Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, as legislators, all sorts of laws pass through our hands—the good, the bad and the ugly. All are consequential for our fellow citizens, but rarely does a Bill weigh as heavily as this one. Wherever we stand, this law change could have a seismic impact on social attitudes to life, illness and death. Our task is formidable because of how many norms the Bill will overturn; I will mention a few.

The Bill unsettles centuries-old medical ethics. It rebrands assisting someone to die as a medical treatment, upending its understood meaning. The Bill rewrites the role of doctors. They will no longer be guided by the “Do no harm” ethos of preserving and protecting life; instead, the Bill mandates that they actively engage in taking a patient’s life by supplying lethal drugs that will kill them. The Bill especially shakes the foundations of society’s attitudes to suicide—and, yes, that is the accurate word; we know this because, at present, intentionally assisting someone to end their life is a criminal offence. So the Bill is forced to amend the Suicide Act 1961 to allow medical professionals to plan, prepare and assist in intentionally ending the lives of a particular group of citizens.

My greatest dread is that this state licensing of suicide could unleash a regressive culture change. For decades, we have made concerted efforts to deter people from taking their own life; this was brilliantly documented last week by the noble Baroness, Lady May, and the noble Lord, Lord Jackson.

Now, I pause. Any of us who have known family or friends who have committed suicide know that it is gut-wrenchingly tragic; it brings an especially visceral, raw grief. This is compounded by guilt as loved ones endlessly soul-search, totally unfairly blaming themselves: “What more could we have done?” This is why, if we see someone about to jump from a bridge, even if they give us 100 objective reasons why their life is not worth living or even if they have only a few months to live, we do not just shrug and walk on—we cling on to them and plead, “Don’t do it. Don’t jump”. All this reflects our deep humanistic intuition that, when a person acts to end their life, it should be resisted with all the energy society can muster. What happens culturally, though, when the state shouts, “Jump”, or agrees with those who say that ending their life is a compassionate choice?

I worry especially about what message this sends to the young, who are already often nihilistic and prone to anxiety, self-harm and mental health problems. When we debated the censorious Online Safety Bill, those of us who raised its negative impact on free speech were metaphorically slapped down and hectored. The one indisputable reason for that law was to close down suicide sites—something echoed by the Prime Minister only yesterday. We had to protect the young from malign online suicide influencers, but I worry that this Bill is the legislative embodiment of a suicide influencer. What do we think will happen when we tell newly franchised teens that, in some instances, taking your own life equates to dying in dignity? Saying that it will be restricted to those with a terminal illness just will not wash with a generation immersed in the language of rights and entitlements: “Why not assist me when I am suffering so much? Why am I being discriminated against?”

That brings me to my final point. We have heard some fine speeches from supporters of the Bill, stressing the importance of autonomy and giving people control of their life. I usually champion such sentiments in a political sense, but not when they are used to justify the state having a role in ending human life—forgive my squeamishness. For those who state passionately, “My body, my life, my choice”, why back a Bill that limits that choice to the terminally ill? Surely logically that right should apply to anyone who wants to kill themselves. No doubt this logic will lead to demands to expand the law—God help us once human rights lawyers get involved. As I say, we have a weighty responsibility to ensure that such nightmarish unintended consequences do not become a reality.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I will deal first with the central issue in this debate, which is the amendment from the noble Baroness, Lady Finlay. The wording currently mentions:

“A terminally ill person in England or Wales who … has the capacity to make a decision”.


The noble Baroness proposes that “capacity” should be changed to “ability”. From what the noble Lord, Lord Wolfson, says, I understand that we should read that with Amendment 115, although there is another amendment that the noble Baroness proposes in relation to Clause 3. But I accept what the noble Lord says in relation to Amendment 2.

With the greatest respect to the noble Baroness, Lady Finlay, she is suggesting that we remove “capacity” and replace it with “ability”. The noble Lord, Lord Sandhurst, put his finger on it when he said that “capacity” is well known to the law. You could not possibly have a Bill that did not refer to capacity because what it means, in the eyes of the law and of people in practice, is the ability to make the decision. As the noble Lord, Lord Blencathra, said, if you do not have capacity, you cannot make the decision. That applies right across the doings of human beings, and the law recognises that. If, therefore, you replace “capacity”—

[Baroness Fox of Buckley (Non-Afl)]

On a point of clarification, I thought that the idea of adding both words was very helpful, but when the noble and learned Lord says that you cannot make the decision without capacity, it is not any decision but this particular decision in this Bill. Can he reflect on a point that was made very well by one of his noble friends on something that happened in my family as well? Somebody with dementia was said to have capacity for a particular decision, but I would not have wanted my mother to have been trusted as having the capacity to decide whether to ask for assisted death.

The Mental Capacity Act is fantastically important, but is it appropriate for this decision—not any old decision but this decision—which is a bit more challenging than some of the decisions that the Mental Capacity Act is used to decide on?

[Lord Falconer of Thoroton (Lab)]

That is very well put and is exactly the question. Is it appropriate to bring the Mental Capacity Act into this Bill? I understand that whether you have an assisted death is an incredibly important decision. You cannot remove the word “capacity”, so you have to reject the amendment from the noble Baroness, Lady Finlay.

Her Amendment 115 effectively draws on how the Mental Capacity Act 2005 is currently drafted, except it adds two things. It removes the presumption of capacity and, separately, it requires the person making the decision to be aware of a variety of things that are connected with their illness. To summarise, the way the Mental Capacity Act operates at the moment is that if you are unable to understand information relevant to the decision, to retain that information, to use and weigh that information or to communicate your decision, you do not have capacity under the current Mental Capacity Act. The extent to which the things that the noble Baroness, Lady Finlay, has referred to in her amendment would be relevant would have to be weighed in the context of the decision that has to be made.

I am more than happy to debate whether we need to make the changes to the Mental Capacity Act that she is suggesting. For my part, I do not think we do. One thing that is absolutely clear is that the amendment proposed, as the noble Lord, Lord Sandhurst, identified, is completely ridiculous. You cannot remove the question of capacity from this choice. Putting aside some detail hurdles, there are two hurdles that need to be overcome in how this Bill is constructed. You have to be capable of making the decision, as the noble Lord, Lord Wolfson, said, and—completely separately—you have to make that decision completely voluntarily. It has to be your own decision, not the product of pressure.

We have had—and I say this with warmth and respect—a rambling debate going over a whole range of issues, miles away from the question of whether one should remove the word “capacity” and put in the word “ability”. If this House wants to make the law completely confused in this area, either put in the word “ability” or put in “capacity and ability”. I echo the speech of the noble Baroness, Lady Hayman, when she says we have to approach this in a grown-up manner, and to remove the word “capacity” is not a sensible way to deal with this.

I also echo those who have said that the idea of running two systems at the same time—the Mental Capacity Act system and the separate system proposed by the noble Baroness, Lady Finlay—is wrong and confusing. I congratulate the noble Baroness, Lady Fox, for spotting what the right decision is. Of course, under the Mental Capacity Act some unimportant decisions are taken, but a decision such as whether to have the ventilation removed from you if you have motor neurone disease, that will almost certainly lead to your death, is without a shimmer of a shadow of doubt a life and death decision.

The Chief Medical Officer of England and Wales, in evidence to the Lords Select Committee, said:

“it is far better to use systems that people are used to and that are tested both in practice and, where necessary, in law”.

He went on to say:

“I have a concern that you could have a conversation in one bed in a hospital where someone is talking about, for example, an operation where they might well lose their life, because they are frail and there is the operative risk, done under the Mental Capacity Act, and, in the next-door bed, someone is trying to do the same process of having a difficult conversation about someone who might die, or could definitely die, as a result of that decision, but using a different legal framework. The risks that that could lead to confusion are not trivial”.


I also echo what the noble Baroness, Lady Browning, who sadly is not in her place, said. There are problems about practically every aspect of how various parts of the health service work, but she was part of a process that considered how the Mental Capacity Act worked. The broad conclusion was that it was a good, workable Act, and we should not stray from it in this particular case. I invite the noble Baroness to withdraw her amendment.