eligibility criteria that someone is entitled to benefits under the special rules, for example, personal independence payment on the grounds of terminal illness. I accept that the noble and learned Lord, Lord Falconer, may quibble with the wording, but the point is to make sure that the person has gone through that process to apply for that benefit to make sure that one of the reasons they are seeking assisted suicide is not because of financial pressure. There may be other ways of achieving that, but that is the purpose of the amendment, and that is very important.

The Committee will be aware that under our rules for personal independence payment, if you have a terminal illness diagnosis, there is a fast-track procedure, rightly, so that you can get financial support much quicker than under the normal process. That is very important to ensure that someone facing a terminal diagnosis does not have financial pressures added to all the other things they are dealing with. The amendment is a sensible way of ensuring that someone has got that financial support and to make sure that is not the reason they are seeking assisted suicide.

Secondly, I support Amendment 31 and Amendments 68 and 68A, to which I have attached my name. They would make sure that it is genuinely somebody’s own request. The reason why that is important is—we will hear from the noble and learned Lord in a minute about whether he thinks the drafting of the Bill already deals with this—that I am very mindful of the issue that we hear about pretty much every week, and I suspect we will hear it again today from the Minister, who usually has an extensive piece in her briefing that counsels us on concerns about the European Convention on Human Rights and the extent to which decisions that this Committee takes might end up being challenged under that legislation and that we should bear that in mind.

I always listen to the Minister with care, and I am effectively doing what she is asking us to do, which is to be concerned about that issue. Even if the noble and learned Lord, Lord Falconer of Thoroton, is able to assure us that, in his view, the Bill as drafted does not present that risk, I still want him to look seriously at these amendments because of my concern—which we have seen in other jurisdictions—about judicial oversight and judicial moving of the goalposts. This legislation will inevitably be challenged, and I want to make sure that we do not find judges starting to move the goalposts when there are challenges and allowing things to happen that we would not have wanted to happen.

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[Baroness Butler-Sloss (CB)]

My Lords, I very strongly support what the noble Lord, Lord Deben, said. I would just like to correct something that the noble and learned Lord, Lord Falconer of Thoroton, said in his email yesterday, I think. I am extremely anxious to get this Bill through to Third Reading, but I profoundly dislike it, and I never said that I wanted to get it right the way through to the House of Commons. I just wanted to put that right.

I doubt the point made by the noble Lord, Lord Harper, that judges would be moving the goalposts. I think he is in a different world from me. Having been a judge, I do not remember ever moving the goalposts; it is only when the law is uncertain that judges, from time to time, have to come to decisions.

[Lord Harper (Con)]

I am very grateful to the noble and learned Baroness and, of course, I defer to her knowledge of the law. The point I am making, which I think is the same point, is that we should make sure that the legislation is absolutely clear, so that there is no risk of that. The other issue, of course, is that so much of this legislation is not in statute but left to regulations, which are much easier for judges to challenge than primary legislation.

[Baroness Butler-Sloss (CB)]

I am not at all sure that they are. If Parliament has passed regulations or primary legislation, judges apply it; they certainly do not try to move the goalposts. That is the only point I am making.

The last point I want to make is that as the recipient of a lasting power of attorney, which is in the hands of my children, I certainly do not want them to decide when I die.

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[Lord Markham (Con)]

This whole debate shows that these are not black and white matters. Although they are all relevant criteria, which absolutely should be in the assessment—my understanding from the Bill is that they are in the assessment—it should not be put down as some sort of tick-box exercise that says you are either eligible or not, according to them.

[Lord Harper (Con)]

May I just check: is the noble Lord, Lord Markham, really saying that he wants it to be open so that a lasting power of attorney could be used by somebody else to seek the death of the person on behalf of whom they have that power? Does he want that to be available? I do not think he does, and it appeared that the noble and learned Lord, Lord Falconer, did not either. If we do not think it should be, we should rule it out.

[Lord Markham (Con)]

What I am trying to come back to—a point that my noble friend Lord Deben was making—is that there are some valid criteria here. I am trying to build some flexibility into this system. Lots of eligibility criteria are being set out here, in all these different amendments.

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[Lord Falconer of Thoroton (Lab)]

“Available” in that context obviously means available in a practical sense for that particular patient. If you live in the western part of England and there is palliative care of a particular sort available in a place you cannot access, that would not be “available”.

My noble friend Lady Merron indicated what the effect of Amendment 28 is, which was again proposed by the noble Baroness, Lady Finlay. The effect is that there are two additional requirements before you are eligible for an assisted death: first, that you are eligible for certain specific benefits available at end of life; and, secondly, that there has been a home visit by a GP to consider it.

Neither of those is appropriate for eligibility requirements for an assisted death. As my noble friend Lady Merron said, you might well not be eligible for particular benefits because, for example, they are means tested and you are above the means. It would be wholly wrong for that to prevent you getting an assisted death if you are otherwise entitled to it. Again, I do not think that the purpose of the noble Baroness, Lady Finlay, advancing that provision was to say, “You’ve got to satisfy these specific requirements”, with all the problems my noble friend Lady Merron indicated.

What I think she was getting at is that you have to be sure that financial circumstance—being short of money—is not a relevant reason for an assisted death. I put forward the Bill on the basis that choice is the key thing. Your financial position might be an element in what makes you reach a decision. From the way that the safeguards are put in the Bill, they are trying to ensure it is your decision, freely made.

[Lord Harper (Con)]

I am slightly incredulous about this, so I am just going to make sure I understand the noble and learned Lord correctly. As we also heard earlier from the noble Baroness, Lady Jay, he is talking about someone’s autonomy. If you are in a financial position where you feel you are unable to live properly because you have no money, and as a result of that you decide you want to end your life, that is not a freely reached decision; that is being done because of your circumstances. Is he really saying that he is okay with poor people ending their lives, with the assistance of others, because they are poor? That is what it sounds like. All we are talking about with these amendments is putting in provisions to make sure that is not the case. That is not paternalistic; it is protecting people. Exactly as my noble friend Lord Deben said, that is what we should be doing in this House.

[Lord Falconer of Thoroton (Lab)]

I am saying that what the Bill does is allow you to make your own decision. I am strongly against saying poor people should not have that choice, which appears to be what the noble Lord, Lord Harper, is saying. The evidence from abroad is that it is people from perhaps more financially secure circumstances who make this sort of choice.

[Lord Harper (Con)]

I am going to come back once more, because the noble and learned Lord suggested why I was saying what I was saying, which is absolutely not the case. What I am saying is that if someone is making the decision because they feel pressured because of their financial circumstances, that is not a free choice; that is a choice that is being forced upon someone by their circumstances. They are not in an equal position to someone with resources. That would be very wrong, and I think people would be horrified that he is suggesting that someone, because of their financial circumstances, should be more likely to end their life than someone else.

[Lord Falconer of Thoroton (Lab)]

I am saying it is their choice.

I will go on to Amendment 31 in the name of the noble Baroness, Lady Ritchie of Downpatrick, referred to by the noble Baroness, Lady Berger, in relation to the issue. The noble Baroness, Lady Berger, is saying on behalf of the noble Baroness, Lady Ritchie of Downpatrick, that it must be their own request for an assisted death. The whole Bill is posited on the proposition that the person making the request has to be doing it as their own free choice. I draw attention in that respect to Clause 1(1)(a),

“has the capacity to make a decision to end their own life”,

then Clause 1(2),

“has a clear, settled and informed wish to end their own life, and … has made the decision that they wish to end their own life voluntarily and has not been coerced”.

Then, if one goes over the page to the conditions, there is Clause 8(1):

“A person who wishes to be provided with assistance … must make a declaration to that effect”.


The only concession made is in Clause 21 on the declaration. Clause 21(1) states:

“This section applies where a person intending to make a first declaration or a second declaration … declares to a proxy that they are unable to sign their own name”.


It allows a proxy to sign their name. The noble Baroness, Lady Berger, and I are both saying that it has to be you who does it, the person who wants it, the patient. My own view, having consulted on this, is that that is absolutely clear under the Bill and that the terms of the amendment would make absolutely no difference to it legally. I make clear that the policy intent that the noble Baroness, Lady Berger, wishes to achieve is exactly the policy intent that has been achieved.

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[Baroness Whitaker (Lab)]

My Lords, in connection with Amendment 30, I will just say, in a point of distinction to some of the speeches, that if I were interested in having an assisted death, part of the reason would most definitely be that I would not want to be a burden on my family. I have told my children this. They perfectly understand and I trust them to carry out my wishes. If I do not have any more pleasure in living, I most particularly do not want to add to the burden on my family. It seems to me that that is one of the perfectly good reasons to have an assisted death.

[Lord Harper (Con)]

My Lords, I will touch on Amendments 30, 56 and 57, the latter two to which I have attached my name. Before I launch into my arguments, it is, if I may say so, a delight for me to see the noble Baroness, Lady Campbell of Surbiton, in her place after an unavoidable absence. She and I worked very closely when I was shadow Minister for Disabled People. I found her insight and lived experience, and her willingness to spend time with me on improving my knowledge of disability, extraordinarily helpful. I was grateful to her for the time that she was willing to spend. I am pleased to see her here in this important debate.

The latter contribution I thought was helpful. It goes to the heart of two issues: what the Bill is about and whether the promoters of the Bill are being entirely straightforward about what it is about. The Bill is called the Terminally Ill Adults (End of Life) Bill, and the primary requirement is that you have a terminal diagnosis. The arguments made for it are almost entirely around preventing people suffering or having physical pain. However, as has been pointed out, that is currently not anywhere a requirement in the legislation.

Sometimes supporters of the Bill do not make that argument. Instead, they focus on autonomy, as the noble Baroness, Lady Jay of Paddington, did this morning, or on choice, as the noble and learned Lord, Lord Falconer, did in response to my challenging him on someone’s financial circumstances. We should be very straightforward. If the promoters of this Bill are arguing that it is entirely about somebody’s choice, they should be very straightforward about it. They should not argue that people have to be suffering and that this is about relieving it—which, as my noble friend Lady Fox said, is what compassionate and kind people think is the motivation for this legislation. If they think it should be open to anybody regardless of motivation, they should say so. It is very helpful when some of them are prepared to say that, because it makes what this is about more straightforward.

This goes to the heart of why many of us have concerns. We know this will get challenged in the courts and be expanded, because that has happened everywhere else. As I said earlier, the Minister keeps telling us about the human rights provisions. They will absolutely be used, if not to change what is in the Bill, to widen and challenge the regulations made under it. That is why so many of us want more safeguards on the face of it and not left to statutory instruments, which we know judges are very happy to change and strike down.

It will get expanded, so the proposed new clauses we have put down about the motivations are important. If it is about choice, it has to be a real choice. For people to have genuine choices, they cannot be forced by circumstance into making them. I was exercised with the noble and learned Lord, Lord Falconer, earlier because somebody might have enormous pressures on them—financial, housing, feeling like a burden or, as others have said, wishing financial resources to go their families. Some think those are perfectly fine reasons for somebody to have an assisted suicide. I do not, and I think most members of the public do not think those are reasons for somebody to kill themselves or seek to have others help kill them. We should just be honest about it. If noble Lords think that is fine, they should say so and we will see whether that argument carries water.

People are not making that argument; it is about whether you are suffering. If noble Lords think that is the critical matter, they should put it in the Bill and make it so that you can get assistance with your suicide only if you are suffering and in pain, and that is the reason for your seeking this course of action. If it is one of the other things, we should rule it out. If you are not prepared to rule it out, it becomes clearer what this is really about.

That goes to the point made by my noble friend Lord Shinkwin and why so many of us have concerns. The remarks I made at Second Reading are absolutely highlighted by these amendments. Not a single organisation of or for disabled people supports this legislation, because they are concerned about two things. As my noble friend said, they are concerned that, because so many disabled people are made to feel that they are a burden or, because of the costs of their disability, have financial or housing pressures that others do not have, they will feel forced into seeking an assisted suicide when that is not really what they want. Secondly, they are concerned that, if society decides that it is okay for you to get help in ending your life because you feel you are a burden or do not want to cause problems for other people, that fundamentally changes how society treats and looks after disabled people. Instead of wanting them to live well and have great lives, and being prepared to find the resources for them to do so, we would rather they were not here. That is the message they are getting.

These groups of amendments make it very clear that this legislation is about alleviating suffering and pain; it is not about the other things. That is why I strongly support these amendments and I hope that, in his response, the noble and learned Lord, Lord Falconer, will recognise that those are the reasons why so many people take a different view from him, If he limited the provisions of the Bill to people who are in pain or suffering, it would reassure the many disabled people in this country who are terrified that the passage of this legislation will fundamentally alter their lives for the worse.

[Baroness Grey-Thompson (CB)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Harper; when he was a Minister, we had many interesting discussions, although they were possibly not as collaborative as those with my noble friend Lady Campbell. This group talks about motivation and I am sure we are going to be told that these people have terminal conditions and they are dying anyway. We have to understand, however, that there may be a number of other motivations that are part of this.

The noble Lord, Lord Harper, as a non-disabled person—I assume—highlighted many of the reasons why disabled people are very worried about this Bill. We look at what happens in other jurisdictions around the world, including Oregon, Washington, Belgium and Holland. Australia is one of the newer jurisdictions, having recently changed the law, and it has surprisingly high figures on the number of people who request assisted dying because they feel they are a burden. In western Australia in 2022-23, 35.3% of people who requested an assisted death did so because they felt they were a burden. In 2023-24, that figure was 32.2%.

We have to understand that, unfortunately, in the UK currently, the health and social care system is broken for many people. The fact that a person might not be able to get good social care, a job or access to work could add layer on layer to a reason why someone might request an assisted death.

I am told that it is not for disabled people, and I am not suggesting we draw up a list of every single condition of people who would qualify or not. I have spoken many times in the Chamber about how people assumed I would want to change the law because someone with my condition would probably rather be dead than alive. My condition is spina bifida. I assume that I would not be eligible for an assisted death because of that, but, if I got a pressure sore, I would very easily and quickly fit it into that six-month diagnosis.

I have lost many friends through pressure sores, one of whom I was in school with. She also had spina bifida and had a pressure sore on the base of her spine, and one problem with it developing so rapidly was that she did not feel it: she was paralysed and did not realise she had it. It was discovered by the smell. As soon as it was discovered, a number of people around suddenly started talking very differently about that young woman’s life: about how, basically, she would be better off dead, because it was never going to heal.

This is why disabled people are so fearful. If the law changes, it does not matter whether there is one doctor or two in the assessment process—which I do not believe is anywhere near strong enough currently. There will always be ableist doctors out there who would very quickly think and agree that we would be better off not being around.

Let us look at other jurisdictions and the number of people there who choose to end their lives. When I talk to people outside, they assume we are talking about cancer and leukaemia, not lots of other conditions. But in Belgium, for example, the official figures from last year show that 54% of people who requested an assisted death had cancer; 26.8%, however, had polypathology. Now, I am not a medic, so that sounds like an interesting combination of conditions. Actually, though, what is included in those figures is being tired of life.

This comes back to the debate we had in the previous group about the equality impact assessment. That is based on the first 10 years of Oregon, where the numbers were very low because there was no social media and people did not know about it. This provides more evidence of why the Government need to reconsider looking at the impact assessment to actually understand the numbers that might be involved. The noble Lord, Lord Harper, is absolutely right: we need to be honest about what we are doing here, not wrapping it up in euphemisms and easy soundbites. I have said consistently that, when you do an interview about the Bill, it is not easy to lay down every single reason in four minutes as to why a number of people have many concerns with the Bill.

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[Lord Falconer of Thoroton (Lab)]

I am grateful to noble Lords who have contributed to this debate. I will make four quick preliminary points.

First, I join everybody in welcoming back the noble Baroness, Lady Campbell of Surbiton. The noble Baroness, Lady Campbell of Surbiton, and I have been debating this for at least 20 years, or maybe longer. It is very good that she is still with us and doing it in the same way.

Secondly, I mean no disrespect to the noble Baroness, Lady Monckton of Dallington Forest, but I will not deal with the points that she made because in a sense—and I quite understand why—they have nothing to do with these particular amendments, which she acknowledged. However, I am more than happy to talk to her about the process issues and I would welcome a conversation with her.

Thirdly, the noble Baroness, Lady Finlay of Llandaff, asked whether it is a medical procedure and whether it is part of the range of treatments that have to be offered or discussed with the patient. In relation to whether it is a medical procedure, the noble Baroness will know that the Bill provides that the actual provision of assistance has to be given by a doctor. I do not know what the consequences are in relation to either the medical or the legal world, but that is the medical connection.

In relation to whether it has to be raised if it is a possible medical procedure, the answer is unequivocally not, because the Bill specifically provides in Clause 5(1) that:

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


So the matter is put completely beyond doubt in the Bill.

I turn to the substance of the amendments, which fall into three categories. The first is the amendment ably moved by the noble Lord, Lord Weir, to the effect that certain motivations, if they exist, should ban or prohibit an assisted death. Secondly, an amendment says that the only circumstances in which you can have an assisted death are when you are acting for your own sake rather than for the benefit of others. The third category is where you are acting for the primary purpose of avoiding physical pain. All the amendments in this group are designed to try to limit it to certain permitted motivations only.

I want to adopt completely the speech of the noble Lord, Lord Markham, who described what the Bill is seeking to do: to give people who are diagnosed as having six months or less to live the choice about how their life ends in those six months. The choice they make may be motivated by a whole range of factors. The pain may be too much. They may not be able to bear the thought of being reliant on their children, not because they see themselves as a burden but because the whole change in the relationship is just unbearable. They may not want to go through that period while they await death and there is nothing else. They may find the whole sense that they are incurring expenditure for somebody else so awful for them that it makes them feel bad and they do not want to go through it.

I go through all those possibilities simply to indicate that the reasons why you may want an assisted death vary from person to person. From my own experience, it is very often what we would regard as pain and suffering that causes it, but what causes distress or unbearability to people is not always, and may not often be, the pain or the suffering; it is the whole circumstances in which they find themselves during that last six months.

There is an incredibly good article by somebody on what their mother, who had all the access to palliative care, said was awful about their circumstances. All the pain relief was there and everybody had come to say goodbye, but then weeks went by when there was nothing but staring at the wall in a period of not quite being able to engage with other people and wanting it to end. Would they qualify if, for example, pain and suffering was the requirement? No pain would be identified. The suffering would come from the unbearability of it.

The Bill is constructed on the basis that the person who has six months or less to live should have the choice. There are ideas to bring in these particular things. Do they feel they are a burden to somebody? Do financial considerations apply? They might well apply because there is only a limited amount of money to go around, so they might contribute. Is the panel or the doctor supposed to parse the precise part that every one of these motivations plays? In my view, that would be a very bad way of constructing the Bill. I am very happy to explain how I got there. I think it is a choice, and pain and suffering will often be the choice. If you are serious about putting the patient first, you have to give them the choice and not be in a position where you are trying to look into a whole range of multiple motivations.

[Lord Harper (Con)]

I am grateful to the noble and learned Lord for once again giving way. Can I just press him on this choice point? Although I do not agree with the Bill, there is an argument to be made for giving people a completely free choice, but does he accept that many people in society have many constraints on their ability to make choices? These amendments are trying to make sure they are making a free choice, not one that has been constrained by their other circumstances. Does the noble and learned Lord accept that it is a problem if someone has all these constraints on them and is not really making a free and unconstrained choice, which many people in this Committee would be able to make? Does he even accept that it is a problem that, although it may be difficult, potentially needs fixing?

[Lord Falconer of Thoroton (Lab)]

It is very difficult and would be inappropriate to try to examine exactly why people make particular choices. Look at the first Amendment 30 proposal:

“not wanting to be a burden on others or on public services”.

Why does the thought that they are going to be a burden on their children become an unbearable thing for some people to go through? They might make that choice because of what has gone on in their lives, but it is totally inappropriate, impossible and wrong in a Bill such as this to say that we have to ask why they are in that position.

The next proposal refers to a mental disorder—

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[Lord Winston (Lab)]

Many years ago, the noble and learned Lord, Lord Falconer of Thoroton, introduced a similar Bill. I, very misguidedly, introduced an amendment to the title of the Bill; I suggested that the word “euthanasia” should be in the Bill. I did this without believing either that the Bill should pass or that it should fail—I was genuinely uncertain—but, earlier that week, I had talked to a 16 year-old schoolgirl in a school. In the short conversation we had, she asked, “Do you think we always feel that we have to go for and strive for perfection?” I found that very difficult to answer, so I pondered on it.

One of the issues here is exactly what the noble Lord, Lord Frost, has just shown. He tried to demonstrate that there are no absolute meanings of words. In that case, I used Greek, but this is something that we need to go beyond now. These words will mean different things to different people. We waste a lot of time doing this sort of meddling with language when it is unnecessary and when there is no issue with the legal quality of the Bill, which, of course, must be paramount. It is clear that the language we have at the moment is undoubtedly intelligible and largely workable.

[Lord Harper (Con)]

My Lords, let my start by picking up the point that was just made by the noble Lord, Lord Winston. We should be plain and simple in saying what is going on. In effect, the Bill’s central purposes are to amend the Suicide Act and to legalise somebody’s ability to assist someone else in killing themselves. We should be frank about that; that is what we are doing. If people find us being clear and speaking plainly about what we are doing either uncomfortable or distressing, that should make us pause and ask ourselves whether what we are doing is the right thing. We should not change the language to make the thing that we are doing more palatable. We should speak plainly about it then judge accordingly.

There are some real consequences. One of them was set out by my noble friend Lord Shinkwin when he referred to people with learning disabilities. The noble and learned Lord, Lord Falconer, will correct me if I have got this wrong, but I think that, when he gave evidence to the committee, he was clear that he wanted someone with a learning disability to have the same ability to access assisted suicide as anybody else, assuming that they meet the other eligibility criteria. My noble friend Lord Shinkwin put it very well when he said that people with learning disabilities need to have things explained in clear and straightforward language. That is really important.

In an earlier debate, my noble friend Lord Markham talked about relying on the experts, but we cannot do that because we know that they do not always make the right decision. We know that, during the Covid pandemic, many people with learning disabilities were given “Do not resuscitate” notices because some people had made the decision that their lives were not as worthwhile as others. People made decisions about them that they would not have made about somebody who did not have a learning disability. It is important that we make sure that the language we use about this decision, which could not be more important, is understandable and that the consequences are understandable for everybody who will be impacted by such a decision. My noble friend Lord Shinkwin made that point well.

My noble friend Lord Frost has already made the point about the use of the phrase “committing suicide”; I reflected on it before I signed his amendment. Personally, I do not like using that phrase—the “commit” piece, not the “suicide” piece—so I paused before I signed his amendment. However, I thought that having a debate and pressing on clarity was important. Obviously, we are in Committee. If my noble friend were to bring forward these amendments on Report, I would want to work with him on the language. I think that removing “commit” would be better because, as my noble friend correctly said, the Suicide Act has removed that vocabulary.

But using the word “suicide” is accurate. Just because somebody has a terminal illness, that does not mean that in taking their own life they are not committing suicide. It is important because it gets through to people the consequence of what we are doing here and the fundamental reshaping we are doing to the way in which society looks at this. That is why so many of us are concerned about it.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

I hope that the sponsors of the Bill will be persuaded of the benefits of the additional measures that we propose, which no doubt can be improved even further through dialogue before Report, not least with those who have concerns about the Bill. I conclude by asserting that we should put no obstacle in the way of someone of sound mind, of a settled view, in deep distress, with death imminent, being allowed a dignified ending to their life on earth, at a moment of their choosing. I beg to move.

[Lord Harper (Con)]

My Lords, I thought we were taking the remote contributors first. If we are not, since there are amendments from my noble friend Lord Mackinlay of Richborough to which I have attached my name—he is unable to be here today; he sends his apologies and has asked me to speak to his amendments—I will speak to Amendments 223A, 223B, 223C, 495A, 771ZZA and 771ZA. For the avoidance of doubt, I am perfectly happy to take any interventions, if anybody wants to ask me any questions, if anything I am saying is not clear or if anyone wants to challenge my arguments.

The primary reason for these amendments, as was ably explained by the noble Lord, Lord Birt, is that the Bill does not really give the patient choice. It is designed to preference one option—that of seeking assisted suicide—rather than to help the patient navigate all the options that may be available to them.

There were limits on the way my noble friend could table his amendments. The advice that we received was that any amendments requiring a personal navigator to help secure or facilitate access to palliative, hospice or other end-of-life care, as an end in itself, were out of scope because the Bill’s collective purpose is provision for assisted suicide, not the wider delivery or co-ordination of end-of-life care. So amendments were admissible only where consideration of alternatives were explicitly tied to eligibility for or progression within the assisted suicide process. If anyone has any criticisms at this stage of the way that my noble friend’s amendments are drafted, I say that they are drafted in such a way as to fit with the advice that we received, so I will be perfectly happy to take criticisms of the drafting on the chin.

I start with a point that the noble Lord, Lord Birt, acknowledged in his opening remarks. He said that it was of great importance that there is universally available palliative care. He went on to say that, in his experience of talking to people, even where that palliative care was available, it did not always do the job that the person required it to. However, he skated over the fact that high-quality palliative care is not universally available. In the debates that we have had so far, to which the noble Lord, Lord Birt, referred, many of us have thought that, if high-quality palliative care is not available as part of the choice that you face, seeking assisted suicide is not the result of a proper, freely reached choice, because you do not have all the range of things in front of you. I think I am right in saying that, when the noble and learned Lord, Lord Falconer, was tested on that, he accepted that you have to make your decision based on the choices that are actually available to you. Many of us think we should actually be trying to make sure that everyone has access to that high-quality palliative care and understanding that should be part of this process.

The point of the amendments that we have tabled is to try to ensure that this navigator does not just have a conversation at the beginning; if you seek palliative care and it is not available to you in the normal course of events, this person could help you seek that, rather than being able only to help you seek assisted suicide. They can help you get the full range of choices that you might wish were available to you because, if they were, you might make a different choice. So that is the purpose of the amendments.

[Baroness Berger (Lab)]

This is a point of clarification about access to high-quality palliative care. It should also be about timely access, because we know that, even in the parts of the country where high-quality palliative care exists, around 100,000 people do not get it at a time that would amplify it and ensure that they get the maximum benefits.

[Lord Harper (Con)]

I am grateful for that intervention; it is a very good point. The importance of it is emphasised by one of the points that the noble Lord, Lord Birt, made in his opening remarks: that many people do not seek to make decisions on these matters until quite late in the process. If you were facing considerable pain as a result of your medical situation, not only might you not think about assisted suicide early on but, if it not available in your area, you may not have sought high-quality palliative care early enough. Again, that needs to be available at pace, as well as the choice of assisted suicide.

The second reason why I think these amendments are important is this. I do not know whether I am the only noble Lord to have thought this, but it does seem odd that what we are, or the noble Lord is, proposing here is a personalised service, I presume funded by the taxpayer—the noble Lord nods his assent—which would support somebody in a very personal, individual way to seek one particular outcome. But as far as I am aware, unless something happens in the National Health Service that I am not aware of, we do not offer a personal navigator to help somebody with their journey through seeking medical treatment that will actually help them live and live well, and it just seems to me a slightly odd sense of priorities that we are proposing to put in place a service that is only available to help somebody die.

[Lord Deben (Con)]

I wonder whether my noble friend could think a little bit about the money involved in this. I am sorry—it sounds a bit odd, but I do feel very strongly that we ought to talk about how much all this is going to cost and where that money is coming from. In the very unsatisfactory answers from the Minister, who gave the opinions earlier on in previous arrangements, I asked directly whether she would assure the House that this money was additional money, rather than money that would otherwise come from the National Health Service. I wonder whether my noble friend would think to himself about the extra cost that this would mean. Where would it come from, and why are we not spending it on a lively attitude, which is to help people when they are ill with better palliative care, instead of going in for this death concept?

[Lord Harper (Con)]

I am grateful for my noble friend’s comments, and he is right: we had an extensive exchange on this subject on a previous Friday, and I am sure the Minister will correct me if my interpretation of what one of her ministerial colleagues said was incorrect, but it was very clear when I asked whether the Government were going to fund anything in the Bill. The Minister confirmed that, if Parliament were to choose to pass the Bill, the Government would indeed fund it and make sure it could be delivered. But when I asked the Minister whether that funding would be extra funding from the Treasury or would be taken from other parts of the public services—I think this was in the context of the extensive debate we had on the proposals on the court system by the noble Lord, Lord Carlile—it was made very clear that that assurance was not given. I am afraid that the only conclusion I could come to, which was not challenged by the Minister—if she thinks I have got it wrong, she is welcome to intervene—was that the money would come from other parts of the public services.

I have to say for myself that, if this assisted dying navigator proposal were to be funded by taking money away from NHS services to pay for it, I think people would find that quite extraordinary. I personally would find it indefensible that we were, again, taking money away from services to help people live to pay for a service to help them die. That would show a very odd sense of priorities. When the Minister responds, because she is the only one who can answer this question, not the sponsor of the Bill, because he is not, as far as I am aware, responsible for His Majesty’s Treasury, I hope she can tell us—

[Lord Markham (Con)]

My Lords, I think I heard my noble friend say that NHS resources should be used just to help people live. Of course, we would all agree that is a very important thing, but surely palliative care is all about helping people to die comfortably, which I think we all believe in as well. Given that, maybe my noble friend would agree that helping people to die comfortably, such as through palliative care, is a very good way to spend NHS resources as well.

[Lord Harper (Con)]

I agree that palliative care is a very good way to spend NHS resources, to help people live the rest of their lives in as comfortable a way as possible; it is not about accelerating their demise. That is a fundamentally different thing. In the exchange towards the end of our debate last week between my noble friend Lord Markham and my noble friend Lady Finlay about what palliative care is and is not, we had that, and I think it came out very clearly.

I do not wish to overstep the time available to me. The purpose of the amendments is to challenge some of the premises of the proposal set out by the noble Lord, Lord Birt. I hope I have set out some of the concerns that we have, and I hope that the House will support the amendments I have supported on the Order Paper.

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[Baroness Coffey (Con)]

My Lords, I shall speak to Amendments 287A, 287B and 771ZB. I call the noble Lord, Lord Birt, my noble friend. We went to the same school, although admittedly not at the same time. I am conscious that he has come at this with an approach of a lot of research, as he set out. The noble Lord knows that I disagree with him, but I understand why he is trying to speed up. However, I wonder whether he has taken account of evidence presented already. The noble Baroness, Lady Fox of Buckley, talked about the CEO of Mind, but also Marie Curie spoke about this and indeed the Royal College of Psychiatrists.

I am particularly thinking of the speeding up and that moment of reflection, which is really important. I think the noble Lord is already suggesting in his Amendment 771 that patients should be aware of their right to withdraw from the assistance process at any stage. There is quite a lot in here that sets out a framework that could be done through the NHS. I completely agree with what the noble Lords, Lord Stevens of Birmingham and Lord Mawson, have said: it worries me that, if this ends up in the NHS, it will accelerate in becoming a routine end of life. In my meetings with the Royal College of GPs, it has been clear that it does not want this to be part of the NHS and it would absolutely resist it being part of the NHS contract.

[Lord Harper (Con)]

On that point, and the point raised earlier about a conflict of interest, one of the problems if this is in the NHS is the money. The cost of the drugs to end someone’s life, according to the impact assessment, is £14.78, but the saving you would make from four months of healthcare not used would be £13,075, and anyone with any experience of NHS budgets knows that that contrast would inevitably drive people to being pointed towards assisted suicide.

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[Lord Empey (UUP)]

I have to say that that was not my intention—the noble and learned Lord knows that perfectly well. I raised the point merely to indicate the length of time that this is taking and that a lot of the proposals and amendments on the Marshalled List could be addressed if we had amendments put forward by the noble and learned Lord, which he indicated in an email last week would be forthcoming. They are not here.

[Lord Harper (Con)]

I think that the reason why the noble Lord, Lord Birt, has put down these amendments is that it is not clear, from what the Government have said or what the Bill says, where this service is supposed to be—I see that the noble Lord, Lord Birt, is nodding at that. If the sponsor of the Bill had set out in the Bill more detail about how it would work and where it would sit, if there had been a proper process, many of the amendments from people with concerns would need to have been tabled and we would be moving faster. It is because of that gap and that failure, which is the sponsor’s responsibility, that this is taking a long time. It is necessary scrutiny to get the Bill right. That is what the public would expect of us.

[Lord Deben (Con)]

My Lords, I think that we can clear quite a number of these things away by taking one central issue. The big problem about being in government is that it is not a single issue that faces you; it is a whole range of issues, and you have to get a balance between them. When we talk about cost, it is perfectly possible to say that there is a majority of people who want this thing, and there is a majority of people who want that thing. The Minister and the Government have to decide how to share out the money that is available between those things. That is crucial to any decision made by this House. My concern is that we are not facing up to that. This is a single issue being presented to the House as if it can make decisions about single issues, irrespective of the effect of the decision on all the rest of the single issues that people also have strong views about.

If you asked the public whether they wanted more money for palliative care, they would almost universally say yes. If you asked the public whether they wanted a National Health Service where they could get an appointment with their GP within a week, they would say yes. If you asked the public whether they wanted a National Health Service where there was someone who could help them through complicated arrangements, they would say yes. The problem for this House is that we have to decide, first of all, what burden these proposals place on the National Health Service, the judicial service and the Government as a whole.

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[Lord Kamall (Con)]

Sorry, I will try to hasten it, actually, in many ways. Maybe we should slow down.

I start by thanking the noble Lord, Lord Birt, for the amendments in the group and the whole idea of establishing the assisted dying help service. As the noble Lord said, it is based on well-established experience. It seeks to address a number of important questions that the current draft of the Bill does not address. How will important services, such as care for the families of those who are seeking assistance under the Bill, be provided? Who will publish the appropriate information about the provisions of the Bill in the public domain? How will those seeking assistance be supported throughout the process? These are thoughtful amendments, but a number of noble Lords have quite rightly raised concerns about the potential downside to speed and efficiency in this case.

The amendments in the name of my noble friend Lord Mackinlay seek to ensure that when a personal navigator is allocated to the person seeking assistance—that sounds like a good suggestion—there must not be a presumption that, when they appoint that navigator, the person will necessarily continue with the process to its end. That gives the person who seeks it the option of changing their mind.

A number of the issues that we have discussed today have been discussed throughout the passage of the Bill. I have a number of questions; they are more for the Minister than the Bill’s sponsor, but I think that many noble Lords have questions for the Minister.

On the specific matter of the assisted dying help service, as well as the duty to publish information on the Act’s provisions, what consideration have the Government given to the interaction between the legitimate dissemination of information about assistance with ending one’s life and the encouragement of suicide, as prohibited by law under the Suicide Act 1961? I know that this issue came up very early on but, in this specific context, it is worth repeating.

A number of noble Lords have rightly asked about the workability of the help service, including what the cost of managing the service and the other running costs might be. Do Ministers feel that resourcing the service adequately might undermine the effective delivery of other parts of government? As a number of noble Lords have said, the Government have not really answered those questions about the available resources and where the money will come from. Once again, I am taken back to Second Reading, when the noble Lords, Lord Stevens and Lord Hunt of Kings Heath—the latter being a former Health Minister—both said, “We know how the system works. This money will come from somewhere, and it will be at the expense of palliative care”. We are assured by those who support the Bill that that will not be the case; indeed, Ministers have themselves said that sufficient money will be made available. However, a couple of weeks ago, I asked almost the same question as my noble friend Lord Deben asked—albeit in a less eloquent way—of the Minister from the Ministry of Justice, and, last week, of the Minister from the Department of Health. To be fair to the Government, I received an answer from the Minister; if noble Lords allow me, I will touch on a few extracts from that letter and paraphrase where possible. The Minister’s letter to me said

“you sought confirmation that the Government is confident that palliative care will be sufficiently funded, so that those who may seek assisted dying services are offered a real, as opposed to theoretical, choice on palliative care to support them making a more informed decision”.

So far, so good. As my noble friend Lord Gove said, the letter talks about support for the hospice sector, including £100 million for adults and £80 million for children—I almost sound like a Minister responding here, I know, but we have to be fair when we challenge the Government on this. The Minister also mentioned the all-age palliative care and end-of-life care modern service framework for England to improve the services. The noble Baroness, Lady Berger, said that it would be published in spring 2026, but the letter says that it will be published in autumn 2026—I think the Minister answered that; let us be fair: that is better than the answers that many Ministers from all parties have given over the years, where they often say “at pace” or—what is the other phrase?—“in due course”, but at least this gives us a real timeframe. The Minister also talked about the framework being aligned with the ambitions of the 10-year plan.

[Lord Harper (Con)]

On that point, I also got a copy of that letter. It is worth saying that, in the 10-year plan, there is no ambition for high-quality, universal palliative care. It is not there. So, if the plan the Government are going to publish in the autumn is aligned with it, I think we can see that they do not plan on making universal, high-quality palliative care available in the next 10 years. That is a real problem for decisions taken under this Bill.

[Lord Kamall (Con)]

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

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[Baroness Blake of Leeds (Lab)]

My Lords, I was just about to go on to the whole issue of funding, which many noble Lords have raised throughout this morning’s debate. The Government’s position is absolutely clear on this. Should Parliament pass the Bill, the Government would work to undertake development of the delivery model. Until the parliamentary process is complete, we are making no assumptions as to what the delivery model for an assisted dying service would be or what the role of specific departments in delivering the service would be.

[Lord Harper (Con)]

My Lords, may I ask the Minister something that I do not think is an operational decision but a decision in principle, as mentioned by the noble Lord, Lord Stevens, and does not require the Government to take a view on whether they support assisted suicide or not? Is it the Government’s view—do they agree with the noble Lord, Lord Stevens—that we would have to change the founding principle underpinning the National Health Service to put this service in the NHS? If they agree with him, is that something the Government support? The Government can remain neutral on the principle of assisted suicide, but I want to know whether they think it should be inside the NHS or not.

[Baroness Blake of Leeds (Lab)]

My Lords, I am very aware of the repeated requests and comments. I come back again to the point that we have been making throughout the debates on these amendments, and throughout the process: until the parliamentary process is complete, we are making no assumptions as to what the delivery model will be. That is absolutely clear and straightforward, and has been emphasised by other Ministers before me.

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[Lord Harper (Con)]

My Lords, I do not want to unfairly ascribe views to the Minister on behalf of the Government, but, just so I understand this, is she saying that the Labour Government do not have a view at all on whether we should change the founding principles of the National Health Service away from it being one that delivers medical treatment to save lives to one that also helps people to die? Is she really saying that they do not have a view?

[Baroness Blake of Leeds (Lab)]

I am saying that, at this point, the Government are neutral on the whole area.

[Lord Harper (Con)]

That is extraordinary.

[Baroness Blake of Leeds (Lab)]

I do not think it is extraordinary, but I am sure the noble Lord will keep expressing his point of view.

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[Lord Birt (CB)]

I am sorry; perhaps the noble Baroness can talk to me later, as I could not take in what she said.

I am, frankly, open-minded about the NHS question and accept the strength of what the noble Lord, Lord Stevens, says. It may well be that this is an organisation that should be apart from the NHS but uses some of its services. However, I am happy to talk to others about how best to do that.

I reassure the noble Lord, Lord Harper, that the process can, and should, be designed not only to support assisted dying but to painstakingly explore the alternatives to assisted dying, and I did say this. We suggest that palliative care should be one of those services and, whatever the reasons that people have for assisted dying—there may be others beside their chronic near-death state of mind—we also propose that the organisational body should be able to help the person in other sorts of ways. We want it to be a balanced process.

[Lord Harper (Con)]

I am grateful to the noble Lord for taking my question at this stage of the debate. I listened very carefully to him when he was setting out his proposals and I welcome the fact that he said that the navigator can discuss palliative care and such issues with the person concerned. Unless I misunderstand his amendments, they do not propose to help secure those services for the person. They might set out what they are, but they do not get them, so there is an imbalance there. They will help them get the assisted suicide but not proper palliative care.

[Lord Birt (CB)]

I do not think it for us, in framing in principle amendments, to deal with that level of issue, but the noble Lord is right—that is exactly what the body should do. We are talking about highly distressed people, and it should facilitate different kinds of response and reaction to their difficulty.

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[Baroness Finlay of Llandaff (CB)]

That is a very helpful intervention because the evidence from the places that have gone down this road and changed their legislation is that the unassisted suicide rate does not fall. This does not seem to prevent suicides from happening and these amendments are about people having information. With these amendments, we are not debating whether the Bill passes; we are debating the contents of the Bill and whether it is safe for patients.

Given the problems, I ask the noble and learned Lord, Lord Falconer: is there a plan to relicense drugs that in this country are available only for veterinary use, for the purpose of ending the life of patients here?

[Lord Harper (Con)]

My Lords, I will make two brief points. First, I support the important point made by my noble friend Lady Berridge about how we deal with misinformation. In an enlightening exchange I had with Health Ministers on the subject of flu vaccination, I discovered that a significant number of people working in the health service are vaccine hesitant and at least some of them are because of the scare stories that we read about vaccination. I suspect that those people will be more informed than the general public, because they work in the health service, so how we deal with misinformation is very important.

My main question, for which I am pleased to be in this House surrounded by expert lawyers, is a legal question on Amendment 188A, tabled by my noble friend Lady Coffey, about putting current case law in statute. My question is aimed at the Minister, I suspect, but if he is not able to answer it today, I would be grateful if he could write to us. Would it be helpful to put the current case law position in statute? Would that be helpful in the sense of giving Parliament’s imprimatur, saying that we are comfortable and that we think the current position is helpful? Would it in any way inhibit or prevent the development of further case law?

Again, because of what my noble friend Lady Berridge said, I am conscious that a lot of the information that people get is from online sources. Because of the fast-changing nature of the world, artificial intelligence and so forth, I would want to make sure that, in this area, evolving ways of people getting accurate information that they can rely on were able to be taken into account by case law; equally, I would want to ensure that case law could take into account information sources that are not reliable and reputable and give guidance to clinicians about how they deal with informed consent. The danger of putting some of that detail into statute is that it does take some time to update. I am looking for factual guidance about whether that is helpful for us to put into statute or whether it is better to leave it for evolving case law. It is a factual question, and I hope that the Minister can either deal with it today or write to us.

[Baroness O'Loan (CB)]

My Lords, very briefly, I support these amendments. The process is designed only to kill but, inevitably, as noble Lords have explained, there will be complications. People react differently to different drugs. Only with full information will the patient be able to consent. Without it, that consent cannot exist.

I have questions for the noble and learned Lord, Lord Falconer. Why is the doctor required to discuss the nature of the substance—how it will bring about death, how it will be administered—but not to tell the patient that it may not be successful? Why must the doctor discuss with the person their wishes in the event of complications? Why is there no requirement to explain and discuss the risks of complication? How can a patient give informed consent? If the noble and learned Lord does not intend to accept these amendments, can he tell the House what his intentions are?

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[Lord Falconer of Thoroton (Lab)]

I think that this is absolutely clear in the Bill. Self-administration is what is required. We are discussing how to deal with complications, including whether or not the patient wants some sort of non-intervention, which is perfectly possible. If it is not specifically agreed, and the patient is suffering in some way, the role of the doctor is to save their life, because the doctor cannot kill. I do not think that there is any doubt about that position in the Bill. I do not think that this is properly covered by the terms of this amendment—I will look at it again—and so I do not think that any further change is required.

[Lord Harper (Con)]

I again apologise for not being a lawyer. I listened to this very carefully. I think there is a big gap here. The noble and learned Lord talked about the doctor, in effect, giving treatment to save the patient’s life. If the patient has expressed a clear and informed wish to die—I think this is the question that the noble Lord, Lord Stevens, asked—does the doctor owe a duty of care then to save the patient’s life? I do not think that that is clear at all. Doctors, I think, are asking what it is they are supposed to do. If they do not do anything and the patient dies and then it is found that they should have done something, that is incredibly serious. Doctors are asking for it to be put beyond doubt what they should do in those circumstances.

[Lord Falconer of Thoroton (Lab)]

First of all, there is absolutely no need to apologise for not being a lawyer; some of my best friends are non-lawyers. Secondly, this very thing was very closely considered, hence the provision in the Bill to say that, if there are complications, let us try to agree in advance what we should do. We will not, I am sure, be able to cover every complication, hence the questions from the noble Baroness, Lady Finlay, and the noble Lord, Lord Stevens. The answer is clear and beyond doubt—hence the reference to the need to address the question of complications—that the doctor should do what the doctor is always obliged to do, which is to save life.

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[Lord Harper (Con)]

Just for the avoidance of doubt for anyone watching these proceedings, the noble Lord, Lord Polak, is no longer present in the Chamber, but he is very much still with us.

[Lord Hamilton of Epsom (Con)]

My noble friend Lord Harper is absolutely right: he is still with us, but he is absent for the moment. It might have been that, when he was given his diagnosis that he had six months to live, he was told that his final months would be very grim indeed and he would suffer terribly. He might, if this Bill had been in place, have made the decision to end his life. That was 32 years ago and my noble friend Lord Polak is actually pretty fit and doing a good job in your Lordships’ House. So we have to question medical diagnosis in this case.

I am very concerned and would like to hear from the noble and learned Lord, Lord Falconer, what he thinks about the problems of wrong diagnosis. I am old enough to remember that there was a time when we had capital punishment in this country. One of the reasons why it was abolished was because of the miscarriages of justice and the number of people who were hanged when they were innocent. That was a very serious lever used to get rid of capital punishment. What percentage of misdiagnosis of terminal illness would the noble and learned Lord, Lord Falconer, think would be right before he thought about whether the whole basis of this Bill was to be questioned? I do not think we have any statistics on misdiagnosis—maybe he has some—but it really undermines the whole basis of this Bill if we have doctors who quite innocently say that they think a person has only six months to live but then find that they have not and they live on much longer. This is a matter of tremendous concern to people in this country.

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[Lord Moore of Etchingham (Non-Afl)]

My Lords, I 100% support the motive behind the amendment from the noble Baroness, Lady Berger, and what the noble Baroness, Lady Cass, and others have just said, but my question is this: will it make any difference? If you want an assisted death, would you not be able to get it simply by saying that it is related to your terminal illness? You have your terminal illness and you have the prognosis, and you will therefore be advised by anybody who wants to assist you in your death that that is what you must say. How is this therefore a protection for the problem that we are discussing?

[Lord Harper (Con)]

My Lords, in this group of amendments—the two parts of it, if you like—I support the amendment that the noble Baroness, Lady Berger, has brought forward, which sets out that the primary motivation for seeking assisted death is terminal illness. That is important because, otherwise, the terminal illness is simply a trigger.

One reason why I think this is important is something that I am very nervous about. I am not saying, by the way, that this is the motivation of the sponsor of the Bill, but he will be aware that many people think that this Bill is just a first step—there are campaigners outside this House who absolutely think that. One problem with the way that it is drafted at the moment is that, because the terminal illness is simply a trigger, it would be very simple, if this Bill were on the statute book, to simply remove that qualification, so that the rest of the structure and processes in the Bill would then allow anybody for any reason, without having a terminal illness, to seek an assisted suicide. With the amendment that the noble Baroness, Lady Berger, suggests—that the reason why you are seeking an assisted suicide is your terminal illness—then you could not do that. If you were to remove the terminal illness piece, there would be no motivation, so you would have to do a lot more work. Those of us who are nervous about this Bill as a Trojan horse would be more reassured if that motivation were in place.

The second part to this goes to what my noble friend Lord Deben said about what the public think that this is about. If we look at the opinion polling on what the public think should be reasons why someone should be able to seek assisted suicide, the powerful reasons that many members of the public—not all, but significant numbers—support is to relieve suffering and pain. People are broadly compassionate and think that that is a good idea. What they do not support is people being able to seek assistance to kill themselves because they are poor or for other reasons. They think that that is a terrible reason. The amendment from the noble Baroness, Lady Berger, and other amendments in this group would more closely align the way the Bill is structured and what it would do with what many members of the public think that it should do.

I also support Amendment 320ZA from my noble friend Lord Blencathra, which explicitly says that the purpose of seeking assisted suicide cannot be various societal factors, such as housing or financial circumstances. That is important. The noble and learned Lord, Lord Falconer, and I had an exchange last week where he made it very clear that he thinks that, if those things are the drivers for you wanting to end your life, he is okay with that. I am not, and the polling evidence is that the public are not okay with that either.

Choices should be proper choices. My noble friend Lord Deben set out very well the sort of society that I think people want to see. If people want to end their life because of something not to do with their terminal illness or their pain or their suffering—because they do not have enough money or they have poor housing, or they have other things that they are not happy about—then those things are remediable. They may be expensive, but they are fixable and we can do something about them. I want to live in a society where we do something about them and we make people’s lives better—even if it is only for the last few months of their life, that is still worth doing.

My noble friend Lord Deben is right. He is not saying that the sponsor or those who support this Bill are thinking like this, but he is absolutely right that people make decisions all the time based on weighing up financial consequences. Noble Lords have talked about NICE today. When it assesses approving drugs, NICE looks at quality adjusted life years against the price of the drugs to the health service. It literally weighs up how much valuable quality life you are buying versus how much money we are spending. My worry is that, if you do not exclude people wishing to end their lives for these other reasons, we will get ourselves in a terrible place where we are not prepared to spend the money on improving people’s lives but rushing them towards ending their life in a way that is not necessary.

That is a big choice for Parliament to make and there are different views. The noble and learned Lord, Lord Falconer, set out his view last week. I have set out mine and my noble friend Lord Deben has set out his—we are in agreement. That is a decision for the House. I hope that noble Lords will support the amendment tabled by my noble friend Lord Blencathra and make the decision that you can only seek assisted suicide if it is because of your terminal illness, not because of your other circumstances. I think that that is the right sort of society we would be creating. The package of amendments in this group would improve the Bill. They would also reassure many people who are concerned about the Bill to not be concerned about it, which would be helpful for everybody. I commend them to noble Lords.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I completely agree with the noble Lord, Lord Deben, on the society that we are seeking to have. We agree on so many things. We are on different Benches, but we agree on many things. However, the pre-eminent reason for this Bill is a terminal illness for six months. I understand what the noble Lord opposite is saying—that one cannot be sure—but we are talking about six months. As other noble Lords have said, one might aspire to have access to the drugs so that one could take one’s life if one had a terminal illness and it was thought that it was going to last for six months, but it does not mean to say that people are going to use them. It is important to remember that all the time. Six months and a terminal illness is the important thing to keep in the forefront of our minds at all times.

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[Lord Falconer of Thoroton (Lab)]

That was not really an intervention; it was just a statement. I should have said to the noble Baroness, Lady Fox, that, as I said last week, I will make an amendment so that the question of why will be asked, but I do not depart from the proposition that autonomy should be the leading reason for it. We disagree about that, and the House can reject that view on Report, but I am explaining what my position is.

[Lord Harper (Con)]

I want to pick the noble and learned Lord up on the progress that I thought we had made last week, which he has just confirmed a bit, when he accepted that asking the question was valid. The problem is, if the result of asking that question is that nothing changes, it is just cosmetic window dressing. He may not have intended to, but he illustrated beautifully the point of asking the question. If we talk to somebody and it is clear that the reason they do not wish to go on is that they are lonely and they have no one there, we can do something about that. There are organisations and people who would provide that companionship. I see the noble Baroness, Lady Hayter, shaking her head. There are organisations and people who would do something about that.

It comes down to the point I made last week. We are saying that, if your life is terrible and you get a terminal illness diagnosis, under the Bill, you are more likely to want to end your life with assistance than someone whose life is great. That is a terrible thing for us to do. The noble and learned Lord does not agree with me; that is fine. The House will have to make a decision, and I think that the position that we have set out with these amendments would lead to a better Bill and a better society than the one he is setting out. We will keep making that point and attempting to move him to that position.

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, we are meant to be having brief questions here; these are not brief questions.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords, it is far easier to develop a code of practice over time and change it in the context of changes in the environment. It is much more difficult to change a law by statute, which means it has to be brought back into both Houses of Parliament, so I do not really think that the point the noble Baroness just made is valid.

[Lord Harper (Con)]

My Lords, having listened to this debate, I am struck that there seems to be a fair bit of consensus. Thinking back to the arrangement of business discussion we had about the pace before this debate, I have listened to the number of people who quoted Kim Leadbeater and her uncomfortableness about making these decisions on Zoom. It strikes me that if she had followed through on that uncomfortableness and put into the Bill a clear presumption that these decisions should be taken face to face, with some exceptions that I will elaborate on in a minute, we would not have needed this debate and we would be moving at a faster pace. There is perhaps a lesson there for the noble and learned Lord: if more cognisance had been taken about some of these concerns at an earlier stage, we would have moved at a faster pace.

The only reason why these amendments exists, why we have debated them and why the noble Lord, Lord Birt, referenced how important a decision this is to get right is that this issue has not already been addressed. I will just leave that there as a possible reason why there are as many amendments as there are to this lengthy Bill and why the debate is necessary: it is because it has not already been done. I will leave that for noble Lords to think about.

[Baroness Young of Old Scone (Lab)]

I have one note of question. We are all quoting Kim Leadbeater and how she felt about the Oregon example, but, in fact, it may be that she was not talking about the issue of videolinking but about assessments that were done solely on the basis of paperwork. I think we need to find out exactly what Kim Leadbeater was saying before we jump to conclusions about whether the promoters of this Bill have been neglectful in the way that they have dealt with that issue.

[Lord Harper (Con)]

The noble Baroness makes a very good point which illustrates the importance of being able to ask people questions directly rather than hearing reports of what they have said or seeing it on a video call. That is the importance of in-person conversation and the ability to ask questions and hear answers so that you know what people actually think. I think the noble Baroness has illustrated and evidenced my point extraordinarily well, and I am grateful for her intervention.

At the beginning of this, the noble Baroness, Lady Gerada, referred to medical assessments. She is right in saying that many of them can be done very well remotely. I think that is excellent. I am a great supporter of technology. We do not all believe in quills and pens, and I do not think the noble Baroness, Lady Pidgeon, was entirely suggesting that we were. She might want to reflect on that remark and whether it was entirely well-intentioned, given what the Chief Whip said to us about treating everyone with courtesy and respect. I support the use of technology where it is appropriate.

The problem here is that the noble Baroness, Lady Gerada, said that we can all rest assured that doctors would never view this as a routine exercise. The problem is that in other jurisdictions there is quite a lot of evidence that they do. While it is true, as the noble Baroness, Lady Blackstone, said, that the vast majority of doctors will approach this in absolutely the right way, I am afraid not all doctors are perfect. There was an example yesterday of a paediatrician at Great Ormond Street who had an appalling record. We have to make sure that the law makes sure that patients are properly protected in all cases, not just in the vast majority of them. Where I disagree with her slightly is that this is a policy decision, not a medical decision. Whether assessments should be face to face, either in every case or that the presumption should be that they are, is a policy decision, rightly for Parliament, not for clinicians. It should be informed by listening to clinicians, but it should also be informed by listening to evidence from the patient experience, so ably set out by the noble Baronesses, Lady Smith and Lady Berger.

The noble and learned Baroness, Lady Butler-Sloss, gave her own testimony that she has had to make decisions in these cases, and I was very struck by her view that we should certainly have a presumption that these decisions should be taken face to face. I was very struck by listening to her on previous occasions. Her experience on these matters carries a lot of weight. I also listened very carefully to the noble Lord, Lord Carlile, when he set out the GMC’s advice. Decisions for patients with a terminal illness about a course of action that will lead to the end of their life seem to me to fall squarely within the set of cases where you would want a face-to-face appointment, but equally I felt there was good counsel for us and challenge from the noble Baronesses, Lady Jay, Lady Pidgeon and Lady Blackstone, to think of the patient, the person who has the terminal illness who wants a decision. They were right to challenge us on that.

That is why I think, if we look at the balance of amendments in this group, they are very helpful because they set out a span of choices for your Lordships, from saying that every decision has to be taken in person, which I think would be wrong for the reasons that the three noble Baronesses set out, that you have to look at the patient’s views, but equally, I think the present wording is too loose and does not set out a presumption that they should be face to face. I would be very grateful to hear the view of the noble and learned Lord, Lord Falconer, on where he thinks he is likely to settle because that will be helpful for all of us when thinking about whether we have to table further amendments. It seems to be a presumption that it is face to face, but with a very limited set of circumstances where it can be not face to face. But we should not accept the presumption in a patient-centred model that the patient always has to go and see the panel or the doctors. It should absolutely be, particularly because so many people in these circumstances are going to be in poor health, that we think of a system that makes sure that when it comes to the panel at least one member of the panel, the independent person, is physically present.

That is important. These amendments touch on two parts of Clause 17. The first is subsection (6), which states:

“The duty under subsection (4)(b) to hear from the person to whom the referral relates does not apply if the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person”.


That means there are circumstances where the panel does not have to hear from the person at all: not by videolink, not in person, not by pre-recorded video, not at all. That was confirmed to me when the noble and learned Lord, Lord Falconer, and I were doing a media programme—I think it was “The Week in Westminster”—where I challenged him on this. He confirmed that there were circumstances in which a decision could be taken for someone to seek assisted suicide and the panel would never have to see them at all. I do not think that is right.

The other subsection these amendments touch on is subsection (5), which states:

“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material”.


That was inserted in the House of Commons by a Back-Bench amendment. It was not very well debated. The fact that it is pre-recorded means that it gets rid of any opportunity for questioning or challenge. The problem I have with the language there is that it says “medical reasons”, it does not say “medical reasons pertaining to the patient”. This is my last point—

[Lord Empey (UUP)]

We are forgetting that we can use the telephone in this circumstance. It is not even that you would have sight of the person, but you could have a pre-recorded telephone call.

[Lord Harper (Con)]

I am grateful for that. The final point I want to make is that we had experience during the pandemic of too many vulnerable people, people with learning disabilities, having “do not resuscitate” notices put on them by doctors. I do not want to see a system where, if we had a similar circumstance again, these sorts of decisions would be taken remotely at speed. We know from our deliberations in this House, and it is my experience in the other place, that there is no substitute for doing these things face to face where you can challenge people, ask questions, put people under that challenge and get good answers to make good decisions.

I commend this group of amendments to your Lordships, and I look forward to hearing the response of the noble and learned Lord, Lord Falconer.

[Baroness Grey-Thompson (CB)]

I would like to provide a brief clarification on the back of what the noble Lord, Lord Harper, said about the points raised by Ms Leadbeater’s comments about feeling uncomfortable. It came from a report on ITVX on 6 March 2025. An assessment was taking place with Dr Jess Kaan. I believe family members were there, and then she asked the patient’s family to leave the room so that she could privately ask the patient whether it was a settled wish. The patient said yes, it was. I quote directly from the ITV website:

“For Kim Leadbeater, the virtual consultations did not make for comfortable viewing—she says it has made her think about adding an amendment to make clear that consultations with doctors cannot be done via video call and that they should be done in person”.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

As a lawyer, going for a presumption is wrong. I think the right thing to do is say something such as the norm is face to face, but there could be circumstances in which you may not do that. You should give maximum flexibility.

[Lord Harper (Con)]

Can I just illustrate, perhaps, to the noble and learned Lord why people are so nervous? In the Commons, at Second Reading and for much of the Committee stage, MPs were told that the panel would have to speak to the patient. Amendments were tabled subsequently—the ones I talked about—which then allowed the panel to accept pre-recorded video and waive hearing from the applicant entirely in those undefined exceptional circumstances. I absolutely accept the argument against a blanket position, but if there was a rebuttable presumption that it should be face to face and some circumstances were set out, which could be developed with case law, from listening to the debate, it seems that that would command widespread support from the Committee and would deal both with people’s concerns and, rightly, the patient-centred approach that the three noble Baronesses set out for noble Lords.

[Lord Falconer of Thoroton (Lab)]

In relation to the noble Lord’s point about the imposition of subsection (6), the Bill currently says that the panel

“must (subject to subsection (6)) hear from, and may question, the person to whom the referral relates”,

so it has to question the person, though not necessarily in person. Subsection (6), which he referred to, says:

“The duty … to hear from the person … does not apply if the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person”.


That was added during Committee, because a Member of the Committee described the circumstances of his own mother, I think. That is why it happened. But I will note what the noble Lord says. I do not think I will go for a presumption, but I hear what he says.

[Lord Harper (Con)]

The noble and learned Lord talked about questioning; this is important, because I think he slightly misspoke. Subsection (5) says:

“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material”.


The problem with that is that you lose any ability to ask questions, which is critical. That was added afterwards—after people had heard these concerns—and it went backwards. Will the noble and learned Lord reflect on that? If he is going to table an amendment, I ask him to make sure that it reflects the debate that he has heard this morning in your Lordships’ Committee.

[Lord Falconer of Thoroton (Lab)]

Obviously, you cannot ask questions under subsection (6), so it is exactly the same point. The point being made in subsections (5) and (6) is that the panel recognises that there are circumstances in which questioning is not possible. I do not know what additional point the noble Lord was making.

--- Later in debate ---

My noble and learned friend can wipe out many of the amendments, and he can wipe out the ones he has actually tabled by operating the policy of the Government he was a member of. Clause 1 stands apart, and I agree that it is a major junction of the Bill. From now on, the sponsor can get up to speed and get the Bill ready for the Commons, or he can run out of time. It is his call, not ours.

[Lord Harper (Con)]

My Lords, I had not intended to say anything, but I was provoked—in a nice way—by the noble Lord, Lord Rooker, and his advice, which was well meant, to the sponsor of the Bill, the noble and learned Lord, Lord Falconer. I agree with him, but I think a bit more work is required.

I referred earlier to the letter that the noble and learned Lord sent to Members of the House. I urge him to test his mailing list, because it did not go to all Members; I received a copy of it only from another Member, and it would be helpful if we all received a copy. I now hear from my noble friend Lord Deben that he has not received it at all.

I have two things to say. First, I absolutely agree with the noble Lord, Lord Rooker, about the Delegated Powers Committee’s recommendations. It was pretty scathing about the number of powers the Bill gives to Ministers with very little oversight. If I am being fair, the noble and learned Lord, Lord Falconer, has engaged extensively with the recommendations of the committee in what he has set out. That is the good bit.

But I do not think the noble and learned Lord has really taken on board the point the committee made because he has largely, as I see in his amendments, preserved the Bill’s delegated skeletal architecture. Rather than limiting executive power and putting safeguards and limits in the Bill, he has added in all sorts of things, such as scrutiny and consultation, at the back end. He has not actually got the point, which is that the Bill should not have those delegated powers in the first place. Exactly as the noble Lord, Lord Rooker, said, I humbly suggest accepting what the committee said and following its recommendations. That would be helpful.

The second point is about pace. The Delegated Powers Committee reported in September last year, and only half way through Committee we got a letter from the noble and learned Lord, Lord Falconer, setting out his response to it. My experience as a Minister was that if we had received the report from the Delegated Powers Committee, as the Minister I would have been expected to have my response ready at the start of Committee—or, frankly, Members of your Lordships’ House would have stood up and said some very disobliging things.

[Baroness Hayter of Kentish Town (Lab)]

The noble Lord would have had a whole department and civil servants behind him at that time.

[Lord Harper (Con)]

I have two points to make on that intervention from the noble Baroness. First, on several occasions the noble and learned Lord has made reference to quite a significant number of officials that he has had working with him, helping him draft clauses and so forth. If the argument is that that is still not enough resource, that rather supports my contention—which I have made from the beginning—that the extent and nature of this legislation makes it absolutely not suitable for a Private Member’s Bill, and it should have been a government Bill. As I said, the noble and learned Lord has had extensive support from not just one but a number of government departments in helping him draft it.

My second and final point is on the issues that have arisen so far in Committee, particularly the issues that have arisen on Clause 1, which I think is why it is relevant to bring it up on the Clause 1 stand part debate. The noble and learned Lord referenced them in his letter, but he has not yet been in a position to set out what his amendments are going to be. He said that he will make them available as soon as he possibly can. That is good, and I welcome that, but, until we see them, we are not in a position to know whether further amendments need to be tabled for later in Committee or on Report. I finish by saying that I agree with the noble Lord, Lord Rooker. The extent to which we can now make progress is going to be largely governed by the extent to which the noble and learned Lord the sponsor of the Bill engages with the very fair criticisms that have been made across the Committee. We will listen carefully to what he says in response to this debate and in subsequent groups.

[Baroness Andrews (Lab)]

My Lords, I think it is right, as my noble friend Lord Rooker said, that this clause stand part debate is an opportunity for a reset and a rethink about how we are approaching the Bill and the way we are prioritising the arguments. Where I slightly take issue with my noble friend is that I do not think it is helpful to apportion blame. We are where we are with this Bill now, and we are all under the clear impression and instruction that, if the Committee wants to change the Bill, whether those who oppose it or those who support it, we have to get it to Report so that we can do that and then send it back to the Commons improved and amended.

On the question of delegation, I worked with my noble friend Lord Blencathra—I will call him that—on the reports on delegated legislation, and they were extremely important. What we have discovered in this Bill, as the amendments have been put forward, is that there is a difficult balance to be achieved between what goes into the Bill on the principle and the design—our task in this House is to make every Bill workable—and what has been left to delegation. As a result of the nature of the Bill, the behavioural issues that are raised by it, and the extraordinary personal and exceptional circumstances when we are dealing with people in the last months of their life—which we should never lose sight of, no matter what we are debating and how technical and process-driven it is—we have to think about the balance between what is workable because it is in the Bill and will stand in law and what has to be left to delegation going forward and therefore can be amended as circumstances change. That is the situation the Australians find themselves in. We have a lot to learn, as we have already learned, from Australian medics who have told us how they are managing the Bill and what an extraordinary benefit it has been. That is on the public record.

All I would say, before my noble friend Lord Blencathra possibly opposes me, although I hope not, is that this is an opportunity to look at the amendments that are coming forward and the priorities we are attaching to them and whether we can triage them in some way. My noble friend Lord Rooker is right that a lot of these early amendments can fall away, because we have addressed the principle. Can we focus on what it will now take to agree to improve the Bill, so that we can have shared trust across the Committee that this is about improving the Bill and not delaying it to the point that it will never become law?

--- Later in debate ---

Moved by

[Lord Harper]

70: Clause 2, page 2, line 3, after “disease” insert “or injuries”
Member’s explanatory statement
This amendment is intended to include those who suffer unbearable injuries likely to result in death and will be particularly relevant to military personnel and those suffering industrial injuries.

[Lord Harper (Con)]

My Lords, in moving my Amendment 70, I will also speak to my Amendment 78 and to Amendment 829 from my noble friend Lord Sandhurst. The first two amendments were originally tabled in the name of the noble Lord, Lord Hendy, who was unable to be here last week—although we did not get to them then—so I have taken them over in my name.

I will explain to noble Lords why they have been tabled. They are responding to concerns raised by David Green, a barrister specialising in industrial disease cases, and Michael Rawlinson KC, who wrote to a number of Peers, alerting us to the fact that the current drafting of the Bill can negatively affect some victims of occupational diseases. I will set out that concern and then the noble and learned Lord, Lord Falconer, can, I hope, respond to it in a more detailed way than he did in the letter that he circulated to Peers in the past day or so. I will also raise a couple of related issues that we will come to later in our debates and that concern similar issues.

The reference in the amendments is to “injuries” or “disease” that people get during their working life. The reason for including those words is to raise the following issue. If victims of occupational diseases opt for assisted suicide, their dependants, under my reading of it, would probably lose their right to sue whoever caused their disease under the Fatal Accidents Act 1976, unless this Bill specifically provided otherwise, which it does not currently.

I will give noble Lords an idea of the size of the issue. In 2023, 2,218 people in Britain died of mesothelioma, which is the prime fatal occupational disease. It is a fatal cancer caused exclusively by asbestos. By way of comparison, that is considerably more than the 1,624 road deaths that year and we know how seriously the Government take that issue; they have just published an entire road safety strategy to reduce that number. Many more died of lung cancer with asbestos as a causative factor, or of respiratory failure secondary to asbestosis or pleural thickening, or of other occupational diseases.

Since virtually all instances of mesothelioma are caused by asbestos exposure, and most asbestos exposure was occupational, most victims can sue a former employer—in reality usually represented by an insurer. The damages recovered are an important way of paying for medical and nursing care and, importantly, of providing for surviving dependants. Claims arising from these occupational diseases can be pursued during the lifetime of the victim or by their families after their death under the Fatal Accidents Act 1976 and the Law Reform (Miscellaneous Provisions) Act 1934. A good deal of claims are pursued after death in this way for the benefit of families, partly because the prognosis following a diagnosis of mesothelioma is, sadly, relatively short. That is why so many families have to seek the damages rather than the victim being able to do so.

The key point is that the dependants of a deceased person can sue if, and only if,

“death is caused by any wrongful act, neglect or default which is such as would (if death had not ensued) have entitled the person injured to maintain an action and recover damages”.

That is in Section 1(1) of the Fatal Accidents Act. The requirement is that the breach of duties caused the death, but the law that has developed on that section requires an unbroken chain of causation between the defendant’s breach of duty and the death if the dependants of the deceased are to recover damages. In general, an individual’s decision to end their life by suicide breaks the chain of causation between a defendant’s earlier breach of duty and the death. In other words, the law considers that the death has been caused by the choice of the victim and not by the negligence of the defendant.

There are narrow exceptions to this rule—for example, where the defendant’s breach was of a duty to prevent suicide, as it was in the Reeves case, or where the defendant causes a psychiatric injury that itself causes the suicide. But where an individual has full capacity—we know that they must have if they have used this Bill, if it becomes an Act, because we have debated that at length—and the defendant’s duty was decades in the past, the common law would regard a freely made choice to end their life as a novus actus interveniens. Forgive me if I mispronounced that, not being a lawyer, as I have said on many occasions. It is a new and different cause, breaking the chain of causation.

That would mean that the person who died of fatal mesothelioma would have their cause of death recorded by the coroner as an industrial disease, but Clause 38 as drafted makes provision for the cause of death in these cases to be recorded for coronial and certification purposes as an assisted death and excludes this cause from the category of unnatural deaths, meaning that there is no inquest. That means that the assisted deaths will necessarily not be certificated as being caused by industrial disease, even if that were the cause of the terminal illness that led the deceased to be eligible for an assisted death.

That means that, under common law and the Fatal Accidents Act, it would break the chain of causation between the former employer’s negligence and the victim’s ultimate death. That means that a victim of an occupational cancer with a limited life expectancy who would meet the criteria in the Bill—and who would probably face a painful and unpleasant death, even though that is not a criterion in the Bill, as we have debated—has a dilemma. They have a choice between prolonging their suffering but preserving their family’s right to damages and ending their suffering but losing a right potentially worth hundreds of thousands of pounds to the people they leave behind. At the moment, that is not dealt with anywhere in the Bill.

I have a specific question about that, and I will refer in a minute to what the noble and learned Lord said in his letter. But I also want to ask whether there are other areas where similar issues have not been thought about. Two come to mind, the first of which is members of the Armed Forces. I tabled an amendment, which will come up later, because the compensation schemes in the Armed Forces again would not, in my understanding, pay out if somebody got an occupational disease because of their military service. If they were to seek an assisted suicide, that would preclude them and their dependants from receiving compensation under that scheme. That is even more particularly a failure given the duty of care that the state owes to those who put their lives at risk on its behalf.

I would also be interested in understanding the interaction between this and the Government’s statutory diffuse mesothelioma payment scheme. In cases where there is no employer or insurer still in existence, or they cannot be identified, there is a statutory scheme, which I know a bit about; I took the regulations through Parliament as a Minister in the Department for Work and Pensions. That pays out on diagnosis. It means, potentially, someone whose employer was still around and on the hook who sought an assisted suicide would do themselves or their dependants out of compensation, whereas somebody whose employer or insurer was not around or not traceable and who qualified under the statutory scheme, which is paid out on diagnosis, would actually not do themselves— I think—out of the compensation. That seems an invidious position based on complete chance.

I do not know whether that has been thought about by the sponsors of the Bill. I would be interested to know the specific answers to those questions and whether there are other areas like this which have not been considered. If this had been a government Bill, as part of the process, other government departments would have looked at it, thought about these issues and would have made sure they were dealt with.

My final point is that the noble and learned Lord referenced this and dealt with it a bit in the letter that he circulated. He thanked my noble friend Lord Sandhurst and the noble Lord, Lord Hendy—whose name, as I said, was originally on these amendments—for their conversations. He said that he had tabled amendments to Clause 47, the reporting section of this Bill, which would require an early report about the impact. I welcome that, but I do not think it goes far enough.

If this Bill goes on to the statute book, there will be people whose legal position will be put at risk and damaged by what is in it. That is not going to be remedied by a report. If the report comes out and says “Yes, there is a problem”, it will require further primary legislation to fix it. It would be better if we understood what the issue is now and, if there is an issue, we should make sure there is an amendment tabled for Report which would deal with it—both for the Fatal Accidents Act and members of the Armed Forces.

In this area, it would be helpful if—I do not think this breaches the Government’s neutral position on the Bill—any other similar areas were identified so that we could deal with them with amendments on Report. That would be welcome. That was my purpose in tabling these two amendments. It is a very important area, and I look forward in due course to the answers from the noble and learned Lord, Lord Falconer. I beg to move.

[Lord Sandhurst (Con)]

My Lords, I will follow my noble friend and, I hope, be reasonably concise.

I asked for my Amendment 829 to be grouped with these amendments as it covers the same substantive ground. It was helpful that, about a fortnight ago, with the noble Lord, Lord Hendy, I met the noble and learned Lord, and we discussed this situation. Broadly speaking, there was acceptance. As I understand it, the sponsor of this Bill will be bringing forward an amendment which will tidy up various loose ends. The word “review” will be changed to “assessment”, there will be reference to victims of occupational diseases and one or two other tidying-up matters.

As has been explained—I can do this briefly, but it is important—as the Bill is drafted, it is highly probable that a victim of an occupational disease, such as asbestosis caused by the negligence of some tortfeasor, will, if they go down the assisted dying route, lose the right to recover damages for the injury that has put them in the position where they wish to die. This will also mean that their heirs and successors—their family—will lose that right to the Fatal Accidents Act claim.

If someone is suffering from a horrible illness, they may decide that they cannot bear it any longer and that they wish to terminate their life just a few months before the end. It would be quite wrong if their family and dependants, who deserve the money to cover themselves for the whole of the life that that person would have enjoyed but for the injury that created the asbestosis, should lose that entitlement to compensation because the victim has gone down the route of assisted dying. As the law stands—it has been to the Supreme Court or the House of Lords not in this context exactly but in others—it is quite clear that this would be a break in the chain of causation. It seems such to me and to others who are interested in this field.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I am afraid that I am not the Government. On the issue of risk, my proposal—although I recognise that some people want to go further—sets out a sensible course to reach the aim that everyone wants to reach, which is that the problem does not arise. One will have to look at the extent to which one has to warn against that problem when one sees where the review goes, because the question of what warnings have to be given will have to be addressed only at the point when the review has already reported and any action has been taken on it.

[Lord Harper (Con)]

My Lords, this has been a good debate, and it has raised a very important issue. The noble Lord, Lord Hendy, being a distinguished KC, and my noble friend Lord Blencathra spotted that I had not in my remarks pushed the injuries point. I confess that I am torn on that, because some injuries are effectively caused by employment, like mesothelioma where asbestos ingestion through employment results in an illness, as defined in this Bill already. Of course, there are other injuries that can be received in an employment context, where they would not qualify as an illness but where the outcomes may be very similar. But I do recognise all the issues raised by my noble friend Lord Blencathra, so I am torn on that.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am another Peer who sat here for many hours last Friday, desperately keen to speak to this group of amendments. Towards the end, at nearly 5.30 pm, I heard the magnificent speech of the noble Lord, Lord Rook, who is not currently in his place. It really was an incredible speech. I suppose the only benefit of being a sort of carry-over, tail-end Charlie was that I was able to read his speech in Hansard once again. I commend it as superb. I concluded that there was nothing I could usefully add to what the noble Lord had said, so I have decided not to try to add anything more to it, and I conclude my remarks.

[Lord Harper (Con)]

My Lords, I will speak briefly to put on the record one useful piece of information, which is very relevant to the debates that we have had. Somebody previously referred to the welcome cancer plan that the Government published, and I thought it worth sharing with the Committee that there was an important and relevant piece of information in the plan that your Lordships might wish to be aware of.

I think the noble Lord, Lord Stevens of Birmingham, referred to the Government’s plan for palliative care. When we spoke about it, I think just last week, the expectation was that that plan would be published this autumn—I hope the Minister can confirm that I have got that right. The cancer plan makes it clear:

“Next year, we will publish a Modern Service Framework on Palliative and End of Life Care to address these challenges”.


Without being explicit about it, the palliative care plan has now slipped into 2027, with no indication of when in 2027. Given my experience of these things, it could easily be the end of 2027. We are being asked to consider the Bill when the Government are not even going to publish their palliative care plan until some time next year—and it has already slipped twice in a few months.

I draw two lessons from that. First, if we do not have high-quality, universally available palliative care then we are not giving people a genuine choice. As my noble friend Lord Shinkwin said, expectations in society will push people inevitably towards assisted suicide, whether they really want it or not. The second thing that says to me is that palliative care is not really a priority for the Government. If you cannot even produce the plan to improve palliative care, which was originally going to happen this year, until some time next year, with no specific date attached to it, heaven knows what your priority will be when actually delivering the services that people require. My sense is that, if the plan will not come out until next year, we will not see improved services even in this Parliament. In that case, there is no meaningful choice. On that basis, we should not proceed with this Bill.

[Baroness Grey-Thompson (CB)]

My Lords, I have added my name to Amendments 82 and 83A, in the name of the noble Lord, Lord Polak. I note that Amendment 83, which was tabled by my noble friend Lady Murphy and the noble Baroness, Lady Noakes, has been withdrawn. It would have extended the period of eligibility from six to 12 months for neurological conditions.

I added my name to these two amendments because it is important to have real clarity on what we mean by a six-month diagnosis, as well as to have specialist certification by an independent consultant. I added my name because Professor Paddy Stone, who is the former head of Marie Curie palliative care research department at UCL, said there is no reliable way to identify patients with a six to 12-month diagnosis and no method that would provide an adequate safeguard. We have to remember that no royal college supports this Bill or thinks that the safeguards in it are good enough.

Amendments 97 and 98 would tidy up the language in the Bill. This is quite a minor point, but “person with a disability” does not exist in law. It is used interchangeably in the Bill and society, but “with a disability” suggests that my impairment is something I can pick up or put down at will, which I cannot. To show some understanding of what disabled people experience, the Bill should use the language of both the DDA and the Equality Act, and should recognise that the social model of disability exists. I do not know whether the drafting was a refutation of the social model, or perhaps a drafting mistake, but it shows a lack of connection to disabled people and deaf and disabled people’s organisations. We are told that language changes all the time—it really does not. Different language may be used around the world, but this is British law, and we should use the words that are in Acts that already exist.

Last week, the noble Lord, Lord Harper, mentioned things we think we need to fix but never get round to, and I thought of an example at the time. The DDA—I sat on the National Disability Council with the noble Lord, Lord Shinkwin—said 31 years ago that taxis in this country should be wheelchair accessible. Thirty-one years later, we have still not sorted it. I have tabled an amendment to the English Devolution and Community Empowerment Bill, for next week, to fix that. Given that we have had to wait 31 years for taxis to be accessible for disabled people, can noble Lords not understand why disabled people fear this Bill?

Amendment 106 in the name of the noble Lord, Lord Hunt of Kings Heath, and my noble friend Lady O’Loan looks for clarity on that six-month diagnosis. We are constantly told there is nothing to worry about, but those are easy soundbites. The Bill is caught between two competing policies: trying to ensure safety versus personal choice. The state has a duty to ensure that those choices are sufficiently informed and based on accurate medical assessment. Building in an independent prognosis would recognise that, in a life-ending law, the margin for error must be minimal and oversight must be robust. It would send a clear signal that assisted dying is exceptional and that those who seek it must face rigorous, medically sound scrutiny that reinforces public trust and protection for vulnerable individuals.

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[Baroness Merron (Lab)]

We are discussing a group of amendments about the definition of terminal illness. I have already placed a letter in the Library of the House outlining all the work in respect of palliative care. I have also made reference to the modern service framework.

[Lord Harper (Con)]

Having listened to my noble friend Lord Moylan respond to what the Minister said, I confess to being a little confused. The Minister seemed to be saying, in her comments about some of the amendments in this group, that the problem with having a list of conditions is that you could quite often have a terminal diagnosis as the result of a group of conditions, circumstances or illnesses. In my reading, the Bill does not say that. The Bill says:

“For the purposes of this Act, a person is terminally ill if … (a) the person has an inevitably progressive illness or disease”—


not lots of them; one—

“which cannot be reversed by treatment, and … (b) the person’s death in consequence of that illness or disease can reasonably be expected within six months”.

I carefully read the amendment, which talks about a specified list of conditions. Incidentally, coming back to the point made by the noble Lord, Lord Markham, twice as many members of the public support that approach than a terminal illness. The Minister’s answer to my noble friend Lord Moylan seemed to be disagreeing with what is actually in the Bill, so I am now more confused than I was before she got to her feet. Can she clear that up?

[Baroness Merron (Lab)]

I am sorry the noble Lord is confused. I know that my noble and learned friend Lord Falconer will be pleased to assist him with any confusion that there is in the case of this amendment.

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[Lord Harper (Con)]

I deliberately did not intervene on the noble and learned Lord earlier, because he dealt with the point and I thought that we had spent enough time on it. He has now just made it even more confusing. I just want to make sure that I have this right. The Minister appeared to be saying that you could have a set of conditions, none of which was fatal but the combination of them was terminal, and that that would trigger the circumstance. I said that that was not what the Bill said. The noble Lord, Lord Pannick, pointed out that if you had a range of conditions, all of which were fatal, that would count—I do not dispute that at all. The noble and learned Lord seems to be saying that if someone has a condition that is not currently recognised as terminal, they would qualify under the Bill. Did I hear him correctly or have I got that wrong?

[Lord Falconer of Thoroton (Lab)]

The noble Lord has got that wrong. I was saying that, for example, the medical profession could easily recognise that HIV/AIDS is fatal. It would have recognised that at a particular time and that would be a medical diagnosis. The effect of the amendment in the name of the noble Lord, Lord Moylan, would be that you cannot rely on HIV/AIDS as a basis for saying that you have an inevitably progressive illness or disease that cannot be reversed by treatment, which was the position for a long time, unless the state has put it into a list of regulations. I am saying that it should be the doctor’s determination of whether theTo go on with the questions that have been raised, the noble Lord, Lord Moylan, asked what the paragraph under Clause 2(4) means. It means that the fact that you have a disability or a mental disorder that cannot justify a terminal illness does not mean that you cannot nevertheless qualify because you do have a terminal illness that satisfies the requirement of Clause 2(1).

On the question of congenital disorder and Amendment 105, if the position is that you are suffering from a progressive illness or disease that is likely to end your life within six months, I think that you should be entitled to an assisted death. My noble friend Lord Shamash referred to such a condition in relation to his cousin; I am not in favour of excluding a particular category in relation to that.

Everybody in the House has enormous respect for the noble Lord, Lord Shinkwin, and I completely accept the proposition that those of us who are not disabled have to listen very carefully to those who are. It is true that, in the other place, Marie Tidball, who is a Member of Parliament, supported the Bill and was in particular influenced by the fact that amendments were made to it that ensured that a disability group would monitor the performance of the Bill. However, I completely accept the proposition that the noble Lord, Lord Shinkwin, makes that we have to listen as hard as we can because it is not part of our experience. That proposition applies not just to this Bill but to a whole range of Bills.

On two further points, first, a number of noble Lords made the point about developments in medicine. It is true that medicine develops all the time; one needs to keep up with those developments and the doctors making the diagnosis have to have those in mind. But the fact that there are going to be developments in the future does not prevent the position from being that at a particular moment in time—HIV/AIDS is the obvious example—because those developments have not yet occurred, those diseases are going to be fatal. The fact that something may occur in the future does not prevent the judgment from having to be made.

Finally, on Amendments 97 and 98, proposed by the noble Baroness, Lady Grey-Thompson, for understandable reasons she proposes effectively a shift in the wording to be much more respectful of disabled people. I can see no reason why we should not make that amendment.

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I therefore support the amendment the noble and learned Lord, Lord Falconer, is proposing, and the amendment to it. It is a reasonable safeguard for the very vulnerable people—often young women—who suffer from anorexia, which is an appalling disease, and I urge the Committee to support it.

[Lord Harper (Con)]

I am going to limit my remarks to a couple of process points, which think are important. I have listened very carefully to those with considerable expertise on the clinical issues raised by these amendments, and I just want to cover these points.

The noble Baroness, Lady Parminter, has just made the point that this loophole has been well understood for some time and was not dealt with in the House of Commons, although it could have been. I gently say, because there is some frustration from the supporters of this Bill about the time taken to scrutinise it, in repeating what I have said before—it is part of the reason why noble Lords are having to table significant amendments and debate this Bill at length—that there are considerable gaps in the Bill that have been known for some time and have not previously been dealt with. The noble Baroness, Lady Parminter, was exactly right to point out that it is this House that will have delivered an amendment to make that considerable improvement, which has been argued for by a number of people for some time. We are doing good work here, whatever people may think of the principle of the Bill, in improving the drafting.

The noble and learned Lord, Lord Falconer, referred at the beginning to whether the Committee would accept this change to the Bill. I make a clear distinction here—and I am going to be very supportive of his position—between this debate and the earlier debate on what he described as drafting amendments. Many of us considered that they were not drafting amendments but quite significant changes, and we made it clear that, if he pressed them, we would oppose him. In this case, his Amendment 87, as amended by Amendment 87A, clearly resolves one issue in the Bill, and that is welcome. I would certainly have no objection if the noble and learned Lord pressed the amendment, and I hope the Committee would accept it, because there is general agreement that it would improve the Bill.

Finally, as has been said by the noble Baronesses, Lady Parminter and Lady Berger, the noble and learned Lord’s amendment fixes one problem. I am not at all an expert in this area, but I understand from those who are that it deals with the issue of anorexia but leaves other eating disorders such as bulimia unresolved, as the noble Baroness, Lady Berger, said. There are other amendments in this group that raise those issues.

I hope for two things. When the Minister responds, I hope that she can commit at a later stage to setting out that, in the view of the Government and the Department of Health, with regard to the span of eating disorders, the Bill will actually deal with them when we have made some more progress on it. That is a factual point, not an expression of a policy position. When the noble and learned Lord responds, as well as pressing Amendment 87 as amended by Amendment 87A, I hope that he can say something positive about what work he will conduct with the Department of Health on drafting some later amendments on Report to deal with the other eating disorders that have been explained, so that we can make sure that there are no loopholes covering any of these eating disorders. As we have heard, they affect a very significant number of people, particularly younger people, and particularly younger women. I want to make sure that we properly protect them as this Bill proceeds through your Lordships’ House.

[Lord Carlile of Berriew (CB)]

My Lords, I signed the noble and learned Lord’s amendment, and I thank him very much for introducing it. In my view, it is a very important amendment. Noble Lords who have seen a serious eating disorder at close quarters will know that it not only disturbs the person who suffers from that eating disorder, but dramatically affects everybody around them. It is all too easy to be fatalistic about it, not challenge it and try to make one’s way through it.

It is a condition that, in my view, produces three possible outcomes. One, in all too many cases, as we have heard, is suicide. For some, indeed in quite a number of cases, there is recovery. However, perhaps most people who suffer from anorexia, particularly at a young age, learn to live with it. It is that living with it that, in my view, is the most important reason for ensuring that it plays no part in the outcomes envisaged in this Bill. For everybody who suffers from an eating disorder—this perhaps particularly needs to be said to teenagers who suffer from eating disorders, whether boys or girls—the important thing is that there is hope of some kind of good recovery, even if it is just learning to live with it. Something that offers such hope should not, in my view, be part of anything remotely resembling this Bill.

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[Lord Falconer of Thoroton (Lab)]

First, I detect that the mood of the Committee is that I should put my Amendment 87 into the Bill, but subject to the amendment tabled by the noble and learned Baroness, Lady Scotland, and by the noble Baroness, Lady Berger, so I am minded, unless anybody indicates to the contrary, to let that process go ahead. I accept that, in putting it in, there are those who would like to build on it on Report, but I think we should put it in now.

I will deal very quickly with the other amendments in the group. Amendment 88, tabled by the noble Baroness, Lady Grey-Thompson, would leave out “solely”.

[Lord Harper (Con)]

I completely agree with the noble and learned Lord, and I would be happy for the amendment to be made, but he said that he recognises that there are those who would want to build on it on Report. Can he cover the point I made? Obviously, he will have the support of draftspeople and policy officials from the department to help him craft something. Does he recognise that there is still a gap in dealing with some other eating disorders? Will he bring forward some amendments or will he expect those to come from others?

[Lord Falconer of Thoroton (Lab)]

Two groups of eating disorders were identified. First, the noble Baroness, Lady Finlay of Llandaff, identified people who eat only one particular thing. I myself have experience of fruitarians and the consequences of eating only fruit—it may be very bad. Those who have a limited, particular intake are covered by Amendment 87.

A separate group, the bulimic group, gives rise to different sorts of problems. I will consider the position of bulimics, but I do not want to create any expectation that that would lead me to table any further amendments. It may be that other people will table them in the light of what I have said, in which case I will of course consider them, but I think that might be a slightly different category.

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[Lord Moylan (Con)]

My Lords, I have Amendment 235 in this group and I shall speak briefly to it.

I shall probably be mocked for naivety. We have had some 30 years of the Mental Capacity Act. The concept of capacity has been developed in great detail, in a very specialist way. As my noble friend Lord Sandhurst said, the lawyers understand it but perhaps others do not. I am sure that he meant to say that the psychiatrists understand it too, because they have to work with it regularly. However, he is right that ordinary people do not have to engage very much with the Mental Capacity Act. I am one of those ordinary people. I bring no expertise as a lawyer or as a psychiatrist in relation to the Mental Capacity Act. I am simply thinking in this amendment of how ordinary people would regard it if they saw people who were suffering with learning disabilities, autism or mental disorders being led into assisted dying, opting for assisted dying and having that facilitated.

I have no doubt that there is some poll commissioned by Dignity in Dying which says that they would widely applaud it and that it would be a very popular thing, but I do not believe that it is true when actual cases are presented to people and they see them happening. I think that they would say that it is simply wrong that people who have these conditions should be able to access assisted dying. So my Amendment 235 takes the conditions that are specified in Clause 22: learning disability, mental disorder, autism or experiencing substantial difficulty in understanding the processes or information that is relevant. In Clause 22, we say to these people, “We’re going to help you with an independent advocate”. My Amendment 235 says that those people will not be admissible to the process, and I do it by saying that any preliminary declaration they make will be void. Under the terms of the Bill, they will not be able to proceed further.

That is what a large number of ordinary people would expect. They would want us to protect them and the best way of protecting them is to say no. I know that this offends the notion of autonomy held by the noble and learned Lord, Lord Falconer, which he is trying to adjust for these people. It might strike those who spend their lives working at the concept of capacity as being rather naive and backward of me. However, I think that it is what most people want and the safest course. If the Bill is to be implemented, it can be amended in the future if people want, but at this stage it is by far the safest course.

So I recommend Amendment 235, which would terminate this debate by making it impossible for people with those conditions to proceed. Consequently, Clause 22 becomes unnecessary. That is why I have tabled the Clause 22 stand part notice: not because I have an objection to Clause 22 in some complex way but simply because it becomes unnecessary in the Bill. It is otiose.

[Lord Harper (Con)]

My Lords, I will make a few points. The first is in response to the perfectly fair point from the noble Lord, Lord Markham, at the beginning about the difference between this debate and the earlier debate we had. I think there is a very clear distinction. The earlier debate was a very wide-ranging one about capacity. Because of that debate, we now have some very specific amendments to look at, which seek to tackle some of the issues that were thrown up in that debate. The noble Lord, Lord Deben, set out why this is important: the practitioners in this area—the professionals of various types who will be involved in implementing this regime if the Bill becomes law—have been saying publicly, as well as to us specifically, that they want clarity about decision-making, so that they are clear about the legal framework that applies to them and the decision-making regime. That is very important.

I will not speak to all the amendments in the group; I will focus on a couple of points. We have already talked about the capacity issues around people with deprivation of liberty orders. The noble and learned Lord, Lord Falconer, spoke about that debate and the fact that he has—rightly—written to noble Lords setting out his intention to bring forward those amendments on Report. We have not yet seen the detail of those. I have a couple of questions, if he is able to furnish us with that information. I know he said that he was in the process of talking to officials and lawyers about that, but can he give us an indication about whether the protections he is looking at will be something like a yellow flag or a red flag? In other words, would there be a prohibition on someone who has recently been under a deprivation of liberty order so that they would not be able to qualify under the Bill? Also, can he give us confirmation that we would actually have the protections in the Bill, or would they all be left to codes of practice or guidance? Without having done the detailed drafting, if he could give us an indication of his direction of travel, that would be very helpful.

A number of noble Lords have pointed out that there is some confusion. I think that both the noble and learned Lord and the Chief Medical Officer have both said on occasion that there is a sliding scale of capacity in the Mental Capacity Act and that there has to be a higher level of decision-making capacity for more important decisions. I think Chris Whitty had to row back from that in a letter that he sent, as my noble friend Lady Berridge said. So can the noble and learned Lord set out his understanding of the position under the MCA for these sorts of decisions?

Legal experts have asserted that it is factually incorrect in relation to the Mental Capacity Act. Alex Ruck Keene KC, whom my noble friend Lord Sandhurst mentioned as being part of the CLADD group, has confirmed that, while common law may once have suggested a sliding scale, the MCA itself contains no such requirement. Indeed, that is one of the things that the amendment that they have drafted deals with. Even if there is some case law on some MCA decisions that indicates a sliding scale, there cannot be any case law that is relevant to these decisions, because it has not previously been possible for decisions about assisted suicide to have been lawfully taken. There is no case law that specifically pertains to this gravity of decision. It would be helpful to understand what the noble and learned Lord thinks is the position.

I think this is a question that the Minister is capable or answering—or, rather, able to answer—without straying into making a policy decision. Sorry, I changed my word—I was not trying to imply something about her competence at making the thing; it was more about whether she should or should not. What is the Government’s understanding of the MCA, given that the Chief Medical Officer set out one thing in oral evidence and then corrected it? It would be helpful to know what the Government’s definitive view is on this issue of whether there is or is not a sliding scale. That is a factual question that does not go to an opinion about this legislation. It would be helpful for us to know what it is.

I have a final question in this area, and then I will make one final point. One of the things that Amendment 115 is also trying to deal with is that under the Mental Capacity Act there is a support principle that effectively becomes a duty to assist. It mandates that:

“A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success”.


The danger is that the MCA was designed to help people make decisions about things such as finances, care and housing, where support is plainly benevolent. Applying the same duty to a decision to end one’s life is qualitatively different—the noble Viscount, Lord Colville, mentioned the point about how oppressive it can be if you are repeatedly asked whether you want something with this type of decision—and therefore I do not think it is appropriate. I would be interested to know whether the noble and learned Lord accepts that Section 1(3) of the MCA is effectively a statutory duty for doctors to support patients in making this decision, and, if so, whether that balance is accurate.

My final point, for a couple of reasons, is on Amendment 119 in the names of my friends, the noble Baronesses, Lady Grey-Thompson and Lady Hollins, which deals with the mental capacity assessments for people with learning disabilities. The noble Baronesses and the right reverend Prelate the Bishop of Newcastle on behalf of her colleague, the right reverend Prelate the Bishop of Lincoln, powerfully set out their concerns about whether the MCA properly tests capacity for people with learning disabilities making an irreversible decision of this kind. They set out the concerns very well, so I will not repeat them.

I emphasise one danger I can see, which is a point that one or two of them made and that my noble friend Lord Shinkwin made in his earlier contribution, about expectations. We know, sadly, that a number of professionals involved in delivering healthcare have expectations about people with learning disabilities that are not what we would expect. We should all have very high expectations of the quality of life that people with learning disabilities can have. But, just to pick one example, we know how many people with learning disabilities were treated during the Covid pandemic, when many of them were given “do not resuscitate” orders without their consent because medical professionals had taken a view about their quality of life without asking them.

I am afraid I am not prepared to just leave it to medical professionals and their professional expertise to properly safeguard those people with learning disabilities. I think we know enough from experience to know that we should properly protect people with learning disabilities, recognising that they often have capacity and are able to make their own decisions, but that they need extra protection to make sure that those decisions are the right ones. If we do not do that, knowing what we know, we will be failing them.

Amendment 119 is a very valuable one and commends itself to your Lordships’ House. It would do something that I have said on previous occasions is our job: to look out for those without voices, who are more vulnerable and who need our protection. That is not a duty that we should take lightly; it is one that we all have, and this amendment means we would be fulfilling that duty in a very clear and powerful way.

[Baroness Coffey (Con)]

My Lords, I have tabled Amendment 110, which is about trying to understand which version of the Mental Capacity Act we are dealing with. Section 2 of the Mental Capacity (Amendment) Act 2019 would replace what was in the 2005 Act. It has not yet been implemented. I do not know the reason for that. It would be useful to hear from the Minister to get an understanding. This seems to be about how liberty can be removed from somebody—I appreciate that we have had a bit of a conversation already about deprivation of liberty—to have life-sustaining treatment applied. I am trying to understand what would happen under this Act if the life-sustaining treatment was to try to prevent an assisted suicide. I would like to understand what is happening with this part of the law.

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[Baroness in Waiting/Government Whip (Baroness Taylor of Stevenage) (Lab)]

My Lords, I beg to move that the House be now resumed.

[Lord Harper (Con)]

My Lords, before the Committee decides on that question, I put two points on the record. First, we are finishing slightly early. I make the point that some of us would have been perfectly happy to continue to six o’clock to make some more progress, so this is the Government’s decision. However, I understand that we had some confusion on the adjourned group. I flag to the Chief Whip that, when we have an adjourned group and we have a list, perhaps the list could be published in some way so that there is clarity before we start proceedings about who was and was not here at the beginning of the debate on the group. That would avoid the problem we had this morning.

The other issue is that, if we had started the group today, because of the lateness of the hour and the necessity for a significant number of Members to leave early because of travel arrangements to get home, a significant number of people who might have wished to contribute to the debate would not have been able to, even if we had adjourned and continued it next week. Given that the Government Chief Whip said that it was okay for Members to leave early because of those travel situations, can he give some thought to whether, if we start a group to make progress and then adjourn, those Members could still be able to participate in the debate on the group when we resume on the following occasion? I recognise that that is a variation in procedure, but it is about trying to work with the unusual circumstances we face to make sure that people can participate, but also making the best use of the time while complying with the House’s ruling that we make more time available to make progress on the Bill.

[Baroness Taylor of Stevenage (Lab)]

I shall refer the noble Lord’s comments to the usual channels.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I follow the noble Baroness in speaking to the issue of the commissioner. The shift from the High Court to a commissioner has been compounded. The Bill originally proposed that a High Court judge would authorise every assisted death—a feature initially championed by the Bill’s sponsor in the other place to make the United Kingdom’s law the safest in the world, with robust safeguards. That has changed dramatically and we now have a new structure, with a commissioner appointed by a Prime Minister.

The voluntary assisted dying commissioner is an important role. They will be given powers both to run and monitor the service. This creates the obvious risks of inadequate public scrutiny and independent review. It is judicial in the broad sense of involving a judge, but it does not appear to have a judicial function. The commissioner will both run the service and monitor it, which means that a highly controversial and important service will be run with little proper oversight. The commissioner will be responsible for establishing the regime and overseeing appeals as well as monitoring and reviewing its operation. In effect, as others have said, this allows the commissioner to mark their own homework.

Dr Luke Geoghegan, policy lead of the British Association of Social Workers, told the Select Committee that an independent regulator for VAD was essential. He said:

“The other thing that I think would give assurance is that no public sector organisation should mark its own homework. The voluntary assisted dying service needs robust external inspection”.


In its written evidence, the Law Society said:

“We recommend the establishment of an Independent Monitor to review and report on the operation of the Act annually”.


The commissioner could be an assisted dying campaigner or someone linked to an advocacy group. Other countries have experienced problems when the assisted dying service is run by an advocate, yet nothing in the Bill prevents this risk of conflict of interest.

In the Constitutional Reform Act 2005, the noble and learned Lord, Lord Falconer, developed a new judicial appointments process designed to guarantee an independent, impartial judicial appointments process and an enshrined statutory duty requiring respect for the independence of the judiciary by Ministers. Yet in the office of the commissioner, we see a potential patronage office in the political gift of the Prime Minister without any internal or external safeguards. Can the noble and learned Lord tell the Committee how the commissioner’s impartiality will be guaranteed? Why has he changed his mind on the importance of statutory guarantees of independence? Will the public have any right to know the commissioner’s views?

Amendment 127, in the name of the noble Lord, Lord Beith, would

“make the Prime Minister’s choice for Commissioner subject to scrutiny and approval by the House of Commons’ Health and Social Care Select Committee”.

There is a lack of accountability and transparency around the commissioner’s appointment process, which is entirely in the gift of the Prime Minister. Therefore, I ask the Minister who will respond to this group: have the Government followed Cabinet Office guidelines regarding appointments? The Cabinet Office Guidance: Pre-appointment Scrutiny by House of Commons Select Committees, published in 2019, requires:

“When establishing a new public body, departments should ensure that they consider whether any public appointments to that body would meet the criteria”


for a pre-appointment hearing. It continues:

“They should seek guidance from the Cabinet Office and also discuss this with the relevant select committee Chair in a timely manner before establishment of the new body”.


Can the Minister confirm whether the Government have discussed the matter of a pre-appointment hearing with the Commons Health and Social Care Select Committee?

[Lord Harper (Con)]

My Lords, I have a couple of points to make on this group of amendments. Let me start on a note of agreement with the Bill’s sponsor, the noble and learned Lord, Lord Falconer, who has in this group Amendment 131A, which would require:

“Before making an appointment under this section, the Prime Minister must consult the Welsh Ministers”.


I think that is a sensible approach. We have had disagreements about whether the Bill should or should not apply to Wales but, given that it does, it is sensible that Welsh Ministers are consulted.

It is worth noting that Welsh Ministers have some views on this matter. Given that we are talking about consulting Welsh Ministers, this is probably the time to note them briefly. In the vote in the Senedd this week, Wales’s Health Minister, one of those who would be consulted, made two points clear. First, he said that the Motion in the Senedd was not a referendum on legalising assisted dying with only this Parliament able to make that decision. He also said—this is important, given that there are those outside this House who pretend that the only people who think this Bill has any flaws are a small number of Peers, when that is not the case—that he voted against the legislative consent Motion because:

“I’m also clear in my own mind that the fundamentals of the bill, as it’s going through Westminster, don’t provide sufficient safeguards for patients”.


The Welsh Health Minister, who would be one of those responsible for helping to implement it, thinks that the Bill currently does not have appropriate safeguards. He went on to say:

“Although the vote yesterday was on the devolved areas ... the net effect is to give powers in Wales to deliver a service that I don’t think I would support if I was operating over the border”.


For all sorts of reasons, it is helpful to consult Welsh Ministers. We have heard from them this week, and they are very clear that this Bill is currently flawed. Therefore, I think we are doing the right thing by scrutinising it, asking questions and putting forward amendments to improve it. We can see that it is not just Members of this House who have concerns; elected Members serving in the Welsh Government also have concerns, and it is worth getting that on the record.

The fundamental thing that I want to talk about is the prime ministerial appointment process in the Bill. I was quite surprised, not particularly that the Prime Minister was making the appointment, but that there was no other process around it. The Bill currently says that the commissioner is to be appointed by the Prime Minister. The one constraint is that:

“The person appointed must hold or have held office as a judge of … the Supreme Court … the Court of Appeal … the High Court”.


Other than that, there is no process set out that the Prime Minister has to follow.

There are two flaws with that. There is the one that the noble Baroness, Lady Fox, set out, which is that, given that this is an area of policy, the Prime Minister may have their own views about the issue and that may influence the person they choose. My noble friend Lord Markham was quite right that the person would simply be implementing the law. The worry is that if you appoint somebody who has a very strong view about the issue and is prepared to use holding this office to prosecute advancing it, which is the concern my noble friend Lord Moylan set out, that is a problem. The concern I have with the Bill as drafted is that the Prime Minister could appoint such a person, and we would have no way of knowing in advance or of testing that person’s views before the appointment was made. We would find out about it only afterwards, and that is a real problem.

Secondly, I am afraid that we have seen examples of the current Prime Minister making staggeringly bad appointments, and the rather obvious one is Lord Mandelson. I see the Minister shaking her head, but it was a shockingly bad appointment. It is an example of a decision being made to appoint somebody and the process being circumvented in order to get the right result. The person appointed to this role is responsible for life and death issues, and as my noble friend Lord Deben said, it is extremely important that they command the confidence of the public—not just people who are in favour of assisted suicide, but those who are against it and who want to see a proper process with proper safeguards, so that that person holds public confidence.

[Lord Moylan (Con)]

Does my noble friend agree that, given the surreptitious but none the less firm support that the current Prime Minister has shown for this Bill, it is almost impossible to believe that he would not be personally involved in this appointment?

[Lord Harper (Con)]

I think that is right and that that is a concern. The noble Baroness, Lady Fox, set it out very well. There are two approaches in this group of amendments to deal with that issue, and I want to explain why I have come down on one side rather than the other. There is the approach that my noble and learned friend Lord Garnier set out, which is to take it away from the Prime Minister and make it an appointment by His Majesty the King on advice from the Lord Chancellor. The alternative approach, set out in the amendment proposed by the noble Lord, Lord Beith, is a better one, which is to subject the person concerned to a pre-appointment hearing of a Select Committee.

That is a better approach because it is more transparent. As the noble Baroness, Lady Falkner, set out, it is actually quite a tough process whereby the candidates can be grilled about their views and their qualifications, how they intend to use the role and whether they intend to use it to advance the law in any way. They can be questioned on that. There is also a precedent, as has been mentioned in the debate, I think by my noble friend Lady Coffey: appointments to the Office for Budget Responsibility not only have a pre-appointment hearing by the Treasury Committee, but the Treasury Committee has a veto and has to consent to those appointments before they can be made by the Government. That is a good model.

So rather than changing who makes the appointment, I am content for it to remain a prime ministerial appointment, with the amendment to consult Welsh Ministers, but before the Prime Minister can make such an appointment, we should ensure that there is a pre-appointment hearing by a Select Committee of the House of Commons. I am not convinced that it should necessarily be the Health and Social Care Select Committee, as there is an argument it should be the Justice Committee, given the nature of this role. That is a secondary question, but there should be a pre-appointment hearing where the person’s qualifications and motivations can be interrogated in public, and then that committee can make a decision. It would mean that the Prime Minister could proceed only with the consent of a cross-party committee—whether it should be a committee of just the House of Commons or a joint committee of both Houses may be an issue worth considering. That would achieve what my noble friend Lord Deben was arguing for: a transparent process held in public so that the public can have confidence in the person appointed, and the Prime Minister can then move forward with that appointment, knowing that it is not going to generate an enormous amount of partisan controversy, which is the last thing we want for this important appointment.

So, on balance, I am happy if the noble and learned Lord, Lord Falconer, moves his Amendment 131. I would certainly have no problem with adding that to the Bill. I am attracted to the solution proposed by the noble Lord, Lord Beith: pre-appointment hearings, with the Select Committee having a veto on the appointment, and only when that has taken place can the Prime Minister move forward. If we do that, we will have a robust process in which we can have tremendous confidence.

[Lord Carlile of Berriew (CB)]

I have listened to two and a quarter hours of debate on this group. I was not really intending to speak, but I am afraid I cannot resist an “I told you so” moment. I am speaking not because I was name-checked by a number of noble Lords in various parts of the House, but because I think it important to emphasise the background for that name-checking.

First, we have been focusing on the appointment of the commissioner, looking only at Clause 4. I say in credit to the noble and learned Lord that it looks as though a large number of your Lordships have not read Schedule 1 to the Bill, because it is an absolute clear fact and matter of law that if the appointment of the voluntary assisted dying commissioner under Clause 4 was done improperly and not objectively, it would immediately be opened to a host of judicial review cases, which would be brought by every interested party or group looking at this issue.

I want to say something quite different, and here comes my “I told you so” moment. Some noble Lords may just about recall that, early in Committee, I proposed Amendment 120, which proposed returning to a court-based model architecture for the Bill: among others, the noble Baroness, Lady Coffey, referred to that earlier. If we were to follow the provisions of Amendments 120 and 137, which would remove Clause 4(4)(b), (c) and (d), we would have a clear, court-based procedure. Amendment 120 could of course be improved, and I think I am going to be given some facilities by the noble and learned Lord to talk to officials in the near future about that and how it might be designed, but it would mean that the voluntary assisted dying commissioner would then have a much more limited role, which would be to monitor the operation of the Act, receive documents under the Act and report, just as other independent reviewers report, on functions that they are placed in some position of authority over.

I suggest to the Committee that we would not need to have spent the last two and a quarter hours having the debate we have had if we had that simple architecture, which would inspire the confidence of being supported by the courts, knowing that this would be subject to normal court, appeal and evidential procedures. Maybe we should come back to that at a later stage. I hope that the noble and learned Lord may change his mind about that once he considers carefully and in detail what has happened this morning.

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[Lord Falconer of Thoroton (Lab)]

Thirdly, I join with everybody in the Committee in deprecating vicious attacks on the noble Lord, Lord Sandhurst, and the noble Baroness, Lady Finlay. Any one of us who have been involved in this get vicious attacks outside. I agree with the noble Baroness, Lady Fox, when she says there is a slightly testy atmosphere from time to time in here. The best that we can do to try and fight off those attacks is to be as good-natured, funny and warm as we normally are. I am looking forward to the noble Lord, Lord Deben, being warm and funny again.

Fourthly, my Amendment 131A, which the noble Lord, Lord Harper, mentioned, would add that the Prime Minister is to consult the Welsh Ministers before making the appointment. I hope that nobody objects to that; it is what the Welsh Senedd effectively agreed by passing the LCM. When we come to that amendment, I will move it, as I detect no objections.

Finally, I am afraid I will not provide the noble Lord, Lord Moore of Etchingham, with any assistance in relation to the way he conducts himself in the Committee. He always conducts himself, if I may say so, with impeccable manners and courtesy. It is for each one of us to determine what is appropriate and what is not.

I will deal with the amendments quite quickly. They are all to deal with the voluntary assisted dying commissioner provided for in Clause 4. The voluntary assisted dying commissioner will be appointed by the Prime Minister. As my noble friend Lady Levitt, the Minister, has indicated, as long as that stays in, then it will be subject to an open appointment procedure involving an assessment panel.

The idea of the noble Lord, Lord Beith, is perfectly commendable: should a Select Committee look at the appointment? The way that would work in practice is that it would be for the Cabinet Office and the individual Select Committee to agree whether the appointment should be subject to a Select Committee procedure. I would be in favour of it. I do not think it is appropriate to put it into the Bill, but I can see real merit in it. Iwould not only have no objection to it, but I think it is a good idea.

[Lord Harper (Con)]

Given that the noble and learned Lord thinks it is a good idea and that part of the reason—I think the noble Lord, Lord Deben, touched on this—many of us have concerns is that so much of the detail of implementing this is not set out but left for decisions, what is his objection and rationale for not coming forward with an amendment and putting in the Bill so that it has to be done by a pre-appointment hearing rather than leaving it to a decision?

[Lord Falconer of Thoroton (Lab)]

With respect to the Select Committees in the other place, they should be consulted and decide whether they want it.

In the amendment from the noble Baroness, Lady Cass, she draws attention to the fact that the assisted dying commissioner has a function under the Bill. That function is to receive documents, make appointments to the assisted dying panels, make arrangements in relation to such panels—this means that he or she is responsible for making sure the process runs properly—and determining the applications for reconsideration of panel decisions. That means that, if a panel says no to an applicant who wants an assisted death, the voluntary assisted dying commissioner has the power under Clause 18 to say that another panel should look at it. He or she has that power in a semi-judicial function if there is an error of law in relation to it, so that is a function.

The commissioner also has a function to monitor the operation of this Act. If noble Lords go to Clause 49, they will see that he or she is given the power to make reports, give an annual report and identify things that may be of significance in relation to it. One should not confuse this role with monitoring, for example, the performance of doctors in relation to their role. I do not see the very specific functions and the obligation to monitor and give reports, as in any way in real conflict. I think they could be done by the same person, particularly if there is a deputy to be appointed as well. I note what the noble Baroness said, but I do not think it is necessary to make provision in the Bill for a separate role for somebody to do both. I have thought very carefully about it.

The noble and learned Lord, Lord Garnier, has been kind enough to indicate that he has had to leave, but I will deal with his point. He wants not the Prime Minister but the Lord Chancellor to make the appointment. The Prime Minister and the Lord Chancellor are both political appointments. We have chosen the Prime Minister because—even though I think there is practically nobody more important than the Lord Chancellor—the political world, for reasons I am completely unable to understand, regards the Prime Minister as more important. We have chosen the most important person in the Government to make the decision and, with the greatest respect to the noble and learned Lord, I do not think we should change that.

The noble Lord, Lord Weir, asked why we should have a judge. I am a great admirer of judges, and I declare an interest in that I am married to a judge. The reason why we have a judge is twofold. First, ex-members of the Supreme Court, the Court of Appeal or the High Court of England and Wales—it is England and Wales that we have in mind—have high standing. They are regarded as people of calibre, which is why they are put in. Secondly, one of the specific functions in the Bill is to consider whether the rejection by a panel is an error of law. That seems to us to be appropriate to be dealt with by somebody with high legal experience. Separately, the commissioner is somebody who has to issue rules and a process for dealing with it. That is the reason for doing that.

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[Lord Empey (UUP)]

I accept that that may well be the case. I am simply referring to what was in Hansard in 2021. The noble Lord may have changed his mind, as we all do over our lifetime, and rightly so—if you have a completely solid view of everything throughout your life, it is not a good thing. I am not in any sense trying to demean his position in any way; he is a very highly respected member of your Lordships’ House. My point is that his reference to the euphemism is still valid in my view.

Coming to the nuts and bolts of how things would work in practice, at Second Reading of this Bill, and indeed in previous iterations in which I have had any role, I drew attention to one of the key issues: changing the nature of the service that we are funding. If we decide as a Parliament to make assisted dying, or whatever phrase one wishes to use, a legal activity, that does not necessarily mean that the National Health Service has to pay for it. Can you imagine the finance committee of a trust discussing its budget and getting into an argument? The sums may be modest, but to even put something such as that in this context, when we are talking about life and death, is fundamentally flawed, morally and in every other way. The noble and learned Lord needs to reflect on some of these matters.

[Lord Harper (Con)]

I am grateful to my noble friends Lord Moylan and Lady Fraser for tabling these amendments. They have put forward some important questions which are worth raising explicitly with the sponsors of the Bill, so that we can hear what their intentions are and how they have reached those conclusions.

I have a number of concerns in this area, which I will set out. On a previous day, the Minister currently on the Front Bench confirmed, when we were debating resources, that if Parliament were to pass this Bill then the Government would ensure that all the requirements in the Bill were funded. That is perfectly right and proper. It was clear from that debate that there was no guarantee of any extra resources and that therefore money would be reprioritised—not just in the National Health Service but in the courts’ budget, given the impact that this Bill would have on the courts. That has clearly been reflected by what Stephen Kinnock said in evidence and by the Health Secretary, who commented on the need for prioritisation.

I do not make as much of the cost of this as some people, because I accept what the noble and learned Lord, Lord Falconer, said on a previous occasion. Compared with the NHS’s overall budget, the cost of providing this service is relatively modest. I have a different concern, which is twofold. First, as has been raised already in the debate, it would be perverse if Parliament were to pass this Bill and the taxpayer were to fully fund an assisted suicide service when it only partially funds palliative care. That would set out a very weird set of priorities and choices to the country—that the taxpayer should fully fund helping to kill people and not fully fund helping them to live well.

My question to the Minister—which does not trespass on the Government expressing a view on the Bill—is, in the event that Parliament passes the Bill, and the Government rightly ensure that it is funded, will the Government ensure that palliative care is fully funded by the taxpayer? This is not a question about taking a view on the Bill; rather, it is about making sure that when the Government publish in the autumn—this is why doing it in this order is not helpful, because we are not going to hear about palliative care services until the autumn—they will fully fund those services so that the taxpayer will ensure that any individual facing a choice has a proper choice and, if they choose palliative care, they will have care fully funded by the taxpayer in the same way that they would have a fully funded assisted suicide. If you do not fund it on that basis, you are not providing people with a proper choice. That is a question for the Government to answer.

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[Lord Falconer of Thoroton (Lab)]

This group concerns the question of funding. First, the noble Lord, Lord Moylan, raised the question: should the people who benefit from this have to pay for it? Secondly, the amendments from the noble Baroness, Lady Fraser, raised the question of whether it should be free to the patient. Could it be provided by private providers? Separately, there were questions along the lines of: will this change the nature of the relationship between the doctor and the patient? Finally, there were questions over whether this might lead somebody to urge people to take an assisted death.

I start with the provisions of the Bill at the moment, which, subject to the amendments to Clause 41 that I propose, require that the integrated care board, or NHS England or the Secretary of State, commission the services. A separate provision, in Amendment 753A, makes provision that, in practice, they have to be free for the person getting them.

The principle that underlies that approach—my noble friend Lady Levitt is right and this is the choice that the Bill makes—is that it will be available free to somebody who wants it and who satisfies the conditions. The reason for that is that we do not want to create a two-tier system where you can have an assisted death only if you can afford to pay for it.

In evidence to the Commons Public Bill Committee, Dr Michael Mulholland, the honorary secretary of the Royal College of GPs, said:

“Whether it occurs in the NHS is not our decision, but we would be very concerned about health inequalities creeping into any part of the health service … If the Bill comes through, we will want to make sure that there is not a differential in who is able to access it”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 278.]


The amendments of the noble Baroness, Lady Fraser, do not affect that. The amendments of the noble Lord, Lord Moylan, do, and it is for that reason that I oppose them.

I will first deal with the amendments of the noble Baroness, Lady Fraser, which would restrict the model that could be used to private providers only—albeit that she is not saying that it should not be free. I agree with what my noble friend Lady Levitt has said, to the effect that the way it is delivered should not be restricted. I would therefore not be in favour of the amendments of the noble Baroness, Lady Fraser, in that respect.

[Lord Harper (Con)]

Does the noble and learned Lord not see that the argument that he has just made in favour of having a fully funded assisted suicide service is exactly the mirror of the argument that I made on palliative care? The argument from the quotation that he gave is exactly the argument that I made. If you fully fund this proposal but you do not fully fund palliative care and make that universally available at high quality, you have an inequality where wealthier people can get palliative care and poorer people cannot. On previous occasions, the noble and learned Lord has made it quite clear that he is comfortable with those being reasons for people seeking an assisted death. I do not think that they are. You have to fund both services on an equal basis. Does he agree?

[Lord Falconer of Thoroton (Lab)]

The impact assessment suggests that in year 10, assuming the highest possible cost, it would cost £37 million in total to do assisted dying. This is not by reference to any savings and it includes not just the health elements but also the panel and the assisted dying commissioner. It is plain that palliative care should get as much funding as possible. It is patchy throughout the country and it needs more funding. For me, it is not right to delay the option of assisted dying, particularly when the amount of money that we are talking about to fund assisted dying is so much less than that amount of money, which I would fully support being provided as much as possible. I understand what the noble Lord, Lord Harper, is saying. I am fully behind him if he is saying, “Let’s all put our backs into getting as much money as possible for palliative care”. But I do not accept the argument that the inadequacy in some parts of the country of palliative care is a reason for delaying the assisted dying Bill.

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[Lord Harper (Con)]

I shall speak briefly to the three amendments that I have tabled in this group, to start off with. First, Amendment 472A would slightly tighten up the requirement for the panel to speak to the person’s proxy, when they have a proxy. Currently, as the Bill is drafted, they may speak to the person’s proxy, but I think that they should speak to the person’s proxy. There are no criteria set out about how they make that distinction. Given that the person’s proxy will have signed the declarations that kick off this process, they should speak to them. I do not anticipate it being a very long conversation, but it is essential that they do so.

Amendments 495D and 496D reference the appeal mechanism in Clause 18 and set out a time limit in line with normal tribunal and administrative appeals—so somebody has to appeal against the panel’s notification of the refusal of the grant of certificate within 10 calendar days. I shall not labour the point, but it is just sensible to have a time limit to make sure that there is a clear process.

I had intended to limit my remarks to that, but I have done the dangerous thing of actually listening to the debate, and I wanted to reference my noble friend Lord Jackson of Peterborough’s amendment. It came out in the contributions of the noble Baronesses, Lady Fox and Lady Hayter—a perfectly reasonable difference about exactly where we need to have transparency and balances against privacy. The noble Baroness, Lady Hayter, is perfectly at liberty to disagree with the noble Lord, Lord Jackson, and she obviously does, but I was surprised that she appeared to take against him for the temerity of even tabling his amendment. She said she was shocked. The presumption in the Bill as drafted, as far as I read it, is that in Schedule 2 the panels are to determine referrals in public; that is their default procedure. I give way to the noble Baroness.

[Baroness Hayter of Kentish Town (Lab)]

That is very helpful, because I can say what I said to my noble friend in private. Had we been doing this Bill at the sort of speed I hoped we would, I would have tabled an amendment that it should be in private. My personal view is that it should be. Because of the way things are happening—I will say no more—I have not tabled those sorts of amendments.

[Lord Harper (Con)]

That is very helpful. It enables me to make this point, because this is where we have a disagreement. It gives the sponsor of the Bill the opportunity to set out why the Bill is drafted as it is. I will set out why I think my noble friend’s amendment is broadly right, but perhaps there is a comparison with what we already do in similar cases. That may give the noble Lord, Lord Carlile, the opportunity—he may not wish to say so—for another “told you so” moment, as it is a judicial comparison.

The presumption in the Bill is that panels will do the referrals in public. There is a “subject to” on that: the chair of the panel can decide to do it in private if they feel that is appropriate. I accept that there is a balance to strike because, for obvious reasons, these panels are making decisions about personal, private matters. It is also right that there is some transparency. My noble friend Lord Jackson’s amendment would give quite a big window, 28 days, to publish the notice of the panel meeting. It would also include the name of the person.

The comparison I looked at, which I thought was a reasonable one, was what the Court of Protection does. It makes decision about sensitive financial and welfare matters. It used to be the case that the Court of Protection’s presumption was to sit in private and not hear cases in public. That has changed over time. The presumption now is that cases are heard in public. Again, my understanding is that there is the ability for the judge presiding on those cases to decide for them to be in private if that is felt necessary. Even when they are in private, I understand, members of the public can make applications to go and listen to those cases. I think that is all right and proper. That appears, I presume, to be where—the noble and learned Lord, Lord Falconer, is nodding.

[Lord Falconer of Thoroton (Lab)]

This is an important issue. Let me say what I think the purpose of this is, so that it can be properly debated. The norm for the panel—the noble Lord, Lord Harper, is right—is to sit in public, but it is such a thing that it should be determined by the patient. If the patient says that he or she wants it in private, and they very regularly will, the chair can say, “Okay, it’s in private”. The expectation is that it would normally be in private if the person asks. However, there is still a discretion for the chair. It is not like the Court of Protection where the judge is making a decision in a much wider public interest. The reason it is drafted like this is that there needs to be some transparency but, if the person wants it in private, they should generally be entitled to that because it is so personal.

[Lord Harper (Con)]

That is helpful in one sense because it is helpful to have fleshed out the noble and learned Lord’s intention. It is not helpful in the sense that he has made the Bill less attractive to me than I thought it was. I thought the presumption was more that it would be in public.

[Lord Falconer of Thoroton (Lab)]

It is very important that the noble Lord knows.

[Lord Harper (Con)]

I do. The reason why I partly agree with my noble friend Lord Jackson is that I had a look at what the Court of Protection does in terms of publicity—the bit that the noble Baroness, Lady Hayter, objected to. It publishes hearings in advance—not 28 days—but it does not publish the full name of the individual. It publishes initials and what the case is about: the broad category of the decision. That strikes me as quite a good balance, which provides transparency but maybe avoids people coming to “watch a spectacle”, to quote the concern of the noble Baroness, Lady Hayter.

However, there is some necessity for it to be in public. The reason for that is also set out in the Bill, which says the panels

“must hear from, and may question, the co-ordinating doctor … must (subject to subsection (6)) hear from … the person to whom the referral relates”.

At this point, I agree with the noble Baroness, Lady Berger. That should absolutely be a must; there should not be an exception. If it is the case, as I understand from the appearance of the noble Lord with me on a media programme, that the exception is designed for cases where the person’s medical situation is very severe, they should not necessarily have to come to the panel, but at least one member of the panel should absolutely still have to go and talk to them. It really should not be okay for the panel to authorise somebody to have an assisted suicide without ever having spoken to the person concerned.

[Baroness Hayter of Kentish Town (Lab)]

I am sorry that we are doing this, but the person will be at home, very often, and bedridden. Are we actually expecting a panel to go to their home, into their bedroom, and do this there? Again, this is not the sort of world that I know from some of the people who I see living in surroundings where it would be quite difficult even to put a spare chair in their bedroom—they could be on oxygen, or whatever—for someone to see them there.

[Lord Harper (Con)]

These are difficult issues, but the panel is being asked to authorise their death, so this is a serious issue. I accept that this is uncomfortable, and I am not suggesting the entire panel would rock up at their home, but at least one member of the panel ought to have to talk to them. The idea that the panel would authorise somebody to have an assisted death, never having spoken to them, is frankly appalling.

I shall just finish, because I want to stick to time—although I am conscious that the noble and learned Lord nicked a bit of it to explain to the Committee. I shall finish by saying that the amendments that have been put down are very helpful, because we have fleshed out this very sensible issue of how much of this should take place in public.

The other reason for it being in public is because, otherwise, there are two groups of people the panel is asked to talk to. It may hear from and question any other person and may ask any person appearing to have relevant knowledge. The problem is that, if these hearings are done in private and no one knows they are happening, I do not know how the panel is supposed to know who any of these people are; these people are not going to be able to make themselves known to the panel. So there is a clear argument about where you draw the line and there is clearly a balance to strike between openness, transparency and privacy, but it seems to me that this is a good debate for the Committee, and I want to hear where the Bill’s proposer thinks that balance should be struck. We have heard a little bit about that, and we can hear a little more later.

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

I am conscious of the time; it is now nearly quarter to six. So, it quite clear that this debate is not going to finish tonight and we are going to have to adjourn mid-group. This is absolutely fine, but we will take the intervention from the noble Lord, Lord Jackson, and maybe one other contribution. Then we will probably have to adjourn mid-group.

Terminally Ill Adults (End of Life) Bill

Lord Harper Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I have thought very carefully about the amendments we have gone through. I am sure they are all based on attempts to improve aspects of the process, such as the appointment of the panels, how the panels operate and the privacy issues. I should say that very considerable thought went into those issues before the Bill was drafted and as it went through the other place. I have given detailed reasons as to why I think the amendments we have debated would not really improve the position. For those reasons, after giving it considerable thought, I think that the Bill probably reached a better conclusion on, for example, the “must” and “may” issue that the noble Baroness raised and the need for special extra expertise. I have given it careful thought, but I do not think any of the amendments we have gone through would improve the Bill.

[Lord Harper (Con)]

I want to pick up a point made by the noble Baroness, Lady Berger, and the noble and learned Lord’s response to it. There are two aspects to what she said: whether the noble and learned Lord thought that any of the specific amendments might need bringing forward in a different form, and whether he thinks any of the issues raised, or concerns expressed, by any of the professional organisations that gave evidence raise any issues at all that he thinks need improving in the Bill, even if he thinks none of the amendments is acceptable. Does he think that all of those professional bodies’ concerns, and the evidence they gave about them, are misplaced?

[Lord Falconer of Thoroton (Lab)]

Professional bodies have raised a whole range of concerns. That has informed the drafting of the Bill, and certain changes have been made in the light of a variety of those concerns. I certainly am not saying that we know better on everything than the royal colleges. Their thoughts since the Bill has been published have been taken into account.

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This, frankly, puts into question what the point will be of Parliament discussing what is likely to be an NHS Bill that will be put forward in the upcoming King’s Speech, when, regardless of what Parliament decides in respect of the NHS Bill in the next Session, the mechanism at Clause 41(6) could subsequently be used to undo all of that anyway. Surely the right thing to do is to specify in this Bill what the mechanism is supposed to be. Then, when Parliament subsequently passes further primary legislation for the NHS, if it wants to make some adjustments at that point, it can do so in the full light of day.

[Lord Harper (Con)]

My Lords, I will come on to the exposition by the noble Baroness, Lady Finlay, on this group of amendments shortly. I will also pick up on the important and perfectly fair point raised by the noble Baroness, Lady Jay of Paddington, following on from the speech of my noble friend Lord Deben, about what end of the telescope you are looking at this from. She was right to challenge those of us who are focusing on the safeguards. It is also important that a Bill passed by Parliament is workable.

However, there is a reason, if I may just gently say to the noble Baroness, why we are focused in the way we are. It was put extremely well by Johann Lamont, who Members opposite will know was the leader of the Scottish Labour Party between 2011 and 2014. This is in the context of the debate on a different but similar piece of legislation currently going through the Scottish Parliament. She said:

“In my time as MSP I came to appreciate the challenge of understanding that something can be of benefit to some but the unintended consequences for others matter just as much. We should not just ask how it might help some but ask what if it means undesirable results for others”.


In effect, that is the nub of what we are trying to do here.

The Bill’s proposals, perfectly understandably, are focused on those who wish to seek assisted suicide. Those of us focusing on the safeguards in the Bill are worried about all the people who may be adversely affected: the vulnerable, disabled people and—before we fixed the gap in the Bill, which took a very long time to do—those with anorexia. Those are the two perspectives, both of which are valid, and that is what the debates in your Lordships’ House are trying to reconcile in this legislation.

The other very important issue—I am pleased to see my noble friend Lord Markham in his place, because he rightly often references this—is public opinion. On an issue such as this, it is more important that Members of Parliament, including Members of this House, do what they think is right. This is a very important moral question. We should do what we think is right, explain why we are doing what we are doing and then allow ourselves to be judged. People will draw conclusions about your Lordships’ House based on how we conduct ourselves and how we debate this legislation.

Since the proponents of the Bill are often happy to quote polling, it is worth just putting on the record some recent polling by Whitestone Insight for Care Not Killing. Whitestone Insight is a member of the British Polling Council. The key findings are very relevant to this group of amendments. When the public were asked whether they would support a law that enabled patient choice if it risked harm to vulnerable people, 42% said they would oppose such a law, and only 35% said they would support it. More than twice as many respondents strongly prioritised safety over choice, rather than choice over safety, which is not the position of the noble and learned Lord, Lord Falconer, who frequently says to us that the important thing here is autonomy. That polling is important, because that is indeed the job this House is trying to do. It is about making sure that the legislation contains appropriate safeguards, so that it ends up being used only by those who have exercised a genuine wish to do so and not anybody else. That is incredibly important.

Having said that, I turn to the group of amendments put forward the noble Baroness, Lady Finlay of Llandaff. I listened very carefully to what she said. She set out a very good, workable proposition on how to ensure that such decisions are made by a genuine multidisciplinary panel that is clearly separate from the people providing care. She set that out in a detailed way and explained it very well. Noble Lords are free to disagree with her, but I do not think that anybody could reasonably argue that this has not been done in a careful and thoughtful way, informed by her years of clinical experience in palliative care. So, it behoves all of us, whether we agree with her or not, to give her proposal due weight. When the noble and learned Lord, Lord Falconer, responds, I hope he will take time to reflect on her proposal and, even if he does not agree with all of it, see if there are some things that are worthy of taking forward, from his own perspective, even if he cannot support all of them.

One of the important things the noble Baroness referred to—we have already discussed this and is not universally agreed with, but I strongly support it—is keeping the provision of assisted suicide separate from the provision of NHS care. That is very important for several reasons. Assisted suicide is not a healthcare treatment, so it is very important that it be kept separate from healthcare provision, partly for the reason set out very ably by my noble friend Lord Deben: if vulnerable people and other patients facing a terminal illness and needing palliative care think that, at some point, the people providing that care are going to try to end their life, encourage them to do so or put pressure on them to do so, the practical effect will be to put them off seeking palliative care at all.

My noble friend is right that many people fear, if they think there is going to be bad news, approaching doctors and healthcare professionals. Those involved in healthcare delivery know that many people seek medical treatment too late. Speaking as a man, men are particularly bad at going to see the doctor—far worse than women—leaving it until it is too late. That is something we should not be encouraging. We should be trying to make sure that people are comfortable in seeking support. It is important that, when they seek palliative care, they are clear about what they are getting and are not confused.

The points made by the noble Lord, Lord Stevens of Birmingham, are informed by his enormous experience in running the National Health Service. Clearly, in this country, there is an enormous amount of support for the principles of the NHS, whatever the level of performance is at any given time. It is also clear that the founding principles of the NHS would need to be altered to be able to deliver assisted suicide. I personally think that it would be best not to alter the founding principles of the NHS in order to do that. If you are going to do it, that should be an explicit decision of Parliament; it should not be a decision taken by Ministers.

If it is the wish, as I believe it is, of the sponsor of the Bill, the noble and learned Lord, Lord Falconer, to have this as an NHS service, it should be explicitly written into primary legislation, with the necessary consequential changes to what the NHS does. That should be a clear-eyed decision that Parliament takes, with all the consequences that flow from it—we have debated those, and I will not repeat them here—such as challenges about whether decisions will be taken because of funding and resource reasons, and about pushing people down one path rather than another. We have heard examples in previous debates where that has already happened, such as the Liverpool care pathway. For those reasons, I support the amendments set out so ably by the noble Baroness, Lady Finlay. The points put forward by the noble Lord, Lord Stevens, are also very worthy of consideration.

Finally, I return to a point I made earlier in supporting the noble Baroness, Lady Berger. I accept that the noble and learned Lord, Lord Falconer, does not agree with everything we say, but I hope he accepts that all the royal colleges he referenced, having looked at the Bill, do not take a view on the principle, but do not support the legislation in its current form. So, even if the noble and learned Lord is not minded to support these measures, I hope he will at least listen to the concerns other people have expressed and take these as practical mechanisms to try to improve both the Bill and its workability. I hope he accepts them in that spirit.

[Lord McColl of Dulwich (Con)]

Is the noble Lord aware of a rather alarming story from Holland that is relevant to the separation of the two services that he mentioned? A gentleman witnessed the euthanasia of his mother. It was done by an anaesthetist, who came in and said to the lady, “Now, I’m just going to put a needle into your vein and inject this medicine, and you’ll go off into a wonderful sleep and have no further worries”. A month later, the gentleman was involved in a road traffic accident, and he had to have an emergency operation in that very hospital. He was waiting for the anaesthetist to come in, and he was horrified, because it was the same anaesthetist that had dispatched his mother. The anaesthetist used the same words: “I’m just going to put a needle into your vein and give you an injection and you’ll go off into a deep sleep with no worries”.

[Lord Harper (Con)]

I am grateful to the noble Lord for that information, but I am conscious that, because of his intervention, I am well over time. I am going to conclude my remarks there and allow the Committee to hear from the next speaker in the debate.

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[Baroness Blake of Leeds (Lab)]

As always, my noble friend raises an important point. I will go on to talk about the whole issue of substances, so if I do not address the points he raised, I will be happy to speak or write to him afterwards to make sure that he has had the clarification he requires.

[Lord Harper (Con)]

I want to press the Minister a little for an answer, not necessarily this minute, on the point that my noble friend Lord Deben makes. It is perfectly proper for matters of genuine detail to be dealt with after Parliament has passed primary legislation; there are many pieces of legislation where we do that. However, there are quite a lot of issues which are not set out in the legislation—this is part of the concern that the Delegated Powers Committee set out—and they are not, by any stretch of the imagination, details. They are fundamentally important issues around, in this case, the substances. Can the Minister therefore take away the idea that if the Government cannot answer on some of these really big issues that are left not set out in the legislation, it will make it incredibly difficult, even for people who support the principle of the legislation, to support it in practice? It would be more helpful if, on these bigger issues, the Government could set out what their position is.

[Baroness Blake of Leeds (Lab)]

I just reinforce to the noble Lord that it would be completely wrong to pre-empt the decisions of Parliament—I am sure he is fully aware of that. I just want to give reassurance that, across all these issues, evidence would be considered in the usual way in considering the substances to be used should the Bill pass. I think I have been exceptionally clear on this, and we need to move forward.

Given the size of the group, I reaffirm that it would be impossible to address each amendment specifically, but the broad thematic workability concern is that the use of unclear and ambiguous language could result in unworkable duties and increased risk of legal challenge.

I turn to amendments tabled in relation to the regulation of approved substances and clinical trials. Many of these amendments are policy choices and are therefore a matter for the sponsor and for Parliament. However, noble Lords may wish to note that many of these amendments also introduce new concepts that would require significant work to ensure the policy intent is clearly understood and that they are coherent for the rest of the Bill. I draw noble Lords’ attention to a number of amendments where the Government have major workability concerns.

Amendments 701 and 713, tabled by the noble Baronesses, Lady Grey-Thompson and Lady Hollins, relate to clinical trials for approved substances. First, these amendments could delay implementation of the Bill until a clinical trial or evidence-gathering study is completed, which could make implementation within the four-year timeframe difficult. Noble Lords may wish to be aware that these amendments could create workability concerns relating to the ethical and regulatory challenges for clinical trial processes for approved substances.

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[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful to the noble Lords who have participated in this debate. I will divide my responses thematically under four headings.

I turn first to the new scheme proposed by noble Baroness, Lady Finlay of Llandaff, in relation to how one deals with safeguarding here. The scheme would involve not having two doctors, then the panel, and then a doctor again at the point of administration; instead, the person who wants an assisted death would have to apply to a separate organisation, where a panel of up to seven people would consider their application. That panel would consider whether the safeguards are satisfied, as well as a number of other questions. If it were satisfied, it would give a provisional certificate of eligibility. The drugs could not then be delivered—I use that word without meaning “delivered to the person”—because an application for fast-track care and support would have to be made. If that application were granted, then—and only then—could the drugs be administered.

If there were doubt in the mind of the seven-person panel, the matter would be referred to the High Court. The provisions put forward by the noble Baroness do not specify what the role of the High Court is. The panel has to satisfy itself that a number of questions have been addressed, although those questions do not determine whether or not somebody is entitled to an assisted death. That is the proposal from the noble Baroness, Lady Finlay. The current proposal in the Bill is that the co-ordinating doctor has to satisfy themselves of seven or eight strict matters, and then the panel considers the case. The co-ordinating doctor then, satisfied that the conditions have been met, provides assistance to the person who wants to die.

Underlying the distinction between the two proposals is the wish of the noble Baroness that the whole process of assisted dying be kept completely separate from the care that is being given to the patient. I am sorry that neither the noble Baroness, Lady Cass, nor the noble and learned Baroness, Lady Butler-Sloss, is here, for they both highlighted that, under the scheme in the Bill, the people who will be going through the checks—the co-ordinating doctor and the independent doctor—will have to have opted in to specialist training. To some extent, they will be specialists themselves in assisted dying.

If one wants to give as much help as possible to the person who wants an assisted death, it must be better that the person providing the assistance can work within the team that is already providing care. It does not mean that they should be in any way pressing for a particular result. But, if we introduce assisted dying, and we want somebody to do the assessment and give the assistance, we are probably going to have ask somebody with some experience. We do not want to force the patient into an over-complex, entirely separate process.

I note that the noble Lord, Lord Stevens of Birmingham, said that he wants the process kept separate from the NHS, but I am absolutely sure that he does not want the patient to embark on a very complex bureaucratic procedure. He has given reasons why he wants it kept separate from the NHS. As sponsor of the Bill, whether it is precisely separate or not is, for me, not the key question; the key question is whether, if a patient wants an assisted death, there is a practical and safe way of doing it that does not place an undue burden on them.

The proposal from the noble Baroness, Lady Finlay of Llandaff, is overengineered and much too separate from the care of the patient. It leaves out so many aspects. In particular, the drafting of her proposal does not indicate what her seven-person panel has to be satisfied of. The idea that seven people have to be satisfied is, in my respectful submission, much too onerous. Having two specialist doctors and a panel of three examining the case is, with respect, a much better proposal. I have thought very carefully about the noble Baroness’s proposal, but I have to say that the proposal in the Bill is so much better, so much more workable and so much more focused on the patient.

[Lord Harper (Con)]

My Lords—

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[Lord Falconer of Thoroton (Lab)]

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

[Lord Harper (Con)]

I wanted to ask the noble and learned Lord, on his comments about the contribution from the noble Lord, Lord Stevens, about the role of the NHS. As noble Lords know, that this is to be provided by the NHS is not set out in the Bill. It is allowed for, and there are powers to amend the founding principle of the NHS to make it possible, but I had understood and Ministers indicated that, if this legislation were passed, this would be done by the NHS.

The noble and learned Lord said that this question is not of enormous importance to him; it is more about the process, which comes back to the point that the noble Baroness, Lady Jay, made about it being workable. However, I should like the noble and learned Lord just to set out his view about where assisted suicide should be provided, because the question about whether it will be provided by the NHS or not is really important. Whatever view the noble and learned Lord takes, the Committee deserves to know which of those two scenarios it is, before it makes a decision on whether it wants to support the Bill.

[Lord Falconer of Thoroton (Lab)]

When I said that I am really focused on how to provide a proper assisted death and that that is not a technical question about whether the NHS will provide it, I did not mean to say that it is not important for this issue to be resolved. If I did, I misspoke, but please do not read me as saying that. That is an issue on the way to the Bill providing a compassionate and workable way of providing an assisted death to those who want it.

As to the second part of the question asked by the noble Lord, Lord Harper, about my view in relation to it, it is that it is ultimately for the Secretary of State for Health to decide how it is provided. The power is given to the Secretary of State to decide that in Clause 41, with the amendments that I have put down in relation to it. It gives him power to commission it himself or through a variety of other bodies. That might involve some body other than the NHS providing it. Ultimately, it is for the Secretary of State to decide how that is done. I think I have said enough on the scheme proposed by the noble Baroness, Lady Finlay.

I will go on to substances. There is a range of amendments in relation to substances. We shall come back to substances in relation to Clauses 27 and 37. They are in this group because they relate in part to the scheme proposed by the noble Baroness, Lady Finlay. She proposes designated pharmacies so that only particular pharmacies can do it. It is again—this is the wording of the Bill—for the Secretary of State to decide how substances are to be selected, how drugs and devices are to be approved, and then how they are to be dealt with. Subject to my amendments, which give more limitation to Clauses 27 and 37, I think the right principle in relation to that is that it is for the Secretary of State to decide how properly to regulate and choose the substances, and he or she is to do it only after taking proper advice.

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[Baroness Coffey (Con)]

My Lords, briefly, Clause 6 standing part has been opposed by my noble friend Lord Moylan because of other aspects of amendments he has tabled. I very much support Clause 6 staying in the Bill: it was the one amendment on Report in the Commons where there was a significant majority in favour. In particular, I found it astonishing that anyone could even consider raising this with a child: it disappointed me that the sponsor of the Bill in the Commons voted against that amendment, but I am relieved it got through. It is also worth pointing out to the Committee that there is slightly different wording between Clause 6 and Clause 5(1), which my noble friend Lord Moylan’s Amendment 152 addresses by making sure “other health professional” is included, not just “medical practitioner”.

I have also seen multiple times what my noble friend Lady Fraser has just referred to. It is very irritating, especially when somebody is being taken home to die, if, against their wishes, DNR had been put in place by medical practitioners and then had to be rescinded. It is somewhat frustrating in that regard.

My noble friend Lord Goodman was succinct; I think that is partly the training of a journalist, or it might have been two years of quiet contemplation when he considered his vocation in an abbey on the Isle of Wight.

I want to briefly raise one point: the noble Baroness, Lady Blackstone, referred to the BMA. I am conscious that it is a trade union for doctors and does a lot of work on their behalf, but it is not a clinical body. However, the BMA pointed out its concerns that, without it, there would be uncertainty and legal risks for doctors. The BMA went into more detail on that in its evidence. In contrast, the Medical Defence Union’s written evidence to the Commons Select Committee—by the way, the MDU is an organisation that specialises in providing indemnity and other legal issues regarding doctors—came up with a different thing. It said:

“The MDU is concerned that the legislation, as … drafted … leaves doctors who do raise it at greater risk of a complaint”,


and then subsequent legal things.

So, as has also been pointed out, at what point would this ever be raised? I support more generally the approach and understand that, if a doctor is asked about this, of course that should be open to a response, unless they do not wish to do so, and part of Clause 5 covers that. But, overall, that initiation should not be in the hands of the medical practitioner, and we will come on later in further clauses to debate the recording of such discussions.

[Lord Harper (Con)]

My Lords, I shall focus my remarks on two points. One is that I thought the speech of my noble friend Lady Monckton of Dallington Forest was very powerful. I strongly support what she said about proper safeguards for people with learning disabilities and she has an amendment which deals with that. But I really want to test the thinking here, because there is a view, and this is where I settled, on whether medical professionals should be able to raise things proactively.

What I was thinking through—I would be interested in what the noble and learned Lord, Lord Falconer, thinks—is that the Bill is obviously about, first, legalising assistance to help someone take their own life, but it is also about putting a process in place, and those are two separate things. I was also thinking about the thing that is currently lawful, which is that someone is able to take their own life if they do not require assistance. I do not know whether it is just me but, if you were diagnosed with a terminal illness and suggested to a medical practitioner that you were thinking of taking your own life if the Bill were not in force, as far as I understand it—there are many in this House who can correct me—the medical practitioner has a duty under various existing suicide prevention strategies to take steps to try to prevent you taking your own life. They are absolutely not supposed to help you; they are supposed to try to stop you, up to and including using provisions in the Mental Health Act.

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[Lord Falconer of Thoroton (Lab)]

I completely understand what the noble Baroness is saying. Suppose you cannot find a doctor with that information about you—the noble Baroness, Lady Cass, is not talking about the sorts of cases that many noble Lords were talking about, where, by raising it, you are leading to a situation where somebody might be persuaded when they otherwise would not—the answer would be that you would have to consent to all your records being given to a doctor with whom you could have the conversation.

Noble Lords should remember that Clause 5(6) says:

“A registered medical practitioner who is unwilling or unable to conduct the preliminary discussion mentioned under subsection (3) is not required to refer the person to another medical practitioner but must ensure that the person is directed to where they can obtain information and have the preliminary discussion”.


So you can get assistance from a doctor who is not willing to have the discussion. The noble Baroness is absolutely right that, in order to have the discussion, the doctor has to have all the information I referred to. If no doctor in possession of that is willing then you will have to consent to it being given to somebody else—and a patient can consent to their records being given to another doctor.

I turn to the position for those with a disability and, in particular, will deal with the point so powerfully raised by the noble Baroness, Lady Monckton. My Amendment 548A would require that anybody providing a relevant activity under the Bill—new subsection (8) defines “relevant activity” as including “conducting a preliminary discussion”—must not carry out that relevant activity unless the person seeking assistance has an “independent advocate”.

The amendment says that

“‘qualifying person’ means … a person with a mental disorder (as defined by section 1(2) of the Mental Health Act 1983) … a person who (in the absence of support) would experience substantial difficulty in doing one or more of the following … understanding relevant information … retaining that information … using or weighing that information as part of the process of making relevant decisions, or … communicating their views, wishes or feelings”.

Where there is to be a preliminary discussion, the person has to be accompanied by an independent advocate, unless—this is in new subsection (3) to be inserted by the amendment—the person

“seeking assistance informs the relevant person that they do not want an independent advocate, or … where the relevant activity is conducting a preliminary discussion, 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”.

What the sponsor of the Bill is aiming at there is as follows. If there is any question about one’s ability to process information—what the noble Baroness, Lady Monckton, said about the suggestibility of people with Down syndrome is incredibly resonant—I would envisage the position to be that you have to have an independent advocate but you may not need to have one if it is known to the doctor, or if it becomes apparent, that a family member would be adequate. That would be a reason for not having an independent advocate. But, if there is no family member—for example, if the person suffering from a disability has no parents, siblings or whatever—there has to be an independent advocate.

It may be that the area I should focus on in the amendment on independent advocates is this: you can say no to the need for an independent advocate, maybe because you have nobody else, but is that too risky? I need to consider that, given the point on suggestibility raised by the noble Baroness, Lady Monckton, and Mr Ross of the Down syndrome advisory policy group, whom I have discussed that with.

The points made about people with a learning disability are, I hope, addressed in my amendments on an independent advocate. Ultimately, where there may be no family, the independent advocate has to be the rock-bottom protection.

I move on from that to children. I remind noble Lords that, as the noble Baroness, Lady Coffey, made clear, Clause 6 says:

“No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18”.


It cannot be raised, and I completely stand by that. What happens if it or something like it is raised by a person who is under 18? I found what the noble Baroness, Lady Finlay, said, to be resonant and insightful. You have to deal with it in a sensible way. You cannot just say, “I’m afraid I can’t talk about that. That’s the end of it”. You have to treat the person with a degree of maturity.

The noble Baroness, Lady Finlay, supported Amendment 211, in the name of the noble Lord, Lord Rook, which says:

“If a person under the age of 18 raises the subject of the provision of assistance under this Act, the medical practitioner must refuse to discuss the subject and shall inform the person that such assistance is not available to individuals under the age of 18”.


I am sure that the medical practitioner should say that it is not available to persons under the age of 18, but I am not sure that it would be wise for the Bill to prescribe that no further discussion is appropriate—particularly for 17 year-olds, who are often quite perceptive. The idea that you cannot have any discussion about this is just not practical or sensible and it would drive people to other sources, which may be more dangerous.

[Lord Harper (Con)]

I will press the noble and learned Lord on that point. The ability for medical professionals to discuss this with patients is prescribed in the first part of Clause 5, but only

“in accordance with this Act”.

If you were a medical professional and a child raised this with you, and you started discussing it, would you not be obliged, under your legal and professional suicide prevention duties to that child, to take steps to protect them? Under the Bill, they would not be eligible to have an assisted suicide. I do not understand this—and the noble and learned Lord has not answered my question about what happens with adults—but if a child goes to a medical professional and starts suggesting that they want to end their life, that medical professional is under a clear duty to take steps to protect the life of that child and even to take steps to force that to be the case. Unless I am missing something, nothing in the Bill will change the legal and professional duties on that medical professional.

[Lord Falconer of Thoroton (Lab)]

The noble Lord is right. The point I was making was that, if it is raised, it is not sensible to just close down the discussion altogether. There has to be an informed discussion, which is completely consistent with the duties that the noble Lord referred to. The idea that there cannot be any discussion about it, which is what I think the amendment in the name of the noble Lord, Lord Rook, says, is, in my submission, neither practical nor wise. It is for the doctor to decide how to deal with it, of course in the context that the noble Lord mentioned.

Finally, if the Bill passes, Parliament will have decided that the option of an assisted death for those who are terminally ill is an appropriate option. It may well have come to that conclusion because it thinks that it is a compassionate option to give people, as has occurred in so many other countries in the world. Once Parliament has said that that is the position, those people who are in a position to access assisted dying should be given appropriate assistance to do so. That is why, in my view, it is perfectly acceptable for it to be discussed by doctors as an option for people who are terminally ill, because they will look to those who are caring for them for assistance to determine how their life ends. I am not sure whether the noble Lord, Lord Moylan, was saying this, but I do not believe that adopting that option is morally abhorrent.

[Lord Harper (Con)]

I will press the noble and learned Lord because I genuinely want to understand what is going to happen. This is quite a big deal for the health service and other professionals in this area. When, under the Suicide Act, which the Bill amends, somebody trying to take their own life stopped being a criminal offence, we did not suddenly say that we thought that was an acceptable thing for them to do; we recognised that making it a criminal offence did not make a lot of sense. Therefore, just because we make assisted suicide lawful—getting assistance to take your own life—in itself that does not change the suicide prevention duties.

I want to understand, if the Bill were to become law, what steps the Government would have to take on the legal duties that medical professionals have under the suicide prevention duty and their professional duties; otherwise, I do not think we are being very consistent here. I do not want medical professionals, who we are asking to do this work, to be conflicted or to think they are at risk. Organisations such as the Medical Defence Union think we are in great danger of putting those medical professionals in that invidious position, and the noble and learned Lord has not really answered my question satisfactorily—or certainly not to my satisfaction.

[Lord Falconer of Thoroton (Lab)]

The point of this part of the Bill is that it is a legitimate option. If the noble Lord is saying that because we have suicide prevention policies in other areas, we should still treat it as something that we should not in any way encourage or help people to access if that is what they want, that is wrong. The true position is that, once it becomes an option, subject to the safeguards being gone through, it is something that people should know about and make their own judgment about.