Terminally Ill Adults (End of Life) Bill

Baroness Hayman Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Lawlor (Con)]

I thank the noble Baroness for that, but I point out that the Netherlands has many significant problems to do with various aspects of its legalisation of certain medical actions and operations. I will not go into them, but other countries are suffering from a fallout of what is happening, especially those on a rail service from Amsterdam.

If we leave the door wide open, it can happen. A doctor may only be raising the possibility, but a patient may be more swayed by a doctor’s opinion than their own. Indeed, where no pressure is intended, the pressure may be there none the less. The position of trust can therefore survive only if the doctor recognises that their normal role is limited to supporting the health of the living, helping the patient to live life as fully as possible by managing an illness or its symptoms or coping through the ups and downs of treatment. Participating in assisting suicide, for those doctors who agree to do so, is an extraordinary non-doctorly role that they should enter into only at the self-initiated request of the patient.

[Baroness Hayman (CB)]

My Lords, I have found some of this discussion quite difficult to compute with my own very limited—non-doctor—experience of end-of-life care and relatives who have been dying. The noble Baroness, Lady Lawlor, spoke as if there was a very binary division between assisted dying care and palliative care. Yet the cases that I have been involved with and seen very closely have been of people very definitely frail and at the end of their lives, and where the range of options they wanted to talk about were not simply pain relief. This whole time, no one has mentioned the right of people to exercise autonomy, to stop eating and starve themselves to death. Does the doctor not consider what happens in those circumstances and talk about options then? There is the option, of course, to turn off life support. There is the option—which my mother chose—to refuse any blood transfusions. Doctors talked her through how that would reduce her life expectancy.

[Baroness O’Loan (CB)]

My Lords, I will speak to Amendments 150, 156, 166 and 205, to which I have put my name, and in support of other amendments in the group.

As drafted, the Bill would permit a discussion about assisted dying with the patient before any requirement to discuss expert palliative care. The noble Baroness, Lady Blackstone, said that it would be irresponsible not to allow this. In Australia and New Zealand, doctors are not permitted to initiate such discussions.

As drafted—

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[Baroness Hayman (CB)]

It is very important that the doctor should listen to the wishes of the patient. I certainly think that a doctor should not be able to force-feed a patient in those circumstances.

[Baroness Meyer (Con)]

My Amendment 169 is a very modest one. It simply proposes that, if the Bill proceeds, before any doctor raises the possibility of assisted dying, the patient should first receive a psychological assessment from an appropriately qualified specialist. This is not an onerous hurdle but a basic and sensible safeguard.

As many noble Lords have said, when people are approaching the end of their life, they are often in a very vulnerable state. Feelings of sadness, anxiety or despair are not unusual and even the most resilient of individuals is affected. That vulnerability can become much more acute when patients are told that they have a terminal illness and perhaps only six months to live. Such news can be profoundly shocking and can often trigger despair and even suicidal thoughts.

The evidence reflects this reality. Research drawing on data from the Office for National Statistics, King’s College London and the University of Manchester shows that the risk of suicide rises significantly in the first six months after diagnosis. In other words, the period immediately following diagnosis is often when patients are at their most fragile psychologically. This is precisely why we must proceed with great care.

Before introducing the possibility of assisted dying, it seems only prudent to understand the patient’s mental state. Without a proper psychological assessment, we cannot know whether patients are coping as well as they appear to be or whether they may be struggling with depression and even suicidal thoughts. Studies suggest that from 20% up to 40% of patients with advanced cancer experience clinical depression. Dr Rachel Clarke, a palliative care physician, warned the Commons Public Bill Committee exactly about this situation, saying that raising the question of assisted dying can unintentionally place pressure on a vulnerable patient.

Autonomy is often far more fragile and complex than we assume. When someone has just received devastating news, even a carefully framed question may be interpreted in ways that we never intended. Both the Royal College of Physicians and the Royal College of Psychiatrists, as well as palliative care and disability groups, have warned that vulnerable patients are not adequately protected by the Bill as it currently stands.

Ordinary doctors are not usually trained to make complex psychological assessments. According to the Government’s own impact assessment, doctors involved in these early conversations may receive as little as 90 minutes of e-learning and one hour of an online interactive session. Surely that is unlikely to equip them to recognise subtle depressions or suicidal feelings in patients who are already known to be at great risk.

My son is a consultant physician at the largest psychiatric hospital in Berlin. For many years he has worked on the front line treating patients in acute crises and teaching junior doctors how to recognise mental illness. His view is very clear: depression can be remarkably easy to miss if you are not a specialist.

We assume that every human has free will, but this will be impeded by severe depression. People suffering from severe depression may appear calm, rational and composed—they may even seem cheerful—yet internally they may be struggling with profound hopelessness and suicidal thoughts that impair their judgment and decision-making. Research published in the Lancet has shown that general practitioners detect depression in only 50% of cases. This is not a criticism of them. It simply reflects the fact that recognising depression, especially in people with a serious physical illness, requires time, training and specialist experience. In the context of assisted dying, this matters enormously. A misdiagnosis is not a harmless mistake. It can have fatal consequences for a patient whose suicidal thoughts might be treatable and whose desire to die may have been only temporary.

For that reason, many psychiatrists across the United Kingdom and Europe believe that a specialist psychological assessment should come at the very beginning of the process. It is a careful, humane and responsible safeguard that ensures that a request for assisted dying reflects a settled decision, not untreated despair at a moment of profound vulnerability. If we fail to make that assessment first, we risk confusing a treatable cry for help with a settled and autonomous decision to die. To proceed without that knowledge is unfair, unethical and legally questionable, as many noble Lords have said before me. The noble Baroness, Lady Finlay, one of the most authoritative medical voices in the Lords, has warned:

“Without proper psychiatric assessment, a request to die may reflect treatable depression rather than a settled wish to end life”.


I very much hope that the noble and learned Lord, Lord Falconer, will take into account these worries and accept my amendment.

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Finally, the noble Baroness, Lady Hayman, spoke as if there was not already at least 3,000 years of philosophy and moral theology devoted to the difficult issues she raised. We know that nobody is obliged to accept medication that keeps them alive artificially if they decide that it is not the right thing for them. Nobody is obliged to accept more blood transfusions that—

[Baroness Hayman (CB)]

I am grateful to the noble Lord. I was trying particularly to get to the point of the doctor’s role. I understand what he says, and he is quite right. I was trying to advocate that doctors should be able to have conversations with their patients about care, not just medical treatment—which is the phrase he was using before—to look holistically at what that dying person wants and needs, and be able to respond to their desire not to have any more pain, drugs or treatment. The doctor should be able to talk freely about all those options. In my view of the world, that would include assisted dying, but there is a spectrum.

[Lord Moylan (Con)]

There is, indeed, a spectrum, and the doctor should be able to speak. As I say, there have been 3,000 years of thought given to this. What has resulted from that is a firm conviction that, while some medications that do you good may also do harm—and the doctor has to make careful judgments about that—the active killing of a patient, the actual administration of substances with a view solely to bringing about death, is morally abhorrent.

It may not be morally abhorrent to the noble Baroness, but she has to understand the novelty of this and the violence that she is doing to our inherited moral framework when she—