Terminally Ill Adults (End of Life) Bill

Debate between Baroness Coffey and Lord Harper

Friday 27th March 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I strongly support Amendments 169, 268 and 657. In my discussions with a variety of doctors’ representatives, two issues clearly came out straightaway. They volunteered them— I did not ask for them—and they were about how this must shift to being an opt-in process. As it stands, it still definitely feels like an opt-out process in this legislation. The other thing that they were absolutely clear about was that this should not in any way be considered a treatment, because it is not. I do not need to repeat some of the arguments that have already been well articulated by the noble Lord, Lord Stevens of Birmingham, and others.

On Amendment 169, it is sensible to have a register. The noble Lord, Lord Moore of Etchingham, explained one of the reasons why, but I think that it is just for straightforwardness, so that people who are considering this potential approach can do it. Although I disagree with the BMA, and we are not discussing the clauses today about whether things can be raised by judgment, it would be helpful to give confidence in this process.

The questions that I have are principally for the sponsor and the Minister. The noble Baroness, Lady Blake, knows that I value her very much, but I appreciate that she is not the policy Minister, so if she does not have the answers today I would be more than happy to receive a letter in this regard from the relevant Minister. I want to talk through some of the amendments that the noble and learned Lord, Lord Falconer, has tabled. On Amendments 422 and 423, there are other groups later when I think we will discuss replacement of doctors—it does not matter whether that is in this group or not. I would like to get a sense of why he feels the need to do that.

One of my broader concerns, more generally, about Amendment 669A is that, while I appreciate that the noble and learned Lord is trying to address a challenge that has been laid, it still feels as though it has either not gone far enough or is almost tipping it the other way. If we consider the impact assessment, the Government suggest that even by year 10, fewer than 8,000 people may have taken advantage of the Bill. That contrasts significantly with Marie Curie’s figures that over 300,000 people engage with hospice care and palliative care every year. It does feel, and part of the debate we had earlier almost suggested it, that doctors should do it unless they choose not to, and I strongly believe we should do it the other way. Some of the amendments to the Bill lend themselves to that opt-in register, in effect, and then providing the necessary training to support this approach. I think it is fair to say that Schedule 3 is comprehensive, but again, sometimes when you are relying on aspects, you end up becoming a minority, and that in itself can bring coercion to perhaps go against your own personal views.

A few weeks ago, we got into the whole issue of providing treatments and the legal ruling that led to the GMC changing its guidance, which was deemed enough. Actually, the GMC has just published new draft guidance tackling issues to do with personal beliefs and the like. In particular, I am concerned that, unless the Bill is explicit that this is not a treatment, with all the forward implications of the fact that it is not there, we may end up with a lot of case law, or a lot of rulings. Also, point 23, I think, of the draft guidance that the GMC has put forward suggests, basically, “If there’s no alternative, you’re going to have to do this. You’re going to have to offer it, whether you like it or not”. That is more or less what it says, so it would be useful to hear from the Minister what discussions have been had with the GMC in considering that approach in the guidance, because it is relevant to our consideration of the Bill.

Amendment 888, tabled by the noble and learned Lord, extends Clause 31 to everybody in Scotland. I have an amendment, which I did not talk to because Amendment 888 was in this group, which is just trying to understand whether it was the Government or the sponsors who had already started to expand a series of primary legislation issues, I guess, to practitioners in other countries where the Bill does not generally apply. We had a debate a while ago about Section 30 orders, which is now somewhat redundant given the decision by the Scottish Parliament not to proceed with the Bill that it was considering, but I want to get a sense from the Government of where they are on this. I thought that the issues proposed in Amendment 888 would have been covered by a Section 104 order if the Scottish Parliament had gone ahead, so I want to get an understanding of the reasons for tabling this. If the Bill is going further and trying to bring the Scottish medical profession into potentially providing services in this country, that opens up a whole new chapter of consideration. In asking these questions, I am just trying to deepen my understanding and get clarification, both from the sponsor and from the Minister.

[Lord Harper (Con)]

My Lords, I want to cover a couple of points and reflect on what the noble and learned Baroness, Lady Scotland, said, which was that, despite the debate, there is a sense that people are agreed that this should be an opt-in rather than an opt-out process. The problem is that the way the Bill is drafted does not make that clear, and that is not just my view but the view, as we have heard, of many of those who are going to be involved in delivering this service. I will not go into that in great detail because many people have done so, but the Royal College of General Practitioners thinks that there should be a register and a more explicit opt-in system. Some of the other royal colleges do too and, as I think somebody else said, the Royal College of Nursing thinks it should be very clear that no one should be forced to participate. Of course, I give way to the noble and learned Lord.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Coffey and Lord Harper

Committee stage
Friday 13th March 2026 Lords Chamber

[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.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Coffey and Lord Harper

Committee stage
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 Baroness Coffey and Lord Harper

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 Baroness Coffey and Lord Harper

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.