Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Friday 9th January 2026 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I have put my name to a number of the 79 amendments in this group. As the noble Lord, Lord Carlile, said, there was initially provision for judicial management of these cases, given the magnitude of the risk. The assisted dying panel was substituted as a consequence of the difficulties that were identified.

So, what is unsatisfactory about the assisted dying panel process, and why is change necessary? Despite the remarks of the noble Lord, Lord Pannick, the Bill does not provide for family knowledge or involvement as a right. Surely, we do not want our people to end up in the position of the woman who heard of her mother’s death in Switzerland when she was told the ashes were in the post to her. We do not want families to discover after the event that their child, whom they are trying to support after a diagnosis of a terminal illness, having reached the grand old age of 18, has opted for physician-assisted death, leaving them no chance to intervene.

Inevitably, there will be major difficulties in providing professionals to act as panel members. We know that the lowest level of assisted dying deaths is in Oregon, where it is nearly 1%, but in Canada and the Netherlands it is nearly 6%. If only 1% of deaths here were assisted deaths, it would be 6,000 deaths a year. This is the figure referred to by Sir Nicholas Mostyn when addressing the Commons Public Bill Committee.

There are only 29,500 social workers in England and Wales, according to the impact assessment. There are quite simply not enough of them to care for and protect children and vulnerable adults now, so what element of the crucial and challenging work of child and vulnerable adult protection would be sacrificed to support the existence of assisted death panels? This is a very real question. The Royal College of Psychiatrists has said consistently that it cannot support the Bill, and there is a major shortage of registered psychiatrists.

As the noble Lord, Lord Pannick—and, indeed, the noble Lord, Lord Carlile—said, the Bill requires that the legal member of the panel holds high judicial office, is a KC, etcetera. But there are currently only 107 High Court judges, 20 Family Division judges and 41 designated judges, and our KCs tend to be fairly well occupied. Nearly 104,000 children were trapped in the family court backlog during 2023. The average time for dealing with cases involving children—very important cases—is 43 weeks, and there are currently thousands of couples and nearly 20,000 children waiting for hearings. Given the delays, and despite the intervention of the noble and learned Baroness, Lady Butler-Sloss, I do not believe that family court judges would be available to act as legal members—yet the decisions by the panel required by the Bill must be subject to time pressure, because there is the requirement of death within six months. Even if we allowed only three hours a case, at the lowest figure of 6,000, we would need 54,000 hours of members’ professional time. If the figure was 5%, it would rise to 270,000 hours.

How is this to be funded? How are these professionals to be trained, supervised and managed? What will be the cost of the panel members and the administration of the panels? The impact assessment provides no answers to these questions. Where is the money coming from? It is not coming from savings in care, because most palliative care is actually provided by donations from the public; only 30% is funded by the state. Therefore, the system now in the Bill is simply unsafe. It provides virtually no protection for the weak and vulnerable; it is not workable.

The very extensive amendments tabled by the noble Lord, Lord Carlile, and others are complex. Like the noble Baroness, Lady Hollins, I welcome the introduction of the changes in the terminology of, for example, a terminal illness and lethal drugs. However, the Bill’s current panel provision would be replaced by this new system. Judges would be able—and would be most likely, I think—to appoint a medical adviser in each case, as provided for in proposed new subsection (5) of Amendment 426. That would provide additional assurance.

Amendment 116, tabled by the noble Lord, Lord Carlile, sets out an excellent framework for judicial decision-making. It includes the consideration of six complex reports, including submissions by the applicant; evidence about diagnosis and prognosis of the illness; evidence of a specialist medical practitioner’s assessment of a mental condition; evidence about living conditions; evidence about the availability of suitable housing, effective palliative care and social care; evidence of a specialist palliative care practitioner; and evidence of people who are familiar with the applicant’s character and personality. This is the kind of evidence that would enable proper consideration to be given to this momentous decision to apply to end one’s own life with the assistance of the state—a state that has previously devoted all its resources to protecting and saving life.

If such proper evidence is to be considered in each case in which an assisted death is sought, there would be a requirement for some further 30,000 reports from specialists of various kinds as well as social work reports on a person’s living conditions. Without this type of evidence, there could be no assurance that an applicant actually satisfies every requirement of the Bill, that there has been no coercion or undue influence, or that the person has simply lost all hope of anyone helping them live out their life in peace and with dignity. There is also a major shortage of specialists in virtually every area of NHS work. Although the system proposed in the amendments in this group does not immediately provide a definite route for family and friends who fear coercion and so on, that would be required.

If there were 6,000 applications for assisted death a year, and if a judge had to gather and consider all the evidence and reach a conclusion, it would probably take him or her at least four hours—about 24,000 hours of judicial time would be required. Family courts have frequently been described as complex, inefficient and difficult to navigate for families without legal support. The PAC heard concerns that court staff, legal advisors, and Cafcass staff are

“poorly resourced or trained to support domestic abuse victims, and that their needs are not being met by the family justice process”.

Moreover, if those courts cannot identify and provide for abuse arising in the current context of current cases, how will they identify abuse in cases where a person seeking an assisted death has been subject to coercion or abuse? Yet failure to do so may well result in the state dispensing death to someone who is not making an independent and informed decision.

There is also a problem about the cost of lawyers. The current fees for the family court range from £579 to £200 per solicitor per hour. Noble Lords can calculate what this would cost a family seeking to be represented in the court. The assumption must be that this will not be publicly funded. The PAC recently published a report about access to legal aid. It states that about 24% of the population, often those most in need of legal assistance—disabled people or those living in poverty—are excluded from the remote access now provided by digital means.

These matters should have been considered in a public consultation, but there was none. There should have been an assessment of risk and cost, but there was none. If judges are to make these decisions, we need more judges. It is not enough to say that judges will deliver if we tell them to. The reality, as we know from examining and observing the operation of the courts, is that cases are delayed. There are 80,000 cases alone waiting in the criminal justice system for trial. Rape cases are being listed for hearing in 2029. How are we to care for rape victims and other litigants when we are also providing this extra urgent need to make determined applications for assisted death? I therefore ask the Minister: how do the Government propose to resource even the panels’ work. Is the intention to designate other judges who sit largely in the Crown Court? A person making an application will have six months to live, so this is going to be urgent in any situation.

The amendments tabled by the noble Lord, Lord Carlile, are necessary and would provide far greater protection. However, if the original proposal, which gave very little protection and was secret, could not be delivered, it is difficult to envisage how judicial capacity could be found to deliver the service in a timely manner. An impact assessment is urgently needed before your Lordships can rationally make a decision on these cases.

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[Baroness Hayter of Kentish Town (Lab)]

I will take the advice of the noble and learned Baroness, Lady Butler-Sloss, and now get rid of what I was going to say, because the noble Lord, Lord Markham, has said most of it. I now have only three points to add, so I thank the noble Lord for that.

First, the big discussion is on whether it should be a court or panel. The reasons for the panel have been put, so I do not need to repeat that. The only thing I would say is that when this was discussed in the Commons, it was not about the capacity of the courts that made them make the change to a panel but about the advice they got that this would be a much better, holistic and patient-focused way of doing it. In fact, making sure that that bit was added was very much welcomed by the British Association of Social Workers and the Association of Palliative Care Social Workers.

Secondly, the mention just now of legal aid says it all. Surely, we do not want this to be an adversarial process. It should not be argued in front of a court that way. I want to be very brief, because I am taking the advice of the noble and learned Baroness to be very brief, but we want this to be a conscientious decision and not one that is adversarial, which is why I think the panel would be so much better.

Lastly, this is not a life-or-death issue, because these people are dying. We are discussing only when they die, not whether. That is different from deciding that a baby will die who was not going to die anyway, or even someone in a permanent vegetative state. That is why I really do not agree that it is right to use the word “suicide”, rather than “assisted dying”. People are dying, and this is the issue of when they die and not whether.

[Baroness O'Loan (CB)]

Is the noble Baroness aware that we are discussing the possibility of having either a panel or a court process? The research and reports show that families and individuals have great difficulty negotiating the Family Division of the High Court and the family-designated judges processes. Legal aid may well be necessary to assist in some of these matters.

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[Lord Falconer of Thoroton (Lab)]

I take that to be a yes. The position the noble Lord is proposing is that the judge hears the evidence of the doctors on issues, for example, of coercion, capacity and firm and settled view, and then makes the decision. The comparison we have is between what is in the Bill—two doctors each forming a view on the terminal illness decision and the issues of capacity and whether the person has reached a voluntary decision as to whether to have an assisted death, and the panel either endorsing it by giving the certificate or rejecting it—and, as the noble Lord is suggesting, letting the court in effect decide the whole thing. I reject that view because I am absolutely satisfied, although I accept that this issue requires a lot of work and thinking about, that you are much better off having a multidisciplinary approach to somebody making an assisted death decision. It is much better to let the social worker, the psychiatrist, the doctor and the legally qualified person look at the situation and then decide whether somebody should make that decision on assisted death.

The evidence given in Committee—

[Baroness O'Loan (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

May just continue? I will come back to the noble Baroness in a moment. This is very important—it is the critical bit of the whole thing.

There was a lot of evidence given to the Commons Committee in which this very issue was discussed. Sarah Cox, an expert, gave evidence. She said:

“The other thing that concerns me is that we are putting all these assessments on the shoulders of two doctors individually, followed up by a High Court judge. In any other clinical practice, when we are making very serious decisions, we know that shared decisions are much better quality, much more robust and much safer. In clinical practice, we make all these decisions in multi-professional teams. I would never make these decisions independently of my team, because the perspective they bring can help me to understand things that I am not seeing”.”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 74.]


Judges are marvellous, but a number of pairs of eyes in relation to this is better.

A huge number of questions were asked as to why the sponsor in the Commons and I—

[Baroness O'Loan (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

Will the noble Baroness let me finish? I am sorry but I am not going to take interventions at this stage. I will come to the noble Baroness in a moment, but I think I should make this argument in full.

The argument is that we made the decision to change from the judge, which I initially favoured, because of pressure and advice from the Ministry of Justice. That is not right. The change was made because the evidence was very clear, and I accepted that people are better off and it is safer if one does it with a multidisciplinary panel.

What are the reasons the noble Lord, Lord Carlile, has advanced for saying that we should have a court-based, not a panel-based process? First, he says that the court has experience of making analogous decisions. The type of decision he is referring to is the one the noble and learned Baroness, Lady Butler-Sloss, referred to: the Bland case, and whether people in a permanent vegetative state should have their life support turned off. That would be of assistance, but what we are proposing in the Bill is a panel, supervised by a commissioner, devoted completely to the question of whether assisted deaths should be permitted. Yes, we would get the benefit at the very outset of the analogous decisions the court has made, but here we would have a panel devoted only to that issue, and which is bound to become more experienced in it than the courts, which are rightly dealing with a whole range of things.

Secondly, it is said that the courts would give a reasoned judgment. As was pointed out in the debate, there is a requirement in paragraph 9 of Schedule 2 to the Bill that the panels give reasons in writing, and that will give rise to a body of decisions being made.

Thirdly, it is said that the court is a court of record. Yes, it is a court of record, but the key thing is, who is best at making the decision? Is it better to have just a judge, or an experienced legal member, a psychiatrist and a social worker? I do not think in all honesty that the fact it is a court of record will make any difference to that.

Fourthly, it is said that you can appeal to the Court of Appeal. We are talking here about people who want an assisted death. We want a safe process; we do not want an overengineered process. In my respectful view, the idea that you have to go into a system that carries with it appeals puts too much of a burden on the people.

Fifthly, it is said that the judges have a special respect in our system, a point made by the noble and right reverend Lord, Lord Harries. The key thing is not whether the judges have respect but whether our system of assisted dying will carry respect. This is a better way of making the judgment; that is why I support it.

A final point made by the noble Lord, Lord Pannick, who raised it and said it was the answer—it may have to do with the fact that it is a court of record—was that the courts have discovery powers et cetera. Yes, they do, but if the panel feels that there are areas that it is not getting to the bottom of, then of course it will not be satisfied and cannot give the certificate. For all those reasons, the panel is better than the courts. That is why the decision was made.

I will now answer the question from the noble Baroness, Lady O’Loan; I apologise for not answering it before.

[Baroness O'Loan (CB)]

I thank the noble and learned Lord. The question I wanted to ask him was connected to him telling us about panels and judges. As I understand it, the three members in the legislation he has presented to the House have expertise in their own area of competence. Does he accept that the benefit of the system devised by the noble Lord, Lord Carlile, is to bring many more disciplines—medical disciplines in particular—into the agenda? In particular, the judge would have the right to sit with the doctor, and there would be a psychiatrist’s report on the capacity et cetera of the individual, so the psychiatric issues would be taken care of. The amendment from the noble Lord, Lord Carlile, proposes something wider than that which the panel could provide.

[Lord Falconer of Thoroton (Lab)]

I do not accept that. The position is in relation to the panel. If it wants a report from a doctor, it can get it. I understand the noble Lord, Lord Carlile, to be saying that the court can ask for all these things—which of course it can—and if it thinks they are appropriate, it will do so. I assume it will not ask for them when it does not think they are necessary to the resolution of the issues. The panel can do the same and, if it does not get them, just like the court, it will have to say no.

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[Baroness Cass (CB)]

My Lords, I will be brief, because many of the points have been made, but I would really like to make two points. My first point follows the comments of the noble Baroness, Lady Smith, about—I hesitate to use this term—“levelling up”. We know that there is a spectrum of provision available, not just in palliative care but in all the other aspects of care that a dying patient needs, as referred to in Amendment 221 in the name of the noble Baroness, Lady Hollins. I would love there to be the kind of wraparound care within the community that my noble friend Lady Gerada described, but for some patients that is not the case. So, specifying those components that should be available and making them available should be the basic right of every dying patient, particularly one who is carrying as onerous a decision as seeking an assisted death.

But I think the second, and equally important, point about this is front-loading the multidisciplinary assessment, and, ideally, having it clearly written down and held by the patient, which empowers the patient to hold that information and take it with them. Therefore, it facilitates the co-ordinating doctor, the independent doctor and the panel or judiciary process to have available that information from the team who know the patient best, so that they are not having to delay the process by scurrying around in hospital notes or seeking additional information late on in the process, when the patient will inevitably have made a decision, potentially with their family, and a delay due to missing information would be unbearable. So, front-loading is absolutely key to streamlining this process throughout.

[Baroness O'Loan (CB)]

My Lords, I have put my name to nine amendments in this group and I declare my interest as an unpaid trustee of a hospital which has a hospice attached to it.

We are very fortunate in your Lordships’ House to have among us distinguished doctors who have spoken with great experience and understanding of the need for access to expert palliative care when a person faces death from terminal illness. For many people, particularly those in care homes, such palliative care is simply not available. I think of my own mother, who died just three years ago and was in a care home, and for whom such care was provided either by the GP or by paramedics who came and administered morphine—that was not expert palliative care. Many people, if this Bill is passed, will be in exactly the same position as my mother, unless there is change to the current systems. Expert palliative care, as has been said, is unavailable in many parts of the country, and so it is not enough to know that expert palliative care could be available, it must be available. That is the most significant thing.

Police, Prison and Probation Officers

Baroness O'Loan Excerpts

Tuesday 13th May 2025 Lords Chamber

[Lord Timpson (Lab)]

I am pleased to know that we have a race action plan that we are working with police constables; it is really important that we recruit fantastic people and make sure that we represent the communities we serve.

[Baroness O'Loan (CB)]

My Lords, in answer to the noble Lord, Lord Rogan, the Minister said that there was an extra £1 billion coming into policing this year. However, not one penny of that £1 billion will go to Northern Ireland because policing is a devolved matter. Given that the Northern Ireland policing budget is significantly eroded by paying out for dealing with legacy in Northern Ireland, when will the Government create ring-fenced funding to deal with the situation in Northern Ireland, which will then allow Northern Ireland’s police to serve the community in the way in which they wish—properly staffed and properly resourced?

[Lord Timpson (Lab)]

I will pass that question on to the Northern Ireland Secretary responsible for legacy issues and write to the noble Baroness.

“Hillsborough Law”

Baroness O'Loan Excerpts

Tuesday 22nd April 2025 Lords Chamber

[Lord Ponsonby of Shulbrede (Lab)]

The Government have said that they want to introduce a duty of candour, with criminal consequences for those who do not live up to that standard. But it is part of a greater whole, which is the reason why the legislation has not come forward as we would have liked and why we are undertaking further talks with the parties I have mentioned.

[Baroness O’Loan (CB)]

My Lords, is the Minister aware that, in 2021, following a very lengthy process, which was exacerbated by prevarication, obfuscation and failure to deliver materials to the panel, the Daniel Morgan Independent Panel, which I chaired, recommended the creation of a statutory duty of candour, to be owed by all law-enforcement agencies to those that they serve, subject only to the protection of national security and relevant data protection legislation? The response of His Majesty’s Government, in June 2023, was that the Home Office was reviewing this recommendation and working with HMICFRS on the introduction of a statutory duty of candour. Will the Minister please tell your Lordships’ House the current position of the Government?

[Lord Ponsonby of Shulbrede (Lab)]

Yes, the Government are very clear: we remain fully committed to bringing legislation forward at pace, which will include a legal duty of candour for public servants and criminal sanctions for those who refuse to comply with that duty of candour.