(2 days ago)
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Baroness Thornton (Lab)
My Lords, it is indeed an honour to open the second day of our debate on the Terminally Ill Adults (End of Life) Bill. I pay tribute to my honourable friend Kim Leadbeater, who represents the seat in which I was born, for bringing the Bill to us from the Commons. I thank my noble and learned friend Lord Falconer for the clarity and excellence of his introduction to, and leadership on, this Bill.
As my noble friend the Chief Whip said, last Friday’s debate was outstanding and the House of Lords at its best. There are many questions to be addressed as we do our job in scrutinising the Bill, and the questions posed come from those of us who support the Bill and those who do not.
I am greatly relieved that my noble friend Lady Berger and my noble and learned friend Lord Falconer, in their joint email to all Peers, say that their agreement will allow the Bill to go through all its stages in your Lordships’ House. With respect to those who disagree in principle with assisted dying, it is important that we remember that the Bill came to us from the Commons, and has undergone significant scrutiny and change. Our job is to scrutinise it further and improve it if we need do so. It is not our job to kill this Bill.
I was saddened last week when the noble Baroness, Lady May, spoke about this being a suicide Bill. People have written to me in the last week, very distressed. They add things such as, “We are not suicidal—we want to live—but we are dying, and we do not have the choice or ability to change that. Assisted dying is not suicide”.
I hope that today the House will continue to conduct this debate with compassion. I shall read an extract from one of the many letters that I have received, which explains the importance of compassion; I cannot better it. This concerns a woman, Pamela Fisher, a lay preacher in the Church of England and who has terminal cancer. I am reading these words with Pamela’s permission. She says:
“I live in terror at the prospect of how my final weeks of life may be. I have seen other family members (brother and father-in-law) at the end of their cancer journey, and I know what may lie ahead. Even the best palliative care has its limits. This is the dead weight of fear that I carry around with me, all the time.
I am not asking anybody to help me to shorten my life. In supporting the Bill, I seek to have the choice to shorten my death in my final weeks should my pain and suffering prove unbearable. As a Christian, I believe in loving my neighbour as myself and, on this basis, I seek the same choice for eligible others.
As a lay preacher, I cannot reconcile Christian compassion with the status quo that obliges people to suffer a drawn-out process of dying in pain when this is against their will and they have the capacity to choose. Church leaders often apply the concept of the ‘sanctity of life’ to resist assisted dying. The sanctity of life is rightly central to Christian faith. For me, the sanctity of life is about honouring the life of every individual, and this necessarily includes providing the care and treatment they need including, of course, excellent palliative care. I reject the assumption that the sanctity of life requires terminally ill people to undergo a distressing and painful death against their will.
I am asking for you to support this Bill. It would be tragic if the Bill were to fail now, having passed through the Commons with a clear majority. It would be personally devastating for me and for countless others. The majority of the UK population supports the Bill, and there is also a majority among Church of England congregations, despite the Church leadership’s energetic lobbying against the Bill.
Please remember, this is not about shortening life; it is about shortening painful and distressing ways of dying. Despite the best palliative care, around 20 people die in agony and/or awful distress every day”.
This is Pamela’s plea for compassion, and mine too.
Lord Deben (Con)
My Lords, the House will know that I have a moral position on this, but I am not going to talk about that.
This has been a most remarkable debate, and all of us from both sides have learned from what has been said. What has come out of it seems to be, first, that this is a very difficult issue. Secondly, although other countries have tried to do this, no one has produced an example of saying, “That’s where it works”. Instead they say, “That needs to be changed” or “There’s a problem”. Yet we are trying to debate this serious matter on a Private Member’s Bill that was inadequately dealt with in the Commons and has been criticised seriously by two of our expert committees.
What we are trying to do is momentous because we are seeking to depart from what has always been our attitude—apart from the question of capital punishment, which I fought against for many years—by empowering the state to kill. You can argue that, but let us realise just how serious it is.
I was an MP for 40 years and met wonderful people in both my urban and rural constituencies, but I also met people who felt that their old relations were a terrible burden and were spending money that would be much better left to them. I do not think we can ignore that fact, and I disagree with my friend, the noble Lord, Lord Dubs, when he suggested that somehow or other this was inconceivable. I put it to the House that not only is it conceivable but it is increasingly dangerous, because many families who have never seen any real money now see an aged relative who has a house worth £200,000 and more. There is a temptation for those people, whom I know and have met, to say to that person, “You really have a duty to save this money for your family. You know that Roger’s got a real problem and you can help him. This is what you should do”. No doctor is going to be able to analyse what has happened over a long time; the incident that we are discussing is very often at the end of a long period, when people come to that decision with that kind of pressure.
I am sorry that that is the case, and it is the case in a society that has far too many people about whom it has been suggested, because they do not work, are not worth anything. We must recreate the worth of all of us and the place that we all have in society. I am an individualist and a Tory, but I have to say that I see individuals as living in a society, and that means that we have responsibilities. It may be—I say this with due humility—that the contribution to society that someone in great pain may make is to protect vulnerable people by bearing that, in order that they will not be destroyed.
Baroness Parminter (LD)
I support the intent of the Bill to increase personal autonomy for those with life-limiting illnesses, but good legislation must provide adequate protection for the vulnerable, including those with eating disorders. The malnutrition that accompanies anorexia means, as the noble Baroness, Lady Debbonaire, said, that if treatment is delayed or refused, the physical condition of someone with a mental illness can deteriorate to a life-threatening degree.
Starvation of the brain causes distorted thinking and severely impairs how a person weighs up information. I remember vividly when our daughter was in the grips of severe anorexia. She could debate proportional representation with me, but she was adamant that she would rather die than put on weight. Yet, in countries where assisted dying is legal, lethal drugs are being given to people with this condition, which has a well-established link to depression and suicidality, despite the fact that, with the right treatment and support, recovery is possible even after many years of having the disease.
According to a systematic review of the available evidence of assisted dying published in Frontiers in Psychiatry, eating disorders are being classed as terminal, and at least 60 people with them have been helped to die. To be clear, that is in countries where, as this legislation proposes, assisted dying is legal only for those with a terminal illness.
In the debates in the Commons, Kim Leadbeater MP said she did not want people with anorexia to be included within the scope of the Bill and I agree, but, as it stands, they are. The Royal College of Psychiatrists has called for the Bill to be amended so that it explicitly states that the physical effects of a mental illness such as an eating disorder would not make a person eligible. I urge noble Lords to heed that call. Vulnerable lives must be protected if we are to take this momentous step.
Lord Curry of Kirkharle (CB)
My Lords, it is a great honour to follow the noble Baroness, Lady Parminter. We are at a crossroads and must decide what kind of a nation we want to be. We have long believed that human life is sacred, worthy of dignity and respect. This has been enshrined in the biblical foundation of our laws. Some would say that this belief in the sanctity of human life is outmoded, and only compelling if you hold old-fashioned religious views. As a Christian, I strongly adhere to those beliefs. What happens if we reject this fundamental principle, which has served this nation so well for so long? Is it not time to bin this old-fashioned view of life? To do so, in my view, would undermine the very foundation of our societal values.
Writing in the Times recently, Matthew Parris argued that the elderly and infirm are a drain on resources and that it would be “a good thing” if they felt the unspoken pressure that their “time is up”. This kind of attitude will lead to an economic evaluation of human life, carried out against the backdrop of the crushing weight of the pressure on the NHS and the nation’s finances. There is absolutely no question that the Bill, if passed, will devalue the importance of human life, and economics will become part of the decision-making process.
The NHS will save money, and families will protect their inheritance, as the noble Lord, Lord Deben, said. It has been estimated that the Canadian Government and their provinces are now saving at least $150 million a year as a result of assisted suicide. As we know, the scope for eligibility continues to be expanded there, and the same will happen here. I am not at all reassured by the Bill’s sponsors about restricted eligibility. The slippery slope will become a reality, for sure.
We must not dismiss the deep concerns that many in the medical profession have expressed about the Bill. So many individuals and organisations have flagged that they are either opposed to the Bill or extremely worried about aspects of it, including most of the royal societies, as has been mentioned a number of times in the debate. This is deeply concerning.
It became apparent last Friday that some supporters of the Bill believe that amendments in the Commons might prove the Bill to be “unwieldy if not unworkable”, to quote the noble Baroness, Lady Murphy, who said there is already
“too much bureaucracy and oversight”.—[Official Report, 12/9/25; col. 1797.]
in the Bill. Others—I agree with them—consider that the Bill needs lots of additional safeguards, including to protect those with mental illness, eating disorders, disabilities, communication difficulties and so on. Not only is the Bill currently not fit for purpose; it will become completely unworkable when amended even further.
If we continue down the road enshrined in the Bill, we will not only devalue the precious gift of God-given life; we will see people who could live for years dying early for want of compassion, depriving them, their families and society of their valuable contribution. This is not an exact science. Freedom of information data from the DWP shows that one in five people who qualify for end-of-life benefits are still alive three years later.
The noble Lord, Lord Forsyth, referred to his father in his contribution. As I recall, he also did so the previous time we debated this topic, and I referred to our daughter, who died aged 42 in 2013. I would get very emotional if I explored that further. I mention it because we all have personal stories and family experiences that have shaped our views, for or against the Bill, but we have to stick with principles. If we support it, we risk diluting our sympathy and concern for the elderly, the frail, the disabled and the depressed, seeing them as a drain on resources when they opt to live at society’s expense rather than conform to the new norm and opt to die. The Bill is dangerous and a retrograde step.
The Lord Bishop of Chichester
My Lords, it is a privilege to follow the noble Lord, Lord Curry. I begin by acknowledging reverence for all contributors to this debate, which touches on our deepest emotions: lacrimae rerum, the things of which tears are made.
The noble Lord, Lord Carlile of Berriew, reminded us that, since the end of capital punishment, causing the death of another citizen is not allowed in our law, other than in war. The noble Lord, Lord Herbert of South Downs, was not alone in describing the introduction of a provision in law to cause death as a “crossing the Rubicon” moment. Although the right to life, enshrined in law, is a moral principle consistent with the Christian faith, it should not be regarded as the imposition of Christianity on the pluralist democracy we are proud to be. However, many Christians, including myself, see the Bill as crossing the Rubicon, and this is why.
Christians derive commitment to the sanctity of life from our understanding of the very nature of God as Trinity: three persons, not begotten or made of material substance, one in nature and omnipotence, but distinct persons in the relationship of Father, Son and Holy Spirit. Distinctness and relationality in God also become characteristic of how and what, in love, God makes us to be as human beings, endowing us with free will and the capacity to use or misuse God’s gift of life in all its dimensions. A unique likeness to God, which encompasses an immaterial, spiritual dimension, subsists equally, we believe, in the flesh and blood of every human being. This is a foundational contribution to the common-law prohibition of homicide, and it consequently inhibits us as Christians from supporting legislation to take the life of another person, as envisaged in the Bill.
Furthermore, the Bible repeatedly identifies compassion as essential to the nature of God, so human suffering, especially around the end of life, compels us to press ever more urgently for significant, increased and sustained investment in palliative care and to learn lessons from the hospice movement’s attention to the qualities of distinctive, individual needs and relationships, in sharp contrast to the complex bureaucratic processes outlined in the Bill.
Our scrutiny of the Bill must also assess its disproportionate effect on many people, which the noble Lord, Lord Deben, referred to, who already doubt whether they are valued and understood—people, for example, in the outer estates of coastal towns and the shadowlands of rural villages where I minister in Sussex. The Bill takes from them the law’s protection of their right to life. It is a fundamental assault on their dignity.
When Pope Benedict XVI addressed Parliament in 2010, he asked where the ethical foundation for political choices was to be found and whether social consensus was a sufficient basis for addressing the moral dilemmas, considerable as they are, of the present age. Beyond a limited degree of social consensus, I do not see a solid ethical foundation for what is presented in the Bill. Human dignity demands of us better treatment.
Baroness Blackstone (Lab)
My Lords, I have spoken in favour of assisted dying in previous debates in this House, and that is still my position. Therefore, I am grateful to Kim Leadbeater MP for her work in steering the Bill through the Commons. We must not forget that the elected House has supported it; our task is to scrutinise, not reject it.
Like my noble friend Lady Thornton, I was concerned at proposals last week for a Select Committee, which might undermine the agreed timetable for such scrutiny in Committee. After so many years considering assisted dying, whether in Select Committees or Private Members’ Bills, it is now important that we complete the process. Therefore, I am grateful that my noble friend Lady Berger has agreed to a committee that is limited in scope and time, allowing the Bill to go through all stages before this Session ends.
With a view to improving the Bill, I welcome the opportunity to look into procedures and safeguards, calling evidence from experts. I am impressed by many of the contributions made so far, including some speeches from those not in support of the Bill. However, I regret the language used sometimes, such as references to the “killing Bill” or the “assisted suicide Bill”. Because of my personal experience, I am affronted by this.
When my former husband, in hospice care, was dying of stomach cancer at the age of 44, in agonising pain, with terrible nausea, too, he desperately wanted it to “come to an end”, as he put it, and asked for my help. I tried to persuade his carers to speed up his death, but failed. Is this “killing”? Was his wish to die “suicide”? Surely not. He loved life and had not wanted to die, but he was dying and, when life became truly unbearable, he longed for death. Because of the law, I could not help him end his torture.
As legislators, we have a duty to consider public opinion. Rigorous surveys all report high support for the Bill, ranging from 73% to 80%. The Nuffield Council on Bioethics set up a citizens’ jury on assisted dying earlier this year. Support for law change actually grew over the eight weeks of deliberations, when participants heard views from all sides. There are also large majorities in favour of assisted dying among Christians and those of other faiths, as well as disabled people.
Some speeches have referred rightly to the inadequacies of the status quo. Prosecutions of people who admit to helping a close relative die usually end in juries refusing to convict. Laws should not remain on the statute books where this is the case. Currently, there is no safeguarding when people end their lives at Dignitas, nor when unregulated and drastic ways of ending life, such as starvation, take place. Those who oppose the Bill need to address the problems of the status quo. We need more palliative care, yes, but it cannot always end the horrors of agonising deaths.
I end with two pleas. First, allow our fellow human beings greater autonomy over how they die; it is for them to decide and not for others, whether for faith or other reasons, to impose their views. Secondly, be truly compassionate in sparing terrible suffering as death approaches, allowing those who choose to die sooner to do so.
Lord Patten (Con)
My Lords, I have two points that I wish to make. First, I do not support the Bill in its stated aims; neither do I support the increasingly strange and weird way it has proceeded before Parliament, mutating into some sort of ever-changing hybrid Private Member’s Bill invention. HMG have been giving some covert, and now more overt, help to these beleaguered measures, rather than taking their own responsibilities, which they should have done from the start.
It was truly prescient of Cardinal Nichols when he said on 5 February that there was
“something deeply lacking in a government that isn’t prepared to guide and sponsor, if it wants to, this process of legal change”.
If I may say so, I think His Eminence has been proved spot on in what he said then. This unholy legislative mess can be helped—a bit—only by the excellent and still to be consummated proposals of the noble Baroness, Lady Berger, and all that she has suggested for a time-limited Select Committee. That must be a help to improve it.
My second point after procedure is on palliative care. I am not in favour of suicide facilities being provided by the state in the face of possible terminal illness. Illness is not always accurately diagnosed in the first instance. I do not believe there is some automatic choice between dying badly and, if you do not want to do that, having some self-styled assisted suicide. Rather, we must look after the very seriously ill with great compassion, and so much better than we do now.
We need much greater protection from, and legal penalties against, coercion to die. Families are not always very nice places in the way in which they behave, alas. The domestic setting can sometimes be one for domestic abuse, elder abuse, abuse of the mentally disabled, which I am very worried about indeed, and the physically disabled. We need a much more precautionary effort to protect and safeguard those at risk, maximising the opportunities to safeguard the vulnerable, which I think the Bill fails to do in what it has said so far.
Lastly, I do not pretend that we can make death lose its sting; of course, we cannot. As Mother Teresa, who has prayed here in our Chapel of St Mary Undercroft, once so wisely said, the real freedom is to value all people exactly the same and to value them all, not to think of them as trouble or a nuisance. We need more palliative care, which is woefully underfunded in this country, and it has long been so; it is a shame on us all. Its provision remains a patchy postcode lottery, with current estimates of around 100,000 people per year who should be getting it not getting it.
From my own entirely personal point of view, worst of all, if from now on death becomes the default solution to perceived suffering—if it becomes the new normal—I believe this will have implications which will be more than significant just for the way we live now.
Baroness Royall of Blaisdon (Lab)
My Lords, I support the Bill. I'm grateful to Kim Leadbeater for her work, and to advocates such as my courageous friend Esther Rantzen. I am also grateful to my noble friend Lady Berger for showing us a way forward, in terms of a committee, and for setting out a clear timetable.
While I warmly welcome the compassionate and moderate tone of last week’s debate, from which we learned a lot, like my noble friend Lady Thornton, I was dismayed at the conflation made by some of suicide and assisted dying. This is not just about careless language; it is actively damaging to people who are already suffering. Let us be clear: people who choose assisted dying are not suicidal. They are dying and they want to regain some choice, control and dignity where it has otherwise been stripped away. We should hear the views of terminally ill people, some of whom had a letter published in the Independent this week:
“We are not suicidal – we want to live, and to make the most of the time we have left with the people we love. But we are dying and we have no choice or ability to change that … We are not seeking to make a choice between living and dying but between two kinds of death … To equate choice and control over the timing and manner of inevitable and imminent death with suicide is deeply insensitive to those of us facing this position”.
Australia’s leading suicide prevention organisations have warned that confusing these terms can delay access to suicide prevention services for people in distress, and complicate or delay care for people with terminal illness who are seeking an additional choice at the end of life. When in 2021 I asked the Government to provide data on the number of people who take their own life every year, I did so because this debate needs to be guided by evidence and the lived experience of dying people and their families. The best available evidence estimates that around 300 terminally ill people end their own life at home every year in England. These deaths are recorded as suicides, but it is clear from talking to and listening to bereaved family members that these are not people who wish to end their own life but people who are taking drastic and often violent steps to control an inevitable and imminent death.
There is absolutely no evidence that assisted dying undermines or runs counter to effective suicide prevention strategies, nor is there evidence to suggest that legalised assisted dying leads to a shift in attitudes towards suicide. Figures from Victoria in Australia show a slight decrease in suicide rates since it introduced assisted dying.
In 2021, at Second Reading of the Assisted Dying Bill of the noble Baroness, Lady Meacher, I said:
“The current blanket ban on assisted dying does not eradicate demand for choice at the end of life; it simply forces people to take matters into their own hands in loneliness and in fear”.—[Official Report, 22/10/21; col. 495.]
Those words remain true today. We continue to hear of dying people taking their own life and we continue to hear about the devastating impact this has on their families. It is time to change the law.
I am a humanist. I respect those who believe in the sanctity of life and I subscribe to many of their values, but this Bill will not compel anyone to act against their conscience. It provides agency and choice for people who are near death, with the ability to decide how they spend their final days—whether they have faith or no faith. I am confident that the scrutiny of the Bill will be as robust in your Lordships’ House as it was in the Commons. We will do our work with compassion and diligence, improving the Bill, including by making anorexia outwith the Bill. But we must always be mindful of our duty to respect the primacy of the Commons.
Lord Jopling (Con)
My Lords, I have not changed my opposition to the concept of assisted dying since the previous debates in your Lordships’ House in 2015 and 2021. My views, which are not influenced by religious teaching, are based on my opposition—like the noble Lord, Lord Deben—to the passing of laws that permit the taking of life. That is why, in 1964, I supported the Silverman Private Members’ Bill to abolish capital punishment, much to the irritation of some of my then constituents.
In particular, I am concerned about two dangers in these proposals. We have heard already about the effects of the Bill in encouraging greedy families. As an example, I quote my own mother, who was widowed at 58 and, during temporary bouts of illness and depression, on many occasions told us that she wished she could die. Of course, we jollied her along and, in the event, she lived until she was 96, having led an interesting life and having seen a good deal of the world during those years. I know that, during those depressed moments, we could perfectly well have agreed with her and told her that we would try to arrange assisted dying if it had been then available.
My second concern is about the issue of doctors for hire—people who strongly support assisted dying, build a reputation for sanctioning it and become what I can only describe as a soft touch. In the torrent of information we have had about this Bill, I noticed the example of the Canadian situation, where 4% of medical-aid-in-dying practitioners provide these services more than 30 times a year. That is the sort of danger I am concerned about when I talk about doctors for hire.
On two previous occasions when we have discussed this Bill, I have put down amendments to restrict the number of times a doctor can sign the certificate. If this Bill is given a Second Reading, which I am sure will happen, I intend to put down an amendment to suggest that no doctor should sign a certificate more than twice in four years. That is a limitation which is open to discussion as to the frequency with which a doctor might be restricted to signing the certificates. We could discuss this between Committee and Report.
Finally, I remind the noble and learned Lord, Lord Falconer of Thoroton, that when I made this proposal in 2015, he told me:
“I am very happy to discuss with the noble Lord the idea of there being some limit”.
He went on to say:
“However, I am completely engaged on how one seeks to deal with the issue of doctors for hire”.—[Official Report, 16/1/15; col. 1060.]
I hope that this would be a helpful amendment to this Bill in preventing doctors from setting up this type of reputation, which I think would be a mistake.
Baroness Butler-Sloss (CB)
My Lords, while I oppose the Bill, I recognise we have heard arguments that people support it, so I am particularly relieved at the Motion of the noble Baroness, Lady Berger, to get some proper scrutiny of the Bill.
My main concern is that it is a badly flawed Bill, it needs radical improvement and, as many have already said, it is probably one of the most important Bills that this House will ever have to consider. However, this Bill is not the right way to go into law.
We start with 42 delegated powers, which will be dealt with by the Secretary of State, but more likely by the civil servants in the Department of Health. We are not asked to consider nearly all the crucial details of this enormously important Bill. We have already heard of the very real concerns of the Delegated Powers and Regulatory Reform Select Committee and the Constitution Committee. I do not remember ever before reading in such a report words like
“the power… is inappropriate and should be removed”,
and, among others,
“the highly inappropriate nature of Clause 37(7)”.
Is the panel intended to meet in public and hear evidence? Will it meet at all, or will it be a tick-box ceremony? Why is there no coroner check? Surely that is an obvious safeguard.
Assisted dying will be paid for by the NHS but, as so many have pointed out already, only 30% of palliative care is paid for, so this is an obvious inequality. I declare an interest as a former vice-president of the Exeter and Devon Hospiscare—a wonderful institution that helped a dying friend of mine to stay at home.
The process will require the preliminary assessment of the co-ordinating doctor, the independent doctor, the panel psychiatrist and the doctor at the death. Is the NHS ready to cope with this?
We should not ignore the very real concerns of several medical colleges, including the psychiatrists, who are very concerned about the flaws in the Bill. They are, of course, expected to provide panel members. I declare an interest as an honorary fellow of the Royal College of Psychiatrists.
It is not easy to assess when a patient will die within six months. The Lockerbie bomber lived for three years, as has already been said. Six months may also be very unfair to those with motor neurone disease or other similar diseases, who may not have the physical ability to take the final step they need to take.
Is this Bill intended to be the start? Is it to be amended shortly to increase the ability to help assisted dying to one year, two years or three years? Clearly, as others have said, this is a slippery slope. The possibility of coercion, or even more likely, the feeling of being a burden on others—especially a financial burden—is obvious.
As I have already said, this is a seriously flawed Bill. It is a Private Member’s Bill, and it is time the Government took it over and put it properly into order.
Lord Moore of Etchingham (Non-Afl)
My Lords, I could not possibly attempt to compete with the forensic skill of the noble and learned Baroness, Lady Butler-Sloss, which is so impressive. I simply want to add to this excellent debate one striking comparison which I hope may illuminate it.
Near my home in Sussex stands the beautiful cliff of Beachy Head, which is the most popular National Trust property, with 2.5 million visitors every year. Unfortunately, it is also the number one suicide spot in the world. Online suicide forums instruct people exactly how to get there and jump to their death. At least one such candidate arrives every single day. Also every day, however, a remarkable charity—the Beachy Head Chaplaincy Team—is there, based five minutes’ walk from the fatal cliff edge. The team’s purpose is the opposite of assisted suicide: they try to persuade those who have come to die to live. They are astonishingly successful. I have the latest figure from Gerry Howitt, the team’s CEO. So far this year, they have engaged with 271 people who have come to kill themselves. Of those, only four have jumped.
The chaplaincy team also works tirelessly with Sussex Police, the council, clinical mental health professionals, the local pub, the local taxi service and the National Trust at all practical measures of dissuasion. This means, for example, that lay-bys close to the cliff are blocked, pushing people to park nine minutes’ walk from the edge. Such preventive actions work. The total of those who arrive intending to jump has fallen by 32% since 2023.
As these potential suicides make that nine-minute walk, the chaplains, who are well trained in spotting symptoms and often carrying intelligence about individual arrivals, try to engage them in conversation. Their carefully honed technique starts by showing empathy and moves through establishing rapport to suggesting behavioural change and walking them down to the team’s building for a cup of tea.
Studies show that suicidal ideation, the overwhelming presence of thoughts of death and suicide, is never continuous for more than four hours, often for much less. Offered the right mixture of professionalism and human kindness, people change their minds. Of those 271 with whom the chaplaincy intervened this year, only 57 even reached the cliff. As I say, only four actually jumped.
I am sure your Lordships’ House will admire this moving example of co-operation between private charity and public services and this triumph for life itself. Indeed, the police intervene against suicide attempts under Article 2 of the European Convention on Human Rights—the right to life. Some may object that the sort of suicide being assisted by the Bill before us is very different from that being prevented on Beachy Head, and in some ways that is true. But I end by asking your Lordships to consider the following thought.
The Bill does not support the freedom to kill yourself: that, we already possess. It confers a right to kill yourself with the active assistance of the state and doctors, and at public expense. It also reverses the operation of that power of human persuasion which works such wonders on Beachy Head. Under this legislation, the professionals will, by definition, be people wishing to fulfil a person’s wish to die. No one will be present to advocate the choice of life.
I do not believe that our country, particularly our National Health Service, can successfully contain such a contradiction in public policy and morality. If the Bill is enacted, the same hospital whose professionals help rescue potential suicides will contain other professionals who give gravely sick people the substances to kill themselves.
On Beachy Head, the chaplains say, “Please don’t jump”. In regard to this Bill, my Lords, I say the same to you.
Baroness Coffey (Con)
My Lords, sadly, over 1,500 people will die in the UK today. Of those, nearly 500 will be from cancer. Death comes to us all, and of course we want to make sure that people have as comfortable a death as possible. But in the legislation before us, we are being asked to agree that someone be enabled to be given and use a concoction of chemicals to take their own life, and we are being asked to require the Government to provide services for that to happen.
I recognise that we have heard a lot of distressing stories of people suffering pain, intolerable pain, at the end of their life, and the suggestion is that by introducing assisted dying, or controlled suicide, that pain could be avoided. There is no reference to pain or suffering in the Bill. We have heard in the debate about polling. In other surveys, when it is explained that the assisted dying in the Bill is effectively controlled suicide, support falls. The BMA survey this year shows that support from GPs has fallen. The royal colleges have expressed their concerns.
I do not want to extend life unduly. In a week when the Government have introduced the Hillsborough law, I think of the legal case of Tony Bland, the 96th Hillsborough victim. That decision to stop artificially keeping him alive was the right one. I also support the concept of DNR. However, without going into too much detail, I have seen first-hand how the clinician/patient relationship can be frighteningly coercive, even for something as simple as sedated surgery for a broken hip.
I also think back with a shudder to the Liverpool care pathway. What an awful way to die. It had become commonplace. I raised this when I first entered Parliament, and gathered enough support from other MPs to get the Government to review and end that practice.
I have serious doubts about how, or indeed whether, we can get this legislation right to cover indirect coercion in particular. This indirect coercion is real: the feeling of being a burden; knowing you could save money for the NHS if you went that bit earlier; knowing you might be able to leave more money to your children, rather than pay care home fees. As such, I am genuinely concerned about how this may become commonplace here, as it is already in Canada. I will also raise other concerns in Committee, including the provision in Wales, given that the Welsh Senedd has voted against this—but I have to say that indirect coercion is my biggest concern.
I have followed the proceedings of the Bill since it was introduced in the Commons, and it has changed considerably since it was first introduced, so I welcome the proposal for a short, targeted Select Committee ahead of our consideration in Committee. One change that the Commons made on Report, which I welcome, was not to allow doctors to raise this option with a child, which the promoters of the Bill opposed. It got through against their desire.
Addressing the amendment of my noble friend Lord Forsyth, which I am pleased he has already indicated he will withdraw later, I need not dwell on the differences in processes between the Commons and Lords and their consideration, but I do not agree that this Private Member’s Bill should get particularly special treatment in your Lordships’ House. It has already received substantial support from civil servants. I am not questioning that, because I appreciate that they have to get this in a way that can be delivered, but as has been exposed by the two Select Committees that have already considered the Bill, that has led to an extreme number of regulations and unlimited powers. Both the MoJ and the Department of Health and Social Care have rejected my FoI requests asking which specific areas they had helped on.
I take noble Lords back some time, to a much shorter Bill of five clauses, with a majority of 275 in the Commons—not just the 23 this Bill enjoys—which, by the way, fell from Second to Third Reading; your Lordships stopped consideration in Committee. The Government then put that Bill in their manifesto at the election, and it passed eventually through both Houses. This Private Member’s Bill should not be turned into a government Bill now. It is going to take a lot of fixing, so I hope we will ask the Commons to start again, rather than let the Bill pass. But I assure noble Lords that I will be doing my best to scrutinise and to try to get something that may work—but I fear it may not.
Baroness Alexander of Cleveden (Lab)
My Lords, it is not easy to be speaker 108, but it is presumably even harder to be speaker 168. As a relatively new Member of your Lordships’ House, for me, last week’s debate was a privilege: arguments about choice, autonomy and the sanctity of life, leavened throughout by extraordinarily moving personal experiences and stories. For this Lords novice, it seemed in every sense a classic Second Reading.
Yet today’s debate seems to call for something slightly different, and to focus on what is being asked of us as legislators. For its supporters, the Bill provides choice, alignment with public opinion, respect for the other place and no compunction on anyone to do anything they do not wish to do. But for the 40-plus opposing speeches, it was more nuanced. The opposing speeches fall into two main categories. First, there are those who oppose the Bill in principle because they believe in the sanctity of life as a universal value in all circumstances, and it is an honourable position. Yet more opposing speeches focused on the Bill’s details. These noble Lords professed no philosophical objection to the right to end one’s life under agreed conditions, but they nevertheless expressed profound concerns about the Bill’s provisions.
For those whose concerns lie with the details, a week has indeed been a long time in politics. We now have a new and exceptional Select Committee—a space to probe whether the protections for the vulnerable are the right ones; whether the safeguards against coercion are appropriate; whether any of the processes are over-complex; and time to interrogate those 42 delegated powers.
As a Scottish resident, I will not be subject to the Bill. The sister Bill making its way through the Scottish Parliament has different safeguards—for example, it also involves two doctors, but no panel and different timelines. As a supporter of the Bill, I recognise that all these aspects and more will be up for scrutiny in the Select Committee and at Committee and Report stages. Our scrutiny really matters because our postbags are heaving with legitimate but also misplaced anxieties. It is proper to be awed by the responsibility of scrutiny—of interrogating the detail and making the Bill as good as it can be in our less than perfect world.
I say to noble Lords with practical reservations: please do not kill off the Bill because the details are demanding. Has the time not come to bring together all those who recognise, as the noble Lord, Lord Macdonald, the former DPP, did last week, that our current laws are not being enforced? We no longer prosecute family members for offering support and we permit indefinite sedation. As we have just heard, people take their own lives, and those who can afford to do so go overseas. It is time to bring the law up to date.
To conclude, I recognise that, for some, the Bill is a personal moral red line, but I believe that, for most noble Lords, for the Commons and certainly for the country, it is time to make the choices currently available to the few available equitably. In the service of a quiet and loving end, it is time to do what this place does best: interrogate, scrutinise and improve. It is time to move forward with compassion, care and kindness.
Lord Willetts (Con)
My Lords, like the noble Baroness, I welcome the important development since our debate last Friday of the new Motion from the noble Baroness, Lady Berger, and the noble and learned Lord, Lord Falconer. It is very important that we take every opportunity to scrutinise the Bill and consider the issues without jeopardising the overall timetable for parliamentary scrutiny.
In today’s debate, as last week, many concerns have been expressed about coercion, in various forms, to get people to an assisted death. The Bill has many provisions to address these concerns about coercion, and, of course, more options need to be considered. But we have heard less about the coercion that is already in force under the law today: using the power of the state to forbid some of the most compassionate forms of assisted dying. That is coercion too, and it is causing deep human distress, as we have heard throughout this debate.
Sometimes we can and do use the power of law to enforce a settled moral consensus in our society, but that is not the case here. Many humanists and others do not see any objection in principle to assisted dying, especially when, as with this legislation, it is restricted to people who are terminally ill.
Like the noble Baroness, Lady Blackstone, I have been very influenced by the most careful study of public attitudes by the Nuffield Council on Bioethics, which included a sustained citizens’ jury that showed very clear majority support for assisted dying, provided that it is limited to people who are terminally ill and who have capacity to make a decision for themselves. That is the settled moral view of our society, reflected in the vote in the other House recently.
There are people with strong objections of principle. There should be no coercion for them to go for assisted dying; they should live and die according to their beliefs, but equally there is no basis for them to forbid others who are terminally ill and who have a different and legitimate moral view from taking the opportunity of assisted death. In his powerful speech last week, the noble Lord, Lord Roberts of Belgravia, showed that that view on the right to assisted dying if terminally ill is deeply rooted in our western tradition.
The noble Lord, Lord Mohammed of Tinsley, made a very powerful point last week. He said that he and his family, with their religious beliefs, would absolutely not wish to have anything to do with assisted dying, but that he did not wish to forbid others who had a different moral view from taking the opportunity provided through the Bill. This debate and legislation are about how a society with a range of different moral and religious views can live together. The Bill, with its protections and provisions, paradoxically shows how our treatment of assisted dying can also enable us to live together as a society.
Lord Empey (UUP)
My Lords, I have been shocked at the inaccuracy of the parliamentary process applied to the Bill. It has lacked the detailed scrutiny that such a major piece of legislation requires, as confirmed in recent devastating reports by committees of this House. Despite all the hype in the Commons, it failed to gain the support of a majority of MPs.
Let us be clear what the Bill does. It authorises medical professionals in the employ of the state to introduce and ultimately provide the means by which an individual in the care of the NHS can be assisted to commit suicide, and to observe and supervise that process. The Bill also gives unprecedented powers to the Secretary of State. The Bill is not fit for purpose, and I am not convinced that it can be adequately reformed. As a member of the Presbyterian Church in Ireland, I accept my Church’s teaching on the principle of the Bill, but I am also a legislator, and that confers its own distinct obligations and responsibilities.
In my family’s case, we were faced with the illness of my late wife, Stella. She suffered from complicated medical conditions. In January 2023, she was very unwell—to the extent that the consultant called the family together and said that she was not going to pull out of it this time. Had he been asked whether she was terminally ill and would die within six months, he would have said yes. Would he have signed off as expecting her death in six days? I believe so, as that is what we were told. Nine months later, I was still taking her out most days, and she was able to enjoy that time with our children and grandchildren. I am also aware that she felt she was impacting on the ability of our children to get on with their careers. I could sense the anxiety she felt at impacting on our lives. This is the pressure point that is glossed over in the Bill and the discourse around it.
Doctors do not get it right all the time, and this arbitrary six-month timescale is a dangerous nonsense. The Bill would fundamentally change the relationship between the medical profession and patients at all levels. Gone would be the days of “do no harm”. Doctors could be seen not only as healers but as instruments to end the life of a patient in hospital, maybe spurred on for financial reasons. Families are not always welcoming environments. They can be toxic with competing pressures, especially over money. It is in these circumstances where subtle pressures to end a life can be generated.
Some of the basic practicalities have not yet been investigated because of this mad dash to get the Bill through. I know that all of us in this Chamber want the same thing: to reduce and minimise suffering. None of us knows how our days will end, but I believe that we are adding to suffering by introducing massive anxiety to patients at the most vulnerable time of their lives.
Our mailbags have been characterised by messages from disabled people, the elderly and others who feel a sense that they are no longer valued by society, surplus to requirements and mere cost centres. I know this is not the intention of the sponsors, but that is the inevitable outworking. To involve the entire NHS and turn its ethos upside-down is a serious mistake. People may also be afraid to present themselves to doctors for fear of getting a one-way ticket. Those of us with the financial means to get the best advice can do so, but for those without the resources it is the NHS or nothing.
It is time to think again. We have underinvested in palliative care for years, thus reducing rather than enhancing choice. Surely it makes sense to follow that route, as emphasised by former Prime Minister Gordon Brown, rather than risking the nearly 80 years of the embedding of a life-saving NHS in our nation’s DNA.
Lord Griffiths of Burry Port (Lab)
My Lords, I am aware that many noble Lords will, knowing that my life has been spent as a Methodist minister in pastoral work, have reached an assumption that they know what I am going to say. It is not necessarily the case. I have tried, knowing that that awareness would exist, to give my best attention to the material that has flooded our way over the last month, of which I have tried to make sense in as rational a way as I possibly can.
If I have a qualification for speaking in a debate of this kind, it is simply my experience of the phenomena we have been describing: beginning when symptoms present themselves, people moving through to diagnosis and then to treatment, and then seeing the last days and the end of a particular person’s life, dealing with all the emotions released after the death among the nearest and dearest of the person who has died. Being with people directly affected by the phenomena that we are talking about is a long curve.
Families are not necessarily good places. Within families, there are those with views that put pressure on people for money, and others who take a much more humane view of things. Sometimes, there is blame after the death—the view that things could have been done better and that this and that should not have been done. Choice is not an individual making a decision, forensically separate from all the circumstances and contexts within which that happens; rather, they are surrounded by complexity and predisposed attitudes. Therefore, I wish that we could look again at what we think we mean when we say “choice”. The choice for the person who needs or wants to die is not, for the most part, a choice exercised in isolation from other factors.
I am delighted that the noble Baroness, Lady Berger, and my noble and learned friend Lord Falconer have come to an agreement about a Select Committee to look further at the sorts of issues and phenomena that we are describing, concerned with and taxed with in a debate of this kind. Her letter, along with her associates, was the lodestone for my making sense of all the material I was wrestling with. I am glad that we received a subsequent letter to suggest there may be a proper place where we can look into the proper worries that have been expressed here in this Chamber. I wonder whether 7 November is too near the starting point, but we can look at that in due course.
All I know is that a person who is dying may want to or may not want to and may be led to want to or averted from wanting to. There are near and dear people who turn out to be quite problematical in the total pastoral situation. This is not an easy matter.
At the end of the day, I will vote, I suppose, with all of us now that this situation is emerging, for the amendment. I cannot dismiss from my head what a senior doctor said: “This will change the practice and culture of medicine in ways that no amendment of this Bill can prevent”.
Lord Frost (Con)
My Lords, I am against the Bill, because it is legally and practically defective in many ways, as many other noble Lords have already said. I am against it for philosophical and religious reasons too. For the first time ever, a Bill seeks to give a person of sound will and mind the right to act contrary to a fundamental element of the ethical tradition that has been fundamental to this country—Judeo-Christian morality, and the view that our life is not our own possession to dispose of as we see fit, nor to be taken from us by others, even at our own request.
Noble Lords may ask, as many have done so already, why this should matter to them. They say that they are not religious and that they do not share that ethical system. We have heard some noble Lords say that they have the right to free choice, autonomy over their own life and to protect the dignity, as they see it, of those close to them. I want to briefly explain why I do not think this argument is sufficient and why even those of no religious belief should still be concerned by the prospect of going down the road set out in the Bill.
As I see it, the problem is that the values used to justify the Bill—those of ensuring dignity and preserving autonomy and personal freedom—are also derived from that Judeo-Christian ethical system. As my noble friend Lord Roberts of Belgravia reminded us last week, there have been in the past, and there still are today, many societies that do not fully share those values. They are not self-evident, however much many of us would wish they were.
The Bill is proposing to dismantle part of that inherited ethical system by allowing the state to engage in killing innocent people at their request. Once we have dismantled one part of that system, because we think we know best, what then is the status of the rest of that moral and ethical system? Once you have introduced utilitarianism into our society’s decisions, where do you stop? The ultimate destination of this journey is a utilitarian society with a utilitarian Government, one where there are no free-standing, inherited moral principles of any kind, only the principles that we think we are clever enough to create.
The problem is that in such a society none of us is really safe. The only protection for any of us then are the collective wishes of society, whatever they are at any given moment. In such a society, the rights of those who are inconvenient—the disabled, the ill, the elderly or maybe those who are just unpopular—have no robust defence and are potentially vulnerable. Any of us might one day fall into any of those categories. At that point, your only protection against the general will of society comes from an appeal to the same ethical system that you have just decided is merely contingent, capable of being disposed of if it is inconvenient. Noble Lords may think, as I do, that human dignity and autonomy and freedom are important, but what if the general will of society does not? What ground do you have to stand on there? That is why it is so dangerous to continue dismantling this ethical code, as the Bill does.
I urge noble Lords to think hard about whether we are really confident that we are the generation that is so sure of its judgment and so wise, knowledgeable and confident that we can create a good society on foundations not that we have inherited but which we ourselves have designed. Are we so sure of all those things that we can casually cast aside 2,000 years of our moral tradition and tell ourselves that it does not matter? Noble Lords should look around our country and ask themselves that question. I do not think so, and this is why I hope the Bill will founder.
Lord Beith (LD)
My Lords, I do not bring to this debate any medical knowledge or expertise. My relevant experience is in having cared at home for both my first and my second wife as they faced the terminal stages of metastatic cancer. Noble Lords will have memories of my second wife, Baroness Maddock, and her work in this House, which she continued with determination as she coped with her cancer treatment.
Whatever ethical or religious view I might take about assisted dying or assisted suicide, I respect the sincerity and strength of feeling of those who want this change in the law. Whatever view I individually take, as a liberal I cannot simply deny that freedom to others, unless granting the freedom causes or could cause so much harm to others that it justifies the intervention of the law. The debate has demonstrated that there are potentially very significant harms to others which could result from the Bill. Whatever our personal view, we are duty-bound to assess the harm and consider whether it can be successfully mitigated or is so great that the Bill should not proceed.
I will not list all the numerous dangers already identified, but high among my concerns is the fear that many people will have that they and others will be put under or feel pressure to end their lives. They may feel that they should take this course rather than being seen as a burden to their families, the health service or society—and that is envisaged in the impact assessment.
I am concerned that this will severely damage the way medical staff interact with patients, and it would be quite wrong to offer an unequal choice to patients between assisted suicide and palliative care when the suicide help is available but the necessary level of care may not be. I have met wonderful people working in palliative care, but there are not enough of them, and the service varies greatly in availability and quality in different areas.
I am also concerned that existing palliative care practice could be adversely affected by the Bill. If medical practitioners have administered drugs to relieve pain and symptoms for a patient, and that patient dies within six months, will they be accused of failing to go through the procedures this Bill provides for intended death when there was no such intent and the drug use was entirely to bring comfort to the patient?
The hospice movement, which is massively dependent on charitable giving, has many concerns about how the Bill would operate, both in clinical practice and in its impact on giving from people who do not want their gifts to support assisted suicide. As the Bill stands, hospices, whether residential or home-based, are not allowed to opt completely out of the system, and that cannot be right.
I serve on the Constitution Committee of this House and fully endorse the objections it has raised to the use of unamendable secondary legislation and disguised legislation to define many of the most central features of the system being created and its relationship to the NHS. I am also worried by the exclusion of the coroner’s jurisdiction in England and Wales. There will be cases which would, without this provision, justify investigation and, in some cases, an inquest. It is unwise of us to forget that, although doctors and families will almost always be acting in good faith in very distressing circumstances, medical carelessness, malpractice and undue influence can occur.
I was also struck by the reference of the noble Baroness, Lady May, to the Bill’s potential to impact on the very worrying level of suicide among young people. The Bill may offer a wholly unintended signal that taking your own life is the answer to your problems, and we will have to do something about the growing crisis if the Bill proceeds.
If I were a determined supporter of the Bill, I would still want it to have the most careful scrutiny informed by detailed evidence, not just a few Fridays of conventional House of Lords sittings. We may get that, although under a very tight timetable. I say this not in criticism of the Bill’s promoters; they were working within the straitjacket of Private Member’s Bill procedure. But that means that we now have to set about filling the gap to make sure that, if the Bill goes ahead, our concerns are met to a much greater extent than was achieved in the Commons. If that cannot be achieved, some of us would feel that we should give up on the Bill and start again. I have this fear—this instinct—that this is one of those big decisions that society may one day regret. There will be no way back.
Baroness Foster of Aghadrumsee (Non-Afl)
My Lords, I want to speak briefly to the concern of feeling a burden to one’s carers and the impact that will have if the Bill passes, which has been mentioned by many of the speakers this morning.
As many of your Lordships across this House know, caregivers are the very best of us. We can all attest to stories of people we know who have given everything to support their loved ones. Imagine an elderly parent, aware of the sacrifices that their child is making to care for them, thinking to themselves that they would be better off dead. This thought may be fleeting or it may take root. The very existence of this piece of legislation gives legitimacy to those thoughts. By legalising assisted suicide, you de facto make the statement that some desires to end your life are justified.
The guilt someone receiving care feels will never be isolated or separate from their desire for an assisted death. Since the Oregon Death with Dignity Act came into effect in 1998, until the end of 2024, 46.6% of those who had chosen to end their lives, when asked for the reason why, cited being a
“burden on family, friends/caregivers”.
Of course, if the Bill is made law, we will not know why people choose to end their lives, as that is not in the Bill. This guilt people feel stands in stark contrast to the ideals of choice and autonomy that proponents of the Bill have attempted to set out to the House both last Friday and today.
Caring for a terminally or chronically ill loved one is undeniably hard. Carers make sacrifices every day, emotionally, physically and financially. The recent impact assessment is explicit about what the Bill might mean for carers. It says, in a chilling paragraph:
“One of the reported benefits of VAD services to unpaid carers is the reduction in time spent providing care for the terminally ill adult who chooses to end their own life. Evidence suggests that providing unpaid care, particularly at higher intensities, is associated with negative physical and mental health outcomes, and employment impacts”.
The impact assessment also set out that a person privately funding their residential nursing care pays on average £1,567 a week and that someone paying for care at home could be paying £32 an hour. This financial impact compounds the already present emotional burden of terminal illness for both the individual and their unpaid carers. But they should never, under our law, feel pressured towards a premature death. Today, it should be a cause for great sadness that we are discussing how to help people die sooner rather than how to support them to live more comfortably, and to support those who care for their family members.
My own loved and precious mother died in June of this year. Rather than feeling a burden, however, she was surrounded by the most excellent care, in her residential home and then latterly in the South West Acute Hospital in Enniskillen. The palliative care she received at the end of her life was compassionate, pain-relieving and such a comfort to her and to us, her family. I want that care and compassion for all who are dying, not just some, and I certainly do not want someone like my mother feeling that they have to end their life prematurely because they are a burden to the taxpayer, their carers or their family. No one should feel pressured toward death because of financial strain or emotional guilt. There is no safeguard against the silent pressures of care. No clause can protect against the internalised belief that one’s life is too costly, too demanding or too much.
Today we debate how to help people die sooner. But we should be asking how to help them live better—and how to support those who care for them. Creating a burden to die because we have not addressed the burden of care is not a legacy I want for this House.
Lord Young of Norwood Green (Lab)
My Lords, as somebody once said at this stage in the debate, “Everything that can be said has already been said”, and then added, “But not by everyone”. I am the everyone, if you like, but I hope I will add something of interest.
The noble Lord, Lord Deben, said that this has never been tried before and proved effective. Actually, it has, in Oregon and a number of other places. It is a matter of opinion: you have your opinion and I have mine. The overwhelming weight of correspondence that I received was in favour of the Bill and I am sure people did not single me out because they knew what I thought on this issue.
The other problem that has been drawn to our attention is that if we go down the road of this Bill, it will put an enormous strain on the NHS. I must admit that I do not understand that argument. Whether anybody opts for this or not, palliative care will have to be provided, and that is already being provided by us, so I do not really understand that.
We are then told that this Bill is not the right one. I have looked through it and it seems to me that this is a very carefully worded and structured Bill. It provides all the safeguards that we should want: preliminary discussion, first declaration, subsequent assessments—it goes on and on with safeguards. The Bill contains a number of safeguards to establish that, at various stages in the process, including at the time the approved substance is provided to the person for self-administration, the person
“has capacity to make the decision to end their life”,
they have
“a clear, settled and informed wish to end their own life”,
have
“made the decision that they wish to end their own life”,
and have a requested provision of assistance. I will not go on to read all of it, but there are more than enough safeguards in there.
I listened carefully, as one would, to some of the best legal brains that we have in this House. I listened carefully to the noble and learned Baroness, Lady Butler-Sloss, who said that it is badly drawn. With due respect to her, that is a matter of opinion. I do not think it is badly drawn. This is a carefully thought out, well-drawn Bill that has been developed over a significant period.
I say this to the House: what are the alternatives that present themselves to somebody in this situation? Are we really saying that we want people to make a choice to go to Switzerland to Dignitas, with the rest of their family feeling anxious, concerned and worried? I do not think that is the sort of choice that we should be inflicting on people.
I am in favour of scrutiny, and this House will do it. A Select Committee will look at it, but not in a way that will prevent the eventual progress of the Bill. I hope that the House will recognise that this is a good and fair Bill that gives people the right to choose at a very difficult time in their life, without coercion but with support and help.
Baroness Finn (Con)
My Lords, the powerful speeches in this debate have shown compassion and seriousness and reflect the depth of feeling on all sides. It is a privilege to take part. Like other noble Lords, I thank all who have written to me on the subject.
Let me begin with the law as it stands. The Suicide Act 1961 is shot through with contradiction. It makes suicide lawful, yet criminalises assistance with a penalty of up to 14 years’ imprisonment. That contradiction does not fall just on private individuals. It is the daily terrain for doctors, nurses, police officers, coroners and prosecutors, who must operate within rules whose boundaries are blurred. Patients, families and professionals are all left to navigate an area of law where the line between compassion and crime can be perilously unclear. In practice, we have combined a lawful right to end one’s life with a criminal prohibition on the assistance that may be needed to exercise that right safely and humanely. That is the very tension that our clinicians and our prosecutors are asked to manage without clear parliamentary settlement.
The human cost is all too real. Families live in fear and uncertainty. If a person, because their suffering is intolerable, wishes to exercise their lawful right to end their life, the law pushes them towards doing so alone—too often, in messy, improvised and traumatic ways. Others are driven overseas. Hundreds of our fellow citizens have travelled to Switzerland to die, and those who book tickets or accompany them risk investigation on their return. Under the Forfeiture Act 1982, it is entirely plausible that if they are a beneficiary under the deceased’s will, they could also be deprived of any inheritance. This is not a humane or dignified settlement.
Since the CPS began collating cases in 2009, well over 190 suspected assisted suicide cases have been referred. Enforcement is arbitrary, because the framework is incoherent. No family can know in advance whether an act of love will be treated as a serious crime. The courts have done what they properly can. In the cases of Diane Pretty, Debbie Purdy, Tony Nicklinson and Paul Lamb, judges recognised the failings of the law but concluded, rightly, that only Parliament can resolve them.
We have also heard about the morality of assisted dying. I honour and respect those who differ from me, especially when their views are grounded in personal religious faith, but we should respect the decision of the elected House on the principle, a decision that reflects the settled view of a great many of our fellow citizens. In our democratic system, the proper role of this House is to improve the Bill so that it gives effect to that decision with the greatest possible care.
The Bill before us is not perfect. No Private Member’s Bill on a question of this magnitude ever could be. Noble Lords have raised serious concerns about process, safeguards and palliative care. Ideally, this should have been a government Bill, drafted with the full resources of Whitehall and the time such gravity deserves, but the constructive path is not to block the Bill but to engage with it, strengthen it and improve it. I pay tribute to the noble and learned Lord, Lord Falconer, and the noble Baroness, Lady Berger, for their agreement to set up the Select Committee to hear further evidence, and that it will report back in time to allow the whole House to consider the Bill through all its stages. We should, in the same spirit, match the quality of this debate in our approach to the Bill not by defending an indefensible status quo, not by closing the door on the elected House, but by doing what we do best—rigorous scrutiny, honest debate and constructive amendment.
Lord Brooke of Alverthorpe (Lab)
My Lords, I have no interest to declare other than that I book the Lords Residence Room 2 for Christian Peers of all denominations to meet weekly for interesting conversations and study. The meeting starts at 1 pm and runs for 45 minutes. All are welcome. So, at least I have found something new to say that has not already been said.
I am a believer that there is some higher power, some spirit or energy of creation. It was there before humans and their religions came along, and it is here now with us. If the human race disappears—as it might, faced with AI and climate change—that power, which gives purpose, goodness, beauty and love, will continue indefinitely. For me, it is my source of hope.
That power, however, also gives me the freedom of choice. I have been here since 1997, so, like the noble Baroness, Lady Hayman, I have been involved in numerous attempts to change this law. Unlike her, I voted against Lord Joffe’s Bill in 2004, and I voted against other similar initiatives. In 2014, I spoke and voted against the Bill of the noble and learned Lord, Lord Falconer of Thoroton. But much has changed since then, and God moves in a mysterious way, in my experience. I have come now to take a decision to change my mind.
Experience has shown over recent years that change does happen: it happens to churches and it happens to me. When I first came here, there were no women Bishops. The Lords Spiritual (Women) Act 2015 changed that. That is a minor change compared with this century’s growth in the world population from 6.1 billion to 8.2 billion—a 25% increase in 25 years. Just think what the 2025 numbers would be if abortion had not been legalised or there had not been wide-scale usage and advocacy of contraception. Indeed, the growth of homosexuality throughout society has reduced the number of children that we would have had. Had the churches had their way, we would have had a very much bigger population than we presently have, facing the difficulties we have with climate change. We all have change taking place around us, including the churches.
For some, dying is welcomed and is peaceful and serene; for others, it is full of great difficulties, pain, anxiety and misery, notwithstanding all the admirable efforts of palliative care. In my experience in recent years, I have seen people with terminal illnesses dying in fear, acute pain and misery. Of course, this can be avoided, as has been said by others, if one has the money. Anyone can go to Switzerland to Dignitas for assisted dying at a price. Further, you can go virtually safe in the knowledge that it is highly unlikely that any punitive action will be taken against you. Why is not such action taken? Is it not because most people see assistance with dying for the terminally ill as an act of caring, compassion and love? For those without the funds for that, this Bill, amended as the House sees fit, provides just that: for them to do it at their home. Who am I to deny that those less able to afford it should not have that choice?
Baroness Fox of Buckley (Non-Afl)
My Lords, as legislators, all sorts of laws pass through our hands—the good, the bad and the ugly. All are consequential for our fellow citizens, but rarely does a Bill weigh as heavily as this one. Wherever we stand, this law change could have a seismic impact on social attitudes to life, illness and death. Our task is formidable because of how many norms the Bill will overturn; I will mention a few.
The Bill unsettles centuries-old medical ethics. It rebrands assisting someone to die as a medical treatment, upending its understood meaning. The Bill rewrites the role of doctors. They will no longer be guided by the “Do no harm” ethos of preserving and protecting life; instead, the Bill mandates that they actively engage in taking a patient’s life by supplying lethal drugs that will kill them. The Bill especially shakes the foundations of society’s attitudes to suicide—and, yes, that is the accurate word; we know this because, at present, intentionally assisting someone to end their life is a criminal offence. So the Bill is forced to amend the Suicide Act 1961 to allow medical professionals to plan, prepare and assist in intentionally ending the lives of a particular group of citizens.
My greatest dread is that this state licensing of suicide could unleash a regressive culture change. For decades, we have made concerted efforts to deter people from taking their own life; this was brilliantly documented last week by the noble Baroness, Lady May, and the noble Lord, Lord Jackson.
Now, I pause. Any of us who have known family or friends who have committed suicide know that it is gut-wrenchingly tragic; it brings an especially visceral, raw grief. This is compounded by guilt as loved ones endlessly soul-search, totally unfairly blaming themselves: “What more could we have done?” This is why, if we see someone about to jump from a bridge, even if they give us 100 objective reasons why their life is not worth living or even if they have only a few months to live, we do not just shrug and walk on—we cling on to them and plead, “Don’t do it. Don’t jump”. All this reflects our deep humanistic intuition that, when a person acts to end their life, it should be resisted with all the energy society can muster. What happens culturally, though, when the state shouts, “Jump”, or agrees with those who say that ending their life is a compassionate choice?
I worry especially about what message this sends to the young, who are already often nihilistic and prone to anxiety, self-harm and mental health problems. When we debated the censorious Online Safety Bill, those of us who raised its negative impact on free speech were metaphorically slapped down and hectored. The one indisputable reason for that law was to close down suicide sites—something echoed by the Prime Minister only yesterday. We had to protect the young from malign online suicide influencers, but I worry that this Bill is the legislative embodiment of a suicide influencer. What do we think will happen when we tell newly franchised teens that, in some instances, taking your own life equates to dying in dignity? Saying that it will be restricted to those with a terminal illness just will not wash with a generation immersed in the language of rights and entitlements: “Why not assist me when I am suffering so much? Why am I being discriminated against?”
That brings me to my final point. We have heard some fine speeches from supporters of the Bill, stressing the importance of autonomy and giving people control of their life. I usually champion such sentiments in a political sense, but not when they are used to justify the state having a role in ending human life—forgive my squeamishness. For those who state passionately, “My body, my life, my choice”, why back a Bill that limits that choice to the terminally ill? Surely logically that right should apply to anyone who wants to kill themselves. No doubt this logic will lead to demands to expand the law—God help us once human rights lawyers get involved. As I say, we have a weighty responsibility to ensure that such nightmarish unintended consequences do not become a reality.
Lord McDonald of Salford (CB)
The last time your Lordships’ House debated assisted dying was in October 2021. More than 130 noble Lords signed up for the debate. I did not. I was a relatively new Member of the House and I thought that, with so many speakers, someone was bound to say what I thought—but that was not the case. Everyone I heard spoke eloquently, passionately and persuasively, but everyone had made up their mind for or against. I felt that I was torn in two directions.
In the past four years, though, I have settled. I am in favour of the Bill because it addresses one of my chief hesitations on that day, when it felt as though the Bill of the noble Baroness, Lady Meacher, was a foot in the door and would inevitably get wider. This Bill is framed very precisely. It is for the terminally ill with capacity in the last six months of their life. It excludes a large number of people; I know that that distresses my noble friend Lady Murphy, but I think it is right that mentally ill or depressed people and people with dementia will not be part of the Bill. It serves as a reminder to us and to the people of this country that we should have an advance care plan, which helps our relatives and doctors know what to do when we do lose capacity.
My second point is about safeguards. The safeguards in the Bill are elaborate; I fear that they may be too elaborate. Last week, the noble Lord, Lord Meston, reminded us that the first attempt at such a Bill foundered because it was felt that the safeguards were too cumbersome. I wonder what the panel would do. It feels to me that the key things here are that the patient is in control, and that there need to be two expert, senior and independent from each other doctors. One of them should probably be a consultant in the disease from which the terminally ill patient suffers, while the other should be a consultant in palliative care. With that amount of assurance, people at the end of their life should be able to proceed rather more quickly than all this bureaucracy would suggest. I was a bureaucrat; the idea that bureaucracy makes things safer is, I think, sadly wrong.
One bit of safeguarding that I would like to be included covers what happens to the unused doses. Last week, the noble Baroness, Lady Hayman, reminded us that up to 40% of doses in Oregon are not used. Could there be a line about whether they are destroyed or kept by the doctor for future use? It feels to me that that point needs to be addressed.
My last point is that this Bill is so important that we need to get cracking. A lot of people hesitate because it is a Private Member’s Bill, but I remind your Lordships’ House that these societal issues usually start as such a Bill. Sydney Silverman has already been mentioned; his efforts were a Private Member’s Bill. This is the same, but, clearly, it needs greater government help and attention if it is to become law. I hope that it does become law, and I hope that we can improve it, but, even if it is not changed, I would vote in favour.
Baroness Crawley (Lab)
My Lords, in a House packed to the gunwales with legal, medical and moral experts, it feels almost impertinent to intervene. However, along with many noble Lords, I have experienced unprecedented lobbying on this Bill. It is only respectful to those who have contacted me to say a few words in one of the most significant Second Readings in my 27 years in this House.
We have watched loved ones die, sometimes peacefully and sometimes in a drawn-out struggle. Like many noble Lords, I am conflicted on this end-of-life Bill. I voted against the last Bill to come before us some years ago. However, in the intervening years, I have tried to see the arguments for self-determination at the end of one’s life and to acknowledge the current, totally inadequate, position of the law in this area. After all, in nearly every other aspect of our lives, we are able to practise autonomy in our decision-making—well, those of us with agency are—so why should we not have self-determination in death if that is our wish and if life has become unbearable?
Yet still, I cannot dismiss my misgivings about my noble and learned friend’s Bill: not religious misgivings—I am afraid I am a collapsed Catholic—but misgivings about the Bill underestimating the coercive factors in society that could affect people at their most vulnerable time, be they personal or financial, and the Bill overestimating people’s ability not to feel a burden on their families and caregivers.
I know that in Clause 11, regulations are to be set out to avoid this happening, but the whole issue of the Bill relying so much on regulations yet to be seen has been rehearsed in the report of the Delegated Powers and Regulatory Reform Committee, which has a point. I worry that we have not yet had time to listen to those professional bodies that are hesitant about the Bill and to ask them about the reliability of a six-month diagnosis. I worry about the lack of learning from other countries where assisted dying is already the law, which provide examples of assisted dying being offered too quickly to those who simply need greater support.
I worry too about the economics of healthcare under the Bill—that assisted dying will be fully funded in our overstretched NHS, while palliative care is only partly funded, as the noble Lord, Lord Stevens of Birmingham, highlighted last week. Choice is squeezed out in such a scenario. I do not wish to see a future where palliative care withers on the vine while assisted dying becomes the default and cheaper option.
Having said all that, the Commons has spoken and sent us the Bill, and it is our responsibility now to take it and make it as workable as possible for our most vulnerable citizens, as seen in the compromise reached between my noble and learned friend Lord Falconer of Thoroton and my noble friend Lady Berger. We have a job to do in the coming months, and the whole country is watching—not something you often hear about your Lordships’ House.
Lord Harper (Con)
My Lords, it is a great pleasure to follow the noble Baroness. At the end of her speech, it was very clear that she should have had no concerns about the contribution she would make to the debate—it was a very powerful speech.
We are all the product of our experiences. One of the most profound and shaping that I had in public life was being shadow Minister and then Minister for disabled people. The reason for that was the opportunity I had over the four years or so in those two roles to meet people of all ages who had thrown in front of them, sometimes over the whole of their life and sometimes as a result of circumstances, challenges and difficulties that they faced doing the things that we all take for granted: living an independent life, working, bringing up a family, contributing to society and making the best of what they had in front of them. Many of those people are profoundly concerned by what the Bill will do to society’s view of people who have challenges thrown in front of them.
I know that is not the intention of the promoters of the Bill, but it does say something fundamental about society’s view of life, particularly life lived by people who have profound challenges. That is why the Bill is not supported by a single organisation in this country that represents disabled people—not a single one—and we should listen to their views and take them very seriously.
The second very powerful argument we have heard in this debate, referred to by the noble Baroness, Lady Fox of Buckley, is the one about choice and autonomy. The reason why that argument fails in this case is that you are taking a decision that impacts only upon yourself and has no consequences for others. The problem is that in delivering rights and choices for those who will be the beneficiaries—if that is the right word—of the Bill, you are effectively taking away choices and opportunities from others. There are competing rights, and when we have competing rights, we always have the most difficult decisions to make, and they are always the most charged political conversations we have.
The second reason why that argument fails is that, for choice to mean anything, it has to be a meaningful choice, and we do not have that in this country. We have some excellent palliative care, but it is not universally available to everybody; and in the Government’s 10-year plan for the NHS, there is no plan and no ambition to make it so, not even at the end of that 10-year period. I am afraid that a choice for assisted suicide without access to good quality palliative care is no choice at all.
My final point is about being clear about what we are doing here. As the noble Baroness, Lady Fox, said, and my noble friend Lady May of Maidenhead said last week, this is about assisted suicide. We are amending the Suicide Act to provide a defence for people taking their life. If the promoters of the Bill and those who support it find plain and clear language uncomfortable, rather than attacking those that use that plain and clear language, as they have done with my noble friend Lady May, they should perhaps reflect upon what it is they wish to do.
Baroness Smith of Llanfaes (PC)
My Lords, I begin by thanking the hundreds of people who have written to many of us about the Bill. Their letters, often deeply personal, deserve our attention and respect: diolch yn fawr iawn—thank you.
I have also listened carefully, last Friday and again today, to the many thoughtful contributions from noble Lords, each informed by personal and professional experiences. As this is a matter of conscience, I will share my own perspective. My view on the principle of the Bill has been shaped in part by my own experiences as a carer for my late father and by the experiences of my friend Claire O’Shea, who recently passed away at the age of 42.
Claire was initially misdiagnosed with IBS and was later diagnosed with terminal gynaecological cancer. In the face of her devastating diagnosis, she founded Claire’s Campaign, turning her own difficult experience into a campaign for change in Wales and building a platform to amplify the voices of women who had long gone unheard. Claire said last November:
“This Bill legislates for people with a terminal diagnosis and 6 months to live. Thankfully there aren’t many of us who are facing those circumstances imminently. So for those of us, who will face this reality sooner rather than later, this bill offers something really important. I have excellent palliative care; but it doesn’t address all of my needs and how I imagine a good death. It’s not just about pain management”.
For many people facing the end of life, simply having the choice, even if they never act on that choice, can bring immense comfort. For those reasons, I support the principle of the Bill.
Clear communication in healthcare is vital, especially when people face complex decisions. That is why I want to highlight the clause in the Bill, secured by my colleague in the other place, Liz Saville-Roberts, which requires that “all reasonable steps” be taken to ensure access to assisted dying services in the Welsh medium. Imagine discussing such sensitive matters with your GP and being unable to use your first language. Welsh speakers must be able to receive care yn eu mamiaith —in their mother tongue.
However, I must raise a serious concern: the constitutional implications of the Bill for Wales. While the criminal law remains reserved, health is not. The Bill, if passed, will have serious consequences on a completely devolved matter in Wales. Just less than a year ago, the Senedd debated assisted dying. The result was 19 in favour and 26 against. Those voting against included the First Minister and the Health Minister. So I ask this House: if the Bill proceeds at Westminster, are we comfortable asking a Welsh Government Minister who has voted against the principle of assisted dying to make the decision on whether to deliver this service within the NHS in Wales? Should the Senedd not have the first say on whether such a service should be introduced at all in Wales? It is the Senedd’s role to scrutinise the delivery of health services in Wales, and the Welsh Government’s budget would fund any new service.
In Committee in the other place, a provision was inserted to reflect the need for devolved consent. Regrettably, this was removed on Report. This is deeply problematic. There is a strong argument that the entirety of the Bill engages devolved responsibilities. Restoring a requirement for the Senedd’s consent makes sense, regardless of what your view is on the Bill’s principle.
As the Bill continues its passage through this House, I urge all noble Lords to reflect carefully on not only the moral weight of the matter before us but the constitutional responsibility we bear. We must respect the role of devolved Parliaments in matters that are clearly their responsibility.
Baroness Stroud (Con)
My Lords, it is a privilege to speak today and to contribute to a debate that has been characterised by such thoughtful, considered and respectful speeches from all points of view. I will speak on the dangers of the Bill and add my voice to those who believe that it should not proceed.
This nation was founded on the principle that every human being is not just of value but of infinite value. It is what led this nation to be a world leader in our care for the poor, refugees, children, the elderly and those with disabilities.
It is all too easy to make laws that are well motivated, but that have unintended consequences. All of us are moved when we hear stories of people who are experiencing significant suffering and who feel that they cannot go on, but the Bill does not address that issue. There is a danger that the Bill will put the vulnerable, the elderly, the poor, the lonely and people with disabilities particularly at risk.
I know that many in this House are sympathetic to the Bill. We are people who are used to being in control; we are used to being listened to and to being heard. It is why many here do not fear this legislation—in fact, they quite like it. The idea of being in control, right to the end of our days, is appealing, but life is not like that for most people. This ought to be a particular concern to us, as we face a future with increasing pressure on social care and the NHS, as more people live for longer and the cost of care increases.
It is not hard to see how assisted suicide could, over time, be portrayed to the elderly or people with disabilities as a way not to be a burden to loved ones. We need to listen to the voices not just of celebrity endorsers of the Bill but of the vulnerable. There is a reason why over 350 disability groups oppose the Bill.
I am also concerned about people feeling they are a burden on the state. As we have heard this morning, a Canadian report projected savings of nearly 150 million Canadian dollars each year as a result of the country’s medical assistance in dying programme. In a context where there are often not enough hospital beds and a shortage of hospital and care staff, it is not impossible to imagine vulnerable people feeling a duty to choose assisted suicide or being subtly coerced by a misguided or even sinister word from a frustrated family member or medical professional. In fact, a professional colleague recently said to me that, in Canada, the common recommendation has become not go to hospital on your own if you are over 60. That is a pretty drastic state of affairs.
Where good palliative and social care are lacking, demand for assisted suicide will grow and the danger is that it will fill a gap in places where palliative care services are inadequate. Last week, as we have heard, there was an Oral Question on the suicide prevention strategy. I listened to the concerns from all corners of the House, and the determination from the Government Front Benches to ensure that everyone had the appropriate support, so that no one would ever be tempted to choose a suicide pathway. Yet in the same Chamber we are debating a Bill that seeks to legalise this pathway.
Before the summer, the Bill passed the Commons with a small and decreasing majority. Over the summer, we were given a moment to pause, stop and examine ourselves as a nation. Is this the sort of nation we want to be, where protection is removed for the vulnerable, the poorest, the elderly and those with disabilities; where budgets for health provision can be cut because the vulnerable are being encouraged to choose death? I can just hear the Department of Health working through the budgetary reductions with the OBR, based on the percentage increase of those expected to choose assisted dying. I believe that this country can be better than this, that we should be having a different conversation and that the palliative care we provide for those who are terminally ill could be developed so that we become a world leader. Now that would be an ambitious vision that would be worth voting for.
Lord Sassoon (Con)
My Lords, my reason for speaking in this debate is that I also feel that the many people who have written to us deserve to know where each of us stands. I support the introduction of a carefully circumscribed assisted dying regime along the lines of the Bill.
I have seen two very severely ill immediate family members have the times of their deaths determined by a combination of medical practitioners and other close family members. If such decisions can be made on behalf of individuals who are very ill, who are not capable of making the decisions themselves, why should we deny a similar right to people who can make such decisions? I firmly believe that any moral or religious Rubicon over the determination of the time of a person’s death was crossed long ago in this country.
If I have significant doubts over the Bill, they are very much those of the noble Lord, Lord McDonald of Salford, on whether the safeguards within it risk imposing excessive bureaucracy to the detriment of the effective protection of the individual. Many have criticised the Bill for the extent of its delegated powers and, if this were a government Bill, I would also be appalled. But in this case—it is a Private Member’s Bill and there is clearly not a question of the promoters taking powers for themselves without proper scrutiny—I am not unduly concerned. The committee raises important questions and those delegated power issues will, quite properly and importantly, be carefully considered in Committee.
On the passage of the Bill through the House, I feel strongly with others that we must return it to the other place. It is a Bill that has already been through the other place and that has wide public support. It will be extensively scrutinised and, no doubt, improved by this House; it should then be returned to the other place in the normal course. In that connection, I add my thanks to the noble Baroness, Lady Berger, and to the promoters of the Bill for agreeing to an improved scrutiny process.
So I believe that this is an important Bill. It needs much more scrutiny, but it would further improve the dignity of dying in this country. I hope the House gives it a Second Reading.
Lord Truscott (Non-Afl)
My Lords, I am not a medical expert nor a lawyer, but I am a trained historian, so I can say that the international precedents for assisted dying or assisted suicide are not good. When William Beveridge set out his report on the future welfare state, the idea was to support life from the cradle to the grave. When Nye Bevan established the NHS in 1948, it was with the goal to preserve life and improve health outcomes for all. Assisted dying simply had no place in the founding principles of the NHS.
For 2,500 years, the Hippocratic oath has been a foundational code of medical ethics, and the principle “do no harm” has been a central tenet for all those years. Many doctors and medical professionals are uneasy about crossing that line, and so they should be, as the trust between doctor and patient is at the core of the patient-doctor relationship. The societal impact of changing the relationship between doctor and patient will be profound and may well lead to fear and mistrust, as noble Lords have heard. The person before you may not be there simply to care for you but to actively end your life.
Dying a painful death—which affects about 5% of people but is not a ground for assisted death under the Bill—underlines the key point that more resources should be put into our Cinderella palliative care and research services. While one in 20 may die a painful death, terrible as that is, in the Netherlands, where assisted dying is well established, one in four deaths are now assisted suicides, showing that the painful end is not the main reason for people to seek a state-enabled suicide.
Noble Lords with legal training will be aware that, despite the Government’s statement that the Bill is compatible with the European Convention on Human Rights, Article 2 of the ECHR protects the right to life. It does so by placing two obligations on the state: the positive obligation to protect the right to life by law and the negative obligation not to intentionally deprive the individual of life.
My second major concern about the Bill is the issue of coercion. Despite it being mentioned throughout the Bill and being made a criminal offence under Clause 34, it is almost impossible to prove and police, as noble Lords have indicated. According to the Home Office’s own figures, 50% of coercive cases are dropped through lack of evidence and only 5% result in conviction. Internationally, as research from the excellent House of Lords Library has shown, known and proven cases of coercion in jurisdictions which allow assisted dying are few and far between. Subtle coercion is well-nigh impossible to prove.
In any event, the most common reason for people choosing assisted dying elsewhere is the fear of becoming a burden to others, a form of self-coercion, not the fear of a painful death. At a time when the UK is about to see the biggest transfer of wealth in its history, with £7 trillion moving between generations by 2050, primarily from the baby boomers, this is not the time to pass this assisted suicide Bill.
Nor should we as a society normalise suicide, as has been mentioned. Studies show that assisted suicide laws have led to a substantial increase in total suicide rates, including unassisted suicides, and the most affected group by this legislative change is women.
The Bill as drafted has simply too many flaws, in my view, and unintended consequences, as your Lordships have heard at length. It should be rejected.
Baroness Berger (Lab)
My Lords, there are passionately held views on the subject before us, and the informed and respectful deliberation so far shows your Lordships’ House at its best. We are being asked to legislate for autonomy, but we also have a duty to set out that principle within the reality of our unequal society. I am deeply concerned that the Bill as it stands would not only ignore but deepen those inequalities.
My views are shaped in part from learning about my mother’s work as a counsellor in a palliative care unit and the hours I spent at the bedside of three of my grandparents as they neared the end, including as they took their last breaths. While I am one of the younger Members of this place, and I hope I have at least another 50 years ahead of me, I have thought about the end of my life. Ideally, I would like to die naturally at home, with, if needed, access to the high-quality palliative care that everyone deserves.
While I would not want an assisted death, I recognise that some noble Lords do, as expressed during this debate. We are fortunate: as noble Lords, we have a voice, above-average resources, and agency—the ability to make our own choices, free from interference, prejudice, coercion or undue influence. But assisted dying, if introduced, would exist as a choice not only for us and other comparatively fortunate people; it would enter the lives of those most at risk—people already overlooked, unprotected and vulnerable at the end of life.
It was a privilege to be a Member of Parliament for almost a decade, and I have so many fond memories of my former constituents. But some of the most searing moments I experienced as a Member of the other place came at my weekly surgeries. The first time I heard someone speak openly, in the most unsavoury terms, about wanting a family member dead, I shook. I was appalled, and I could not believe what I was hearing. I was naive to think that this would be an isolated case. I have also not forgotten the words and realities of too many former constituents: people isolated and abused in their own homes, sometimes for decades, in fear for their own lives; people who felt like a burden because of long-term illness or serious mental health conditions, especially the elderly; and people treated as though their lives were worth less because they had a disability. Many were from low-income backgrounds, facing not only poor health but the crushing stress of unaffordable care costs.
These voices still ring in my ears and motivate me profoundly as I consider this Bill, alongside the many powerful representations we have heard in recent weeks, including, as we have heard from other Members, that there is no organisation of or for disabled people in this country that supports the Bill. In considering who the Bill might benefit by giving them more autonomy, we must equally consider who it may harm by taking their autonomy away.
We have a duty in this House to test the Bill’s safeguards when they meet reality, and I think we must also consider the role of family members and carers. The Bill does not require their involvement. It does not even guarantee they will be informed. Yet these are exactly the people who know a patient best, and who may spot signs of coercion, confusion or fear that professionals might miss. Their exclusion is not just a procedural oversight; it is a moral failing.
In conclusion, if the Bill passes, the relationship between vulnerable people and their doctors and the state would change for ever. There would be no going back. This Bill touches the deepest and most exposed moments of human life. It demands our utmost scrutiny, not just in principle but in practice—and, in practice, it currently falls short. We cannot legislate for irreversible decisions on the basis of incomplete protections. We have important work to do.
Lord Markham (Con)
My Lords, like many noble Lords, I come at this debate from a point of personal experience. My mum, Judy, was 62, a fit and healthy Macmillan nurse, when, out of the blue, she was diagnosed with terminal cancer and given weeks to live. She was taken to a hospice three weeks later, barely conscious, and, very quickly, the clinicians gathered round her next of kin and suggested that she was in a lot of pain, that she did not have long, and that maybe helping her to take an earlier train would be the kind thing to do. We all agreed, and we all thank that hospice to this day for the kind and peaceful death that they gave her.
This happened not in some far-away land but right here in the UK. I think we are all probably aware of many such instances in the UK where, informally and quietly, terminally ill people are helped to have a kinder, compassionate, pain-free death. It is because of that experience that I am in favour of finding a way to allow other people to experience a kinder, safer death in a way of their choosing. I know from talking to many terminally ill people that it gives them great comfort knowing that they could have the ability to take that earlier train home.
I understand the concerns of many noble Lords here. I understand that, for some, it is a point of principle, for religious or moral reasons. I understand the concerns that many others have about the risks presented by the Bill, which is why I support the approach taken by the noble Baroness, Lady Berger, in her amendment to have a Select Committee scrutinise the Bill to make it the best it can possibly be. That is, after all, what we do best in the Lords.
However, I believe that arguments against the Bill about the burden on the NHS can be addressed by making sure that the Bill enables provision by the voluntary sector, just as happens with our excellent hospices, which are majority funded by voluntary rather than government money. I do not believe that arguments about undue burden on the NHS should be a reason to oppose the Bill.
After speaking to many terminally ill people, I think that it is wrong to equate their wish to die in comfort and without pain with suicide. My experience is that these people very much want to live but unfortunately know that they will shortly die. They therefore want to have the choice to do that in a way of their choosing, with comfort and in a pain-free way.
To conclude, the Bill is about choices—whether terminally ill people are given the choice voluntarily to face a kinder, pain-free death and to take that earlier train home, or whether we choose that that choice should be denied to them because we feel that, somehow, they are not fit to make that choice or may have felt coerced into it. Giving people that choice is a fundamental right, which is why I want to work on the Bill to ensure we do it in the kindest and safest way.
Lord Carey of Clifton (CB)
My Lords, it is a great honour to participate in the debate. I particularly thank the noble Baroness, Lady Thornton, for her excellent opening speech.
I support the Bill. As some know, I have been on both sides of this debate over the years. I voted against Lord Joffe’s Bill in 2005, but then, as I went deeper into the subject, I began to realise that the Christian faith had very little to say directly about this modern issue. That shocked me very deeply, and I then explored further the shocking experiences of people going through pain and indignity. We have heard many of these stories, as survey after survey shows that some 75% of our population, our fellow citizens, want a change in the law.
It is right that the Bishops have spoken so powerfully and well in this debate, but the irony is that they are not representing their own church in this matter—I am doing that today, with others. In addition, there are many Jews, Muslims, Hindus, Sikhs and other worshippers who are also in favour of the legislation, led by Rabbi Jonathan Romain of Religious Alliance for Dignity in Dying.
The Bishops will know—I am not haranguing them—that in Christian spirituality there is a prayer called the Jesus Prayer. It stems from a blind man, Bartimaeus, calling to Jesus from the wayside, “Lord, have mercy on me. Eleison me. Have mercy upon me”. We must hear that cry in this debate, and we have heard it. Compassion, mercy, the act of kindness and the art of healing must accompany a pain-ridden person to the point of death, alleviating their sufferings, even if it requires powerful opioids to give them the peace they seek.
There has been some questioning of the legislation in this debate. The noble Baroness, Lady May, used the graphic phrase “licence to kill” to describe the legislation. Much as I respect the noble Baroness, I resist that description. The Bill gives safeguards and protections that, without question, will resist abuse. We may want to add to those safeguards.
I add, with temerity, a rhetorical question addressed not only to the Bishops’ Benches but to us all: do we really want to stand in the way of the Bill? It will pass, whether in this Session or the next. It has commanding support from the British public and passed the elected House after an unprecedented period of scrutiny. Both this House and the Church are in the midst of renewed public debates on our roles in society. I pray that both these institutions, which I hold so dearly for the importance of their roles in public life, do not risk our legitimacy by claiming that we know better than both the public and the other place.
Lord Bellamy (Con)
My Lords, it is an honour to follow the noble and right reverend Lord, Lord Carey of Clifton. In declaring my membership of the Constitution Committee, I say first that the delegated powers in the Bill are excessive. Clause 41(4) permits the Secretary of State to amend the National Health Service Act by delegated legislation. Allowing that fundamental legislation, dedicated to prolonging life, to enable the Minister to do the exact opposite—namely, to assist death—with no detail as to how that new function should be discharged, is not a proper exercise of delegated powers.
I turn now to the fundamentals. The Bill is not, in fact, based on suffering, as others have pointed out. According to the impact statement, other regimes are based either on intolerable suffering, such as in Canada, Belgium, the Netherlands et cetera, or on terminal illness, such as in some US states, Australia and New Zealand. Under this Bill, those with terminal illness but who are not suffering may request assisted death, but those who are suffering intolerably but are not terminally ill may not do so. Given that so much support for the Bill depends on the avoidance of suffering, and so that we are all clear, I respectfully ask the noble and learned Lord the sponsor to put fully on the record why the Bill is not based on suffering.
We are told in the impact statement that, by year 10—14 years’ time, given the four years of preparation—the Bill will give rise to around 7,000 assisted deaths a year in England and Wales. Given that roughly 570,000 people die every year in England and Wales, that is around only 1% of deaths. That raises two opposite questions. First, if so few people are to benefit from assisted dying, is that sufficient to justify the profound change to society and the role of the state that the Bill aims to bring about? Secondly, can we credibly trust that 1%, which is, apparently and somewhat bizarrely, based exclusively on the experience of the largely rural state of Oregon in the western USA? If we cannot trust that estimate, is the Bill the thin end of the wedge? Once the principle is conceded, will pressure to go further inevitably increase? I ask the supporters of the Bill to give the House reassurance on that important point.
Finally, as many have already said, individual autonomy, which is the other main argument in this debate, cannot be exercised in isolation from the rest of society. Once the principle is conceded, everyone’s doctor-patient relationship is affected. It affects all our relationships with our doctors. Similarly, the vulnerable, the inarticulate and those for whom “autonomy” is largely illusory are all affected.
Given these very difficult questions, including those of mental capacity, the Bill’s complex bureaucracy and the role of the coroner, to give only a few examples, we need much more substance in the Bill before we can proceed any further.
Baroness Ramsay of Cartvale (Lab)
My Lords, like all of us in this House, I have been inundated by a flood of mail, by post and online, on this Bill: more than I have ever experienced in my almost 30 years in your Lordships’ House. Unfortunately, it is not possible to answer them all individually, but I put on record my appreciation to all who sent their opinions and shared personal details, which were often emotional to read and certainly must have been very emotional to write.
I lived for three years in the Netherlands. Recently, my closest Dutch friend of many years, an intelligent, attractive, brilliant linguist and professional interpreter, became ill with terminal cancer. After undergoing treatment for some time, she decided to end her suffering and her life. Her wishes were granted after she had fulfilled the required procedures. I spoke with her brother, a retired doctor in the Netherlands, by telephone on the afternoon of the day she died. He told me that that morning he had brought his sister home from the hospital. He said, “All the decisions were completely hers. She was in her own bed and in her own house”. He added, movingly, “And she was still a beautiful woman”. I was, of course, very sad to lose my friend, but I felt contentment for her having the end that she wanted.
I would like to make it clear that my support for this Bill does not in any way affect my admiration and respect for our excellent hospices for those who wish for and need hospice care. A shining example with which I am familiar is St Christopher’s in south London, which was founded in 1967 as the first UK hospice. Its purpose was and is to link pain control with compassionate care.
We all know that legislation on the choice of ending life and on dignity in dying has been debated in Parliament over a number of years. The dates and details are clearly set out in the briefing papers. Many changes were made in another place’s exceptionally long consideration of this Bill, and changes will no doubt be made here, but the fundamental decision that we are trying to make here is whether to give individuals the choice of ending their life, with whatever safeguarding requirements Parliament decides.
No one can disagree with the statement that, in the interests of good legislation, this House should have the opportunity to scrutinise and make decisions. If this can indeed be done in the timescale of the amendment from the noble Baroness, Lady Berger, to report by 7 November, and the dates of the parliamentary Session allow time for the Bill to go through all its stages, it warrants support. But let us not forget that the time has come to answer the fundamental question.
Lord Moylan (Con)
My Lords, so much has been said about the principle and the technicalities of the Bill that I thought I would use my few moments to return to the language used in the Bill. I realise that that is a controversial thing to do, because I have seen the reaction to the speech of my noble friend Lady May. I wish to express some solidarity with her, because the argument against her has been that people wishing to access an assisted death do not actually want to die, but suicides presumably do. I think that is a mistake. In the case of suicides, most of them do not want to die. Most of them want their girlfriends or their families back, their fortunes restored or their pain taken away. The distinction collapses when you look at it closely. They are very much in the same position as people who are trying to avoid pain at the end of their life. So I express my solidarity with my noble friend.
There are other points about the language. It is notable that the words “death” and “dying” hardly appear. The poison to be used is described as an “approved substance”, and the still mysterious contraption by which it is to be administered is called an “approved device”. The business itself, when you get to Clause 25, is headed “Provision of assistance”. “Assistance” is the term used throughout the Bill. Is this something that is going to become part of our daily language? “Have you considered ‘assistance’, Mrs Smith?”
We know what this is: it is euphemism, an ancient Greek device for hiding from the gods, through the use of flowery language, something of which you are ashamed. That is what the language of this Bill is constantly expressing at every turn. I think we are right to be ashamed of what is in this Bill. I think we should take the opportunity not only to scrutinise it but, if we see fit, to give the Commons an opportunity to consider it in a second parliamentary Session to see whether its view remains as firm as it is now—which after all is not very firm, purely on the numbers.
I will make one final point in response to an argument that I have heard several times in the course of this debate: that it is somehow discriminatory that some well-off people can afford to go abroad to evade the law and that this is a discrimination that needs to be addressed by giving everybody the opportunity to evade the current law. We never use that argument on anything else, do we? Have I ever heard that argument used when it comes to tax evasion, for example? It is a very strange argument indeed, and one that I think does no credit to those who promote it.
I think this Bill indeed deserves scrutiny, but we are not in any way committed or obliged to pass it. It is a Private Member’s Bill and, if it is the view of the House that it should not pass, that is the view the House should take.
Baroness Berridge (Con)
My Lords, sadness and sympathy are palpable in our inboxes and in this Chamber. Your Lordships’ House is a sobering scene. I begin with what is missing from the Bill—the letter “S”, the plural. As the noble Baroness, Lady Berger, has outlined, there is no mention of family or relatives. Its premise is the western Enlightenment view of the self and individual autonomy, which is alien to parts of the UK, let alone to some of our ethnic minority communities. On the latter, I can put it no better than an article by Chine McDonald, director of Theos, in a post on 26 November last year:
“Many people will be familiar with the southern African term ‘Ubuntu’, which means ‘I am because you are’. In my own community—the Igbo ethnic group of south-eastern Nigeria—there is the concept of the Umunna: the fraternity, the clan or the community … there is a strong sense of existing not as an individual, but knitted into a family … The idea that someone who is facing death might not want to be a burden … is anathema to West African tradition. You can’t be a burden because you are not a separate entity. You’re part of a whole”.
Anyone who has visited the north-east of England might attest to a similar “thick” community.
I heard the compelling story of someone with PTSD after watching the huge syringes of drugs go into their father. There is no duty under the Bill to warn them. What about the effect on you of witnessing the failed process that the Bill outlines? Or are they just not allowed to be there?
Another “S” is “subtle”. Many noble Lords have spoken of subtle pressure, and pressure and coercion are used in the Bill, by relatives, which can be hard to detect. There is another wrong premise in the Bill: that pressure comes from a person. If you join a Facebook networking group, say, for fellow sufferers of the same disease, the algorithms can alter the content offered to you, or comments by others can cause you to idealise the thought of assisted dying, create a reward pathway in your brain and even, according to studies, change the network and structure of your brain. Thus, in fact, the coercion could come from an unquantifiable force, or even an algorithm, not a person. How can medical practitioners ever know if you have been pressurised like this? Although this research field is still in its infancy, could we, in 10 years, be reporting that deaths were actually through coercion on social networking? Even today, a family is suing OpenAI, saying that ChatGPT encouraged their son to take his life. Other studies are now reporting that people are more likely to turn to social media for medical health reports than to qualified physicians. This is the world in which we are legislating. We know that this can influence elections; how can it not influence these decisions?
The clause to prohibit advertising is insufficient. This Bill is for an analogue age, not one on the cusp of AI. Although I support the suggestion of the noble Baroness, Lady Berger, for a Select Committee—and I hope I am not throwing a spanner into the timetable—I do not think we can ignore these issues. I am an optimist, and I hope that the six-month timeline in the Bill—again, because we are on the cusp of medical breakthroughs—will in the future become impossible. Anyone who knows parents of children with cystic fibrosis knows that the new-gen drugs are transformative. How will clinicians advise when they do not know what breakthroughs we are on the cusp of?
My final “S” is single women, as the noble Lord, Lord Truscott, talked about. A meta-analysis of the best quality of Oregon between 1998 and 2018 says that it witnessed an increase of 50% in voluntary suicide of older women over the age of 65. We know that suicide can be contagious. Are we opening up that Pandora’s box again? I agree with the right reverend Prelate the Bishop of London about voting on the principle. This is leadership from the Church of England, and the feedback to me is very welcome. I do not view this as taking your own life; I view it as giving your life back to God. This is a sacred act, and not one the state should provide.
Lord Banner (Con)
My Lords, I oppose the Bill, largely for the reasons so eloquently articulated by my noble friend Lady May of Maidenhead, the right reverend Prelate the Bishop of London and my noble and learned friend Lady Prentis of Banbury, whose own personal, harrowing experience—following her diagnosis of cancer, and feeling a burden on her family despite all the advantages in life she is lucky to have—speaks volumes to the pressures that those less fortunate will come under if the Bill becomes law.
I will add two points to those already made: first, this is not a debate about the principle of assisted dying. We are not being asked to answer an essay question; we are being asked whether this specific Bill is the right Bill. Many speakers on the opposition side of this debate have drawn attention to a wide range of shortcomings within the Bill. On the whole, the speeches in support have focused instead on advocating the principle of assisted dying, often citing very moving stories of the suffering of those who endured a painful death, or faced prosecution for helping loved ones avoid it. Horrendous though those stories were, they provide no answer to the concerns expressed about this particular Bill. As my noble friend Lord Sandhurst said last week:
“Hard cases make bad law”.—[Official Report, 12/9/25; col. 1855.]
Secondly, I would like to address the contention that any expansion of the Bill’s criteria—to the extent that they are on the face of the Bill at all—would need to come back before Parliament. I remind noble Lords of the interpretive force of Section 3 of the Human Rights Act 1998, which states in subsection (1):
“So far as it is possible to do so, primary legislation … must be read and given effect in a way which is compatible with the Convention rights”.
There is judicial authority, at the highest level, that this can enable and indeed require a court to twist the words of legislation. For example, in the case of the Queen v A (No. 2) 2002, 2 AC 45, Lord Steyn held:
“In accordance with the will of Parliament as reflected in section 3 it will sometimes be necessary to adopt an interpretation which linguistically may appear strained. The techniques to be used will not only involve the reading down of express language in a statute but also the implication of provisions”.
I therefore caution noble Lords against assuming that the words in the Bill will be interpreted in the literal way. On the contrary, Section 3 of the Human Rights Act is a goldmine for judicial expansionism, without Parliament being reconsulted. Those concerned about considering whether this is the right Bill—as opposed to being swayed by jury speeches about the principle of assisted dying—would therefore do well to treat its wording with a considerable pinch of salt, unless it is amended to exclude Section 3 of the Human Rights Act, as Section 1(5) of the Illegal Migration Act 2023 does.
I respectfully invite the noble and learned Lord, Lord Falconer, in winding up this debate, to address whether he would accept such an exclusion. If he cannot, or does not give an unequivocal commitment to do so, that would clearly indicate the scope for mission creep without parliamentary scrutiny.
Lord Browne of Belmont (DUP)
My Lords, like many in this House, I have always opposed a change in the law to allow for assisted dying. I understand the sincere motivations of those who desire to change the law, and I have listened to the many eloquent speeches given by Peers across the House in favour of the change.
However, I have never been convinced by the idea that such a law would be the right way forward. I continue to believe that this is not the path we should go down. In addition, I strongly agree with the concerns expressed by many noble Lords that such a serious issue has been introduced using the Private Member’s Bill process and thus has received such scant scrutiny.
We are making life and death decisions today on this Bill. As we do so, it behoves us to listen to the authoritative medical voices publishing their views on this issue as the conversation on assisted dying has proceeded and the Bill has been developed. Several professional organisations have made statements on this legislation. It is not just one medical association that has given us a warning, which we might be tempted to discount as an outlier; at least five organisations have done so.
First, the Royal College of Physicians said that
“there currently remain deficiencies that would need addressing to achieve adequate protection of patients and professionals”.
The RCP is neutral on the principle of this Bill but has warned that it is essential to consider the current Bill—and decisions that patients may make—in the current context of the NHS and healthcare in England and Wales, especially the access to and availability and equity of services for people who may be terminally ill.
The Royal College of Psychiatrists was even more explicit when it said it could not support the Bill in its current form. It highlights that:
“The Mental Capacity Act does not provide a framework for assessing decisions about ending one’s own life … It is not clear what a psychiatrist’s role on a multidisciplinary panel would be”,
and that:
“Terminal illness is a risk factor for suicide”.
I believe we need to take note of these important points.
Secondly, the Royal College of Physicians joined forces with the Royal College of Psychiatrists on 12 June to warn this House again about the impact of the Bill. They expressed concerns about safeguarding and fears that the NHS workforce does not currently have the resource required to meet these additional demands.
Thirdly, the Royal College of Pathologists said that it could not support the Bill, and that
“deaths following assisted dying should be notified to the coroner, just as other deaths following the administration of drugs, prescribed or not, must be”.
Clause 38 does not line up with the advice of the Royal College of Pathologists.
Fourthly, in June the British Geriatrics Society highlighted that:
“There are inadequate safeguards to protect older people from harm”.
Fifthly, and finally, the National Down Syndrome Policy Group added its name to those concerned about the impact of the Bill on individuals with Down’s syndrome and learning disability.
We are repeatedly told that this Bill is the safest in the world. Our medical professionals and organisations caring for those affected by the Bill are warning us that it falls well short. This is not the right Bill to protect patients. I hope noble Lords across this House will take those warnings to heart today; we should not be coerced into believing that we must pass such flawed legislation.
Lord Johnson of Marylebone (Con)
My Lords, I was one of 118 Members of the other place who voted unsuccessfully in favour of the Assisted Dying (No.2) Bill a decade ago when it was thrown out by that House in September 2015. Notwithstanding many powerful speeches that I listened to last Friday, and again today, my position on this subject has not changed. I support this latest effort to legalise it. As we have all heard, assisted dying has strong public support. It also has the mandate of the elected House in our Parliament. We should give it a fair hearing today and speed it on its way.
People who suffer from an incurable condition should not be forced against their will to endure intolerable suffering. The case for change, I believe, remains strong. It will provide terminally ill adults with the choice and dignity of a compassionate death within the law, and it will provide autonomy to those who feel that they are lacking agency and control over their lives.
There is also strong agreement in this House that the Bill is not yet perfect, and a desire to use our best efforts to improve it. That is what we should all focus on in the coming weeks. One area where it might benefit from further debate is the rather arbitrary, in my view, six-month threshold for eligibility. It will be worth us debating carefully whether there is not a case for instead having a test based on clinical progression, so that assisted dying is available to adults with a progressive disease, illness or condition from which they are unlikely to recover and which can be reasonably expected to cause their death.
Either way, I am confident that this House will do its job: it will scrutinise the Bill carefully and improve it where possible and where necessary.
Lord Green of Deddington (CB)
My Lords, this has been a most impressive debate, with the House operating at its best. However, we now face a challenge because, frankly, the Bill as drafted is a bit of a shambles. An enormous amount of work needs to be done, both on the detail that has been raised and on its central issues. It also contains the risk that some people will feel that they must end their life because they fear that they have become a burden on others.
The noble Lord, Lord Kakkar, described the Bill as
“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”.
That point has also been made today. The noble Lord, Lord Kakkar, also pointed out that
“passing a Bill that makes provision for the state to pay for an assisted dying service … while not fully funding the provision of palliative care”—[Official Report, 12/9/25; col. 1809.]
would have wider implications, which was rather tactfully put, if I may say so. Indeed, it may be partly for this reason that a clear majority of palliative care doctors are opposed to the Bill in its present form.
One cause of concern, which I share, is the disappearance of the High Court judges from the oversight system, for reasons that are entirely understandable. As a result, those panels are likely to be staffed mainly by those who favour the new arrangements—and we have seen in Canada how rapidly the number of assisted deaths could grow. In seven years, they have increased from 1,000 a year to 15,000 a year.
A further major difficulty in the present Bill is that, while doctors can decline to be involved in the new system, hospices and care homes cannot, as bodies, opt out. Indeed, some care homes might well feel obliged to close. That will be a very serious blow to a lot of people.
The Bill even includes a requirement for medical professionals to “signpost” patients towards information about how to access an assisted suicide if they so wish. That is an extraordinary requirement, not so different from the ordinary suicide websites that we rightly seek to prohibit. The Bill would also permit doctor shopping, where a patient refused by one doctor could simply find another who was willing to sign the documents, and there could indeed be money to be made by some people in those circumstances. It is even the case that such suicides would be explicitly excluded from a coroner's investigation—yet another point that needs to be looked at very carefully as this goes forward.
I trust that this House will now address itself to the many amendments that are needed. They were brilliantly summarised by the noble and learned Baroness, Lady Butler-Sloss, while the noble and right reverend Lord, Lord Carey of Clifton, spoke powerfully on some wider issues. That leaves me in two minds, and I will see where we get to before I decide to vote.
Lord Shinkwin (Con) [V]
My Lords, it was a day much like any other when I was diagnosed. A busy day at the office was followed by a hospital appointment to find out why, within months, my face had, in effect, shut down on the left side. Nothing prepared me for what came next: an MRI scan showed that a succession of mini-strokes was killing me, and I had six months left to live. The only hope was neurosurgery.
I asked the neurosurgeon my odds on making a full recovery. Her reply was direct. She said, “I can’t give you odds on survival”. What she did not say was, “I can help you to die”. This Bill would fundamentally alter the conversation that a patient has with the doctor whom they trust to do no harm, as the noble Lord, Lord Truscott, and others have highlighted.
Notwithstanding an excruciating and painful long recovery, the surgery was a success, although I have to speak slowly to be understood, and I am grateful for noble Lords’ patience and understanding. Ironically, my shock then and my shock subsequently at becoming, 20 years later, a Member of your Lordships’ House have something in common: they were both unforeseen.
That brings me to some wise words from Hansard on 12 March 2007:
“Our role in scrutiny is vital … we are a legislative Chamber … There will no doubt be … unforeseen consequences, but they would all need to be considered”.—[Official Report, 12/3/07; cols. 451-56.]
I thank the noble and learned Lord, Lord Falconer of Thoroton, as the words are his. It is indeed our duty to scrutinise the Bill and consider all its unforeseen consequences, for they are legion.
I wonder whether we have any idea of the Pandora’s box that the Bill will prise open. Many noble Lords have referred to jurisdictions where assisted dying has already been introduced. The precedents that those jurisdictions provide clearly show the chain of events that the Bill would set off, not just for disabled people but for older people, young people with mental health issues, and young women with eating disorders. It is the stuff of nightmares.
My noble friend Lady May of Maidenhead told us how her friend referred to the Bill as a “licence to kill Bill”. She is right: it gives the state a licence to kill the wrong type of people. I am the wrong type. As the noble and learned Lord, Lord Falconer, pointed out in his speech, there are savings to be made should assisted dying be introduced. This Bill effectively puts a price on my head. Indeed, should it become law and precedents set elsewhere apply in the UK over time, I face the realistic possibility, as a severely disabled person, of being killed as a result of legislation passed by this House. As my noble friend Lord Harper reminded us, no organisation of or for disabled people supports the Bill.
I close with a plea that we do not allow anything to deter us from doing our duty and subjecting this Bill, with all its unforeseen and irreversible consequences, to the scrutiny it not only deserves but so desperately needs. I support the Motion in the name of the noble Baroness, Lady Berger.
Lord Taylor of Warwick (Non-Afl)
My Lords, I found the dignified words of my noble friend Lord Shinkwin to be most powerful and persuasive. He used the phrase “Pandora’s box”, and I too oppose this Bill.
It is said that one of the lessons of history is that we do not learn lessons from history, so we must learn lessons from the history of this important matter. One can only have compassion for those who are in so much pain and suffering that they wish to end their lives, but supporters of this Bill say that this is a matter of choice. I question that, because assisted dying would not be a real choice if the alternative option of high-quality end-of-life palliative care is not available.
This Bill is based on assessing someone as being within six months of natural death, but such a prognosis is often unreliable. I still recall that awful time when a hospital doctor asked for my permission to turn off the machine that was basically keeping my mother alive. I was aware of the fact that her church and her family were praying for her, so I said no. The doctor said, “Well, that is your choice”. She went on to live for several years longer, enjoying her family, and in particular her grandchildren. As that doctor said to me some years later, “Wow: it was a miracle. There must be power in prayer”. I said, “Yes, that’s right”. Those who accept a time limit of six months now to get the Bill passed could come back again in a few years’ time to shorten or even remove a time limit.
I believe that this Bill lacks genuine safeguards for vulnerable people. There is no longer judicial oversight, namely, that a High Court judge should approve assisted suicide. I use the word “suicide” not to cause offence, but because this is really what it is. The original key safeguard has been replaced. Psychiatrists and social workers, who are to be included in the panel system, have warned that there are not enough of them to fill this role.
Unfortunately, there are very well-meaning and experienced social workers who miss the abuse of children and babies, and yet this Bill seeks to put even more pressure on that profession. Evidence from countries where assisted suicide is legal and available, such as Canada, New Zealand and the Netherlands, indicates that there is likely to be a move from assisted suicide for the terminally ill only, to those with other health conditions.
The National Health Service is already under huge pressure, struggling to meet targets. This Bill would put even more pressure on the NHS at precisely the wrong time. As the Health Secretary Wes Streeting MP has said:
“If parliament chooses to go ahead with assisted dying, it is making a choice that this is an area to prioritise for investment”.
These choices would come at the expense of other choices. Surely the investment should be in better palliative care for the terminally ill in hospices or care homes, ensuring a better quality of life in the last years, months or days.
In the Bible there were five characters in particular who contemplated suicide: Hannah, Elijah, Job, David and Jonah. But in each case, even during the anguish of their suffering, they eventually found that the God who created them gave them a reason to continue living until the natural time for their death. I oppose this Bill. The first duty of government is to protect its people, not to give the state licence to kill its people.
Lord Moynihan (Con)
My Lords, the passage of this Bill owes much of its existence to my grandfather in your Lordships’ House. The Voluntary Euthanasia (Legalisation) Bill 1936, introduced under the society’s aegis, was fathered and written by my grandfather. Berkeley Moynihan was the leading surgeon of his generation. As surgeon-general in the First World War, he had the unenviable job of overseeing medical treatment along the Western Front. He spent many months organising treatment for the 2.5 million military personnel who were wounded.
My grandfather introduced the Bill at First Reading. Days later, his wife of over 40 years died peacefully. He was grief-stricken in his Leeds home. He sat in his office, wrote a letter about her to his son and died a few days later from a broken heart, never to speak at Second Reading. It was left to the great grandfather of the noble Lord, Lord Ponsonby of Shulbrede, to move the Second Reading and give the opening speech. Berkeley Moynihan’s commitment was borne of a lifetime dedicated to caring for patients, to surgery and medicine, for which he became the first man from outside London to be elected president of the Royal College of Surgeons and the only one to be elected twice.
Like my grandfather, I believe that the right to die within the law is a matter of ultimate importance, and the ultimate compassion and human dignity for those approaching the end of their lives, with any decision to exercise that right to die to be taken only with the most robust legal safeguards possible, and above all to protect the vulnerable. I will quote him:
“Briefly our desire is to obtain legal recognition for the principle that in cases of advanced and inevitably fatal disease, attended by agony which reaches, or oversteps, the boundaries of human endurance, the sufferer, after legal inquiry and after due observance of all safeguards, shall have the right to demand and be entitled to receive release””.—[Official Report, 1/12/1936; col. 468.]
Of course, medicine has moved on and we are blessed with ways to address many instances of the agonies such as those suffered by those fighting in the Great War. In no case is it a question of this being a trade-off of palliative care, or whether palliative care should be made available or not—in all cases palliative care should be available. I believe it is for those facing imminent death to do so at a time and place of their choosing, rather than in ways which they fear, and that may cause intense suffering. This is not a Bill compelling anyone to act against their conscience.
I was deeply moved by the speech of the noble Lord, Lord Alderdice—a man of deeply religious beliefs who comes from a Christian perspective and can reach a different view from that of the right reverend Prelate the Bishop of London. I welcome the decision of the noble Baroness, Lady Berger, working with the noble and learned Lord, Lord Falconer, that a Select Committee should be set up to hear evidence. Her proposal respects the right timetable to allow, should both Houses wish, the Bill to go through all its parliamentary stages.
I believe my grandfather was right about providing a patient who is terminally ill, where all the legal safeguards are met, with the choice that they, like us all, should have about how to die. That is why I support this Bill and the opportunities we have to improve it.
Lord Rook (Lab)
My Lords, I am grateful to all noble Lords for the sincerity and seriousness of the debate over these two days. It has been illuminating and moving to hear so many family stories and personal testimonies. I note my interest as a carer for my father, Roy, who suffers with dementia.
This time tomorrow, my dad will knock on the door of the care office in his supported living complex to address an issue of singular importance: whether his choice has been registered for the 4 pm fish supper. Dad will have already made this trip four or five times, and Dawn, his ever-kind and patient carer, will smile and affirm once again that he has chosen haddock and chips and paid his £7 bill. My dad will beam back and say, “Thank you. I’ll see you soon”. This will indeed be true; in the hours that follow he will return many times to ask the same question.
I do not make light of my father’s condition: all carers know that we see many dark moments, and some of the lighter moments give us a degree of hope and happiness. But the truth is that my dad’s life is immeasurably improved by the fact that he lives in a loving environment with tailored medical support, endless activity and entertainment and an astonishing team with almost infinite capacity for kindness and compassion. Despite his diminishing and terminal condition, he has a good standard of living. Why? Because he can afford it.
We have heard a great deal about choice in this debate. I believe choice is a good thing; hence my concern, in assessing this legislation, is for those who have less choice than us—those who, unlike my father, cannot subsidise their own care in the final season of life. The most disadvantaged members of our communities already suffer increased mortality rates and the pronounced effects of health inequalities. They find it hard to see a GP, they wait longer for treatment and they struggle to navigate complex health systems. We have heard it said over and over: the NHS is currently able to support only 30% of the palliative care costs of our country. I simply cannot see how the introduction of this legislation will not pressurise those who, unlike my father, are without access to first-rate care and cannot afford to supplement what the NHS struggles to provide, to turn to assisted dying, not as their first choice but as their last and final option.
Noble Lords sceptical of this point should pay attention to states that have gone this way before. In Canada, increasing numbers of patients, many of them disabled, are being driven in the direction of assisted dying, due to poverty and a lack of ability to fund their own care. In Victoria, Australia, Robert Clark, the former Attorney-General, has said that disadvantaged patients are likely seeking assisted dying precisely because of the problems in accessing adequate care. The same is true in the United States. In Washington, the proportion of people choosing assisted dying because of concerns about their finances has risen fivefold, from 2% to 10% of cases. In Oregon, the percentage of patients choosing this route because they fear becoming a burden to their family has climbed from 13% to 52%.
In scrutinising the Bill, I hope that we will learn from these countries and take a different course. Where my own choice is concerned, I have chosen to support my noble friend Lady Berger’s intervention and her proposal to convene a Select Committee. I hope that this will give us an opportunity to listen carefully to voices that have not been heard as much as they should have in the procedures, processes and legislation before us. I look forward to working with noble Lords in Committee for as long as it takes to ensure that we can give a good end for all.
Lord Green of Hurstpierpoint (CB)
My Lords, I have agonised, as we all have, about the Bill. I will make three brief points. First, I support the principle of the Bill. I say that as a religious person. I seek to live by a Christian narrative and I share with many Jewish and Muslim friends, among many others, a belief in the givenness and sanctity of life. But there is no simple deduction to be drawn from this as to what the state can properly permit or prohibit. If a terminally ill person of sound mind and settled disposition wishes to end their suffering and die in dignity, I do not think that it should, in principle, be a criminal offence to assist them.
Secondly, though, I share the worries of many noble Lords about encouraging a climate of suggestibility that subtly, or not so subtly, influences the vulnerable. However, I want to tell a story that, in effect, raises the opposite issue. This occurred in a jurisdiction notorious for its relatively loose framework of legislation on assisted dying. I will disguise the details somewhat, because this is still raw for those intimately concerned.
A person with terminal cancer decided to die with dignity. A family meal was held to celebrate their life, all drank a glass of champagne and then the person went to the next room, where the doctors were ready to administer the dose. In the aftermath, the spouse was grief-stricken and depressed, the grandchildren were in floods of tears and demanding to know why their grandparent had done this and the parents, struggling with their own bereavement, had to cope with the emotional distress of three generations.
In the last analysis, we may want to acknowledge that it is the person’s decision—it is their life and their death—but I cannot help asking what this says about those precious human relationships being terminated along with that life. Martin Luther is said to have said that we believe alone and we die alone. Well, yes and no.
Thirdly, we can hold our heads up in defending the principle of the Bill only if we ensure not only that its constraints remain robust but that it is holistically focused on how to end life as well as possible. Above all—and so many of us have already said this—palliative care must be integral to any satisfactory approach. I would add to that the crucial importance of mature societal discussion of what dying well means. We need to move beyond the bare assertion of a libertarian principle and beyond our sanitising euphemisms about death.
There is no way of making this simple and it cannot be a matter just for lawyers, legislators and care professionals. It is surely also a matter for conversation in families, schools, religious groups, humanist discourse—for all of us. I will support the Motion from the noble Baroness, Lady Berger. I will not do so to delay the Bill; I want to see an appropriate Act on the statute book in a reasonable timeframe. But, if this is as important as we all say it is, we should devote the time needed, including, dare I say—I am not an expert on procedure—the Fridays in the new year that we might need if that is what it takes to get this right.
Baroness Verma (Con)
My Lords, I refer to my interest in the register as a founder and director of an adult social care business of 25 years. Over those 25 years, there have been many times when we have seen people who had to be looked after at the end of their lives. I have only got a few points to make. I have listened to the excellent contributions from around the House, but my mind remains firmly that we need to be a society that is willing to care to the last minute of every single human being who comes into this world.
I am a Sikh with Hindu practices. The core of my faith is to serve, protect and uphold the law. I would not want to uphold a law that takes life, because life is absolutely the most precious thing that we have. I do not want to see a change in relationship between the medical practitioners and the patients. We will slip down a very slippery slope if we start introducing things that we will have very little control over afterwards.
I was really pleased to hear from my noble friend Lord McColl last Friday when he said, in his expertise, that everything can be managed. We need to give pain relief not when pain is too much but at the beginning of when pain starts, to ease it and make sure that the person is comfortable.
A few years ago, my uncle received a diagnosis of stomach cancer. He was really well looked after by Macmillan nurses and stayed in LOROS for a while. Then, when he felt he wanted to come home, because he knew he was coming to the end of his time, he came home, and his family were around him to see him slip away. It was not an easy death, but it was one where we all shared time with my uncle.
It is hard for me to stand here and say that all people will be well informed. I know there are many among my own community, such as women in relationships where they have suffered abuse and coercive behaviour—how can they be given the option to make those choices for themselves when most of their decision-making will not be in their hands? I worry very much for those people who cannot, for circumstances they have no control over, take those decisions. I really want to make sure that whatever we pass and whatever we do has protections for those in our communities who do not have control over their lives, as we all think we should have.
I will finish with the wonderful words of my noble friend Lady Berridge. The family, the village that we live in, is surrounded by people we love. We would never knowingly want to inflict pain on anyone, but what we would willingly do is stand up and help everyone in our family to go through the journey as smoothly as possible.
The Earl of Oxford and Asquith (CB)
My Lords, I am opposed to the Bill, partly on principle and partly on specific matters of detail.
On the issue of principle, first, I believe that the Bill will radically alter our society’s view of the value of life by introducing a utilitarian calculus of value. As the noble Lord, Lord Frost, and others have said, if assisted dying is to be determined by that calculus, then very quickly, what appears to deliver the most efficient outcome for the NHS and patients will become acceptable. That will fundamentally change the culture of medicine and the therapeutic role of doctors and carers which we have accepted for millennia. Assisted dying is not a medical treatment. Ending life is not a therapeutic act. Most people do not believe and have never believed that doctors should be allowed to recommend a dosage of lethal substances.
Secondly, the supposed defence of autonomy or optionality is perhaps not what it may seem at first sight. Once you have legalised the option for assisted dying, within no time, you will have created a right to die. Not one of us has exercised an option to be born. Indeed, an ancient Greek thinker, in one of his gloomier moments, suggested that if we could be offered a choice to be born, we should be best advised to refuse it, on the grounds that suffering is endemic to humankind. Once we establish a choice to die, to withhold such a right will amount to discrimination against a person. Once discrimination law rises in the ascendant, there is no limit to its zenith.
On matters of detail, I, like many others, have very severe doubts about the criteria for eligibility in the Bill. In other countries, as we have heard, we see the rapid expansion of eligibility criteria. It has become discriminatory to restrict assisted dying to the terminally ill. We learn of assisted dying being offered to sufferers of many non-terminal physical and mental afflictions. As it stands, I now wonder whether we may have to reject the Bill itself to prevent incremental expansion of eligibility criteria alone.
There is abundant evidence that there is no possibility of providing 100% safeguarding against coercive influence, whether overt or covert coercion. This is probably one of the biggest questions to which the Bill cannot offer an answer. Coercion is always likely to be present if you cannot get the basic care you need.
We have spoken a great deal already about palliative care. The noble Lord, Lord Baker, has told us that investment in palliative care is not a “political alternative”. Is that so? He may be right in the short term, but I do not think that to abandon such an aspiration can be endorsed as a justification for inaction.
The strongest motive among terminally ill patients for requesting or desiring an assisted death is not so much insufferable pain but their feeling abandoned, unvalued and cast aside on the scrap heap, for which no society has the care. If they can be helped to feel valued, their mentality can entirely change. The feeling that you are a burden is one of the strongest motives for suicide. If the Bill works specifically to address intolerable suffering, perhaps assisted dying could more respectably be presented as a last resort for intractable suffering.
In that case, palliative care should assume far greater prominence. Of the half a million people who die in this country every year, thousands do not have appropriate palliative care in their last two months. These are the people who most need our attention. The Bill, as framed, does not address this issue at all.
Many speakers have already rehearsed several other procedural defects to the Bill, including conscientious objection and opt-out clauses, the consequences for hospices, delegated powers, the certification of drugs and lethal substances, and the absence of a coroner. Many speakers have argued that the present law is untenable. Yet, as it stands, the Bill, if passed into law, will have numerous untenable consequences over the years.
I have some sympathy with the view of the noble Lord, Lord Patten, and the noble and learned Baroness, Lady Butler-Sloss, that the Government should take over the Bill. At the very least, I support the call for a time-limited Select Committee—the Motion in the name of the noble Baroness, Lady Berger—to hear evidence that could introduce further modifications, although I suspect that more and more amendments will make the Bill unworkable.
The renowned Nobel Prize-winning physicist Werner Heisenberg wrote:
“I am firmly convinced that we must never judge political movements by their aims, no matter how loudly proclaimed or how sincerely upheld, but only by the means they use to realize these aims”.
In my judgment, the Bill is not safe; there are just too many defects in it that need to be dealt with. Most fundamentally, if the ultimate aim of the Bill is to relieve suffering, self-evidently, the means proposed are not therapeutic.
Lord Magan of Castletown (Con)
My Lords, I must make it clear that I oppose the Bill. Morally and ethically, this is a most fearful piece of proposed legislation. Beyond that, the Bill is very deeply flawed. The flaws are legion. We must not lose sight of the Bill’s multiple deficiencies. This legislative proposal that seeks to legitimise assisted suicide is clearly unacceptable to a significant majority of conscientious medical practitioners. It is no surprise that so many leading medical organisations and medical schools have expressed very significant concerns.
The Bill includes no requirement for a person to be suffering or in pain in order to be eligible for an assisted suicide. It is now notable that majority GP opposition has continued to increase significantly. There is a huge risk that this right to die will quickly translate into an expectation, or even a duty, for healthcare workers to facilitate death when requested. There are no effective legal safeguards to protect the elderly and vulnerable.
The overriding necessity for the provision of universally accessible, high-quality, supportive and palliative end-of-life care has been swept aside. It is particularly striking that an overwhelming majority—between 70% and 85%—of palliative care doctors are opposed to assisted suicide.
Crucially, there are no built-in checks to protect against the inevitable risk of coercion. People with disabilities, in particular older persons, may feel subtly pressurised to end their lives. The replacement of High Court judicial oversight by a judicial panel—a lawyer, a psychiatrist and a social worker—brings an uncontrolled risk that such panels will become staffed by those who favour assisted suicide. Such judicial panels are clearly not qualified to overrule the joint view of two expert medical practitioners. Further, those who are not actually dying would be eligible for assisted suicide, and “terminal illness” is not clearly defined; the law could be applied to those who have years of life ahead of them.
We must also recognise that there has been totally insufficient pre-legislative scrutiny of the Bill, with no public consultation and no proper engagement with the medical profession. Most of the amendments tabled in the other place were not even debated. There is also silence as to where the necessary funding will come from. Most likely, it will have to be found from existing overstretched health budgets, removing funds from palliative support that relieves suffering and saves lives. There is a real fear that the funding will be subcontracted out, leading to a rapacious, callous, profit-driven system.
It is unsurprising that, contrary to the contention of the noble and learned Lord, Lord Falconer, support for assisted suicide among the general public is significantly waning. Rarely has our role in this House, as a scrutinising and revising Chamber, been so important. It is imperative that we do not give succour to this charter for the culture of death.
Lord Grade of Yarmouth (Non-Afl)
What a privilege, but what a responsibility, to be a part of this debate. It is clear from every speaker that we all feel that responsibility.
If this legislation passes into law and subsequently proves, like all legislation, defective in some respects, there is no way in which subsequent revisions can restore the lives of those who have succumbed to its provisions. Nearly all noble Lords, for or against, have expressed huge anxiety about the so-called safeguarding clauses in the Bill. I urge your Lordships to reread these clauses. Surely, they must alarm us all. Why are these clauses necessary at all? All sides agree, I think, that there are real dangers of coercion, mistakes, wrong judgments and undisclosed facts that surface after the death warrants are signed. These clauses are not, and can never be, a guarantee of fair play. No drafting can eliminate the life-and-death risks arising from the Bill. These clauses represent an acceptance that there will be circumstances where mistakes, greed, ignorance, coercion and other unknown factors are at play after enactment.
Despite the fatal consequences of drafting errors and omissions, supporters of the Bill are asking this House to believe that their safeguarding clauses will work exactly as drafted and that doctors can always know when you will die. No, this Bill, like all Bills, will not be perfect when enacted. In real life, it is certain to prove defective in some unforeseeable ways. Unlike other legislation, there is no redress—certainly not from the graveyard. I cannot support the Bill. It is a risk too far. I have listened to the front-line palliative care specialists whose concerns easily outweigh the eloquent pleadings of lawyers and others a long way from the front line. These are my practical objections and the reasons I believe that this legislation should be put out of its misery.
I finish with some words on the underlying principle: not my words, but those of one Mr James Wickes of Esher in Surrey, who wrote to the Daily Telegraph as follows:
“SIR—Assisted suicide is not a private medical matter—it is a moral line. If Parliament crosses it, the message will be clear: some lives are no longer worth living.
No person, institution or machine is worthy to make that judgement. Yet we now find ourselves debating it as though it were just another healthcare policy. The Terminally Ill Adults (End of Life) Bill is not about compassion: it is the logical end of a society that has replaced shared moral foundations with individual subjectivity and duty with personal preference. We do not and cannot fully understand the mystery of life—its beginning, its purpose, or its end. From that uncertainty flows a duty to protect life, not to authorise its termination.
MPs who are wavering should recognise this legislation for what it is: a profound statement about who we are and what we value. I urge them to vote against it and uphold the principle that life is not ours to dismiss.”
On the evidence of this debate, Mr Wickes, I believe, speaks for the majority of this House.
Lord Oates (LD)
My Lords, I shall focus today on the group of people to whom the Bill actually relates—those terminally ill patients with capacity whose death in consequence of that illness or disease can reasonably be expected within six months. We can argue about whether the Bill should be wider or narrower in scope, or not at all, but our key focus should be on scrutinising the Bill, not speculating about legislation which may or may not come to us in future. Some time ago, I sat with a very dear friend in an oncologist’s office in Pietermaritzburg in South Africa as he learned that his prostate cancer had spread and was no longer treatable. Just over a year ago, he told me that the pain was becoming unendurable. Shortly afterwards, his daughter contacted me to say that he had died. She also sent me his death certificate. I thought that strange, but then I read it and I understood why. Under the cause of death, it states “cancer, prostate”, but above it, another cause is listed: organophosphate poisoning.
My friend would not have benefited from this Bill because he lived in another country. I share his experience only because several noble Lords have sought to restyle this Bill the assisted suicide Bill and, like the noble Baronesses, Lady Thornton and Lady Royall, I think that is quite wrong. My friend’s death cannot in any meaningful way be described as suicide. He did not choose death over life. He wanted more than anything to live, but that was not an option open to him. His choice was between the kind of death he was to have: an immediate and tragically painful one, or the prolonged and agonising death he had decided was unendurable. We should be clear. We are discussing an assisted dying Bill, not an assisted suicide Bill.
Although I believe strongly in the right of individuals to take decisions about their own lives, particularly when denying such rights may make them suffer intolerable pain in the way that my friend did, I do not discount the concerns of those who oppose the Bill. Alongside my belief in individual autonomy, I have an informed scepticism about the state and its institutions. I take seriously the concerns raised by the noble Lord, Lord Rees of Easton, and others last Friday about inequities of NHS treatment, particularly impacting black and minority ethnic groups and people on lower incomes, and the dangers of introducing assisted dying in such a system. I was struck by the compelling speech of my noble friend Lady Parminter, which alerts us to the risk to people suffering eating disorders, and I worry about the lack of value often put on the lives of older people and the serious concerns expressed by disabled groups.
Clause 5(2), which allows a medical practitioner to initiate a conversation with a patient about assisted dying, is particularly problematic to me, not because I believe that the medical profession is full of people who want to end the lives of their patients, but simply because I know that it is full of human beings. As such, it will have its share of bad actors but, more pertinently, it will have far more than its share of tired and overstretched professionals juggling competing priorities and resources.
Finally, there is the issue of coercion. Of course most families act in the best interests of their relatives, and many make huge sacrifices to do so, but there will always be some that do not. We must make sure that the safeguards in the Bill are workable and effective.
I thank all those who have written or spoken to me with great conviction on either side of the debate. In many ways I envy their certainty, not because I lack clarity on where I stand on the principle of the Bill, but because I find it harder to discount the flaws both in the existing state of the law and in the Bill before us. I therefore welcome the proposal to hold a Select Committee to take evidence, and I look forward to detailed deliberations on the Bill.
Lord Freyberg (CB)
My Lords, over the past two days of debate, we have heard sincere and often moving contributions from every side of the House. The arguments for and against assisted dying touch on the most profound questions of life, death, autonomy and compassion. I have also received a large number of letters and emails from the public, some urging reform and others expressing grave concern. What unites them is the strength of feeling and the urgency of this issue.
The case against change is serious. Many fear that legalising assisted dying would undermine the sanctity of life, send the wrong message to those who feel themselves a burden or erode the doctor-patient relationship. Some point to examples abroad where, over time, laws have been expanded, and ask whether we can ever be certain that similar pressures will not emerge here. Others remind us of the patchy provision of palliative care and argue that real choice does not exist until every dying person can be confident of the very best care at the end of life. These concerns deserve to be heard with respect.
Yet the arguments in favour are no less compelling. For all our advances in medicine, palliative care cannot always relieve suffering. Too many families have watched a loved one endure a prolonged and degrading death, or else travel abroad—often alone—to places such as Switzerland, because the law here forces them into exile. Those who cannot travel sometimes resort to desperate means. In these cases, the current law does not protect the vulnerable; it abandons them.
It is regrettable that no Government have yet established a royal commission to examine this question fully, despite clear and enduring need. For over 20 years, efforts to legislate have drawn on international evidence and proposed careful safeguards, but each has faltered, leaving the cost borne not by us in Parliament but by dying people and their families. That failure of political will should not prevent us addressing the issue now. But alongside reform, we must also act to strengthen existing provision. I therefore hope that the Government will do more to ensure that palliative care is properly and fairly funded, so that nobody feels forced into a choice by a lack of support.
In taking this step, we can draw on the experience of others. We are not without guidance: over 300 million people worldwide now live in jurisdictions where assisted dying is legal for the terminally ill. No country that has taken this cautious route has reversed its law, and the evidence shows that, far from undermining palliative care, such laws often strengthen it.
The Bill seeks to offer choice—not compulsion—under the tightest safeguards ever proposed: multiple medical assessments, an independent multidisciplinary panel and new coercion offences carrying life sentences. It has been scrutinised for hundreds of hours in the Commons, amended repeatedly, and now comes to us for further examination. I therefore welcome and support the initiative of the noble Baroness, Lady Berger, and the noble and learned Lord, Lord Falconer, to establish a Select Committee, so that further evidence can be gathered and considered without delaying the Bill’s progress.
The question before us is not whether dying people should suffer—none of us wishes that—but whether we should give them the right, under strict conditions, to decide for themselves when suffering becomes unbearable. To deny them that choice is to impose our values at the most intimate moment of another’s life. To grant it shows compassion, respect and autonomy, and would protect the vulnerable through law rather than turning a blind eye. That is why, after weighing both sides, I support the Bill.
Baroness Mobarik (Con)
My Lords, the assisted dying Bill presents one of the most profound moral and legal questions of our time: how to balance personal autonomy with the duty to protect society’s most vulnerable. It asks whether we can lawfully offer people a choice over the manner and timing of their death while preventing pressure, abuse or error that would put the frail and dependant at risk. That tension, between respecting individual liberty and safeguarding life, demands legislation that is morally clear, legally robust and equipped with uncompromising safeguards.
The Bill is presented as compassionate, but it sets us on a dangerous drift. In other countries, what began for the terminally ill has widened to include the chronically ill, the disabled and people with mental illness. In Canada, between 2022 and 2023, legislation led to a 15.8% increase under the medical assistance in dying programme. A point that has been made numerous times in this debate is that vulnerable old people could be coerced by their children or other relatives, driven by selfish interests, into prematurely choosing assisted suicide. My concern is for those who have no children because, in reality, most children love their parents deeply and would go to any length to protect and shield them. That love is a safeguard in itself.
However, many young people are increasingly choosing to remain single and childless. That is their choice, but it brings with it a deep vulnerability. If safeguards erode, we risk reaching a point where strangers, doctors, officials and even the state could decide that certain people are expendable, especially when there is no one left to protect or speak for them, and they are seen merely as a burden and a cost to the state.
The Bill leaves too many safeguards unclear. At what precise point would professionals have legal permission to end a life? How can we ever be certain that consent is genuine and not born of fear, depression or loneliness? These are not minor details; they are matters of life and death.
Let us not assume that an assisted death means a good death. We know from documented cases of state executions in the United States that lethal injections can take far longer than intended, with visible suffering. If even executions by professionals sometimes go horribly wrong, is it unrealistic to assume that assisted dying under this Bill will always be safe and dignified?
On a personal note, my late parents, who were exceptional people of strong faith, would say that the time of death, place of death and manner of each person’s dying are preordained. Far from being a cause of fear, such belief allows one to live with courage, knowing that the end is not ours to determine.
I am aware that, even as we speak, there are those in terrible pain and suffering, but true compassion is not found in offering death. It is found in ensuring that no one dies in pain or alone, with proper investment in palliative care, pain relief and social support, especially for those who have no family to care for them.
This debate is not just about individual choice; it is a question of what future generations will inherit. Whether we remain a society that protects the vulnerable and honours life in all its frailty, or whether we enable a quiet erosion of the value of life, our responsibility is to preserve the intrinsic value of every individual, which is why I cannot support the Bill.
Lord Cashman (Non-Afl)
My Lords, I watched as my late husband and partner of 31 years died, knowing there was a better, more humane way. When my dear friend of many, many years suffered for months, she knew there was another way, and she implored me to help. And I did. I was prepared to break the law, as I contacted clinics in the Netherlands and Switzerland. However, it was to come to nothing.
But these are the words of an observer. I would rather you hear the words of someone facing death, my dear friend, Elise. She writes:
“I’m 51 years old, and I have secondary cancer of the lungs, liver and bones. Or to put it bluntly, I’m dying. I was diagnosed just over a year ago. My medical team are very reluctant to give me a number, but I’ve been told that people with similar conditions can expect to live for around two years. I’ll let you do the maths ...
I’ve just been told that my life-extending drugs have stopped working. I’m in a horrible limbo, awaiting test results to determine the next course of action, and hoping against hope that my liver holds out until I can get onto a different medication. I’m absolutely terrified.
I’m not telling you this to garner pity. Believe me, I am living my very best (end of) life. I am surrounded by beautiful family and friends, and immersing myself in art and culture, and generally having as much fun as is humanly possible. I try to find the joy. Every. Single. Day. But some days that’s harder than others. Not least because I know that one day, things will start to deteriorate. And the pain (which on a bad day is already pretty bad) will become intolerable.
I’ve witnessed terminal illness close up. I’ve seen a long, painful, drawn-out death. It was deeply traumatic. I still have nightmares about it. I can still smell it, and taste it. I do not want that for myself. I don’t want that for anyone.
This Bill is urgent. The stakes couldn’t be higher. It is 100 years in the making, and it can’t come soon enough. And much as I’d love to be a medical miracle and defy the odds, if it does pass, it will probably come too late for me. But I’m asking Peers to vote in favour, in the hope that it will save the unnecessary pain and suffering for many hundreds, indeed thousands of people just like me. And their families.
Since becoming part of this campaign, I’ve heard the most harrowing end of life experiences from people I now consider my friends. People like Gareth whose father … blew his head off with a shotgun. And Lucy, whose partner Tom eventually suffocated after hours of faecal vomiting. Every single story breaks my heart all over again. Not least because there could have been another way. And that’s why this vote is so important. It’s a vote for another way. A more progressive, compassionate way. A vote for choice for terminally ill people …
I don’t want to die. Of course I don’t. I am having the time of my life right now. Truly, there’s something about a terminal diagnosis that makes you really live life to the full. But I do have to face reality. I’ve had a pretty good life, and I want a Good Death. I deserve a Good Death. And I would challenge any Peer that votes against, to look me in the eye and tell me why I don’t deserve that. Why don’t I deserve to die in dignity?”
These are the words of my friend, Elise Burns, about a Bill that does not impose choice, but allows it.
Lord Robathan (Con)
My Lords, anything I say will probably have been said before, so fortuitously I shall not speak for long, which will please the Government Whips.
On both sides there have been some outstanding speeches over both days, and we can all appreciate that this is hugely complex. People very often tend to speak from their own position, and I have spoken to several older Peers who wanted to be able to die in their own time, so they would support the Bill. I have had innumerable emails and letters from both sides, and I thank the people who sent them. Some were very informative; the majority were opposed to the Bill.
I understand the dilemma. I am already 74 and, should I be terminally ill and suffering, I would wish to be able to take my own opportunity to die—I would probably need to find some poison; of course, that may not work for a handicapped or disabled person who can no longer take a drug—but this does not mean that I support the Bill.
For me, there are two big issues. First, for some reason, society strives far too hard to keep very ill, dying people alive. We shall die, and we must all accept that. As a Christian, I have absolutely no idea if there is an afterlife—perhaps the Bishops might fill me in later—but I do know that I shall die. I hope I can die cleanly and without pain.
Part of the problem is Harold Shipman, over a quarter of a century ago. He was a murderous doctor, and he has prevented what used to be actually quite common: namely, that doctors would increase morphine for very sick, dying patients, which led to their relatively simple and relatively comfortable death—I emphasise “relatively”. The idea that you could prosecute a doctor for assisting an imminent death seems to me rather foolish, but apparently it happens.
We should educate everybody better to understand that death happens and we cannot always cling to life. The Covid experience, where the entire economy and our children’s future was sacrificed because this nasty disease was killing people, most of whom were in their late 70s or more likely over 80, is surely an example of how we should be aware that people will die and that we should accept that.
The second major issue against the Bill relates to coercion. That coercion may be unintended, and an old person can see that continuing life will reduce the prospect of the inheritance of their children. Indeed, the children might easily not wish the elderly parent to die, but the parent might decide that that was best for them. Some 30-odd years ago, I was a new MP, and the Major Government introduced a scheme where people entering care would have to sell their houses to pay for that care—I think I have got that right. This, of course, remains a big issue for Governments. I recall a queue of people coming to my advice session who would say, “But our mother wants us to inherit her house”. I pointed out to them that people save for old age—and I was still re-elected, by the way. However, it is only one small step beyond that to hint, encourage, or push a decaying relative to go for assisted suicide to avoid care home bills.
The Bill is seriously flawed. As many have said, this is an extraordinary change to our law. It changes the general attitude to death and, indeed, to doctors. It changes one of the basic tenets of our society. Suicide was a criminal act until 1961, which was in my lifetime. Now, we are going to change it in my lifetime by allowing assisted suicide—and it is assisting suicide. This will destroy the Hippocratic oath and the maxim, “first, do no harm”. It is being brought forward without the proper consideration that it should certainly have. The Delegated Powers and Regulatory Reform Committee and the Constitution Committee have pointed out huge weaknesses, especially regarding lack of proper regulation and scrutiny. I therefore cannot support the Bill, although I can see the merit of allowing suffering people to die more peacefully.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my roles in palliative medicine, caring for thousands of dying patients over decades, and in Living and Dying Well.
The Bill as written does not improve patient choice or control. True choice would ensure patients can get the care they need. Control will rest with the doctors who can initiate the conversation and are the gatekeepers on eligibility for lethal drugs.
Supporting a patient who wants to stop treatment is not assisted suicide. Stopping unwanted treatment allows life to close in a timely way. The person dies of their underlying disease; it is good care.
Training in palliative care is lamentably poor across most of health care. Ignorance of pain and symptom control management is widespread across the globe. Morphine to control pain does not kill, although some mistakenly think it does; it provides comfort as life slips away.
Specialist palliative care can save millions a year to the NHS through care that meets need, substantially improves well-being and comfort, and avoids unnecessary interventions. It does not keep people alive who do not want to keep living.
The Bill’s impact assessment suggests that there will be up to 4,500 assisted deaths by year 10. The Bill does nothing for the over half a million people dying each year on whom it will have a profound impact, many with needs not addressed but wanting to live better right to the end of their lives. They are unheard, already often made to feel a burden; they fear being persuaded to take lethal drugs; and they face their local services being further eroded to fund the assisted death service. It is unethical for us to pass poor legislation for a state-provided NHS assisted death service while leaving the care of half a million dying people to be patchy, often inadequate, and, at best, subsidised ad hoc by struggling charities.
Throughout, we have heard horror stories of bad care and inadequate or appalling management, especially out of hours. The Bill does not require any attempt to relieve pain or suffering, even if they are present. It puts power in the hands of the two assessing doctors, who may know nothing about the condition of the person, who cannot detect undue influence or coercion and whose motivation may be opaque. Prognosis is a guess and diagnostic errors are common. These doctors do not need to be certain; only on the balance of probability do they need to believe that the criteria are met. With no oversight of their assessment, how can a panel approve the death with any certainty when there is no ability to appeal against a panel approval and no coroner oversight? How many wrongful deaths a year is acceptable? No system can be 100% safe.
Providing massive drug overdoses in an unlicensed way to end life is not a therapeutic act and has no place in health and social care provision. Evidence, not heard in the other place, from other jurisdictions reveals complications, slow deaths, complex grief in the bereaved and profound clinical distress. Whether or not you feel that some people should be able to have an assisted death or even euthanasia, this Bill, as written, is deeply flawed. It must have essential scrutiny.
Some noble Lords have suggested that a timetable has been agreed. That is not the case. It has been agreed to have a Select Committee that will complete its work in November, allowing the Committee of the whole House to get under way promptly to undertake that scrutiny, which is absolutely essential.
Baroness Bray of Coln (Con)
My Lords, it is a privilege to participate in this important debate and a pleasure to follow the noble Baroness, Lady Finlay, and her excellent speech. I would like to add my words to those of many colleagues who have already spoken of their deep concerns about this assisted dying Bill, not out of a lack of compassion but because of a worry about the legal, moral and practical consequences of what it proposes.
Effectively, it says that the Government should take on a new role which requires them to lay out rules and procedures to facilitate what is in essence suicide with the co-operation of the medical profession. This would be a profound and troubling move. Once the state begins to legislate for the ending of life, however well intentioned, it takes on the responsibility for deciding when life is no longer worth living. At the moment, it would apply only to patients with terminal conditions and a prognosis of six or fewer months of life left. In other countries whose Governments have already gone down this route, the conditions of eligibility have been constantly widened over time to include non-terminal conditions. It is highly likely that, if this assisted dying Bill were to succeed, we would also in time see constant pressure to widen its scope.
I seriously doubt that the medical profession as a whole would wish to participate as a matter of course. Indeed, many in the medical profession have already expressed their concern. After all, doctors train to save life and to heal where possible. The Hippocratic oath remains “Do no harm”.
There is another crucial dimension here. In previous generations, patients often had much longer-standing relationships with their GPs, built on years of trust and understanding. A doctor who had supported a patient for years, often decades, might indeed ascertain their true wishes, knowing their history, their character and their needs. They would have been well placed to navigate end-of-life care sensitively, including when a patient was truly ready to go. However, as we all know, that reality has all but disappeared in today’s NHS, where quite often patients are lucky if they see the same doctor twice. This means that decisions about assisted dying could easily be made by professionals with little or no personal knowledge of the patient making the request, which must increase the risk of misjudgment.
Meanwhile, it is pretty clear to us all that the NHS is already under immense strain, as we have been hearing, with chronic staff shortages, long waiting times and huge gaps in palliative and end-of-life care. Surely, this additional procedure would create considerable new demands on staff and facilities, which could only throw doubt on the smooth and gentle manner of support that anyone would want for those undergoing the assisted dying process.
That leads me on to perhaps the greatest concern of all: how do we safeguard the process against coercion? How can we ever be certain that a person seeking assisted death is not doing so because they feel they are a burden on their family or society, or even on the system that is keeping them alive? The choice to die under conditions such as those is a fragile thing. It can be heavily influenced by illness, fear or, indeed, loneliness. No set of procedural safeguards could fully take account of that complexity, particularly without the input of a GP who properly knows the patient.
Surely the true mark of a compassionate society is not whether we give people a way out of life but whether we support them to live with dignity even when life becomes difficult. We need to ensure that sufficient funding is ring-fenced for high-quality palliative care with far greater access for all who need it, rather than legislating for death to become a treatment option.
Lord Brennan (Non-Afl)
My Lords, on Saturday last week the Times newspaper ran a centre-page editorial with the headline:
“The flaws of the assisted dying bill may prove irreparable”.
The editorial stated:
“It should not have fallen to the Lords to protect the public”.
What follows is, putting it kindly, harsh but, putting it bluntly, necessary to be done by this House or in some other way.
The Bill in its present form is not conducive to the common good, for the following reasons. First, we have no idea of its scope in medical terms. Cancer, cardiac, cerebral, immobility, mental—where is the end? Who is going to be trained in these different specialities? Which one is going to be preferred if preference is suggested by the Government? None of the royal colleges has plainly adopted support for the Bill. The psychiatrists are against it, particularly regarding the mental state of a patient to whom assisted dying is offered and what the effect would be. So the scope is big.
Who is going to pay for it? Is this part of the NHS budget? If so, how much? If it is private, how are the two going to divide? There’s a section in the draft Bill about advertising. Do we want to finish up with a system, private or public, of death clinics?
What do the professions say about this? Are doctors going to sign up to do this task, when they might have thought their job was to cure? Nursing staff who might help, or technical staff who might assist in the preparation of the poison or lethal dose of whatever is given to the patient to kill that person—what are they to do? This is putting people to death, whether they want it or not. In Clause 32, we find that we have to amend the Suicide Act, otherwise we will be legislating for unlawful killing, aiding and abetting the person who wants to die.
So the scope is enormous, the effect on the professions is unknown, and the cost, the effect on palliative care and so on could be deeply damaging to all our communities. This is a topic of in-depth complication and the highest level of importance, in which Parliament’s duty is to serve the people it represents here in these two Chambers, no matter what. We can start with the attempt by the noble Baroness, Lady Berger, to put coherence to it.
What about the Hippocratic oath? Several thousand years ago, Hippocrates said, “First, do no harm”. Doctors, and to a similar extent nurses, take that oath to serve us. How does assisted suicide fit into, “First, do no harm”?
I am concentrating on the difficulty because this is probably one of the most serious matters that can affect the public, brought forward to be considered by Parliament. In the House of Commons, both the Justice Minister and the Health Minister were against the Bill. The system rejected it. How on earth will this be resolved.
Baroness in Waiting/Government Whip (Baroness Taylor of Stevenage) (Lab)
I remind the noble Lord of the advisory speaking time.
Lord Brennan (Non-Afl)
If we vote, let us vote at some further stage when we have something serious, coherent and plausible to consider.
Lord Bailey of Paddington (Con)
My Lords, I rise, with deep concern, to oppose this Bill, not out of indifference to suffering but because I fear that it will place the most vulnerable at the greatest risk. We should be clear: this is not just assisted dying; it is assisted suicide. Far from offering genuine choice, it risks becoming a pathway to people struggling with poverty, poor care or depression seeing it as their only option. This is not dignity and it is not compassion.
I have been written to by many members of the public, as we all have. I want to put on record their voices. They are worried about where the Bill is leading us. I cannot cover all the points they raised but I will cover a few.
There is no requirement for suffering: the Bill does not require a person to be in pain or distress. The only requirement is an irreversible illness and a prognosis of six months. Extraordinary as it may seem, there is no consideration of palliative care or pain relief. A person could qualify even if they are not suffering at all. For my own community—a working community, a poor community—this is deeply troubling. Many face hard financial realities and social pressures every day, and adding a law that allows assisted suicide without any requirement for suffering could turn hardship into a reason for death itself. This is where coercion is born.
Research in Oregon shows that nearly one in 10 people who opted for assisted death did so partly because of financial pressures. We cannot allow a situation where people feel forced into death because they cannot afford life. Coercion is not only about another person’s influence; it can also be about the crushing weight of poverty, isolation, fear, and loneliness. Listening to the great speech made by my noble friend Lord Banner, the Bill already has mission creep built in.
Research by the Marie Curie Palliative Care Research Department found that prognoses can be accurate only 23% of the time. Many patients given six months to live survive and even thrive for years. In a community such as mine, which struggles, the danger is doubled; such a prognosis may make people feel the pressure to give up too soon because of financial worries. This combination could be lethal. To legislate with such weak foundations is reckless.
This Bill cannot and should not pass into law. It is built on a flawed assumption and will expose the most vulnerable in our society to irreparable harm. We are told that it is about choice. But it could lead the poor, the sick, the isolated, the terrified, the people who have grown up relying on the system—not people such as us in this Chamber, who have benefited from it, but the people who rely on it, trust it and believe in it—to see this as a burden, a pressure, and even a duty to take their own life.
We cannot expose the poorest people in this country, the people most dependent on we in this Chamber to do the right thing for them, to this poorly thought-out legislation. It will devastate communities—communities that many of us have never been to and do not understand. We will be enacting something that will become a myth in those communities. We will be pre-legislating for people’s early deaths because their lives have been hard.
As the Bill stands, instead of working for vulnerable people, it will make more people vulnerable. We must choose life over fear.
Baroness Watkins of Tavistock (CB)
My Lords, I thank all those who have sent me opinions and information on this issue. I declare my interests as a registered nurse and a fellow of the Royal College of Nursing, which has adopted a neutral stance on the Bill, recognising the wide disparity of opinion within its membership.
The fury expressed by some people that they will be coerced into asking for assisted dying is real. The concerns are particularly strong among marginalised communities, as so amply demonstrated by the previous speaker.
Many people with severe disabilities who believe that they may become a burden to other family members, as well as those living alone who express fear about the future and the difficulties of living with a progressive condition, do not like the Bill. However, considerable safeguards in the Bill are designed to ensure that undue pressure concerning assisted dying is never placed on individuals. If a patient is given the opportunity to discuss their future options when planning the last months of their life, this should include the right to refuse further treatment and receive compassionate palliative care.
Patients must be given the chance to explore the options available to them. One of the many issues raised in this House, and in correspondence with the public, is that many people fear staying with the uncertainty about dying—not necessarily about when they will die but how their health and bodily functions, including continence and mental capacity, will deteriorate. People report being fearful of incontinence, speech difficulties and losing capacity, so that they are unable to express their wishes as they become increasingly dependent.
Let us encourage society to discuss and complete advance directives relating to future care, in the way that we are encouraged to make wills. This approach would enable those who would never want to discuss or consider assisted dying to make that clear in their personalised advance directive, and vice versa. Nurses and care workers are often those who are asked about assisted dying by patients, frequently during intimate procedures, including, for example, changing soiled bedding and washing.
I recall, when I was a district nurse, a patient saying something similar to me: “My kind husband just can’t cope with washing me, so I wait for you and I do not tell him I am dirty below but just lie here in it. He does not know, nurse, because he does not sleep in the bed with me any more. We were so happy together. We are worn down with it. Can’t you hurry it up for me?” The Royal College of Nursing has published excellent guidance on how to respond to such a request to hasten death. It states that
“nurses should acknowledge and act on all concerns raised”,
investigating and escalating them to the doctor responsible for the patient’s care and treatment.
The Bill is designed to establish a system for terminally ill adults to access assistance, yet no mention is made in it of the responsibility of health professionals to refer patients to an appropriate medical practitioner for preliminary discussion, to be recorded in the person’s notes when such requests are made.
When the process works well and advance directives have been made, agreed active treatments may be stopped and compassionate, excellent palliative care interventions accelerated. Early clarity on the patient’s position on assisted dying would be helpful to everyone. However, if the patient’s wishes have not been recorded, and they choose an assisted dying pathway in the late stages of their illness, should the Bill pass, there could be challenges from relatives who are vehemently against assisted dying for religious and/or ethical reasons.
I am broadly supportive of the Bill, but I would hope that we can consider the two issues I have raised—advance directives and other healthcare professionals’ involvement.
Lord Mackinlay of Richborough (Con)
My Lords, I will present five bases of rejection to the Bill. The first is the evolution of the Bill in the other place, which we can hardly call Parliament at its best. It was deemed to be a Private Member’s Bill, but I am sorry to say that I think we are being fooled here; it is quite obviously a government Bill in disguise. The noble and learned Lord, Lord Falconer of Thoroton, indicated this last week in his fine speech, when he referred to the Civil Service assistance he had had to date, which is more than unusual for any Private Member’s Bill.
From the start, Committee in the other place was stilted in its composition, and many respected institutions that will be operating in the space of the Bill were denied their opportunity for input. What worried me more than anything else were the joyous, tear-flecked celebrations by some parliamentarians of the passing of the Bill in the Commons; it is a Bill of death. I found that quite bizarre and chilling. I should not be surprised, however, as many of the same people are jubilant about the opportunity to home-conduct abortions up to full term without sanction. I celebrate life rather than death.
The Bill as originally drafted had 16 Henry VIII clauses; that has now grown to 42, including many that will allow ministerial powers and secondary legislation to create criminal sanctions. Noble Lords will be aware that this is just not right in legislation; this should not happen without great cause, to create criminal sanctions by secondary legislation. It is usually widely condemned.
My second objection is the reality of what we have seen in other jurisdictions, where we have seen a loosening throughout—whether that be in Australia, Canada or most certainly Belgium. The noble and learned Lord, Lord Falconer, predicted last week that only 1% of deaths would be through legalised suicide within 10 years. That does not fit very well with Australia’s 3% and Canada’s just under 5%. In all jurisdictions, “I don’t want to be a burden” has become bigger and bigger. In Belgium, children as young as nine are being euthanised under similar legislation—let me repeat that: in Belgium, children aged nine are being euthanised. I have grave concerns about the human rights industry in this country, where whatever happens in Parliament gets overturned through judicial activism. I am absolutely sure that this would be watered down to death on the state on demand in due course. That is my great fear.
My third grave concern is inheritance. I am professionally trained and licensed to do probate work through the Institute of Chartered Accountants; believe me, post-death battles over inheritance can get very ugly. I am fearful of the coercion of the elderly and the vulnerable. It is so obvious.
Fourthly, I am worried about the six-month time limit. We have a similar thing in the DWP for end-of-life PIP, where you have to have an assessment that you may live for only up to 12 months. The reality is very different: the average is over two years, and very commonly people live for three when the assessment was just a year. Are we really going to terminate lives earlier than may be the case? The noble Lord, Lord Forsyth of Drumlean, gave a fine speech last week: a personal account of his father. What he is looking for, and what I would be looking for, is that very end-of-life solution where things can be put right, the making a person comfortable, that we know happens, sort of, today. If that is the bit that needs codification into legislation, that is fine; we should be considering that.
Fifthly and finally, I am concerned that we want to embed an option for death within the NHS, where its modus operandi should be for life and for doing its bit, obviously, when palliative care is needed. To have this as an option is very dangerous. I would like to see—if we have to have this at all—a separation, because unfortunately the NHS would have skin in the game in terms of costs and staff problems. This is an unwholesome Bill, and I will oppose it.
Baroness Porter of Fulwood (Con)
My Lords, there is nothing easy about confronting mortality or dealing with suffering. The number of us who have chosen to speak at this Second Reading is a reflection of the importance of these issues and how universally relevant they are. Every one of us in this place has been touched and shaped by losing people we have loved and seeing what they have gone through as they reach the end of their lives. Like others, I value deeply the personal stories of so many who have written to me over recent months and hearing from practitioners who work with families at the end of people’s lives.
Whether the law is in the right place today or whether it can be improved is an important discussion to have. This, though, is not the right time to have it. The noble Lord, Lord Stevens, could not have put it better when he said that
“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”.—[Official Report, 12/9/25; col. 1789.]
Until we are confident that palliative and end-of-life care in the UK is functioning as well as it possibly can be, this debate cannot be had sensibly. It is clear that, if assisted dying were brought in before we had better provision of care, there would be too great a risk that too many people could feel forced into choosing to end their lives prematurely because they believed there to be no reasonable alternative. Too many people who could be supported better at the end of their life today are simply not receiving that care.
Clause 47 obliges the provision of
“an assessment of the availability, quality and distribution of … palliative … care”
within a year of the Bill passing. This is a tacit acknowledgement of this point, but it is the wrong way round: we need to do the work on palliative care provision now, then come back to the Bill and have this discussion later.
Numerous reports and analyses have been published recently showing just how inadequate the current resourcing is. To quote from just one of these, a Marie Curie report was published this time last year and painted a deeply concerning picture:
“Our findings reveal patchy and inconsistent provision of care for people approaching the end of life. While there were examples of excellent care, the overall picture is of overstretched services, with health and care staff lacking enough time to provide care, and where coordination and communication are inadequate. This means that people lack timely management of symptoms and family carers spend precious time struggling to access, navigate, and manage different services, in addition to providing much of the care needed themselves. This leaves carers feeling unprepared, unsupported, traumatised, and let down, which has lasting consequences into bereavement”.
Another report, this time by King’s College academics, called for a comprehensive plan to look at care for people in the final stage of their life. In all aspects of this, from earlier access to palliative care right through to better support for informal carers, it is clear that current provision is woefully inadequate.
Numerous issues with the Bill have already been raised, from the definition of mental capacity to the relatively arbitrary six-month terminal prognosis threshold and the lack of detail around the practicalities of what will be administered or how it will be supervised. That is before we even consider the deeper cultural challenges around how to ensure that such a piece of legislation does not lead to a cultural redefinition of how we view people’s worth. The overseas evidence on people feeling a burden is particularly troublesome.
A mix of some very profound and very practical questions needs to be looked at, but we cannot even begin to have this discussion sensibly until we are confident that people, no matter where they live in this country or what community they are part of, have greater access to support and care as they reach the end of their life than is available to them today.
Baroness Whitaker (Lab)
My Lords, I had not intended to join this long list of speakers, but it has become increasingly clear that it is right to register all testimony in support of the Bill. I was not at first in favour of it, as I thought it could result in the exploitation of elderly or infirm people’s vulnerability, but as I saw the evidence, particularly from people with disabilities, I came to the conclusion that this choice must be made available. Perhaps I should declare that I am a patron of Humanists UK, but my conclusion in this case was not determined by the admirable way in which it has set out a systematic exposition of the issues.
My views were further strengthened by experience. I am in my 90th year, and I have seen all too many of my friends, and their partners, put under all-consuming stress and suffering by having to postpone an inevitable death, in great and continuing pain and increasing loss of capacity. I well understand those feelings myself. I have seen instances of those caring for people in those last but often prolonged stages taken over by care, helpless compassion and powerless sympathy, of which their dying companion explicitly wanted to relieve them.
I too would like to be able to relieve my family, as well as myself, of intolerable suffering—so how could I deny it to others? I recall, in one of the many debates on this subject that we have had in your Lordships’ House, when the late, much lamented Baroness Warnock asked: why should not old people be allowed to be altruistic? I have spent a large part of my adult life putting the interests of my children at heart, and I do not see why I should stop now. This does not feel to me like altruism, just a continuation of normal service—I hope my children are not listening to this.
The last point I want to make is the part played by other people’s opinions. Like most of your Lordships, I have received very many letters and emails about this Bill. It was striking that almost all of those against were professionally informed, well-marshalled arguments—if often with unusually similar turns of phrase—and many coming from the same email address. By contrast, those for largely wrote from lived and agonising experience, some not very articulately, and in not very educated handwriting. All through my Civil Service career I was conscious of less powerful voices, less well organised, whom it was difficult to reach but who were in the majority—rather like the opinion poll evidence of national feeling in favour of assisted dying. This reflects, of course, the verdict of their elected representatives in the other place; people who we need to pay attention to. I would like to do that now, and make available the compassionate choice about the last, momentous event in people’s lives. I conclude that it is nationally important that this Bill should pass through all its stages.
Viscount Astor (Con)
My Lords, I have listened to many of the speeches over the two days of debate, and I have also carefully read the Hansard of those I missed. My conclusion is that whatever the issues surrounding assisted dying, it is clear that this should have been a government Bill with a free vote. There should have been pre- legislative scrutiny by a Joint Committee and, as we have heard, impact assessments were issued late during its progress through the Commons.
The Bill clearly gives excessive use of delegated powers, 42 in total, and we all know how difficult it is to reject—and impossible to amend—secondary legislation in this House. More surprising is that it gives the Secretary of State the right to delay its implementation for up to four years. I am not aware of any other recent Bill that has such a power. This is a private Bill, not covered by any convention, passed only by a small majority. I am sure, therefore, that it will be subject to amendment.
I understand the moral arguments against assisted dying, but one cannot help being moved by the terrible tales of excruciating pain and suffering that could be avoided. We all have personal experience of friends or family suffering in such a way. I do not believe that assisted dying means that as a society we believe some lives are not worth living, but that as a society we recognise that prolonging extreme pain and suffering can be properly remedied with all the necessary safeguards.
The fact that more than 50 people go abroad, at considerable expense, to end their life cannot be ignored, compared with the many who cannot afford such an outcome, and of course the many who already take their own life in this country, as we have heard. Having listened to the arguments, I am in no doubt that palliative and end-of-life care is not good enough. We cannot allow those suffering to feel that they must end their life due to lack of resources or of decent care, or guilt, or due to a fear of being a burden on their families or on the state.
In the end, it is about choice, individual choice, a decision made by those who seek an end to prolonged, severe pain and suffering on medical grounds: a choice made by no other. This is an outcome that is certainly better than the painful alternative of some who have refused food and medicine. Pain, of course, is subjective. It is personal.
I support those who, in terrible circumstances, wish to end their life; palliative care does not always reduce the pain or the mental anguish. I have a nagging doubt, however, that better care and better pain management would make assisted dying unnecessary except in extreme circumstances.
Baroness Hayter of Kentish Town (Lab)
My Lords, we have heard three arguments against the Bill: from those who oppose assisted dying in principle, those who say it will undermine pressure for palliative care, and others who think that the Bill is faulty.
There is not much I can say to those whose objections are deeply religious, but I disagree with the right reverend Prelate the Bishop of London that enabling a dying person to end their own life means that we, as a society, believe that
“some lives are not worth living”.—[Official Report, 12/9/25; col. 1785.]
I say no; it means that we value our fellow human beings and their choice to hasten the inevitable, at a time of their choosing.
I acknowledge the views of the noble Baroness, Lady May, although I do not think she should prevent others from exercising a different view. I disagree with her that:
“As a society, we believe that suicide is wrong”.—[Official Report, 12/9/25; col. 1784.]
As the noble Lord, Lord Pannick, says: it is legal, but there are no safeguards—particularly when people go to Switzerland. As we have heard from a former DPP and a former chief constable, the current need to interrogate the loved ones of those who have legally taken their own life is a situation none of us would want to face.
As the noble Lord, Lord Purvis, and others have said, the Bill is not about people choosing to die. They are dying. The Bill is about helping to make those final days easier for those who so choose. It is about dying people who want a loved one with them; the Bill allows that. It is not just about a medical intervention. It is for those who want a loved one with them, if they choose to end their own life, when the pain, discomfort, indignity or scale of intervention become unbearable.
Some noble Lords claim that the Bill would undermine pressure for palliative care. But there is no evidence for that. Indeed, the Bill has already led to more discussions about dying; the need for dignity, support and help; and it may even have increased the likelihood of improved provision. I say to those noble Lords: campaign away for palliative care, but do not do so at the expense of those who have had palliative care and then, in their final hours, want help to die.
Palliative care is about improving the quality of the last part of life for those approaching death, by managing pain and other symptoms—often in their own home. Why, when those symptoms are no longer manageable, should professional help be unavailable at a time and manner of their choosing and in their own surroundings, alongside those they love?
I address the argument from those—who would otherwise support assisted dying, rather than those who never would—who say that this Bill is not right. Our task is not to undermine the clear public desire, and the Commons’ support, for this measure. Our task here is to ensure that it achieves its ends but with proper safeguards, albeit not with so much bureaucracy that its purpose is defeated. We should look for genuine improvements, helped by a timely Select Committee and then by the whole House, without derailing its timetable. Let the Commons then have the final word.
There is a right to die; it is already in law. This is about helping those who, in their final days, when the inevitable is coming, can have the comfort of professional help as well as having their families around them if they choose to end their life.
Lord Taylor of Holbeach (Con)
My Lords, it is a pleasure to follow the noble Baroness, Lady Hayter. We often debate and we do not necessarily agree; we do not on this occasion. I wish I were participating in the Second Reading of a government Bill, but we are where we are. Most of us will have found ourselves examining our prejudices and experiences of the issues underlying the Bill. I say at the outset that my views are conditioned by my convictions and experiences. At the bottom lies a belief that life is a precious gift from God. I think these views are widely shared, and not just on the episcopal Bench: we have heard them from my noble friends Lady May, Lord Deben and Lady Verma.
On my direct experience, a number of noble Lords will know that, for 18 years before coming here, I was chairman of Holbeach and East Elloe Hospital Trust, a community charity. In 1988, I headed up a group of concerned individuals from my hometown who were shaken by the health authority’s decision to close Holbeach Hospital, leaving us with a district general hospital 14 miles away, with no direct bus route between the people of Holbeach and East Elloe, the rural district in which it was situated.
With the support of the local community, we formed a charitable trust and bought and took over the hospital as a community hospital, providing many facilities, including nursing care, with 30 beds, including six doctors’ beds. With further local support, we now have 47 beds. Increasingly, the need for palliative and end-of-life care has become more acute, and it is very much valued by the local community. Some 25 years ago, my own father died there, and I was able to be with him and knew the care that he had been given. It was a hugely emotional experience, as many people have had and described while giving their views on the Bill.
Listening to the contributions to the debate, I conclude that the principal concern is the unavailability and lack of NHS funding for end-of-life care. The role and funding of palliative care cannot be overestimated, as the noble Baroness, Lady Finlay, and many other noble Lords have explained. It is self-evident that it is a key element that the NHS has not been able to fund properly. As the noble Lord, Lord Stevens of Birmingham, indicated, thank God for the hospice movement. We should listen to it and recognise that it is not supportive of the Bill.
The noble Baroness, Lady Watkins, described how getting old can be a messy business. As it stands, we do not have enough information, and the Bill runs the risk of too much legal controversy, too little medicine and a total absence of a funding commitment from the Government for what is needed to implement the Bill. That is why it should have been a government Bill: the Bill needs commitment from the Government for it to be safely passed.
We need time to build a greater consensus not just in this House but in the other place. I will support the noble Baroness, Lady Berger, in her proposal to set up a Select Committee to report back to this House, so that it can examine the Bill thoroughly before we set out to amend it. We need time to make it fit for purpose in the ways that almost every speaker has suggested, and we will use parliamentary processes to do so.
Baroness Hollins (CB)
My Lords, it has been an extraordinary two days. After last Friday’s debate, I went to a Beatles tribute band with my learning-disabled son, and we sang “All You Need Is Love”. Compassion is love, and it means journeying alongside someone, even at the end of life, as I did when my husband died from motor neurone disease earlier this year.
I nursed him with the help of fast-track NHS continuing healthcare funding, alongside hospice and district nurses and the brilliant Epsom rapid response team, which aims to keep frail and dying people at home. MND is often called the most feared disease. Martin just smiled and told his grandchildren and his friends that he was fading away as his paralysis increased. Some want the Bill to pass because they are afraid of dying, even though most of us will die peacefully, as my husband did.
During my 40-year career as a doctor in the NHS, I worked on the front line as both a general practitioner and a psychiatrist, two of the specialties most affected by the Bill as it stands today. As a medical student, I was taught by Dame Cicely Saunders, the founder of the hospice movement. Hospices should be our pride and joy; we are world leaders in palliative care. However, the evidence from the Association of Palliative Medicine is that growth in palliative care slows in countries with assisted dying services. Can the noble and learned Lord give us details of the anticipated impact on the availability of palliative care services of introducing assisted dying in this country? What measures would need to be put in place to prevent that happening?
In highly centralised healthcare systems such as the NHS, the integration of assisted dying would risk subtle systemic coercion. Institutional endorsement would normalise its practice and implicitly shape patient decisions. The existence of statutory powers can, over time, drive their own use beyond original policy intentions. Just look at what has happened in psychiatry, where an increase in coercive measures cannot just be explained by clinical demand. It must also be understood in terms of the institutional and cultural momentum generated by the availability of the powers in the Mental Health Act.
Can the noble and learned Lord explain what safeguards will prevent coercion by doctors? Does he support the contention by doctors that assisted dying is not a treatment? Alternatively, if he thinks that it is a treatment, why are there no plans to license and regulate the experimental lethal substances that will be used, rather than leaving it to the Secretary of State?
I will correct an earlier assertion about suicide rates. There is substantial evidence in 10 US states that legalisation is associated with a significant increase in suicide.
I support the Select Committee proposed by the noble Baroness, Lady Berger, and we must listen carefully to the evidence and not rush it. The evidence taken in the other place was partial—at first attempting to exclude even the Royal College of Psychiatrists, despite psychiatrists being given a key role in the Bill.
The lawyers and campaigners have left their mark on the Bill, but there is considerable and more relevant expertise in your Lordships’ House: Members who could competently question witnesses on areas such as capacity assessments, coercion, psychological issues at the end of life, the role of doctors, the licensing and monitoring of lethal substances, and more. There is expertise that could be harvested to see how and if the Bill can be amended to make it fit for purpose.
The other place has left us a lot of work to do. The Bill is neither safe nor workable as it stands today.
The Archbishop of York
My Lords, it is an honour to follow the noble Baroness, Lady Hollins. I will of course speak for myself, but I also know that I represent views held by many faith leaders—not just Christian leaders—across our nation, with whom I have been in discussion and who have written to me.
Jesus teaches us that how we live our lives in relationship to others is vital for the health of our society and our own personal well-being. We belong with and for each other. The Bill is wrong because it ruptures relationships, serving one need but creating many others.
The noble Lord, Lord Baker, and several others in this important and moving debate gave the game away early on: no Government, he said, will be prepared to provide palliative and social care in the way it is needed, thus revealing that the Bill’s impact will be economic as well as social. Several speakers said there were too many safeguards; others, that provision for assisted dying ought to be expanded.
As the noble and right reverend Lord, Lord Harries, pointed out, if this is where compassion leads, the logic of compassion demands the scope be widened. On this side of the argument, and also motivated by compassion, we must say that, while we share the same anguish as we witness the death of a loved one and long for the suffering to end, there is a moral universe of difference between doctors and clinicians in consultation with families withdrawing treatment in the last days of someone’s life, and picking out six months as the point at which life for some can be extinguished.
If we do this, we unleash into our society a fundamental change in our relationships: the relationship between death and life, between doctor and patient, between parent and child, between citizen and state. Last year I saw this at first hand in Canada, where priest after priest told me heart-rending stories of people choosing an assisted death because it was better for their family than spending an already meagre inheritance on expensive care and sometimes feeling forced into this choice; they felt it was their duty to die. I know this is not what we want here, but this is what we are proposing. Do we seriously think that if the Bill is passed, palliative care will not be detrimentally impacted or six months will not in due course become 12?
I think we can do better than this. Of course, I do not want anyone to die a painful, agonising death, but nor do I want poor and vulnerable people to be faced with such agonising choices. Better palliative care can massively ease the first dilemma. Assisted death will turbocharge the latter.
Before I trained for ordination, I worked for a year at St Christopher’s Hospice. It was probably the most formative year of my life. On my first day on the ward, I was terrified; all I could see was cancer and death. But during that year I learned that it is possible to live until you die, and although there are some illnesses so hideous that they cannot be completely controlled, in most cases they can, honouring people’s dignity and upholding their value as someone made in the image of God until their life’s end. Why then, I ask the noble and learned Lord, Lord Falconer, does the Bill deny the right of hospices to opt out?
I welcome the amendment in the name of the noble Baroness, Lady Berger, but I also want to say, alongside the right reverend Prelate the Bishop of London, that if the Bill reaches a Third Reading, we on these Benches will be prepared to table an amendment to offer us a vote. Meanwhile, I give the last word to Dame Cicely Saunders:
“You matter because you are you, and you matter to the last moment of your life. We will do all that we can not only to help you die peacefully, but also to live until you die”.
Baroness Pidgeon (LD)
My Lords, I rise to speak at the end of this important and significant debate. I thank Kim Leadbeater MP and the noble and learned Lord, Lord Falconer, for leading this significant Private Member’s Bill through Parliament. I must add that this is a free vote on these Benches, and I am therefore not speaking on behalf of my party.
We have heard passionate speakers on both sides of this debate and many Members flagging important issues they want to see looked at to ensure that processes work and safeguards are in place. I have every confidence that these will be addressed in Committee. I want to emphasise that I was particularly moved by the very personal stories last week from the noble Lords, Lord Mitchell and Lord Alderdice. Throughout our lives we are able to make decisions about most things that affect us: where to live, what to eat, how to live your live, what to do each day, and so on. Yet the one thing we do not have any control over is our end of life.
When someone has been diagnosed with a terminal illness, I believe it is only right, with the necessary safeguards in place, for them to be able to choose at the right time and place for them to end their life. BBC News ran a very moving package earlier this year about a man in the United States. The gentleman was terminally ill but, having seen relatives die terrible, drawn-out deaths in significant pain, he wanted to die on his terms. The safeguards were strong; his family supported his wishes, and he died at home with his family around him as he had wanted. This should be a right here too.
As we have heard from others across this Chamber, this is already happening here now. Loved ones who are able to do so are travelling to Switzerland or staying at home and taking their own lives. This leaves behind devastation for their families, who pick up the pieces afterwards and are haunted by the experience. Like my colleagues in this House, I have been overwhelmed by the many personal letters and emails I have received from people across the country with their own stories; I thank each of them for taking the trouble to share their personal thoughts on this issue.
I am at an age where, in the past two years, I have lost my father-in-law and my mother-in-law to long, drawn-out illnesses. Sadly, my own mother has terminal cancer. I would have liked all of them to have had the option to decide whether they wanted the right moment for them to go to sleep and leave this world; I know that my father-in-law certainly wanted this. I do not want people to have to suffer in pain and discomfort, as many do now even with the palliative care services that exist. I stress that investment in palliative care services sits beside this legislation, not as an alternative.
This Bill is about improving health at a time of suffering. It is about being able to live with dignity and die with dignity. For those people with a terminal diagnosis, this is not a choice between life and death; it is a choice between death and death. Having some control over the dying process and being able to die on your own terms must be a right. I want people to have that choice, control and freedom.
This legislation has gone through line-by-line, rigorous scrutiny in the elected Chamber. On a free vote, our MPs voted for this Bill. It is not for this House to obstruct this legislation, which has been supported by elected Members of Parliament. I hope that this Chamber will play its proper role in reviewing the legislation without seeking to prevent the Bill moving forward. I support the right of individuals to choose their end of life, and I hope that this House will do the same.
Lord Wolfson of Tredegar (Con)
My Lords, it is a privilege to follow the noble Baroness, Lady Pidgeon, and take part in this important debate. We have had two days of discussion, with many fine speeches. The ones we have heard today are still ringing in our ears, but let me take a moment to remind the House of a few of last week’s contributions.
I will never forget the exchange between my noble friend Lord Forsyth of Drumlean and his late father. I will never forget the tragic story of the parents-in-law of the noble Lord, Lord Mitchell. I remember the point made by the noble Lord, Lord Stevens of Birmingham, with all his experience—that without the proper provision of palliative care, you do not really have freedom of choice. At the same time, I recall the warning from the noble Lord, Lord Baker of Dorking, that proper government funding for palliative care might always remain elusive. I know that the whole House shares my admiration for the brave, moving and extremely personal speech made by my noble and learned friend Lady Prentis of Banbury, and will join me in wishing her well in the months ahead.
Although I am winding up for the Official Opposition, we do not have an official position. These Benches have a free vote, so I speak for myself and my conscience. Two points flow from that. First, we all bring to this debate our background; our education; our professional or other knowledge; our faith, or lack of it; and our personal experiences of the fact of death and the experiences of the dying. I suggest that it is as wrong to discount an opinion because it is informed by religious faith as it is to ignore an opinion grounded in a sincere belief in the irrelevance of faith, because both the supporters and the opponents of this Bill sincerely believe in the validity of their arguments. There is no doubt that the noble and learned Lord, Lord Falconer of Thoroton, places the Bill before us in perfectly good faith, but I repeat a point made by my noble friend Lord Polak in the name of the former Chief Rabbi, Lord Sacks; on a personal note, I miss him especially on days like this. He said that
“purity of motive has never ensured rightness of outcomes”.
Secondly, we do not sit here as moral philosophers or, with the evident exception of the Lords spiritual, as theologians. Over the past few weeks, I have looked deeply into the learning of my own tradition. I have read the letter from the current Chief Rabbi and essays by Orthodox thinkers. I have considered articles from modern Reform Rabbis, such as Rabbi Romain, who was mentioned earlier today. I have studied responsa from a rich written legal tradition extending over 3,000 years.
Yet, I confess to your Lordships that I vacillate on the underlying moral question. As a lawyer, I spend my life dealing not with black and white but shades of grey. I feel like I ought to have clarity on the underlying moral and philosophical questions. If I may borrow respectfully from another biblical tradition on this issue, I see through a glass, darkly. But—and this is the key point—we sit here as legislators. It is as a legislator and a lawyer that I look at the Bill. The ultimate question before us will be whether the Bill should become law. My answer to that question is no, and certainly not in the state the Bill is now in.
By contrast, my answer to the question, should anybody put it, of whether the Bill should get a Second Reading, would be, “Of course it should”. I say that for two reasons: first, because this is a serious, if also seriously flawed, Bill which merits this House’s careful consideration in Committee; and secondly, because the other House passed the Bill and handed it over to us. But that, I suggest, is the limit of the force of the point—that the House of Commons passed the Bill.
Some have suggested that, because the House of Commons passed the Bill, we should not reject it. For my part, I reject that contention. I accept that this House should not, except in the most exceptional of circumstances, unceremoniously dispose of a Bill passed by the House of Commons. So the fact that the House of Commons passed the Bill means that we need to take it seriously, and we are taking it seriously, but it does not mean that we have to pass the Bill as it is or even as it might be following amendment. That is right as a matter of constitutional principle, but it is especially right in the case of this Bill. A number of Members of the other place passed the Bill only on the basis that it would be the subject of detailed scrutiny here. In those circumstances, the idea that we should uncritically defer to the House of Commons seems to be the parliamentary equivalent of “heads I win, tails you lose”.
Let me make four short substantive points about the Bill. A number of us have repeatedly made the argument that because some people in this country have the option of paying to go to Switzerland and Dignitas, the Bill is needed for those who cannot afford that option. That superficially attractive point suffers from two defects. First, there is a conceptual problem. The fact that Switzerland offers assisted suicide and offers it to non-Swiss residents does not mean that we have to follow because of that. Otherwise, the fact that any country in the world adopted the Swiss model would mean that we should also pass such legislation. That is not a sound basis on which to legislate.
The second defect is a practical problem. The Bill would not cover many, if not most, of those who travel to Switzerland, because if you have a degenerative disease but have more than six months to live, you can go to Switzerland but you are outside the scope of the Bill. That also means that relatives who are anguished by the idea of what might happen to them if they assist their relative in going to Switzerland would still be in that predicament, even if the Bill were to pass.
The second point is in response to an important speech by the noble Lord, Lord Pannick, who will know that I listen to anything he says with particular care. He made two points. First, the law already rejects the absolute sanctity of life and recognises the right to suicide. Secondly, citing the decision in the Bland case, he drew an analogy between the right to refuse life-saving treatment—which is our right under English law, and which I support—and the right to demand an assisted death.
As to the first point, it is not correct to say that the law recognises a right to suicide. Suicide is no longer unlawful, but that does not mean that there is a right to commit suicide. Indeed, that point was emphasised by Lord Bingham, the former Master of the Rolls, in the earlier case of Pretty. As to the second point made by the noble Lord, Lord Pannick, I accept that the law rejects the absolute sanctity of life, but that is a straw man. In practice, all religious and philosophical traditions, if sometimes sotto voce, reject the absolute sanctity of life. Nobody would suggest that we should tax everybody in the country out of half their wealth to give one person another three months of life. Absolute sanctity of life is a straw man.
However, the law does respect the sanctity of life. The sanctity of life is a religious and philosophical principle. That means that, in our law, all human life is regarded as being intrinsically valuable and that we do not deliberately terminate a life even if the patient so consents. Indeed, that is at the heart of the decision in the Bland case, to which the noble Lord, Lord Pannick, referred. The House will be happy to hear that the detail will await Committee, but Lord Goff of Chieveley began his speech in that case by referring to
“the applicable principles of law”,
of which the first was
“the fundamental principle … of the sanctity of life”.
He drew a clear—his word was “crucial”—distinction between the withdrawal of life-supporting treatment and actively causing death. The key point is that withdrawal of treatment by doctors does not cause death; it is the underlying disease that causes death. The doctors do not have any intention to kill; they want to discontinue something that is of no benefit to the patient.
It is on that basis that most religious traditions, including my own, support the withdrawal of treatment in those circumstances. For example, there is the authoritative responsa of Rabbi Moshe Feinstein in his monumental Igrot Moshe, where—le’havdil—he draws the same distinction as Lord Goff does in Bland between removing impediments to death on the one hand and hastening death or assisted suicide on the other. Therefore, my answer to the question from the noble Lord, Lord Pannick—why, if you can refuse treatment, can you not demand to be provided barbiturates?—is that this is contrary to the basic principle that human life is inviolate, even if the person in question has consented to its violation.
Thirdly, I have carefully read the human rights memorandum that accompanies the Bill, but I have not seen in it any response to the question of why the line is drawn at six months. The legal challenge is going to go along the following lines. First, “My personal status for the purposes of Article 14 discrimination is how long I have to live”. Secondly, “I cannot access assisted suicide at more than six months, even though my suffering may thus be longer than somebody who only has six months to live”. Thirdly, “There is no obvious reason why six months has been chosen”. Perhaps that is a lawyer’s way of putting the slippery slope argument. However, in my professional experience, legal slopes are exceptionally slippery. It seems that, once we are on this slope, we will slide inexorably to the point where anyone with a terminal illness shall be permitted to avail themselves of the provisions in the Bill.
I am afraid that we have an inherent contradiction regarding the supporters of the Bill. My noble friend Lord Johnson of Marylebone accepted that the logical outcome was that anyone with a terminal illness should be permitted to avail themselves, but at the same time we are told that the six-month limit is a fundamental protection. Both points cannot be right at the same time.
Finally, let me say a word about an absent friend: the High Court judge who, we were told when the Bill was introduced, would stand as guardian to make sure everything worked as it should. But our judges have their work cut out making sure that we can live in peace, and they did not like the idea of having to make sure that we die in peace as well. So the High Court judge has gone, to be replaced by what is now rather euphemistically called an “expanded panel”. Well, it has been expanded in that there are more people on it, but it has been diminished because one member does not have to be a judge: a King’s Counsel is sufficient.
I am the last person to denigrate the ancient and honourable status of one of His Majesty’s Counsel, learned in the law. But the fact is that there is now no minimum period of practice before you can apply to take silk, and it is also not immediately apparent to me why a barrister of, say, 12 years’ call who took silk last week can be on the panel but the senior partner of an international firm of solicitors cannot.
The truth, I suggest, is that this judicial panel falls between two stools. It is too complex for the normal, straightforward case, while it is not equipped with anything like sufficient powers for the more difficult cases. I am not sure what the answer is, or even if there is an answer, but I am afraid that the current proposal is neither fish nor fowl; it is something of a statutory red herring.
To repeat, although I have spoken from the Dispatch Box, I have spoken only for myself. I look forward to the forthcoming stages, so that, if and when this House has to decide whether the Bill should pass into law, it is by then in the best possible state. But, as matters stand today, the Bill is not fit for the statute book.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I start by thanking all noble Lords for an extensive, passionate and insightful debate. As noble Lords have observed throughout this debate, its quality and its conduct have been exemplary, and I believe that that has allowed the expression of differing and deeply held views. I thank my noble and learned friend Lord Falconer for his work in introducing this Bill to the House, and I know that many noble Lords are waiting to hear from him as the sponsor.
We have all heard the debates across the country, in which campaigners on both sides have made their case with conviction and care. We have also heard the debates in the other place, and we know the previous consideration that this House has given to the topic of assisted dying. Now it is our turn to scrutinise this legislation.
I turn first to the important issue of the role of the Government, which relates in some part to the Motion in the name of the noble Lord, Lord Forsyth, and the amendment to it from the noble Lord, Lord Carlile. The Government are neutral on the principle of assisted dying. It is a matter of conscience. Whether the Bill becomes law is a decision for Parliament, and my role, alongside that of my noble friend Lady Levitt, is to help ensure that, if this legislation is passed, it is legally and technically effective and workable. So, as with any legislation, if Parliament chooses to pass the Bill, the Government will be responsible for its implementation.
The noble Lord’s Motion refers to time being made available for consideration of amending stages. Scheduling is of course a matter for my noble friend the Government Chief Whip, who will indeed keep this under review. The Government have a duty of care to the statute book and, as such, my officials and those in the Ministry of Justice have worked with my noble and learned friend Lord Falconer and the Commons sponsor Kim Leadbeater MP to offer drafting support and workability advice. This will continue throughout the passage of the Bill and is and has been usual practice.
Turning to the Motions in the name of my noble friend Lady Berger—
Lord Forsyth of Drumlean (Con)
Can the Minister explain why, despite requests from the sponsors of the Bill, and despite the precedent which has been taken with other Bills which were Private Members’ Bills but matters of conscience, such as capital punishment and abortion, the Government are not prepared to provide time so that this House can ensure that it is properly scrutinised and considered?
Baroness Merron (Lab)
I can only repeat the point I made that the Government Chief Whip will listen to the will of Parliament and will review as necessary.
The Motion and the amendment in the name of my noble friend Lady Berger refer to a Select Committee reporting to the House ahead of Committee of the Whole House commencing. The Select Committee should report by Friday 7 November. The outcome of these Motions and any others are indeed a matter for this House to decide on.
To the points that noble Lords have raised over whether this matter should have been for a Private Member’s Bill or a government Bill, I remind us all that, on matters of societal change, the Private Member’s Bill, with government neutrality, has long been used as the right vehicle to handle matters of sensitivity and importance such as this one. On this point of neutrality, I hope that noble Lords will understand my role and why it is not appropriate or possible for me as the Government Minister responding to respond to every point raised during the debate.
I thank the Delegated Powers and Regulatory Reform Committee and the Constitution Committee for their scrutiny of the Bill. As many noble Lords have highlighted, their recommendations will be important in the consideration. The content of this Bill and any delegated powers are a matter for the sponsor and Parliament. I am grateful to both committees because their recommendations will inform the scrutiny of your Lordships’ House. Noble Lords heard my noble and learned friend Lord Falconer’s opening remarks. He has already considered those reports and will continue to do so.
Many noble Lords have spoken about the importance of high-quality palliative care for all those who need it. I want to be clear that irrespective of any legislation on assisted dying, everyone must be provided with high-quality compassionate care through to the end of their life. While the majority of palliative and end-of-life care is provided by the NHS, we recognise the vital role played by the voluntary sector in supporting people at the end of their life. That is why we are providing the hospice sector with £100 million of capital funding for eligible adult and children’s hospices, to ensure that the best physical environment for care is available.
We recognise that more could be done to support people who need palliative and end-of-life care, as a number of noble Lords said. We are looking at how to improve the access, quality and sustainability of all-age palliative and end-of-life care, in line with the recently published 10-year health plan, and to make the shift from hospital to community, including making that care part of the work of neighbourhood health teams.
I thank noble Lords once again for their engagement, care and thoughtfulness during this debate. As I have said, the Government remain neutral on whether the Bill becomes law. Should Parliament pass this legislation, I can say to your Lordships’ House that it will be our responsibility to ensure that it can be implemented safely and effectively.
Lord Falconer of Thoroton (Lab)
My Lords, I draw attention to my entry in the Register of Lords’ Interests, which refers to the facts that I have an assistant funded by Bernard Lewis to assist me in the conduct of this Bill and that Dignity in Dying funded the printing of the literature that I sent to your Lordships in connection with the Bill. I apologise for not mentioning this in my opening speech.
This has been a debate of the highest quality, probably the highest quality I have heard in 28 years in this House. Your Lordships brought passion, expertise and wisdom to the issue. I thought that every single speech that was made rose to the gravity of the occasion. I would wish to refer to every speech, but I cannot.
I pay particular tribute, however, to those of your Lordships on both sides—some people have mentioned them—who have identified their own personal suffering in relation to this. I pay tribute to all of those speeches and will mention just two of them. First, the speech of the noble Baroness, Lady Prentis of Banbury, was very striking. She will know that she has the wishes of the whole House with her. I also mention the speech of the noble Baroness, Lady Falkner of Margravine. She, too, has the wishes of the whole House with her.
The debate shows beyond doubt that this House will bring both expertise and human understanding to the important task of scrutiny that we must now undertake. I express genuinely my gratitude to your Lordships’ Constitution Committee and the Delegated Powers and Regulatory Reform Committee respectively. As I indicated in my opening speech, I will be bringing forward amendments to deal with many of the recommendations that they raise. I have to say that my experience as a Minister was that both those committees frequently made recommendations of the sort that have been made here requiring changes. I very much hope that, in consultation with the Government, I will be able to make those changes.
I also mention the status of this Bill. This is a Private Member’s Bill because it is a matter of conscience. No major political party agrees on whether or not it supports assisted dying, and I do not find that surprising. It has to remain a Private Member’s Bill for that reason. I should say, as my noble friend Lady Merron referred to, I have had assistance, as has my friend in the other place, the Member for Spen Valley, from the Government—civil servants and lawyers—seeking to ensure that the Bill is workable. That explains very many of the changes that have taken place. But, ultimately, this is a Private Member’s Bill and must be treated as such.
I believe that the Commons was very capable and proved able to properly scrutinise this Bill. It gave the Bill 100 hours of scrutiny. At the same time in this House, we are looking at the Children’s Wellbeing and Schools Bill, which, as it happens, is longer, and it got 40 hours of scrutiny. We are looking at a Bill for which, in the Commons, there were no guillotines, so every clause was debated, not just those that were reached before the guillotine fell. We are looking at a Bill that has had a very large number of Select Committees look at it. The last one reported in the Commons in March 2024. We have a job of work to do, but I earnestly ask your Lordships not to approach this Bill on the basis that it has not been properly scrutinised in the other place.
Baroness O'Loan (CB)
I thank the noble and learned Lord for yielding. I simply wanted to say that a number of Members of the other place have said that the Bill did not receive proper scrutiny in the other place. They have also said that they expected that it would receive scrutiny in this place because that is what we do. That is profoundly important, and I do not think that what the noble and learned Lord just said is actually correct. I would also say that there were a number of amendments tabled and a number of MPs who wanted to speak who were not permitted to do so. That is reflective of the fact that the Bill did not receive proper scrutiny in the other place.
Lord Falconer of Thoroton (Lab)
I am grateful to the noble Baroness for her intervention. I have laid before the House the facts. I recognise that some Members of Parliament say that the Bill was not given proper scrutiny. I wonder if those were Members of Parliament who did not agree with the conclusion—I do not know. I have laid before your Lordships the time that was spent and the fact that it got more scrutiny than government Bills.
The essence of this Bill is that those who are terminally ill—and that means that they have a diagnosis that they will die within the next six months—should have the option, subject to safeguards, to be assisted to take their own life. One of the features of this debate was the personal experience that so many people have had of how, had that option been available, it would have ended terrible suffering. That suffering is not often about the pain but about the lack of dignity and the profound desire to keep control, because that is what people want.
I believe, from my own experience and from talking to so many people, that having that option is important. The points that have been made against it, which I have listened to incredibly carefully, are, in essence, not that people should not have that choice but that it brings dangers with it. The dangers are, first, that people will be overpersuaded and, secondly, that it will affect society in other ways.
On the idea that people will be overpersuaded, the Bill provides for the following: first, a conversation with the doctor in which all the options, including the palliative care options, are laid out; secondly, that a doctor decides that it is a free choice; thirdly, that a second doctor decides that it is a free choice; and, fourthly, that a panel, consisting of a senior judge or a King’s Counsel, a psychiatrist and a social worker, concludes that the person is not being coerced, that they are capable of making the decision and that it is their free choice. As it happens, that is probably the most safeguarded procedure in the whole of our healthcare system. It is certainly the most safeguarded process when compared with terminal illness Acts in other countries in the world.
I profoundly believe that people should have this choice—a profound belief that is based not on either my spirituality or my lack of spirituality, but on looking at the evidence from other countries that this will not lead to people being overpersuaded. I have in mind those countries that already have a terminal illness Act. The one that has been in force for longest is the one in Oregon, but there are many other states in the United States of America that have terminal illness Acts that have been in force for 20 years and more. They do not have those safeguards. They do have annual reports and record-keeping of the highest sort about assisted death. They show no evidence of the coercion that some noble Lords referred to in this debate.
I would have expected that, if there were real evidence of that, somebody in the course of the debate would have referred to a case from one of those countries where there is a terminal illness Act showing that there was coercion. There was none. I am convinced, first, that the Bill has had proper scrutiny in the other place and, secondly, that there is no real danger in relation to coercion. Thirdly, I completely accept the point made by noble Lords who said in this debate that they wanted more palliative care—I want more palliative care, and we should do everything we can to promote it. However, as so many people said, it is not either/or—it is both.
Some 75% of people in Victoria, Australia, who have had an assisted death came from palliative care, and 92% in Oregon came from palliative care. The Select Committee in the Commons to which I referred, which reported in 2024, said that palliative care in many jurisdictions went up in terms of its resources. In answer to the question that was raised about what the effect will be on palliative care: on the basis of other jurisdictions, it will get better. In fact, the debate here has provoked the Government to spend more money on palliative care.
Many noble Lords have talked about language. I take no point about language. I simply say this. For over 10 years of having been engaged in this debate, I have found that, for people who are terminally ill and want an assisted death, nothing upsets them more than saying that that is suicide. They hate that because of the impact it has on those they leave behind. What they feel is that they are dying anyway, and what they want is some degree of control over when and how it will happen.
I turn briefly to what happens next. I very much welcome my noble friend Lady Berger’s Motion to set up a Select Committee that can hear evidence. I very much welcome that it is time-limited, because, as my noble friend and I indicated in the letter we sent to every Peer, it allows for the Bill to go through all its phases after 7 November. I will therefore support my noble friend’s Motion to set up a Select Committee.
We have a job of work to do. I agree with everybody that, plainly, this House must give the Bill a Second Reading. We must listen to the evidence that my noble friend Lady Berger’s Select Committee will supply, and then we must do what we do so well, which is scrutinise and amend the Bill as necessary, and then send it back to the other place for a decision.
I have heard some noble Lords say, “Oh well, we can say no to this Bill”. Ultimately, on an issue such as this in our system, somebody has to decide. It is not the electorate because it is never in anybody’s manifesto, with the exception of the Greens. Therefore, Parliament has to decide. Ultimately, in our system, that means it will have to be those who are elected—not those who are unelected—who make that decision.
I end by expressing my profound gratitude to the House for the attention and quality of the debate it gave to the Bill. I commend this Bill to the House.
Lord Forsyth of Drumlean (Con)
My Lords, I do not know if I am alone in being frequently asked by people, from time to time, “What is the point of an unelected House of Lords?” I now have the absolutely mind-blowing answer, which is to refer them to these two days of debate on this really difficult subject and the range of expertise which we have heard.
I am speaking because I tabled an amendment. That was last Friday, so some noble Lords may have actually forgotten what it said. It called
“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”.
Despite the differences that we have heard in these two days of debate, there is a clear and absolute consensus across the House that the Bill is in need of amendment and further scrutiny.
I listened very carefully to the speech of the noble Baroness, Lady Berger, and I see her amendment. I am a little doubtful about how a Select Committee—which is not really a Select Committee because it is not going to produce a report; it is simply going to hear evidence—is going to change or alter the noble Baroness’s opinion on this matter, or indeed anyone else’s. However, it means we cannot actually start that task until 7 November, so we have lost some time.
As many speeches pointed out, none of us knows when and how we are going to die; none of us even knows when the end of the Session is going to be. So, between 7 November and the end of the Session, having listened to all the speeches and thinking of the number of issues that are going to have to be addressed, I venture to suggest that four Fridays for private Members’ legislation, unless we are going to completely destroy the prospects of other people with Private Member’s Bills, are not going to be sufficient time. It therefore seems essential that the Government provide time.
I understand why they do not want to do that: if I were in government and in the Prime Minister’s Office, I would be saying, “But that means we won’t have time for this, that or the other”. But this is an absolutely life-and-death issue and it is important that it is considered properly and put on the statute book, if it is to be put on the statute book, in a way that will satisfy my noble friend Lord Wolfson of Tredegar in his brilliant speech. He showed that what we are doing here is making legislation and we should put legislation on the statute book that has been properly thought through, which means that there has to be government time.
I happen to know that the Cabinet Secretary advised the Government that this should be treated in the way that all Private Members’ Bills dealing with matters of conscience are. Abortion, the death penalty and the decriminalisation of homosexuality were Private Members’ Bills that the Government took on board in order to ensure that they had proper time and were properly supported, and I do not—I was going to say “for the life of me”—understand why that should not apply to this Bill, having listened to these two days of debate. I suspect it might be because the Health Secretary and the Justice Secretary were opposed to the Bill—but we are told that the Government are neutral, and therefore I do not see why they should not provide that time in order to satisfy those people who have written to us on both sides of the debate.
I say to the right reverend Prelate the Archbishop of York, who threatened to vote down the Bill at Third Reading, that I hope he will think again about that. The expectations are sky high and to vote down a Bill that had not been properly considered or given enough time would put this House in a very awkward position, for no good reason. Our duty is to scrutinise the Bill, send it back to the House of Commons and ensure that we have the time to do a proper job.
Lord Carlile of Berriew (CB)
My Lords, noble Lords may recall—but I will remind them in case they have forgotten—that I tabled an amendment to amend the amendment from the noble Lord, Lord Forsyth, because it seemed to me that the noble Lord wanted to turn this Bill into a government Bill and give it all the authority of a government Bill, with a Minister in charge, or by putting the noble and learned Lord in the position of being a Minister. However, I have listened to the noble and learned Lord and he has said—absolutely rightly, and I totally agree with him and the noble Lord, Lord Wolfson—that this absolutely should be, and should remain, a Private Member’s Bill.
I have also looked at the potential effect of the amendment to the commitment Motion from the noble Baroness, Lady Berger, who I think has approached the Bill with great energy, superb intelligence and good judgment, and has done great credit to the House. Having considered that and the state of play as it is now, I think it is right that I should withdraw my amendment so that we can move quickly on to other, more substantive matters. I beg leave to withdraw the amendment.
Lord Forsyth of Drumlean (Con)
My Lords, I beg leave to withdraw my amendment.
Lord Falconer of Thoroton
That the bill be committed to a Committee of the Whole House.
Baroness Berger
At end insert “but that the Committee of the Whole House shall not commence before a report has been received from a select committee appointed by the House to consider certain aspects of the bill.”
Baroness Berger (Lab)
My Lords, I have spoken already about how my experience as a Member in the other place has made me very concerned about this Bill, and more determined that it must not be a cause of further harm to vulnerable people. Many unanswered questions about the Bill before us have been raised during the course of this important debate. This is why I have tabled the amendment and the following Motion to hold a Select Committee before Committee of the whole House begins.
This is a significant and complex piece of legislation by any definition. It demands a process that can withstand the weight, but it is clear that there are serious shortcomings, as both the Constitution Committee and the Delegated Powers and Regulatory Reform Committee noted in their reports last week. Indeed, I am concerned that the legislative process is being asked to compensate for the absence of robust policy-making before the Bill was published: no comprehensive review; no public consultation or prior engagement with professionals and other stakeholders; no Green Paper or White Paper, which we would have seen had it been a government Bill—I understand the case made for why it is not a government Bill, but that has diminished what is before us today; and no published analysis of international experiences. Instead, Parliament has been asked to grapple with questions about implementation, safeguards and NHS implications without this groundwork, which we would usually turn to for a law change of this magnitude.
Back in March, Jill Rutter of the Institute for Government—which is neutral on the principle of assisted dying—said:
“We’re expecting Commons scrutiny to do far too much—things it simply can’t do … Commons scrutiny is being left to solve a whole range of problems it isn’t equipped to deal with”.
We have seen the dropping of key but expensive safeguards, such as the review by a High Court judge, and whole new clauses and schedules introduced to replace them with very little opportunity for thorough scrutiny.
It was a clear pattern in the other place that when significant concerns were raised that had not been anticipated, the response was often to add another delegated power. There are now, as we know, 42 delegated powers contained within the Bill: 42 areas where government will work out the detail later, with Parliament largely excluded from the conversation. The result is a Bill that is today substantially different from when the Bill Committee in the other place took evidence in January this year, but now with less clarity.
I do not wish to detain the House any longer than is necessary, but I have been asked many questions on the process about what is before us, which I will seek to address. My amendment ensures that we can have some evidence, expertise and insight on the Bill before us today. We need this information before we commence line-by-line scrutiny.
Noble Lords will have received a letter setting out a condensed list of witnesses that I and other supporters believe this House must hear from, including my noble and learned friend Lord Falconer of Thoroton and those who will bear the responsibility for delivering the Bill, should it pass, and setting out how they would use their delegated powers. These witnesses are to include the Secretary of State for Health and Social Care, the chief executive of NHS England, the Secretary of State for Justice and the Chief Secretary to the Treasury.
We must also take evidence from the professional bodies whose members will be asked to carry out the functions that the Bill sets out: the Royal College of Psychiatrists, the Royal College of Physicians, the Royal College of General Practitioners, the British Association of Social Workers and the Law Society.
We are, of course, not able to hear from serving members of the judiciary, but may hear from the former Chief Coroner of England, Thomas Teague KC, and Sir James Munby, President of the Family Division of the High Court. We must also ensure that we understand the impact of the Bill on our hospices and care homes, through Hospice UK, the Association for Palliative Medicine and Care England.
A previous suggestion of a Select Committee in parallel, alongside a Committee of the whole House, would not achieve—
Lord Kamall (Con)
I apologise, I do not want to detain the House any longer than is necessary. Just to clarify, will all the evidence before the Select Committee be published?
Baroness Berger (Lab)
I am very grateful for the intervention, and I was just about to come on to that, but I will answer that now. The answer is yes, absolutely. The intention is that all the evidence accumulated and amassed during that time will be published for everyone in the House to interrogate and consider in advance of us going into Committee of the whole House. To confirm, this Select Committee cannot take place in parallel in order that we can receive evidence on vital parts of the Bill before we go into debate, so that we are not in the unenviable position of knowing what is wrong with the Bill but being unable to amend it.
My Motion provides that a Select Committee would be intended as a focused piece of work, hearing vital expert oral evidence, as I have just set out, rather than it being a more time-intensive open exercise. It may report by simply publishing that evidence before we go into Committee of the whole House, in order to inform our detailed consideration of the Bill. As I understand it from the clerks, the revised timetable allows the committee to hold six meetings over three weeks, with two panels of witnesses on each of the days, to begin the week commencing 20 October and allowing it to conclude by 7 November. The revised timetable ensures that the Bill can progress to its next stage and maintain the opportunity for four sitting Fridays before Christmas.
We have, over the past two Fridays, shown the determination of your Lordships’ House to discuss the Bill in a considered and constructive way, and it is my strongest hope that we can continue to do that. If my amendment is accepted, I do not intend to speak on the Motion that will follow, which contains the detail that I have just set out. I am grateful to my noble and learned friend Lord Falconer of Thoroton—
Baroness Watkins of Tavistock (CB)
Is the list to give evidence that the noble Baroness has detailed finally determined or would it be possible for us to add the Royal College of Nursing with its 500,000 nurses?
Baroness Berger (Lab)
I thank the noble Baroness for her intervention. As I understand it, it is within the gift of the Select Committee to determine who will be called for evidence. I have sought to set out the key people, but of course there will be many other suggestions. Obviously, conscious of the tight timetable, we will not be able to have an extensive list, but I am sure that the chair, when appointed, will consider the suggestion that has been made.
I return to expressing my gratitude to my noble and learned friend Lord Falconer of Thoroton for being prepared to work with me to reach an agreement that would allow the House to engage carefully with the substance of what is being proposed and the powers we are being asked to bestow on Ministers. I am grateful to the many noble Lords who have already indicated in their speeches their support for my amendment and my Motion. I beg to move.
Baroness Berger
That it is desirable that a select committee be appointed to consider the safeguards and procedures contained in the Terminally Ill Adults (End of Life) Bill; that the Committee shall hear evidence from professional bodies, those with professional experience of coronial services, and Ministers; that the Committee, notwithstanding the usual practice of the House, may report by drawing the attention of the House to the evidence received without making recommendations; and that the Committee do report by Friday 7 November.
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, at the end of this September sitting, when we have made good progress on the legislation before the House. I thank the usual channels and all Members for that most sincerely. As we adjourn our proceedings, I am sure all noble Lords will join me in thanking the catering staff, the attendants, the clerks, Hansard staff, the broadcasting unit, the security staff, the police and the doorkeepers for their excellent support in keeping the House operating and keeping us safe. I recognise, as Government Chief Whip, the pressure that this places on the staff of the House, and I will continue my discussions across the House to ensure that proper support is always in place when we return on 13 October.
I wish everyone a well-deserved break as we move into the conference season. For everyone attending a party conference, whether that be in Bournemouth, Liverpool, Manchester or elsewhere, I wish them an enjoyable time. For those who are not attending a party conference, they probably have the best deal, and I also wish them well.