Terminally Ill Adults (End of Life) Bill

Baroness Cass Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

They will not be involved in the judgment as to whether the person is eligible for lethal drugs; they are providing their clinical expertise and knowledge. It is the panel who, separately, independently and through a process that can be completely scrutinised and documented, would make that assessment. That would mean that the patient’s care could not be contaminated by pressures causing the doctor to be burnt out, financial pressures on the system in which that patient is being treated, or even administrative pressures, such as the patient’s discharge becoming difficult and the hospital needing beds because patients are being treated in corridors—which we know is happening all the time. It provides separation and a degree of clarity over the assessment and judgment.

[Baroness Cass (CB)]

To clarify, whether we take the system proposed by my noble friend or the original system with the series of doctors, it is very unlikely under any circumstance that the clinician who is providing primary care for the patient will also be in one of those formal roles specified by the Bill. The reason is that, as we have discussed, people will need to opt in to that kind of role and have very specific training for it. Given the number of people who are predicted to be required to grant an assisted death, that will be quite a small cadre of clinicians. Therefore, although I understand the aspiration of the sponsor in the other place, and certain Members here, for there to be close integration between the team providing normal care and those involved in the dying process, in practice I do not see how that would be feasible in either system.

[Baroness Murphy (CB)]

My Lords, I oppose the view of the noble Baroness, Lady Finlay, that we should have a completely separate service. That would target and isolate people who are dying. They will wish to be supported by the people who they have known through the course of their illness, so it is crucial that they be seen and examined by those people and not moved to another place. Yes, there will perhaps be separate people who take on this role, and they should be properly qualified and discuss it with the panel, but it is utterly crucial that, when patients are in the process of dying, we do not separate and reject their carers, who should be part of the palliative care provided to them.

In other countries, assisted dying usually happens as part of a palliative care service. That is how it is done, very successfully, in Oregon and Washington. We should not separate carers who are there to support patients during this process. These little nitpicking changes to the Bill will just make it worse.

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[Baroness Stedman-Scott (Con)]

My Lords, I will speak to the probing Amendment 161 in my name. It asks the simple but profoundly important question of whether registered medical practitioners should be granted a blanket legal protection to raise the possibility of ending any person’s life or whether that protection should be carefully and responsibly limited to patients already in their care.

At the heart of this debate lies the issue of safety and trust. The relationship between a patient and their doctor is not a casual exchange. I hope it is a deeply personal, often vulnerable, bond built on confidence, continuity and professional responsibility. When someone receives a terminal diagnosis, they are not merely confronting medical facts; they are confronting fear, uncertainty and the fragility of their remaining time. In that moment, words matter immensely. To grant blanket legal protection to any registered medical practitioner, regardless of whether they have an established clinical relationship with the individual, risks undermining that trust. It risks introducing the possibility that a suggestion about ending life could come from a professional who does not know the patient’s history, values, mental state, family circumstances or vulnerabilities.

Amendment 161 does not seek to obstruct lawful medical practice or to deny terminally ill adults the autonomy that the Bill intends to provide. Rather, it seeks to ensure that conversations about assisted dying occur in the right context, within a relationship in which the doctor knows the patient, understands their condition and is responsible for their ongoing care.

We must consider the subtle power imbalance inherent in clinical settings. A doctor’s words carry authority. Look at the effect they have on the noble Baroness, Lady Fox, at times. For a patient who is elderly, disabled, isolated or feeling like a burden, even a carefully phrased suggestion can carry unintended weight. If such a conversation is initiated by a practitioner with no established duty of care, we risk normalising a culture in which ending life becomes a broadly available option rather than a carefully safeguarded patient-led request.

Limiting legal protection to practitioners involved in a patient’s care and case strengthens safeguards. It ensures that any discussion arises from clinical knowledge, not abstract eligibility; it reinforces accountability; it reduces the risk of inappropriate suggestion; and it protects vulnerable people feeling steered towards a decision at a moment of profound weakness.

Autonomy is meaningful only when it is protected from subtle coercion, even unintentional coercion. By supporting Amendment 161, we are not diminishing choice: we are strengthening the ethical framework in which that choice is exercised. In matters of life and death, precision, boundaries and safeguards matter. Amendment 161 offers a proportionate, reasonable and ethically sound safeguard. It preserves trust in the medical profession, protects vulnerable patients and ensures that, if such conversations occur, they do so within the context of established clinical responsibility. For those reasons, I urge the Committee seriously to consider the intent and spirit behind Amendment 161.

[Baroness Cass (CB)]

My Lords, I say to the noble Baroness, Lady Fox, that my mother held doctors in great esteem and reverence until the day that I and my rowdy friends qualified, and then the whole mystique was exploded overnight.

My serious point is that I am still mystified by Clause 5, because it remains completely unclear who is having this preliminary discussion. Even if we safeguard against the doctor raising the subject of assisted dying without it being initiated by the patient, none the less this clause is still opaque about who this person is. If, fortuitously, the patient has a good relationship with their GP and is able to raise the matter and have a full discussion, they may be able to cover all the things that are listed in this clause—diagnosis, prognosis, palliative care, hospice, available treatments and so on—but, if it is not their GP, who is the medical practitioner supposed to direct them to? Unlike the co-ordinating doctor and the independent doctor, they do not have the right written into the Bill to access the patient’s records or make inquiries of the person who is looking after them, so I am unclear about how they are supposed to discharge all these duties.

Also, it does not reflect reality. If somebody is starting to think about possibly seeking an assisted death, they may ask their GP about one part, their priest about another aspect, their next of kin about another aspect, and they will gradually form a view. But to lay it down in statute seems to be putting an additional hurdle in the patient’s way. Surely, at the time when they want to ask about the detail of assisted death, what it might entail and its feasibility, the person to seek advice from is the co-ordinating doctor or the first doctor within the voluntary assisted dying service, who will have had the training and will have some knowledge to be able to say with confidence what the individual should expect. So I strongly support my noble friend Lady Hollins’s view that Clause 5 should not stand part of the Bill, because it seems to be a complete muddle that we have been discussing various aspects of for some time now.

[Lord Jackson of Peterborough (Con)]

My Lords, I think the debate that we have had for the last two and a half hours shows this House in a very positive light. It goes to the very essence of what some of us who are sceptical about the Bill believe to be the most crucial issue: how the Bill will impact the most vulnerable people in society. I say in passing how moved I was by the wonderfully powerful and emotional speech from my noble friend Lady Monckton, as well as by my noble friend Lord Shinkwin’s speech on his amendment.

Noble Lords might ask a rhetorical question: why are we spending so much time on this particular group? I will offer an anecdote to your Lordships on why it is important that we have spent this time talking about people with disabilities and learning disabilities, and particularly people with Down syndrome. In the summer of 2024, my 91 year-old father was admitted to Peterborough hospital and spent a number of hours in what is euphemistically called “ambulatory care”—which is the back of an ambulance—before being able to access a trolley for a number of hours. As it happens, he was terminally ill. He died a few weeks later from bladder cancer that had metastasised to the rest of his body, but he did not have a diagnosis of terminal illness.

When I reached the hospital, his belongings were adjacent to where he was. At the bottom of the Sainsbury’s carrier bag that held all his personal belongings was a “Do not resuscitate” form that had been filled in. In fact, I think it was what they call—again, euphemistically—a “respect form”. It had been countersigned by a doctor without any discussion with myself or my two brothers. As your Lordships know, none of us are shrinking violets. My brother is a decorated police officer and my other brother is a world-leading scientist and a professor of psychology. We are all quite smart people, but this form had been completed without any discussion with the family.

Indeed, it was alleged that my father had had capacity to sign that form and had agreed to it being countersigned by a doctor. That was a very significant development. I found myself having to front up a difficult conversation with the clinicians in accident and emergency and the geriatrician who was on duty that day. I thought to myself: what if my father had a learning disability? What if he could not read or write properly? What if he was anxious about dealing with bureaucracy and professional people? I thought about how much more difficult it would have been if he did not have a family: if he had not had three sons watching out for him and protecting his interests. How much difficulty would there have been in him challenging the professional bona fides and authority of a clinician—a medic who is well educated and articulate and knows their profession.

I posit that that is the reason we have spent so much time debating these issues. It is not for people such as my father, who, as I say, was terminally ill, but for the many people who have great difficulty: people who are already in a position where they are sad, lonely, depressed, bereft and distraught after a diagnosis of a terminal illness. Those people need assistance in primary legislation to protect their interests, because otherwise no one else will look out for them. That is not to say that those doctors were in breach of the Hippocratic oath, or that they were not compassionate, empathetic, caring and feeling for my father and many thousands of other people in similar situations, particularly old people. Nevertheless, they are busy and stressed and that form was filled in in good faith.

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This was thought about in great detail and, in my view, the correct policy was reached; in relation to somebody without any sort of disability, it is right that you should leave it to the doctors, for the reasons I have given. I very much hope that my explanation of how it operates in practice shows that it means that it cannot be a random doctor. Again, I do not think that any change is required, having listened very carefully in relation to people without a disability.

[Baroness Cass (CB)]

I am still not sure what a person is supposed to do if they cannot access a doctor who is in possession of the full information. If the GP, for example, has a conscientious objection, that potentially puts a hurdle in that will stop them being able to move on to the next stage—they will have to cast around to find a doctor who can have that full discussion. I would have thought that the proponents of the Bill would not want that to happen.

[Lord Falconer of Thoroton (Lab)]

I completely understand what the noble Baroness is saying. Suppose you cannot find a doctor with that information about you—the noble Baroness, Lady Cass, is not talking about the sorts of cases that many noble Lords were talking about, where, by raising it, you are leading to a situation where somebody might be persuaded when they otherwise would not—the answer would be that you would have to consent to all your records being given to a doctor with whom you could have the conversation.

Noble Lords should remember that Clause 5(6) says:

“A registered medical practitioner who is unwilling or unable to conduct the preliminary discussion mentioned under subsection (3) is not required to refer the person to another medical practitioner but must ensure that the person is directed to where they can obtain information and have the preliminary discussion”.


So you can get assistance from a doctor who is not willing to have the discussion. The noble Baroness is absolutely right that, in order to have the discussion, the doctor has to have all the information I referred to. If no doctor in possession of that is willing then you will have to consent to it being given to somebody else—and a patient can consent to their records being given to another doctor.

I turn to the position for those with a disability and, in particular, will deal with the point so powerfully raised by the noble Baroness, Lady Monckton. My Amendment 548A would require that anybody providing a relevant activity under the Bill—new subsection (8) defines “relevant activity” as including “conducting a preliminary discussion”—must not carry out that relevant activity unless the person seeking assistance has an “independent advocate”.

The amendment says that

“‘qualifying person’ means … a person with a mental disorder (as defined by section 1(2) of the Mental Health Act 1983) … a person who (in the absence of support) would experience substantial difficulty in doing one or more of the following … understanding relevant information … retaining that information … using or weighing that information as part of the process of making relevant decisions, or … communicating their views, wishes or feelings”.

Where there is to be a preliminary discussion, the person has to be accompanied by an independent advocate, unless—this is in new subsection (3) to be inserted by the amendment—the person

“seeking assistance informs the relevant person that they do not want an independent advocate, or … where the relevant activity is conducting a preliminary discussion, the person seeking assistance informs the relevant person that they are content for the preliminary discussion to be conducted without them having an independent advocate”.

What the sponsor of the Bill is aiming at there is as follows. If there is any question about one’s ability to process information—what the noble Baroness, Lady Monckton, said about the suggestibility of people with Down syndrome is incredibly resonant—I would envisage the position to be that you have to have an independent advocate but you may not need to have one if it is known to the doctor, or if it becomes apparent, that a family member would be adequate. That would be a reason for not having an independent advocate. But, if there is no family member—for example, if the person suffering from a disability has no parents, siblings or whatever—there has to be an independent advocate.

It may be that the area I should focus on in the amendment on independent advocates is this: you can say no to the need for an independent advocate, maybe because you have nobody else, but is that too risky? I need to consider that, given the point on suggestibility raised by the noble Baroness, Lady Monckton, and Mr Ross of the Down syndrome advisory policy group, whom I have discussed that with.

The points made about people with a learning disability are, I hope, addressed in my amendments on an independent advocate. Ultimately, where there may be no family, the independent advocate has to be the rock-bottom protection.

I move on from that to children. I remind noble Lords that, as the noble Baroness, Lady Coffey, made clear, Clause 6 says:

“No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18”.


It cannot be raised, and I completely stand by that. What happens if it or something like it is raised by a person who is under 18? I found what the noble Baroness, Lady Finlay, said, to be resonant and insightful. You have to deal with it in a sensible way. You cannot just say, “I’m afraid I can’t talk about that. That’s the end of it”. You have to treat the person with a degree of maturity.

The noble Baroness, Lady Finlay, supported Amendment 211, in the name of the noble Lord, Lord Rook, which says:

“If a person under the age of 18 raises the subject of the provision of assistance under this Act, the medical practitioner must refuse to discuss the subject and shall inform the person that such assistance is not available to individuals under the age of 18”.


I am sure that the medical practitioner should say that it is not available to persons under the age of 18, but I am not sure that it would be wise for the Bill to prescribe that no further discussion is appropriate—particularly for 17 year-olds, who are often quite perceptive. The idea that you cannot have any discussion about this is just not practical or sensible and it would drive people to other sources, which may be more dangerous.