Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Stevens of Birmingham

Committee stage
Friday 27th March 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

I will be equivalently concise. It is important to connect Amendment 657, which specifies that assisted dying

“is not to be regarded as medical treatment”,

with our debate on the broader conscience protections that the Bill needs to include. The reason is not just that regarding assisted dying as a treatment is a conceptual error. As Wittgenstein pointed out:

“Death is not an event in life”.


We are talking about a personal existential choice. It is in no sense a treatment, but the Bill is silent on that question. As the noble Baroness, Lady Fox, and others have pointed out, that matters in the real world because, notwithstanding the employment protections included in the Bill, the professional duties on a doctor are potentially in play if assisted dying is determined to be a treatment. That will give rise to questions on the obligations of a doctor to raise assisted dying as a possibility, even if that doctor’s conscience is against participating. It will give rise to consent questions—we talked previously about the McCulloch test—and negligence questions from surviving members of the family. It is therefore important that we put this beyond doubt.

Given the understandable desire of the House to move on to the next group, I will just commend to fellow noble Lords an article in the BMJ from 9 June last year, written by Professors Gareth Owen, Alex Ruck Keene and Katherine Sleeman, which sets this all out beautifully. Their conclusion was:

“Statutory ambiguity serves neither professionals providing assisted dying, nor patients requesting it. Parliamentarians must consider this question”.


That is what we are doing. Amendment 657 would put it beyond doubt, and I hope that the noble and learned Lord the sponsor will accept it.

[Baroness Grey-Thompson (CB)]

My Lords, I have Amendments 673A and 679 in this group. Amendment 673A would provide that a medical practitioner who had opted into the process could choose to opt out at any time, and Amendment 679 would insert a new clause.

I will start with a number of questions for the noble and learned Lord. In a letter to Peers on 28 January, the noble and learned Lord said that he had had very productive discussions with Hospice UK on institutional protections, and that he would table amendments as soon as possible. I think that three amendments have been tabled, but I am not sure that they solve the problem that we are trying to solve. There is nothing in those amendments that requires any training to be kept up to date, there nothing about revalidation, and there is no requirement to be trained and up to date to enter the assisted suicide process.

Can the noble and learned Lord provide an update on his statement that he is working with officials to address Hospice UK’s concerns? Does he accept that the red line for many care homes is that they are not willing to tolerate this process on their premises? In the other place, the honourable Member for Spen Valley resisted a blanket institutional opt-out, arguing that it could lead to “stress and distress” for terminally ill patients if they are forced to move out of their “so-called home” on their final day. But what about the stress and distress of those who share that home, should the process take place on the premises?

Does the noble and learned Lord accept that it will be very difficult to extricate care home staff from involvement—such as organising appointments connected to the provision of assisted dying, assisting in the organisation and sending of documentation connected to its provision, or accommodating the doctor who must remain with, although not necessarily in the same room as, the resident until they die—were assisted suicide to take place on the premises? Do the noble and learned Lord and the Minister recognise the seriousness of a situation where hospices feel forced to close, which could cost around £8.4 billion a year to the public purse?

It has been very interesting to talk about the number of people who may be trained. However, if the equality impact assessment is anywhere near correct, the estimated number of patients in year 1 will be somewhere between “273 and 1,078”, and in year 10 it could be between “1,737 and 7,598”. This does not sit alongside the 310,000 people who accessed hospice care last year. Therefore, if there is no expectation of overwhelming demand from people wishing to end their life, why is there need for mass enrolment?

There might be a number of different reasons why organisations with principled opposition might want to be exempted: freedom of association in law for charities, legal rights guaranteeing patients a choice of their place of care, the cost to the public purse, freedom of religion and belief in law, and the public benefit of faith-based charities.

We currently have a fragile workforce. In 2024, the Royal College of General Practitioners surveyed GPs, 42% of whom said that they were unlikely to be working as a GP in the next five years. This brings us back to the number of people who we may need to have trained. Whatever we think the Bill says, I am concerned that it is not clear enough. We also cannot underestimate the pressure on doctors and medical practitioners who may choose to opt out. If they work in an organisation that feels very strongly that this process should take place on its premises, someone’s career might be in jeopardy if they are not willing to sign up to it.

The noble Baroness, Lady Fox, raised issues around porters. Although we have discussed prisoners in previous groups, we have not discussed prison officers in this group. There is another group of individuals—not just doctors—who might want to exercise a conscience clause. It might include administrators as much as anybody else who works in the system.

My noble friend Lady Watkins of Tavistock rightly said that many people would choose to have excellent palliative care. The reality, as we have discussed, is that it is a postcode lottery. It is a great shame that as part of this Bill we were not able to discuss the provision of palliative care—it was ruled out of scope—because I think it would have given many of us a level of reassurance if we could have debated that at the same time.