Terminally Ill Adults (End of Life) Bill

Debate between Lord Harper and Baroness Coffey

Friday 6th February 2026 Lords Chamber

[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.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Harper and Baroness Coffey

Committee stage
Friday 23rd January 2026 Lords Chamber

[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.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Harper and Baroness Coffey

Committee stage
Friday 14th November 2025 Lords Chamber

[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.

Health and Social Care Update

Debate between Lord Harper and Baroness Coffey

Thursday 22nd September 2022 Commons Chamber

[Dr Coffey]

The hon. Lady is absolutely right, and I completely agree with her: it is a real problem. We have started making some changes already, but we need to do so in more detail right across the country. My hon. Friend the Minister responsible for dentistry will be looking into that more intensively.

[Mr Mark Harper (Forest of Dean) (Con)]

In Gloucestershire, the inability to discharge people from hospital because of inadequate social care is the primary reason why we have ambulances queuing, so I welcome the adult social care discharge fund that the Secretary of State has announced. Can she set out how that £500 million is going to be allocated, so that Gloucestershire’s local NHS will know how much it can expect and can work with Gloucestershire County Council to improve matters for my constituents?

[Dr Coffey]

My right hon. Friend is correct to raise that question. We are still working on the detail of where that funding will be allocated across the country.

Covid-19: DWP Update

Debate between Lord Harper and Baroness Coffey

Monday 4th May 2020 Commons Chamber

[Dr Coffey]

On the question about the self-employed, where people have assets—for example, savings set aside for paying tax—they need to check carefully and go through that as they make their claim, because it will not be considered part of savings with regard to the £16,000 threshold. On housing, we have increased the local housing allowance, and I am sure that the discretionary housing payments have gone to Ealing Council. It is open for councils to come back to central Government if they would like that to be raised substantially.

[Mr Mark Harper (Forest of Dean) (Con) [V]]

It is clear from the Secretary of State’s statement and her answers to questions from Members that universal credit has been much more effective at scaling up to deal with the unprecedented level of claims arising from the coronavirus pandemic. I know from my constituents’ experience that we get half the number of problems that we got with the legacy benefits. May I therefore take the opportunity to thank all the staff, including those in my constituency, who have delivered universal credit? May they continue to do so.

[Dr Coffey]

My right hon. Friend is right. The old system would not have coped with what universal credit has done. It has helped more than 1.8 million people making that claim.

Immigration Rules: Sponsors

Debate between Lord Harper and Baroness Coffey

Thursday 14th March 2013 Commons Chamber

[Mr Harper]

I was listening very carefully to what my hon. Friend said, and I will reflect on it. I thank him for making that point.

Let me say a little more about the financial changes—

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I am glad that my hon. Friend is moving on to that point, because residents in my constituency are surprised that the limit of £18,000 is so low, given that we hear concerns about the benefits cap of £26,000. I am delighted that he is going to explain why the limit is £18,000—of course, it is more for people with children.

[Mr Harper]

The previous requirement, which I think has been alluded to, was that applicants had to be “adequately maintained”. The courts generally interpreted that to mean income equivalent to the level of income support for a British family of that size, which was about £5,500 a year for a couple at that time. Our view was that that level of income was not an adequate basis for sustainable family migration and did not provide adequate assurance that UK sponsors and their migrant partners could support themselves and their children over the long term.

The previous regime also required quite a complex assessment, both for applicants and caseworkers, of current and prospective employment income and other financial means. It made decision making difficult, as was highlighted by the independent chief inspector’s report of 24 January on the processing of applications under the old rules for spouses and partners. Again, that was partly why we wanted a financial requirement that was clear and transparent; applicants would know where they stood, and we could make clear and timely decisions.

The minimum income threshold is £18,600 a year, with a higher amount with those sponsoring dependent children—it is £22,400 for those sponsoring one child and an extra £2,400 for each further child. We based that on the expert advice of the independent Migration Advisory Committee. It gave us a range of figures and that was at the low end. Its figures went up to about £25,000, a level at which someone would be making a net contribution to the Exchequer. The £18,600 level we settled on is broadly the income at which a couple, once settled here, cannot access income-related benefits. It is not an exact match, but it was as close as we can get. Our approach broadly says, “If they are here earning that amount of money, they are going to be able to stand on their own two feet and not expect the taxpayer to support them.”

--- Later in debate ---

[Dr Thérèse Coffey]

Does my hon. Friend agree that plenty of companies in this country regularly secure permits to bring talented people to fulfil specific roles? So, it happens now and we are proud to welcome talent into our country to fill those roles.

[Mr Harper]

My hon. Friend is right. If people have married or are with a partner, they are looking at a particular route. It is worth saying, and her intervention highlights this, that there are alternative routes for people under the immigration rules for some of these difficult cases.