Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, mine is an amendment to Amendment 552A from the noble Baroness, Lady Hollins, which itself is an amendment to Amendment 552 from the noble Baroness, Lady Finlay. I think that this is a very good group of amendments: they avoid the potential conflict of interest about which we have heard and they make things clear in law. To answer the noble Baronesses, Lady Murphy and Lady Jay, I prefer a law made in this House to one made by the gentleman in Whitehall down the line. I shall speak to these two amendments, to which mine is a further amendment.

Amendment 552 would require that the provision of lethal substances through pharmacies is restricted to a limited number of designated pharmacies. The substance is documented, kept under lock and key and, when unused, disposed of safely. Amendment 552A from the noble Baroness, Lady Hollins, which she introduced so well, would restrict the pharmacies further to only dispensing and storing the drug, not preparing it on the premises, under MHRA rules. My amendment would prohibit pharmacies from stockpiling or storing any quantity of lethal substance in the pharmacy: it must be ordered on a case-by-case basis.

At present, the Bill has no chain of custody for the secure storage of these lethal drugs, even though some that we know are used for assisted dying, such as benzodiazepine, have a black-market use. The measures in these three amendments go some way to addressing this problem of secure storage. I draw particular attention to the role of the Medicines and Healthcare products Regulatory Agency, the MHRA, specified by Amendment 552A from the noble Baroness, Lady Hollins. It is the body that regulates, licenses, inspects and enforces the rules for pharmacies and manufacturers, on which I have a later amendment to Clause 37. Under this body, there is an existing legal framework for looking after drugs when they go to pharmacies—the 2012 regulations outlining the legal framework for distribution and storage and the directive to prevent counterfeit medicines from entering the supply chain.

Even the tightest regulatory system is not foolproof, so other safeguards are needed to protect against theft from the premises and to ensure security so that the drug is not counterfeited. The MRHA had a great victory last month in seizing thousands of counterfeit anti-fat drugs, the drugs that people take to help them to slim. That was a very good operation which turned up trumps, linking a Lincolnshire raid on an illicit drug-making factory to one in Nottingham. The MRHA works with the police. It can seize, check and license. However, we need even greater security, because of thefts from pharmacies, a known address, and it would be better to limit the storage of these lethal substances in the pharmacies to those ordered on a case-by-case basis. Do not tell me that this does not happen now: if I have to go to Boots for a prescription, sometimes they have to order it. In the matter of assisted suicide, if there is a delay, that may help the patient to reflect further and perhaps have a second opinion.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak to two amendments in this group, Amendments 701 and 703. The noble Lord, Lord Murray of Blidworth, raised some very valid points in the earlier group on local variation. The method that my noble friend Lady Finlay has raised seeks to address some of the issues that many of us have with the Bill, in terms of having a centralised process. We need to find a way to avoid doctor shopping. The reality is that medical issues, legal issues, social issues and economic issues are not separate; they all intertwine with each other. What my noble friend has suggested is a clearer process and fills some of the gap, because there are problems with reporting in the Bill as it stands and there needs to be strict data collection. The commissioner cannot report what the commissioner does not know, and Parliament can regulate only through reporting requirements.

The noble Lord, Lord Deben, spoke about palliative care professionals. They are one of the groups that have consistently raised concerns about this Bill. We had an interesting debate about whether we should have a service separate from the NHS. It would be my preference to have something unconnected. That does not mean that doctors caring for patients cannot communicate and still provide care for somebody who wants to enter this process, but we have to think about the possibility that there may be some doctors who, for various conscientious reasons of objection, may not want to have this conversation with a doctor.

My amendments are looking at clinical trials for the drugs and the regulation of approved substances. I would be interested in the noble and learned Lord’s opinion. I recognise why a clinical trial for these drugs would be very difficult, but there may be cases where people who want to request assisted suicide would be willing to have an enhanced level of study to understand how these drugs work on a patient. It is important that we understand what drugs are going to be used. In different jurisdictions around the world, there are very different combinations, often referred to as a cocktail. In effect, the patient is being given a massive overdose, because we do not know enough about how these drugs work.

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Moved by

[Baroness Grey-Thompson]

149: Clause 5, page 3, line 5, at end insert—
“(A1) No registered medical practitioner may raise the subject of provision of assistance—(a) within 48 hours of a terminal diagnosis;(b) until a multi-agency assessment to identify the patient’s current support needs since diagnosis has occurred;(c) unless the necessary steps have been taken to meet the needs of the individual and both the assessment of and support for this is fully funded.”

[Baroness Grey-Thompson (CB)]

My Lords, the purpose of my amendments in this group is to ensure that all patients’ needs are taken into account and support is given so that people have a genuine choice. I am delighted that my noble friend Lady Campbell of Surbiton will speak to this group. Amendment 149 would ensure that the subject of assisted suicide is not raised within 48 hours of a terminal diagnosis. Perhaps this should be considered a cooling-off period. I have been with someone when they received a devastating diagnosis that they were dreading. They had not considered assisted suicide, but neither of us heard much after initially being told.

This is about a timing issue that could be seen to be a power imbalance or an implied endorsement. Options need to be very carefully discussed. If discussed straight away, treatments might seem so awful that assisted suicide is considered the best option. It might be quicker or easier to talk about this than a complex set of treatment options. To give patients choice, a multi-agency team assessment should take place to identify current support needs and ensure that steps are being taken to meet those needs.

This amendment would also offer some protection to doctors. If the conversation is discretionary, there may be a difficult legal dilemma: if it is raised at the initial consultation, it might be seen to be implicit coercion, but if doctors fail to raise it, that might be considered blocking access. There was a case in South Australia, mentioned in the Voluntary Assisted Dying (Voluntary Assisted Dying Board Annual Report 2022-23). Siblings said that, when they were with their relation, who was given VAD, it was the only time that doctors had shown empathy or understanding. The Medical Defence Union, which supports 200,000 healthcare professionals, is deeply concerned about the appropriate time to raise the subject.

This leads us into a grey area of suicide ideation. We fund suicide prevention; we do as much as we can to prevent someone dying by suicide. This Bill could lead to unforeseen consequences. As previously debated, it does not guarantee a quick or painless death, and if this process exists, the rate of suicide may even rise, as has happened in Australia in the over-65 age group.

There is also an assumption that if a terminal diagnosis is given, the process will be entered into, which might not be the case. ONS data from 2022 shows that people with terminal conditions can feel suicidal. One year after diagnosis for low-survival cancers or COPD, the suicide rate for patients was 2.4 times higher than the suicide rate for the matched controls. One year after diagnosis for chronic ischemic heart conditions, the suicide rate for patients was nearly two times higher than for the matched controls.

In oral evidence, Dr Price said that, of those who would qualify under the Bill,

“around 20% will have diagnosable depression, around 10% will have a wish to hasten death, and around 4% will have a more persistent wish to hasten death”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 270.]

She added:

“Those who had a wish to hasten death were 18 times more likely to also feel suicidal”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 276.]


The Royal College of Psychiatrists has raised issues, stating that doctors do not know how to assess the presence of depression. In a large-scale survey of professionals in England and Wales, co-authored by Professor Gareth Owen in 2021, only 6.9% of non-psychiatric doctors rated themselves as assessing capacity “very well”. When Fazilet Hadi from Disability Rights UK gave evidence, she said:

“We often find that doctors, because they cannot treat or cure us, do devalue our lives”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 29/1/25; col. 180.]


She was referring to disabled people.

The VAD review board of the Australian state of Victoria says that doctor initiation might be the reason for increased take-up. Previously, there was a prohibition on doctors raising it, but that gagging clause has now been removed. A JAMA Psychiatry paper from 2019 also highlighted the heightened risk during the first week after diagnosis. It said:

“Clinically, our results identify specific cancers associated with significantly elevated risk of suicide”.


The combined literature suggests that the first week after diagnosis has the highest risk for suicide, and it falls thereafter. It therefore makes sense that those who have received a shock terminal diagnosis are most vulnerable and suggestible and may have low self-worth. Macmillan Cancer Support recommends a holistic needs assessment as part of cancer care. The Bill will be better for having this assessment built in and will lead to more patient-centred care. It is impossible to have true agency when only one realistic choice is offered. That is why it is crucial that the patient’s current support needs are identified after diagnosis.

I strongly support Amendment 155 in the name of the noble Baroness, Lady Keeley. I feel very strongly that patients should be able to discuss their diagnosis and treatment with no fear of potentially being encouraged or having this process suggested to them.

On Amendment 176, we have covered complications before. The noble and learned Lord said in the Chamber that a discussion should take place before the first set of drugs are taken, and, if they do not work, the patient can choose to take a second dose of poison. But what is there to protect the doctor? Will the wishes be written down or witnessed? What should the doctors do if the drugs do not work? Should the doctor have a second dose with them? Will it be a doctor or, perhaps, a physician assistant? Is euthanasia the next step? It could be seen to be the next logical step in expansion. If one or two bad deaths are recorded, we might be told that we need to be more compassionate, and this is the best way to go.

In Hawaii, a doctor allegedly completed the death of a patient after the woman began choking; it was reported in the Honolulu Star-Advertiser. That doctor was charged with second-degree murder. Legally, a patient needs to know the effect of the drugs. Clause 12(2) refers to the need to discuss the complications, but we cannot play down the risks. Data from Oregon from between 2012 and 2022 showed a complication rate of 11%. In the Netherlands, in one-third of cases it takes up to 30 hours for a patient to die. As I have said before, assisted suicide is often represented as painless and quick, allowing for a calm and meaningful goodbye, but the reality from cases around the world shows that it can be far from this. The case of Kurt from Colorado has been raised previously by my noble friend Lady Finlay.

There has been much said in this Chamber about the importance of words, and I strongly believe that the word treatment does not cover what we are talking about. Using “treatment” to mean a lethal mixture of drugs intended to end life is clearly an attempt to soften the blow of reality. That is why people are not aware of the frequency of complications, and of the need to know the wishes of the patient in the event of complications.

My Amendment 200 is very similar to Amendment 149— it just seeks to amend a different part of the Bill. Briefly, I will talk to Amendment 200A and the unique context around the preliminary discussion, because failure to comply with regulations is appropriately treated as misconduct and subject to existing disciplinary procedures. I know that the noble and learned Lord is not keen to ask someone why they would want an assisted suicide, but I think the question should be asked. People do not need to answer, but we need to ask, to understand the process and look at whether there are other ways that we can improve our health service.

In Victoria, in 2023, the reasons for accessing VAD were not recorded, so the nature and source of the suffering—which is a clear criterion for access to VAD—is not known. This information could help us improve legislation in the future, or close gaps. The impact evaluation of VAD is undertaken by researchers funded by time-competitive grants, which means the results can be piecemeal and the data not always accurate. In 2023-24, 10 doctors with the highest VAD caseloads consulted on 55% of all VAD cases. In Australia, the VAD substance is often taken in the absence of a health professional, and there are no specific requirements or procedures for gathering or publishing information, including on whether complications have occurred.

Turning to my Amendments 207 and 207A, I have previously quoted Tommy Jessop and his concerns for people with Down syndrome. People with Down syndrome put great store in people in positions of trust around them, and the Learning From Lives and Deaths report that was published in January 2026 discussed some of the challenges. The proportion of deaths of people with learning disabilities classified as avoidable was 40.2% in 2023; it was 21.8% for the general population in 2022, so the figure is almost double. That demonstrates that there are problems in healthcare for people with learning disabilities. Some 72.7% of adults with learning disabilities who died in 2023 were reported to have received the reasonable adjustments they required when they accessed care, but conversely, 27.3% were reported to have needed at least one reasonable adjustment that they were not provided with.

There are already deficiencies in our system, and disabled people are discouraged by ableist attitudes in our culture. In 2024, Autism Alliance UK reported that 91% of autistic people feel that society does not accept them, or only sometimes accepts them. That is the reason why my amendments would widen the definition, so that we should be looking to support from a “guardian, or independent person”. Many families are loving and caring, but we have to recognise that some are not, and we should ensure that people have the right protection and support around them. I beg to move.

[Lord Weir of Ballyholme (DUP)]

My Lords, I will speak to my amendment in this group, Amendment 200B. It would insert a new clause to say that care professionals are not permitted to raise the subject of assistance. For the avoidance of doubt, the proposed new clause says that anyone who is engaged in patient care may not

“raise, suggest, encourage or initiate consideration of the subject of the provision of assistance under this Act”.

There are four main reasons why I have tabled this amendment. First, it would give clarity and absolute legal certainty to those in the medical profession and to care professionals regarding the initiation of discussion of the subject. We know that other parts of the Bill set out a clear position on what actions will be taken by medical professionals when it comes to the administration of the assisted death, but it is important that we have a clear legal position when it comes to the front end of the process. That is not simply to give assurance that there is clarity in the law; I think it would give comfort and certainty to anyone who is involved in the care profession. If I were a care professional, I would want to know with certainty what I am entitled to do and not entitled to do. My amendment would give a level of support to those people.

Secondly, the amendment is very much in the spirit of trying to create a distinction between healthcare and the provision of assisted death. A concern has been raised on a number of occasions in this Committee about the extent to which assisted death will alter the perception of the National Health Service and its mission statement. This amendment in and of itself would not solve all those problems, but at least it would go some way to having a level of protection for the National Health Service, which is very much the jewel in the crown of this society. It was created through probably the most significant legislation that a Labour Government ever put through, and it is important that we look at the implications of this.

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[Lord Falconer of Thoroton (Lab)]

A whole range of issues is covered to a large extent by the Online Safety Act in relation to the promotion of suicide, particularly to young people. That, in a way, is a separate issue from this issue. I fully encourage and support all attempts to try to reduce the risks to young people, but I am afraid that the Bill cannot take that on, on its own.

[Baroness Grey-Thompson (CB)]

My Lords, I thank all those who have contributed to the debate on this group of amendments on raising AS in conversation and preliminary discussion, including training.

I thank the Minister for her response to my amendments. However, given the government response and the question about funding, it lays open the bigger question of the whole Bill that many of us are grappling with: who pays for this and what that final bill may be.

The debate has gone in a slightly different direction from what I expected. It is interesting that the noble and learned Lord, Lord Falconer, differentiated in his response between non-disabled and disabled people. Independent advocates will come up in a later group, but I think it is really important that it is understood, as part of this group, when we are talking about learning disabilities, that it may be very difficult for someone with a learning disability to understand what an independent advocate is and what their role is. They may say that they do not need it but not really understand what they are saying yes or no to. We will cover that next week.

I am slightly worried that there may or may not be guidance from the GMC and/or the Secretary of State. I will be very interested to discuss that with the noble and learned Lord away from this Chamber. This is where we probably disagree. Those who support this Bill will talk about Victoria and say that it gives greater access; I say it is a slippery slope and that it is making it easier for a wider group of people to enter this process. We have covered in previous amendments the use of language. “Person with a disability” is not used in the Equality Act. I had hoped, through my contributions to previous debates, that there was some understanding of it and why organisations of and for disabled people are worried about this Bill. It is not just about the contents of the Bill; it is about the language of the Bill. Organisations of and for disabled people use the social model. I will not go through that again, but the language they choose to use is “disabled people”.

The noble Lord, Lord Weir, has apologised for having to leave, but he raised the issue of how disabled people are treated. I am going to raise a difficult question, not to anyone in particular but to the whole Chamber. It is rhetorical. How many in your Lordships’ Chamber have ever felt sorry for me because I am a wheelchair user? My previous career as an athlete negated some of that feeling because, if you like sport, competing for Great Britain is a privilege: of course it is. In my second career, however, I consider the way that I am treated every single week. I am a long way from my sporting career now but, if I am rushing to a meeting, I luckily do not hear “It is not a race” too often these days. I know: I am not in my racing chair and I am not wearing Lycra. I am not sure sometimes, when people say this, whether they think they are being kind, sweet or funny. I did not have a traumatic or dramatic accident; I was a wheelchair user from a very young age. There were a few points in my life when I had three spinal surgeries and experienced terrible pain, but I am healthy.

The noble Lord, Lord Weir, raised the different views that doctors have of people. I have said before that my husband had a traumatic accident at 21. He broke his back and spent nine months in hospital. Many people assumed that it irreparably changed his life. It did not. He went on to complete his PhD. He changed sports; he went from cycling to wheelchair racing and he met me. But the way that he was and is treated is very different depending on whether he is walking with his crutches or is occasionally using a wheelchair. If he is walking, people like to think that he has had a skiing accident or something quite cool but, when he is in his wheelchair, people talk down to him. His colleagues have completely forgotten that he has a PhD and have talked to him differently.

He had a stroke in 2020 and I was really worried about him going into hospital because I was not sure of the outcome. I had calls with doctors telling me about the impact of the stroke. The noble and learned Lord talks about doctors needing to know all the information. It was really clear in his patient notes that he had a spinal cord injury, but the doctors rang to tell me that both of his legs were really badly affected, and I was saying, “Well, that would be the spinal cord injury”. They then told me that his grip strength was really good. Well, 30 years of doing wheelchair racing and cycling and walking with crutches would make that happen; they had no idea what his grip strength was like before he had the stroke. So the information they were giving both of us was not very helpful at all.

All our experience of healthcare is very different. I had a doctor in a spinal unit ask me, “How did you catch spina bifida?” I laughed. I have been asked it several times. I think the first time was when I was in my early 20s, and I said I had caught it with a butterfly net—humour does not always go down very well, either in the Chamber or outside. I was really shocked that a doctor in a spinal unit was asking me how I caught a congenital disability. Because of my scoliosis, my internal organs are all in rather strange places in my body. Every time I go to the hospital for a kidney scan, I am asked, “Do you have one kidney?” I say, “I have two kidneys; look at the notes”. “Are you sure?” “Yes. I haven’t had an operation to remove one of my kidneys”. Every time you are measuring what you say because you do not want to offend doctors and you do not want to be rude or flippant. I sit there and say, “I have two kidneys. My right kidney is somewhere up under my arm”. “It can’t be there”. “Look at my notes”. Eventually, they find my kidney somewhere up underneath my right arm.

This is the frustration that disabled people feel. It is lovely to say that doctors will read all the notes and understand them, but actually something as basic as “I have two kidneys” is often misunderstood. So I challenge your Lordships’ Chamber. Have you ever pitied me? Do you think I am brave? Do you ever think, “Well, at least it’s not me?” Am I brave as a wheelchair user or brave because I was an athlete? How many people consider that, because of my impairment, I suffer? I apologise for sighing when the noble and learned Lord talked about the suffering of disabled people. My phone started pinging. I cannot read out any of the responses or the messages I have had on that, as all the language is unparliamentary. This is why disabled people are scared. The assumption is that we suffer. I do not suffer.

Disabled people are worried. That is why they are fighting this Bill. It is not kind, it is not sweet, it is not being understanding, it is not being compassionate. We are constantly having to try to fit into a version, an idea, of what non-disabled people think of us. If we dare challenge that, we have a chip on our shoulder, and we are one of those funny disabled people who just do not understand that we are meant to deal with people being kind to us. We have to deal with being patted on the head, literally and figuratively. It once happened to me in this building. It was a Peer who did it to me. I was with colleague who was a wheelchair user and we were chatting about a Bill that we were working on. The Peer came up to us and said, “Are you having a nice time?”—in that tone. We said, “Yes, actually, we’re debating the Bill that we’re working on at the moment”. The Peer ruffled my hair. This is patronising. This is ableist. It is not kind. How does the noble and learned Lord assume that people like me “suffer”? I am really squeamish about the word. So many people are frightened because of the assumptions that are constantly made. I want to take my challenge further. How do you see disabled people who might be on the streets? Are we deserving and undeserving disabled people? That happens between Paralympians and non-Paralympians.

My noble friend Lady Campbell of Surbiton talked about DNRs being put on healthy disabled people. By virtue of how people who speak remotely are able to contribute, my noble friend and the noble Lord, Lord Shinkwin, were not able to come back into the debate. My noble friend wanted to make it clear that she has to rely on doctors for everything in terms of her well-being. We put huge trust in those people. My noble friend has been in hospital many times, and it is important to listen to her experience of what it is like. I will keep raising this in terms of how I am able to contribute in debates. I can sit in one place—well, three places—in the Chamber. I cannot sit with my colleagues. Those speaking remotely cannot come back and ask questions. There was one time in the time that I have been here when five wheelchair users wanted to speak in a debate. We had to tag-team in and out of the Chamber. How many other noble colleagues have had to do that?

My noble friend Lady Campbell wanted to reiterate the unequal nature of the system. She also wanted to draw attention to a BMA survey looking at doctors and medical students who are disabled or have long-term health conditions. It was published on 3 December 2025. The author, Natasha Wilcock, is deaf. It raised the ableism that exists in that profession. The assumption is that the barriers are from patients, but actually there are deep-rooted issues in the experience of doctors who are disabled. A huge amount of prejudice comes from other doctors.

The noble Lord, Lord Shinkwin, again, was not able to come back in, but he wanted to raise a couple of points. He asked me to say that the noble and learned Lord did not answer any of his questions and that he would be happy if he could write to him.

If you treat your disabled colleagues with prejudice and contempt—sorry, I am again referring to the BMA survey—how do doctors treat disabled patients? The equity of treatment of staff and of patients is inextricably linked.