Death of a Member: Lord Howarth of Newport
The Lord Speaker (Lord McFall of Alcluith)
My Lords, I regret to inform the House of the death of the noble Lord, Lord Howarth of Newport, on Wednesday 10 September. On behalf of the House, I extend our condolences to the noble Lord’s family and friends.
Arrangement of Business
Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)
My Lords, before we begin Second Reading, I want to remind all noble Lords of a few important points. There is an advisory speaking time limit for Back-Bench contributions of four minutes. This reflects the large number of speakers, while providing a respectable amount of time for everyone to outline their views. This means that when the Clock reaches three minutes, you should begin to make your concluding remarks, and when the Clock reaches four minutes, your time is up. It is designed to ensure that we can rise at a reasonable time. I estimate that, if speakers keep to the four-minute advisory speaking time, we should be able to finish at around 5 pm today and next Friday. I ask all noble Lords to respect the advisory time limit and all other noble Lords who are speaking in debate.
Openers and winders, including my noble and learned friend Lord Falconer of Thoroton, the Front-Bench speakers from the Official Opposition and the Liberal Democrats, and the Government Minister, will have longer, as per the usual conventions, although I am sure those colleagues will make sure that their remarks are considerate of the overall debate. I remind those who have tabled amendments that they should keep their remarks within the four-minute advisory time.
I would like to highlight the general rules. All noble Lords speaking should be here at the beginning, at the end and for the best part of the debate, as set out in the Companion.
Finally, noble Lords have sincerely held views both in support and in opposition to the Bill. Please respect that, and in our debate today and next Friday remember courtesy and respect, and show those watching the debate the House of Lords at its best.
Terminally Ill Adults (End of Life) Bill
(1 day, 13 hours ago)
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Lord Falconer of Thoroton
That the Bill be now read a second time.
Relevant documents: 32nd Report from the Delegated Powers Committee and 12th Report from the Constitution Committee.
Lord Falconer of Thoroton (Lab)
My Lords, this issue has been debated for years, particularly in this House. The House is full this morning; that reflects the seriousness with which your Lordships take this issue. For the first time, we have before us a Bill on assisted dying, which has come from the other place. I know that we will do what we do so well, which is scrutinise. This is a historic occasion.
The current law is confused, causes terrible suffering, and lacks compassion and safeguards. People must be at the heart of this debate. The Government’s own estimate is that, if the law was changed to introduce assisted dying, less than 1% of deaths would be assisted after 10 years. However, it is right that we allow assisted dying as an option for those who, despite the best palliative care, still want an assisted death.
Palliative care cannot alleviate the pain of everyone. Lucy Davenport’s husband, Tom, had an agonising death from bile duct cancer, despite receiving excellent care in a hospice. He died by choking on faecal vomit:
“The look on Tom’s face of terror and horror, that’s going to be with us forever. He would be horrified to think that was our last memory of him”.
For many others, it is not about pain; it is about alleviating fear or bringing to an end the terrible and continuing loss of dignity and control, which has no end, except in death.
If the patient wants to take control of the time of their own death, they are, under the current law, legally entitled to take their own life, but they must do so without any assistance, often horribly. Many of your Lordships were with me in the Archbishops’ Room in Millbank House when the widow of a man who had a lethal brain tumour described how she found her husband’s body in their garden, having stabbed himself in the heart.
Others go to Dignitas, often alone, because those who accompany them from England fear the consequences of the criminal law. Catie Fenner’s mother, Alison, had motor neurone disease and died at Dignitas in Switzerland. Catie could not join her for fear of a police investigation. She found out about the moment her mum had died by text. Catie says:
“We didn’t see her go, we didn’t hold her hand”.
The DPP’s guidelines make it clear that anyone with medical qualifications who provides assistance will certainly be prosecuted. Where the authorities learn that somebody has provided assistance or they suspect that they have, they investigate that person, invariably with compassion. But no matter how kind the process of investigation, it is an agony for the person investigated. It can go on for months, and sometimes for over a year. They fear prosecution as they grieve for the person they love.
It is right and possible to pass a law which allows those who are terminally ill to die with dignity and at a time of their own choosing, without the fear and the horror I have described and with appropriate safeguards in law, not as currently, where people, in order to have a death at their own choosing, seek to evade the law and therefore evade the protections. Some 300 million people in the world live in jurisdictions where there is such a law. There must be safeguards. The Bill we are debating today has benefited from those other jurisdictions. It is the most safeguarded assisted dying measure in the world, particularly in the light of the safeguards inserted in the Commons.
Key provisions in the Bill are as follows. The criteria for requesting assistance is that the person is terminally ill, has the mental capacity to make the decision, is 18 or over, is resident in England and Wales for the last 12 months, and is registered with a GP in England or Wales. The safeguards are designed to ensure that the patient has a clear, settled and informed wish to end their life and has made their decision voluntarily and without coercion. “Terminally ill” is defined as having
“an inevitably progressive … disease which cannot be reversed by treatment”,
with a reasonable expectation of death “within six months”.
The Bill is for the terminally ill only. It is about how you die when you are dying already. It is not for those with unbearable suffering, irrespective of their life expectancy, as in some countries, such as Canada. The Bill is clear that a person is not to be considered a person who is terminally ill if they are a person with only a disability or a mental disorder, or both.
Safeguards are layered throughout the process as set out in the Bill. First, a doctor in a preliminary conversation has to lay out all the care options, including the palliative care available in the context of the likely progress of the illness. Then two doctors, independent of each other, have to be satisfied that the illness is terminal within six months, that the patient has the mental capacity to make the decision, and finally, that it is their firm and settled wish arrived at without coercion. After that, a panel comprising a senior judge or King’s Counsel, a psychiatrist and a social worker has to be satisfied of the same things as the two doctors. If they are, then and only then can medical assistance be given.
I acknowledge that some think the process is too complicated and excludes too many people. On complicatedness, I am very conscious of the words of the Chief Medical Officer, Chris Whitty, who gave evidence in the other place that we should not create a “bureaucratic thicket”, and I very much hope we have avoided that. But it is vital that we should have a Bill that is robust in its safeguards in a matter of this gravity.
Disabled groups express fears that they may be vulnerable to being overpersuaded into an assisted death. I well understand the fears of the disabled in their dealing with healthcare providers, but the evidence strongly suggests that the disabled want the same rights as the rest of us when they become terminally ill. The Bill gives them excellent protection. There may be risks for them in other interactions with healthcare, but not in relation to this issue.
The multidisciplinary panel, which I have referred to, was added by amendment in Committee in the Commons, replacing the High Court judge alone. The panel provides a better safeguard than a judge alone because of the wider experience of the panel psychiatrist and social worker, but accompanied by the retention of the senior judge.
Beyond the current safeguards, some people have sought a compulsory psychiatric assessment for everybody. I do not believe that that is necessary or appropriate. The Bill provides that if either of the doctors have a doubt on capacity, they must refer the patient to a qualified psychiatrist. The panel includes a psychiatrist, and the panel can, if it wishes, require more psychiatric assessment.
No doctor or other person is required to participate in the provision of assistance under the Bill. Only those who opt in to participate in the work of the Bill need play any part. The Bill is explicit and wide in making that clear and provides extensive employment protections for those who do not wish to participate.
There are those who argue that it may be a terminal illness Bill now but its provisions will be expanded. Any such change would require primary legislation, and the experience of all other jurisdictions is that where they start with a terminal illness Bill such as this one, that is where they end. The Health and Social Care Select Committee in the Commons conducted an inquiry into assisted dying, ending in March 2024. Its conclusion on this issue was as follows:
“We … conclude that jurisdictions which have introduced”
assisted dying
“on the basis of terminal illness have not changed the law to include eligibility on the basis of ‘unbearable suffering’”.
It said that none of the jurisdictions which have introduced a terminal illness Bill has revoked it—and they have been there for as long as almost 30 years.
The Bill provides that for England:
“The Secretary of State must by regulations make provision securing that arrangements are made for the provision of voluntary assisted dying services”,
and that in Wales, Welsh Ministers “may” make such regulations. The difference between “must” and “may” is that we respect the devolution settlement. It is for Ministers in Wales to make their own decision in relation to that.
Concern is sometimes expressed about the cost of an assisted dying service and its effect on NHS provision. I draw your Lordships’ attention—please read the 151-page impact assessment that the Department of Health has produced—to the fact that the current budget of the National Health Service is £188 billion. On the central estimate as to what the service will cost once it is up and running, the impact assessment says it will be approximately £25 million a year. The figure does not take account of the annual savings calculated in the impact assessment, which exceed the figure of £25 million.
The NHS should have all the time it needs to introduce the service properly. It has said that it may need up to four years. The Bill has a backstop of being brought into effect after four years. We reflect what we have been told in relation to that.
The provision of assisted dying is not an alternative to palliative care. The Commons Select Committee report did not suggest that the availability of assisted dying compromised or reduced the availability of palliative care: rather, the reverse. Its conclusion was that
“we did not see any indications of palliative and end-of-life care deteriorating in quality or provision following the introduction of”
assisted dying, and
“indeed, the introduction of”
assisted dying
“has been linked with an improvement in palliative care in several jurisdictions.
The next stage is for this Bill to be scrutinised by your Lordships’ House in the normal way. I have been intimately involved with the Bill since it started its journey. This is a Private Member’s Bill, invariably and inevitably, because it is a matter of conscience. Once the Bill passed its Second Reading in the Commons, the sponsor of the Bill in the Commons, the honourable Member for Spen Valley and I, as the sponsor of the Bill in your Lordships’ House, have been provided with very substantial support from the Civil Service machine to ensure that the Bill is workable. The Government, in providing that support, did not forgo their neutrality. Rather, they provided comprehensive policy and drafting support.
I have long experience of shepherding Government Bills through Parliament. The support that I have had in relation to this Bill is second to none. The Bill passed its Third Reading in the Commons in June after more than 100 hours of debate, including 29 sittings in Bill Committee, two full days of debate on Report on the Floor of the House and a full day’s debate at both Second Reading and Third Reading.
I have to say that that compares very favourably. It is almost double the time given to scrutiny in the other place of the Children’s Wellbeing and Schools Bill, which we are dealing with now. Altogether, the Bill Committee considered and debated over 600 amendments, accepting around a quarter of them. Over 100 amendments were made in the sponsor’s name, and more than 30 amendments that had been tabled by MPs who voted against the Bill were passed.
I very briefly turn to the Motion in the name of the noble Lords, Lord Forsyth and Lord Bridges, and the amendment in the name of my noble friend Lady Berger. The noble Lords, Lord Forsyth and Lord Bridges, refer to the Delegated Powers Committee report, which I have considered along with that from the Constitution Committee. I will be tabling amendments to deal with many of the points that both committees raise. They always help us in our deliberations.
There are some amendments which I will not be able to accept: for example, that your Lordships specify the drugs to be used in the process. Medical advances come thick and fast. This legislation is designed to last for the ages. Civil Service support is mentioned in the amendment from the noble Lords, Lord Forsyth and Lord Bridges: I have already dealt with that. With regard to the availability of government time, which is also raised, I am confident, after conversations with the Government, that your Lordships will have more than enough time to scrutinise this Bill thoroughly—as long as, of course, we start our process of scrutiny in the ordinary course of business after we have given it a Second Reading.
I turn to the amendment from my noble friend Lady Berger. Unfortunately, I only got notice of this last night. I did not have the opportunity after that of talking to my noble friend, and she had not discussed it with me previously. I make no criticism of her, but these are my initial thoughts in relation to it. It is proposed that a Select Committee precede the Committee of the Whole House. It has been clear for some time that at least seven days will be required to complete the passage of the Bill: four days in Committee, two days on Report and a day for Third Reading. There will then need to be ping-pong between the two Houses. If the process cannot start until January, which is what my noble friend’s amendment suggests, and must complete by the spring—the spring is when the Government say this Session will end—we will have to fit seven Fridays in between 9 January and 31 March. Having regard to recesses, the need for the normal intervals and the fact that other business will be conducted on some of those Fridays, so it cannot be every Friday, I am afraid that it is not possible to do that. I will therefore be opposing that amendment on the basis that it is not a workable timetable. That does not rule out a Select Committee running in parallel to the Committee stage, and I would be more than happy to discuss such a proposal with my noble friend, or anybody else who has such a proposal to make. But we must do our job in this House, and our job is not to frustrate, it is to scrutinise.
The Bill has been passed by the Commons. The decision on whether to change the law in our democracy should be for the elected representatives. We should improve where we can, but we should respect the primacy of the Commons. There are so many people who have been following the debate who recall the agonising death of a loved one or, like the people I mentioned at the beginning of this speech, fear what their own death might be like. The public want this and the elected House has expressed its will. I am confident that your Lordships will now do what you have done so well in the past. Whatever view we might take on the decision that the Commons arrived at, the way the debate was conducted there enhanced the reputation of Parliament. I hope and believe that we can embark on our scrutiny in a manner that will reflect just as well on our House.
The Bill before us has already given hope to those with personal experience of the injustice of the current law. They will be looking to us to play our proper role. If we can improve it further, we should and we will have done our duty. I commend this Bill to the House and I beg to move.
Lord Kamall (Con)
My Lords, I thank the noble and learned Lord, Lord Falconer of Thoroton, for the comprehensive way in which he presented this Bill. In opening the debate for the Official Opposition, let me be clear that, as a Front Bench, we have no collective view on either the principle of terminally ill people receiving interventions to end their lives early or on the drafting of the Bill. Noble Lords on this side of the House will have a free vote both on the Bill and on the Motions we are debating. The Official Opposition do not have a collective position on those Motions.
Given this fact, I will speak neither in favour of nor against the Bill. But, as the noble and learned Lord said, this is a historic occasion. It is not hyperbole to say that this Bill may be one of the most significant pieces of legislation ever to be considered by this Parliament, with far-reaching implications for our society and the sort of society that we want to live in. Noble Lords will appreciate this significance simply from the sheer volume of correspondence received. Those speaking on both sides of the debate will be informed by their own experiences, whether that be professional or personal experience. We will hear many moving stories in these debates, and perhaps even shed a few tears. But, as a revising Chamber, I know that noble Lords will respect those experiences and reflect on them in good faith as we work to properly scrutinise and improve the Bill where necessary.
As the noble and learned Lord, Lord Falconer, said, we have received a clear signal from the elected House on the principle of the Bill. While that does not prevent noble Lords opposing the Bill per se, it is the duty of your Lordships’ House to do its work as a revising Chamber diligently. This Bill has received much scrutiny in the other place: over 100 hours across all stages, more than other Private Members’ Bills. But we should also not forget that 174 amendments were made to the Bill in Committee, and further amendments were made at Third Reading, not all of which have been properly scrutinised. So the Bill your Lordships received in this House is much changed since its introduction and is in need of thorough scrutiny.
The arguments around this Bill are finely balanced. A noble friend of mine who, let us put it this way, is not exactly known for sitting on the fence, said to me that he attended the last time we debated this and that, after almost every speech, he found himself agreeing with the speaker. To this day, he remains torn. It just shows how finely balanced these arguments are.
Let me attempt to frame the debate and touch on some areas that noble Lords may wish to probe in Committee. In debating this Bill, we must have in mind the well-being and dignity of those for whom it was originally proposed: the terminally ill who want to end their lives early. We will hear powerful arguments based on compassion and bodily autonomy from the Bill’s supporters.
The noble and learned Lord, Lord Falconer of Thoroton, has indicated his openness to amendments to the Bill. We on these Benches welcome that openness. I expect amendments to come from supporters of this legislation who want to make it the best Bill possible. We have seen that in some of the emails noble Lords have shared with each other; we also saw it in Committee in the other place, where the Bill’s sponsor, Kim Leadbeater, tabled 142 such amendments.
On the other side of the debate, there will be noble Lords who oppose the Bill on principled grounds. For some, it will be based on their faith. Others may support the principle behind the Bill but not the current drafting, either because of insufficient safeguards or because of limited access to palliative care, which denies patients a meaningful choice. They too approach this Bill with compassion. This is a matter of conscience, and as the Government Chief Whip said, we should respect the views of noble Lords who disagree profoundly with this Bill just as much as we respect the views of those in favour of it. Those who oppose the Bill will also choose to bring amendments to improve it, despite their overall view. So, whether an amendment is tabled by a supporter of the Bill, an opponent of the Bill or someone who has yet to make up their mind, those watching the debate from outside your Lordships’ House should not mistake amendments to this Bill for outright opposition.
A number of organisations, including the Law Society, the Complex Life and Death Decisions group at King’s College London, the Royal College of Pathologists and the Royal College of Psychiatrists, have proposed amendments to address some serious concerns over the drafting of the Bill as it stands. As the noble and learned Lord, Lord Falconer of Thoroton, has himself acknowledged, both the Delegated Powers and Regulatory Reform Committee and the Constitution Committee have recommended amendments to the Bill, highlighting that there are now 42 regulation-making powers in this version of it—the version that came to this House. Both the Hansard Society and the Constitution Committee have pointed out that, as it is a Private Member’s Bill and the Government remain neutral as to its purpose, it is unclear how these powers will be used. These are all important challenges that we must take the time to consider carefully.
There are noble Lords with strong views on both sides of this debate, but all approach it in good faith. My opening comments are not meant to persuade your Lordships to vote one way or the other or to support certain amendments over others; they are an attempt to frame the overall debate and to touch on some of the issues that may need to be probed in Committee. The decisions we take are not easy and the consequences are not always clear, but I have no doubt that the Bill will receive the scrutiny needed in this House—whether we are in favour or against—with all the emotions and concerns that will be expressed. No matter how challenging that may be, let us work together to examine the Bill in detail and do our work diligently.
Lord Alderdice (LD)
My Lords, although I am the first Liberal Democrat to speak in this debate, I am not speaking on behalf of all Liberal Democrat Peers because, as in all the other groupings in your Lordships’ House, there is a divergence of views on these issues. The divergence is not just between Members; it is often within each of us. There are dilemmas of an almost insoluble kind in some of these questions.
The two previous speakers have addressed some of the technical questions surrounding this Bill admirably. I want to speak about it in a different way. The first time I had to think about these questions was as a young doctor, when I found myself with patients who were suffering a great deal of pain and wanted to bring their lives to an end. For me, the question was, “How should I help them manage?” I can recall getting into a conversation with one elderly lady in her 90s who was suffering from a cancer in her gullet, which meant that she could not swallow anything. I said, “We have two choices here. One is that we can put a tube down so that we can keep you alive for as long as possible and relieve your pain as best as possible”. Before I went on to say anything further, she said, “Young man, I am now in my 90s. I’ve had a fair life, with its ups and downs. I do not want tubes going down. I just want you to keep me as comfortable as you can. I know that you cannot relieve all the pain; but keep me as comfortable as you can”. That is what I did, as best as I could, because, however much we wish to rid people of their pain and discomfort, it is not always possible, even with the best will in the world and the best medication available.
Sometimes, though, the situation is much more difficult than that. A close friend of mine was a very distinguished and highly respected teacher in one of our communities in Northern Ireland. He was the chairman of the Alliance Party—the party I led. He had a son who was a doctor and a wife who was suffering from an illness from which she would not recover. She was in a terrible state about it, and getting worse. She made him promise that, if it got to the point where she could not bear it any more, he would assist her to pass away. When the time came, one night, he put a pillow over her face. She passed away and he went straight out and drowned himself in a nearby lake. He could not discuss it with his son, who was a doctor, because that would have implicated his son, and as we have heard before, that would have been a difficult thing.
The point in raising these questions is that they are not academic questions. They are real human challenges that can only be engaged with not by rules, regulations and protocols but by engaging with people in terrible dilemmas. The only way we can really understand what we are trying to do here today and next week is to put ourselves in the same position. Some of us will say, “Whatever the pain and discomfort, I simply want to be around for as long as possible”. Some may even say, “I want to be around for another month because my first great-grandchild is going to be born; but after that, it is a different story”. Others will say, “This is intolerable. It’s excruciating. It’s dreadful. I desperately, desperately wish to be relieved of it”. I rather suspect that, in those circumstances, most of us would want the help to do what we wanted to do and to be relieved of the excruciating pain, emotional or physical.
Amendment to the Motion
Lord Forsyth of Drumlean
As an amendment to the motion that the bill be now read a second time, at end to insert “but that this House calls upon His Majesty’s Government, in the light of the 32nd Report from the Delegated Powers and Regulatory Reform Committee, to ensure sufficient time is available for consideration of amending stages of this bill, and to provide full support at ministerial and official level to the peer in charge of the bill for its remaining stages in the House of Lords.”
Lord Forsyth of Drumlean (Con)
My Lords, this amendment would simply implement the advice given by the Cabinet Secretary to the Prime Minister as to how to handle this Bill, which was to treat it in the same way as other Private Members’ Bills bringing in changes to legislation on matters of conscience, such as the abortion Bill, the end of capital punishment or the decriminalisation of homosexuality. The advantage of that, of course, is that it means that government time is made available and all the resources of the Government and the Civil Service are made available for the purpose. I am most grateful to the noble and learned Lord, Lord Falconer, for his assurances that he has been given some help.
I am not so sure, however, about the noble and learned Lord’s assurances on the time needed for this. As I understand it, four days have been allocated between now and Christmas to consider the Bill—the Employment Rights Bill has a total of 15 days. These are Fridays, and there are other Private Members’ Bills. It is really important that this matter be discussed properly, and that is why I have tabled this amendment. Anyone who has read the report from the committees of this House will realise that there is much to do on amending the Bill.
My father died in agony. When I went to see him, I said, “I’m so sorry that your cancer is causing you this distress”. He said to me, “Michael, you are to blame”. I was completely poleaxed by that. I asked, “How can you say that I am to blame?” He said, “Because you have consistently voted to prevent me getting what I want, which is the opportunity to decide how and when I come to die”. As a Christian, I have thought about that long and hard, and I have come to the conclusion that my father was right and I was wrong. Therefore, I support absolutely the principle of this Bill.
However, I have some problems with it. On page 7 of the excellent Explanatory Notes to the Bill, a table on what is required is set out. I suspect that people will get to the stage where they just cannot go on any longer. They will do their best to hang on, but they will get to the stage where it is just too much, as my father did. However, under the provisions of this Bill, you have to see a GP, then you have to see another GP and then a panel. There then must be a holding period of no less than three weeks before you can get to the position where you are given what you want. That is completely impractical and impossible. I know that some people will say, “We’re doing that in order to provide protection”, but whom are we protecting? Surely the patient should come before anything else.
I am conscious of time, but one thing more that worries me is the provision in the Bill leaving the Secretary of State for Health, who is against the Bill, up to four years to delay its implementation. The noble and learned Lord, the sponsor of the Bill, said that it is giving hope to people. Well, there is not much hope with the possibility of the Bill not coming into effect until well into the next Parliament. We need time. We need every resource available in government and we need government time, so that we can get this absolutely right. There will not be a second opportunity for a very long time. Anyone who has read the letters that have come into us will know that many people are holding great hopes for this Bill. It is up to this House to amend it so that the other place can make it worthy of their hope.
Lord Carlile of Berriew
As an amendment to the amendment in the name of Lord Forsyth of Drumlean, to leave out “and to provide full support at ministerial and official level to the peer in charge of the bill for its remaining stages in the House of Lords”.
Lord Carlile of Berriew (CB)
My Lords, I should make it clear at the outset that I am opposed to this Bill in principle but, above all, I am opposed to it because it is not an adequate Bill to deal with all the issues raised and does not provide anything like sufficient protection for those vulnerable people who might be persuaded, against their real will, to accept assisted suicide.
I agree with the words in the amendment tabled by the noble Lord, Lord Forsyth, apart from his bold bid that, in effect, this Private Member’s Bill should be treated as a government Bill. That was not what the noble and learned Lord, Lord Falconer, said was happening; I am sure that he would confirm that civil servants are insisting on their neutrality being maintained, even when they are looking at the feasibility of the Bill—I see him nodding in agreement. The noble Lord, Lord Forsyth, asks for
“full support at ministerial and official level to the peer in charge of the bill”.
That would put the noble and learned Lord in the position of a Minister. Such support is inappropriate for a Private Member’s Bill of this kind. It does not pretend for one second to be neutral or even-handed.
If the last 27 words of the amendment tabled by the noble Lord, Lord Forsyth, were removed, I would agree with it completely, but he seeks to take the steps that I have just described. Indeed, despite the large resources supporting the purposes of this Bill and the involvement of many experts, including the noble and learned Lord, Lord Falconer, one of our most respected and knowledgeable legislators, this Bill earns a D-minus for its draftsmanship, even after all those committee meetings in the other place. It needs to be dismantled if it is to be an effective and proper Bill, to give it what I would, as a shortcut, call legislative legitimacy.
What evidence is there for the propositions that I make? I will cite two pieces of evidence that emerged from your Lordships in the last two days. First, the Delegated Powers and Regulatory Reform Committee, chaired by the noble Baroness, Lady Ramsey of Wall Heath, produced a report a couple of days ago which there is no time to read out. I will simply summarise that, by the calm standards of that committee, its criticism is excoriating. I was on that committee for a considerable period, and I never saw any Bill criticised to that extent. It says that the Bill is simply not fit for purpose, breaking several standard rules of draftsmanship. It is incompetently drafted, after all the time that has been spent on it, with the steersmanship of the noble and learned Lord, Lord Falconer. Then yesterday, the Constitution Committee reported and endorsed the views expressed by the other committee, saying, in effect, that the Bill was not fit for purpose.
We must remember that this Bill would allow a citizen deliberately to perform acts which are intended to cause the death of another citizen. Since the end of capital punishment, no such act is allowed in our law to any citizen other than in war. That is the weight of the change which this Bill seeks to make. We must be given time, the space and the methods to amend the Bill if that can possibly be done, hence my support in due course for the amendment tabled by the noble Baroness, Lady Berger, which would allow a Select Committee to hear evidence which the Commons committee chose not to hear and would have been very persuasive. I beg to move.
Baroness May of Maidenhead (Con)
My Lords, I declare my interest as an ambassador for Thames Hospice, but the views that I express today are my own. I recognise that across this House there will be very firmly held views on both sides of this argument, some coming from personal experience, as we heard from my noble friend Lord Forsyth.
However, I oppose this Bill and wish to set out my main reasons. First, I do not believe that the safeguards in the Bill will prevent people being pressurised to end their lives, sometimes for the benefit of others. I worry that, as we have seen in countries where there is such a law, people will feel that they must end their lives simply because they feel that they are a burden on others.
I worry about the impact that it will have on people with disabilities, with chronic illness and with mental health problems, because there is a risk that legalising assisted dying reinforces the dangerous notion that some lives are less worth living than others. Again, as we have seen in other countries, once a law like this is passed, the pressure grows to extend the scope of it. I also oppose the Bill because I believe that, by dispapplying the default of a coroner’s report, there is a danger that this could be used as a cover-up for mistakes made in hospital or for a hospital-acquired infection which has led to an increased likelihood of death. I have a friend who calls it the “Licence to Kill Bill”.
This is not an assisted dying Bill but an assisted suicide Bill. As a society, we believe that suicide is wrong. The Government have a national suicide prevention strategy. We bemoan the number of young people who are lured into committing suicide by social media and by what they read on the internet. This week, we had World Suicide Prevention Day. Suicide is wrong, but this Bill, in effect, says that it is okay. What message does that give to our society? Suicide is not okay. Suicide is wrong. This Bill is wrong. It should not pass.
The Lord Bishop of London
My Lords, as the noble Lord, Lord Kamall, has already pointed out, we in this Chamber share the same goal: for people to die with dignity and compassion. They are critical concerns for those who, like me, believe that the Bill is deeply flawed. Noble Lords will know that I am a former government Chief Nursing Officer, and I chaired the UK Commission on Bereavement. As a nurse, a priest, a daughter and a granddaughter, I have had the privilege to be with many people as they die. Most people die well although, as we have heard and will continue to hear, that is not always the case. I have known people to experience some of the most valuable days of their life as it comes to an end, including those with terminal illnesses.
As the noble Baroness, Lady May, has just pointed out, to change the law is to change society. Any law that introduces choice for a few is not limited in its effect to only those few. If passed, the Bill will signal that we are a society that believes that some lives are not worth living. The Bill would become our state-endorsed position, and our NHS would be active in its delivery. It is the role of the House to scrutinise, but there are no amendments to the Bill that could safeguard us completely from its negative effects.
I am concerned for those who will face internal and subtle pressure to end their lives in the absence of adequate palliative and social care or to avoid being a burden to their families. I understand the fear of many that they may be offered free assisted death before they are offered the care and equipment that they may live. I am concerned that we are still in the dark about how the Bill will be integrated into a struggling health and social care system, as the Delegated Powers Committee report has shown. I am concerned that the Bill is unequal to the task of preventing avoidable deaths due to the existing problems of discrimination, inequality and abuse. I am deeply concerned that so many in Parliament are not heeding the voices of professional and representative bodies that are raising the alarm. Above all, the Bill fails in its central claim that it delivers choice. A meaningful choice would see the measures in the Bill set alongside equally available, fully funded palliative and social care services. Without that being offered, this choice is an illusion.
It may not be the will of the House to take the decision on the principle of the Bill today, but I firmly hope that we will do so at Third Reading. If it is necessary, I will table the amendment myself, so the House is given the same opportunity as the other place to decide. Until then, I have no doubt that the scrutiny given to the Bill in the coming stages will make plainer its inadequacies.
As we have heard, much of the debate is about fear: fear of pain, illness, dependency, loss of control and being somehow unrecognisable to yourself and to others. The challenge, however, is that life is not something to be managed or limited when it becomes difficult. Life is often more than we can ever understand it to be. I believe in a God whose very being is life and, in that gift, we can discover meaning, dignity and innate worth, even if we are dying. To speak of God is to speak of the one who never is indifferent to human fragility, but who holds it and tends it. That is why I believe that there is always hope—hope that what looks like an ending is not the last word and hope that, with proper care, support and research, dignity and compassion are still possible. It is this firm belief that compels me to resist the Bill.
Baroness Hodge of Barking (Lab)
My Lords, while I respect the views of the right reverend Prelate the Bishop of London, I speak in support of the Bill, in support of the principle of assisting people to die with dignity and in firm support of the legislation before us.
In my view, we are presented with a straightforward choice. Are we prepared to allow people in this country who are facing certain and imminent death to choose how they die? I want that choice for myself. I would have wanted that choice for those close to me whom I have seen die in terrible agony. I want it for the 650 terminally ill individuals who take their own lives each year; for the thousands of the terminally ill who attempt suicide each year; and for the roughly 50 who travel, often alone, to Dignitas each year; and for the many who die in pain each day, even with the very best of palliative care. I ask each and every noble Lord to reflect on whether, whatever they want for themselves, they are prepared to deny others the choice of how they wish to die. Who are we to deny others their right to choose? Denying choice represents a fundamental attack on the freedom and right of individuals to control their lives at that terrible time when they are dying.
There are those who argue that they are not opposing the principle of assisted dying, they just want yet more time for yet more consideration of yet more changes. I must say to noble Lords that I had 30 years in the House of Commons and I have never seen such scrutiny, such openness to considering amendments and such attention to detail as I saw when watching the Bill make its way through the House of Commons. We are deeply indebted to my honourable friend the Member for Spen Valley for the collaborative and collegiate way in which she steered her Bill through the Commons.
We have ample time here to fulfil our role to consider further amendments and to improve and revise the Bill during the consideration of its processes. Sadly, I have come to the view that those who have tabled the Motion to delay the passing of the Bill are more committed to killing the Bill than improving it. For that would, I fear, be the inevitable consequence if we adopt the proposal to establish a Select Committee.
We are not elected, so in carrying out our duties we must look beyond our own interests and views and listen to public opinion on this very personal and sensitive issue. We know from the most recent surveys that nearly three in four members of the public want us to make it lawful for an individual to seek assistance in dying in the UK. We also know that nearly four in five of those who live with a disability support a change in the law, and that two in three respondents, with faith, also expressed support for the law.
The time has now come to change this law. Across the world, jurisdictions are introducing laws to enable assisted dying. We should proudly be the standard bearers of this important societal change in Britain, and we should demonstrate, by our support for the Bill, care and compassion for those who need it most: those who are coming to the end of their lives and dying.
Baroness Grey-Thompson (CB)
My Lords, I declare an interest as a director of Living and Dying Well. While my view on this subject has been publicly expressed, today is about the contents of the Terminally Ill Adults (End of Life) Bill and the implications for wider society with all its pressures and tensions.
We should therefore learn from other jurisdictions. Just as good laws are not made from hard cases, soundbites do not make watertight Bills. We have heard that the Bill is “the safest in the world”. However, in Committee in another place, judges were replaced with a panel, in a contradictory term called “judge-plus”. This change was made after the Ministry of Justice and senior judges raised concerns about the impact on courts. The Royal College of Psychiatrists says that the suggested model is not even possible. The EHRC stated that the impact assessment in another place was published too late for it to be properly utilised to strengthen the Bill. The Bill gives the Secretary of State extensive powers. The Henry VIII clauses allow statutory instruments to be endlessly rewritten.
Specifically, Clause 5(4) requires
“the provision of adjustments for language and literacy barriers”,
but there is no requirement for modified information for those with learning disabilities or additional needs. Additionally, the doctor only has to “ascertain” that the person has been coerced. But how? It is not in the Bill. Clause 25(8) allows the co-ordinating doctor to assist the person
“to ingest or otherwise self-administer the substance.”
This blurs the line between assisted dying and euthanasia.
At a recent meeting with those who provide voluntary assisted dying in Australia, claims were made that all deaths were peaceful. But there are no requirements to report adverse events, and no impartial oversight. In Oregon, the presence or absence of complications was left unrecorded in 72% of deaths. The Bill does not sufficiently outline protocols for recording or dealing with complications.
The “approved substances” mentioned in Clauses 27 and 37 do not explain how a drug will be approved. In Oregon, patients were given experimental drugs, with one treatment turning out to be
“too harsh, burning patients’ mouths and throats, causing some to scream in pain”.
Over 27 years, half the patients in Oregon took between 53 minutes and 137 hours to die. If the Bill is to bring compassion and calm at the end of life, how can this be ensured when we do not know what lethal drugs will be given?
Having no requirement in the Bill for a coroner’s report could lead to a lack of proper oversight. There are cases where it is revealed post-mortem that the patient did not have a terminal illness. As the Bill stands, we would never find out. If there is nothing to fear from the Bill, there is nothing to fear from accurate reporting.
Claims have been made that once on the statute books, the law cannot be expanded. Just as the Bill amends the Suicide Act 1961, fundamentally, our role is to scrutinise and improve legislation. Parliament can do anything, but it cannot bind its successor. I am constantly told that there has been no expansion in jurisdictions such as Oregon. But 2020 saw the removal of the 15-day waiting period between requesting assisted dying and administering it, and in 2023 the residency requirement was removed and the definition of “terminal” expanded by interpretation. In Victoria, Australia, a five-year review in February proposed a plethora of “improvements”, which lead to substantial expansion.
Our role, and what we must endeavour to do, is to weigh up the evidence, safeguard the vulnerable and avoid wrongful death.
Baroness Featherstone (LD)
My Lords, first, I thank the many people who have written to me to beg me to support the Bill, and I do. So many of those letters tell a horrific story of watching a loved one suffer. The proportion of those letters that are in support compared to those opposed is overwhelmingly in favour, by a ratio of 4:1.
But today, I speak for myself, for my rights, for my autonomy, for what I want to happen should I face the appalling circumstances of a terminal illness with six months to live, and for my right to choose. Autonomy is a central principle in modern ethics and law—the right to make decisions about your own body and life. If people can refuse life-saving treatment, create advance directives, or choose risky medical procedures, consistency suggests that they should also be able to choose when and how they die if terminally ill. Assisted dying does not force anyone to end their life; it simply respects the choice of those who want that option.
We already recognise the right to live according to one’s own values in freedom of religion, reproductive choices, sexual orientation, and marriage or not. So why not with this, the most intimate and important decision of our lives? Choosing assisted dying should be framed not as a rejection of life but as an embrace of dignity. People facing terminal illness or unbearable suffering may wish to avoid a drawn-out decline that strips them of control, of independence, of even their ability to recognise themselves. Respecting their choice acknowledges their humanity, rather than reducing them to passive recipients of medical care.
John Stuart Mill’s philosophy was that individuals should be free to make their own choices unless they harm others. Choosing to end one’s own suffering does not harm others, whereas forcing someone to endure against their will is a harm.
There is a divide. Those with means can travel abroad to access assisted dying, creating inequality, and often a lonely end. Allowing it locally ensures that choice is not only for the wealthy or the privileged. When assisted dying is illegal, people sometimes take desperate or violent steps to end their lives. Allowing a safe, regulated pathway gives people peace of mind and reduces traumatic situations for families and healthcare workers.
I thank Kim Leadbeater for her calm and thoughtful approach to addressing the fears that people naturally have about coercion. It seemed to me from reading the Commons debates that those concerns had been addressed and changes had been made. But I have absolute confidence that, should there be any remaining issues that give rise to further concerns, they will be found and addressed in this House.
I say to those with disabilities who are understandably very nervous and worried, this does not apply to disability. Disability is not a qualification. To those who raise palliative care as the answer, I wish it was the answer. But it is not a good enough answer in the reality of the circumstances people face today.
Lastly, I say to all those who may vote against the Bill for religious reasons, assisted dying is not compulsory. If your religious convictions require that you do not take advantage of the Bill, please have compassion and enable us who do not have your convictions to have the right to choose.
Lord Stevens of Birmingham (CB)
My Lords, palliative care may not be the answer but it has to be part of the answer, and unfortunately that is just not the case across England and Wales as we speak today. It is estimated by my colleagues at King’s College London and the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care—some of the foremost experts in the country—that over 100,000 people die each year in this country without the palliative and end-of-life care that they would have benefited from. Two-thirds of people report being fearful that they will not have access to palliative care when they need it. So, to the extent that the Bill is about autonomy, you cannot have meaningful choice without having palliative care as part of that choice. By the way, I place high weight on the principle of individual autonomy. My question is, how autonomous can you be when you do not have a meaningful set of choices?
Advocates for the Bill make the point that in some countries that have introduced assisted dying legislation, palliative care services have improved. I have looked at those instances and that is because, when the legislation has been progressing, there has been a matched government effort specifically to increase funding for palliative care. I am not aware of any such effort on offer in this country. Although, as the noble and learned Lord, Lord Falconer said, the assisted dying service will, as per the estimates, be remarkably cheap at only £25 million, the cost of doing something in palliative care would be far greater. Therefore, it makes it far riskier to envisage that this will automatically come about.
Instead, we have in the Bill two reports on offer, in Clauses 47 and 50: one a year after the Bill is passed—if it is—and another, in effect, in nine years’ time. Frankly, those reports on the state of palliative care are not going to be worth the paper they are written on. It would be the Secretary of State at the time marking their own homework. It would be a one-off assessment. In any event, it would have no consequences, because the Act would have automatically commenced within four years anyway.
So, what could be done about this? There are some practical amendments that would improve the prospects. I would like to see a triple lock, as it were, for palliative care. First, I would like to see the attestation that the two doctors are being required to provide attest that there has been a comprehensive offer of palliative care and end-of-life support made available to any applicant to this scheme—not simply that they have had described to them the availability, or lack thereof, of any palliative care in their local area.
Secondly, we should see an attestation from the patient themselves that that genuine offer of palliative care has been made available. Thirdly, it would obviously be entirely perverse if the only way you guaranteed access to palliative care was by going through the assisted dying service. Therefore, we need to see an attestation, periodically independently verified by the Care Quality Commission, that everybody who might benefit from palliative and end-of-life care has access to it across the country. Absent safeguards such as that, we should take very seriously the warning from Hospice UK:
“The introduction of assisted dying, while palliative care is underfunded and inequitably delivered, as is currently the case, therefore brings evident and substantial risk”.
Baroness Primarolo (Lab)
My Lords, I am very grateful to the hundreds of people who have written to me about their views on this Bill, both for and against. Many of the letters made for very difficult reading—goodness knows how difficult they were to write. We all have personal experiences of loved ones’ painful deaths in circumstances in which they were denied the choice of how they died and when. This is, of course, an important debate for the whole country. It is right that your Lordships balance legal and ethical considerations, the level of public support and the requirement for practical safeguards in legislation, while responding to clear signals from the majority that they support this Bill as drafted.
I believe that, above all the considerations that we will discuss, there is one towering point: the fundamental right of the individual to exercise agency and autonomy over their own life. As the noble Lord, Lord Alderdice, so eloquently put it, those choices are hard indeed and not taken easily. Denying the ultimate right to end one’s life in peace and dignity in the manner and circumstances of one’s choosing, when the alternative is so scary and appalling, is not being compassionate. We need to facilitate this Bill. I am reminded of when I was a Health Minister of the complex human interactions and how we tried to legislate, particularly when we undertook reforms in the embryology Bill. We took on the challenge, got the detail right and did not delay or deny the choice of those who seek this.
The Bill is not a reckless attempt at unchecked freedoms; far from it. It provides measures that will offer carefully regulated paths to ensure that only those with a confirmed diagnosis of illness are covered by it. The imperative here for me is to respect human agency and autonomy. It is a travesty and ultimately wrong for the state or any other agent in civil society to intervene or to impose their values above the right of the individual to self-determination in circumstances where there is no perverse impact on the community. In a democracy, we must trust individuals to make informed decisions about their own bodies and lives. We must resist imposing our values on others when we have no right to intervene. To deny agency to those seeking the freedom to end their lives on their own terms is wrong. The greater good is not served by sacrificing the few to the pain and suffering they face. I support this Bill as it is drafted, and I will vote to resist any attempts to delay its passage through this House.
Lord Lamont of Lerwick (Con)
My Lords, I speak with enormous hesitation on this complex and sensitive issue. Any Second Reading of a Bill must inevitably discuss the principle behind it. I acknowledge the principle of choice and the argument that, by changing the law, we may avoid unnecessary pain. Against that has to be weighed another principle: attitudes to human life. The wider consideration that legislators must take into account is not just the immediate consequences but those over the longer term, not just the intended consequences but the unintended consequences as well.
We have to take into account the patient-doctor relationship. Assisted dying is not a treatment and sits oddly with the concept of a cradle-to-grave national health service. Regardless of the stance we take on the principle, any Act that is passed must function as a workable framework that protects the interests of patients and professionals and ensures that the safeguards are proper safeguards. I have been struck by the concerns that have been expressed to me by medical practitioners and the evidence from several prestigious medical organisations, including several royal colleges, which, while remaining neutral, have expressed specific concerns about the Bill.
Points that need to be addressed in Committee include these: why does the Bill not require the person who wants to end their life to be asked why they wish to do so? It is of paramount importance that we avoid a situation in which anyone who wants an assisted death does so because they fear they are becoming a burden. That is a crucial point: people should not be forced to consider that they are becoming a burden. Would it not be better if pain and suffering were written into the Bill as the exclusive reason for allowing assisted dying? Another unanswered question is how the regulation of the lethal drugs will be carried out. The system seems to bypass the MHRA and the UK-established drug approval process. How are we going to judge capacity—that is, the ability of the individual to make the decision about whether to end their life? In Belgium and New Zealand, medical practitioners are prohibited from initiating discussions about the possibility of assisted dying. Should there not be a similar prohibition in our legislation? On capacity, one of the royal colleges has criticised the use of the Mental Health Act as an inappropriate reference point by which to judge the individual’s capacity. That is a point that needs to be explored in Committee.
The Secretary of State has made it clear that there will be no extra resources to cope with this Bill. The noble and learned Lord, Lord Falconer, has assured us that the costs will be minimal. We shall see, but we may end up in a curious situation in which palliative care is funded 30% while state-assisted dying will be funded 100%.
The crucial point about this Bill is that, as the Delegated Powers and Regulatory Reform Committee pointed out, so much is left to be decided later, to be decided over time or to be delegated to decisions by Ministers. This is an unsatisfactory position. We need to know more detail. For this reason, many amendments need to be made in Committee. We need intense scrutiny, and the Bill as it is at the moment is not satisfactory.
The Lord Bishop of Southwark
My Lords, I acknowledge with deep respect that those arguing for the passage of this Bill are often speaking from personal experience of the pain and suffering of someone’s final illness. Yet, along with many other speakers, I have deep concerns about legislating to permit the practice of assisted dying. I caution the House against the remedy of choice in this area. My concern is that those who are most vulnerable in society will become more vulnerable should this Bill find its way on to the statute book.
Related to this, and as a Bishop, I wish to say something on the subject of life, which I believe we must consider in any Bill making provisions for its termination. In the Old Testament, the principal word for life is the Hebrew word “hayim”, a plural noun. This expression signifies both our physical life and our source in God, who is the source of all life. It is a relational term, and, like most societies until our own age, it reflects a view of life as a gift and one lived out with others. It is a sign of the deep richness of the journey of life, which, of course, encompasses mortality and the finality that takes us to our very last breath. We need to be immensely careful in supporting a departure from the practice and wisdom of centuries.
The consumer age in which we now live presents us with technology with built-in obsolescence on a narrowing timescale. It tells us that choice will make us free, but choice itself needs to be examined closely. Instead, humanity acknowledges finitude, which gives our lives meaning, for we are all mortal and each of our lives will in due course come to an end. But in this life, in the words of the general thanksgiving, we give thanks for our creation and preservation and all the blessings of this life. That is not to ignore the imperative of compassion and assistance for those who are suffering. The Christian conviction retains the belief that life is of intrinsic value at all stages. There is never a point at which it may be said that it is not worth it or that life is not worth living.
Assisted dying would dangerously introduce the concept of the limited worth of human life into our medical practice and our relationships. We would be signing up to an essentially consumerist understanding of life, with many potential perils. Life is to be cherished, and those of us with faith acknowledge life to be sacred. That is why it is imperative that we address the chronic underfunding of palliative care and resource our hospices to do the work they do with such care and dedication for those who need their services. This provision would enhance dignified dying and should be our first priority. I cannot in all conscience support the Bill.
Baroness Falkner of Margravine (CB)
My Lords, I declare an interest as chair of the Equality and Human Rights Commission, but I am speaking in a personal capacity. This is particularly pertinent today because the EHRC has briefed on the Bill and I must therefore stress that my remarks are entirely personal and to my own circumstances and knowledge.
Some colleagues will know that I was found to have advanced stage 3 ovarian cancer last summer, after seven months of an unsuccessful diagnosis at a major NHS teaching hospital. My experience in that distressing period was of a disregarding and, at best, incompetent NHS. Finally, I turned to the private sector last August. Since then, I have had two rounds of chemotherapy and three operations, and I am now on relatively debilitating medication until 2027. So in this period, I too feel as though I glimpsed the Grim Reaper through my hospital window, in a morphine-induced haze. We know that 460 people die of cancer every day in this country, so I know I am not alone.
Before going further, I acknowledge the great suffering that is caused by several other illnesses that may result in applications for assisted dying but, today, in our limited time, I will concentrate on cancer. This is because the data tells us that, for every four-week delay in treatment, a patient is 10% more likely to die. The EIA on the Bill tells us that, in New Zealand and California, two-thirds of those who seek to end their lives this way are cancer sufferers.
I recognise the need for dispassion and objectivity when one is trying to pass legislation, so I turn to the flaws that I see in the Bill. The Constitution Committee of this House has stated that a Private Member’s Bill on this subject is wholly inadequate. Recognising the repeated attempts in my 21 years here to put this kind of legislation on the statute book, I would have expected the Government to have taken over the Bill and paused it for pre-legislative scrutiny through a Joint Committee. The amendment from the noble Baroness, Lady Berger, may give us that opportunity and I intend to vote for it.
The second flaw lies in the definitions of the Bill. How do we define “terminal illness”, measure the six months to live or calculate monetary equations that measure our lifespans more poorly than they do bats in HS2 railway tunnels, as in this impact assessment? What do we make of the impact of these measures, the lack of compassion for those genuinely concerned about the impact on disabled people or the questions of mental capacity—or for religious individuals and, of course, the elderly, who feel unwanted enough as it is?
Importantly, the most critical agents in this story, other than the patients themselves—GPs and specialist doctors—are given an impossible task. Doctors dread that inevitable question from the patient, “How long do I have?” It puts them in an invidious position, particularly in the case of cancer care, where management of the illness is the challenge. “How well?” and “How long?” are the critical questions asked on a daily basis. In England, a third question arises: “How much?” This is because NHS drugs for some cancer treatments in Scotland and Wales are simply not available here. That is the cruellest aspect of that postcode lottery.
There is much to discuss in the scrutiny of this flawed Bill—and I say that as someone who previously supported assisted dying. I wish we did not have to deal with this flawed Bill, but we will do so in good faith.
Baroness Hunter of Auchenreoch (Lab)
My Lords, wherever you may stand on the principle, the fact is that assisted dying is already a reality. It is available to those who have the means and ability to go abroad. The question before us is whether we continue with this two-tier system or whether people suffering here should be able to die at home, in our own country within our own regulated and safe framework, more stringent than any overseas, as set out in the Bill.
I am inspired by the experience of Michael Stubbs, the father of my son’s close friend. His widow, Christine, is with us in the Chamber today. After struggling with degenerative Parkinson’s for 10 years, Michael was wheelchair-bound, with double incontinence, seizures, spasms, insomnia, dyskinesia and depression. He was at the end stage of Parkinson’s, with a life expectancy of between six and 12 months. He wished to end his life, to spare himself and his family. After much research and two months’ review of his medical records, Michael made the arduous journey to LEIF in Belgium, where physical and psychiatric assessments were completed. Then, following the requisite cooling-off period at home in Brighton, the family crossed the channel again.
Michael remained calm and resolute: as Christine said, “Compos mentis to the very last second of his life”. The drug was administered and Michael died quickly and painlessly. “The moment was sad”, his son, David, wrote to me, “but there was also a beauty and so much dignity in it. Everyone got to hug and say our last words. He seemed so at peace and filled with acceptance”.
Two days later, Christine had to travel back to Belgium to collect her husband’s ashes. All that unavoidable travel inevitably added to the family’s stress and pain. But they know they were lucky: so many in this country do not have their opportunity. This is about equity of choice for terminally ill people here about how and where they die. I urge noble Lords to support the Bill.
Baroness Goldie (Con)
My Lords, I oppose assisted dying on principle; I voted against it in the Scottish Parliament and I want to be transparent. But the task before this House today is to scrutinise the Bill, and that is the process to which I wish to contribute. I reserve the right to vote against the Bill if—or, as seems more likely, when—such a vote arises, but I accept that the promoters of the Bill act with sincerity and with the best of intentions.
The genesis of this Bill is the profound distress which has attended many patients as they approach the end of their lives. Prominent in that distress is the management of pain. The answer to that problem is not assisted dying; it is how we care better for terminally ill patients and how we manage unbearable levels of suffering. That requires two things: a reversal of chronic underfunding over decades of palliative and terminal care, and a restoration to clinicians of their proper clinical discretion and professional obligation to always act in the best interests of their patients without fear of the consequences. If it takes legislation to provide that immunity and reassurance, that is a Bill I would support.
Within this Bill, which is literally dealing with life and death, we should find explicit detail, clarity and certainty. We should know as legislators what we are being asked to turn into law. We do not. Detail, clarity and certainty are missing. For example, the attempt to define terminal illness as
“an inevitably progressive illness or disease which cannot be reversed by treatment”,
with death reasonably expected “within six months”, is incapable of precision. Diagnosis is not an exact science and six months is an estimate—think of the convicted Libyan bomber, al-Megrahi. But the patient will certainly be influenced by that opinion, even if it is wrong.
There is an attempt to spell out the criteria which must apply to a patient requesting assisted dying, including
“a clear, settled and informed wish to end their own life”,
doing so voluntarily and not being
“coerced or pressured by any other person”.
But there is a crucial omission in the Bill: I can find no definition of a clear and informed wish. What constitutes that? Yes, a doctor has to refer to that in the report following the assessment, but what are the criteria? If the answer is to ask the patient the question and tick the box, that is grossly inadequate.
Equally troubling is the declaration to be repeated by the co-ordinating doctor—someone still to be defined by regulations—that the decision is made voluntarily and not under coercion or pressure. If the co-ordinating doctor has met the patient only once, how can that possibly be a basis on which to have formed an opinion about third-party coercion or pressure? As many noble Lords will know, such coercion and pressure is not trumpeted from the bedside; it is furtive and covert. It will take a skilful doctor visiting the patient on a regular basis to be able to make any informed judgment on such issues. On that, the Bill is silent.
This takes me to the most concerning omissions from this Bill. Where we should have explicit provisions in primary legislation, we have repeated reliance on delegated powers. That is what makes this Bill opaque and impossible to understand. On an issue of life and death, that is completely unacceptable. We should be indebted to the Delegated Powers and Regulatory Reform Committee of this House for its objective but deeply disturbing report laying bare these omissions and inconsistencies. This Bill should be rejected. It is not fit for purpose.
Baroness Murphy (CB)
My Lords, I have often spoken in support of this and in most debates in this House on every Bill to introduce assisted dying in England and Wales since the Joffe Bill in 2005, and I will continue to support it. I hope that this Bill will make it through. For me, the principles are guided by support for the importance of respecting the autonomy of mentally competent people to make their own decisions about their lives, and that, as a matter of compassion, people should be assisted to end their lives when terminal illness means they no longer want to contemplate further existence or tolerate the possibility of a difficult death.
As we have heard, there are numerous jurisdictions that have implemented legislation on this based on the Oregon model, which is a very successful one and is tried and tested. Other jurisdictions have gone for another model, which I would broadly call the Canada model—a rather wider scheme, which I would have supported strongly. The Oregon model is the one we have before us, albeit modified, and that is what we need to get right and through Parliament; it is the one that has been approved by the Commons.
We know from good peer-reviewed research that there are no risks for the vulnerable. They are largely a rallying point for the fundamentally opposed, and that is all. There is no evidence of any undue influence impacting on the decision. The process can be part of good palliative care services and in many places where this model has been taken up palliative care services have improved. It makes people focus more on the realities of care of the dying. Yes, it would be great to see better palliative care—I would support that and always have—but not at the expense of trying to introduce another legitimate arm to it, which is part of good palliative care.
My problem with this Bill is what the Commons has done to it. As the noble Lord, Lord Forsyth, said, it is now hedged around with so many so-called safeguards that have been inserted that it might prove to be unwieldy if not unworkable. The notion that a psychiatrist should be called in to confirm capacity in some cases is probably unnecessary. All doctors are trained to assess capacity; they have to be for testamentary capacity. Of course, I love dearly psychiatrists—after all, I am one—but I think it is unlikely that my colleagues will want to be involved, except in very exceptional and unusual circumstances. Frankly, there is too much bureaucracy and oversight in this Bill. The experience of other countries suggests that the less bureaucratic the process, the better the experience for patients.
The Bill is very narrow in its criteria for eligibility. I am content to go through with this Bill as it is, but I am one who would like to see in the future an expansion of eligibility criteria to support people with irremediable diagnoses, such as Tony Nicklinson and other people with locked-in syndrome. My 100-year old mother decided to starve herself to death when her pain was excessive. She had very good palliative care support and a brilliant GP, but those three weeks in which she was determined to die—she was fully mentally competent—were the worst three weeks of my life. Nevertheless, I want to see this Bill go through, and hope it becomes legislation as soon as possible.
I am sympathetic to the amendment in the name of the noble Lord, Lord Forsyth, but I am very worried that it would create further problems for us. Let us try to get this Bill through, and then at least we can make some progress and respect the wishes of the Commons.
Lord Hunt of Kings Heath (Lab)
My Lords, confronted with the death of my mother four years ago, I have thought long and hard about this bill. Just days after celebrating her 99th birthday, she suffered a stroke, and she died three months later. Her final weeks were distressing, prolonged by unnecessary medical intervention. It was an experience which showed me the urgent need for a huge improvement in end-of-life care to prevent futile treatments and avoid unnecessary prolonged suffering. For me, that is very different from assisting suicide at a person’s most vulnerable moment.
Having sat with my mother in those last days, I can understand why so many noble Lords here today will argue that dying people should have the choice of the time of their own death. But I agree with the right reverend Prelate the Bishop of Southwark that the preciousness of life is paramount, and I have not changed my opposition to the principle of assisted dying.
We are going to hear a lot about international evidence. I think there is enough international evidence to suggest that, wherever you start, laws framed as modest and limited expand to cover non-terminal conditions, psychiatric illness and even minors. The Canadian example is very interesting on that point. There is a real risk of vulnerable people being pressurised to end their lives because they fear being a burden. There is a potential impact on the doctor-patient relationship, which could be corrosive. I worry about the application of the Mental Capacity Act, as it was not designed to deal with the judgments on capacity in this Bill.
On the issue of NHS costs, it is to be underfunded. My noble and learned friend Lord Falconer said that it is very small compared with the overall cost, and he is absolutely right. My concern, to which the noble Lord, Lord Stevens, has already referred, is that over decades—and there is a collective group of former and current Ministers here, including me, who are partly responsible—we have completely failed to ensure the proper funding of palliative care. My worry is not only that we will not get palliative care funded wholly but that the money for assisted dying will come out of palliative care. With all my experience of the NHS, I know that is how NHS bodies think about funding issues.
We have had two Select Committees; they have identified flaws in the legislation. Coming from where I am, I ask the House that we at least have sufficient time to go through some of these very important questions. My noble and learned friend has said that he is prepared to make changes—although, interestingly enough, not to Clause 27, which gives the Secretary of State the power to set out the substances to be used to enable assisted dying to take place, even though the Delegated Powers and Regulatory Reform Committee suggested that we could start off with a list of substances in the Bill and then amend through affirmative secondary legislation. I ask him to give that some further consideration.
It is essential that we have enough time to debate the Bill and that the Government maintain their neutrality. I go quite some way with the noble Lord, Lord Forsyth. I certainly agree with him that four days in Committee and two days on Report is insufficient. I am concerned about the position that the second part of his amendment will place on my noble and learned friend—in essence, placing him in the position of a Minister. It is why I hope the House will support the noble Lord, Lord Carlile, and my noble friend Lady Berger on having a proper Select Committee as well.
Lord Ahmad of Wimbledon (Con)
My Lords, I will speak in strong opposition to the Bill before us today, not only as a Member of your Lordships’ House but as a person, like all others—whatever side of the argument they are on, deeply committed to the values of compassion and dignity. I add to that the value and sanctity, both through faith and principle, of the preservation of human life.
I had the great honour to serve as the United Kingdom’s Human Rights Minister for many years. For me, the most fundamental of human rights that we must continue to protect is the right to life itself. The noble and learned Lord knows that I have immense respect for him, and I regret that I cannot lend support to his Bill. Of course, I acknowledge the deep pain and suffering that many individuals and their families face when confronted with terminal illness—we have heard many moving stories. We have all been there with parents, families and friends. No one should underestimate the emotional toll of witnessing a loved one enduring excruciating suffering or the anguish of being in a state of health where one’s life seems to offer no prospect of meaningful recovery. Yet it is precisely because of this shared humanity and compassion that we are rightly driven as a country and a community to seek solutions that alleviate suffering in ways that are aligned with our collective values of preserving life.
One of the central arguments in favour of the Bill is that it provides individuals the opportunity to exercise autonomy and control over their own deaths. I understand the appeal of that. In a world that increasingly celebrates individual rights, it is only natural that we would seek to extend such autonomy to the ultimate decision in one’s life: of how one departs from this world. However, we must ask the question: is it truly a sign of freedom when we open the door to a practice that could be used to expedite life’s end, rather than seeking, as the noble Lord, Lord Stevens, said on the issues of palliative care, to preserve and enhance life, even in its final moments? I believe that we have a moral as well as a legal and legislative duty to preserve life and offer care in its most fragile stages, not merely through the provision of medical interventions but through dignity, compassion and kindness.
As has been mentioned, psychological and emotional pressures can often cloud one’s judgement. We must therefore also ask ourselves whether we as a society have done enough to support those who are facing such dire circumstances, not just through palliative care but through the emotional, psychological and social support that would empower them to live the remaining days of their lives with dignity and peace.
Let us be clear, the very essence of the Bill—that assisted dying should be available as an option—represents a major shift in the values we uphold as a society. If we as a nation say that it is acceptable to take life in certain circumstances, I fear that we risk opening a door to consequences that go way beyond the current scope of the Bill. The noble and learned Lord mentioned Canada in his opening speech, but after that Bill was introduced in 2016, changes were made in 2021, with the words “terminal illness” removed. One in 20 deaths in Canada are now through euthanasia.
The fundamental question we must ask is: are we truly offering compassion when we facilitate death? At a time when technology is advancing and pain management methods are improving, we must ask ourselves whether assisted dying is the right approach. The role of the state is to protect life. I have many concerns about the Bill, such as the lack of family involvement and engagement and that the actual reflection of our diverse communities is not included. Ultimately, when we offer choices towards the end of life, it is certainly my view that we as a society that cherishes lives should provide for the dignity of every individual, with not only the medical care but the emotional and social support and investment that are required. When people are seeking to end their lives, and for those who are at the end of their lives, we should help them to live with dignity so that they choose, and we choose, life over death.
The Duke of Wellington (CB)
My Lords, I enter this debate with trepidation. Unlike some noble lords, I am not a professional in medicine or law, but I have a view on this most complex matter that touches on so many aspects of humanity. Many of us will know of relations or friends who have died in pain. We must therefore do something to alleviate the unacceptable situation where, in a developed country in the 21st century, there are still too many people dying in pain or with a total loss of dignity. I am therefore in favour of the principle that something must be done.
When considering legislation, we are trying to prevent a present or future wrong without inadvertently creating an unintended further wrong. Looking at the Bill, we are all aware that a possible future wrong could be that a vulnerable person might in some way be or feel pressured into seeking an end to their lives when circumstances do not justify such an action. However, as far as I can see, there are more than sufficient safeguards in the Bill to prevent such a situation. In fact, I am concerned that the process of seeking assistance has become too onerous, particularly for vulnerable people.
The process involves, first, consulting the co-ordinating doctor, who must be appropriately trained, and then the independent doctor, who must also consult other professionals; then the commissioner has to refer the case to an assisted dying panel consisting of a psychiatrist, a social worker and a person who has held high judicial office. After the various consultations, another 14 days of further reflection and a second declaration are required. I am concerned that this lengthy and detailed process will be difficult, particularly for people who might be described as vulnerable. I question whether the Bill, in trying to create sufficient safeguards, has not in fact exposed the patient to further anxiety, distress and probably pain.
The Bill is drafted to give a choice to the patient about how they wish to die. The current law does not give patients that choice. The patient should have a choice, and therefore I support the Bill. It would clearly be wrong for a patient to be pressured to seek an assisted death, but it would be equally wrong for a patient who is terminally ill and in pain to be put off seeking assistance because the process of application is too complex and lengthy.
There are strong arguments on both sides, but I come down in favour of giving to the terminally ill a choice to end their lives in a dignified way with as little pain as possible. The alternative is the status quo, where those who can afford it and are in good enough health go to Switzerland. That cannot be right, and I therefore support the Bill.
Lord Dobbs (Con)
My Lords, I speak as a cancer sufferer, as a man who applauds and supports the hospice movement and, I hope, as a conservative. I reject, as a matter of principle, the idea that the state can demand ownership of my body any more than it can own my spirit or my soul. The current law is cruel and untenable. The Supreme Court says it must be reviewed, the police refuse properly to enforce it and the public demand that it be changed.
There is the contrary argument that our lives and our deaths belong to God. I understand the strength of opinion of those who plead that case. But I suggest that you have no right to impose your view on others who do not agree. With respect, I see no hand of any God that I recognise in laws that condemn innocent men and women to die in agony even when they beg for their pain to stop.
Why are we so afraid to change? Do we really believe that there are ruffians waiting to pounce from the shadows upon their own families? That is the other argument that is put against the Bill. Are we to believe that we have become so cruel that we have turned into a society of casual killers? Is that what we are supposed to believe, what we are supposed to have become? Let us weigh that supposition—that is what it is—against actual suffering and against the reality of the totally unnecessary torments that so many are forced to endure, even when they beg for mercy. Weigh those things up, one against the other—measure fear against fact—and there is surely only one compassionate outcome: this Bill, or something very much like it, with all its many safeguards.
A nurse wrote to me: “I have never met a nurse or a doctor who is eager to end the life of any patient, but I have known many nurses and doctors who want to end their suffering. I hope and pray that the law will change and I will not be subjected to the laws dictated by those who do not agree with me”.
I wish I had had the opportunity, out of love, to help my mother pass peacefully in my arms, instead of watching her years of suffering. It would have been her choice, but she had no choice. Instead, I am left with an enduring memory of endless pain. Your body, your life and your choice—I wish all noble Lords long lives and a quiet and gentle and loving end.
The Lord Bishop of Newcastle
My Lords, this is not the first country in which I have lived and worked during such a debate as this. I was a Bishop in New Zealand ahead of the referendum on a similar Bill there five years ago. I witnessed the arguments, heard the reassurances and have since followed its implementation, including the pressures on healthcare professionals and the unforeseen consequences from a lack of clarity around process.
Only recently, New Zealand published its five-year review of the Act, highlighting significant practical challenges, concluding that the review committee is ineffective as an oversight body and recommending reforms. Five years on from the passing of a Bill much like the one before us, it would be irresponsible not to take its findings seriously. Most strikingly, the report highlights confused principles for the service and even recommends that the New Zealand Government establish specific principles to underpin the Act. This is no small matter—to be five years into providing the service without clarity on the principles on which it was built. For legislation where the consequences of poor drafting are so high, it is alarming that such principles were not defined from the outset. Yet, almost a year into the passage of this Private Member’s Bill, we are still discussing core concepts, without sufficient detail on how a state-sponsored suicide service would be implemented. That should trouble us all.
In that regard, I will support the amendment put forward by the noble Baroness, Lady Berger, to enable at least more scrutiny by professional bodies. While such uncertainty remains about how the Bill would operate alongside our most important end-of-life care institutions, we should not legislate at this speed or in this way. Our first responsibility must be to ensure that palliative and end-of-life care is accessible and effective for all. Last week, I visited a hospice in Newcastle. I saw and heard at first hand how an affirmation of life and dignity matters for all of us. Proponents of the Bill say that it is about choice, yet I cannot see how this is true when it is both unsafe and unworkable in its current form.
Within the Judaeo-Christian tradition, the idea of being human begins with God, as my right reverend friend the Bishop of Southwark has asserted—the sense of transcendence that informs personhood. Our obsession with selfhood and individual choice belies our dignity and respect for others. In being human, we begin not so much with selfhood but with the idea of the other and of who we are in the realisation of community and society.
Surely, the moral imperative is to help people live. I recall the words of my Bishop, growing up in the north-east, David Jenkins—words now written on his tomb:
“God is. He is as He is in Jesus. So there is hope”.
It is this that deepens and enriches my vision of life and faith, a vision of hope in humanity shared with those of other faiths and none, which are inextricably bound together. I cannot support the Bill and urge other noble Lords to resist it too.
Lord Baker of Dorking (Con)
My Lords, this is the third time in my life that I have spoken in this House on assisted dying. The first time was over 20 years ago, when it was not very prominent at all. I have been a strong supporter of it. The argument then was that the sanctity of life was so important, and the Bishops have said this today—they believe that very strongly. But many of their parishioners do not believe that. I am an active Anglican and, in my church, my friends are all very keen on assisted dying. The right reverend Prelate is nodding; I see that he has some as well.
Something very extraordinary about this is that the recent Directors of Public Prosecution have been most reluctant to charge husbands for killing their wives because they know that, when they go to court and the court hears how the husband has worked not from greed but from love—how he has been asked by his wife constantly to end her life so she does not suffer any longer—they do not convict. When laws do not convict, they should be changed. That is the reality, and the Prime Minister has shared in it.
This House has always been very supportive of assisted dying, because we are much older than the Commons. I am now one of the older Members—I am 90—so I am much closer to death than any of you. The one thing I would say is that it would be wonderful if there were a choice of palliative care, but it is totally unrealistic that it will happen. It will cost billions. Is the Labour Party or the Conservative Party going to say in its next manifesto, “We will spend billions on palliative care”? I do not think even Farage is mad enough to do that, and it just will not happen.
My father died watching the television news, and I hope I might go as quickly—but one may not; one may live. I visited two palliative care homes to meet friends, and they were looked after very well, but they all wanted to go home. They wanted to get out as quickly as possible to die at home, because they wanted to control their own death, so it is not really an alternative. It is absurd for people to think that it is a political alternative to spread palliative care in the way that it may be needed.
I think this Bill should be supported because it is compassionate and it wants to prevent suffering. It also wants to protect people from coercion. I visited two friends who were dying and who were surrounded by family, and there was coercion—but it was coercion to go on living, not to die. That is often the pattern. I believe that the safeguards in this Bill are quite adequate, and those who wish to destroy or undermine the Bill or to increase the safeguards so much that hardly anybody will ever die in this way should consider very carefully the great indignity of extended old age. I am now aware of it, and one thing I would say to noble Lords—a bit of good advice—is that it is very costly and you should save some money for being old, as you really will need it, I can assure you.
People must die in dignity. The simple reason is that you can anaesthetise suffering, but you cannot anaesthetise dignity. Many people feel very indignant indeed that they are going to have to suffer for so long. I want to my death to be my death. I do not want some intruder who has never intruded upon my life to intrude upon my death.
Lord Mohammed of Tinsley (LD)
My Lords, as one of the younger Members of your Lordships’ House, I start by thanking the hundreds of citizens of this nation who have taken time out to write to us or email us. I have read some of the very personal letters that have been sent to us, and I want to thank them all, regardless of whether they were in support of the Bill or against it.
I want to thank the MP for Spen Valley, Kim Leadbeater, for introducing this Bill, and thank the Members of the other place who worked on the committee. I see one of them stood here in the Chamber: my good friend Tom Gordon, the MP for Harrogate and Knaresborough.
For me, the concept of choice is always important, and I speak in favour of this legislation because it is fundamentally about choice and compassion. This Bill is not about compelling anyone to act against their conscience; it is about giving individuals and families the ability to decide how they spend their final days, whether they have faith or no faith. Let us be clear: today we have heard speakers who are in principle against people being assisted to take their own life, but that discussion has been held previously. People already have that choice, which is simply exercised by leaving this nation and going to places like Switzerland. It is therefore time that we in your Lordships’ House moved on to see how we can assist those who want to exercise that choice to do so in our nation, rather than limiting it to those who can afford to travel abroad.
Let me be clear: I would not personally choose assisted dying, and nor would any member of my family. Our faith teaches us to endure life until its natural end, and we respect that. But my personal decision or that of my family should not mean that others who hold different beliefs and make different choices are denied the ability to act according to their own conscience.
As a society, we already grant a great deal of choice in how we treat a person after death. Families decide whether to bury or cremate. In some faiths, including my own, and for our Jewish friends, there is a duty to bury as soon as possible. Others may take more time; some choose a more natural, environmentally friendly option; some choose to share a grave with a loved one. In each case, the law allows space for those decisions to reflect conscience, culture and personal beliefs. If we grant such choice after death, why do we withhold choice in the last days of life? Why do we say to those suffering unbearably that they must endure their final hours in a way they would not choose, even when the medical profession can provide safe and compassionate assistance? The Bill does not compel anyone to end their life; it does not diminish the sanctity of life; it simply allows those who, after careful consideration and with proper safeguards, wish to have control over dying, and to do so with dignity and without the fear of criminalisation.
I will follow the passage of the Bill carefully and remain open-minded to amendments at later stages if they genuinely enhance its intentions. At its heart, this is a question of individual freedom. A central pillar of liberalism is the freedom to choose for oneself, provided it does no harm to others. Laws should not enforce needless pain but should offer dignity, compassion and, above all, choice. If we honour freedom in life, we must honour it at life’s end.
Lord Harries of Pentregarth (CB)
My Lords, if we pass this Bill, we choose to go down a particular road. Before we do that, we ought to ask where the road leads and whether there are any stopping places on the way. First, I much respect those who have long campaigned for this Bill. Their position rests on two convictions that I share: the importance of free choice, and a desire to relieve human suffering. However, I ask supporters of the Bill to think about those who experience unbearable suffering but who have many years to live.
In 2008, 23 year-old Daniel James went to Switzerland with Dignitas. As a 16 year-old he played rugby for England, but, paralysed from the waist down as a result of an injury, he could not bear the thought of a whole life in that situation. The hearts of all of us go out to people in that position. It is of course difficult to weigh the intensity of one person’s suffering against another, but we can measure time. Is not the thought of having 60 years of hopelessness ahead worse than six months of pain? In the course of my life, I have met many people suffering from acute schizophrenia and multipolar disorder who time and again have tried to kill themselves. Even when they are in a good period, they have said that they would rather be dead than have to go through the cycle of their illness again. One has to ask whether it is worse to have six months to live, or a lifetime of mental anguish.
It seems to me clear that, if the desire is to relieve people of unbearable suffering and they have the right to choose whether they live or die, the logic of the argument—if you like, the argument of compassion—is absolutely inescapable: that a Bill more along the lines of the one in Canada or the Netherlands is the only one that will do what is needed. If this Bill goes through, there will be inevitable pressure to amend it to include unbearable suffering of many kinds, physical and mental, not perhaps in the next year or two but certainly within a few years. It is inevitable because the logic of compassion is even more strongly in favour of such a Bill than it is in favour of the present one.
Therefore, I ask the supporters of this Bill to think about whether they really want a situation such as in Canada and the Netherlands, where it is possible to be assisted in dying for a whole range of causes, mental as well as physical. I am not arguing for or against a Bill like that; I am just asking whether supporters of the present Bill regard that as desirable. In 20 years’ time, the proportion of elderly in the population will be much higher. Millions will be suffering from dementia, and it is difficult to believe that the resources to care for them, already badly stretched, will be adequate. There is a kind of nightmare scenario of assisted dying becoming the default option.
The noble and learned Lord, Lord Falconer, pointed out that the law in Oregon on assisted dying for the terminally ill has lasted now for 25 years or so and has not been changed to a law like the one in Canada or the Netherlands. That is a good and absolutely fair point, and I totally accept it, in principle. But my argument is that the argument from compassion based upon free choice and the desire to relieve suffering is even stronger in a Canada-type Bill than it is in this one, and therefore there will be inevitable pressure. This morning, as I was sitting at the bus stop waiting to get on, a lady asked me what I was doing and I told her that I was coming to do this. She immediately said to me, “But what about those people who are suffering from incurable conditions and have years to live?” It is safer not to go down this road at all.
Lord Herbert of South Downs (Con)
My Lords, earlier this week, this House earnestly discussed in Oral Questions how to reduce suicides. Suicide has not been a crime for over six decades, but we still think that it is wrong and we still try to prevent it—until today. Today, we consider crossing the Rubicon. We debate not how to prevent suicide but how to facilitate it with the support and resources of the state.
We are told that the purpose of the Bill is to prevent terrible suffering, but there is nothing in the Bill that says this. The essential condition is that someone must be terminally ill, not that they are suffering. We are told that there are safeguards. In the House of Commons, the Bill’s proponents relied on what we were told was an internationally unique safeguard, the authority of a High Court judge. Then that unique but inconvenient safeguard was dropped. We are told that only the terminally ill will be permitted to be helped to end their lives, but if you believe that personal autonomy, the right to choose death, is the overarching principle, why should the law logically stop at the terminally ill? What about the terminally miserable? Why should it not be their right, or anyone’s right, to be helped to die?
I am afraid we already know how the elderly are too often regarded in our society as a burden or a nuisance. We are less inclined than other cultures to care for our elderly in our own homes and more inclined to place them in care—“They’ll be happier there”; “They’ll be better off there”. In these daily acts of purported compassion is betrayed how some will deal with the unwanted elderly if they can. It is not hard to see how, with just a small slip down the slope, the elderly will be dispatched. Of course, it will be “their choice”, as they will not want to “get in the way” or be a “burden”. When the vulnerable are encouraged towards the view that it is better for them to die, the Orwellian-named assisted dying service will be there to step in.
The stories we have heard about the suffering of the terminally ill are heart-rending and we cannot fail to be moved by them, but that is surely a reason to invest more in palliative care, not to commit resources to assisting suicide, and we cannot responsibly legislate simply because we are moved. In truth, we cannot legislate away suffering. No so-called safeguard will persuade me that this Bill is safe or right. Indeed, the very need for safeguards—for instance, against coercion—should warn us of the profound danger to which we are about to expose the elderly and the vulnerable. I cannot support this Bill, and I fear for the consequence if it passes.
Baroness Keeley (Lab)
My Lords, I declare an interest: my brother is a consultant in palliative care. Today, I want to speak in defence of palliative care and hospice support for people with terminal illnesses. It is deeply troubling that this Bill and the debate surrounding it, certainly before today, have given so little consideration to palliative care.
I oppose assisted suicide in principle and I oppose this Bill. It is poorly constructed and it was rushed through the Commons with inadequate scrutiny, with many amendments not debated. Crucially, it does not even require that those requesting assisted suicide are offered a palliative care assessment first, yet specialists tell us that palliative care can help people who wish to die to rediscover reasons to live. At a recent Lords briefing, palliative care practitioner Dr Lucy Thomas shared the story of a patient who had considered Dignitas but changed their mind after receiving hospice care. Within days of starting that care, they felt valued rather than abandoned.
Sadly, too many terminally ill people feel abandoned by the NHS due to the lack of palliative care. Sarah-Jayne Blakemore wrote movingly in the Times about her father, the neuroscientist Sir Colin Blakemore, and the palliative care he received. Diagnosed with motor neurone disease, he had planned to go to the Netherlands for euthanasia. He never did that, as at each stage of his illness he was supported by his family and paid carers to cope and to find enjoyment in life. When his wife died, he struggled with depression and feared losing control, a fear echoed in the debates on this Bill. But after a hospice doctor explained his palliative care options, his daughter says he became optimistic and hopeful again. He went to stay at the hospice after developing a chest infection. His daughter describes how, for the last 10 days of his life, he received
“the most gentle and attentive care from people who had dedicated their lives to end-of-life care”.
She acknowledges that her father was lucky to live near a hospice
“that enabled him to have a peaceful and dignified death”.
Ahead of this debate today, we have been privileged to have briefings from leading palliative care experts including Professors Mark Taubert, Katherine Sleeman and Fliss Murtagh. Those clinicians, with decades of experience, tell us that almost all patients offered high-quality palliative care benefit from it, but it is often too little and too late, or indeed not offered at all. We do not provide enough care and support for people with life-limiting illnesses or for their families. Over 100,000 people die each year with unmet palliative care needs. Indeed, a Marie Curie survey found that in only half of expected deaths did families feel that their loved ones received adequate support with health and care in their final three months. We should have invested in palliative care so that more people can benefit as Sir Colin Blakemore did. It is unethical to leave the needs of 100,000 dying people unmet. We must consider those who do not and would not choose assisted suicide and ensure that they are offered palliative care first.
I pay tribute to my colleague Florence Eshalomi MP, who tabled an amendment in the Commons to ensure that no care home or hospice should be obliged to provide assisted dying. Hospices exist to offer comfort, dignity and holistic support, not to facilitate premature death. Introducing assisted dying into hospices risks undermining their purpose and deterring those who seek life-affirming care. Hospices are places of hope and compassion; they should not be asked to become sites of medicalised death. We must protect the integrity of our care institutions. We must safeguard the vulnerable and uphold the rights of those who dedicate their lives to end-of-life care. This Bill is not the solution. We should start with investment in palliative care to make it available to all who need it, including care at home.
Lord Blencathra (Con)
My Lords, I am not opposed to assisted dying in principle but I am opposed to this appallingly drafted Bill, which is a travesty of a Private Member’s Bill. It is a massive 51 pages, with 59 clauses and three schedules, and is one of the largest so-called Private Members’ Bills ever introduced in Parliament. It is larger and more controversial than many government Bills, and should have proper scrutiny. Since we need proper government Bills to make laws on prison sentences, penalties for killing with knives or dangerous driving, serious drugs et cetera, it is wrong to pass a law on how people should die through the Private Member’s Bill procedure.
The Delegated Powers Committee has issued a scathing report on the excessive 38 delegated powers, including all the Henry VIII powers, and that report alone should be enough to condemn this Bill to the scrap heap. Then yesterday, the Constitution Committee criticised it. If this Bill passes, it will not be MPs and we Peers writing the law on how we die but civil servants in the Department of Health writing up all those 38 delegated powers. Quite simply, I do not trust the Department of Health to write one word on the implementation details. The department has so far failed to implement single-sex wards for women and it failed for many years to take action on the discredited Liverpool care pathway, where 3% of patients being expedited to death actually recovered. A department that apparently cannot tell the difference between men and women is not fit to write guidance on legislation on when people should die and the drugs used to kill them.
Every year, 550,000 people die of terminal illness in the UK. From my 42 years in Parliament, I am convinced that it is impossible for Parliament to draft a general law—even with thousands of pages of regulations—which can cover every possible individual circumstance relating to those 550,000 people. We as parliamentarians have to realise and accept our limitations. I can draft a foolproof law for myself but not for any of your Lordships’ situations, nor for half a million others. The variables are simply too great. There are numerous cases of people diagnosed with terminal cancer making a full recovery and living five to 20 years longer than expected, proving correct the famous Sir William Osler, the father of modern medicine, who said:
“Medicine is a science of uncertainty and an art of probability”.
Prognostic uncertainty is one reason why the Royal College of Physicians does not support the Bill.
This Bill will give lawyers the ultimate power to make the final decisions, not the doctors. We have all seen firms of lawyers pursuing fraudulent medical negligence cases in respect of our soldiers who fought bravely in Afghanistan and Northern Ireland, and corrupt immigration lawyers running fake cases. Almost every clause in this Bill can be used by lawyers on all sides of an assisted dying application to take the case to court, and all those regulations will be a judicial review paradise for lawyers. I will trust my doctor to do what is in my best interest on my deathbed on the basis of the medical mantra, “First, do no harm”. I will be damned if I let any lawyers decide how I die.
In 2016, I tried to help pass the Medical Innovation Act, also known as the Lord Saatchi Act, which aimed to promote innovation in medical treatments in England for terminally ill patients. I recall at the time that most doctors were in favour of it, but the lawyers were opposed since it would remove their ability to sue if the treatments did not work. My perception is that most doctors have serious concerns about this Bill, but most lawyers are in favour. I do not want lawyers to come within a million miles of decisions about how people should die.
We need to start again, possibly with a royal commission led by doctors who will set out the principles and all the safeguards required. Then, there needs to be proper public scrutiny on a draft Bill that a joint parliamentary committee can consider. Finally, we need a proper government Bill and to see drafts of all the regulations that will be made. We cannot buy a “pig in a poke”, which this Bill is, and hope that the regulations will be just all right on the night.
Lord Kakkar (CB)
My Lords, I thank the noble and learned Lord, Lord Falconer of Thoroton, for having introduced this Bill in your Lordships’ House, and I thank many noble Lords for their thoughtful and deeply insightful contributions to this debate, which have helped inform, in effect, the crux of the matter; that is, that this is a very complex and serious issue that will ultimately change the relationship between the citizen and the state, and indeed between patients and their doctors. However, it has also highlighted the important principle that, as a matter of course, we offer our fellow citizens rights as long as those rights do not result in harm to other citizens. Therefore, it is appropriate that, at this moment in time, we consider the question of whether citizens should be given the right, when terminally ill, to consider when and how their lives are ended. In doing so, however, we need to be deeply sensitive to the many residual anxieties that still exist and the many issues that have been raised that attend this Bill in its current form.
The principal consideration here is whether in introducing a right for the individual, the Bill inadvertently creates the opportunity for harm to other individuals, and whether sufficient steps have been taken to protect against those potential harms. There are a series of other issues as well. There is precedent, though, that when Bills of this nature have arrived in your Lordships’ House—the nature being Bills that have a profound societal impact—the Government of the day have made additional time available. Two examples are the Murder (Abolition of Death Penalty) Act 1965 and the Abortion Act 1967. So, at the very least, it is essential for His Majesty’s Government to ensure that time is made available for appropriate scrutiny.
That appropriate scrutiny must consider a series of issues, many of which have been raised in this debate already. One that has been raised with me by many colleagues in active practice is that they are, in principle, strongly in favour of the provisions of the Bill, but in practice, they are very concerned about how it might be applied in the NHS, in particular about how it might end up being used in a substantially protocolised fashion, where the thoughtful and insightful application of its provisions to the individual is lost in the way that so much care is now organised in the NHS. This is something that we will need to explore.
The other point that has been exceedingly well made is on the implications and the message sent by passing a Bill that makes provision for the state to pay for an assisted dying service in its entirety, while not fully funding the provision of palliative care. What are the implications, and what message does that send? What might be the inadvertent consequences of pursuing that approach? This is another matter that will need to be considered very carefully in Committee.
If this Bill is to pass, it must do so enjoying the maximum amount of confidence possible, having provided the appropriate safeguards; to pass it in any other way will regrettably result in serious adverse consequences.
Lord McColl of Dulwich (Con)
My Lords, I have attended and spoken at most of the debates on euthanasia over the last 35 years, and one feature that has always struck me is that they have been full of anecdotes. Perhaps we ought to consider that the Greek word “anecdote” means “unpublished”, which is arguably what most anecdotes should remain.
I will avoid anecdotes and stick to my practice over the last 50 years, looking after people who are dying. Perhaps I can best illustrate that by referring to a lady aged 28 who came in with an inoperable cancer of her throat. She was in pain and in great respiratory distress, and I said to her to that I could relieve all her symptoms with an intravenous injection of an analgesic. I said to her, “Would you like me to do that?”. She said yes. I put a needle into her vein and started to titrate her, as it were, with a very powerful drug, and I was amazed at how much I had to inject. Eventually, all her symptoms went. She died three weeks later, having had three weeks symptom-free.
Cicely Saunders, with whom I was a contemporary at Guy’s and St Thomas’ Hospital, was the founder of the hospice movement. She devised this technique of keeping the level of analgesia in the blood at a constant level. She found that it was best to prevent pain rather than wait until it had come. That worked, and the patient was much more wide awake and could enjoy what life remained with this technique.
One of the worrying features of this whole subject is that many of those who are keen on euthanasia have taken it into their heads to rubbish the hospice movement and spread rumours that it does not know how to relieve pain. This is a lie. I have worked in hospices for all these years, and that is not the case. They say, “Oh, well, we weren’t allowed to give more analgesia because of the law”. There is no law that prevents that. You can give as much as is needed. That is what Cicely Saunders promoted and did so very well.
We hear a lot about freedom, that people must have freedom. A man came into a hospice, and he had multiple myeloma, so it was infecting his bone marrow and releasing large quantities of calcium. Too much calcium in the blood means the heart stops beating. He said, “No no, I want euthanasia”. They said, “Look, you are having a drug that keeps your calcium down to stop you dying. If you want to die, all you have to do is stop taking the drug”. He never stopped taking the drug until the day he died—so much for freedom.
Baroness Noakes (Con)
My Lords, I support the Bill. Much has changed in the many years that your Lordships’ House has been debating assisted dying for the terminally ill, but public support for it has been constant. The British Social Attitudes survey has found around 80% in favour and 20% against consistently for the past 30 years. Your Lordships’ House should certainly not be a slavish follower of public opinion, but noble Lords should at least hesitate before saying that this House knows better than the pretty settled view of the vast majority of the public, especially now that the other place is aligned.
I support the Bill because it respects personal choice and autonomy. However good medical care may be, it is a fact that it does not always cope with the physical and mental suffering associated with terminal illness. Terminally ill people have choices at present beyond accepting the medical treatment on offer. They can choose to refuse medical treatment, they can choose to refuse hydration and nutrition, and they can also commit suicide, but these are rotten choices usually associated with an unpleasant death. This Bill gives another choice to people facing certain death: the possibility, or indeed the likelihood, of a peaceful death.
I completely accept that there are dangers for those who are unable to make rational choices or who are pressured to make choices that they do not want to make. That is why the Bill is so complicated. The Bill goes out of its way to try to ensure that choice is genuine. I am sure that we will debate in Committee whether further safeguards are needed, but I hope that noble Lords will accept that there will never be a way of eliminating all risks without in practice denying choice to those for whom the Bill is designed. That is why I think that, in many ways, the most important parts of the Bill are those relating to the commissioner and to monitoring and review of the Act. If problems emerge, they will be reported, and they can be acted on. That is an important safeguard in the Bill.
Lastly, while I respect the Delegated Powers and Regulatory Reform Committee, in this instance, it has gone a little bit too far. Secondary legislation and Henry VIII clauses are not the devil incarnate; they are often the most effective ways of getting the details right on a sustainable basis to deal with how things evolve over time. I hope that our approach to delegated powers and indeed to the whole of the Bill as it moves through the remaining stages will be pragmatic, and that we will not let the best become the enemy of the good.
Lord Morrow (DUP)
My Lords, on Wednesday we marked World Suicide Prevention Day. This year, the theme was “changing the narrative on suicide”, and we were reminded how simply being willing to open a conversation with a person in crisis can interrupt suicidal thoughts and renew hope.
It is with tragic irony that just two days later, we are debating legislation that would indeed change the narrative on suicide, but in exactly the opposite way than intended. In fact, experts have warned that this legislation
“may reduce societal taboos against suicide in a way that conflicts with campaigns aimed at suicide prevention”.
Since assisted suicide was introduced in Victoria, Australia, assisted suicides have increased by some 50% among older people. Similar patterns have been observed elsewhere.
I am conscious that the Bill’s supporters feel uncomfortable with the language of “assisted suicide”, but we cannot shy away from the facts of the Bill itself. Clause 32 amends the Suicide Act 1961 to avoid doctors being prosecuted for providing lethal drugs for patients, an act that would otherwise clearly be categorised as, in the words of the statute,
“capable of encouraging or assisting the suicide or attempted suicide of another person”.
The argument is made, rather callously in my view, that terminally ill people are dying anyway, but why should the importance of suicide prevention disappear just because someone is terminally ill? In truth, I would go further and say that this time of vulnerability is precisely the time when the protections afforded by the Suicide Act are most needed.
As the Royal College of Psychiatrists explains:
“Mental disorders, such as depression, are more common in people nearing the end of their life”,
and,
“Anxiety can amplify fears of future suffering”.
The tragedy is that, under the Bill, a person’s wish to die could be endorsed before that person can see the benefits of psychiatric or psychological treatment. Evidence suggests that suicidality in chronic disease often peaks at 90 days, but the assisted suicide process could take less than a third of that time.
The requirement in Clause 12 for psychiatric referral if there is any doubt as to the patient’s capacity does not resolve the problem. Many people may reach the low threshold of capacity set out in the Mental Capacity Act but still have their thinking obscured by poor mental health or other disabilities. For this reason, the Royal College of Physicians and the Royal College of Psychiatrists have made clear:
“Vulnerable patients, particularly those with remediable mental health or other unmet needs, are not adequately protected by the current Bill”.
Human rights lawyer Tom Cross KC goes further, warning that the Bill as drafted,
“unjustifiably discriminates against those persons whose disabilities manifest in the expression of suicidal ideation”,
and so breaches Article 14 of the European Convention on Human Rights.
To finish, it is unconscionable to me that a doctor might be seeking to persuade a suicidal terminally ill patient of the value of life one week, only to effectively abandon suicide prevention and endorse despair once he considers they have only six months to live. The law should not send the message that some lives are not worth living. For that reason, I will be opposing the Bill.
Lord Swire (Con)
My Lords, I start, as others have, by thanking all those who have taken the trouble to write to me, raising some very personal stories, some very tragic. I have no personal stories myself, but I am very moved by those who have. It is one of the few debates in which I wish I was speaking much later on so I could sit and listen, as I seem to change my mind with every speaker and their own personal experience.
Here, we have a piece of legislation which raises profound ethical and moral issues. We therefore owe it to ourselves and the country to spend as much time on a deep dive into many of the issues they raise. It is the duty of this House to do that. I do not agree with what the noble Baroness, Lady Hodge, said, that in some way the Commons being elected means they have more rights than we do. We have absolutely every right to amend the Bill or send it back if we are not happy with what is in it.
The Bill, as currently construed, leaves me with an overriding nervousness. What happens next if we pass this legislation? The noble and learned Lord is reassuring on the matter of primary legislation being required were this to be amended in any way in the future. But the noble Baroness, Lady Murphy, is honest enough in saying that she would be seeking immediately an extension of eligibility. You can quite envisage how, in a few years’ time, people will say, “Things have changed and medical things have changed. Shouldn’t it be 12 months, and shouldn’t there be others who can come into this category? Shouldn’t we extend the category, as they have done in Cananda?”, with all the profound problems that have arisen in that part of the world. I am nervous about that.
I have a deep unease that we are going to be asking part of the NHS staff, full of dedicated people, who are working there, on the whole, because they wish to preserve and enhance life. We are hypothecating part of it to create a category of workers within the NHS who will be dedicated to ending life. That leaves me with a sense of profound unease. Surely, we should be spending more time, effort and money on palliative care, end-of-life care and social care. That should be where we are concentrating all our efforts and energies.
We have heard very little about the amazing advances that there are in treatment on an almost daily basis. What is inoperable or life-threatening today very often is curable tomorrow, or life can be extended tomorrow. I think we should be a little bit more positive about the ability for people to recover from illnesses which now, frankly, they would die from.
I am worried about the asymmetry of this legislation—that we will have different regulations, perhaps, in different parts of the United Kingdom. I am concerned by the report of the Delegated Powers and Regulatory Reform Committee, which expressed its concern that so much of the Bill is being left to delegated legislation. I am concerned that the Select Committee on the Constitution is concerned about the lack of pre-legislative scrutiny, saying that
“deliberation, assessment and scrutiny is … significantly less than we would expect”
from a government Bill, which is why I completely support my noble friend Lord Forsyth of Drumlean’s amendment, because that makes complete sense.
I have not made my mind up finally and shall not do so until I have heard all the arguments at the end, but currently, if the vote were today, I would not be in a position to support the Bill.
Lord Barber of Ainsdale (Lab)
My Lords, I have been asked by my long-standing friend and TUC colleague, my noble friend Lord Monks, of Blackley, to contribute to this debate. My noble friend Lord Monks is unable to be present today due to family reasons, and what follow are his remarks, which I am pleased to bring to your Lordships’ attention.
“Some of you will be familiar with Daniel’s story. Daniel, our son, died just over a year ago. His story was featured in an ITV documentary titled ‘A Time to Die’ and in an article in the House magazine. Daniel was 48 years old, a music teacher and a popular live-wire presence in many situations. When he was 26, he was diagnosed with MS, almost certainly primary progressive MS, which by early 2024 had wiped out all his movements except for speech. My wife and I had looked after him since 2016. In 2023, an attack of pneumonia left him unable to move any limb and a concurrent attack of Crohn’s disease caused a blockage in his bowels. He was then placed in palliative care.
Daniel always maintained a cheerful and positive outlook on life despite his enormous disabilities, enduring his suffering with good temper and consideration for others. He did not suffer from depression, but he did decide that he had had enough; he wanted to die.
He had registered with Dignitas in 2022, and had explored the Dutch system of assisted dying, as he had a Dutch passport. Neither option worked for him. So, he did the only thing he could in the absence of any UK system for assisted dying: he starved himself to death by not taking anything by mouth, and a week later died in St Christopher’s Hospice in south London—who, by the way, were marvellous.
So ends Daniel’s story. But I ask those of you who are opposed to assisted dying to face the same choices Daniel and our family faced. Would you have helped him? Would you have put obstacles in his way, or would you have helped to smooth his passing?
This Bill, unfortunately, does not cover Daniel’s type of illness. In my view, that is its major weakness. Nevertheless, in due course, I shall vote for it. It may not ease the end of life for those suffering from neurological illnesses, but it will help many more if Parliament has the guts to give them a choice. And please, my Lords, do not make exercising that choice a hugely bureaucratic Grand National course that is very difficult to navigate. Put the emphasis where it should be—trust people to make the right choice for them. Please pass this Bill when the crucial vote comes”.
I will now speak very briefly for myself. Daniel was a talented, impressive, lovely man, and his loss is still deeply felt by a lot of people. I recognise that there are concerns among some colleagues about whether the safeguards currently built into the Bill leave uncertainties in some minds about possible unintended consequences—issues which we will be debating thoroughly in the Bill’s detailed scrutiny to come. But what is absolutely certain is that, if the Bill is not passed, countless people will continue to suffer painful, horrific, undignified deaths—suffering from which they could be relieved if the Bill passes. That is why, like my noble friend Lord Monks, I strongly support the Bill.
Lord Bridges of Headley (Con)
My Lords, I am opposed in principle to this Bill for a myriad of reasons, very well articulated by my noble friends Lady May and Lord Ahmad.
We have heard—we heard just now—other noble Lords whose principles and experiences, often heart-rending, lead them to support the Bill. I very much respect their views and their position. But I say to those who disagree with me and other noble Lords on matters of principle, and those who support the Bill, I am sure we can all agree on one point. It is simple and obvious, but it merits saying. On legislation on an issue as sensitive as this, we cannot and must not rush ourselves; quite the reverse. On this subject, almost more than any other—indeed, more than any other—it is imperative that we set a very high bar in terms of the scrutiny we give the Bill, which is why I support so wholeheartedly what my noble friend Lord Forsyth has put in his amendment to the Motion. If the Bill is to pass into law, that law must not just be merely workable and practical; it must be a law which commands people’s trust and which ensures that those who implement its measures can be held to account.
Although I hear the heartfelt points being made today, I do not think that the Bill in its current state meets the exacting standards we should demand of it. Day after day, like I am sure many other noble Lords, I have been receiving emails and letters raising specific points of concern about numerous aspects of it: the eligibility criteria; the definition of terminal illness; the suitability of relying on the Mental Capacity Act; the role of doctors; the safeguards to ensure that vulnerable people are not coerced into making decisions; and the impact on NHS resources and on palliative care. The list goes on and on—the noble Baroness, Lady Grey-Thompson, cited many others. These concerns are coming from experts and members of the public, and they cannot and must not be brushed aside.
Added to these concerns is another that, I think, unites many of us on all sides of the House, and that is the use of delegated powers. We often bemoan how Governments—and I include those I have been part of—have produced Bills that give Ministers powers to make regulations which receive minimal parliamentary approval. On any issue, chipping away at Parliament’s ability to hold Ministers properly to account is bad enough, but on this issue that is literally related to life and death, it is, in my mind, unacceptable.
The Delegated Powers Committee quite rightly calls several clauses “highly inappropriate”. Let us remind ourselves: it said the clauses give
“sweeping, unspecified and unjustified powers to the Government while removing Parliament’s scrutiny role for provision that should be in primary legislation, and replacing it with the considerably more limited role of scrutinising delegated legislation”.
I was delighted to hear the noble and learned Lord, Lord Falconer, suggest that he will address this, but I am not surprised by it. Just last year, he gave a lecture in which he bewailed
“primary legislation giving huge power to ministers and other bodies which would previously have required either primary or secondary legislation”,
citing, for example skeleton legislation, Henry VIII powers, legislative sub-delegation of powers and disguised legislation. He concluded by saying—and I end on this point—that if legislation offends in one of these four ways, it is unconstitutional. Well, this is another reason why this Bill is flawed, why it needs a complete overhaul, and why it is laced with ambiguity, riddled with unanswered questions and breeding anxiety among so many people.
Baroness O'Loan (CB)
My Lords, I declare an interest as a trustee of St John’s Hospice.
This is one of the most important Bills we will ever see. For centuries, we have protected and preserved life, which is to me, and to so many, sacred. We are now asked to change utterly and create a way to help people die. The opposition is massive, particularly among medical practitioners and their professional associations. This is a profoundly dangerous and flawed Bill. The Constitution Committee rightly affirms our right to scrutinise, amend or reject it.
The noble Lord, Lord Alton, was to speak today. He was seriously injured last week and he cannot travel. He is not permitted to speak remotely. Had he been here, he would have warned against coercion, inadequate safeguards, inevitable incrementalism and the risk posed to human rights—very important issues.
Is this Bill clear? The consequences are not known. There was no pre-legislative consultation and no proper impact assessment. The committee was selected by the Bill’s promoter. The witnesses selected largely supported the Bill. The evidence secured did not reflect a wide evidence base. Most amendments tabled on Report were not debated or voted on. Many MPs who wanted to speak were not called. The Constitution Committee said yesterday:
“The degree of deliberation, assessment and scrutiny is therefore significantly less than we would expect to see for an equivalent government bill. This is especially concerning given the subject matter of the bill”.
The Bill is a framework for assisted death, nothing more. There are 42 delegated legislative powers, including Henry VIII powers—powers which the DPRRC described as “sweeping, unspecified and unjustified”. Eligibility is very uncertain. What is a reasonably expected death? The definition of terminal illness is unclear: 36% of such diagnoses are recorded after death to be inaccurate; only 48% of prognoses are accurate at six months; and one in two prognoses will be wrong.
Is it safe? Capacity is to be assumed under the Mental Health Act. The assessment process involves two doctors, only one of whom must meet the patient. How will they determine capacity, especially in those suffering from shock, grief and depressive illness after diagnosis? How will it be assessed and monitored? Deaths may take place in hospices. Hospices have said that the Bill is not safe. In care homes, how could it be safe? In people’s homes, are doctors going to be able to manage their practices if they have to stay until the patient is dead—for up to 137 hours? What if someone does not die? It does happen.
Nobody has to check why someone wants to die. Coercion? Someone who feels they are a burden on others, or is lonely or isolated. And how will we keep our doctors and other clinicians safe? Clinicians are being asked to forget, “First do no harm”, and to provide medication to terminate a patient’s life. Many will not do it. What will be the effect of this on our doctors? Suicide rates are already higher among doctors than generally. According to the BMJ, a doctor dies by suicide every 10 days. How will we care for our doctors and keep them in practice? There is a shortage of obstetricians and gynaecologists because of the processes around abortion. The president of the Royal College of Radiologists recently said that there is
“a chronic lack of radiologists and oncologists … the outlook is bleak”.
What will be the effects of the introduction of assisted death in this situation?
Finally, is it accountable? If only 1% of people seek assisted death, that will be nearly 6,000 a year. How will the VAD commissioner find the psychiatrists, lawyers and social workers to constitute panels for 6,000 applications a year at a time when all three professions are understaffed? At only one hour a case, it would take 18,000 panel member hours a year—and, internationally, the rate is much higher than 1%.
The Bill provides little protection and no security around how death comes about. There will be no inquests. Nobody will ask about coercion, abandonment or anything else. Around 50% of those who die cannot get specialist palliative care. Why do we fund 100% of services at the beginning of life but only 30% at the end? Dame Cicely Saunders said:
“You don’t have to kill the patient in order to kill the pain”.
This Bill is ill-conceived, uncertain and unsafe. It should be rejected.
Lord Polak (Con)
My Lords, on 6 May 2006, just prior to the Bill to legitimise assisted dying coming before Parliament, the late Chief Rabbi, Lord Sacks, published an op-ed entitled, The Jewish Tradition is Firmly Opposed to Assisted Dying. I quote its final paragraph:
“Those who propose the current Bill do so from the highest of motives. But purity of motive has never ensured rightness of outcomes; often it has been the reverse. To give the dying dignity, using all possible means to treat their pain is one thing. To allow medically assisted suicide is another. If we lose our reverence for human life we will one day lose much else besides”.
Today, the words of Lord Sacks should once again ring loudly and clearly—as loudly and clearly as they did in 2006.
I have no desire to diminish the heartfelt convictions of anyone here in this Chamber or anyone who has written so movingly, but I speak out of a deep and abiding concern for the society we are shaping, for the values we hold and for the vulnerable, whom we are duty-bound to protect—and I speak as someone who was given six months to live 37 years ago.
The assisted dying Bill before us carries risk that we cannot and must not ignore. The debate is not about compassion: all of us want to alleviate suffering. It is about the means by which we do so. It is about the kind of society we want to be and the message we send when the law itself offers death as a solution. I fear that the Bill crosses that moral Rubicon. However it is regulated or framed, once the state endorses the intentional ending of life, we embark on a journey whose destination is uncertain and deeply troubling.
We are told that safeguards will be in place, but what starts with those deemed mentally competent and terminally ill so easily extends, gradually and quietly, to others. Look at the jurisdictions where such laws have been passed: criteria loosen and the line that was once thought so firm fades. What message do we send to the elderly, the disabled and the chronically ill when the law declares that their lives are potentially not worth living? Will they not begin to feel a quiet obligation to relieve their families, to save resources and to cease being a burden? That is not compassion—it is quiet cruelty masked as choice. Rather than offering death, let us commit to better palliative care. Let us train, fund and support hospices and home care so that no one is forced to consider death out of fear, loneliness or despair.
Lord Sacks said:
“Life is sacred. It is God’s gift, not ours. It is the physician’s responsibility to heal, not harm”.
Jewish law, halacha, teaches that every moment of life, even in suffering, has meaning and value. Every breath is a blessing. We are not absolute owners of our lives; we are the guardians. Ending a life at someone’s request is considered to be taking what ultimately belongs to God. We all recognise the terrible fear of degenerative illness, the dread of indignity, the anxiety of being a burden. But enshrining this Bill in law risks turning the immeasurable sanctity of life—kedushat ha-hayyim—into something to be weighed, measured and judged.
Lord Sacks reminded us that life is not ours to end. I urge your Lordships to consider the long-term consequences of this Bill not just for the individuals but for the moral fibre of society. In that moment of suffering, do we offer death or do we offer care? I choose care.
Lord Campbell-Savours (Lab) [V]
My Lords, I do not intend, in a brief intervention, to argue the case for the Bill. I support the principles behind the Bill as set out; however, I do harbour some reservations as to the process of implementation. I want to concentrate my remarks on that process and in particular the Bill’s handling in this House and—hopefully in an amended form—on its return to the Commons.
After 43 years in Westminster, I have learned a simple lesson: legislate in haste and repent at leisure—there are too many precedents. I am worried that if we pass the legislation in a single session, in the period of implementation it will be subject to repeated attack as unforeseen problems arise. So I propose that we proceed on the following basis. The legislation should be the subject of annual renewal over a period of three years. There are a number of precedents in primary legislation for defined period renewal. For those who follow proceedings outside the House, they may well wish to look at the precedents. The Northern Ireland Act 1974 provided for annual orders on direct rule from Westminster. Section 17 of the Prevention of Terrorism (Temporary Provisions) Act 1976 provided for annual renewal powers, as did Section 13 of the Prevention of Terrorism Act 2005.
Then we have the provisions under the Imprisonment (Temporary Provisions) Act 1980. We also have Section 98 of the Coronavirus Act 2020, which required that the temporary, now devolved, provisions be voted on in Parliament every six months. I understand that attempts were made during passage of the Fixed-term Parliaments Act 2011 to introduce annual renewal, which the House later rejected. So the precedent is there.
Prior to annual renewal, dependent on how the renewal notice was drafted, the Government could introduce amendments to deal with problems identified during implementation of the legislation. On each occasion, Parliament could, if subject to statutory instrument approval, kill the legislation if it was dissatisfied with any proposed efficiency reforms. Equally, if Ministers failed to take renewal orders, the legislation would lapse. If satisfied, however, Parliament could renew. Yes, it is a steep hurdle, but controversial legislation on this scale needs some form of consensus. We need to heed the concerns of those who will support its provisions only in conditions of minimised opportunity for abuse.
Unlike many others, I am not convinced that the annual review by the Chief Medical Officer and the five-year review by the Secretary of State provide sufficient safeguards for Parliament to have a hand in dealing with potential public concerns. I hope to be tabling an amendment in Committee dealing with my concerns. I understand that my son, who is of a similar mind, will speak to such an amendment in the Commons if the opportunity arises.
Lord Patel of Bradford (Non-Afl)
My Lords, I was somewhat hesitant to speak today, not because I do not wish to contribute but because I am currently caring for a loved one, which makes my time in this Chamber unpredictable and, at the same time, makes this Bill so much more important and personal to me. I spent much of my professional life working in the health and social care system, in mental health services and hospitals in the community, working with those who had been misusing drugs or alcohol. I have met people at their most vulnerable, often in pain, sometimes in complete despair, ready to take their lives. I have also seen the extraordinary capacity of compassionate palliative care, skilled pain management and the support of family and friends to transform a person’s final weeks or months.
My own family experience gives me reason to tread carefully. When my brother Krishna was in his late 20s, due to childhood health issues he suffered a series of strokes that were not diagnosed at the time. Over just a few months, he went from being an intelligent, charming and much-loved man to someone unable to speak, eat or care for himself. All the clinicians told us that there was no future for him; it was only a matter of time. Caring for him at home took a terrible toll on my mother, and he was eventually placed in an old people’s home in his early 30s, heavily sedated with drugs for his own good. Years later, by which time I had become a social worker and was convinced that more could be done, Krishna was moved to a specialist Leonard Cheshire home. There, without sedation, with therapy and with love and attentive care, he lived another 20 years. He enjoyed life, saw his son grow into a teenager and formed loving friendships. I sometimes wonder, had this Bill already been law, would he have been given that second chance? The prevailing medical view at the time was very clear: that there was no future for him.
By contrast, I think of my mother, who suffered her third stroke. Even then, A&E waiting times were poor, and she did not receive timely treatment. Her condition deteriorated rapidly in hospital. Consultants told me that her organs were failing and she was suffering greatly. They asked me for a “do not resuscitate” order, and I reluctantly agreed that she should be made comfortable. She was given morphine, never regained consciousness and passed away peacefully three days later. I still live with that decision today. These experiences pull me in different directions. They show me the danger of making assumptions about the quality or length of life someone may yet have. They also remind me that there are circumstances where easing someone’s suffering and allowing a natural, peaceful death is the kindest thing we can do.
In a country as rich in diversity as ours, we cannot ignore the influence of faith, culture and tradition in shaping how people view these questions. For some, life is a sacred gift from God, and only God should decide its end. For others, personal autonomy is central to human dignity. The law must tread carefully to respect both positions without eroding trust in our healthcare and legal systems.
The Bill before us seeks to set out a framework for assisted dying with safeguards, but questions remain unanswered. How can we ensure that safeguards work in practice as well as in theory? How can we guarantee that access to high-quality palliative care is a right for everyone, so that no one chooses assisted dying because they cannot get adequate support? How do we avoid unintended consequences for the most vulnerable: the elderly; those with disabilities; those struggling with mental health or addiction; and those from minority ethnic groups, which we know greatly mistrust the system, and rightly so, and for which there is clear evidence of inequality in care? These questions are not barriers to the debate; they are the debate, and we need time to debate them. That is why I approach this Bill with neither blanket opposition nor uncritical support, but with caution and a desire for evidence. We must look carefully at the experience of other jurisdictions and hear from those most affected: patients, families, and the clinicians who will be asked to make life-ending decisions.
Whatever view we hold today, this conversation will not end with this stage of the Bill. It will and should continue, and our responsibility is to ensure that it continues in a way that is informed by evidence, rooted in compassion and respectful of the dignity and value of every human life.
Baroness Smith of Newnham (LD)
I am grateful to follow the noble Lord, Lord Patel, because he has just outlined many of the issues that your Lordships’ House needs to think about in the context of this Bill.
We have heard from several noble Lords that this is a matter of choice. Suddenly, the main campaign of those advocating for the Bill is to give people choice. In particular, we have heard that it would create a sense of equality and that, at the moment, if you have the resources, you might be able to go to Dignitas to end your life in the way that you wish but, if you do not have those resources, you will have to stay in the UK and potentially die a more difficult death. Therefore, the logic of the argument goes, by passing the Bill we will create a sense of equality. But the Bill fails to do that. The safeguards in it are not adequate and the time being proposed for us to debate and scrutinise this legislation is not adequate.
I say this, in many ways, for the reasons we have already heard in the Chamber today. The noble Baroness, Lady Falkner, talked about her own medical case and the very different situations if you manage to have quick healthcare through private provision or are stuck on an NHS waiting list. There are disparities at all stages. Those very people who might be able to pay to go to Dignitas may also be the very people who can pay to have private healthcare and have their medical treatment brought forward. Those disparities inevitably exist, so we need to be very clear that just suddenly saying that we are equalising provision and opportunities may not actually make it the case.
There is a very clear sense that ideas are put forward in the Bill but not fully defined, as the noble Baroness, Lady Goldie, in particular noted. The noble Baroness, Lady Primarolo, suggested that many people have written to her and other noble Lords saying, “Please adopt the Bill as it stands. We agree with every word of it”. Really? Much of the legislation is vague and the terms are not defined; I suspect that many of the people advocating for it will not have read it line by line. The noble Lord, Lord Lamont, pointed out many of the questions that remain unanswered in the Bill. Those questions require very significant scrutiny.
As the noble Lord, Lord Bridges of Headley, pointed out, this is one of the most significant pieces of legislation that we have had pass through your Lordships’ House. The Children’s and Wellbeing and Schools Bill has 12 days in Committee. This Bill is scheduled to have four days in Committee. Would it be beyond the realms of possibility for the noble and learned Lord, Lord Falconer, to work with the usual channels to find a way to have more time devoted to the Bill? It does not need to be nine Fridays in the period between January and March; there could be creative ways of giving the Bill time so that it can be fully scrutinised, the safeguards that are required can be put in place and we can do our job of legislating, not just for ourselves and the choice that we might want, but for the most vulnerable in society. At the moment, the Bill is not fit for purpose.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I cannot support the Bill, and I am also opposed in principle to assisted dying. Those in favour have spoken today of those who face physical pain at the end of their lives having personal autonomy. That is not a view that I share, but I do believe that more needs to be done to address the state of palliative care in the UK to improve the treatment of those at the end of life.
However, of most concern to me is that the Bill poses an inherent risk to the elderly and disabled. Decisions to end life are complex and not simply procedural. They take place in the context of individual daily lives. The context of many elderly and disabled people today should raise red flags about how we are caring for them and whether they will face abuse and pressure to end their lives. It is a context where 46.6% of those who have died in Oregon have cited being a burden; and where 21.1% of those who died in 2023 in Canada whose death was reasonably foreseeable cited isolation or loneliness as a factor in their decision-making. Age UK reports that 1.4 million older people in the UK are often lonely. According to Hospice UK, 90,000 of our citizens die in poverty every year—that is 247 people daily who have faced the financial impact of a terminal illness.
It is also a context where, as Disability Rights UK has observed, the Government, sadly, do not have a good track record of protecting the vulnerable and disabled—I am talking about all Governments in the past 30 years. The Bill poses a danger to disabled people. The British Geriatrics Society says that many of its members are not confident that effective legal safeguards could be developed to protect older people from unwarranted harms. Perhaps most worryingly, research from The Other Half in June stated that we should prepare for one in seven of those being assisted to die in a single year being a recent victim of elder abuse.
This is all is especially pertinent in a nation that is rapidly ageing. In 2022, 19% of our population was aged over 65, and this is expected to rise by 27% by 2072. With several millions more elderly and sick people to be expected in the coming decades, what will be our message to them? Will it be that they are a burden on our NHS and economy and should therefore consider ending their lives before they get worse? As a House, we have a duty to protect the vulnerable. Should not our response to the elders of our nation be to reverently love and support their need? Should it not be to invest in our care services such that they do not have to suffer alone?
I am not persuaded by the apparent procedural safeguards contained in the Bill. None of them does anything to ameliorate the concerns I have raised for the elderly in particular. I will be supporting the amendments in the names of the noble Lord, Lord Carlile of Berriew, and my noble friend Lady Berger. I believe in letting us fulfil the duty of the State to protect the vulnerable and not encouraging them to die.
Baroness Morris of Bolton (Con)
My Lords, it is 19 years since I first spoke in your Lordships’ House on the hugely emotive topic of assisted dying. My view then, that however well-intentioned legislation may be, the safeguards just are not good enough, has not changed in the intervening years and debates. If anything, my concern for the vulnerable and the frightened has increased, but I also recognise that, over these years, opinions have changed, often due to distressing family experiences. I understand the strength and feeling of those here today and throughout the country who support the Bill but, as the noble Lord, Lord Carlile of Berriew, so rightly said: this Bill is not adequate.
However well intentioned, a promise made in a general election campaign, delivered through a Private Member’s Bill, with all its constraints and time limits, is not the way to fundamentally change the compact between government and the people. The report of the Constitution Committee completely captures where I stand on the Bill. A Private Member’s Bill simply cannot undergo the same scrutiny as a government Bill. As that committee says:
“This is especially concerning given the subject matter of the Bill”.
I also agree with the committee’s advocacy for parliamentary pre-legislative scrutiny. If ever there were such a need, it is for this Bill. Any legislation that so profoundly changes the norms of society should be undertaken only after seeking the widest views. That is why I do not think my noble friend Lord Forsyth’s amendment will make this a Bill fit for the statute book, however many hours we debate it. We do not need more time to listen to ourselves; we need more time to listen to the voices of others. We have a chance to do that with the amendment in the name of the noble Baroness, Lady Berger, which I will support.
To all those who have written to me, either for or against the Bill, I say a huge thank you for sharing your stories. We heard from the noble and learned Lord, Lord Falconer, the harrowing story of Tom’s death from bile duct cancer. Yet choosing when to die does not guarantee a gentle end. In 2015, I raised the issue of a handful of people who had woken up from the drugs administered—it is now nine in Oregon—none of whom asked to repeat the experience. With the drugs taken now as tablets, it is not just one tablet; you have to swallow something like 100. I thank those who have written to express their concerns around the issues of complicated grief, which haunts many relatives of those who have chosen assisted suicide and about which we hear too little.
In almost all the letters I received, there was a desire to address the fear and reality of dying in pain, which exists. As we have heard so eloquently expressed around the House, any discussion of assisted dying must go hand in hand with the provision of, and access to, the very best palliative care. If we could achieve that, we really would be fulfilling this Bill’s stated purpose of giving those who are already dying a choice over the manner of their death. But, as things stand, I wholeheartedly agree with the noble Baroness, Lady Smith, that this Bill is not fit for purpose.
Baroness Hayman (CB)
My Lords, I can beat the noble Baroness, Lady Morris of Bolton, by two years: in 2004, I was appointed a member of the Select Committee of this House investigating the Bill brought forward by the much-missed Lord Joffe. After that Bill, that committee had an extensive programme of work. It travelled—although not as far as it would have to travel today—to see all the jurisdictions where legislation is in place. We saw Dignitas, and we had many evidence sessions. Listening to the debate today, I wondered how many Members of your Lordships’ House had actually read that report and seen how these issues come up again and again.
Of course, there have been other Bills and other debates—more in this House than in the other place—and there have been many reports, most notably the Select Committee of the other place on health and social care. We have had a lot more evidence and looked at different ways of approaching it. What we have not resolved, of course, is the issue of principle that divides many people in this House.
I had a wry smile when the noble Lord, Lord Campbell-Savours, said we should not rush into this. It has been 21 years; I am getting near retirement, and I would like to see some progress made. We have to recognise that other jurisdictions have made progress and that there have been advances in palliative care, which I of course support. But I have to say to the noble Lord, Lord McColl, that, however advanced palliative care is, it does not help everybody. I am still haunted by the last conversation I had last year with someone very close to me who was dying in a London teaching hospital that had cared for him for many years, with wonderful palliative care. The last thing he said to me was, “Every night I go to sleep, I pray that I won’t wake up”.
On our visit to Oregon, one of the things that struck me most, which was new to me, was learning how many people asked for a prescription for the drugs to end their life but did not use them. It was around 40% and has been a pretty constant figure, I think, which has been replicated in other jurisdictions.
The right reverend Prelate the Bishop of London rightly said that if we change the law, it will affect more people than the 1% who have an assisted death; but that is a good thing. It would give tremendous comfort and courage to many people with terminal diseases to know that, if the worst comes to the worst, if palliative care cannot help them, there is an option they could choose to take. That would be a good and compassionate thing not just for the 1% but for many more of us.
Lord Gold (Con)
My Lords, when I spoke at Second Reading of the Assisted Dying Bill in 2021, I expressed grave concern about the “hidden persuasion” being used by family members, encouraging loved ones to take their own lives. This means that by words or conduct a patient is made to feel guilty that they continue to live, that they are a burden and expense on the family and that it would be better for everyone if they were no more. This new Bill fails effectively to address this issue. Yes, it outlaws coercion, but it does not deal at all with the issue of hidden persuasion.
In the earlier Bill, a High Court judge was required to confirm the patient’s eligibility for assisted dying. Those involved could be questioned and the process tested. The role of the judge is now to be taken by a panel comprising a “legal member”, a psychiatrist and a social worker, but the lawyer’s view could be ignored, as decisions are by majority vote. Removing proper judicial scrutiny is a most worrying development. There is no requirement in the Bill that the patient must be known to the two doctors who are required to be involved, and the patient will certainly not be known to the panel, so determining capacity and intention will be extremely difficult.
Inevitably, the patient will be in a vulnerable state. They may be distressed that their family is inconvenienced by having to visit, sometimes coming from afar. For those in a care home, there may be a concern about the substantial cost being incurred, eating into future inheritances. Nobody outside the visiting family will know what pressure has been put on patients. How can we ever be sure that there has not been abuse?
Further, the Bill expressly provides, in Clause 38, that a death by self-administration does not constitute an “unnatural death”, so there will be no inquest unless a senior coroner has reason to suspect that the deceased died an unnatural death. No guidance is offered as to what might persuade the coroner to undertake such an investigation.
I have a further major concern about the Bill: far from ending the debate about assisted dying, it is the beginning of a far bigger debate, as touched on by some noble Lords today. The replacement of judicial scrutiny by the proposed panel is a warning that safeguards risk being abandoned. We should have no doubt: if the Bill becomes law, this is the slippery slope to further change, with calls for us to introduce euthanasia, which has been the experience of other countries. Euthanasia is now accepted in Belgium, the Netherlands, Canada and the state of Oregon. In some places, patients have been euthanised for psychiatric conditions, including depression.
Indeed, the Netherlands has proposed extending the law to elderly people with completed lives. There is already pressure to extend this Bill, with some suggesting that doctors should be able to administer the drug, not simply assist, when the patient is too ill to take it themselves. Is this what we want? I certainly do not.
This Bill outlines a complicated process before a patient will be permitted to receive assistance in dying. The Bill is silent as to how this is to be done. I am concerned that none of this has been sufficiently thought through. I do not believe our present medical staff can cope with assisted death in addition to the very valuable work they now do, so something different is needed. The NHS is finding it hard enough coping with the patients who want to live, let alone those who want to die.
One possibility is that Ministers might create mobile assisted death units, making the option of choosing death far easier for vulnerable patients to accept because all the problems of the process will be managed by professionals who know the system, know what is required, provide the two doctors needed, liaise with the panel and assist patients with all the administration and form filling. Frankly, this risks a further means of subtle coercion.
I have only touched on some of the concerns I have about this Bill. It is a thoroughly bad measure and should be rejected. Nobody wants patients to suffer a painful death, but assisting an early death is not the answer. If this measure is approved and the Government have to make it work, the costs and administration involved will be colossal. It would be far better spending this money and putting our efforts into improving the palliative care we offer.
Lord McCrea of Magherafelt and Cookstown (DUP)
My Lords, we have heard a variety of opinions, and I wish to express mine on what is a vital issue: that of life and death. As a gospel minister, I have been present at the sick and dying beds of so many of my fellow travellers to eternity. It can be a difficult and heart-breaking experience for the individual and their loved ones. But sickness is a reality for us all at some time in our lives and death is inevitable; we all must needs die. Death passes no dwelling, whether the occupant be rich or poor. It is a great leveller.
I thank those who sent me numerous letters and emails, from deeply concerned individuals, health professionals and organisations expressing various viewpoints. We in this House must made a decision about the legislation presented to us. I unashamedly state that I believe that human beings are unique among God’s creatures in being made in the image of God. When our first parents rebelled against the revealed will of God, they chose their own way and nothing has changed, for the accepted opinion of society today is “It’s my body, my life and nobody can and should tell me what to do”. As in the Book of Judges, every man did that which was right in his own eyes. I know that philosophy is very popular today. Not one of us decided when we would be born, and the cardinal question is: have we the right to decide when we should die? Again, the word of God says that it is appointed unto men once to die, not appointed by them. We live in a secular society that has pushed God out of its reckonings, and it wanders on aimlessly and hopelessly, seeing little reason or meaning in life itself.
Each of us can mention individual harrowing cases of the severe struggles endured in life and the pain of death suffered by our fellow human beings. Some conclude that the answer to these stories of human suffering is to assist the person to end their life, rather than improve the management of the end of life.
The Bill makes it a legal right for patients to access assisted dying, but does not mandate a comparable right to access other end-of-life services. We are aware that patients with a diagnosis of a terminal illness are very vulnerable and weak, and that elderly people are at serious risk of coercion and left to feel that they are only a burden to their families. I have heard that so many times in my ministry.
Estimating how long a patient will survive is also, at best, very difficult, even for specialists. I know of patients who were given a three or six-month prognosis who are still alive today three years later, enjoying life and making cherished memories with their loved ones. Were they to act on a similar prognosis using the Bill, that decision would be fatal and final.
The legislation before us is called the Terminally Ill Adults (End of Life) Bill, but, in reality, it is assisted suicide. Euthanasia is killing and, in most countries, killing another person is considered murder, even if the intention is to ease the pain or if the person has a terminal illness. Giving one category of sick people a legal right to exercise autonomy by killing themselves logically opens the door to, and creates the legal conditions for, expanding it to others. Indeed, an expansion has already been supported by some of the groups that are supporting the Bill.
It was only last Wednesday that we marked World Suicide Prevention Day. Today we are debating a Bill that creates an exception. One day we tell them, “Don’t give up”, but at the same time we make legislation to allow the NHS to give drugs to make people end their lives. Some years ago, Parliament rejected capital punishment on the basis that, if one innocent life was taken, it would be one too many. I ask: how many innocent elderly or sick people will die through this legislation if it is enacted? I have no doubt that the number will be great and I strenuously oppose the Bill.
Lord Meston (CB)
My Lords, I am one of the two survivors of the Committee on Medical Ethics that reported in 1994, consequent on the case of Anthony Bland. Since then, my views have changed, assisted by the report from the Nuffield Council on Bioethics. While some arguments for and against the Bill are finely balanced, it now seems to me that the balance comes down in its favour, and I support it.
The status quo is unacceptable. At present, it is possible irrationally to refuse life-saving treatment, but not possible to pursue an independent, rational request for life-ending treatment. At present, the law allows suicide but can criminalise any compassionate loved ones from whom the person may want or need help. The law cannot be left as it is: discriminating in favour of those who still have the physical ability and finance to travel abroad unaided, while allowing other unregulated, covert and sometimes drastic practices to continue. Opponents of the Bill must consider how much of the existing status quo they wish to continue.
I do not accept the more extreme objections to the Bill. The legislation is indeed not rushed; the topic has been extensively considered in and out of Parliament for years. Ironically, the first Bill rejected by this House in 1936 is said to have failed because the safeguards were too cumbersome. I do not accept speculative, overstated, slippery slope arguments. Good legislation can and should provide firm footholds on any perceived slope through unambiguous drafting, clear and specific safeguards and guidelines—including active oversight—and proper exploration of realistic alternative medical options, including palliative care. Parliament can and should retain control of the focus and clear confines of the new law, and the courts and the Government can be expected to make clear that any further permitted extension of such law should be for Parliament and require primary legislation.
The risk and sources of possible improper pressure by unscrupulous partners or relatives can be discerned and addressed by appropriate regulation and procedures, and by informed assessment of the family’s structure and dynamics and the financial implications. The proposed multidisciplinary panel should have an inquisitorial approach to collect and test the necessary evidence and, where necessary, make factual decisions.
Further consideration should be given to requiring earlier notification to family and carers, and encouraging their participation, if wanted, and requiring disclosure of testamentary arrangements. I would like to see a wider role for the independent advocate, authoritative guidance for vital assessment of capacity and possible protection of anonymity. This Bill was improved in another place; it can be further improved here.
Finally, I would suggest that perhaps the worst possible outcome would be differing laws in different jurisdictional parts of the British Isles.
Baroness Monckton of Dallington Forest (Con)
My Lords, I declare my interests as chair of Team Domenica and patron of the Acorns Children’s Hospice.
In 2018, along with two other mothers of young adults with learning disabilities, I took a test case to the High Court to challenge the way in which the Mental Capacity Act was being interpreted for this cohort. Essentially, it meant that authorities had no obligation to consult us as parents on so-called “best interests” decisions for our children, because they were chronologically adults and therefore, in the eyes of the law, deemed to have capacity. The High Court judgment, although sympathetic to our case, did not radically change anything, and it is still extremely difficulty for parents to become welfare deputies of their own children.
I recall this to draw your Lordships’ attention to a particularly disturbing aspect of this Bill. Someone such as my daughter, who has Down’s syndrome, could be advised by a doctor whom she may never have met that she should consider that it would be best to have her life ended because she was deemed to have a terminal condition. Not only that, but the Bill specifically excludes any obligation to discuss this with us, her parents, or other family members. I can only imagine the fear and terror that would go through my daughter, and a total lack of comprehension. Yes, she is capable of making decisions on what to wear, what to eat and what to watch on Netflix, but when it comes to something more abstract she is, at best, extremely confused. Also, like many with Down’s syndrome, she is highly suggestible; she is anxious to please those whom she perceives to be in authority. I can clearly see where the danger lies.
It is regrettable that the other place did not find the time to discuss the amendment tabled by my right honourable friend Damian Hinds, which would have excluded any person with a learning disability from initial discussions about being given a fatal dose unless they themselves had raised it. I do not mean to cast aspersions on the medical profession—we have wonderful examples of it in this House—but there is a tendency within it to regard those living with learning disabilities as suffering. We saw that clearly in Covid with the “Do not resuscitate” notices at the end of their hospital beds. People with Down’s syndrome, for example, do not suffer; they do not have a disease.
Nor do I question the good intentions or compassion of those who have promoted this legislation, but I was startled to see in a pamphlet circulated to all Members of this House by the campaigning organisation My Death, My Decision a paragraph urging us not to contemplate any amendment that would “encourage interference from family members”. What a strange view that is to have of the very nature of what a family is. I shall certainly be putting down such an amendment.
I urge the House to consider, when voting on this Bill, the most vulnerable among us. A coalition of more than 350 disability organisations have expressed their opposition to this Bill. For parents who have spent lifetimes fighting for their children to have now to worry about them being disposed of by lethal potions is inhuman and devastatingly cruel.
Lord Dubs (Lab)
My Lords, it is a privilege to be able to take part in a debate such as this. Even if I disagree with some of the views that have been put forward, I fully respect the sincerity with which they have been put forward.
I pay tribute to Kim Leadbeater. She has done a tremendous job. For her tenacity, sensitivity and campaigning fervour, she deserves a lot of respect, even if one does not agree with her views. I do agree with them. I have always felt that I cannot deny to others something that I would want for myself, and I would certainly want to avail myself of the provisions in the Bill if my health had reached the position where I qualified for it.
The present position is surely unsafe, cruel and unworkable. Those Members of this House who do not want the Bill in any circumstances are, I think, obliged to say what they have to offer. Or do we simply keep the status quo? For people who have the money to go to Switzerland, there are no safeguards at all; they can just go—provided they have the money, off they go. At least here we have a Bill with numerous safeguards.
Public opinion is very much on the side of the Bill. All the surveys show that the public want to be able to have a choice. We the politicians are in danger of being out of step with the public.
We have had the experience of Oregon put before us. My understanding is, as the noble Baroness, Lady Hayman, said, that people who get palliative care in Oregon also have the right, if they want, to end their lives if they qualify under the legislation. Yet, because they can do it at any time, because they are in control, they often do not use that option at all. It is a sign that people want some control over their destinies.
The Bill had extensive coverage in the Commons, and I think we have to be very careful before we challenge the elected House, which has been through such long processes of debate and consideration of this measure. It would be a regrettable step if we were to block it by procedural means rather than by the principles that are there for us to scrutinise legislation. The Bill received more scrutiny in the Commons than virtually any other piece of legislation in the world. It was very clear that the Commons in the end were in favour of it.
People have talked about pressure. There is also the possibility of pressure the other way: there might be an individual who wants to take advantage of the Bill and whose family will not let him or her. So, the pressure can work in both directions. What we need are adequate safeguards.
I finish by describing an experience. We have all had personal testimonies. Some years ago, there was a similar attempt to pass legislation in this House. A friend of mine was very ill with motor neurone disease and I used to see him quite often. On one particular occasion, he was anxious, through his family, to ask if I could be there because he wanted to talk to me. I got there, his wife and children were there and at that point all he could do was tap out on a keyboard—on my next visit, he could not even do that. He was in a pretty bad way. The purpose of my visit, or rather his intention for my visiting, was that he wanted my views on a Bill similar to this one going through. He wanted me to give a promise that I would support such legislation. I gave him that promise.
Lord Grabiner (CB)
My Lords, I will address two points. When you read the debates in the other place, you immediately see a strong focus by proponents of the Bill on the pain and suffering of the terminally ill individual in the period leading to death. That distress and suffering also impacts the lives of the family and friends of the individual. This point has been made by other noble Lords and was pressed by the noble and learned Lord, Lord Falconer, in his opening remarks. The curiosity is that, when we examine the conditions or safeguards designed to ensure, so far as possible, the integrity of the process devised for ending a life prematurely, there is a striking omission from the drafting. Specifically, no condition has been inserted to the effect that the patient should, still less must, be suffering pain or anguish of the kind that has been emphasised.
This looks like a mismatch or non-sequitur. It is a convenient and emotionally appealing argument for those who propound this dramatic change in our law to stress the suffering of the patient. We all hate the idea of our nearest and dearest having to live with excruciating pain, but for some reason the Bill does not make the existence of that pain one of the conditions that needs to be satisfied before assisted death would be legally permissible. Perhaps the noble and learned Lord, Lord Falconer, will be able to enlighten the House with an explanation for the non-sequitur. Alternatively, he may support a suitable amendment to deal with the point. We shall hear his view when he winds up. I think that the noble Lord, Lord Lamont, made a similar point a little earlier.
The other point I want to draw attention to is that the conditions identified in the Bill are quite inadequate to cope with coercion—by which I mean family or social pressure put on the patient, which impacts or undermines what should genuinely be the free choice of the patient. Where money is involved, people have been known to misbehave and to do so badly. The noble Lord, Lord Dobbs, took a different view, with which I profoundly disagree. The point is neatly, if rather crudely, captured by the expression, “Where there’s a will, there’s a relative”. Google attributes this remark to the comedian, Ricky Gervais, but it is a serious point.
At first blush, the proposed safeguard is the requirement for an opinion of the attending doctor, plus that of an additional independent doctor, supported by a panel which includes a lawyer—why lawyers are said to have any special capacity I do not begin to understand. I ask: what does any of this mean in practice? I am afraid that years as a lawyer may have made me a bit cynical. In particular, the reference to the involvement of the panel, including a lawyer, looks like a piece of window dressing. If two reputable doctors are in agreement, it is impossible to see what useful function the panel can perform. The panel cannot gainsay the joint view of the medical practitioners; they are the experts. By parity of reasoning, it is obvious that if the two doctors have not agreed, the case will never get to the panel.
Unsurprisingly, it is not suggested that the panel should have the power to summon witnesses or to satisfy themselves whether the patient has been coerced or encouraged in the direction of suicide. I would add that coercion can be a thing of great subtlety. Even in court, where the validity of a will is debated, with all the panoply of documentary disclosure, witness statements and cross-examination, the truth may never emerge. None of these courtroom safeguards are contemplated by the Bill. The reference to the requirement for a panel to approve the Bill is just a fig leaf calculated to cover the doubters; on analysis, it provides no comfort. The safeguards in the Bill with respect to coercion are inadequate and I am not convinced that they can be satisfactorily improved.
Lord Johnson of Lainston (Con)
My Lords, I feel pretty humbled by the debate so far and by the many people who wrote to me; I thank them for doing so. I feel certain that the nation is looking to us here today in this House to deliver on this final liberty—that of being able to decide how, in certain specific circumstances, one leaves this world. I know that there are rightly concerns about the Bill and how, in practice, the prospect of giving people this right will operate, and I do not take this lightly.
Obvious and reasonable objections have been well raised today, and these concerns must be answered by the body politic. We must be aware that people may feel pushed to end their life early, as we have just heard. Vulnerable people must be protected, and I am always sceptical as to how the state can be genuinely compassionate. Safeguarding, well-being and other such nomenclature are often simply a mechanism to protect institutions and facades behind which officials hide.
These are not technicalities. We should also not use this, as has been well raised, as an excuse to reduce funding for palliative and end-of-life care. For this to be right and proper, it must indeed be a genuine choice, not a false one. However, in reality, this Bill is more about decriminalising those who help me with a choice that I want to make than about giving me that choice in the first place. As the noble Lord, Lord Dubs, has just so eloquently said, we already have that choice, but it is absurdly complex and solitary, and those who love us are removed from the process.
This Bill changes that. It allows us to have access to proper care in this country; it enables us to have real dignity in our departure; and it ends these, in my view, absurd situations we currently endure, where a spouse is arrested, potentially at Heathrow, having taken their partner to Dignitas. The fact is that this is happening today, already, in the worst possible way, and this Bill, with however many issues it contains, is at least fundamentally better than the situation we currently suffer. To this end, we in this House must not let the complexities defeat us. We should not use the technical needs of regulation as a block on the principle. I, who fundamentally dislike all forms of regulation, actually, in this instance, support proper clarity for doctors and a structure for families around this urgent need. We should be more fearful of failing to deliver this freedom than of the risks that the freedom of choice may entail, because with freedom always come risks. It behoves us to use all our talents to find a way to deliver on this last and final right of our citizens.
I am an optimist. Legislation can be revised and reviewed. Secretaries of State can take common-sense decisions, it is true, and the medical and other professions can pride themselves on really owning the process over which they have control. This is all possible. People often ask: what is the House of Lords for? I say it is precisely for situations like today, where we focus on solving complex and highly sensitive problems with a single goal in mind, which is to allow people to live their lives as they want, free from pain and suffering, from the moment they are born to the very end. I look forward to working through this Bill with that single objective in my mind.
Baroness Debbonaire (Lab)
My Lords, I was explaining to a group of people last night what the virtues were of speaking in your Lordships’ House and of being in the debate. Somewhat controversially, perhaps, for a former Member of the other House, I found myself saying that the advantage of having no constituents is that you can look at the evidence and listen to the arguments. I find myself in awe of the depth and quality of evidence assessed and arguments made today, and of the listening.
I intend to use the prism of eating disorders as a way of examining some of the arguments that have not yet been made, because I am going to stick to my resolution not to repeat points that have already been well made about the lack of choice when there is not a sufficient quality of hospice care, and so forth. Other noble Peers have made those arguments very well. If you are a young woman, and it is typically women, with an eating disorder, you may have consulted a website about how to do that better. We in both Houses have tried our best to legislate against such websites, with the Online Safety Act, and rightly so. You may not have consulted a website about how to commit suicide, but you may have done. Again, the Online Safety Act rightly seeks to stop that happening. Many of us voted for that Act, and we did so thinking about what was currently legal but harmful. I stand by that, and I am committed to it.
If you have an eating disorder, that is in fact a mental health condition. It is not covered by Clause 2(2) as it stands, because voluntary suspension of eating and drinking is not the same as an eating disorder. They are different things, and it is important to distinguish them. I do not pretend that this is easy for anybody. I do not pretend that it is easy for us in this House, who have to take incredibly seriously the fact that if we get this Bill wrong, people will die who should not die at the stage they will die.
That is one of the reasons, as one of my noble colleagues has already expressed, why your Lordships’ House came to view many years ago that capital punishment was wrong. I hold that same view now about this Bill. I speak with intense pain and love for those who have made eloquent and heartfelt cases to end the suffering of those who are terminally ill. I understand that. However, this Bill is not worded so as to end suffering; it is worded so as to end life, and we have to draw that distinction. If it was a Bill about ending or alleviating suffering, the provisions of the Terminally Ill Adults (End of Life) Bill would be about palliative care, and they are not.
In the case of eating disorders, I represented a constituency where there were no specialist treatment beds in hospitals when they were needed, at the point when that mental illness had become life-threatening because of the physical consequences. As the noble Baroness, Lady Falkner, so truly said, treatment delayed increases the risk of a terminal end. Do we really want to legislate so that people who cannot get treatment then become terminally ill and seek assisted dying as the route out of that? Is that what we want to do? We are in danger in your Lordships’ House of doing just that.
I do not think that is the intention of my noble and learned friend Lord Falconer, or of my friend, the much-loved Kim Leadbeater, or anybody else who is in favour of assisted dying, but that is where we are going to end up. I am not in favour of assisted dying, for a complex set of reasons—but I am not here to speak against the principle, I am here to speak against the Bill, because we are legislators, and that is what we are here to do.
I wish for all noble Lords in their thoughts over the coming weeks to consider the specific case of eating disorders, how that does not work in the context of the Bill and why that matters, and then to consider that frame for other conditions for which lack of treatment will exacerbate the risk of terminal illness which was preventable.
Lord Farmer (Con)
My Lords, I want to stand back from this Bill and call out the dangers of the wider cultural drift towards hyper-individualism it epitomises. Freedom to end life on our terms—making death accessible as a personal convenience—desacralizes and cheapens death, life and humanity itself.
Professor Louis Appleby, advisory group chair of our national suicide prevention strategy, warns that our socially remarkable consensus that it is right to try to prevent all suicides will be radically altered. He also said the phrase “assisted suicide” should not be considered offensive.
At the time of Second Reading in the Commons, two of my friends who were suffering terminal conditions—one has since died—both followed the debate and news coverage and told me that the subject’s very airing made them feel that they were a burden to their loved ones.
Assisted dying is the latest blatant promotion of personal autonomy over any obligations we owe to each other as members of a shared society, and over reverence for life itself. It flouts the important “do no harm” principle underlying classical liberalism. As well as immediate harms to the disabled, those who fear becoming a burden and those vulnerable to coercion, there are long-term harms to the Bill typical of what pollster James Kanagasooriam calls “shrouded attributes” of policies: costs and liabilities, hidden at point of sale to the public, which inflict a later tail of pain.
First, there is the inevitable extension to other groups beyond those catered for in the Bill. International examples abound of legal creep, whereby mental illness, non-terminal conditions and ever-younger sufferers become eligible. Secondly, Canada has shown how palliative care withers, yet two-thirds of the public agree that Labour should prioritise sorting out palliative, social and end-of-life care before even thinking about assisted dying; less than a fifth disagree. Two-thirds of assisted dying supporters agree that our threadbare, charitably sustained hospice movement needs strengthening first, otherwise there is no genuine choice, as we have heard already in this debate.
Hospice movement founder Dame Cicely Saunders’ philosophy of palliative care was:
“You matter because you are you, and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die”.
Helping patients live until they die is what very many doctors want to keep offering, or to offer more reliably. Fear of missing out drives calls for assisted dying: supporters are significantly more likely than opponents to believe they will be unable to fund their own end-of-life care, and that the Government will not pay for it.
Thirdly, the cheapening of life and disregard for relationships flow from outlawing physical and mental suffering, despite these being part of our universal human condition. Although those should of course be alleviated whenever possible, actively taking the escape route of death is intensely painful for many years for close family members and friends when they have had no say in the matter. When personal autonomy trumps everything, we end up, dare I say it, deifying selfishness.
A former Chief Rabbi, the late Lord Sacks—we have heard his name already today—wrote this in his last book, Morality:
“Western society has all too often been insensitive to the dimension of time. Thinking through the long-term, unintended consequences of policy changes is imperative. Beware short-term fixes to individuals’ pain which will inflict life-long pain on those near to them—and sow seeds of destruction into our society”.
Lord Birt (CB)
My Lords, I strongly support this Bill. Overall, it is well considered. Importantly, it benefits from the experiences of many other countries that started this journey well before us. In no sense would we be pioneers.
The carefully designed process that the Bill sets out should address the possible risks—for instance, severe coercion—that have, reasonably, been identified. We know from surveys that there is overwhelming public support for assisted dying. All of us have received heart-rending letters pleading for the passage of this Bill from individuals who have had the harrowing experience of witnessing loved ones slowly dying in extreme pain or in utterly debilitating circumstances. This Bill confers the right for such an individual facing imminent death not just to avoid intense anguish and pain—as well as the prospect of their condition progressing intolerably—but to die at a moment of their choosing, in the circumstances of their choosing, and with dignity. I want that right, and anyone who wants it should have it, too.
No doubt the Bill can be improved further. The Delegated Powers Committee makes many persuasive points which we should take on board. However, the Explanatory Notes remind us of decades of attempts to introduce assisted dying legislation that have simply failed. It is highly unlikely that any Government in the foreseeable future will seize the baton. We must therefore make this Bill work, then pass it.
I have only one personal reservation, which I share with others, including the noble Lord, Lord Forsyth. Although I entirely see the value of a process setting out two independent medical assessments, two periods of reflection and an independent review panel, in a world of constrained resources where it is hard these days even to see your GP, there may be the risk of unwelcome slippage and a prolonged delay—perhaps in August or over the Christmas period—that intensifies suffering. Should we build into this process, on the one hand, greater certainty on the total time normally taken; or, on the other, some flexibility on telescoping time when circumstances demand it, particularly for those who may enter the process at a later stage?
Finally, I strongly advise anyone who is uncertain and harbouring doubts about the Bill to watch the one-hour discussion, hosted by the Healthcare Professionals for Assisted Dying, with four Australian practitioners working in this field. Without exception, they come across as people of enormous integrity and humanity, caring, truly dedicated to their work, and entirely convincing about the necessity and effectiveness of a carefully considered assisted dying process. It is well worth watching. I have no doubt whatever that our medical professionals who volunteer—and you have to volunteer—for a role in the assisted dying process will equally rise to the challenge.
Let us further improve, but then pass, this critically important Bill.
Baroness Fraser of Craigmaddie (Con)
My Lords, I have spent some years working to improve care and support for vulnerable people, specifically as chief executive of Cerebral Palsy Scotland, through my involvement in the Scottish Government’s framework for action for neurological conditions and as a previous trustee of the Neurological Alliance of Scotland. I believe that we all want to ensure that compassionate care and services are available for anyone when they need it; I also believe that everyone is entitled to be supported to make informed choices about their treatment, to access care that ensures they are able to live as pain free as possible and with dignity.
Sadly, however, as we have heard, for too many people that is not a reality. Lack of access to condition-specific support, to palliative care and to social care are all reasons why the status quo does not work for too many people. Set in the context of clinical backlogs and constrained funding in health and social care, people will not make all their choices in a context that is equal.
Here in this Chamber, we are all, in the main, healthy, competent, articulate and above all, privileged people. I have been asked whether I would not want an assisted death if I was unable to speak for myself, dress myself or eat by myself, but this is the reality every day for many disabled people. In seeking to ensure that the Bill leaves this place fit for purpose, we must consider assisted dying not through the lens of what we think we might want for ourselves, but rather through its impact on the most vulnerable in our society. We have been told that the Bill gives people choice, but which people and what choices?
As it stands, the Bill leaves me profoundly uncomfortable. The personal stories of people seeking choice and control over the manner of their death, or the heart-rending examples of poor care, seem not likely to be resolved by the provisions of the Bill. I am also concerned about the differences between this Bill and the Bill currently going through the Scottish Parliament, and the implications of those differences for service provision and regulation across the UK if both Bills pass. I gave evidence to the lead committee scrutinising the Bill on behalf of Cerebral Palsy Scotland in Holyrood, and both Bills leave too many details to be agreed later. Sweeping consequential powers, such as the process for the approval of drugs or other substances and the regulation of professions, will require co-operation and co-ordination between the two Administrations and should, I believe, require full and transparent scrutiny in both Parliaments. Where these Bills use words such as “terminal”, “progressive” or “treatment”, we need greater clarity on what exactly these terms mean, otherwise such broad terminology and the lack of detail around the process of assisted dying will result in unintended gaps that would be challenged.
I also want to seek provisions to ensure mandatory involvement of health professionals who actually know the person and are experts in the condition the person is presenting with. There is, however, a host of other issues that currently concern me, including greater clarity on how people will die, especially if they are unable to use their hands or ingest a substance; direction on what medical professionals are supposed to do or not do in case something goes wrong; stronger protections for conscientious objectors; and far greater clarity on training and reporting standards and requirements.
At the moment the Bill presents too many questions and not enough answers. I look forward to playing my part during its passage, as it is essential that these questions are not brushed aside or dismissed and that clear answers are provided.
Lord Carter of Haslemere (CB)
My Lords, the noble Baroness, Lady Merron, stated in this House on 4 September last year, that the Government’s commitment is
“to ensure that any debate on assisted dying … will take place in a broader context of access to high-quality palliative and end-of-life care”.—[Official Report, 4/9/24; col. 1151.]
Well, here we are having that debate. Has access to palliative and end-of-life care improved so much in the past few months? The experts say not. We have heard—but it bears repeating—that the evidence shows that 100,000 people die each year in the UK with unmet palliative care needs. Fewer than 50% have input from a specialist palliative care team in their last three months of life.
The Bill sidesteps this crucial issue because, as was pointed out by the noble Lords, Lord Lamont and Lord Grabiner, it contains no requirement that a person who is suffering from a terminal illness must also be suffering intolerable pain. Under the Bill, anyone given a prognosis of six or fewer months to live would be eligible for assistance to die, regardless of whether they are experiencing pain. Some of these people will require palliative care in any event, but if the focus of the debate were instead on relieving intolerable pain and suffering, then it would be more apparent that we should be legislating for wider access to higher-quality palliative care, not a state-assisted death regime.
As the Health and Social Care Committee heard, patients in countries with assisted dying who request help to die frequently change their mind if provided with proper palliative care. Evidence from Oregon, for example, showed that 46% of patients who received substantive palliative care changed their minds about an assisted death, compared with just 15% who did not receive such palliative care. Yet the Bill does not require a person to receive palliative care before electing an assisted death, merely that they be given the opportunity to discuss it. There is therefore a strong case for the huge sums that would be spent on state-assisted deaths to be spent instead on improving access to specialist palliative care.
Yet the intention seems to be quite the opposite. The impact statement sets out the tens of millions of pounds currently spent on care, state pensions and benefits that would be saved if this Bill were enacted. Is this really a relevant consideration? If so, we need to re-examine our priorities here. We should be encouraging those who are ill, depressed or struggling in any way to believe that life is a precious gift and worth living. We should be treating them as individuals who never cease to be important, even in frailty or decline, and that they deserve to have a dignified life in all its seasons by being cared for to the end, with the state meeting the full costs of that.
In speaking on this Bill, each of us will individually have searched our consciences, which is exactly how it should be. In searching mine and taking the line that I have, I have been guided by my Christian beliefs on life and on how life comes to an end.
Lord Roberts of Belgravia (Con)
My Lords, the measure before us represents the possibility of the greatest alleviation of pain and suffering in this country since Sir Alexander Fleming discovered penicillin 97 years ago. It is no criticism of our excellent hospice movement to point out that no amount of resources given to palliative care can alter the ultimate result, or abolish the fearful pain and indignity that terminally ill people have to go through unless they take so many painkillers that they become prey to weird delusions, essentially becoming different people from those whom their loved ones know.
Families gathered around death beds are presently denied the right to help to end their loved ones’ suffering because of the so-called sanctity of life, even when that life has lost any possible meaning. Hamlet wishes in his first soliloquy
“that the Everlasting had not fix'd
His canon 'gainst self-slaughter!”
However, the commandment “thou shalt not kill” can be suspended in exceptional circumstances, such as in wartime, and so it should be in the case of the horrendous pain of an irreversible, slow death. Wanting to avoid such excruciating pain is not selfish but a human right.
Going back further in history, beyond Augustine of Hippo and Thomas Aquinas, the theologians who proscribed suicide, the ancient Greeks and Romans recognised that there was nothing ignoble in it if the alternative is far worse. It should be up to the individual, along with their doctor and family, protected by robust safeguards and oversight mechanisms, but not up to the state or the Church, to decide whether he or she wants to escape pain and suffering in their final days. The autonomy to die on one’s own terms, not on those imposed by others, should not be denied any longer.
The defenders of the status quo have been talking about this being the thin end of the wedge, but hardly any legislation we consider here cannot be seen as the thin end of some wedge or another. The idea that Britain is going to turn into some kind of hecatomb of grannies being killed off by families eager for bequests is ludicrous, and this Bill has safeguards against it anyhow. This is not about the disabled, the mentally ill or those with eating disorders.
Future generations will consider us monsters for stopping people from shortening their death agonies if they wish to, especially as the majority of the population and of the elected House supports the Bill. People will rightly condemn this House if we refuse a person in desperate pain, with only six months to live, the right to choose the time and method of their death. We spend a good deal of time criticising our ancestors for their antediluvian views on race, sex and class, but those people who come after us will stand aghast that we allowed some of our old people to die in pain akin to torture, rather than simply overturn a medieval and sadistic practice.
Baroness Prentis of Banbury (Con)
My Lords, I apologise for giving you three very personal examples. When I was in my late twenties, we had a baby son who died, and I almost died giving birth to him. For a few short hours, while our lives held in the balance, it looked as if choices would have to be made. In fact, this was not the case. There was nothing to decide. But the whole experience gave me a much deeper understanding of where law and medical ethics collide. I learned that, to be kind, law must be very clear. I was able to use this in my later practice in coronial law and, for example, in representing the Government in some very high-profile cases on this issue.
My second point is that death within the law can be—and indeed usually is, as the right reverend Prelate the Bishop of London said—very good. My parents’ deaths are examples of this. My mother’s six years ago and my father’s 12 days ago were assisted by excellent palliative care. Drugs were able to help my parents to breathe and ensure that their pain could be managed at the last. These were good deaths. But my concern is that doctors need to be empowered to be frank and honest and to provide holistic care for the person they are caring for. One of the best things we did for dad was to go round his body disconnecting some of the bleeping machines and syringes that were in him and ask, “Why do you need that? What’s that for? You know that he’s dying. Let’s take it away”.
Those on my side of this debate must be honest as well. There is a small group of illnesses for which a peaceful death is not a likely outcome. We need to focus our efforts collectively on these—on managing them and on managing the law to support them being better deaths.
My third concern is that the ill are very vulnerable. I have recently been diagnosed with aggressive cancer and my treatment starts this week. My prognosis is excellent. I have every advantage. I have a strong faith, a loving family, an interesting workplace, good colleagues, a supportive community, enough money, underlying good health—and indeed excellent treatment, I should say. But there have been some very low moments in the past few weeks, when I have realised the burden I am to my family, who are currently arguing about who should take next week off to look after me. I also have concerns about watching them watch me suffer, as well of course as my own fear, frankly, of pain and loss of control.
I watched that final debate in the Commons, and what struck me was that woman after woman and ethnic minority after ethnic minority, and disabled people, stood up and said, “This Bill is not good enough for my vulnerable community”. My Lords, please do not write me letters and messages; I am drowning in kindness. Instead, I ask noble Lords to think hard about me, with all my advantages, feeling like a burden—just briefly, not all the time. Do not worry; I will be back this time next year, bouncing around. But I ask noble Lords, instead of messaging me, to think about the vulnerable and how easy it is for them to feel that their lives are not worth living.
Baroness Cass (CB)
My Lords, like others, I thank the many people on both sides of the debate who have written to me to share their views and deeply personal stories. For the sake of transparency, I will say that, on a personal level, I am supportive of the principle of assisted dying in very narrowly defined circumstances. However, I am deeply concerned about the Bill as it stands and do not consider it either safe or deliverable. I will focus on just one aspect.
As part of the consent process, the Bill requires three different doctors—the one undertaking the preliminary discussion, the co-ordinating doctor and the independent doctor—to discuss the primary diagnosis, prognosis and treatment options, as well as palliative care options, including symptom management. The latter two doctors must also assess for coercion, domestic abuse and capacity, as well as discussing the assisted dying process. I believe I am the most recently retired medic in this House, having given up my licence to practise last month.
Throughout my recent review, I devoted much time and discussions to thinking about meaningful informed consent. Back in the day when I was a junior houseman, we were expected to take consent without knowing much about the relevant procedure or how adequately to answer patients’ questions. We have come a long way since then. Options are explained to patients first-hand by clinicians who are specialists in the topic they are discussing, because it is impossible for other doctors to be up to date with a rapidly evolving range of treatments. You may assume that in the case of those seeking assisted dying, this has already been done by the treating doctor, but when someone imparts a serious diagnosis, you often blank out everything that is said thereafter and may be fearful of asking additional questions.
We know nothing about the background and qualifications of the three doctors who are expected to fill this potential gap. The latter two are at least supposed to be able to examine the patient’s medical records and speak to treating professionals, but written records are rarely adequate as a basis for such discussion and there are major complexities in doctors external to an organisation accessing electronic records. Furthermore, the treating doctor may not be available in a timely way. As for advising on palliative care options, the only professionals who can explain the full range of symptom-control measures are palliative care consultants.
In other words, the co-ordinating and independent doctors are being asked to take on two wholly different roles. The first is to substitute for a full multidisciplinary assessment involving the team managing the primary diagnosis, a palliative care specialist and, in some circumstances, a psychiatrist and a social worker. I submit that such an MDT assessment should be a core NHS function. It should identify the patient’s main concerns and fears and share information about possible options, ideally in a family context. This should happen up front, before discussions about an assisted death, rather than at the end of the process, when it is far too late to generate a trusting relationship.
The second role is the process of consenting to assisted dying, which should be considered separately once other options have been discussed and rejected. For the reasons that the noble Lord, Lord Lamont, gave, I believe that this should be through a service external to the NHS.
I have worked in MDTs throughout my career, and the key is respecting the unique skills of colleagues and listening to their views, so I have formed my views on this topic on the basis of not just my experience but, in large part, by listening to organisations representing key professionals: GPs, psychiatrists, palliative care consultants and physicians. I strongly encourage noble Lords to take their views very seriously in further deliberations, and for that reason I will be supporting the amendment from the noble Baroness, Lady Berger.
Lord Goodman of Wycombe (Con)
My Lords, others have referred to report of the Delegated Powers Committee on the Bill. I am a member of that committee, but I should emphasise that I, of course, speak today for myself personally, and not for the committee collectively. Indeed, I have no idea whether most members of the committee share my view that assisted dying is deeply problematic in principle.
But, as has been made clear, we unanimously concluded that the Bill is flawed in practice. By my count, our report made 13 main recommendations, covering vital matters such as the investigation of deaths, approved substances, the prohibition of advertising and, perhaps, above all, voluntary assisted services—in other words, the relationship between what the Bill proposes and how the NHS will dispose if the Bill comes into effect.
I quote from the report:
“There are several themes running through many of the issues we draw to the House’s attention … some delegated powers have very limited provision on the face of the Bill and leave so much to delegated legislation that there is insufficient detail or principle evident for proper Parliamentary scrutiny of the underlying policy; … in some cases, particularly where a substantial regulatory regime may be needed, this tendency results in skeleton legislation; … there are several clauses where delegated powers can be used to do anything that an Act of Parliament can do. This is a highly inappropriate formulation that gives sweeping, unspecified and unjustified powers to the Government while removing Parliament’s scrutiny role for provision that should be in primary legislation, and replacing it with the considerably more limited role of scrutinising delegated legislation”.
Noble Lords will have perceived that the main question the committee was tasked with answering was not “What does the Bill seek to do?” but “How does it seek to do it?”. I suggest that this is the key question, not just for the committee but for the whole House, which, for better or worse, tends to scrutinise legislation more exactingly than is sometimes the case in the other place. If the answer to the question “how?” is “inadequately”, a further question arises, namely, “How could the Bill be made adequate?”. Indeed, can it be made adequate at all?
I intend, as many other noble Lords intend, to table amendments in Committee and on Report, some of which will seek to effect the recommendations of our report. However, I cannot see how the Bill can be made adequate, no matter to what degree it is amended, for as Jill Rutter and Hannah White of the Institute for Government have noted, this Private Member’s Bill carries matters more weighty, profound and complex than it can properly bear, whatever the degree of government involvement and support. They write that
“a key problem with using this route to legislate is the lack of pre-legislative stages … Legislation on an issue like assisted dying would have benefited enormously from a more thorough preparation phase …a well-led review, involving many of the people on both sides of the argument, and with a mandate to engage the public, could have addressed the whole range of issues that MPs are now trying to navigate”.
I should add that this view was backed up by the Constitution Committee, which has echoed many of the criticisms of the committee that I have the privilege of sitting on.
I end with perhaps the most crucial criticism of the Bill in the committee’s report: it surely cannot be right that a matter so vital as the relationship between assisted dying services and the NHS is left to Ministers to propose by regulation. I ask noble Lords to consider whether a Bill that contains such a proposal can possibly be fit for purpose.
Baroness Stuart of Edgbaston (CB)
My Lords, we have had several references in the debate so far to a settled public view: that the public are in favour of this legislation. I briefly revert to my previous existence as a Member of Parliament, when I took part in the 2015 Private Member’s legislation on assisted dying. My constituency was Birmingham Edgbaston, which had some interesting aspects, such as Harborne having the highest concentration of doctors per square mile anywhere in the country. Across the road from the constituency was the Birmingham Oratory, which had very strong Catholic views.
As the debate was coming up, I thought I would do something very unusual for an elected politician, because if you are elected, your voters want only to hear your certainties; they never want you to go out and say, “I really don’t know what I think about this. Could you help me?”. I organised three public meetings: one was organised by the Birmingham Medical Institute and was attended largely by members of the medical profession, another was organised by St John’s Harborne church and brought in all the faith groups, and the third was a public meeting open to all my constituents or anybody nearby who wanted to come.
The format for all three meetings was the same. I had a lawyer there who would explain what the Bill was about, and I said, “I’m going to make up my own mind, by the way; you’re not going to mandate me on how I’m going to vote, but I really want to test my views and hear what you have to say”. The outcome was very surprising. The one group which was almost unified in its view was the doctors, in that the legislation was about what should happen if you needed medical assistance, and they said, “We don’t think we should go there.” Here, again, we have this argument between choices and palliative care. The group which was most divided—with apologies to faith leaders—was the churches. They were arguing from one end of the argument to the other. The most thoughtful debates were among the public, who, in essence, were making the cases for and against, and, at the end of the meeting, when I asked, “Broadly speaking, what should I do?”, one of them got up and said, “You’ve got a really tough job on your hands, love. Just try and do your best.”
I am explaining this because I think we should be very careful. If you have a survey which asks, “Do you want to reduce pain?”, of course you say yes, but as many speakers here have said, it is about palliative care, where the money goes and the consequences of that. I do not think we have really considered that.
The other thing which I want specifically to address is personal autonomy. To make choices for the few and assume that that will not have implications for society as a whole is deeply misguided. The essence of society is that it is a collective of individuals. We can permit it when we stop criminalising suicide, but to suddenly make it an option, is, I think, problematic.
I want to finish with something which the noble Baroness, Lady Debbonaire, started to address and to quote Bronowski, who in one of the episodes towards the end of “The Ascent of Man” said:
“Science is a very human form of knowledge … Every judgment in science stands on the edge of error and is personal”.
In the end, he quoted words by Oliver Cromwell:
“‘I beseech you in the bowels of Christ: Think it possible you may be mistaken’”.
As the noble Baroness, Lady Debbonaire, reminded us, this is one of those occasions when, if we are mistaken, we cannot reverse it.
Lord Bethell (Con)
My Lords, it is a privilege to follow the noble Baroness, Lady Stuart, who makes a very good point on public opinion. I am persuaded that one of the reasons why the Bill should pass is that the public broadly support it. But they support it only if it works. If it does not work, and if it does not deliver what it has promised, the public will be extremely sceptical and angry that we have allowed this to happen. I have some concerns on the fundamental workability of aspects of the Bill, and in this I shall invoke my noble friend Lord Goodman and the noble Baroness, Lady Cass.
This Bill creates a vast laundry list of new responsibilities without the clarity and consensus on execution that such a Bill requires. I convened a meeting of front-line clinicians downstairs in the Attlee Room on Tuesday to listen to some of these concerns. The feedback echoed what we have been hearing from medics time and again. On testing capacity, which a number of noble Lords have alluded to, the criterion remains contested. On the signing-off of medicines, the process is extremely unclear. Huge palliative care expectations are totally unfunded, which the noble Lord, Lord Stevens, referred to. The expert panels will consume vast amounts of very senior professional time, particularly of psychiatrists. We do not have that many psychiatrists in this country. If they spend all their time on these panels, I am afraid that the rest of us will not get any support at all. There are ambiguous doctor roles, including in the presence of death. The six-month prognosis judgments do not have a very clear methodology. Very importantly, provisions for what I would call the non-NHS sector are completely unstructured and left to civil servants and secondary legislation.
This leads to what the noble Lord, Lord Kakkar, acutely termed over-protocolisation. I think what he meant by that was the sort of bureaucratic complexity without clinical clarity that blows up the intimacy that is needed for the best medical care, without managing down the risks of something going wrong.
I know from my time as a Minister that confusion in the business of health and, for that matter, in the business of death, very quickly wastes vast amounts of resources. It breeds litigation and costs lives. Who will defend these court challenges? The DHSC’s already stretched legal teams? Who will pay compensation if things go wrong? NHS Resolution, which already has a £60 billion liability bill? Sloppy legislation costs an absolute fortune in the business of health.
When we considered IVF, which is different but has some of the same considerations, we had very rigorous preparation, a royal commission, detailed legislation—twice—robust regulation and private sector delivery. Here, we have instead what my friend, the noble Baroness, Lady Murphy, called an “unwieldy if not unworkable” Bill.
I am sorry to say that I am concerned that the role of the commissioner, in particular, needs to be clarified. There is no private sector regulatory capability and there are large, sweeping Henry VIII clauses. I draw noble Lords’ attention to the very important Clause 40, which is particularly weak. The Constitution Committee demanded
“greater detail on the face of the Bill”
regarding the intended guidance and direction of this clause, and I fully support that.
The principle of the Bill is very important and it does have the support of our public. But, without substantial clarification and reform, it could devastate the NHS and our healthcare system. We must address its fundamental flaws, or this legislation should take pause before it irreparably damages our health system.
Lord Biggar (Con)
My Lords, we face a tragic dilemma. On the one hand, advocates for the disabled and several royal colleges voice persistent concerns about the risks of abuse that the Bill’s legalisation of assisted suicide would create. On the other hand, as we have heard, are dreadful cases of individuals suffering grievously, where those who help them find relief through suicide must endure police investigation.
This intolerable situation, we are told, would be solved by the Bill before us—except it would not. By limiting assisted suicide to the terminally ill, the Bill excludes those who are not dying but are still suffering grievously. Anyone supporting the Bill who intends that terminal illness should remain a prerequisite of eligibility, accepts that some people, tragically, have to suffer, and others have to endure police investigation, because the social dangers of wider access are just too great.
But if the Bill, despite its tragic imperfection and risks, is supposed to be tolerable, how come the legal status quo, with the same tragic imperfection and fewer risks, is not? If we were serious about reducing the quantity of human suffering, we would not focus on assisted suicide at all, reckoned to be chosen annually by up to 7,500 people after a decade. Instead, we would focus on ensuring the universal provision of adequate palliative care, which, as we have been told several times today, more than 100,000 fellow citizens every year need but do not get. We have known that for decades and done nothing about it.
Indeed, if we were to pass the present Bill before ensuring that, we would create an unjust inequality of autonomies. Some—typically privileged like us—would have a choice between decent palliative care and assisted suicide. But others—poorer and less white—would have to choose between grievous suffering and killing themselves. That is why two-thirds of the more than 5,000 people polled by Focaldata last November wanted end-of-life care sorted out first before any thought is given to assisted suicide.
It is also why the 2012 report of the Demos commission on assisted suicide, chaired by the noble and learned Lord, Lord Falconer, himself, stipulated as an “essential” condition of legalisation the universal provision of the
“best end of life care available”.
I refer noble Lords to pages 24 and 299.
Compassion is a virtue, but it needs to look in more than one direction and distribute itself equitably. Compassion that takes impatient and imprudent risks with the lives of the vulnerable is no virtue at all. To pass this Bill in the current state of palliative care provision would be, I think, unjust and imprudent, and I cannot support it.
Lord Rees of Easton (Lab)
My Lords, I, too, begin by thanking the many members of the public and Members of this House for the letters I have received, as many others have, and for the power of the personal testimonies that have been brought to me. I have been particularly struck by the hand-written letters which have been sent, which speaks about people’s real dedication.
I find this a difficult debate, not because I do not have clarity on my position, but because I absolutely hear the legitimacy of those in favour of the Bill: the very real pain in people’s lives. I am thinking about some of the key words that have floated around today. We have talked about choice, fear, pain and protection. The reality is that those things do not land equally in different people’s lives. They mean different things, people have different degrees of vulnerability to them, and they have different sources.
I bring two areas of experience to this discussion. The first is my time as mayor of my city for eight years. One of the reflections we had at the end was that good things can have negative consequences for some people. That is a very real danger. One of the things we grappled with in Bristol was that there was a 10-year life expectancy difference and a 16-year healthy life expectancy difference. People on lower incomes, born into poor backgrounds, were destined to become unwell to the point of being unable to work 16 years before the wealthiest. That means that those people from those backgrounds will be more likely to end up in situations in which they feel the pressures towards the end of life.
The second is that I was the manager of race equality in mental health—the noble Lord, Lord Stevens, was head of the NHS at the time—and we looked at the reality that, from determinants to access to experience to outcomes, people from black and minority ethnic backgrounds were disproportionately getting the bad end of the stick in terms of our mental health services. One of the things we recognised was that services designed by people in positions of power are designed for people in positions of power, not for vulnerable people. If you are not one of those people, you do not have the resources to navigate those services. Even if those services are good, you can fall into the cracks between those services if you do not have the personal assets to navigate those limbos.
The social, political and economic inequalities within which this Bill would be put, if it were to pass, are not inconsequential. What this service means is not just what exists on paper and how it is designed; it is the product of its interaction with those inequalities. I fear that, landing on such an unequal society as we have today, the circumstances and consequences could be quite dire for some communities.
It is also true that we have not tackled inequalities in NHS services—from access to experience to outcomes. I fear that putting a terminal service into an organisation that, to all intents and purposes, has not solved health inequalities will mean that both the context within which it will work and the outcomes for our population will be incredibly risky.
The challenge of palliative care has been raised. While I absolutely agree with the principle of dignity in dying, that cannot be detached from an absolute commitment to dignity in life and dignity in sickness. That means tackling the social, economic and political context in which people experience life.
Finally, because the consequences are so big, we cannot afford to try to fix this on the move. It has to be sorted before the legislation goes through.
Lord Young of Acton (Con)
My Lords, the noble and learned Lord, Lord Falconer, suggested that the effect of the Bill on palliative care would be to improve it. That is not the view of my sister, an NHS nurse who has spent much of her career working in palliative care. It is her reservations about the Bill that I want to share with your Lordships. Like many noble Lords, she is concerned about the shortage of GPs and other qualified medical practitioners to see patients who want to avail themselves of the assisted dying service, and the shortage of psychiatrists to refer those patients to if there is any doubt about their capacity.
The noble Baroness, Lady Meacher, in outlining the reasons for introducing the Bill, said that this law would provide reassurance to those living with a terminal illness that this option will be available to them if the worst should happen. However, as my sister points out, not all terminally ill patients will have that option, because patients will have to self-administer the life-ending drugs. As my noble friend Lady Fraser said, some terminal patients will be unable to do this if they are suffering from a neurological illness like motor neurone disease or Parkinson’s.
My sister asks the reasonable question whether terminal patients will still be eligible for treatments designed to prolong their lives, such as oncology treatments, palliative chemo, immunotherapy and hormone treatments, if they have expressed a desire to die and have already embarked on the pathway set out in the Bill. Would those patients be reluctant to undergo treatments designed to prolong their lives if they knew that they have to secure a prognosis of having less than six months to live to be eligible for the service? How are palliative care doctors and nurses supposed to help those terminal patients who have an incentive to reject their advice?
My sister acknowledges that, at some point, most palliative care patients express a wish to die, whether because of pain, nausea or extreme fatigue, because they are anxious about dying at home without adequate care or support, or because they feel they have become a burden on their families. However, in her experience, most of those patients change their minds when help does come, solutions are proposed and symptoms are alleviated, and they are grateful for the opportunity to spend extra time with their loved ones.
It is providing terminally ill patients with these opportunities that makes the work of people in hospices so rewarding. It is why many of them do it. Their sense of vocation comes from wanting to improve the health and extend the life of their patients, not from accelerating their deaths. My sister also makes the point that many terminally ill patients have considerably less than six months to live. Would there be a statutory minimum amount of time patients are expected to live for, alongside the six-month statutory maximum? Even if there is no statutory minimum, the time it will take to jump through all the hoops before a patient is prescribed life-ending drugs will mean that there is a minimum, in effect, if not in law. What is my sister to say to those patients want to end their own lives but have no realistic chance of being approved by a panel in the time they have left?
More generally, my sister is concerned that any attempt to integrate an assisted dying service into one of the most overstretched parts of the NHS, with the inevitable bureaucracy and delays, the forms incorrectly filled in, the unreturned phone calls and the missed appointments, will end up making the lives of terminally ill patients even more miserable. She says that her job often feels like working in a war zone, and fears that the Bill, particularly as currently drafted, will only make things worse.
Lord Pannick (CB)
My Lords, I will focus on the content of existing law relating to end-of-life issues. I do so to make the point that the current law recognises the fundamental importance of autonomy. It rejects the absolute sanctity of life, about which we have heard much from the Bishops’ Benches and noble Lords, and the Bill will introduce greater dignity and greater safeguards than currently exist.
There are two basic legal principles. The first is that you have a legal right to end your life. Since the enactment of the Suicide Act 1961, attempted suicide is no longer a crime. You do not need to satisfy a panel of doctors or psychiatrists. There is no special protection against your relatives. If you are a competent adult, the doctors cannot require you to eat, to have a blood transfusion or chemotherapy, and they cannot stop you going to Dignitas. Why is that? Because the law recognises that it is your life, and so it is your decision, and because the law rejects the absolute sanctity of life.
There is a second legal principle that follows from this, and it is that the health system has a legal duty in some circumstances to take positive steps to implement your wish to end your life. I will give noble Lords an example: the case of Re B (Adult, refusal of medical treatment) [2002] 2 All ER 449. This was an adult woman who was paralysed from the neck down. She was dependent on an artificial ventilation machine to breathe. She wanted the machine turned off: she wanted to die because of the poor quality of her life. Her doctors declined to do so, so she applied to the courts for an order that they do so. The noble and learned Baroness, Lady Baroness Butler-Sloss, then the president of the Family Division, granted that order. She said the woman was an adult; she was of sound mind; it was her decision whether to live or die.
Parliament has intervened in this area. We made provision by the Mental Capacity Act 2005, Sections 24 to 26, to allow an adult of sound mind to make an “advance decision” refusing treatment to prolong their life, should the occasion ever arise, and should the person at that time lack the capacity to indicate their wishes.
I have one other example. When Tony Bland, a victim of the 1989 Hillsborough football stadium tragedy, was in a persistent vegetative state with no prospect of recovery and could not express a view about whether to live or die, the Appellate Committee of this House decided in 1993 that because he had no quality of life, there was a legal duty on the health authority to end his life support—to pull the plug. That is what the doctors did, and there have sadly been many similar tragic cases since.
For this Bill to authorise doctors to assist a person to end their life by providing a drug so they can die with dignity is entirely consistent with well-established legal principles which respect autonomy on end-of-life decisions. The Bill contains many more safeguards than already exist. It enables terminally ill people to end their life in a less painful and more humane manner than starving themselves to death or otherwise committing suicide, or travelling to Switzerland.
Lord Pannick (CB)
Because we are restricted to four minutes.
I support the Bill. I look forward to debate—including debate with the noble Lord, Lord Carlile—in Committee. Thank you.
Lord Weir of Ballyholme (DUP)
My Lords, 60 years ago Parliament passed what I think would be by common consensus one of the most significant pieces of legislation of the 20th century—namely, the abolition of capital punishment. The rationale for that decision was largely based on three principles that are difficult to argue against: first, that in a modern civilised country it was barbaric for the state to decide to kill its own citizens, even after a judicial process; secondly, that whatever protections or procedures were put in place with a judge, jury, tribunal or panel, it is made up of human beings who ultimately from time to time will make mistakes; and, thirdly, that when we are dealing with a situation involving the death of a person, the consequence of a mistake in those circumstances is irreversible. The clock cannot be turned back six months later when new evidence emerges, if that person is dead.
Those principles have held firm throughout the decades, which is perhaps why, in the 60 years since then, there has never been a realistic prospect of that law ever being revoked. But I contend that the legislation before us today reverses and repudiates all three of those principles, with the added expense of offering in return a false prospectus of a painless, easy death.
If this legislation passes, the state will have control over who is eligible for assisted suicide and control over how that is done, and it will ultimately be administering the killing of the individual. Whatever procedures we put in place, the panels will make mistakes. We know that the prognoses that doctors make, no matter how qualified or specialist they are, cannot be got right all the time. But what worries me most is the issue of coercion. This is not simply an academic or hypothetical question. Sadly, we have seen too many cases over the years, particularly those resulting in the tragic deaths of partners or children, in which it has then emerged at a later stage that there were years of abuse and coercion. The reality is that coercion is not easy to spot because it happens behind closed doors. It can be blunt and aggressive, but it can also be sophisticated and subtle—a drip-drip message to a person that they are a burden on their family.
The reality is that even beyond the coercion that comes from others, there is a risk in this legislation of what I would call self-imposed coercion, whereby a person decides or convinces themselves that the burden that they place in terms of caring and financial responsibilities means that they feel compelled to make the supreme sacrifice for their family. As with capital punishment, if we get it wrong on an issue of coercion, we cannot look back six months or a year down the line and reverse that decision.
Finally, to use a classical analogy, today we cross over not only the River Styx but the Rubicon if we accept this legislation. Some of the proponents of this legislation are already saying that it is the first step. We have seen that happen in country after country, perhaps less in a direct change of the law and more in change of practice. While I am sure that we have great faith in this country, we cannot be that uniquely arrogant to believe that we will be the one country where there is not an expansion of the issue of assisted dying.
This Bill, rather than being progressive and permissive, is cruel and regressive. This House should do the mature thing and reject it.
Lord Hacking (Lab)
My Lords, my phone is ringing—I have to sling it away from me. This is very embarrassing—I am so sorry. I will start again; can the clock start again? I have lost 12 seconds to that intrusion.
As with my noble friend Lord Rees and as with many Peers in this Chamber, I have received lots of communications on the Bill, both in the post and by email. In my case, every one of these communications—except the paper by the sponsors of this Bill, which I hold in my hand—was against the Bill. I did not count them all, but there must be up to 50. Although we are an unelected Chamber, I believe we should take note of these representations that we have received.
I therefore thought that I should give the Bill careful study. I found it thoughtful and well drafted. It is readable and comprehensible—quite a change from every other Bill that is now descending on this House. It provides safeguards on the proposed assisted dying. There is also the appointment of the assisted dying commissioner and the assisted dying review panels. It carries a number of helpful stipulations and goes right to what should be discussed with the patient, and it deals with other safeguards. Importantly, it defines who is entitled to apply for assisted dying. My noble and learned friend Lord Falconer covered this in his opening remarks, and I therefore draw attention only to the crucial one, which is that the patient has to be terminally ill, with the prospect of death within six months.
However, these provisions do not cover those with neurological disorders. I refer to multiple sclerosis, motor neurone disease, muscular dystrophy and advanced Parkinson’s. These are all terrible diseases, where the patient loses all control of their body movement, but they have no direct expectation of death. I could also refer, like the noble and right reverend Lord, Lord Harries, to those who have severe spinal injury. One of my sons received a very serious spinal injury and went to Stoke Mandeville. There I met a rugby player—he must have been 18 or 20 years old—who had quadriplegic injury right up to his neck, with no movement of his body. I am told that he wanted to go to Dignitas in Switzerland. I do not know whether he ever went there, but I can say that he felt he had no future in life.
My concern about the Bill, if passed, is that inevitably its terms will be extended. That is exactly what has happened in Belgium, the Netherlands and the US state of Oregon, all of which have had assisting dying legislation for over 20 years. One can expect the lowering of the age from 18 years and the inclusion of many more who do not have terminal illness. The prospects for extending this Bill are never-ending.
This brings me to a moral position and a practical position. The moral position is that no doctor should ever be asked to kill his patient. The practical position relates to palliative care: the Bill overrides the wonderful work of palliative care in providing every help to a dying patient. That brings me to oppose the Bill.
Baroness Meyer (Con)
My Lords, like many noble Lords in this House, I have wrestled with this Bill for weeks on end and have changed my mind several times. My father died at the age of 97, a proud and honourable man, a veteran of the French navy and a devout Catholic. He spent his last days almost blind, incontinent, in pain and confined to a hospital bed. When I visited him with my late husband and sons, he looked at us with love, but could barely speak. He whispered only two words, “Quel supplice”—what torture. That night, after saying goodbye, he tried to end his own life by pulling out his drips. Alarms sounded and the nurses bound his hands so he could not try again. The next day I was horrified to find my father reduced in this way. That experience left me sympathetic to the right to die.
On a personal level, I would want that choice. I do not want my sons’ last memory of their mother to be like the one I have of my father, but personal experiences, however powerful, are not enough to justify enacting a law of such gravity. The risks are stark: coercion, irreversible errors, erosion of trust between doctors and patients, pressure on the elderly and the infirm, financial costs and the burden on an already overstretched GP workforce. I could add to this the long list of concerns so clearly listed by many noble Lords who spoke before me. Some argue that we are behind other countries, but so what? Canada gives me pause. Eight years on, assisted dying has become routine and is now the fifth leading cause of death. Reports show that people are seeking euthanasia not because they are terminally ill, but because they are poor, isolated or unable to access proper care. A right to die has become a duty to die. Now in Canada, there is a question of expanding this law to include children.
At present, doctors feel compelled to keep people alive at all costs, because it is a crime to hasten death. This has caused some to suffer unnecessarily but, if the law changes, we must be equally vigilant that it does not push people in the opposite direction, towards feeling that death is expected of them. The advocates of the Bill cite many cases like my father’s. They are motivated by compassion, yet to enshrine in law the deliberate taking of life is a moral hurdle too high to cross, particularly when key details will be decided later, through regulation. In our law, a case must be proved beyond reasonable doubt. Here, for me, that doubt remains, and it is too great to ignore.
I finish by telling the story of a 72 year-old Swiss woman who had put her name down with Dignitas. She never made it, because Covid happened, so she did not die. Soon, a neighbour moved in, she met him, liked him, they fell in love and they married.
Lord Tyrie (Non-Afl)
I will not try to match that story. All I will say is that this has been a brilliant debate on an extremely controversial subject. Some people have opposed the Bill on principled grounds. The first point I make is that, in practice, on a number of the areas of principle—and I agree on this point with the noble Lord, Lord Pannick—the Rubicon has already been crossed. I shall mention two. First, the withdrawal of care essential for the preservation of life is already permissible, including the withdrawal of food, and even water in certain circumstances, in a controlled medical environment. Secondly, indefinite sedation with drugs is also permissible, even when it is understood that it may shorten life. These are already practised to some degree.
What we are primarily debating are the practical consequences for the terminally ill, their families and the medical profession of widening somewhat a discretion that is already there. Most people want to be able to exercise control, especially when they are elderly, fearful or in deep pain, although the point has been made that those in pain will not benefit from the Bill, because it is silent on the issue.
I remain very nervous about this legislation on several practical grounds, many of which have already been mentioned. Can six months be defined? What constitutes mental capacity? Can assistance be legally defined, and, once legalised, as has just been pointed out, will the eligibility criteria be expanded? Will the Human Rights Act get engaged here? I think it will.
We have already seen that medical science and practice, and court scrutiny of both, have taken us well beyond the intentions of Parliament in the Suicide Act 1961, and it will undoubtedly happen again if this Bill is on the statute book. It is important to bear in mind that the discretion I described a moment ago, which is already exercised, was almost certainly not envisaged at the time of that legislation.
A further concern has been aired very widely already, so I will not linger on it. Some people may feel pressured into taking decisions at the end of their lives which do not reflect their true wishes. We know that some people hold one view of the termination of their apparently hopeless lives while they are discussing it when they are well, but quite another when they are very ill.
A third point, which has already been aired to some degree, is that the medical profession is deeply split on many of these issues, just like this House. I personally support people’s right to exercise control over their deaths, as well as their lives, but we have to accept that the regulation needed to support this legislation will be complex and will almost certainly have unintended consequences. In my view, we have to try much harder to get this right, particularly to assist the clinicians on the front line, in ICUs and in the hospices.
To pass the Bill in its current form, heavily laden with controversy and with many arguing, as they have today, that it has not been properly debated, would be a very profound mistake and would make for bad law. At the very least, we need a Select Committee. We perhaps need a royal commission. Then, we need a Bill in government time, as was the case with the Suicide Act and with the Mental Capacity Act. What I have suggested might lead to some delay, but we would probably get better legislation as a consequence.
Lord Murray of Blidworth (Con)
My Lords, irrespective of the underlying moral and policy question, as many noble Lords have already identified, the Bill in its present form is seriously procedurally flawed. I am against it.
I am most concerned about the impact those flaws will have on vulnerable people. Given the time available, two points occur to me which demonstrate this problem. First, at no point in the mechanism under the Bill does anyone expressly ask the applicant the reason why they wish to die. Such a question would not be an intrusion on private autonomy; to the contrary: it would be a reasonable and compassionate inquiry. In its own way, it would be a significant guard to protect the most vulnerable.
Secondly, more technically, there are very significant failings in the panel stage of the process, as described in the Bill and embodied in Clause 17. In its current form, the panel stage of the process, as the noble Lord, Lord Grabiner, identified, is lawyer window dressing—I agree. Unlike him, though, I suggest that this stage could and should be used to reinforce the process and to protect the most vulnerable against abuse.
Clause 17 provides that the panel’s function in an application for a certificate of eligibility for assisted suicide is simply to determine whether the nine tick boxes set out in Clause 17(2) are met. To do so, the panel, who are described in Schedule 2 as comprising a lawyer, a psychiatrist and a social worker, must hear from the co-ordinating doctor, the applicant, and they may hear from anyone else. Subsection (7) then requires that the panel must grant a certificate if they have satisfied that the nine boxes in subsection (2) are met.
This is a quasi-tribunal process in which the tribunal is bereft of any appropriate powers. Frankly, even a parking adjudicator has more evidential power than these panels. In the past few months, this Government have given more enforceable rights to employees and tenants, to mention two Bills that have recently passed through your Lordships’ House—the Employment Rights Bill and the Renters’ Reform Bill—than to those who seek assistance to die under this Bill. How is that so? Because those other pieces of legislation—employment legislation and landlord and tenant legislation—go before a court or tribunal with evidential powers to look into the matter before them.
The panel in this Bill is toothless. It has no power to require evidence to protect vulnerable people, no power to summon witnesses or experts, no power to order the disclosure of documents and no powers of compulsion at all. Indeed, the panel would have no power even to see an applicant’s will or to summon witnesses to explain the relationships in the application before them. There is no logical reason why those applying for assistance to die should have their request for a certificate of eligibility scrutinised by a body with fewer powers to compel evidence and make decisions than a person would have had if they had brought an employment claim, a landlord and tenant claim or a road traffic matter. At the very least, this Bill should explicitly provide that part of the statutory role of the panel should be to investigate motivation and possible coercion. The panel should have the powers of any other tribunal in performing that task.
Baroness Goudie (Lab)
My Lords, I thank all those who kindly wrote to me and sent emails, including members of the public, religious organisations, religious leaders and many people in the medical profession. There is no greater responsibility than how we treat those at the end of their life—the vulnerable, the ill, the elderly and the dying—and that is precisely why this Bill troubles me so deeply.
I will start by addressing something fundamental: language. Euphemisms are dangerous; they are designed to conceal what is actually happening. Why is this called by its supporters an assisted dying Bill? It is nothing of the sort. Assistance sounds good, and dying is a natural process which comes to us all. Pain relief and emotional support are vital and uncontroversial. However, this Bill is not about that; it is about assisted suicide, and that is altogether a different matter.
I understand why some see this as a matter of choice, but they cannot ignore the context in which that choice is made. When someone is terminally ill, frightened, exhausted and overwhelmed, they are at their most vulnerable. It is precisely at that moment that this Bill proposes to offer them a legal means to end their life, aided by others, approved by our institutions and normalised by law. An individual who takes their own life alone does so out of desperation, but a combined operation involving doctors, lawyers, family and the state is something entirely different. Those who support the process may act with the best of intentions, but motivations are not always pure.
It is rarely simple and, even when it is, the risk of coercion remains real. I do not believe that we can eliminate that risk and this Bill certainly does not do enough to do so. Once we create a legal route to assisted suicide, how can we ever be sure that a patient’s choice is not shaped, even subtly, by pressure, manipulation, guilt or simply the sense of being a burden?
This raises another concern: the undermining of palliative care. Palliative care is so important. Instead of extending choice, I fear that we are quietly narrowing it. Not everyone has access to high-quality end-of-life care, and not everyone is given a full range of pain management, hospice support and spiritual care, or even the time to prepare for a dignified death.
Rather than committing to universal excellent palliative services, this Bill offers another option: to end life earlier. This is not a service to people at the end of their lives; it is an abdication of responsibility to provide excellent services to those in need. Some will say that this is about autonomy, but it is not true autonomy; true autonomy cannot exist without full support to live. We have seen in other countries that what begins as a narrow exception can widen. In Canada, eligibility has already expanded beyond terminal illness to include chronic illnesses or disabilities.
Finally, we must listen to the voices of those most at risk. Many disabled people’s organisations oppose the Bill, not because they fear death but because they fear that society too often assumes that their lives are not worth living. If we are to be a compassionate society, we must reject this path. We must invest instead in palliative care, emotional support, hospice services and the time and presence to walk with people to the very end. In particular, people should be able to be looked after at home. We owe our dying not the offer of an early death but the assurance that they are valued, supported and loved until the very last moment. This Bill cannot promise that. So, with deep respect for all who have spoken on both sides, I cannot support it.
Lord Sandhurst (Con)
My Lords, I believe in choice and personal autonomy, but, if this Bill is passed, it will change how we treat each other as humans, and not for the better. Hard cases make bad law and the Bill is defective in too many respects. I say that despite the imperfect state of the current law.
The reports of the Delegated Powers Committee and the Constitution Committee cannot be brushed aside. The Bill is at once long but incomplete. There is insufficient detail or principle evident for proper scrutiny of the important powers to be delegated. We should, for example, have had draft regulations regarding the co-ordinating doctors, who are to have a central role and will make the most important assessments—namely, whether the person seeking assistance has sufficient mental capacity, a clear, settled and informed wish to end their own life and seeks assistance voluntarily, without coercion or pressure from another.
How will this be done and from what knowledge base? My noble friend Lord Murray has explained that. How will the panel then test the process? How long will the panel devote? How will it be resourced, so that it is not, as it must not be, a tick-box exercise? We all know that subtle family pressures are real.
Until now, doctors have been obliged to protect against suicide. The Bill goes against that. Death by poison is not treatment. It brings huge ethical challenges and changes for doctors.
What sort of people will be the independent advocates? What skills will they have? How will the vulnerable be identified? Qualifying vulnerable persons are those with a learning disability, mental disorder, or autism, which is often not diagnosed—people who may experience substantial difficulty in understanding the processes or information relevant to those processes, or in communicating their views, wishes or feelings. But there is no requirement to involve the independent advocate before a doctor decides to initiate a conversation on assisted dying with people in that precious cohort. The independent advocate will only be appointed once someone is on the path.
Who will consider family coercion—subtle family coercion or just the old person who thinks, “I’m probably a bit of a burden”—and with what resources? I am aware of the head of safeguarding in a London hospital who has recently said that there are already issues with families who want to clear the decks. The noble Lord, Lord Grabiner, explained all that.
The overloaded NHS is not always safe. Remember the Bristol Children’s Hospital and Stafford Hospital scandals. My chambers were involved in dealing with the aftermath of those and many other medical disasters. Mistakes happen and practitioners are, I am afraid, known to change the notes after the event. I have personal experience of that in matters in which I have been involved. How will we know whether the system is working properly? Cover-ups will happen. Yet, we are not to have coronial inquest. Why on earth not?
Giving responsibility to the NHS will create a stark financial conflict. It will likely damage the delivery of palliative care: the noble Lord, Lord Stevens, addressed that in detail. Palliative care should be our focus. This Bill cannot be put into acceptable shape. We shall be left with a national death service—and a poor one at that. We should have had a royal commission and proper legislation.
Lord Craig of Radley (CB)
My Lords, I, too, have received and acknowledge many emails and letters. What surprised me is that the vast majority expressed deep reservations and anxieties. I wish to record my appreciation of and thanks to all those who have been in touch with me; it has affected my own thinking.
A wish to help is understandable, but difficulties mount as attempts are made to ring-fence away from all others those who might be allowed to choose assisted suicide. Is the Mental Capacity Act a sufficient safeguard in determining sentience when dealing with this life-or-death decision? Its thrust is to determine whether the individual lacks degrees of capacity, rather than that they have the extra strength and steadfastness of capacity to decide on life or death. With every good intention, this Bill attempts to define the ring-fence, but gaps in the fence exist, such as for accurately assessing life remaining, with or without treatments. It sidesteps the probability of more successful treatments.
Others are overlooked. Take a soldier almost fatally burned, wounded or CBRN-poisoned fighting for his country and with a prognosis of no more than six months to live. Does not such a case equate to, or even trump, a peacetime terminal illness? What, then, of the military covenant? It is ignored, and that is just shameful.
The subject that we are debating is not solely about an adult seeking an earlier death; it is also about the friends and families, and others, who know the individual. Although the legislation addresses the former, the views, feelings and behaviour of the latter cannot be ignored. Even a 59-page Bill with more than 50 clauses, three schedules and ministerial regulations to come may not be foolproof against any venal behaviour.
Presumably for devolved reasons, this Bill covers only England and Wales. Were it a government Bill, would it be thus restricted geographically? The idea that a Dignitas equivalent might be arranged in one part of the UK for use by another is abhorrent. We do not control the time of the first breath in our life. Society places special value on the right to live. Since the abolition of the death penalty, should it be approved by law to time one’s last living breath?
Although I do not wish to set aside all feelings of sympathy, this Bill is flawed. As such, it is not worthy of enactment.
Lord Dodds of Duncairn (DUP)
My Lords, in my view, this Bill invites us to cross into completely new and dangerous territory. Although it has been argued that we already, in the law, allow for intervention, we would be permitting for the first time the policy and widespread practice of ending life by medical means. It would be a fundamental alteration in how we understand the purpose of medicine, the duty of the state and the value that we place on life itself. It is not the natural course of dying with support but the deliberate intervention to end life. If Parliament is to legislate on such a grave matter, the language we use should be transparent and precise so that the public understand fully what is at stake.
It is assisted suicide and we should call it for what it is. Human life carries dignity and meaning in every stage and circumstance. That worth is not reduced by age, illness or disability. When people fear pain, we must provide support for better relief. When they fear loneliness, we must ensure companionship and support. When they fear neglect, we should guarantee care. The solution to suffering is not to make death one of the prescribed remedies.
A number of issues have come up time and time again and it is right to emphasise them because they are at the heart of the concerns that people have. People have written on many issues. I thank people for getting in contact with me. A central safeguard is said to be the requirement of the six-month prognosis. We have heard about clinical prediction of life expectancy oftentimes being totally unreliable. It is an estimate, not a certainty. Doctors acknowledge that such judgments can be mistaken. If a person’s eligibility rests on a calculation that is inherently fragile, the foundation of the safeguard is insecure.
One of my main concerns, shared by so many people, is the pressure on older people. Even where explicit coercion is absent, people will feel that they should choose an earlier death to relieve others of responsibility or to reduce demands on family or care systems. Evidence from abroad shows that individuals frequently cite such considerations in their decisions. There will be a new and silent expectation on those who already feel vulnerable.
Then we are told that this legislation is narrow in scope. Experience indicates, as many noble Lords have said, that once the principle of assisted suicide is accepted, criteria will broaden, through later legislation, judicial rulings or medical practice shifts. Even if the Bill begins with limits, there is no guarantee that those limits will remain firm over time.
Regarding the safeguards that were outlined so fully by the noble and learned Lord, Lord Falconer, in his introduction, some of the most significant checks that we were told about were revised as the Bill progressed through the other place. Oversight has moved from established judicial processes to new administrative structures. Definitions have altered. Clarity has been reduced. There is much vagueness. Too much power has been given to the Government, through delegated legislation, to make regulations. Protections appear less certain, even before the Bill reaches the statute book. What confidence can we have in their long-term durability?
We must have regard to what should be our priorities. Across the United Kingdom, access to specialist end-of-life care remains extremely patchy. There was a conference in Belfast just yesterday on palliative care which illustrated the many deficiencies in Northern Ireland. Too many families still face inadequate pain management and insufficient support. Before contemplating a law that allows doctors to hasten death in a widespread way, our first responsibility is to guarantee that everyone can receive comprehensive palliative care of the highest standard. That is where compassion and justice should direct us.
No one who has listened to this debate can fail to understand that everyone who has spoken has compassion, but compassion must be joined with caution. Even those who agree with the principle of assisted dying or assisted suicide must acknowledge that this Bill is grossly deficient, even for that purpose.
Baroness Nicholson of Winterbourne (Con)
My Lords, I shall speak against the Bill and in support of my noble friend Lord Forsyth’s amendment, as amended by the noble Lord, Lord Carlile of Berriew. I speak as a former World Health Organization ambassador for Africa and the Middle East, and as chair of the AMAR International Charitable Foundation. The mandate of that foundation is health for all, as is the WHO mandate, and education for all, as is UNESCO’s mandate. In that capacity, with an outstanding board and uniquely committed professionals, we have in the last 35 years built 90 to 100 primary health centres and several small hospitals, and we have delivered medical consultations to 50 million people in greatest need. This has taken over 40 years, all in conflict countries: Afghanistan, Iraq, Iran, Lebanon, and Romania, Ukraine, Pakistan and Kashmir.
They are all local medical staff, so there has been no linguistic misunderstanding of what I am going to report. Working to WHO and UNESCO standards for the poorest of the poor in these conflict zones before, during and after their war, I have to report to noble Lords that not one single patient during that long time has asked for death. Every patient has asked for life, understanding, compassion for their suffering and, potentially, a future for themselves. The drive for life is so great that when I was in Damascus last week and saw skeletal figures on the street—I have not seen poverty quite like it for a very long time—they were not begging for death; they were begging to be given the opportunity to live. In other words, the thing to do is to bring joy to the patient who is in trouble and assist in every possible way to ease the pain—perhaps we should lift the restrictions we put in only a few years ago to stop medical professionals easing pain more easily—because the in-built desire to live is so great that in the most intolerable circumstances people beg to be kept alive.
The World Health Organization of course admits that the National Health Service is not yet perfect—for example, it has never really focused on preventive medicine, which is the key to success in the modern world—but this Bill destroys even that opportunity because it would take resources away and, worse than that, it would divert from the primary purpose of the National Health Service, which is to provide health and life to all. You cannot do both in any organisation. Those of us who have chaired companies, businesses and institutions know that you must have a single mission statement. You do not have a mission statement that tells you to turn right one minute and left the next. I recall very well a wonderful example of this from childhood that all noble Lords may remember, a tremendous animal that had a head both ends. It was called the pushmi-pullyu and was owned and looked after by Dr Dolittle. That is what will happen if we take this dreadful Bill before the House any further.
Humans are very imperfect creatures. We look at the example from Utah Valley University, a wonderful university I spoke at recently, where poor Charlie Kirk was slaughtered yesterday. Immediately, people said, “With what he said, he deserved to be killed”. Indeed, I do not wish to paraphrase it so precisely because the incoming head of the Oxford Union said something very like that, as did some local journalists. It is absolutely appalling. We are not perfect people. This Bill gives the opportunity for maximum damage to a huge number of individuals.
Baroness Uddin (Non-Afl)
My Lords, what a pleasure and privilege to follow the noble Baroness, Lady Nicholson of Winterbourne. In the light of the impassioned contributions in this Chamber already, I wish to speak as a mother, a daughter and someone who has worked professionally in suicide prevention. I speak with a heavy heart, acknowledging the hundreds of letters that have spoken of their pain and suffering in support of and in opposition to the Bill.
My beautiful, intelligent 46 year-old son and my equally magnificent 85 year-old mother live with various difficulties and disabilities. My mother has had numerous hospital appointments. They have taught me more about joy, courage and resilience than I could ever have imagined. To my horror, they have on several occasions been offered “no resuscitation” during routine medical treatment. State action such as this for the common good may give rise to fundamental consequences unintended by this Bill. It is lived experience that during Covid people such as my disabled son and my elderly mother, and many people of minority heritage, died in disproportionate numbers, often with “no resuscitation” orders in place on their records without their consent. It is not a surprise if alarm bells ring and fear is raised, as the noble Lord, Lord Rees, said.
That is not fearmongering on my part; it is documented disparity. The Bill, however well-intentioned, sends a powerful message: that in the future, if those people are seriously ill, they will be offered suicide deaths as a compassionate choice. I do not feel confident that the Bill provides safeguarding in wider practices in the real world, as promised in this Chamber by my friend, the noble and learned Lord, Lord Falconer.
This is not a hypothetical concern. In the jurisdictions mentioned that have assisted suicide—in Canada, Belgium and elsewhere—the cliff edge is real. Legislation designed as narrowly as this Bill has expanded rapidly to include, as a matter of choice, people with chronic mental illness and people choosing death not because of physical agony but because they are distressed due to their basic social condition, healthcare, and other state provisions. Such reality may add pressure on those who are already vulnerable and the poorest in our society, as a cloak of choice and relief. Many suggest to me that this is an absolute abandonment of every principle our society values as a fundamental basic right: the choice to live in dignity and care.
Supporters of the Bill say that this is about autonomy, but choice exists only where there is parity of palliative care. Sadly, that is not the case for many elderly people and the disabled. Many already feel a burden when community care, mental health support and other accessible services remain chronically underfunded and out of their reach.
I am all too aware of the agony and suffering. I do not dismiss grief, or people’s human desires to control how they wish to die. But we cannot build laws on the basis of those able to access influence at the highest level, including bringing this matter to our Parliament, which gives the appearance, at least, that we may be overlooking the future rights of the most vulnerable in our society.
This proposal is presented as a panacea of state care, but today’s compassion risks becoming tomorrow’s coercion, especially as health and welfare services continue to feel deep constraints. If the Bill passes, how long before my son or my mother are softly and subtly made to feel that perhaps it is time, as the cost of their care rises, that their life, however full of love, could and should be ended, dressed up as mercy?
Our duty to protect will be fundamentally compromised as the Bill carries the seeds of deep consequences. It will send a powerful message that the majority silent opinion no longer counts, and instead Parliament can be persuaded to legislate over life and death by influential advocacy, to which millions of voices in our country have no access or pathways. I thank your Lordships for your patience.
Lord Jackson of Peterborough (Con)
My Lords, as we heard earlier, this past Wednesday was World Suicide Prevention Day. Suicide is always a tragedy, and its effects profoundly felt by whole communities as well as the immediate family. As legislators, I believe we have a responsibility to affirm every life as having inherent and equal value, regardless of age, health, disability or circumstances. I believe we need to seek to prevent suicide, not facilitate it.
We have a national strategy for reducing the number of lives lost to suicide but sadly, the suicide rate in this country is the highest it has been in over two decades. It is almost unfathomable, therefore, that in the very week we should be shining a light on suicide prevention, we are considering amending the Suicide Act 1961—in Clause 32—to make it legal for the state to give drugs to people to hasten the end of their own lives.
Proponents of the Bill have tried to argue that legalising “assisted dying” will somehow reduce the number of unassisted suicides, but there is robust evidence to suggest that it has the opposite effect. Backers of assisted suicide in the Australian state of Victoria claimed it would prevent 50 suicides of terminally ill people each year. They won the argument. But, since the law was changed, unassisted suicide among over 65s—the largest demographic of terminally ill people—has increased by more than 50%.
You can see why. If the state tells the sick and elderly that suicide is a valid way out, some of those who do not qualify under the terms of the legislation will still feel that they should take that same way out, because it has been normalised. Our commitment to suicide prevention as a society depends on a consistent message that every life has meaning and value and is deserving of protection. Suicide cannot be both something we try hard to prevent and something we assist in some cases. That is nonsensical. For the state to tell certain suicidal people, “You’re right. Your life isn’t worth living”, is an appalling message. It is the ultimate in hopelessness and the very opposite of compassion.
According to the Royal College of Psychiatrists, suicidal ideation in terminal illness typically resolves once a
“person’s physical pain or associated fear of it is alleviated”.
But the Bill ignores our duty of care to these people. It sanctions death by poisoning for those who, with the right palliative care and support, would otherwise often choose to live.
The Bill will put vulnerable people under even greater pressure to end their lives for fear of being a physical, emotional or financial burden on others. We see this in Canada, where the medical assistance in dying law has become, in the words of an ME sufferer called Madeline, a “brutal practicality” for people seeking to escape poverty and social isolation. One 37 year-old homeless man applied for medically assisted death because, in his words, he felt “useless” and thought he was “hurting society”. Another woman, in her 50s, asked to die because she could not get adequate housing. Who wants to live in a society like that? This utilitarian way of thinking becomes normalised once assisted suicide is legalised. Polling shows that over one quarter of Canadians now think that it should be acceptable for people to seek state-assisted death as a solution to poverty and homelessness.
The current law exists to protect those who might otherwise feel pressured into ending their lives, and that is why we must keep it. We should be seeking to strengthen people in hope, respect their agency and give them the care and support they need—not affirming them in their hopelessness and giving them drugs to kill themselves. We need to ask: is this Bill really the best we can do for society’s most vulnerable? The Bill cannot be improved; it must therefore fail.
Baroness Bennett of Manor Castle (GP)
My Lords, I am speaking far into a frequently heart-rending debate that has included so much about agonising death and so many speeches that deserve to be noted, particularly that of the noble Lord, Lord Forsyth, about his father’s death and his own reflections on it.
I speak from a unique position, even as speaker number 85, for the policy of the Green Party of England and Wales is to legally provide, with all the appropriate safeguards, provision for assisted dying. But that does not in any way tie my hands, for the Green Party does not whip, so every vote is a conscience vote. That policy position was extensively debated in the party, and we heard a great many concerns from disabled people, people from global majority communities and people who fear they are discriminated against and badly treated in our current medical system and who fear discrimination here, too. I also heard fears from learning disabled people at an event I hosted earlier this month.
But as the noble and learned Lord, Lord Falconer, said, the safeguards built into the Bill mean that people are more protected in this than they are in other areas of healthcare. Imposing those protections right across our health service should certainly be a priority, as should fully publicly funded quality palliative care. Polling evidence shows that, overall, disabled people want the same rights as the rest of us when terminally ill.
To lay it out plainly, one of the chief reasons why I will support the Bill is that assisted dying is already available to people in Britain, but only some people: those who have the financial wherewithal and confidence to navigate foreign systems and travel, and the remaining health and capacity to get to Dignitas in Switzerland. That is a profound inequality that leaves some dying in the many harrowing conditions we have heard about today. As we have also heard, it means that people die alone, without their loved ones even knowing of their final choice, for fear of the legal repercussions for those they leave behind, and that people die sooner than they might otherwise because they fear being too ill to travel.
I oppose the amendment from the noble Baroness, Lady Berger, which I am afraid can be regarded only as a wrecking amendment, setting an impossible timetable for the Bill, as the noble and learned Lord, Lord Falconer, explained. I am not so sure about the obviously constructively intended amendment from the noble Lord, Lord Forsyth. I will listen to further arguments on that.
But, in addressing both of those, I want to make the point that, in progressing to make a new law—particularly a law of conscience such as this, as with the laws on access to abortion and the rights of LGBTIQA+ people—debate does not happen only in Parliament. As the noble and learned Lord, Lord Falconer, set out, this Bill has already received far more parliamentary attention than many government Bills. But debate and scrutiny does not happen only in Parliament: it happens in the media, in communities and now, of course, on the internet and social media. We should not discount the power and importance of that in shaping the law.
On the level of correspondence that I and many other noble Lords have received about this Bill—for me, hundreds of contacts—the balance of that reflects the views of the public in the polls. I thank all those who have taken the time to be in contact with me about this. That is people’s politics. If we look at the opinion polling, the people have a clear and settled view on the need for assisted dying to be available in the UK, rather than relying on the decisions already made by the people and legislature of Switzerland. The people expect politics to deliver on their view.
Finally, I have been asked to note that my noble friend Lady Jones of Moulsecoomb, who is on medical leave, is listening to this debate from home and wishes to put on record her support for this Bill.
Lord Ashcombe (Con)
My Lords, this Bill raises profound concerns for me, and I wish to outline five reasons why I cannot support it in its current form. First, although many of us have faced the death of loved ones, in my case I have witnessed the extraordinary comfort that high-quality palliative care can offer, both to patients and to their families. This level of care is not universally available, as we have heard. I consider myself extremely fortunate. Far too many people, due to underfunding and limited access, are denied this vital support at the end of life. When individuals are left without access to proper palliative care, they may begin to see assisted dying not as a choice but as the only escape from suffering.
My second concern is that, as people grow older, many lose confidence and become vulnerable. This leads them to being susceptible to subtle pressures—pressures that can arise from well-meaning family members and friends. More troubling still is the potential for overt coercion, where someone may be made to feel a burden or believe that their life no longer holds value, and thus opt for a path they do not truly want. How and by whom is this being evaluated?
Thirdly, even with the strictest safeguards, we must learn from the experience of other countries. In places like Canada and the Netherlands, as we have previously heard, we have seen a gradual expansion of the eligibility criteria far beyond the original intent. What begins as a tightly controlled process can, over time, become worryingly permissive. There are reports of individuals shopping around for sympathetic doctors, even when they are not terminally ill. This risks the potential of normalising suicide as a legitimate solution to human suffering.
Fourthly, I am deeply concerned about the position in which this Bill places medical professionals. Although I acknowledge that some doctors believe that helping a patient die peacefully is, in certain circumstances, an act of compassion, there is a stark difference between that and actively participating in determining who qualifies to die. I am particularly concerned that a doctor can raise the thought of assisted death with a patient without the requirement to also discuss palliative care. This means that discussing assisted dying alone could almost be considered coercion. It also goes against the current UK medical law—and the GMC—on informed consent, which requires doctors to discuss the various treatments and options for patients and give them long enough to consider these options. This is ethically very problematic and challenges the very foundations of the medical profession, which is grounded in the preservation of life. It runs counter to modern GMC guidelines and risks turning doctors into the gatekeepers of death, not life.
Finally, I worry about the broader cultural impact. Our society is built on the principle that every life has an inherent value, from the beginning to the natural end. This Bill risks undermining that ethos. It sends a dangerous message that lives of the elderly, disabled or chronically ill may be less worth living—that they are expendable when they are no longer seen as contributing or useful. I do not deny that there are tragic cases, and we have heard some today, where medically assisted death may appear preferable to prolonged suffering. But this Bill, as it stands, is not the right instrument. Its potential consequences are too grave, its safeguards too uncertain and its impact on our societal values too profound. For those reasons, I cannot support it.
Lord Macdonald of River Glaven (CB)
My Lords, when this question was last before your Lordships, I opposed any alteration to the present law, but I have changed my mind because I have come to believe that our present arrangements are discriminatory and hypocritical. These arrangements benefit one group by conferring upon them effective immunity from prosecution for assisted suicide and damage the rest by withholding that same immunity on what looks like an arbitrary basis.
To explain this, let me go back to my five years as DPP, when around just 100 cases involving assisted suicide came across my desk. We did not prosecute a single one of them. In some cases, this was because the bodies had been cremated in Switzerland and there was no firm evidence of cause of death. This meant that our first test for prosecution—that a realistic prospect of conviction existed—was not met. In other cases, bodies were repatriated for burial, and we had a cause of death—usually massive barbiturate poisoning. Here, the evidential test was clearly met. However, even where it is, there is a second test to consider, because prosecutors are given the discretion to determine whether a prosecution would be in the public interest. In each case, we decided it would not. Why? At a basic level, we felt that a mother, father, son or daughter asked to accompany a loved one to Zurich faced a choice that no jury would regard as real—what to do: to take your terminally ill, suffering daughter yourself and to stay with her while she died, or to leave her to be taken by somebody else? Even presupposing a rational English jury, following proper directions of law from a rational English judge, we believed that that jury would never convict a mother or father in that situation. In all likelihood, they would regard the intrusion of the criminal law into such grief as an abomination.
Since my time, my successors have invariably followed this reasoning except in cases of exploitation or other venality, which were never present in cases I considered. Indeed, my immediate successor, Sir Keir Starmer, was even required by the then judicial committee of your Lordships’ House in its last judgment before becoming the United Kingdom Supreme Court to publish guidance on the factors prosecutors would consider in determining where the public interest lay in assisted suicide cases. Like me, Sir Keir had resisted this step on the grounds that it would constitute the DPP issuing guidance to the public on how to break the law and get away with it.
But that is where we are. We all know that if you assist a suicide in Switzerland and avoid anything the DPP has categorised as an aggravating feature, you may be investigated but you will never be prosecuted. Of course, there are cases where improper pressure, greed or wickedness are involved, but these would remain serious crimes even were this Bill to pass. These few cases aside, it means that the reality is that the vast majority of assisted dying cases abroad have, in effect, been decriminalised, with notable help from the old judicial committee and no involvement from Parliament as a legislative body. That, in itself, is strange, but what is worse is that this dispensation—this de facto right to die—applies only to those with the physical ability, the wherewithal, family and friends willing to risk breaking the law to help them, and the knowledge to do so. Those who are too ill to travel, who do not have the wherewithal, who cannot find anyone to help them or who are simply unaware of the extreme unlikelihood of prosecution are left to suffer in the UK. They are abandoned by a state that is unwilling to put the current law into practice yet equally reluctant to ensure the benefit of its studied inactivity is available to all. In my view, this represents an abuse of the cardinal principle of equality under the law and it can be addressed only by provisions of the sort contained within the Bill.
Baroness Maclean of Redditch (Con)
My Lords, as I speak towards the end of the day, the range of the arguments has been thoroughly rehearsed. I want to focus on an uncomfortable truth that most of us do not want to admit, even to ourselves: the issue of human nature and the evil that is in every human heart. I pay tribute to the noble Lords, Lord Grabiner and Lord Sandhurst, and to the noble Baroness, Lady Nicholson, who touched on this in their contributions.
As we gather here every day, we pray the words that Christ taught us,
“lead us not into temptation; but deliver us from evil”.
It is this that has informed my strongly held opposition to the Bill. No amount of additional scrutiny or legislative tweaks would make it acceptable, because I oppose the principle of assisted suicide. As a Christian, my faith shapes my view, but not from a rigid doctrinal perspective. Rather, it is through reflecting on the teachings of Jesus, who knew humans are capable of great love but also of great evil. We pray “deliver us from evil” because we know that, without God’s help, we are too weak to resist.
It is much too easy not to be honest about human nature. We pretend that all families are happy and that all children want the best for their dying relatives. We have rightly heard much about elderly people not wanting to be a burden, but we have not talked about putting temptation, at a very distressing time, in front of otherwise good and moral people. No amount of safeguards can take away the temptation to kill off one’s relatives under the euphemism of “assisted dying” to get hold of one’s inheritance. Care home fees are eye-wateringly expensive, and one can see how easy it would be to say that she or he “would not have wanted to live that way”, and no one would ever need to know. We cannot know how we would behave under these conditions of extreme temptation. Let us remember in our human history where we have witnessed human beings carrying out unspeakable acts of wickedness and violence against one another.
Supporters say that the Bill is narrow and safe, but the evidence from abroad does not persuade me. It tells me that, no matter how many safeguards are introduced, we cannot escape human nature. How often in this place, and in the other place for those of us who have been Members of Parliament, have we heard about so many terrible things happening and authorities letting people down? We gather together and say that such and such a terrible thing must not happen again and that we must introduce safeguards, but I am afraid that too often it does. However, we are not destined to repeat these actions, which I am convinced will lead to more suffering and more pain.
We have talked about vulnerable people, and I want to add my words about victims of domestic abuse. Coercive control in particular is extremely sophisticated. Abusers are perfectly capable of manipulating their victims to convincingly express a wish to die, and by the time the courts, with their delays, have caught up, it is too late.
This debate is about what kind of society we want to be. Do we hold to the truth that every life is made in the image of God? Are we able to be clear-eyed about the capacity to do the evil that lives in all of us, even though it is extremely uncomfortable for us to admit, especially in this Chamber? I know my view, and that is why I do not support the Bill.
Lord Purvis of Tweed (LD)
My Lords, the right reverend Prelate the Bishop of London said this morning that to change the law is to change society. The reality is that society has already changed, and it wants us to change the law. When the House of Commons passed the Bill, the Daily Express newspaper hailed the success of its campaign. Some 21 years ago, when I lodged my Bill in the Scottish Parliament, the entire front page of the Sunday Express—coincidentally on 12 September—shouted:
“MSP in bid to change law to kill patients”.
The death threats I received as a consequence seemed rather ironic to me. So some people have changed their minds over the years, even in the Church, as up to 2017, it denied someone a Christian burial if they died by suicide.
However, the Bill does not concern people who choose to end their life; it concerns those whose life is ending and the choices that they are denied to make that ending better. The arguments I heard in opposition then asserted that palliative care was either the answer or part of the answer, but I think we all know that, even with comprehensive and universal palliative care, there would be times where someone would prefer not to die through sedated starvation. You can prescribe morphine, but not personal dignity. A common argument I heard then was just to allow doctors to quietly ease the passing of people—do not interfere. I do not want an approach to the permanent turning of a blind eye to potential coercion and denial of transparency and protections.
Twenty-one years ago, police and prosecutors rigorously investigated and prosecuted those loved ones for travelling abroad because this enforced the law on assistance. I argued then it was unjust. Now, as we just heard a few moments ago, this is considered unheard of. I have not heard any calls today to return to the approach taken before then, nor have I heard any argument to return to the approach where a patient did not have the right to an advanced directive, to reject a doctor’s insistence on resuscitation or to refuse food and hydration. In their own right, all these changes are accepted by opponents of the Bill, but they provide for an inconsistent, unfair, confusing and, too often, inhumane legal framework.
These inconsistencies within England and Wales will be alleviated by the Bill, but they also exist where I live in Scotland. Liam McArthur MSP is, with great care, taking his measure through the Scottish Parliament. I hope it passes, as I hope this Bill will here. Perhaps because I live on the Scottish border, I note that we will need to address the cross-border issues of residency for those who live in one country and receive services in another. This concerns adult competences laws, the interaction of devolved and reserved competences and the relationship between health bodies south and north of the border. None of the issues that we need to resolve is prohibitive or should in any way block progress. Indeed, it is the reverse, as they will assist operability.
I do not question the motives of those who have principled objections to the Bill, but I note that they favour the current legal right to allow a patient, either by choice or through persuasion that they are a burden, without full reporting or transparency, to decline food and water and to die of sedated starvation. I do not want this carrying on for another 21 years.
The Bill is not about people choosing to die. They are dying. Indeed, the point missed by many is that this debate is about people who do not wish to die. How someone dies impacts on how their loved ones live the rest of their lives. A better final few days, with dignity, love and care means that loved ones remember their life lived and less so how it ended.
Lord Jamieson (Con)
My Lords, I wish to raise two concerns with the Bill. The Bill seeks to prevent coercion, but that is a high bar. My concern is with undue influence. As with many others who have been elected, I came across many elderly, vulnerable and lonely residents. Often, they lacked the support that they should have had and needed. Yet, they voiced concern that they were a burden to their family, to their friends and to society.
I combine this with the risk of undue influence being brought to bear. One of my earliest experiences as a councillor was with an elderly lady who went into hospital for a major operation. She had few relatives and gave one of the few relatives she had left power of attorney. The operation was successful, yet the relative put her into a care home and sought to sell her home. Fortunately, she had good friends who managed to nullify the power of attorney, and she returned home. This may be an extreme case, but it demonstrates the risks, and I have other less extreme examples of relatives seeking to gain their inheritance sooner.
My second concern is the role of the NHS. The NHS is a large and complex organisation. It already has a great deal of difficulties in delivering its current roles. From a personal perspective, I have had several family members being treated for cancer and, despite many good staff, all too often it felt like they were being treated as a unit and not an individual. In the case of my mother, palliative care was only available eventually. I know that both my noble friend Lord Bethell and the noble Lord, Lord, Stevens, have raised the issue of the capacity of the NHS to implement this Bill. In my opinion, the NHS’s whole focus should be on the health and well-being of the individual; it should not have an additional role, to kill people. If this Bill were to progress, its delivery should be entirely separate to the NHS, and I intend to table such an amendment.
Baroness Wheatcroft (CB)
My Lords, the strength of feeling on this issue is understandable. Rarely do we get to debate such a truly momentous issue. But in the end, this is a question of personal choice. No one is suggesting that assisted dying should be mandatory, nor even that it should be widely available. In fact, under this Bill, few might be eligible to ask for it, let alone choose to take up the option. All that this Bill would do is make it possible for a dying person to die the death they want. I do not believe that it is my right, or the right of any of us in this House, to deny another individual that option.
Could anyone have been in Milbank House on Tuesday listening to Nathaniel, now battling with pain in order to continue walking while he can still move his cancer-riddled body, and deny him what he craves: the certainty that, when he can cope no longer, he can have the death he chooses? It is, he says, his dying wish that this Bill should become law. Barely 40, until very recently a music teacher and marathon runner, he says that he is receiving excellent palliative care. He does not wish to die yet, but when life becomes intolerable, he wants an assisted death. He is anything but suicidal, and the use of that word is an emotive effort to confuse two very different things. Nathaniel does not want to kill himself; he is dying already.
Many noble Lords have talked of the need for investment in palliative care. That is not a matter for debate. We all want investment in palliative care. Assisted dying should be viewed as merely part of a palliative care package. Palliative care cannot always deal with all pain. One of the many letters I received on this subject said: “No matter how good we can make palliative care, there are always those for whom the experience of terminal illness and dying involves suffering that cannot be alleviated nor endured … We need both good palliative care and assisted dying to be available”. The author of that letter was a former hospice director and consultant in palliative medicine.
Sophie Blake has been a vigorous campaigner for better palliative care and for assisted dying. She does not want to die, despite the pain that she suffers from multiple cancers, but she is allergic to opioid painkiller, which makes pain relief difficult. She is terrified of going through excruciating pain when she does die. But worse still is the fear of her daughter watching that, so while she fights for better palliative care and for her life, she is desperate for the right to have the peaceful and dignified death that this Bill could deliver for her. I want to be able to reassure Sophie, Nathaniel and others that I will help to give them the reassurance they crave, and that I could not give my own mother when she was dying.
During the course of this long and balanced debate—and we are only halfway through—many have voiced concern over a lack of safeguards, but there are safeguards, and there will be more. The Bill is not perfect, and this House will do its job: scrutinise it and improve it where possible. But we need this Bill to move ahead quickly. I support it.
Baroness Lawlor (Con)
My Lords, this is a difficult and controversial Bill, not only because of the substantial amount of delegated legislation, the problem of skeleton legislation and the lack of adequate pre-legislative scrutiny, as committees of this House have pointed out and as the evidence presented by lawyers and academics, including at the think tank where I am research director, also points out; and not only because of the magnitude of the proposed change and the potential impact to which your Lordships have drawn attention—even though this has no electoral mandate, which would have allowed for pre-legislative consultation and debate nationally, which is not guaranteed by opinion polls. Most important of all, the Bill fails to recognise the nature of and basis for the law in the fundamental matter of life and death.
Once assisting suicide is allowed, it becomes impossible to detect cases where more than assistance is provided and someone is in effect induced to kill themselves. This is a criminal act, but under this Bill it becomes impossible to police. As the Chief Coroner has recently pointed out, the Bill removes any realistic prospect of an effective inquest. The Bill also ignores the moral and religious underpinning of a historic tradition based on the principle that the life of each person is sacred, irrespective of how much or how little value may be put on it by others, or the state, or whether that life has a cost to others. Without such a premise we risk a descent into barbarism, where human lives may be done away with as fast as battery chickens: by category, by age, by disability, or on account of mental and psychiatric condition. Indeed, the mask proposed by the dramatic change in the law in the Bill—the veneer of strict conditionality and the obligation for the person himself or herself to want to commit suicide and prove consent—reveals an ignorance of the very nature of our society.
Society is based on kinship, on interdependency, on networks of support, both in the private and the public sphere, and ultimately on trust. It is underwritten by tradition and conventions which for centuries have been given the protections of the law. At the basis of this whole structure, though it is unfashionable to say so, is the conviction that human life is sacred. Despite the Bill’s conditions, its alleged limitations and restrictions, it strikes a hammer blow at a civilisation supported until now by law, custom, kinship and trust throughout the centuries, whether in peace or war, but now struggling to keep afloat.
Lord Mitchell (Lab)
My Lords, on 9 October 2000, my parents-in-law, Jack and Ruth Lowy, committed joint suicide. He was dying and she had decided to accompany him on this last journey. Jack was born in Bratislava in what was then Czechoslovakia. The family were Jewish and following the events in Munich in 1938, they fled to Philadelphia. When war was declared, Jack went to Canada and joined the Czech division of the RAF. He survived a punishing war and then worked for British intelligence.
Jack went to Cambridge as a demobbed airman and became a brilliant scientist, a professor in biophysics, specialising in the movement of muscles. His work required him to conduct experiments on animal tissue. He spent much of his time using X-ray refraction in his lab at King’s College and at the Daresbury synchrotron in Cheshire. In those days, no one quite understood the long-term dangers of radiation, and protection was rudimentary. For him, it was fatal. In 1998, he was diagnosed with acute myeloid leukaemia, which he knew was terminal. He told me, in his usual blunt way, “I know how this story ends and it is not pretty. I’m bloody well going out with my boots on”. Not much room for doubt on that one.
As he became weaker, they both cut themselves off from us, gradually then completely, so as not to involve us in their deaths. Letters were returned, emails bounced back, and telephone calls went to the answering machine. We were bereft. We had no one to talk to and, to be honest, when we tried, no one believed us. When we said there was a chance that Ruth would commit suicide along with him, people shook their heads in disbelief.
My wife in particular sensed that they would carry out their wishes. After all, they were both intelligent people who had carefully thought this through. There was no one to support Jack and no one on hand to help Ruth in what must have been hell for her. The main practical problem for Jack was procuring enough barbiturates to ensure one and then another successful suicide. He found a way. Being the scarred Holocaust survivor that Jack was, and the brilliant scientist that he had become, there was no way he was going to get the dosage wrong.
If there had been assisted dying legislation at that time, I am certain that things would have turned out differently. We could have talked about it openly, without the fear of legal consequences. We could have engaged professional help. I cannot be certain about my mother-in-law’s motivation to join him, but they both knew that his own suicide at home could well run the risk of her being charged with committing a crime as an accomplice. What I do know is that had this Bill been law, she probably would have chosen life. My family would have been spared a double bereavement that was unnecessarily brutal and psychologically damaging for us all. Not surprisingly, I support the Bill.
Lord Evans of Rainow (Con)
My Lords, it has been a great privilege to sit here all day and listen to noble, and noble and learned, Members of this House. The problem is that when you are the penultimate speaker, most of the good ideas and suggestions have already been made. I pay tribute to my noble friend Lady May, the noble Baronesses, Lady Falkner and Lady Hunt, and indeed the noble Lord, Lord Stevens, on his very good point regarding palliative care in England and Wales, which is highly relevant to this debate.
I am concerned about the fundamental shift that the Bill will cause for our relationship with the medical profession. As legislators, we owe it to the public who will be impacted by the Bill to think through all consequences carefully, whether intended or not, and to think about who we will empower to pass legislation.
If this Bill passes, we will be moving from an NHS where doctors are focused solely on healing to an NHS where, when the conditions of the Bill are met, any individual doctor with no specific training can raise ending a terminally ill patient’s life with the state’s endorsement, no matter how vulnerable the patient. We place a lot of trust in our doctors and healthcare professionals to seek what is best for us, and the Bill risks the implication, if not outright declaration, that ending your life early is a suitable course of NHS treatment.
The honourable Member for Sleaford and North Hykeham in the other place, who is an NHS consultant doctor, reflected on this issue of how patients interact with their doctors during the debate on Report:
“As a doctor, I am very aware of the trust that the public place in doctors and the seriousness with which they take what we say. If a doctor gives somebody information about assisted dying, it is quite reasonable for that person to think that the doctor is suggesting that they should take part in that process, or is hinting that their death will be dreadful and trying to be kind. If doctors are allowed to say, ‘This is a good process,’ more people will take it up than would otherwise have wanted to”.—[Official Report, Commons, 16/5/25; col. 646.]
I know when I go to the doctors, I assume that the doctor before me will be there to help my health and recovery and nothing else. That should be our experience. Any threat to this kind of relationship between the medical profession and its patients must be rejected. We cannot afford to fundamentally rewire the NHS to the effect that the public will no longer be sure that their recovery is occupying the totality of the doctor’s thoughts, or will worry that in a cash-strapped NHS trust, somebody is calculating, as set out in the impact assessment, that £13,000 could be saved per patient for every four months of unused healthcare for the cost of a £14 prescription.
As this Bill passes into law and establishes assisted dying as a regulated and approved treatment, something commonplace, we will have to be sure not just that systems and process are beyond reproach; many professionals at all stages on their career will have the opportunity and ability to put patients on the route to an assisted death. This means that we will have to have faith in the competence and professionalism of every individual. I have no problem, having closely interacted with three NHS trusts as a Member of Parliament, in saying that some of the most dedicated people in our country work in the NHS. However, I would be delusional to pretend that that is universally true. I have seen deeply worrying cases where one bad apple was simply shunted from job to job. As with all institutions, doctors are fallible human beings. Mistakes will be made through exhaustion, misunderstanding and, yes, in some cases, malice.
Yet advocates for this Bill would have us reject common experience. When the Member for Vauxhall and Camberwell Green raised the point on Report that many constituents
“have grave concerns about the way in which they are treated, because they feel that they do not have a level of equality within our NHS”,
the Member for Solihull West and Shirley rejected it as
“rhetoric that engenders a fear around the medical profession”.—[Official Report, Commons, 16/5/25; col. 651.]
We must not underestimate how much power this will put into the hands of, potentially, very junior medical professionals, and the scope of impact that a very small cohort can have. That is evident in the international jurisdictions with similar regimes. According to an official report in 2021, a single doctor in Oregon wrote one-eighth of all assisted dying prescriptions. In Victoria, according to the Voluntary Assisted Dying Review Board, during 2023-24 10 doctors handled 55% of all cases. This Bill should not pass in this current form.
Lord Hogan-Howe (CB)
My Lords, as the noble Lord, Lord Evans, has indicated, everything has been said—but, obviously, not yet by me. For me, it is a simple matter of choice. I support this Bill. It is a choice to end your life at a time of your choosing, when all hope of survival has gone; a choice to ensure that your passing is peaceful and controlled; and a choice, as far as possible, that it occurs where you would prefer, with or without the people you choose to be present.
At the moment, people have that choice, as people have mentioned, to travel to a jurisdiction in which it is legal, but that choice is hampered by conditions. If you wish to travel to Switzerland, you will need to be able to afford a ticket and, if you are in prison, you will not be able to travel at all. You will probably need someone to accompany you and help with the arrangements, and those people need to risk an investigation and prosecution. It is not about whether the prosecution takes place; it is about the investigation that you are under and the family who are affected for the time that it takes to decide that you have not committed an offence. Finally, something that has not been mentioned too often is the fact that you need to be well enough to travel. Of course, illnesses progress, and not always at the rate at which medical people expect, so it can remove that possibility at a time when you most need it.
If those three conditions are not met—if you are poor, alone or already extremely ill—you do not have that choice. Why do only the rich and the well enough to travel have a choice? That cannot be right. Even for those fortunate enough to travel, they have to end their life in a foreign place, which is clinical, cold and anonymous, when they could have been at home, in the home they have enjoyed, surrounded by the people they love and the animals they probably regard as family.
Those who oppose this Bill say that better palliative care should remove the need for assisted dying. I do not accept that, because there have been too many cases where palliative care did not work. I agree with the noble Lord, Lord Stevens, in particular, who said that we should have far more palliative care. There is an irony that, while 100,000 people do not have that opportunity, they are probably more in need of this option. To sit in a room and say to them, “We can’t ease your pain, but we might provide more palliative care in the future, but that is probably five to 10 years away”, is hardly a conversation that I would like to have with the people affected by it. Each one of us might want to imagine that we have to have that conversation, because that is the power that we hold in our hands. For me, it is not for doctors to say what a dignified, pain-free death is; it is for the person who is suffering that trauma to decide when enough is enough.
It is said that people may be induced or pressurised to go early. I am afraid that the risk of that outcome is already with us. If anybody imagines that no one is being pressurised at home to go early, they are naive. However, this provides the possibility that someone could intervene, should that be happening against someone’s will, and gives an option that might provide a better end than someone is anticipating.
People could of course take their own life, and I have seen people take their own life when all hope is lost. It is not attractive; they are not in control and they usually do it in a way that affects many other people. Then, of course, their families are left with all the uncertainty and pain that that can bring to them, when they have not been there or had the opportunity to make sure it is a far better end.
I will mention something very briefly. Once or twice today, I have heard people say that suicide is wrong. That is the underpinning of why we used to say that attempted suicide was a criminal offence. I do not think it is wrong. It may not be the best end for anybody, but I understand why people come to that conclusion. It is a very brave decision for those who make it and I do not think we are right to say it is a wrong thing.
Finally, we are told that 80% of the population support this Bill, and that matches my own polling with people I meet. This is a moment of conscience for all of us to vote according to our best judgment. However, that does not mean that anyone should try to stop the progress of this Bill by procedural mischief or interminable debates. If the Bill is voted down, that is what democracies do. It would be very unwise and unfair to prevent the opportunity for this vote.
So I support the Bill. The time has come to be more humane to the dying, and this Bill achieves a humane solution to the most awful problems at the end of our time on Earth.
Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)
My Lords, it has been a long day at the end of a very long week. As we adjourn our proceedings, I am sure all noble Lords will join with me in thanking the catering staff, the attendants, the clerks, Hansard staff, the broadcasting unit, the police, security staff and the doorkeepers for their excellent support in keeping the House operating and keeping us safe. With that, I beg to move that the House do now adjourn.