Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Friday 5th December 2025 Lords Chamber

[Baroness Berger (Lab)]

My Lords, my Amendments 4, 249, 257, 304, 337, 446 and 448 raise the eligibility for the provision of assistance under the Bill from 18 to 25.

There is no reason, either in law or in principle, why we should assume that 18 is the right age for eligibility for an assisted death. It is not only an arbitrary starting point; it is contrary to the mounting evidence of when the brain is fully formed, which I shall come to in just a moment. When I asked the Children’s Commissioner, Dame Rachel de Souza, whose role it is to promote and protect the rights of children and young people, what she thought of 18 being used as a cliff edge for eligibility under the Bill, she answered:

“The reality of life on the ground, as those of you who work with health will know, is that 18 is not really a thing … when it comes to the most vulnerable, that is extended to 25”.


She went on to say:

“I think that we are missing a trick by thinking somehow 18 is the cut-off. I really do strongly think that. I would like the committee to consider that”.


Noble Lords will be aware that there are a range of existing circumstances where 25 is already seen as a threshold to adulthood, instead of 18. This is particularly relevant when we consider vulnerable young people with a terminal illness, whom we need to consider in this legislation—lest we forget that children are not currently mentioned in the Bill.

The point was forcefully made to the Select Committee. The Children’s Commissioner said:

“They are the children I am worried about: children with special educational needs, children who are already in hospital with life-limiting diseases, children who have EHCPs—education, health and care plans—that provide support for them until the age of 25. The reason they do that is that they are vulnerable, whether it is mental health concerns, whether it is because they have had terrible lives and might have all sorts of problems, including suicidal ideation. It is a real concern”.


Noble Lords will know that local authorities are responsible for preparing and maintaining EHCPs for children and young people with special educational needs up to the age of 25. Our local authorities have a statutory responsibility for young people up to this age, particularly those in care and those with special educational needs. It was more than a decade ago that the Department of Health, in its document Future in Mind, recommended an extension of child and adolescent mental health services up to the age of 25 to end the practice of discharging young people out of mental health services at 18.

In the context of criminal justice, I am mindful of the words of the noble and learned Lord, Lord Falconer, himself, who said in his speech in 2021 on the Police, Crime, Sentencing and Courts Bill that a whole-life term should never be imposed on an offender aged 18 to 20 but only on “somebody unequivocally an adult”. I hope that he will agree with me that death is not a less weighty matter than life in prison.

We have heard concerns during the progress of this Bill from experts who work with teenagers and young adults that it will be safer and more in line with the evidence to raise the minimum age for assisted dying to 25. It is by this point that the brain is more fully developed and decision-making capabilities are more secure. In general, the brain does not finish developing until a person is in their mid-20s, which is particularly the case for the prefrontal cortex, which governs our decision-making functions and our ability to think flexibly about potential outcomes.

Noble Lords may have seen research announced only last week by the University of Cambridge which suggests that the brain is fully developed only in our early 30s. I believe that we are here to make good law, and one way we do this is to listen when experts speak and to take their counsel. The simple fact of having enabled experts to give their evidence to this House over recent months does not amount to adequate scrutiny if that evidence simply languishes on the pages of Hansard, instead of being used to shape our work.

Of course, I know that an assisted death would be available only to young people with a six-month prognosis, but we know that it is not always accurate. It is, as I have learned, particularly difficult to get right with young people, who can go on to live for years beyond an initial terminal diagnosis. In its written evidence to the other place, the charity Together for Short Lives wrote:

“We are concerned that the requirement for an accurate prognosis to be provided for a person to be considered as ‘terminally ill’ may result in ambiguity when considering the eligibility of young people with life-limiting and life-threatening conditions whose prognosis is uncertain. Whilst the majority of adults only need palliative care at the end of their lives, many young people with life-limiting and life-threatening conditions require palliative care over a much longer period, often from birth or even in the womb. During this time, it is common for their conditions to fluctuate, meaning many young people may experience relatively long periods of stability. It is therefore much more difficult to provide an accurate prognosis and identify when a young person is moving towards their end of life stage”.


Together for Short Lives also recommends that under this Bill we consider how those aged 18 to 25 with EHCPs—education, health and care plans—will be affected.

The Bill as it stands is at risk of pushing young people with life-limiting conditions into thinking that reaching the age of 18 means that they are not obliged to consider whether they should continue to live or not. What does this say about how we value their lives?

We also cannot ignore the unique responsibilities faced by young people today. We know that social media has become a powerful driver of harm. Research from the Molly Rose Foundation, a suicide prevention charity, shows that vulnerable young people are disproportionately exposed to posts that glamorise suicide or present suicidal thoughts as normal, appealing or even fashionable. Alarmingly, 68% of young people with low well-being are being served this type of content. In such an environment, how can we claim to be safeguarding young people if, beyond the hospital bed, the digital world is telling them that their lives are not worth living? If this content is impacting young people when they are well, how much more so will it play on the mind of a terminally ill young person? To allow access to assisted dying at an age when external pressures are so pervasive, and when identity and resilience are still forming, risks compounding vulnerability rather than offering protection.

When families, carers and local services should be striving to provide the very best care, we would instead be sending them the confused and dangerous message that 18 year-olds are instead now ready to choose and plan their own deaths. This is of particular concern when we consider young people with learning disabilities, and how competence should be established in those cases, particularly given the fact that young people with learning disabilities receive worse healthcare in general, as evidenced by the National Child Mortality Database. In its learning disabilities and autism study, it exposed the fact that children aged four to 17 with a diagnosed learning disability accounted for 31% of all deaths, despite only 2.5% of children in the UK having a diagnosed learning disability.

There are challenges with a health service that misses lots of health issues for this group of children and young people because of communication and advocacy barriers. The 2023 report, Learning from Lives and Deaths—People with a Learning Disability and Autistic People, found that 42% of deaths of people with a learning disability were rated as avoidable, compared with 22% for the general population.

It is in this context, and for all the other reasons I have set out, that I am strongly persuaded that raising the age of eligibility to 25 is the right thing to do. I am also haunted by the words of one child that were shared with the Select Committee. The young person said:

“I’m in care. I’ve got disabilities. The Government will pay for me to die under this Bill, but it won’t pay for me to live”.


I conclude with a final contribution from the from the Children’s Commissioner, where she said:

“I would far rather that we erred on the side of caution, protecting those who have had terrible lives, terrible experiences, have been abused, have had their families turn them out, protecting those who are suffering from extreme mental illness, protecting those with special educational needs and disabilities, protecting anorexic children who are heading into adulthood, and saying, ‘Let’s err on the side of caution and go for 25’”.


I am clear that we must continue to say to children and young people, “Yes, your life matters. Even if it will be a short life, it matters”. We must amend the eligibility for assistance under the Bill to 25. I beg to move.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support this amendment in principle, based on the research in relation to cerebral development. I think it is well made and an example of something that we are really here to think through to enhance the Bill. However, I point out that the Bill excludes anybody with a lack of capacity, so several of the people that the noble Baroness referred to would not be entitled to consider assisted dying.

--- Later in debate ---

[Baroness Lawlor (Con)]

I hope that noble Lords will show the customary courtesy, particularly with regard to views to which they have objections.

[Baroness Watkins of Tavistock (CB)]

Would the noble Baroness consider joining the meeting with the noble and learned Lord, Lord Falconer, to talk about her additional points? I think the majority of the Committee is keen to move on so that we can facilitate further groups.

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, and I certainly will consider it, but I think it is important that we have a discussion about what I regard as a compromise Motion, which may be useful in the discussions noble Lords have with the sponsor or those who wish to proceed in that way.