Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

Friday 21st November 2025 Lords Chamber

A credible legislative framework must prevent institutional and societal coercion as rigorously as it guards against interpersonal coercion. The appropriate response to systemic forms of coercion is not the inclusion of particular words or phrases in primary legislation but, I suggest, the establishment of processes and structures that minimise the risk of such pressures arising in the first place. We will have an opportunity to discuss better structures later in the debate.

[Baroness Coffey (Con)]

I think the noble Baroness’s amendment about videoing affects Clause 25, which is considerably later, when the Act is about to happen. I wonder whether she would consider whether it should be done earlier in order to reduce that because, by the point of her amendment, the certificate of eligibility has already been issued. I would be interested to hear her thoughts on that and on whether video recording, as proposed in Amendment 612, should be considered at a much earlier stage.

[Baroness Hollins (CB)]

I thank the noble Baroness. I thought about that, and it could indeed be brought back in a different way later in the debate, but I feel that the prevention of coercion is really important, so thinking about it at this stage is really helpful.

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[Baroness Rafferty (Lab)]

My Lords—

[Baroness Coffey (Con)]

My Lords, I still have tabled amendments to speak to, but I will let the noble Baroness, Lady Rafferty, go first.

[Baroness Rafferty (Lab)]

I thank the noble Baroness so much. I speak as a nurse and a former president of the Royal College of Nursing. I thank the right reverend Prelate the Bishop of London for referring to the broader family of health practitioners who are impacted by the Bill.

I also note the comments made by the noble Baroness, Lady Berridge, about training. I wonder whether the noble Baroness is aware of the current intercollegiate guidance on safeguarding, which covers many of the types of abuse touched upon in our current debate. Secondly, does she agree that many of the scenarios that have been presented and portrayed in this debate could provide very helpful material for the training that would be provided were the Bill to be passed?

[Lord Ashcombe (Con)]

My Lords, I just want to raise one point. We have heard an awful lot today, but I very much support what my noble friend Lady Berridge and the noble Baroness, Lady Rafferty, have just said about training. I do not believe a doctor, or any form of medical practitioner, can spot coercion with one discussion. Training in this area is absolutely imperative to have any way of making it work reasonably. That has to be part of the overall solution to this problem.

I will just add that, while I support every one of these amendments to a greater or lesser extent, I hope that the noble and learned Lord, Lord Falconer, will consider them all very closely and not ignore them.

[Baroness Coffey (Con)]

My Lords, I have tabled Amendments 47 and 49. It should be no surprise to noble Lords that this group is going to take some time, because it is probably one of the most important elements of our consideration of the Bill.

I also gently point out that it feels like coercion is being applied, but I am not going to be bullied by people into not raising my concerns at this point. I point out that it is the Department of Health and Social Care that proposed the groupings, and I believe it was passed by the sponsor. Therefore, we have had over 18 amendments from 14 people grouped together. If the concern is that we are taking too long with big groups, that will actually encourage people like me to degroup even further. That is not necessarily fruitful in addressing some of the concerns of the Bill, when we need some joined-up conversations.

The noble Lord, Lord Pannick, and the noble Baroness, Lady Hayter, have talked about existing safeguards. There is an obvious one at the moment: it is against the law to help somebody to go to Dignitas. The person who wrote the guidelines on whether to press charges is of course now the Prime Minister. There are amendments made in Committee that reinstate the element of the DPP undertaking that.

In answer to questions that I tabled to the Government, the Justice Minister fortunately replied, basically indicating how many people had had proceedings against them. On average it was one a year for the last decade, and only two people have been convicted. But I am still waiting to hear about the arrests and charges made, never mind the proceedings. I will give an example. Sean Davison, who was in the papers in the summer, was arrested for helping 29 people take their own lives by going to Switzerland—not to Dignitas but to another place. This is the same man—he is well known—who had already been convicted of helping his own mother take her life, which was against the law, in a different country and jurisdiction. This is why I was interested in tabling questions: to understand what is actually going on.

The figures of people going to Switzerland are quite small—it is about 40 people. One of the things that worries me—and, I think, worries a lot of people—is how this whole situation could start to become commonplace. The Liverpool care pathway became commonplace—what a horrible way to die. I specifically mentioned at Second Reading that my greatest concern of all is indirect coercion. I appreciate that some other noble Lords have already spoken to this, so I hope to bring a slightly different angle with some of my concerns.

If I have time, I will try to explain why I strongly support several of the other words being used, particularly “encouragement”, which appeared in the speech by the noble Baroness, Lady Fox of Buckley, and got support in certain parts of the Committee. That is interesting, bearing in mind that the campaign group Dignity in Dying, anticipating the passage of the Bill, has now initiated a new element by creating a conversation guide on how to start to bring up assisted dying in conversations with people. Never mind the coercion that very obviously exists in the medical profession in trying to coerce people into “do not resuscitate” orders. That is already happening in our medical system today, which is why several Peers, I think, are generally worried.

Turning to my amendments, I will start with Amendment 49. As the proposer and sponsor of the Bill put forward, it started off as a judge-led process, which is why I support what the noble Lord, Lord Carlile of Berriew, seeks to do in amendments in later groups. We have a situation here where this is turning into a sort of commissioner/panel. We need to make sure that the legislation is as simple as possible to the ordinary man and woman on the street. I appreciate that there are some legal niceties about what the word “person” means in law—I believe it can mean almost anybody—but we need to be more explicit, which is why I have suggested talking about

“body corporate, institution or organisation”.

I hope that might start to cover some of the online issues that my noble friend Lady Berridge raised; I do not know whether the Online Safety Act can cover this.

I respect what some noble Lords may think: “What is she going on about? These people are dying anyway. We have the general approach of trying to prevent suicide, so what would be different in hastening that?” This is where I turn to Amendment 47, which talks about both external and internal coercion. We have had a considerable debate about external coercion, with some suggestions about that in the amendments, as well as, to some extent, the question of burden. It is that burden that genuinely worries me.

The evidence is clear. We have already heard of the 35% figure from, I think, Western Australia. Whether it is from Oregon, Canada, Western Australia or Washington, the jurisdictions that collect data on this issue show that between 35% and 59% of people cite being a burden. We then heard evidence given to the Commons from Professor Owen, who said that thinking about being a burden is

“an essential question. I work clinically in the over-65 age group, where there is a lot of terminal illness, some of it in the last six months. You have to understand the population … There can be a terminal illness, very typically with comorbidity. That comorbidity is often mental health comorbidity”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 234.]

As Dr Price sensibly said, for somebody who has found out that they have a terminal illness and less than 12 months or six months to live, it would be surprising if there was not an element of depression at that point.

This is where we get into talking about burden. That is where a group already feels burdened, and some of that may be excessive. That is when you start to get into some of these interpersonal pressures. It is also where the impairments will start to interact and amplify each other, and that in itself can have an important consequence in terms of the functional ability of mental capacity. According to Professor Owen, outside the AD context, the Court of Protection itself has been struggling to recognise that. This is where trying to get some understanding of this is really important. But it is not, to the point from the noble Baroness, Lady Rafferty, somewhere where you can just have a ready-built training manual.

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[Lord Falconer of Thoroton (Lab)]

I think I answered that; the noble Lord may not have been satisfied with my answer, but I did answer it by saying that people have to be satisfied that the decision is voluntary and without coercion. If they do not know, because they cannot read adequately the community, they could not be satisfied.

[Baroness Coffey (Con)]

The noble and learned Lord has just made a point about the risk of coercion and referred to a psychiatrist. It would be very helpful to understand what clause in the Bill he is referring to, because Clause 12(6)(b) is only about the capacity of the person; it is not talking about coercion. I am also conscious that capacity is on the balance of probabilities anyway. It would be useful to understand which clause he believes referral would be in, on the grounds of coercion.

[Lord Falconer of Thoroton (Lab)]

I will come to that in a moment, because I have to get through the amendments—we have to make progress a bit. However, I completely understand the question.

Amendment 50 is from the noble Lord, Lord Evans. He basically said that when anybody tries to behave badly, trying to coerce or pressure somebody into making the decision to have an assisted death, that should be sufficient to bar it for ever, even if it had no impact whatever in relation to it. I see the force of that; I think it would be a wrong amendment, for the following reasons. Somebody—a doctor—might go over the line, but it is absolutely clear that the person definitely wants an assisted death. I do not think they should be barred from doing that because they are concerned about what might happen to the doctor or to the person they love if it is absolutely clear that they have not been coerced or pressured into it.

On Amendment 52 from the noble Baroness, Lady Grey-Thompson, she is saying that somebody should not be subject to or at risk of coercive control. Everybody agrees that the person who is adopting the assisted death should not be subject to coercive control. If they are at risk, I would expect the two doctors and the panel to investigate that fully and, if they are not satisfied that the person is reaching a decision of their own, plainly an assisted death cannot go ahead. But I think we are all on the same page in that the risk has to be properly investigated and a conclusion reached.

Amendment 57A in the name of the noble Baroness, Lady Lawlor, says you should not be allowed to have an assisted death if someone has been

“prompted to consider ending their own life”—

presumably in the context of assisted death—by any professional person. Clause 5 leaves it to the judgment of the doctor as to whether they raise the question with the patient. If they raise it, they have to raise it under Clause 5 in the context of the treatment available to the patient and all other options available, including palliative care. I do not think that if a doctor, or indeed any other professional person, makes a judgment that it would be sensible to raise it, that should thereby debar the person from having an assisted death. The noble Baroness wants to intervene. By all means let us prolong the debate if it is a new point.

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[Lord Falconer of Thoroton (Lab)]

With the greatest respect, the noble Baroness has missed the point. If, for example, a person says to the doctor, “I’m not telling you things”, the doctor can never be satisfied. That is the protection.

[Baroness Coffey (Con)]

Would the noble and learned Lord write to me with the answer to the question I asked earlier?

[Lord Falconer of Thoroton (Lab)]

Of course, and I apologise for not answering it.