Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, I declare an interest: my brother is a consultant in palliative care. Today, I want to speak in defence of palliative care and hospice support for people with terminal illnesses. It is deeply troubling that this Bill and the debate surrounding it, certainly before today, have given so little consideration to palliative care.

I oppose assisted suicide in principle and I oppose this Bill. It is poorly constructed and it was rushed through the Commons with inadequate scrutiny, with many amendments not debated. Crucially, it does not even require that those requesting assisted suicide are offered a palliative care assessment first, yet specialists tell us that palliative care can help people who wish to die to rediscover reasons to live. At a recent Lords briefing, palliative care practitioner Dr Lucy Thomas shared the story of a patient who had considered Dignitas but changed their mind after receiving hospice care. Within days of starting that care, they felt valued rather than abandoned.

Sadly, too many terminally ill people feel abandoned by the NHS due to the lack of palliative care. Sarah-Jayne Blakemore wrote movingly in the Times about her father, the neuroscientist Sir Colin Blakemore, and the palliative care he received. Diagnosed with motor neurone disease, he had planned to go to the Netherlands for euthanasia. He never did that, as at each stage of his illness he was supported by his family and paid carers to cope and to find enjoyment in life. When his wife died, he struggled with depression and feared losing control, a fear echoed in the debates on this Bill. But after a hospice doctor explained his palliative care options, his daughter says he became optimistic and hopeful again. He went to stay at the hospice after developing a chest infection. His daughter describes how, for the last 10 days of his life, he received

“the most gentle and attentive care from people who had dedicated their lives to end-of-life care”.

She acknowledges that her father was lucky to live near a hospice

“that enabled him to have a peaceful and dignified death”.

Ahead of this debate today, we have been privileged to have briefings from leading palliative care experts including Professors Mark Taubert, Katherine Sleeman and Fliss Murtagh. Those clinicians, with decades of experience, tell us that almost all patients offered high-quality palliative care benefit from it, but it is often too little and too late, or indeed not offered at all. We do not provide enough care and support for people with life-limiting illnesses or for their families. Over 100,000 people die each year with unmet palliative care needs. Indeed, a Marie Curie survey found that in only half of expected deaths did families feel that their loved ones received adequate support with health and care in their final three months. We should have invested in palliative care so that more people can benefit as Sir Colin Blakemore did. It is unethical to leave the needs of 100,000 dying people unmet. We must consider those who do not and would not choose assisted suicide and ensure that they are offered palliative care first.

I pay tribute to my colleague Florence Eshalomi MP, who tabled an amendment in the Commons to ensure that no care home or hospice should be obliged to provide assisted dying. Hospices exist to offer comfort, dignity and holistic support, not to facilitate premature death. Introducing assisted dying into hospices risks undermining their purpose and deterring those who seek life-affirming care. Hospices are places of hope and compassion; they should not be asked to become sites of medicalised death. We must protect the integrity of our care institutions. We must safeguard the vulnerable and uphold the rights of those who dedicate their lives to end-of-life care. This Bill is not the solution. We should start with investment in palliative care to make it available to all who need it, including care at home.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I do not think I am confused at all. I know what Jess Asato tried to get into the Bill to give her assurances, and that something has changed. I had moved on to talk about the amendment from Jack Abbot, which was very important.

The issue of illness is an example of where the Government said they had worked with the Bill’s sponsor. The challenge of this group—I am thinking about what the noble Lord, Lord Birt, said earlier—is that we are covering multiple issues on the basis of drafting changes. I would rather get into the substance of some of this when we get to later groups. However, Clause 14 says that, in the very unlikely circumstances that the doctor who agreed to give a second opinion “dies” or “through illness” is unable to continue, the person has the right to seek a second opinion elsewhere. My point is about removing “through illness”, which was specifically included the Bill. I am trying to understand why the noble and learned Lord is seeking to do that. I have already heard him say that you can just find another doctor, but I am particularly keen to hear from the Government their view, because they worked with the Bill’s sponsor in the Commons to get this phrasing about illness in.

The sponsor’s Amendment 416 is to do with independent doctors and Commons Amendment 459, and there is more than one reference to this issue. There was significant debate when Sarah Olney introduced her amendment in Committee in the Commons seeking to reduce the possibility of abuse by making sure that the second independent doctor has available the reasons why the first independent doctor concluded that the person was not eligible. My interpretation of the amendment tabled by the noble and learned Lord, Lord Falconer of Thoroton, is that that goes away and there will not be two reports, and the amendment speaks further about aspects of the reports.

This amendment brought attention from other MPs. Lewis Atkinson talked about recognising that the provision of five different touchpoints of assessment—I appreciate the effort that has gone into trying to bring in safeguards around these matters—is one of the strengths of the Bill and that each assessment should be done in a way that can be progressed with more information. On the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process, and therefore there should be an opportunity for a lot of those things to be shared with the panel, as the Bill proposes. Kim Leadbeater said that she was minded to support Sarah Olney’s amendment, but, again, some of those changes are being taken out.

I am not entirely clear about Amendment 417. I somewhat understand the disability definition, although there is only one reference to Section 6 of the Equality Act 2010 anywhere.

This group of amendments needs careful scrutiny as we go through the different groups for later discussion. One of the aspects that we need to make sure of is that the extensive concessions made in the other House do not all of a sudden, through just a few changes here and there, go away. In fact, as we know, in this House we are even considering what further safeguards there could be. One of my reasons for rising today was to bring this to the attention of the Committee. I am not suggesting that the noble and learned Lord, Lord Falconer of Thoroton, has done this in bad faith. He may well think that this is just being more efficient, but the extensive debate and the support in the other place—indeed, the support of Kim Leadbeater—for several of these amendments as they were originally drafted mean we should be asking him to think again. We will get into some of the detail in the debates on future groups. I beg to move.

[Baroness Keeley (Lab)]

My Lords, my Amendment 420 could sit beside Amendment 419 from my noble and learned friend Lord Falconer, but it has not been put in this group. This group is labelled “drafting changes” but, as we have just heard, the effect they would have goes further than that. I have tabled Amendment 420, to be discussed in a later group, to address a concern that the grounds on which a co-ordinating doctor can drop out are already too wide, but I see that the amendments in this group from my noble and learned friend Lord Falconer compound that problem by expanding the grounds even further. I therefore feel I must speak briefly in this debate, despite the fact that my amendment comes later, because your Lordships’ Committee needs to be aware of the concern I am seeking to raise, which the noble Baroness, Lady Coffey, also has.

My Amendment 420 highlights that these provisions should be limited to cases of death or illness. Clause 14 fails to define in which situations it would be acceptable for the state not to be concerned that the doctor is unwilling. As the noble Baroness, Lady Coffey, has highlighted in her Amendment 420A, the danger is that the current wording would allow the risk of changing doctors until the wanted answer is given. These probing amendments are going to be discussed later, and they will focus on the need to restrict the grounds for changing the co-ordinating doctor by excluding the word “unwilling”, which Amendments 420 and 420A both address.

It would be helpful if my noble and learned friend Lord Falconer could answer these questions on this matter. How do we distinguish between a doctor who is unwilling due to conscience and one who is unwilling due to suspicion? Without a requirement to record the specific reasons for unwillingness, is there a danger that we are creating a black box? If a doctor steps away because they are uncomfortable, for instance, with a family member’s influence, surely the system needs to capture that specific hesitation before a new doctor is appointed. Will my noble and learned friend Lord Falconer specify what circumstances cross the line where the state should be more curious about why the doctor is unwilling?

[Baroness Grey-Thompson (CB)]

My Lords, I originally requested that later amendments that I have on disability language, as defined under the Equality Act, be moved into this group, but they were not. I think it is important that we have a chance to debate them as well. Language is the dress of thought, and “person with a disability” is not language that is used in the Equality Act. However, if the noble Baroness, Lady Coffey, seemed to misunderstand these amendments, I think I have misunderstood them as well.

I am particularly concerned about Amendments 290, 366 and 931 around domestic abuse and coercive control, which I have spoken about in other debates. I believe that these amendments go beyond mere drafting changes. The wording as it now exists waters down what the training around domestic abuse is likely to be. For example, it could be a course on physical or sexual abuse, but that does not necessarily mean that it is as comprehensive as I believe it needs to be. I am conscious of time, but I would be interested to know whether the noble and learned Lord or the sponsor in another place, the honourable Member for Spen Valley, has spoken to the honourable Member for Lowestoft, Jess Asato, about the impact of these amendments on her work. It important that we understand the context of what we thought was coming from the Commons and what these changes might mean to the Bill.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Smith of Newnham (LD)]

My Lords, the noble Baroness, Lady Jay, just asked us to consider the circumstances of those who are seeking an assisted death, but I would like to give a salutary lesson—I am sorry to disagree with the noble Baroness, Lady Gerada.

My father was taken ill during the Covid pandemic. He did not have a smartphone and was not able to have an in-person consultation. He had jaundice. The message he came away with from speaking to a doctor on the telephone—the doctor had never met him—was, “It’s pancreatic cancer”. My father then spent weeks saying goodbye to all his relatives and friends. By the time relevant tests had been done, it was shown that he did not have pancreatic cancer.

That demonstrates one of the flaws of doing something remotely, which is: what are the messages? The doctors are not getting the cues and the patient is not necessarily hearing what the doctor is saying. I am sure that the doctor did not say, “Mr Smith, you have pancreatic cancer”—clearly, they could not have said that—but that was the message that my father heard. I therefore very strongly support the amendments in the name of the noble Lord, Lord Evans of Rainow, and two of the amendments from the noble Lord, Lord Blencathra.

However, I want to express one serious reservation about Amendment 406A from the noble Lord, Lord Blencathra. If the discussion has to be taken by video conference, it might not be appropriate to say that in every circumstance the only person who should be on that call is the patient. We all know that, when you go to the doctors, even if you are there in person, you have capacity, you are a rational person and you do not have any cognitive difficulties, you do not hear everything. Sometimes, if it is a difficult diagnosis, you do not take everything on board. For some people who are told that they have a terminal diagnosis and understand that that is the case—unlike in the false case of my late father, who did not have a terminal condition at that stage—we know what their settled will is. There are several people in your Lordships’ House who have what their settled will is very clearly on record, in the public domain. But there will be other people with whom the doctor has never spoken before, so they cannot know whether it is somebody’s settled will in a way that the legislation requires.

If, then, there has to be a video conversation, or indeed an in-person conversation, it might be appropriate for there to be an independent advocate or somebody else who would support that person and could say, “The doctor did not really say that, you know”. We need to think about real-life cases. Yes, we need to understand from the medical profession, and it needs to be from the perspective of somebody with a terminal diagnosis, but we also need to understand the reality for ordinary people who do not have the advantages of the internet or the accessibility that Members of your Lordships’ House have.

[Baroness Keeley (Lab)]

My Lords, I will speak on face-to-face consultation; my Amendment 483 on this is in a later group.

During the Covid-19 pandemic, it was briefly made possible for the making of a will to be witnessed by videolink rather than in person. This change could have been made permanent, but instead the Government decided that the videolink provision should cease from January 2024. The law is now again that the witness must have a clear line of sight of the person making the will. Are these precautions any less important when assessing whether someone truly wants an assisted death and is not being coerced than when establishing what should happen to their assets afterwards?

[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Baroness, Lady Keeley, has already alluded to the issue of wills, so I will not go to that, but there is another legal precedent, Devon Partnership NHS Trust v the Secretary of State for Health and Social Care in 2021, when the High Court ruled that under the Mental Health Act, the phrases “personally seen” and “personally examined” require the clinician and approved mental health professional to be physically present with the patient for detention assessments. Following that, NHS England reviewed its guidance. That underscores the legal and clinical importance of physical co-present evaluation when decisions carry high consequence.

Secondly, during Covid I chaired the National Mental Capacity Forum and ran fast-track online seminars for those who were doing remote assessments because of the problem of people in care homes. It was a very difficult time and that was a public health necessity. Since then, some remote consultations have certainly continued, as we have already heard. However, the qualitative studies of remote mental health care during the pandemic found that a lack of face-to-face contact compromised risk assessment and therapeutic insight.

Systemic reviews have noted significant difficulty establishing a therapeutic relationship, identifying risk, and with challenges in picking up non-verbal communication and building rapport coming through as recurrent themes. They caution how remote assessments can be less effective in capturing complex, subtle behaviours, non-verbal distress, agitation and contextual pressures, which are crucial in determining voluntariness and in detecting distress or coercion. Clinicians and carers have reported that non-verbal cues were often unavailable or obscured in remote interactions, particularly telephone consultations but also by video. Even when remote assessments were used only to triage risk, delaying face-to-face evaluation, the effects slowed down accurate identification of deteriorating conditions.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

Moved by

[Baroness Keeley]

87A: In subsection (2)(a), after “drinking,” insert “either voluntarily or”

[Baroness Keeley (Lab)]

My Lords, I am speaking on behalf of my noble and learned friend Lady Scotland, who made clear last Friday that she could not attend today’s Committee debate. I very much appreciate what my noble and learned friend Lord Falconer has just said, but it is worth me explaining Amendment 87A a little and making another couple of points.

The purpose of Amendment 87A is simple—to retain a safeguard that prevents a person becoming eligible for assisted dying by choosing to stop or limit their drinking. We have heard about what happens around that.

I certainly welcome the intention behind Amendment 87, which rightly seeks to protect people with anorexia nervosa, whose restricted intake cannot truly be considered voluntary. On that point, there is welcome consensus. But there are some points that are still worth making.

As drafted, Amendment 87 would inadvertently dismantle another essential safeguard that would ensure that people who are not terminally ill cannot make themselves terminally ill by deliberately ceasing food and fluids. This issue is entirely distinct from anorexia. The other place added Clause 2(2) specifically to prevent that.

Amendment 87A restores that protection so that Amendment 87 would safeguard both groups—those whose mental disorder limits eating and drinking and those who might deliberately restrict intake. This is not a theoretical concern. The case of Cody Sontag in Oregon shows us that what we fear may happen is already happening in one of the jurisdictions that we keep hearing has not experienced significant challenges with assisted dying. Cody was a woman with mild cognitive impairment who feared future cognitive decline after watching her father die of Alzheimer’s disease. After being advised by an end-of-life organisation that by voluntarily stopping eating and drinking she could bring herself within the eligibility for an assisted death without a waiting period, she did so. Within five days, her doctor concluded that she was terminally ill due to dehydration. Two days later, she died by assisted death.

The American Academy of Aid-in-Dying Medicine acknowledges that this loophole is a legal grey zone. I am sure that noble Lords agree there must be no grey zones when dealing with irreversible decisions about life and death.

Even if amended by Amendment 87A, Amendment 87 would not fully protect people with eating disorders, because many people with eating disorders do not restrict their eating and drinking. For example, people with type 1 diabetes and an eating disorder will manipulate insulin, and people with bulimia binge and purge. Both behaviours can be life threatening—particularly where treatment is refused or unavailable—despite being treatable conditions. Under Clause 2(1), such individuals could still meet the definition of terminal illness.

Throughout the Bill’s passage, as my noble and learned friend Lord Falconer acknowledged, concerns about protecting people with eating disorders have repeatedly resurfaced. Concerns were raised repeatedly in the other place, in oral evidence, in line-by-line scrutiny on Report, and at Third Reading, and we are raising them again here. It is abundantly clear that we have not yet got this right, so my noble and learned friend’s comments about accepting Amendment 87A are very welcome.

The Bill does not yet protect this vulnerable and growing group of people, illustrating how easily complex conditions can fall outside intended protections. For that reason, I support Amendment 101 in the name of the noble Baroness, Lady Parminter, which would explicitly rule out the physical effects of any mental illness, including eating disorders, from qualifying the person for assisted dying.

Evidence from other jurisdictions shows that more than 60 people with eating disorders have already died by assisted death—all women, and the majority aged under 40. We must not repeat those mistakes here.

I also support Amendment 92 in the name of my noble friend Lady Debbonaire, which addresses the serious risk posed when someone with a treatable condition refuses or withdraws consent to treatment. Long, difficult treatment journeys can leave people despairing. Under the Bill as drafted, refusal of treatment would become a straightforward route to eligibility. The amendment from the noble Baroness, Lady Parminter, would close that loophole for eating disorders, and Amendment 92 would extend protection to all treatable conditions. We should adopt both. This is fundamentally a matter of sequencing.

Someone who is terminally ill and chooses an assisted death is entirely different from someone who makes themselves terminally ill by refusing treatment due to suicidal feelings. The Bill was never intended to allow the latter.

Our purpose is to make the Bill safer, and adopting all these amendments is essential to doing so. There can be no grey areas in matters of life and death and the protection of vulnerable people.

[Lord Empey (UUP)]

My Lords, I will speak to Amendment 89. I think that everybody in the Committee is more or less on the same page in what we are trying to achieve here. This amendment would add,

“or withdrawing medication, hydration, or life-sustaining devices”

to Clause 2(2). This has perhaps been forgotten about, but people sometimes rely on ventilators and other equipment to sustain their lives, so it is not a big leap forward to add this to the legislation. It is simple and straightforward, and amending Clause 2(2) seems to make sense. I cannot think of any reason why the noble and learned Lord should not adopt the amendment as a sensible way forward. It indicates—we have had this conversation a number of times, but we have to bear it in mind—that there are still significant weaknesses. We have to make the Bill safe.

On the hostile reaction to what we are trying to do here, I gently remind the Committee that when we last discussed this subject on 22 October 2021, at the Second Reading of the Assisted Dying Bill that Baroness Meacher brought forward, her Private Member’s Bill had 10 pages and 13 clauses. The Bill before us has 51 pages and 59 clauses. People have to understand that this is a massive Private Member’s Bill and is not normal in terms of how we deal with such Bills—it is much bigger. With that, I hope that the noble and learned Lord will have no difficulty in accepting Amendment 89.