Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Baroness Lawlor

Committee stage
Friday 27th March 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I have 12 amendments in this group, and I am going to speak also to Amendment 241, which is in the next group but which probably fits better in this one, because it is about the time period for recording information.

The words “as soon as possible” appear eight times in this Bill in relation to the recording of information. I believe that that is a little too vague; it feels like a non-binding term without a strict or official definition. It makes me think of the parliamentary term “soon”, often used by Ministers to suggest something may be coming soon—next week, next month or possibly never.

I think about this process in what might be a busy hospital. It is important not only to gather data correctly but to record it accurately and at pace. The lack of a precise timeframe makes it feel as though we are giving busy staff too much flexibility, which might end with it slipping down the list of things that they need to do when there is a lot of call on their time. It is about providing and recording information that can be open to scrutiny, but the phrase could be used to deflect an immediate challenge or an urgent question, and cannot be followed up in an appropriate way.

On my Amendment 214, I expect there to be some pushback and to be told that I am being overly prescriptive. However, it is important to understand why the person wants to enter this process and whether there are other events, family issues or anything else that could possibly impact it, such as a lack of health and social care. I have other amendments on support, which have been discussed in other groups.

Amendment 214A is about having a witness present—someone who can record the conversation. My noble friend Lady Cass in the earlier group talked about the importance of having a person there; someone who can watch facial expressions, take the mood of the room and possibly look out for coercion. That would allow those doing the initial recording to actually listen to what the person is saying, rather than necessarily having to record every part of the conversation. Amendments 217 and 218 are about recording in a timely manner.

Amendments 562, 563 and 564 are about how we record the cancellation of the process. I was interested in the amendment proposed by the noble Lord, Lord Wolfson of Tredegar, which looked at recording the cancellation immediately. That is a better version than the one that I proposed. If someone decides to stop the process, everybody needs to know that straightaway, rather than something getting lost in reporting or a medical practitioner or a doctor assuming that the person still wants assisted dying.

It is also important to record how many times somebody may have entered and dropped out of the process, which is covered in another group. That would check that someone is not being guided by mental health issues, suicide ideation or pressure. These things are important. We need a minimum standard, and doctors and patients need to know what to expect from each other. When the Delegated Powers and Regulatory Reform Committee looked at the Bill, it said that it lacked definition and that there was lots of unknown information being recorded.

We also have to think about non-compliance. I have read the Bill many times, and there is not enough in it about what happens if this information is not reported correctly. In Oregon—which has been mentioned many times—we know that around 70% of information is not recorded in the paperwork, so we do not know if people are having a good death or not. The Delegated Powers and Regulatory Reform Committee recommended that the Bill needed amendment. The timely reporting of information avoids any sanitation of the notes. It is very easy to forget—I do all the time. I scribble notes and come back to them, even just a day later, and cannot necessarily read what I have written. So this is crucial to how the process will work.

Proper recording should also be there to protect the clinician. This is the complication of the Bill. I have 13 amendments that I am talking to. Actually, I am asking for very little change to the Bill, but the Bill has to be amended in so many different ways. This group also fits with the previous group. In another place, the honourable Member for Batley and Spen, Miss Leadbeater, said:

“I agree that, under the provisions of the Bill, the doctor will have a duty to lay out options available to the patient, if they meet the eligibility criteria—absolutely. That is the whole purpose of the Bill”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 4/3/25; col. 663.]


That is why it is so important that the information is recorded properly.

One of my passholders, Dr David Prosser, is a specialist in forensic psychiatry who works within NHS secure services and His Majesty’s Prison and Probation Service. We have spent a lot of time discussing the Bill: I have been talking to a doctor who could be at the very sharpest end of this. His view is that a doctor has to have very clear criteria against which any assessment is made.

It is also important to achieve operational consistency and quality, because we do not want information being recorded in a different way in different hospitals in different areas. A small business might have to provide more documentation to HMRC than a doctor working in this area. These amendments are not to overcomplicate the process; contemporaneous documentation is really important. This also fits into how the commissioner might oversee compliance with the process if the records are all kept in a different way.

When, in previous groups, we debated face-to-face discussions, the noble and learned Lord, Lord Falconer, said, in that situation:

“It is wrong and dangerous to try to use a phrase such as ‘reasonably practicable’”.—[Official Report, 30/1/26; col. 1214.]


Can the noble and learned Lord therefore explain why it is it okay to use that phrase when we are talking about recording data?

[Baroness Lawlor (Con)]

My Lords, I will speak to my amendments in this group. They aim to tighten the recording rules in Clause 7 and would make them even tighter than the seven-day limit proposed by the noble Baroness—to whom I am very grateful for her remarks. I propose that, where the discussion is with a practitioner in the patient’s own GP practice, the record of the relevant discussions and assessment is written and saved online on the same day; and that, in other cases, the practitioner must submit the record to the patient’s medical practice, and the commissioner, within a week. My amendments would also require the practice to include this in the patient’s online records. My amendments would impose similarly tight time limits for the submission of the co-ordinating doctor’s assessment.

Speed in recording discussions is of the essence. My experience as a historian, often working with hundreds of documents over a period of a week or even a day in history, suggests speed is important. These are government documents or the private records of officials and politicians. My work suggests that every hour that passes between a conversation and the recording of it brings a loss in accuracy and nuance. In the matter of deciding to take your own life, it is particularly important that the record is as accurate and precise as possible. The same-day requirement should make for greater accuracy, including details that might otherwise be lost if more time elapses. Even insignificant details can turn out to be important.

By contrast, allowing a period of time—the Bill says “as soon as practicable”—will tend to mean that details can be blurred into a general pattern that a doctor may form as a result of having seen a number of patients seeking an assisted death. The individual nature of the case may be lost. A report written up and submitted on the same day is less likely to be affected by hindsight or a desire to tailor the report to ensure that the practitioner will not be held responsible should a breach occur. These amendments in my name leave the medical practitioner the choice of writing a handwritten note at the time or just after the appointment, or keying it later that day into the computer. Although it may be argued that a doctor needs a longer period to see to the paperwork or that the medical practitioner should be allowed more individual choice about how they handle the recording, the obligation for speed and a formal process is imposed by these amendments and is justified, since a person’s life is at stake.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Baroness Lawlor

Committee stage
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.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Baroness Lawlor

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I was going to speak to Amendment 146, in the name of my noble friend Lady Eaton, to which I have added my name. It concerns care homes and a duty on the commissioner to identify and monitor emerging risk and report systemic risk to the Secretary of State so that preventive steps can be taken. However, as the noble Baroness, Lady O’Loan, has so ably introduced it, I simply convey the apologies from my noble friend Lady Eaton, who sent them last night.

The other amendments that I support in this group—Amendments 436, 439 and 913—I will not go into, in the interests of parity. The last one is about conflict of interest. The others seek to put a duty on the commissioners to serve as an extra safeguard, so that the exercise of the commissioner will not simply be to tick boxes but to request further paperwork if necessary, or that the families will be notified, as in the amendment tabled by my noble friend Lady Maclean. That can act as a trigger for a discussion with the families and perhaps prevent the coercion which can happen.

Amendment 913 seeks to prevent those involved with organisations promoting assisted dying, whether as volunteers or employees, being a commissioner, a deputy commissioner or on the staff. There is a conflict of interest if those who have a responsibility for seeing that procedures for assisted suicide are not abused should themselves be actively committed to the cause of promoting assisted suicide. The conflict of interest is so self-evident. I imagine that it is an oversight that a clause to this effect was not included in the original Bill. Perhaps the noble and learned Lord, the sponsor, could comment on that and tell us whether he envisages a conflict of interest and how best we can prevent it.

I associate myself with the very strong expression of support for the noble Baroness, Lady Finlay, who tabled Amendment 913. The support was to give sympathy against the attack on one of the leading medical authorities in this country—a specialist in palliative care who has put her knowledge, expertise and time at the service of those most in need of palliative care. She has done so with her time and her knowledge. Not only that but she has served this country in all kinds of ways: teaching students, seeing patients and building up her profession, which is one of the most important specialisms in medicine. She also gives such service to this House, giving her time selflessly, with her knowledgeable contributions and in sitting on the Woolsack, night after night. We owe her an enormous debt of gratitude, not only in this Chamber but in the whole country.

[Baroness Grey-Thompson (CB)]

My Lords, I have two amendments in this group, the first of which is Amendment 125. I am concerned because the Bill as it stands leaves the responsibility of appointing the commissioner to the Prime Minister alone, with no guarantee of the usual safeguards that are applied to public appointments. As a Cross-Bencher and someone who has been through the independent process— I owe my seat in the Chamber to that process— I believe it is vital.

In October 2025, the Cabinet Office released an updated Governance Code on Public Appointments. The first two requirements are for integrity and openness: Ministers must declare and resolve any interests and relationships, and the processes for making public appointments should be open and transparent. My amendment seeks to bring more transparency and openness, but would leave the final decision with the Prime Minister—once, of course, they have consulted with Welsh Ministers.

There are no such requirements in the Bill for this, just that the commissioner must hold, or have held, office as a judge of the Supreme Court, the Court of Appeal or the High Court. That is a reasonable assumption. However, there is no requirement for the commissioner to declare and resolve any interests and relationships or for the appointment process to be open and transparent. We have to declare virtually everything that we do, so it is not inappropriate that the commissioner should have to do so as well.

I strongly agree with the noble Lord, Lord Deben. That person has to command respect. However, the reason I am asking for this is also to safeguard the individual. We see in the amendments today that the Bill is weak on data and reporting provisions.

My noble friend Lady Finlay raised what has happened in New Zealand. Simon O’Connor, a former New Zealand MP, described some troubling incidents there around the two doctors. Dr Dana Wensley resigned due to her concerns regarding serious problems with the committee’s ability to oversee the implementation of assisted suicide and euthanasia. Dr Wensley is an ethicist. Dr Jane Greville, a palliative care specialist, was pushed out, it is thought, because she was raising too many concerns about the operation of the new law. Both Dr Greville and Dr Wensley went public and stated that the committee’s oversight of the law was so limited that wrongful deaths could go undetected. They cited being extremely concerned about how little information they received relating to patient death, leaving them feeling constrained to the point of irrelevance. They both said that the system was so broken that they would not have been able to identify if somebody had wrongly died.

What happens if normal standards are not followed? We can compare it to someone with significant shares in a drug company being able to decide what drugs the National Health Service could use. As others have said, the assisted dying commissioner will have tremendous oversight. They can make appointments to the list of persons eligible to sit on the assisted dying review panels. They can make arrangements in relation to panels, determine applications for reconsideration and monitor the operation of the Act. This role should be defined by Parliament, not by their own ideas. I would like the noble and learned Lord to give assurance that this appointment process will be looked at to see how we can ensure that the Nolan principles for public appointments will be adhered to.

Looking at the possible scenarios, this individual could be called into a meeting with the Chief Medical Officer to discuss the future of palliative care. They will hold a great deal of power in their hands.

At the Lords Select Committee, Justice Minister Sarah Sackman confirmed that there would be no support to engage or challenge the commissioner. I am very interested in the noble and learned Lord’s view on whether legal aid would be possible to do this. In the case of exceptional funding in coroners’ cases, we might have to be in the position where a person is dead before they get any support to challenge the decision that was taken.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Baroness Lawlor

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Lawlor (Con)]

I thank the noble Lord for the intervention but, if he will permit me, I would like to finish. We can imagine many different sorts of conversation. If noble Lords would like to hear more examples, I am sure they will ask for them.

None of these possibilities is ruled out by the Bill as it stands. They would not be considered an instance of coercion or pressure. Nor will it be possible when this Bill becomes law to investigate with due legal process whether someone has been instrumental in inducing a person to assisted suicide, provided they are covered by the terms of the Bill. Clause 34 outlaws dishonesty, coercion and pressure, and Clause 35 the destruction of documentation or the falsification of what purports to be a declaration, but the Bill does not address other means of inducing someone to opt for assisted dying. Under Clause 32, criminal liability for providing assistance will be removed from the Suicide Act 1961; as will civil liability under Clause 33, which stipulates that

“providing assistance to a person to end their own life in accordance with this Act”

or assisting a person to end their life while performing a function under the Act does not of itself give rise to any civil liability.

Moreover, the Coroners and Justice Act 2009—the duty to investigate certain deaths—will be amended so that the reference to unnatural deaths does not include a death caused by the self-administration by the deceased of an approved substance within the meaning of this Bill. Similar changes will be made in respect of arrangements for medical certificates under the new regulations and for Schedule 1 on suspension of investigations. These changes mean that there will be no effective way of investigating improper behaviour after an assisted death has taken place. The Bill already, in effect, recognises this problem by making absence of coercion and pressure a condition for eligibility for someone to be given assistance to die under its provisions. It opens the possibility to object to an assisted suicide going forward on the grounds that the person about to die has been coerced or pressured.

Furthermore, Clause 10(2) gives the first doctor—the co-ordinating doctor—the duty of ascertaining that the person concerned has not been coerced or pressured. We have heard from the noble Baroness, Lady Finlay, and others who have great professional experience in looking after people with terminal and other grave illnesses how difficult it is to establish coercion. It is often very difficult to establish coercion. It is true that the Bill wants to establish coercion—or so it alleges—but, as has been argued, the grounds are too narrowly defined.

A person in a poor mental state, because of their terminal diagnosis, is especially likely to be open to suggestions from other people, especially figures of authority such as their doctor, or their own family, whom they want to believe are thinking only of them. If we want to be sure that the decision to have assistance to die is genuinely their own, it is not enough just to rule out coercion or pressure. We need also to outlaw subtler, more insidious, but no less effective forms of persuasion. There is a danger that, if the Bill includes, as it does now, just a prohibition on coercion and pressure, the inference will be drawn that any form of encouragement or inducement, so long as it is not coercion or pressure, is allowed. Surely that is not what the proponents of the Bill would want.

The noble and learned Lord the sponsor and his co-sponsor are putting forward the Bill under the banner of giving dying people more choice over what happens to them, and providing greater freedom. Surely, in pure consistency with this underlying purpose, they must be intent on ensuring that the irrevocable choice a person makes to undergo assisted suicide is genuinely that person’s free choice, and therefore must support the amendment I am proposing, and indeed the amendments that others are proposing.

I hope that we can go even further. If my amendment is adopted, a further provision could be added to Clause 10(2), making it the duty of the co-ordinating doctor to ascertain not just that there was not coercion or pressure but that the idea of assisted suicide was not suggested to the person by another party.

[Baroness Grey-Thompson (CB)]

My Lords, I have three amendments in this group—Amendments 52, 58 and 181—which seek to explore coercion and ensure that people are free from undue influence, including social, economic and care-related pressures—not only active coercion, which is very difficult to prove. These amendments also seek to understand the reasons why someone would choose to end their life, so that we can look at how we might improve further NHS services or use that in important debates on reforming the welfare system.

It was raised on the first day in Committee that definition is important, and I believe that much further work needs to be done on the definition of “pressure” and how it becomes a strict liability. However, we find that it is very hard to gather data. We have been told that there is no evidence of coercion in other countries, but Ellen Wiebe et al, in a paper on the reasons why people request assisted dying, highlighted some of these very important issues.

In 2018, Dr Wiebe’s team looked at 250 deaths in Canada and noted that data was collected differently across different jurisdictions. Of the 250 deaths, six charts had no reasons; 56 gave one reason; some of the charts gave three or four reasons, but only two reasons were coded. This does not show the whole picture of why people are choosing to end their life on top of having a terminal condition. Looking to other jurisdictions, in Belgium, legal requirements were more frequently not met in unreported cases of assisted dying than in reported cases, and we still do not really know how it is practised. In Oregon, the data and the records are destroyed a year after someone has died.

Admitting coercion is highly unlikely to occur, so that is why we need a robust process of identifying it so that it can be acted upon. I look forward to debates in other groups on the role of the coroner in this. It is hard to find studies on coercion—I spent a lot of time trying—but it is possible to find a huge number of individual cases. In Canada, Lisa Feldstein was with a patient when the patient was pushed towards assisted dying. The person who suggested it did not realise that Ms Feldstein was a lawyer. Heather Hancock, a woman with cerebral palsy, was told by medical professionals while she was in hospital that she was not living but merely existing. I wonder how that made her feel.

Again in Canada, slideshows of MAID have been shown to healthy patients, which would make you think as your condition deteriorates that you do not have any other options apart from ending your life. In Australia, in November this year, three people were arrested after a man was found dead with euthanasia drugs in his system, and the police believed he was part of a suicide encouragement ring. Ruth Posner ended her life abroad with her husband; a friend spoke publicly about Ruth’s emotionally controlling husband and did not believe it was a free choice. But the difficulty is that, once you are dead, it is really hard to prove. As the noble Baroness, Lady Berridge, raised, the Bill does not take into account the impact of social media.

In New Zealand, doctors are told to do their best to detect how pressure may be placed on a patient, but this is completely unclear as to their duties and does not stand as a safeguard. This is listed in the review of the End of Life Choice Act 2019 in the report published on 19 June this year. In Washington state, physicians are rarely there when lethal drugs are ingested, which makes it nearly impossible to ensure that the patient’s decision is free from last-minute coercion, impairment or doubt. In Holland, it was found that GPs in an interview study felt pressured by emotional blackmail, family influence, time constraints or systematic pressures when processing assisted dying requests. As mentioned before, real-world data from Oregon shows that the top reported reasons for assisted death are loss of autonomy, loss of enjoyable activities, loss of dignity and being a perceived burden—not uncontrolled pain, which is missing from the Bill.

At the Select Committee evidence sessions, the honourable Stephen Kinnock, the Minister for Care, was asked about protecting vulnerable people, but the panel has no power to ensure that unmet needs are supported, such as increased care hours, adaptive technology and palliative input. We should ensure that the law does not default to death as a substitute for deficient services, which is an ethical red line repeatedly emphasised by disability advocates and UN experts reviewing permissive regimes. Best practice guidance from jurisdictions with assisted dying frameworks highlights the importance of exploring whether enhanced external support might address these factors, and it should be the case that the approval process checks them.

What is presented as a voluntary choice may in fact be a choice made under hidden pressure. The Australian Care Alliance research shows that the training for voluntariness and assessing absence of coercion was a two minute and 10 second video, with slides that take approximately two minutes and 50 seconds to read. Qualitative reporting in Canada shows disabled applicants citing inadequate housing or lack of care rather than unmanageable pain.