Live Debate: Lords Chamber

Lords Chamber

Friday 23rd January 2026

(began 2 hours, 52 minutes ago)

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10:05

Lord Watson of Wyre Forest (Labour)

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Third Third Reading Third Reading of Third Reading of the Third Reading of the Licensing Hours Extensions Bill Lord Watson of Wyre Forest.

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To move that the bill be now read a third time. The question is that this bill be now read a third time. As many as are of that opinion will say content. To the contrary, not content. Contents. Have it.

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content. Contents. Have it. I beg to move that this bill do now pass.

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now pass. Which anyone who wants to say something might say something. Yes. I'm very grateful for that guidance, sir. My Lords, this is a modest bill, but a useful one. It makes a small procedural change to the Licensing Act 2003 that will allow the government to act more swiftly and sensibly when communities wish to come together to make moments, moments of national significance, before turning very briefly to the substance. I want to thank those who have helped this bill on its way.

I am grateful to my hon. Friend, the Member for Wrexham, Andrew Ranger, who steered it through the other place with care and persistence, and before that, before the last general election. My hon. Friend for South Shields, Emma Law. I'd also like to thank the Minister and officials and the clerks of the House and staff for their guidance and constructive engagement and support throughout. And I'm particularly grateful to noble Lords on all sides of this House who took an interest in this bill.

You recognise that this bill can bring a little joy in difficult times to landlords and the wider hospitality sector, which is navigating tough economic conditions. Our pubs and hospitality venues are not simply businesses, they're places of belonging where people gather to celebrate, to commiserate and to feel part of something shared. I should also like to particularly thank the noble Baroness Monckton of Darlington Forest, who cannot be with us today because of pressing family commitments. But she has asked me to extend an invitation to visit the North Star pub, a pub she helped open earlier this year through her charity team Dominica, which provides training and employment opportunities for young adults with learning difficulties.

And I'm pleased to say that the good people of the British Beer and Pub Association who support this bill have agreed to accompany any member that would like to take the Baroness up on her kind invitation. And in that same generous spirit, I'd like to thank my Chief Whip, the noble Lord, Lord Kennedy, who is known, who is known for his generosity. And he has asked me to convey the offer to every member in the House today that were you to visit the Baroness Monckton pub.

He would be delighted to buy you all a drink. Now, my Lords, by moving to negative resolution, this bill ensures that licence extensions can be made when they are genuinely useful to communities and businesses, while fully preserving parliamentary oversight. Either House retains the right to object and to secure a debate. Scrutiny remains intact. It's simply better calibrated to the decision being taken. Nothing else changes. Extensions remain exceptional, discretionary and tightly defined. What does change is the ability to use an existing power well at a moment when it matters.

So with the support of the house, we will cut unnecessary delay, reduce administrative burden, support hospitality businesses and help communities celebrate together when the occasion calls for it. So, my Lords, I say cheers to you on all sides for the support before we call time on this bill and before last orders are called. I invite the House to see it safely through

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the. Offer of the noble Lord, Lord

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Offer of the noble Lord, Lord Kennedy. Could I ask the noble Lord whether the first time this bill and hopefully act, comes into and hopefully act, comes into operation, he will by everybody

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present around here today? I know as I know, the noble Lord is an expert on election law. There is an expert on election law. There are certain circumstances where that might be illegal, but I fear that he is correct on this one, and I would gladly take him up on that offer. For those reasons, I commend this bill to the House.

10:10

The Earl of Effingham (Conservative)

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The question is that this bill do now pass. do now pass. >> My Lords, please let me thank all noble Lords who made valuable contributions to this private contributions to this private member's Bill as it has made its way through your Lordships House. way through your Lordships House. When in government. We did indeed support a similar version of the Bill, as proposed by Emma Lewell-buck from the other place, which sadly failed to pass before the general election. His Majesty's Loyal Opposition are therefore pleased to welcome the measures in the Bill as put forward by the noble Lord, Lord Watson, and we thank him for both his work on the Bill.

In addition to his efforts to promote all sectors of the UK music industry. As chair of UK Music at Second Reading, many noble Lords share their extensive knowledge of the hospitality sector and the meaningful, meaningful, positive impact that this legislation will have, ensuring that pubs, bars and other licensed venues can adapt during national celebrations such as royal events, major sporting victories or cultural milestones is beneficial to both businesses and communities, allowing everyone to celebrate together and contributing in some part to economic growth.

Replacing an affirmative resolution with a negative resolution Statutory Instrument provides a faster and simpler mechanism, whilst at the same time retaining the option for consultation and maintaining the relevant safeguards. My Lords. The net result should be that everyone benefits. Yes.

10:12

Lord Lemos (Labour)

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My Lords, if your Lordships pass >> My Lords, if your Lordships pass this bill today, it will not go back to the Commons, but will go straight to His Majesty the King straight to His Majesty the King for Royal Assent. Well, my Lords, I thank and congratulate my noble friend Lord Watson for bringing this Bill forward, as well as my hon. Friends Andrew Ranger and Emma Lou in the other place. I thought I wondered whether we should extend the Licensing Act to celebrate the passing of this bill.

But. But I don't intend to test the opinion of the House on that question. The Chief Whip would have a heart attack, and I understand he has plans for the weekend. But it also would also bring my late blooming political career to an abrupt end. In an earlier debate on this bill, the noble Lord Lord Sandhurst promised to drink more British beer if this bill passes. So I think the drinks in the North Star are actually on the opposition, as well as the obvious economic benefits of this change.

I don't want to trivialise this bill. My Lords, what we celebrate, when we celebrate, how we celebrate, where we celebrate, and with whom we celebrate, are all markers of our shared national identity. These are the occasions where, as a nation, we show the better angels of our nature. With that and with and my thanks again to the noble Lord, Lord Watson, and all those who have supported this Bill and with the government's support. I commend

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this bill to the House. The question is that this bill

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The question is that this bill do now pass. As many as are of that opinion will say content contrary, not content. The contents have it. House to be again in committee on the terminally ill adults. End of

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life bill. Lord before the House considers

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Lord before the House considers that motion. Can I just just make a few remarks before we get on to

10:14

Legislation: Terminally Ill Adults (End of Life) Bill - committee stage (day 7)

committee? I want to thank all noble Lords for the constructive discussions and kind words this

10:14

Lord Kennedy of Southwark (Labour)

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discussions and kind words this week. I understand, empathise with the concerns being raised about the suggestion the House would sit beyond 3 p.m. I am striving to find an approach to minimise the impact on the house, and I've looked seriously all the options given and seriously all the options given and this is very difficult. The options are presented last week were the suggestion of the house should sit suggestion of the house should sit from 7 p.m. to 10 p.m. on a Thursday or earlier on a Friday.

I've discussed these suggestions with the usual channels the clerk assistant and I'm grateful. Their advice, as well as from noble Lords who put them forward. My Lords, I'm also conscious that the House accepted a motion from a noble friend, Lord Falconer of Thoroton, that more time is needed to scrutinise the Bill. There is no easy solution, my Lord, or an option preferred that except for the whole House, the Bill remains and will remain a private member's bill. No government time will be allocated for the bill.

I believe it is right, therefore, that it is considered on Fridays only. I know some Lords would prefer to sit late on a Thursday. Blind mind for the pressure that put late night puts on the house and the staff, especially when we have another Friday sitting the following day. I do not think this is the right course of action. I also spoke to the House authorities about sitting early on a Friday, but for many teams of staff, this would increase the pressure to be here even earlier in the morning to show how to prepare to sit at 9 a.m.

I do not, therefore, think the sitting earlier than 10 p.m. would ensure we're in the best. Scrutinise the bill. As I sent out previously, and as a result, I will not seek to adjourn the House at 3 p.m. today, but will instead seek to do so at around 6 p.m. Of course, this is a matter of the house and not me. As Government Chief Whip and Captain of the Gentlemen at Arms. It remains in the hands of noble Lords and the house, and any noble Lord may seek an early adjournment if they wish to do so.

By moving the motion that the House be resumed. My door remains open to all noble Lords to discuss matters concerning the Bill. My Lords, I have also heard concerns about the pressure for longer days to put a noble Lords who wish to debate most and all the groups in target, and I have been asked about a lunch break. I'm happy to facilitate a break that would adjourn the House for pleasure. During pleasure for around 40 minutes at 1 p.m. That requires a break mid group, although I'd hope we would not be the case.

I also want to put on record my thanks to the staff of the house, both the staff here today and also staff who work in the days ahead to ensure our debates take place today. Can I say also that you know, at all times when we consider this bill, we should always have the front of our mind, kindness, courtesy and respect the hallmark of our debates in this chamber, and especially when we debate the bill before us today. My Lords, with that, I think we should turn the substance of the bill and make more progress on the bill.

Before the noble Lord sits down. He very kindly allowed a number of us to make representations to him during the week, saying that his door is always open, and indeed it was, and I thank him for that. However, the point that I raised last week about those of us who do not live in

10:17

Lord Empey (Ulster Unionist Party)

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London running to six or thereabouts, and that's what it means, makes it impossible for any of us to get most of us to get home. Therefore, we would require to stay Therefore, we would require to stay over until Saturday. Now, given that this is a private member's bill, given the pattern that has been adopted in private members bills since I have been here, and given the fact that we are effectively discriminating against effectively discriminating against a group of people who do not live in the local area, I think that as a matter of principle is a mistake.

And if we allow that to happen on a regular basis, that means that people who are not resident in the south east of England are put at a disadvantage. The point about leaving early and not observing the normal courtesies. I understand the point, but if you put an amendment down, the whole point is to get and hear the response of the Minister and the promoter of the bill. It is not simply an ad hoc thing that can drift off at a certain point in time.

So without any question of doubt, this decision means that those who have to travel a significant distance from this house to get home every week are at a disadvantage. And that's a precedent, because it might be those of us who live further away today, but it could be a different group of people in the next time round. I think that's a mistake, and I'm not satisfied that to leave it just as it sits, and I would not like to be in a position where we had a situation where people were bouncing up and down to ask the House to resume at some ad hoc arrangements.

I think it should be an agreed situation with the promoter of the bill, so that we don't have this business of people doing a count around the room to see if they can get the house resumed. I think we would have a much more mature and professional way of doing the business, but I leave the point with the Chief Whip that this discriminates deliberately against people who do not reside in this area.

10:19

Lord Kennedy of Southwark (Labour)

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Can I firstly say thank the Lord Low huge respect for the noble Low huge respect for the noble Lords, and I thank you very much for his kind. We dealt with our discussion this week. That is why discussion this week. That is why when I said last week that I was, you know, colleagues Lord Rose could leave earlier if they had to travel back back home. I fully accept the point that I made that. Of course, when you move your amendment, you actually want to hear the response.

I fully accept that. What I'm very happy to do this again is to try to find some way forward is that if noble Lords do find they've got to leave for travel arrangements, they can't hear the response from the Minister. I'm very happy to arrange for that, to have a meeting or a briefing to go through that response so they get more rather than have to read it in Hansard. So I hope that's something I'm trying to find ways to square an almost impossible circle here.

But I do appreciate

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the comments of Lord. To be again in Committee on the Terminally Ill Adults Bill end of life Bill Lord Falconer of Thoroton.

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life Bill Lord Falconer of Thoroton. Would I beg to move that the House do once again resolve itself into a committee on the bill?

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into a committee on the bill? The question is that the House do now again resolve itself into a committee on the bill. As many as are of that opinion will say content. To the contrary, not content. To the contrary, not content. The contents have it. My Lords, Lord Shinkwin, Lord Shinkwin and Baroness Campbell of Surbiton will be taking part remotely. I remind the committee that unless they are leading a group, remote speakers speak first after the mover of the lead amendment in a group, and may therefore speak to other amendments in the group ahead of members who table them in clause one, amendment 35 Lord Birt.

My Lords, I.

10:21

Lord Birt (Crossbench)

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Rise to move. Amendment 35 and all the other amendments listed in all the other amendments listed in my name and that of the noble Lord Lord Pannick, who, having assiduously attended, as all will have noticed, our sessions on the bill thus far, deeply regrets that he cannot be present with us today. My Lords, our discussions today have focussed overwhelmingly on risk, and I do not for one moment dispute the necessity and the value of doing that, and I will return to how best we can manage those risks later in my remarks.

But, my Lords, let us not forget that we are not pioneers. 30 countries, states or jurisdictions across the world have already introduced assisted dying, the first over 80 years ago. A steady stream this century and hot off the press. Just two days ago, an assisted dying bill for the Channel Island of Jersey passed its first reading by a 2 to 1 majority and is expected to pass into law next month. So it is, at the very least, equally important, my Lords, that we don't just focus on risk but lean on the well established experience of others when considering the critically sensitive matter before us, which we know from serious studies, carries overwhelming public support.

For my part, my Lords, I've been exposing myself to the Australian experience with considerable help from senior practitioners for which I am most grateful. Without exception, those to whom I have been exposed come over as deeply caring and enormously considered, and what I have learned from them, and from the copious data that is available, is reflected in the amendments before you today. Much that I have discovered, my Lords, has been surprising as well as enlightening. First, applications for assistance in Australia are not automatically accepted.

Something like one third are turned down. Second, around 75% of those seeking assisted dying have cancer, and somewhere between 75 and 90% of all of those who come forward are already in receipt of palliative care, more motivated by their distress and misery than by their pain. And whilst I completely agree with all noble Lords who have stressed how vital it is to have effective, universally available palliative care, it is clear, my Lords, that it is not sufficient for many experiencing truly horrific medical conditions.

For those who have not read it, I commend Jonathan Dimbleby's moving account. In a recent New Statesman of his brother Nicholas's harrowing final days. Nicholas had fallen victim to motor neurone disease. It became impossible for him to take solid food without choking. He then had a tube inserted into his stomach, through which he had to feed himself. Nicholas became increasingly hard to understand. He was barely able to move. He lost control of his bodily functions. He was often frightened and sometimes terrified.

He gasped in vain for breath. Nicholas Dimbleby finally and mercifully died, my Lords, in February of 2024, other UK practitioners I have met recently and simply by chance, have shared with me equally horrific accounts of deaths that they have witnessed in the ordinary course of their work. I think, my Lords, that such experiences must explain why in Australia, whilst around 10 to 15% of those seeking an assisted death apply some months in advance of their anticipated need, a significant proportion wait until their suffering is unbearable.

As a result, around 25% of applicants die within nine days of their first request. I repeat, my Lords, 25% of applicants die within nine days of their first request. A further 25% die within 10 to 19 days. Thus, my Lords, in Australia, around 50% of applicants die within 19 days of their first request. Those leading Australian practitioners in my Lords insist that sheer misery is the primary determining motivation of individuals seeking assisted dying and further, to illuminate the complexities of the process.

Around one third of those who ask for and who are given the death potion do not take it and choose to die a natural death. Furthermore, one of Australia's most senior and experienced practitioners tells me that whilst no. I'm sorry, I have an argument to put, I'm not going to take any interruptions at all. In. Furthermore. Furthermore, one of Australia's most senior and experienced practitioners tells me that whilst in theory it must be a risk, she herself has never experienced a single example of coercion.

On the contrary, she says, she has on occasions experienced the very opposite loved ones understandably pressing someone wanting assisted dying not to embark on that course of action. Overwhelmingly, her experience is of applicants who know their own minds, who are perfectly able to make a considered decision. From all of my discussions, my Lords, I've concluded firmly that if this Bill passes into law, it is vital that the processes are based on day to day realities as well as risk, and work efficiently and sensitively for any individual of firm and settled mind, coming forward in a state of deep distress.

So, my Lords, we need more flexibility in the timelines of the process than the present Bill allows, and a fit for purpose organisational focus that delivers promptly and humanely for individuals in severe need. So Lord panics and my amendments. In our amendments, we propose three key measures one to create a new organisation, the Assisted Dying Help Service, to enable the individual easily to navigate the complex process set out in this bill, which in essence we retain.

Two to ensure that the assisted dying process is expeditious and when conditions demand it, flexible. And three, that the Commissioner acts solely as a regulator with oversight, but without any delivery responsibility. The process currently set out in the Bill, My Lords, before us, is involves a ten stage process, three separate medical consultations with three different doctors, a confirmatory panel and two periods of reflection one of seven days, the second of 14 days, the latter of which can be shortened absent a bespoke organisational focus, my Lords.

This process in a stressed NHS could take a wholly inappropriate and disproportionate period of time. Hence our proposal that we adopt a notion present in many jurisdictions of a purpose built organisation. An assisted dying help service that would provide a personal navigator to take the dying person and their loved ones through the whole complex process, providing introductions, keeping to timelines, piloting the individual through their final challenging and traumatic journey. We also propose an amendment appropriate flexibility at every stage, with safeguards for doctors to act with urgency if the individual's condition demands it.

The final argument, my Lords, for a bespoke delivery organisation. The final arguments are based on global comparisons. We estimate that in due course, once the system is well established, something like 7000 people each year in England and Wales will avail themselves of the assisted dying opportunity. A focussed organisation can acquire dedicated medical and other staff, create a network of consultants, specialists and volunteers to call on, including, for instance, to provide palliative care. A focus organisation can offer and validate training can issue an update, advice for practitioners, can develop appropriate tech supported systems for managing the complex process set out in the bill.

Absent such an organisation, my Lords, the provision of an assisted dying service could be chaotic and prolonged. I will mention two other matters covered by Lord Pannick and my amendments one. We propose in the first medical consultation that the doctors should take the patient through all the options available, including palliative care and hospice opportunity. But having sat through the whole of the Committee stage so far, I have further concluded that at Report stage we should formally build into either the first or the second consultation a requirement for the medical practitioner to explore whether the individual's request is influenced by any of the following factors an inaccurate prognosis or their vulnerability, particularly resulting from disability or their mental incapacity or their financial concerns, or finally their possible exposure to coercion, and moreover, that help as it hand from the Assisted Dying Help Service, which would offer an alternative to assisted death for anyone found to be at risk in any of those ways.

We also propose that the Commission's role should simply be, as a regulator, its prime responsibility oversight of the assisted dying health service. It would ensure that practitioners are compliant with the provisions of the law, and that data is collected and trends reported, and it would issue guidance and guidelines where necessary. My Lords, I hope that the sponsors of this Bill will be persuaded of the benefits of the additional measures we propose, which no doubt can be improved even further in dialogue before Report stage, not least with those who have concerns about the Bill.

But I conclude, my Lords, by asserting that we should put no obstacle in the way of someone, of sound mind, of a settled view, in deep distress, with death imminent, being allowed a dignified ending to their life on

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earth, and at a moment of their choosing. My Lords, I beg to move. Amendment proposed clause one,

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Amendment proposed clause one, page one, line 14. After life, insert the words on the Marshalled

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List. I thought we were. Taking the

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I thought we were. Taking the remote. Contributors first, but if we're not, since there are amendments on the paper from my noble friend Lord McKinlay of Richborough, to which I have attached my name with his

10:34

Lord Harper (Conservative)

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10:45

Lord Carlile of Berriew (Crossbench)

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The noble Lord, my noble friend Lord Birt, was, of course, perfectly entitled to refuse my perfectly entitled to refuse my attempt to intervene in his speech. I am, however, disappointed that he I am, however, disappointed that he chose to defy the determination of this House, that we should not have repeated Second Reading speeches. Every one of us here can stand up and make a Second Reading speech on any of these amendments. If we defy that determination, and I hope that he will not do it again, I'm sure it was a misunderstanding on his part about the way in which he was able to move his amendment.

As to his amendment, I'm afraid I'm suspicious about his group of amendments, and I think he gave the game away in the way in which he later turned to his amendments and referred to them. It's clear that he is very keen on there being a more extensive provision for assisted suicide, that people far beyond the scope of the noble and learned Lords Bill should be able to claim and achieve assisted suicide. And behind his amendment and some of his amendments I agree with, I would love to see better care for people who are facing the end of their lives.

But behind his amendments is a death service as the noble Lord Lord Deben and the noble Lord, Lord Harper said, what he's providing is a way to death, not a way to enjoy and make the most of the rest of your life. And I would urge noble Lords not to support these amendments, because I regret that their motivation is not even consistent with that of the sponsor of this bill.

10:47

Lord Stevens of Birmingham (Crossbench)

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10:54

Baroness Hollins (Crossbench)

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into mainstream healthcare, does appear to normalise the practice, and to lower barriers to the use of assisted dying. And international evidence is instructive because where it is embedded within publicly funded healthcare systems, such as in Canada and the Netherlands, uptake rises steadily over time and eligibility criteria broaden. And you know, as we know in some jurisdictions, it is available to minors. People with non-terminal conditions, psychiatric diagnoses and even people with learning disabilities or autism. As my own published research on the Netherlands has shown, I.

I also agree with my noble friend Lord Stevens that assisted dying is not a treatment. It's a further reason why it should never become part of the National Health Service. The substances proposed to be used are neither treat nor prevent disease. They fall outside the legal definition of a medicinal product, and the drug regimens proposed are unlicensed, have not undergone appropriate clinical trials, and they lack international consensus. They're not even available. Licensed for human use in the United Kingdom, the drugs, which have been more widely and successfully used to to, to to provide a the much lauded, pain free and quick death, such as in Switzerland, the noble my noble friend Lord Birt seems to seek to introduce similar criteria as he used in Switzerland, not just about terminal illness, but he spoke about suffering and pain and conditions which have actually not eligible under the law as it is currently of the bill as it's currently proposed.

So in Switzerland, non-profit organisations such as Dignitas operate within the narrow but deliberately legal space created by article 115 of the Swiss Penal Code, and this states that assisted suicide is only punishable when carried out for selfish motives. That means if it's provided purely out of compassion with no personal gain, it's not a criminal offence. Enabling Dignitas and other similar non-profit organisations to function lawfully, so long as they demonstrate altruistic intent and ensure the individual acts autonomously. Interestingly, article 115 of the Swiss Penal Code containing only only one clause I think just one sentence when it became law in 1942, one wonders whether the sort of rather smoke and mirrors of the is it 59 clauses in this bill and the various clauses introduced by my noble friend Lord Burt to to disguise actually a very similar intent.

It's sort of it's, it's, it's kind of a little bit concerning about the sort of potential changes and development of this, of the various proposals that are before us today and if indeed something very straightforward as is provided in Switzerland was intended, I do not understand why that wasn't proposed in the first place. We do not want this in the National Health Service.

10:57

The Lord Bishop of Newcastle (Bishops)

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My Lords, I just have a very brief thank you brief comment to brief thank you brief comment to make. In his opening remarks. Lord Birt moving his his amendments cited Australia. However, I'm sure cited Australia. However, I'm sure the noble Lord is aware that no Australian jurisdiction is recognised as one of the ten comparable jurisdictions to the bill in terms of eligibility criteria and the government's impact assessment, the most comparable. In fact, New Zealand and the United States. We had this kind of discussion in the select committee actually, and resolved by receiving evidence from New Zealand.

So I think we do need to be consistent and be mindful of the government's impact assessment and ensure that our comments align with

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that. I agree. Entirely with the.

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Entirely with the. noble Lord, Lord Stevens, and his vast experience and Baroness Hollins with hers. My point is a simple one. It's one that's been troubling me as a lawyer for a long time. It's conflict of interest as time. It's conflict of interest as an internal conflict of interest here within the health service. Are you going to spend the money on this, or are you going to spend it

10:58

Lord Sandhurst (Conservative)

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on palliative care? And will this affect decision making by medical practitioners? And I've talked to a number one of them, a member of my family. I won't embarrass that family. I won't embarrass that member of my family by saying more. And it is a matter of real concern And it is a matter of real concern because this isn't treatment. It's something quite different. And we something quite different. And we don't have to have non-medical things like, as we've heard, Department of Work and Pensions assessments done under the NHS label.

And it is contrary to everything the NHS stands for. There will be a conflict of interest within any trust if it is funding this and administering this as to where the money goes, is it going to be given more money specifically and will that be limited? The obvious overseeing Secretary of State for this is the Secretary of State for justice, because you're going to be dealing with life and death, the administration of life and death, not simply trying to cure people and save them from death.

It's quite different. You're saying you can die and we are satisfied that there are no bad people around you who are encouraging you to opt for this course. And there will be the selection of the panel and the management of the panels, and the panels will be performing a quasi judicial function. Like other assessment panels. And so the obvious place for this and it will remove all well, not all, but it will remove or limit at least and reduce the risks within the health service.

If a separate specific budget is given to the Ministry of Justice, and then we'll know what is being spent. Otherwise the X, Y, Z trust will say, gosh, what do we take this from? I'm not going to give emotive examples, but that is what is going to happen in practice. And so we need to know that this is a specific service. And the country has said it will have X million or hundreds of millions a year to run it, but it will be on top of and ancillary to anything which the ordinary health service provides to people who actually want to live or live, at least in comfort.

So I think we really have to be told by the promoter and by the Minister, who is going to be responsible for choosing the panel for a point for overall, which Secretary of State, because there are a lot of references to Secretary of State in this bill, who is going to be the Secretary of State, and will it be the Secretary of State for health or whatever is the relevant one at the time, or will it be the Minister of Justice? I give way, yes.

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Thank the Lord for giving way. Is it also the case that in terms of looking at this much more from a justice prism, if we are looking at the issue of assisted dying, that one of the broader elements, which I think is important to establish where a death has occurred, is has there been any criminal action or there been any criminal action or criminal intent within that, both in terms of the administration of that, but also where there is a that, but also where there is a situation of people coercing somebody to die as to whether there's criminal action there, which is another reason why where this sits, if it is to happen, should be much more with the justice side of things than the

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health side of things. That's why I had, perhaps rather briefly, an elliptically at the briefly, an elliptically at the start, talked about sort of bad agencies and people. That is not agencies and people. That is not the health service's primary role. It will happen from time to time. It will happen from time to time. And I know medical professionals and I mentioned this, I think at Second Reading, who has a relative Second Reading, who has a relative who is in charge of safeguarding in a major north London major London trust.

And one of the concerns they have and what they have to deal with day to day is, in fact families who are not all united in their support for an elderly and tiresome, relevant relative and in fact very often would like them helped on their way. I won't say more, but I think the point is clear that this structural point is a major failing in this bill.

11:03

Lord Moore of Etchingham (Non-affiliated)

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Lord Stevens. >> Lord Stevens. >> Who speaks from great experience and professional knowledge, made a and professional knowledge, made a very clear case about how the assisted Dying navigator is quite assisted Dying navigator is quite outside the normal purposes of the National Health Service, and I guess it could be described as in

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effect as a form of advocacy, or in the ancient world, the the. Dead were were carried across

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Dead were were carried across the River Styx by Karen. And it seems to me that that role would be performed by the navigator, because performed by the navigator, because where is he navigating? He's navigating you to the River Styx, and he's not trying to navigate you anywhere else. Now, if that is actually included in the National Health Service, it creates a quite Health Service, it creates a quite different purpose from from the normal purposes, as noble Lord Stevens has described.

And I wonder, therefore, whether we should consider whether this is actually amounts to the National Health Service trying to persuade people to accept assisted dying. And if it does amount to that, and if you think of the vulnerability of the individual cases, so often, so, so often will occur, could it be argued that his might become an institutionalised form of coercion?

11:04

Baroness Royall of Blaisdon (Labour)

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You point out that I believe this is not a choice between investing in palliative care or in or changing the the laws that we or changing the the laws that we have in assisted dying service. We need to do both. And I am mindful of the point made by the noble Lord of the point made by the noble Lord Lord Stevens about the lack of response from the Department of Health, and I think it would be very good if some of some others of us could press for that, because it would be interesting to know how, when, and how much the government is going to invest in palliative care.

Because whatever we believe about assisted dying, we all fundamentally believe that palliative care needs more investment, and it shouldn't be a

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matter of postcode lottery. Yes.

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Yes. My Lords, I'd like to ask the noble Lord Lord Birt to reflect on the equality implications of this suggestion of a special treatment suggestion of a special treatment service for those. Seeking assisted death. It's just that, following on death. It's just that, following on from the previous contribution, in fact, the noble Baroness Baroness

11:05

Baroness Fox of Buckley (Non-affiliated)

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Royall, everybody, it seems to me, would want for themselves or their would want for themselves or their loved ones a personal, state funded navigator. If you're a patient, but maybe for care. But I mean, those people on trolleys, those people waiting for operations, those people trying to find their way into the care system. And can we into the care system. And can we all have one? And if we don't afford every patient in the country a personal navigator, isn't that an unequal access to services? It just seems a two tier system if you want, and one which I would think that the the public would not approve of.

On another issue, can I ask the noble Lord Birt as well to detail what the workforce demands this service would require from the NHS? Following on from the noble Lord Lord Stevens excellent contribution, but I note that the assisted Dying help service, which, by the way, is awarded significant regulatory powers in these amendments that sorry which will not be subject to approval by Parliament, but will have the power to set training and qualifications for practitioners. That seems like rather a blank check, but I would like to know what the skill set of skill set of a navigator would be and who decides? But in all seriousness, this whole new sort of shadow service being set up with its own qualification system recruitment.

We're not quite sure who they're going to. I mean, it's a bit worrying and just my final query really is I know that a lot of supporters of the bill are frustrated and have raised problems with some of the amendments that have been tabled on the basis that they're somehow creating bureaucratic, preventative barriers to people who genuinely want to afford of an assisted dying service. In other words, that there's an attempt to overengineering the process and therefore I could maybe commend the noble Lord Lord Birt on this creative attempt at cutting red tape.

However, in relation to this, these particular amendments, we all know that mandated timelines can mean shortcuts that could make the process unsafe. Could he comment on that? Because speed and process driven decision making is risky in any instance, but where careful assistance and safeguarding is contested, where, for example, it seems rather dangerous, panels apparently would have to decide within two days of referral, even sitting, by the way over the weekend and bank holidays to make decisions which, by the way, I think that we should apply that to everyone in the NHS and they should do operations over the weekends and bank holidays, and doctor's surgery should be open over weekends and bank holidays, and I wish the courts would sit over bank holidays and weekends and so on, because then we wouldn't have to get rid of jury trials, allegedly.

But anyway. But that would mean a referral on a Friday evening would have to be decided by a Monday. How would a panel have time to investigate everything, read everything thoroughly? Surely they just end up skimming things. And I do really worry as well about the reflection period being cut to 24 hours when experts warn that initial depression after diagnosis, which is completely understandable, might well be temporary treatable. It certainly remedial, could last a few weeks, but then could be replaced by a more positive attitude.

And in fact, the CEO of mind told the Lords select committee they've gone to the brink, they've come back and then have then been able to say 3 to 6 months later, I'm so glad that that did not happen. And the all I'm saying is saying, oh, we're being really efficient. We're going to make sure that your reflection is cut to 24 hours so that you can get what you want. Might well be that you don't get what you would want if you'd had a bit longer to reflect.

11:09

Lord Goodman of Wycombe (Conservative)

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An unreality. >> About this debate, which gives rise to a question for the sponsor of the bill and a question for the Minister. And the unreality is this that the noble Lord Lord Birt, has made the case for his amendments. And my noble friend, the Lord Harper and others have made their case against them. But there is hung about this whole debate, and an assumption that the NHS will deliver assisted dying. But can I remind the House that there is no guarantee of that in the Bill? If noble Lords would kindly turn to the Bill? Clause 41, for the only reference to the National Health Service, is that regulations under this section may, for example, provide that specific specified references in the National Health Service Act 2006 to the Health Service continued, etc.

that's the only reference to the NHS in the Bill. We don't know whether the NHS will or will not deliver assisted dying services, which is an

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extraordinary weakness in the Bill. So yes, I'm very happy to give away. The noble.

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The noble. noble Lord for giving way. And he and I sat on the select committee on this bill, and he may committee on this bill, and he may recall that I pressed the Minister specifically on this point to clarify who would be delivering an clarify who would be delivering an assisted dying service in this country, should this bill be accepted. Only after a number of accepted. Only after a number of questions did the Minister acknowledge that it was the government's intention that the NHS would commission an assisted dying service, but he couldn't clarify or confirm if it would be delivered by the NHS, by the private sector or by the voluntary sector or charitable organisations.

And in fact, if it was the private sector, if they would be allowed to generate any profit. So we are still unclear and it's very, I think, very challenging for us and I hope that the Minister, in her response, might at this moment be

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able to give us further clarity on that very important point. The Baroness is quite correct.

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The Baroness is quite correct. That's exactly what happened in the Select committee. And for my sins, I sit on a surfeit of committees I sit on a surfeit of committees and also on the Delegated Powers Committee, which drew attention to this very deficit in the bill. So this very deficit in the bill. So the question for the noble Lord, Lord Faulkner, is, since the Minister was questioned in Minister was questioned in committee by Baroness Berger, and in the weeks that have have followed, has he had any guarantee from the government that the government will ensure that the Secretary of State, by regulation, does ensure that the NHS delivers voluntary assisted dying services? Has he had that guarantee or not? And when the Minister replies to the debate, can she cast some light on this matter so that we know whether or not the proposal that Lord Birt has put forward and my noble friend, as opposed really has any basis in reality at all?

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Yeah. Well, I it was a delight to hear that noble Lady Baroness Fox of Buckley.

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Fox of Buckley. Hit every nail on the head of everything that is wrong with the noble Lord Lord Birt amendment. And I rise to speak to the amendments in the name of my noble friend Lord McKinley of Richborough. And my noble friend Lord Harper, and I noble friend Lord Harper, and I have signed some of them. I have done so because the bill, as drafted and now is proposed to be drafted and now is proposed to be amended by the noble Lord Lord Birt and the Noble and learned law.

Lord Pannick promises choice whilst

11:13

Lord Blencathra (Conservative)

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quietly engineering speed, centralisation and a single minded pathway to assisted death. That is pathway to assisted death. That is not a neutral design choice. It reshapes incentives, it shifts resources, and it narrows real resources, and it narrows real options for people at the end of life. But otherwise I will. I will give three examples sharp examples give three examples sharp examples of why the noble Lord Lord Birt amendments are wrong and end with a direct challenge to the noble and direct challenge to the noble and learned Lord, Lord Falconer of Thoroton.

First, the bill's timelines turn life and death decisions into a fast track. The amendments proposals turn into fast track process. From first declaration to possible assistance. The clock can run down to 30 days or as little as 18 days. If death is deemed imminent, panels must decide within 48 hours of referral. Reports are forced within 24 hours. Reflection periods can be cut to 24 hours. My Lords, that is extraordinary. Courts take months to resolve urgent life issues. Prognosis measured in months, are notoriously unreliable.

Rushing assessments in this way risks premature deaths, misdiagnoses and inadequate explanation of reversible causes of despair. The amendments in this group push back against the amendments I have signed, and my noble friend's amendments pushed back against that compression. Second, my Lords, as others have pointed out, the assisted Dying Help Service and the personal navigator create an asymmetric system. The navigator is designed to shepherd people quickly through the assisted dying pathway. There is no equivalent statutory guarantee that a person will get timely access to palliative care, hospice support, social services or a person to get timely access to mental health interventions.

In practice, a patient could reach assisted death faster than could gain access, pain control, a care package, or a meaningful social intervention. As the noble Lady said, you can get a GP appointment these days. That's a perverse appoint, a perverse allocation of scarce resources and a distortion of choice when one option is actively facilitated and the others are not, choice becomes a funnel. And third, my Lords, the bill permits remote and pre-recorded assessments. Video cannot reliably reveal who was in the room, what pressures exist off camera, or the subtle cues clinicians use to test capacity and voluntariness.

Evidence from telemedicine and remote and remote court hearings shows the limits of video for assessing vulnerability. The criminal offence of coercion, of course, is reactive. The assessment process must be preventative. Face to face contact is not a nostalgia. It is a practical safeguard against coercion, miscommunication and error. The amendments insist on personal steps and verification, and face to face steps are therefore not bureaucratic nitpicking. They are essential protections and even more so if you are going to have a fast track procedure like this.

So in conclusion, my Lords, the noble and learned Lord Dear Lord Falconer of Thoroton has argued for a patient centred, safe system. I put it to him now, will he accept that a system which institutionalises speed creates a dedicated navigator only for assisted death and allows remote assessments, cannot credibly claim to be the highest standard of patient protection? If he truly believes in patient choice, will he support amendments that restore time for reflection, parity of support for palliative options, and a presumption of face to face assessment so that choice is informed, free and real, not the product of a fast track service designed to deliver an outcome.

My Lords, this is not about denying choice. It's about ensuring that the choice is genuine. And I do

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support the amendments proposed tabled by my noble friend Lord Harper. Just before the noble Lords

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Just before the noble Lords concludes. Can I offer my house? My apologies for not being fully engaged today. I have appointments engaged today. I have appointments elsewhere. I have my father's funeral just yesterday, and I remember during the Covid period we remember during the Covid period we had that sign up that the Minister stood behind. What was it? Stay at stood behind. What was it? Stay at home, protect the NHS, save lives. My my real concern now with the thought of a navigator that only has one direction.

Are we going to? I know it sounds rather flippant, but will it be save the NHS? Choose a navigator, choose death seems to be the rather chilling direction that the concept of a navigator, and one choice only seems to be

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directing us towards death. I feel. Tempted to try and answer that. Very quickly.

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I too will be leaving the house before I suspect we get a vote on this, or at least some decision from the Minister about what the minister's going to say. But I have to say that this discussion about to say that this discussion about the cost of treatment is not a reasonable one. I don't think that reasonable one. I don't think that it's one that the noble Lord Stevens did not discuss this actually in his speech, but I think the speech of the noble Lord Birt is overwhelmingly important, because actually it's about the notion of our sensitivity.

In this situation. There are many people who go to the health service who do not get treatment. It's not always a treatment. I for years was pioneering in vitro fertilisation, which was really not successful for a very long time. We've got 16 babies worldwide in the first four years. There are now millions of happy families as a result, who would not be. Many of them actually are living partly in this house some of the time. And the fact of the matter is, of course, when we discuss this, the people who opposed in-vitro fertilisation in this House and believe me, there were many of them, were often the same people who would have probably refused to accept assisted dying either.

The fact of the matter is that the health service develops. It's not static. It changes depending on what the need is. In vitro fertilisation, instead of now being a orphan subject, it is now a major treatment funded by the health service and unfortunately it

11:18

Lord Winston (Labour)

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should be more funded. But actually we're getting a lot of success doing it in the way we are and we doing it in the way we are and we will increase that. It's also fair to point out that actually there are many treatments all the time in the health service which are the health service which are developing, which of course are not funded at the time when the debate is made, take the number of cancer treatments, which are extremely expensive, with the most expensive drugs.

Very often, of course, we drugs. Very often, of course, we have to deal with the internal market in the health service, but we persuade the people who understand the need for health care and who are actually faced with the patients and have to treat them in the best way, begin to understand that that money I won't, won't give way. Because forgive me, I'll answer the end. I'm almost finish what I have to say. The fact of the matter is that this is not a true argument, that many examples in my practice, probably about 60% of the time when people came to my clinic.

And it was always true, even when IVF was successful, where I refused them treatment, I refused to treat them not because there was no money, although we couldn't afford. To treat them, but because I thought the treatment would actually increase the distress they had. Because the treatment was so unlikely to be helpful. Actually. In fact, when that happens to people, it is a kind of death within them, but they have the great advantage that they can mourn that death and overcome it by doing other things.

Unfortunately, in this situation, when people are dying in the way they are often horribly. There is something that we need to try to do purely out of compassion.

11:20

Lord Markham (Conservative)

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11:28

Baroness O'Loan (Crossbench)

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My Lords, my Lords. are in the name of Lord Pannick and the noble Lord Lord Birt. What they propose is a framework for a propose is a framework for a completely new process outside that already created by this defective bill, requiring a service both at bill, requiring a service both at service and assistance, including the provision of assisted dying assisted suicide every day of the year. As has been said, public holidays, Christmas, Easter, etc. from 8 a.m. to 6 p.m.

unless the doctors in the house and the drug is being administered, in which case he has to stay. There's no impact assessment, as has been said of the cost of this new service, and it is a relevant matter. Concerns must arise, given the advice of the Health Secretary, that there was a there is already a lack of access to high quality end of life care, and there are tightened finances within the NHS, which could add to the pressure faced by dying patients. So these amendments require a new service, must be part of the NHS and we have heard arguments against that and I support those arguments.

They impose deadlines, they create processes for enforcing those deadlines, which will provide assisted death at a time when a person who is terminally ill will, in many cases struggle to access palliative care, and may never even be able to do so. The assisted suicide service will take priority. There is no process, as has been said, for a personal guide to get palliative care or necessary social care. Would the noble Lord, Lord Faulkner, be willing to accept amendments which would require palliative care treatment options to be available and accessible within similar structures and timeframes? We are being told that a system is to be established, which will have to take priority over all the other processes because, as we were told two weeks ago by the noble Baroness, the Minister, what Parliament wants the government will deliver.

But, my Lord, the government isn't delivering a health service despite the best efforts of many of those employed in it. We would be naive to think that the government could deliver this without diverting resources from other health service processes or from the justice system. There isn't a bottomless pit, the noble Baroness said last week in the context of the amendment, requiring that an application for an applicant for assisted death must have been recently visited by a GP. That that again faces poses operation of channels challenges for GP resources.

I ask the noble Baroness, the Minister, if the NHS cannot deliver an occasional visit by a GP, how could it deliver an assisted dying process? And I ask the movers of these amendments what will be the cost of them? We need to know and what will have to be sacrificed to pay for them. If the noble Lord, Lord Faulkner, is minded to accept these amendments, can he provide your Lordships with a costing of the proposed service in all its elements? My Lord, there has been no consideration of the consequences for people like GPS, 76% of whom already say that patient safety is being compromised by excessive workloads.

My Lord, the process which the amendments advocate is undeliverable having regard to the scarcity of the relevant personnel such as clinicians, nurses, lawyers, social workers, psychiatrists, it hasn't been impact assessed. It would require greater concentration of resources. There are major issues in relation to access for all people, and I am among those who have written to the noble Baroness, the Minister for an updated Equality Impact Assessment. If, for example, a person were to seek such death and to choose to die at home, then assistance in reaching this goal would have to be present and available every day between 8 a.m.

and 6 p.m. and when the patient decides that the time has come, the doctor is required under clause 25 to remain with the person until they have died or changed their mind. And my Lord, this process of assisted death isn't instantaneous can take up to 30 hours in some cases, such as one in Australia, which I heard about a meeting organised by the noble Lord, Lord Falconer. It took seven days and under the bill the doctor has to stay with the person.

Given the comments I've just quoted about the availability of doctors, can the noble Lord, Lord Faulkner, the noble Baroness, the Minister, tell us how he proposes to ensure that doctors are available to provide the service? Given the very public statements by the Royal Colleges and professional associations about their negative views of the Bill and the established shortage of practitioners, the amendments will give control of the processes of dying away from the Secretary of State to this assisted dying health service. My Lords, it is not a health service one.

When one examines the amendments, it's an assisted. It is an entire process and it should be called the Assisted Dying Service. Amendment 77 one requires that it has a regional structure, and that is it will validate training qualifications, provide licences, etc. Can the proposals of these amendments all the noble Baroness, the Minister, tell us how the structure will be established, managed, supervised and held to account? The primary point of contact, as we've heard, will be this personal navigator.

One of the difficulties I have with this, my Lords, is there's no definition in the 35 amendments tabled by the noble Lords of who might be a personal navigator, what qualifications they should have. There seems to be no requirement that they even have some form of medical, nursing, etc. qualification. Yet their task will be to ensure that the services required by the person concerned are delivered as required, and to the timeline set in the act. This presumes that the personal navigator is able to understand precisely what the person is seeking, and to ensure that the person understands the consequences of what he or she is seeking, not only in terms of death, but in terms of the difficulties which may arise after lethal drugs have been taken, and to record and to report on these timelines, and to enable personal navigators to assist people requiring assistance to obtain exemptions from the timelines.

This isn't a mere administrative job, my Lord. They'll have to be consideration with the person seeking death of what they want to follow in each of the timescales provided for in amendments two, 333013, two one, etc. it's complex. If assisted death can be made available in 30 days, but accessing palliative care takes months, will there be choice? My Lords, I will not rehearse the truncated timescales, but the effect of them would be that a person could make a choice for assisted death and be dead in 30 or 32 days, depending on the interpretation of the amendments, or in 18 days if death is considered to be imminent.

And as we have heard, suicidal ideation is common following the delivery of a terminal diagnosis, and it's often the case that people fear death and the process of dying. But that is remediable short term bout of ill health and my Lords of prognoses, as we have heard, only 32% in the weeks and months range are exercised, are accurate. My Lords, these amendments will not provide time for adjustment. People will be ushered down a path, a rapid path, and lost to their loved ones when time and the provision of care and assistance will almost inevitably result in a decision to live to the end with dignity.

The amendments impose time limits, which seems must be met. Yet a doctor may not be able to carry out that necessary first assessment within 24 hours. A second doctor, a further assessment with another 24 hours following the seven days of reflection. Can the movers of these amendments explain why the personal navigators will be given some sort of coercive powers? The personal navigator will not be able to force compliance with these standards, unless there is a disregard of all other professional commitments of those involved and consequential harm to other patients.

My Lords, the timescales of this bill are unachievable as things stand, and equally unachievable will be the 48 hour turnaround right through the year, even at Christmas, which is required that panels be established at a time when there is a significant shortage of lawyers, social workers and psychiatrists. The Royal College of Psychiatrists has said it won't engage, and it's profoundly unlikely that there will be any ability to provide such a service as is required by these amendments. And in any event, can I ask the noble Lord, the Minister and the noble and learned Lord Maude Faulkner, what safeguards exist against coercion when timelines of this compressed? What opportunity will there be for the considered professional assessment which will be necessary? My Lords, the noble Lord, Lord MacKinnon, and the noble Lord, Lord Harper, by a series of amendments, seek to ameliorate the situation created by these amendments, and I support them in those attempts.

But, my Lords, the amendments in the names of the noble Lord Lord Birt and the noble Lord Lord Pannick are simply unworkable at the present time.

11:37

Lord Polak (Conservative)

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I have great respect for for Lord Birt, and I think his practical ideas are are very practical ideas are are very sensible. But I think there's a much more fundamental problem which probably frustrates him, and that probably frustrates him, and that this, this whole. Bill, this is we're being the government is sort of hiding from us what in fact it wants to do. And I don't blame the Lord Faulkner for this either, because we're being encouraged to pass a bill which will put enormous obligations, as we've heard on the health service, its budget, its people, whilst at the same time noble Lords are given no direction by the government.

Will they pay? Do they have the money? And if they have the trained staff to deal with it? So whilst HMG hides behind this flawed private member's bill, noble Lords are being urged to legislate blind. It's not remotely acceptable or responsible for noble Lords to make life and death decisions when there is no clarity about the future intentions of the government. And so I go back to, to to Lord Birt. Great idea. But who pays for this? Lords.

11:39

Lord Lemos (Labour)

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I apologise. >> I apologise. >> To the noble Lord. Can I can I just remind noble Lords of the guidance of the House, which is that your Lordship should not summarise or repeat others at length? I know I try and find a length? I know I try and find a different way to say this every week, and I, broadly speaking, fail. And I also realise that your Lordships have spent a lot of time preparing your remarks, but it is my duty to remind you of the guidance of the House.

11:39

Lord Mawson (Crossbench)

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I have tabled two. it's the place where all this detail comes onto the floor of the House. And debates like this, even though they're complicated and difficult. Difficult. I've always encouraging to people like me and the people involved in this, even though they take very positions I like a lot, but I sat in the down the corridor listening to the debate there, which had lots of emotional stories on both sides of this debate and good points and all that, that.

But it was not this level of detail we are dealing with in this House. This is encouraging to me. My life has been spent in the East End of London on housing estates, dealing with practical issues, with a very grey area of the world. And often, if I'm honest, the dysfunctionality in practice and in detail of the NHS on housing estates, I have had to deal with the GP, who is doing female circumcisions in his surgery, that none of the systems had even noticed.

The GP that had given out bought a cheap fridge from G and Q and given out 10,000 legal injections and no notice because actually there was lots of ideology about race that was preventing anyone coming to terms with the detail of that. And my colleagues and I really got into the health system as the noble Lord Lord Deben knows, following the death of a young woman called Jean Wiles, dying of cancer in appalling circumstances with a disabled mother, a mentally ill dad, two children sleeping in the same bed and the absolute failure of the NHS systems and processes and machinery to deal with that stuff.

And we would not have built the Bromley by Bow Centre, which now has 55,000 patients and is starting to operate across the country with a whole programme I now lead. If it had not been for the noble Lord Deben who act as the then Secretary of State, actually intervened in a very serious practical matter following a senior level enquiry at the London Hospital, and enabled us to build the first working model of an integrated health centre that tried to deal with this complexity. The NHS, in my experience, and dealing with it with colleagues across the country, is broken.

It is in a great deal of difficulty. In my experience. Our GPS are overwhelmed by bureaucracy and a whole range of things and they're excellent people. So, my Lords, my point in making

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this, because I come from the world of practicality. So I'm sorry to intervene again,

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So I'm sorry to intervene again, but I would invite the noble Lord to address the amendment directly. I was. Just going to do that. So I

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Just going to do that. So I address the I address the amendment because I worry that whilst intellectually a navigator and this intellectually a navigator and this amendment seems very straightforward intellectually, what I'm trying to suggest to you what I'm trying to suggest to you is that the real practical world out there, when you engage with it, as my colleagues and I have done over the last 40 years, you see something quite different.

11:42

Baroness Coffey (Conservative)

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It's amendments two, eight, >> It's amendments two, eight, seven A and B and 771ZB. This my noble friend, I call on my noble friend Lord Birt we went to the same school, admittedly not at the same school, admittedly not at the same time, but I'm very conscious that he has come at this with an approach of actually a lot of research. As he set out. I, the noble Lord, knows that I disagree with him, but I do understand why he is trying to speed up.

But I do wonder if he has taken account of evidence presented already. The noble Baroness Lane-Fox of Buckley talked about I think it was CEO of mine, but also Marie Curie spoke about this, and indeed the Royal College of Psychiatrists, particularly thinking of the speeding up about that moment of reflection is really important. And by accelerating, I think the noble Lord is already suggesting that that while in his clause 774771 people should be, patients should be aware of their right to withdraw from the assistance process at any stage.

There is quite a lot in here, which I think sets out a framework that could be done through the NHS, and I completely agree with what the noble Lord Lord Stevens of Birmingham said and and others just indeed the noble Lord Mawson. It really does worry me about how if this ends up in the NHS, I think it will accelerate in becoming a routine end of life. And in my meetings with the Royal College of GPS, they've been very clear. They do not want this to be part of the NHS and they absolutely would resist it.

Being part of the NHS contract. I will give way to my. Just very briefly, can I just on that point and I think the point raised earlier about conflict of interest. One of the problems if this is in the NHS is the money, the drugs to the cost of the drugs to end someone's life, according to the impact assessment, cost £14.78. The cost of healthcare for four months, or the saving you would make from four months of healthcare not used would be £13,075.

And anybody with any experience of NHS budgets knows that that contrast inevitably will drive people

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towards being pointed towards assisted suicide. Yeah, yeah. Well, I do understand where my

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Well, I do understand where my noble friend is going with that. I intend to come back to some aspects of this when we get into informed of this when we get into informed consent, because I was somewhat struck by what the noble Lord Lord Winston said, where he declined to give treatment because he wanted people to, in effect, accept they were dying. I think is what he said. I better go back and check that I better go back and check that because I don't want to misquote him, but I've seen that myself.

I've seen that with my mother, where doctors just hadn't treated her. And then when it came to it, when it was near the end, we had to fight to avoid even having a DNR on the ambulance to get her to go so she could die at home in a place of her choice. That's true patient autonomy, not somebody trying to override that. In terms of thinking through, though, some of what the noble Lord has put forward in his propositions, others have already reflected on the concerns about working days and whether that's practical.

I'd be grateful to hear from both the sponsor and the Ministers what assessment they've done of these amendments. I'm also concerned in terms of 771, clause two G, providing publicly available information on assisted dying. How does that start to vary about what is considered advertising, which is explicitly ruled out in other parts of the bill? And the key point of my amendments is actually linking to almost this becoming its own service within the NHS. Now this starts to remove.

There are various clauses that start to remove powers from the Voluntary Assisted Dying Commissioner. This service would start to appoint the panels it's taking up at the moment. All the training, all the licensing and all those different things. Now it's my understanding that this does not happen in the NHS today. What your what we actually get and what I propose with my amendments is that for a start, we have a separate regulator through the Care Quality Commission also, that we have the General Medical Council undertaking the roles that they do for other parts of what happens in the NHS today.

So I think if the noble Lord Lord Birt brings this back at Report stage, he'll think more carefully about how to make this practicable, because I hope that the Minister will actually say this is simply not operable, even if well intentioned, and what the noble Lord is seeking to achieve. Now, the noble Lord Lord Mawson has just started talking about the East End of London. I think it's important that noble Lords consider carefully the evidence that has been given to this House, but also evidence outside about the real concerns of people from Bame communities.

It's very evident that people are in those communities seem particularly worried about this, and that has been communicated directly to this House through witnesses. But instead of not trusting the NHS as it is today to get the treatment, imagine as you go in and you're unsure, your GP is already overworked. Here you go. Here's some information. Somebody can hold your hand. It, I think, worry that too many people would actually stay away from the NHS when they desperately need treatment for other aspects of their lives, whether that's about addressing prostate cancer or other the rare cancers that we debated in the chamber last week.

The other thing, just to remind noble Lords, and I appreciate this is probably the third time I've said it, but for me, this is coming back to the practical experience of when the NHS was left to deal with end of life care. In certain ways, the Liverpool care pathway was so horrific that I cannot in any way see how it can be controlled. If we were to adopt the proposals put forward by the noble Lord Lord Birt, we saw it go badly wrong and I'm pleased that Ministers intervened at the time.

Eventually it took time, yeah, but that it did happen. And we need to make sure that instead of a lot of these regulations or these other aspects of running this service, if we are going to have it. And by the way, I do agree with my noble friend Lord Sandhurst. I think it should be more of an MoJ focus. Inevitably, it's become a big health focus. And what's not clear here in the what the noble Lords have set out in their proposals is how this interacts with the whole Wales situation.

But clearly, now that the sponsors of the bill, I think, have about 12 officials from Department of Health and Social Care working on this bill, I think it's 3 or 4 times the number of MoJ. Clearly, there should be some understanding of where this is, how it's going to work, and I genuinely hope that the Minister will start to share that. So this House can make informed choices when we're considering such a significant change in what could be the future of our NHS.

My Lords, I'm.

11:50

Baroness Berridge (Conservative)

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Grateful to the noble Lord Lord Moore for answering much of what would have been my intervention to would have been my intervention to the noble Lord, Lord Winston. And in my 15 years in your Lordships House it is the usual practice to give way, but I recognise that noble Lords have the prerogative not to accept an intervention. But what I do find surprising, and have never known before, is that the noble Lord is now no longer in his place, and that is, my Lords, not in accordance with the advice that the Chief Whip gave this morning, that we should treat each other in this House with respect.

The only additional point I would make that the noble Lord, Lord Winston, was referring to is I do believe that it is entirely different to talk about the amazing work that he clearly did that was really on the televisions. I grew up about the creation of life, and also as the noble Lord. Lord Markham has talked about the pathway that midwives give for the safe delivery of that created life. It is very different for us to be talking about the situation where the state would be paying for and facilitating lethal drugs to enable a citizen to end their own life.

Looking at the amendment.

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If I may, actually responding to the the earlier point, I believe both Lord Winston and Lord Mackinlay, who also isn't in this place, mentioned that they had appointments that they needed to go to, that I'm just saying that's where that's why I believe Lord Winston isn't here now. I just want.

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To I do hope that he will be writing to me personally about this in relation to the evidence on in relation to the evidence on which the noble Lord Lord Birt is basing his argument. I was surprised at the noble. The right reverend Prelate has mentioned the the Australian non-comparable, but in the impact assessment, the delivery model at 8.4 states that in most jurisdictions where assisted dying is legal, it is provided through the healthcare system. So looking for international comparators is an unusual approach.

But I do want to state that in relation to these 30 jurisdictions that we keep hearing about, some of them are like the Isle of Man and Tuscany in Italy, and only 13 of the 50 states in the United States. This isn't as many progressive politicians like to say. There is this wave and we must get with the wave, because actually, Denmark in 2024 considered this. The the Council of Danish Ethics said 16 out of 17 members voted for them not to introduce assisted dying into their jurisdiction.

And only yesterday the French Senate has not gone forward with legislation. So if this is in no way a sort of progressive train that we need to get with, the second point that I would make is in relation to the speed of these decisions for families. We know that the bill is philosophically based on individual autonomy, which is an anathema to many communities. So for families to know that within 18 days this was done as well will only compound what we do believe will be complicated grief.

And in relation particularly to fitting this speed of service in with what we know is increasing uncertainty of diagnoses for 18 to 25 year olds because of various positive effects of treatments for them. And sadly, with the deficiencies that the noble and learned Lord, Lord Faulkner has admitted, that exists with clause 43 in relation to advertising. I'm sorry, I don't think I'm a cynic, but I can see a competition. I can. I get to 18 years and 18 days and be the first young person to go and meet that milestone.

That is something we don't want to have that culture of speed in this process and limiting the reflection. And I also just finally want to say, maybe I'm the only noble Lord sitting here without the benefits of the pre-legislative scrutiny of a consultation white paper, but I do with many amendments. I'm thinking, well, how is this service going to fit together with a panel, or is it going to be a judge, or is it going to be a judge with a couple of other members? And that really is the deficiency that at Committee stage, I still think we are trying to put right pre-legislative scrutiny, the lack of pre-legislative scrutiny, and I

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don't know whether that is indeed possible. She raised the issue of speed, and it comes back, I think, to a point that Baroness Fox raised earlier, often in public policy earlier, often in public policy issues, there's a trade off between the speed of a decision and the quality of that decision. Sometimes quality of that decision. Sometimes whenever we short circuit or fast track decisions, it can inevitably lead to a greater level of mistakes

11:54

Lord Weir of Ballyholme (Democratic Unionist Party)

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lead to a greater level of mistakes that are that are made. But in a wide range of other public administration or public policy decisions. There's at least the advantage that if a mistake is being made, there is the opportunity at a later stage to come back and correct that, to perhaps appeal that decision, to review it, to reverse a mistake that has been made. Of course, the major problem with this that if we do fast track things and it leads to a death which shouldn't have occurred, we cannot bring the person back to life.

That's why I think there has to be. I agree, perhaps with one remark. I think in response to Lord Markham made, which was that he said he perfectly acknowledged that in response to an intervention from Baroness Berger, that that we should actually be having the safest possible system. I see him nodding in place in relation to that. I find that very difficult, therefore, to say if we're having the safest possible system with a system, if these amendments go through which fast tracks those decisions and inevitably will lead to greater levels of mistakes and greater shortcuts.

11:56

Baroness Finlay of Llandaff (Crossbench)

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In introducing this group of amendments, the noble Lord, Lord Burke, I think, to describe the proposals that we've got in the proposals that we've got in the Bill as potentially chaotic and prolonged as one of the reasons that he was introducing these and these this group of amendments is in some ways something or nothing. The proposals make the case for a profound imbalance, with assisted death actively facilitated, accelerated and led through the dedicated service with speed. As the noble Lord Lord Stevens has said, this is not in scope for the NHS and NHS services and we have to look also at the NHS Constitution.

So I ask the Minister whether, in the light of some of the proposals, there is a plan to rewrite the NHS constitution as well as the fundamental principles of the NHS, as read out by my noble friend Lord Stevens of Birmingham. The amendment structural conflict is between efficiency and caution. So can the noble Lord Lord Birt in responding, explain how the clock will be stopped and by whom, and whether a request to shorten the process will trigger enhanced scrutiny, and how that would be done? And will all the assessments be face to face to improve the chances of detecting coercion to death? And will all the contacts with the navigator be recorded and audited, so that one can be sure that the auditor is not themselves acting in a profoundly subtle and coercive way? Now the navigator seems to bypass a search for many things, and without the amendments in the name of the noble Lord Lord Mackinlay and others, I cannot see how that imbalance would be corrected.

So at least the imbalance is there. But there is something about amendment 77 one, because it gets to the heart of the problem, and that is it tries to stick all of this as a profound NHS responsibility. The NHS, as we've currently heard, cannot cope. We have patients on extra beds in the middle of wards. We have patients in corridors being looked after seriously ill people. We have patients sitting on plastic chairs waiting for a bed, sometimes dying on those plastic chairs.

The NHS is not the place to have a dignified death in the hospital setting in a lovely, planned way, as seems to be being described and designed by some people. People are working into the ground to try to manage the workload that they have at the moment and has have been said. The workforce themselves are indeed completely on their knees. GPS are already overstretched. Evidence suggests that assisted dying would require around 30 hours of an individual case. Yet many palliative care doctors and psychiatrists would opt out, therefore decreasing the pool.

Also involved in the way that these amendments are put together. If I might just respond to some points that have been raised during debate over the question, the public want this in polls. When the public are asked what they understand about assisted dying, 52% say it's your right to stop treatment. Well, they already have that right. Nobody should be treated against their will and they should be supported in that decision. And 17% of people think that assisted dying is hospice care.

We've heard about in in remarks made today about people dying horribly and we've heard about research moving progress forward. So I ask the noble Lord noble and learned Lord, Lord Faulkner, why is there no requirement in this bill that everything which is undertaken is subject to rigorous evaluation and research, with the data available to be looked at in detail.

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And in the spirit of helpfulness on public opinion and whether people understood the question. people understood the question. Again, there's numerous surveys on this. Probably a very, very clear one is the wording is do you think one is the wording is do you think doctors should be allowed to end the life of a terminally ill patient at their request, for which there was support of 75% of 18 to there was support of 75% of 18 to 34 year olds, 80% of 35 to 64 year olds, 78% of 65 plus year olds.

I don't think you could get a question clearer than that, or a

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level of public support greater than that. I'm grateful to the noble Lord

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I'm grateful to the noble Lord for his. I'm grateful to the noble Lord for his intervention, but I actually think we need to stay actually think we need to stay focussed on the amendments in this group and not get diverted off. And that's what I'm trying to do in terms of palliative care provision. terms of palliative care provision. I, I am extremely worried that the amendments put down to amend the amendments of the noble Lord Lord Birt had to be limited because palliative care is repeatedly being deemed out of scope in this bill.

And that is a major problem. When we hear about bad deaths. We know that actually, if clinicians act with urgency and have a 24 or 48 hour limit before they call for specialist palliative care intervention, so there is rapid intervention with highly specialised knowledge that the the all of the outcome measures show an improvement using things like the iPod scale and so on. And family reported outcomes can also improve. So to view bad deaths as something that we should just leave going and tolerate, and that the only solution is the proposal and in these amendments, I think actually does not recognise the reality of the services that are available already.

The noble Lord, also, in introducing his amendments, quoted extensively from Australia and painted it out as being everything perfect. I just would like to briefly countenance that by quoting from the Honourable Robert Clark, who was the Victorian Attorney General in 2010, to to 14, who wrote has written about assisted suicide, the Australian Experience, and he describes a change in attitudes with the ethos of the medical profession moving away from the practitioner's primary duty to solve the problems the patient has, and a grave risk that this will leave over time to doctors forming views that the patient ought to be opting for assisted suicide and becoming inclined to regard patients that they they should go down that road.

He also highlights that there are things going wrong. I won't detain the House because of time, but I do think there are other alternatives. And he does point out that there are some doctors who, when they have resisted going along with a request for an assisted death, have found their whole careers eventually becoming somewhat blighted. Even though I know that there is a clause in the bill which tries to avoid that, but there is concern that that clause is incomplete in the bill.

So I do think when we quote the international evidence, we do also have to be quite balanced in it. The proposal, in the amendments, in the name of Lord McKinley, do us a favour, because they demonstrate that this cannot be part of the NHS as it is at the moment, and it does begin to move us towards viewing some kind of proposal like this as being completely outside NHS services, but not planted in the NHS. And then, of course, the funding question arises because if funding erodes palliative care funding, which has happened in other places, then we really have a problem because the evidence recently to the Public Accounts Committee showed that if you've got specialist palliative care in place and available as it ought to be, the savings to the country would be about £800 million a year.

12:05

Baroness Fraser of Craigmaddie (Conservative)

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Yeah. >> Intending to stand up today. So I apologise. But this group hasn't gone at all how I thought it would gone at all how I thought it would go. When I looked at amendment 771 and the Assisted Dying Health and the Assisted Dying Health Service, I was confused because I had thought that navigators might take a similar role to those of independent advocates. And we have a group about the importance of independent advocacy, which I'm a huge supporter of, and who can advise people on other, whether it's care or health or other treatments.

And that's coming up in 19 groups time. But what it seems to me that that this, that amendment 771 is doing is, is sort of in it's it's illustrating the flaws of the entire bill, whether it's geographical provision or training and qualifications, the right of practitioners to withdraw, and actually the need to support vulnerable people. So we've also had a debate today about funding and funding of what would be assisted dying health service. We have another group, group Group 30, which I hope we get to on the on the provision of assisted dying service by groups other than the NHS.

And may I suggest noble Lords opposite to to take the noble Baroness Royall suggestion to press the government to provide clarity before we get to that group, both on the funding of an assisted dying service, but also following on from the noble Baroness. Lady Findlay's point on the funding of the future funding and support for hospice care. Because I have an amendment in that group 30 and the reason I put it down was because I think that the the proposals of this bill have missed a bit of a trick, because I think if you want to set up an assisted dying service, then you should do so in parity with the current arrangements for the hospice service.

So if we understand what the funding for hospice service is going to be, then we can have our debate in Group 30 on alternative provisions.

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In my intervention I mentioned future of palliative care. I did not mention the costs of assisted dying service, which I'm very dying service, which I'm very willing to ask for as well. But at that stage I was focusing on palliative care.

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palliative care. noble Lady, for her intervention. I think both would help us because I think we've got we've got the confusion about the future of support for palliative care, and we've got the confusion as to we've got the confusion as to whether or not the funding of assisted dying service will or will not take away from other services within the current NHS provision. And just finally, I just want to say that it's very different to the Scottish Bill, which very specifically does say that it's

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going to be within the NHS. Before the noble Baroness gives way. It may aid the House to know way. It may aid the House to know that it was before Christmas that the Minister and the other place the Minister and the other place indicated, via a statement, that the government is currently developing a palliative care and developing a palliative care and end of life care modern service framework for England, and that it's planned publication date is it's planned publication date is the spring of this year.

And in that context, I think, I hope that the government and the Minister here will hear the calls from people both supporting this bill and those that are not supporting this bill, that it would be very, very helpful to us all in the deliberations of this bill. If that framework and the details of it and the funding of it are provided to this House as soon as possible.

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Yeah. Lords, the. Just on that point that she's mentioned about funding, mentioned about funding, unfortunately the Minister has now communicated it won't happen until autumn 26, which any former Minister knows means December the 24th for this House gets to know

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you would like. My Lords. I wonder.

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Can the proposer of these amendments Lord Birt tell us, has he got any indication from the relevant Royal Colleges that their members would be available for this

12:09

Lord Empey (Ulster Unionist Party)

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service? The idea that you're going service? The idea that you're going to have senior clinicians on a 24 hour basis, 365 days a year, I wish hour basis, 365 days a year, I wish that our facilities had sufficient capacity, but, my Lords, it's nonsense. There's not the remotest possibility of the National Health possibility of the National Health Service and the relevant colleges and the relevant clinicians being available. And if I am wrong, and if the noble Lord Lord Birt has got an indication from from them that their members will be available, then the sooner we get that information here, the better.

But I just cannot see it. I mean, we can't even deal with what we've got at the moment, never mind adding to the burden. But on another issue I have to say to the noble Lord, Lord Falconer, it's 12:10. The time we get this group finished, we'll be at the lunch break. And I have to say to the noble Lord, and I said it last week, if we're going on at the rate we're going, he is partly responsible because he has got to bring forward meaningful amendments.

So we see the colour of his money now and not in weeks to come.

12:10

Lord Falconer of Thoroton (Labour)

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We're debating other people's >> We're debating other people's amendments at the moment. This debate is particularly debate has debate is particularly debate has raged pretty far and wide. These are not my amendments. They raised three particular issues. First, should there be a new organisation, assisted dying health Service? Secondly, should we ensure a different and more expeditious series of arrangements than that put in my bill? And thirdly, the Commissioner should only act as a regulator. Those are the three essential parts.

I think there is merit in much of what the noble Lord Lord Birt has said. I'm not in favour of an assisted dying help service. Secondly, my bill sets out very, very detailed provisions for safeguards which are longer and less flexible than that proposed by the noble Lord, Lord Birt. And as far as the Commissioner being solely a regulator, I'm not in favour of that. I think you do need a regulator, and the CQC has been suggested in relation to provision.

That seems quite sensible. I simply rise to say we've raised so far and wide. I'm slightly miffed at the idea that the Lord MP is saying that I'm detaining people from their lunch because we've had this long debate.

12:12

Lord Empey (Ulster Unionist Party)

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Well. well. The reason I raised the point was merely to to indicate the length of time this is taking, and the fact that a lot of the motions that are on the Order Paper and the proposals could be addressed if we had amendments put forward by the noble Lord, Lord, which he indicated in an email last week, would be forthcoming. And they're

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not here. Just say to the noble Lord who's raising this point? The point he's raising this point? The point he's making, I think, is that the reason why the noble Lord Lord Birt put down these amendments is because down these amendments is because it's not clear from what the government has said or what the government has said or what the bill says about where this service is supposed to be. And I see the noble Lord Lord Birt is nodding at noble Lord Lord Birt is nodding at that.

The point is, if the sponsor of the bill had set out on the face of the bill, more detail about how it was going to work, where it was going to sit, there had been a proper process. Many of the amendments that have been tabled by people with concerns would not have needed to have been tabled, and we would be moving faster. It's because of that gap and that failure that is the sponsor's responsibility, that this is taking a long time, but it's necessary scrutiny to get the bill right.

That's what the public would expect

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us to do, my Lord. I do think that we can clear

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I do think that we can clear quite a number of these things away by taking one central issue. The by taking one central issue. The big problem about government is that it isn't a single issue that that it isn't a single issue that faces you. It's a whole range of issues and you have to get a balance between them. So when we balance between them. So when we talk about cost, it's perfectly possible to say that there is a majority of people who want this thing, and there's a majority of people who want that thing.

The Minister and the government have got to decide how they share the money that's available out between

12:14

Lord Deben (Conservative)

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these things, and that is crucial to any decision made by this House. to any decision made by this House. And my concern is that we are not facing up to that. This is a single issue being presented to the House, issue being presented to the House, as if it can make decisions about single issues, irrespective of the single issues, irrespective of the effect of the decision that they make on all the rest of the single issues, which people also have strong views about.

If you ask the public, did they want more money for palliative care, they would almost universally say yes. If you ask the public, did they want a National Health Service where they could actually get an appointment with their GP within a week, they'd say, yes. If you ask the public, did they want a National Health Service where there was someone who helped them through complicated arrangements? They would say, yes. The problem for this House is that we have to decide.

First of all, what is the burden that these proposals place upon the National

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Health Service, the judicial service, the government as a whole. In terms of hopefully being

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In terms of hopefully being helpful? The it is in the impact assessment, it is 28 million or as

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assessment, it is 28 million or as I said, 0.000175 of the NHS budget. I'm afraid.

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I'm afraid. I I'm sorry. I'm perfectly happy to accept the intervention. And I do understand why Lord Birt didn't accept any intervention, because he might have found it difficult to answer the questions that we are asking. But the point I'm making is very simple and it still remains. We have to make a decision always among priorities. The problem with this decision is, and that's why it should have been a government bill and not a private member's bill. Is that as a private member's bill, it is a single issue bill.

It's promoted by people who want this to be decided, irrespective of its effect upon everything else that happens. And it is not acceptable, it seems to me, for the government and this is the purpose of my comment. It isn't about how much the proponents think is going to cost, it is about what is the effect of this over the rest of the National Health Service, and where is it going to fit if this bill is passed and the government really cannot get up and say we are entirely independent and we really it has got to say to us, if this bill is passed, where do they see it sitting? Because the proponents of the bill have not expressed this.

What is the real cost? Not the sum of money, but the effect of it on the rest of the service provided. And thirdly, it has got to say to us, how does that impact the essential demands that the public have for so many other things? Now we can argue about what the public thinks about this bill, and I'm pretty sure that I have a view that they think about this bill rather different from what the bill actually is.

But we can argue about that. But what we do have to say is that the public also has very strong views about what money should be spent in other areas, and we have to get the government to tell us how much it is going to cost. From the government's point of view, what will be the effect on the other services provided, where it is going to sit if it is passed, and how are they going to overcome the problem that many of those who may be asked to support it have said they won't? Those are things for the government to tell us, and so far, the government has been unable to put answers to any of those questions, which is the reason.

The second reason, the other is the point that the noble Lord has just made about amendments. But that's the second reason why we have constantly to go on in detail to argue about this bill.

12:19

Lord Rooker (Labour)

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Example. >> On the. >> 8th of January, a column 1416 Lord Stevens made a short speech Lord Stevens made a short speech consisting of about six specific questions. One of them was about the interaction of the health the interaction of the health service and this bill. Later on that morning, I said to my noble friend in intervention, he should come back within the next ten days and answer those questions. The fact that he's refused to do so, and the suspicion is he has no intention of doing so, is why the amendments will keep being raised.

And that's basically the point that Lord MP was making. There is a suspicion that they won't be answered, and if we can do that, then we could make more progress anyway, because of the nature of the amendments that are down.

12:20

Lord Gove (Conservative)

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I'm wholly in agreement with Lord Rooker and indeed Lord Deben that greater clarity, both from the that greater clarity, both from the promoter of the Bill and from the frontbench, would assist the House in making sure that its mind can be made up on these delicate issues? Lord Birt used to be my boss when I was a junior journalist at the BBC. I owe him a great deal, and in framing this amendment, he has shown that a fine mind, by insisting on speed and precision, can show us just what expedited delivery of a public service can achieve, if only the skill with which Lord Birt has ensured that the ratchet moves forward at speed in this legislation had been applied, for example, to our planning system or to any of the other areas where government is laggardly and failing.

And as Baroness Fox of Buckley pointed out, if the same degree of precision had been applied to the operation of our courts and tribunals, we would not need to be contemplating the end of trial by jury. But in putting forward this proposition, I fear that Lord Birt is guilty of falling prey to two fallacies. The first is the gadarene swine fallacy, the idea that because so many are moving in one direction that we must follow expeditiously. He cited, of course, the fact that Jersey has voted for a form of assisted dying.

And of course, we're aware the debates are carrying on in Scotland and Wales. I shan't go into the devolutionary and union ramifications of those debates here will return to those later. They're critically important. But as was pointed out by Baroness Berridge, the arc of history does not bend in any one particular direction, and certainly not in the direction that Lord Birt wishes to see it bend. We have been reminded this week that Denmark can say no to being told what to do by others, not just in geopolitics, but in other areas as well.

What we can learn from Denmark, and indeed from the French Senate, is that the consideration of the detail of legislation matters. And that takes me to my second point. The other fallacy, which was inherent in his speech is the Robespierre fallacy, the belief that one can discern and interpret the general will and then push in a particular direction, as we've heard on the floor of this House, opinion polling on the question of assisted dying gives us almost the conclusions that we might want to have.

I was struck by the opinion polling cited in the British Medical Journal, which was cited by Baroness Finlay, which pointed out that the majority of those asked, when they were compelled to share what they thought assisted dying meant the majority thought that it either meant the withdrawal of existing treatment at a particular point at the request of the patient, or improved palliative care. Now, of course, Lord Markham cited other opinion polling as well. But the critical thing is that that opinion polling points in different directions.

It causes me concern, but it is the purpose of this House and the purpose not to attempt to di general will and to enact it, look at specific legislation and to decide whether or not it is fit for purpose. And that takes me to another point about the assisted dying health service and question for the promoter of this amendment, for Lord Birt, for the promoter of the bill, Lord Falconer, and of course, for the frontbench. It is undoubtedly the case that if the legislation that were sorry, if the amendment that were standing in his name and Lord Pannick name were put forward, that the process would accelerate relative to that which

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