Terminally Ill Adults (End of Life) Bill

Baroness Berridge Excerpts

Friday 21st November 2025 Lords Chamber

Moreover, doctors have reported how difficult it is to detect coercion, encouragement and undue influence. Just asking a person whether they are subject to undue influence or coercion is not enough—the noble Baroness, Lady Finlay, has dealt with this—as they may be afraid to say that they are. One of the greatest difficulties is identifying where there has been coercion. Doctors are generally not trained to do this, yet, under the Bill, they are the ones who have to decide, without any context or supplementary information, that a person is free from such pressures.

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 48, to which I have added my name, and to my Amendment 846. I added my name to Amendment 48 to explore whether pressure can emanate from a non-human and non-corporate source. As I mentioned at Second Reading, so much pressure nowadays, particularly for young people, comes from the internet, video games, social networking, TikTok and influencers. It is not only the use by people of online devices as a mechanism to pressure another person; it can also be pressure from algorithms themselves, without a human intervening.

In addition to the two prosecutions of OpenAI for ChatGPT allegedly encouraging children to take their own lives, those with chronic illnesses have testified to me that when, for instance, Facebook realises from conversations that you have a chronic illness, it changes your feed from the promotion of group chats and adverts that are positive to negative content about your treatments, whether you can live with it, and even suggesting going to Switzerland. Is it the Bill sponsors’ intention that, when the medical practitioner is verifying under the terms of Clause 10(2)(h), it is not this type of pressure? Are the internet service providers covered by Clause 1, as there is no definition of “person” in the Bill? As I said in Committee, the Bill is designed for an analogue age and not one on the cusp of AI.

Turning to statutory guidance and Amendment 846, the next question is not who applies pressure but what we mean by “pressure”. The former Chief Coroner, Thomas Teague, came to our Select Committee and we asked whether we need to define pressure. He said:

“If it forms part of the ingredients of a statutory offence, then it might be necessary. Frankly, I’m not sure that it would because, for such a common word in the English language, the fundamental principle that lawyers apply is to take the dictionary definition”.


So, last night, I looked in Collins English Dictionary, which defines “pressure” as

“someone … trying to persuade or force”

someone to do something. What a low bar that is that has to be detected. It is a good job that the law will not be retrospective and that there is parliamentary privilege; otherwise, the attempts by the noble and Learned Lord, Lord Falconer, to try to persuade us of the merits of the assisted dying Bill might actually be covered by his own Bill.

I asked the noble and learned Lord in Select Committee whether a consultation is necessary when a new concept is introduced into criminal law. His reply was, “Sometimes yes, sometimes no”. I think that catching mere persuasion means that this is a “sometimes yes” moment, particularly—as has been outlined by the noble Baroness, Lady O’Loan—as this creates the basis for a criminal offence in Clause 34 that can mean imprisonment for life. The noble and learned Lord will not be surprised to hear that later in Committee we will return to his evidence to the Select Committee in relation to Clause 34.

In the Select Committee we asked various professionals what they thought “pressure” meant. Dr Suzy Lishman of the Royal College of Pathologists, who is opposed to the Bill, said:

“I would understand pressure to mean encouragement to go down a particular route, and coercion to involve some force or threat. I have had no training whatsoever in either of these”.


The Royal College of Psychiatrists’ Dr Annabel Price said:

“It would need to be differentiated from coercion in terms of its definition. Coercion would be the application of force, threat”—

[Baroness Thornton (Lab)]

I would like to ask the noble Baroness whether the Select Committee asked anybody who is terminally ill what they thought “persuasion” or “coercion” might mean?

[Baroness Berridge (Con)]

We covered that matter on the first day in Committee.

[Baroness Thornton (Lab)]

The noble Baroness is not answering my question. The truth is, of course, that the committee did not ask anybody who is terminally ill what their view was about any of this.

[Baroness Berridge (Con)]

I will just reply to the noble Baroness, then, that within the Bill that is not necessary. I have outlined Clause 10. This applies to the people who are verifying in the process, not to the individual. It was not in the Motion your Lordships’ House approved that that evidence should be taken.

To continue, Dr Annabel Price said:

“Pressure has a broader definition of perhaps strong encouragement, expectation or the worry of letting somebody down”.


The noble Lord, Lord Patel, joined in this mini focus group and asked:

“If I were to use the word ‘pressure’ and if I were to use the word ‘coercion’, how would you interpret the two?”


Professor Mumtaz Patel from the Royal College of Physicians—again opposed to the Bill—said, “It is grey”.

Amendment 846 also reflects the view of the Law Society, which is neutral on assisted dying but opposed to the Bill. Kirsty Stuart said:

“I think it is really difficult because there is not a definition at the moment … in the Bill”.


That is why Amendment 846 is based on the statutory guidance principle from the offence of coercion under the Serious Crime Act. I note that the Home Office has recently had to issue 91 pages of statutory guidance on that offence. It seems the courts are struggling with it.

Even if Thomas Teague is right that you look at the dictionary, are we talking about economic pressure, emotional pressure, financial pressure, spiritual pressure, reputational pressure, internalised or externalised pressure, or pressure of circumstances—for instance, no one provides you with a hospice bed? As Dr Suzanne Kite, from the Association for Palliative Medicine, said:

“We know that there are pressures of, ‘Can we afford the electricity for the oxygen supply?’ … Yes, these are issues”


that people face “on a daily basis”. The Bill is silent as to what kind of pressure is meant.

To move from individual sources of pressure, there can also be group sources of pressure. Alasdair Henderson, from the Equality and Human Rights Commission, spoke to the Select Committee about

“this wider issue of coercion or pressure at a societal level or an attitudinal level”

and

“the broader trends or cultural issues”.

He said that

“pressure is not always applied directly by another individual, but can result from attitudinal barriers, particularly around disability, and lack of services and support in society as a whole”.

Could pressure come from NICE refusing you, on value-for-money grounds, the drug that you think will wipe out your metastasised cancer? Indeed, the pressure could emanate from the Chancellor of the Exchequer in her Budget, or from the Secretary of State for Health and Social Care, to encourage vulnerable people to take assisted dying, a matter I put to the Government Minister, Stephen Kinnock.

Caroline Abrahams of Age UK said:

“The context again for this is a system in which adult safeguarding is under acute pressure because local government is under such acute pressure”.


The British Association of Social Workers also said that unless these statutory services

“are adequately resourced, that may bend people’s decision a certain way … much of social care is self-funded now. If you are poor and you cannot have access to those personal resources, even more pressure is applied to you”.

I look to the noble Lord, Lord Pannick: how does a medical practitioner sign to say that this kind of pressure—from culture, society or attitudes, or lack of statutory services—is not being put on the individual?

There was unanimity in the Select Committee when we started asking the professionals about training. I said that pressure

“is not defined in the Bill, so I am afraid I cannot help you. We have no definition in the Bill. You are going to need training, though, in pressure. Has any of you received any training like that?”

Professor Nicola Ranger from the Royal College of Nursing, Professor Mumtaz Patel of the Royal College of Physicians and Dr Michael Mulholland from the Royal College of GPs all said no. So we now have additional costs added to the Bill, because we have to devise training in pressure and deliver it to a whole raft of professionals, care staff, et cetera, so that they understand it, in particular bearing in mind the vulnerability to criminal prosecution that exists in Clause 34.

I am going to give the noble and learned Lord, Lord Falconer, this opportunity to shorten Committee proceedings. Deleting “pressure” from the Bill, when it has not been consulted on and has not been subject to pre-legislative scrutiny, would aid the Committee in evaluating the Bill.

[Lord Carlile of Berriew (CB)]

My Lords, in a group such as this, which has so many conceptual, linguistic and semantic alternatives on offer, it is very difficult to see how a Committee stage such as this is going to help very much in determining a final solution to the matters under consideration. Therefore, it could become very tempting to enter into the nice and easy solution suggested by my noble friend Lord Pannick, to the effect that the Bill is quite enough and provides sufficient protection. It is right to say that the Bill certainly seeks to provide sufficient protection, and I do not in any way attribute anything other than good motives to those who sponsor the Bill, in particular the noble and learned Lord, Lord Falconer.

--- Later in debate ---

[Lord Dobbs (Con)]

I will just follow up my noble friend’s remarks. He is a noble friend; I campaigned for him several times in his constituency when he was an MP, and I will remain a friend of his, I hope. I want very quickly to follow up on his remarks about what we might call the “Pannick paradox” between the decision to ask for an assisted death and the decision to refuse any further medication or help that will continue your life for a short time. My noble friend is right. They are not the same: a decision to ask for a death when you know that death is inevitable, and one simply to deny any further help or sustenance, with starving yourself to death the only way of achieving that end, are very different. The difference is that if someone is able to ask for a calm, assisted death, they will die with dignity and not in squalor, having forced the system to cut off any hope of further life. My noble friend knows that I do not agree with him on this, but I absolutely believe he is right in saying that there is a fundamental distinction. That is one reason why I support the Bill.

[Baroness Berridge (Con)]

It might help noble Lords to know that we are being followed on Twitter. This issue—I am aiming to save time—of the Pannick dilemma has been commented on by Philip Murray, who is a law lecturer at Robinson College in Cambridge. He said the following, and we may wish to seek his advice:

“I find it astonishing that various Lords”—


forgive me for the embarrassment—

“including those who should know better (Lord Pannick …), keep conflating withdrawal of treatment and assisted suicide. The act/omission distinction has underpinned morality and law for millennia”.

I hope that either of the noble Lords, Lord Pannick or Lord Dobbs, will reach out to this gentleman to aid all noble Lords so we will not spend any further time on that dilemma.

[Lord Pannick (CB)]

My Lords, may I just say that other views are available in the legal community, including among many distinguished judges who I will not name. There are many law reports that question this distinction, not least for the reasons that have just been given.

--- Later in debate ---

On Amendment 49—

[Baroness Berridge (Con)]

My Lords, my name is on the amendment that the noble and learned Lord has just mentioned. This was also from Second Reading. There are loads of people signing forms saying that coercion or pressure has not happened. What is the situation with the internet? What is the situation for young people? We are failing young people if we do not make clear how that practitioner is going to know. Young people are pressured through non-human means nowadays.

[Lord Falconer of Thoroton (Lab)]

The Bill makes it absolutely clear that it must be your own decision. Let us suppose that your views of the world are affected by the internet and that you are ill and an organisation is urging you to commit suicide, that organisation should be liable if that happens.

In Amendment 49, the noble Baroness, Lady Coffey, wants “person” to include a body corporate or an organisation in relation to pressure. If an organisation or a body corporate is putting pressure on a group of people or on individuals and that makes them do it—this is putting it crudely, but if an organisation says, “Do have an assisted death; it is the right thing for everybody or for you”—that should be covered by the Bill. The noble Baroness adverted to how “person” can generally include both corporate person and human person, but I can talk to her separately about that to make sure that it is covered.