Terminally Ill Adults (End of Life) Bill

Baroness Wheeler Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Lansley (Con)]

My Lords, my amendments would remove the 12 months, because that would enable greater alignment with practice in the NHS. I make a plea to noble Lords that we might hear from those who have tabled amendments so that we complete the group more quickly. I think it is a discourtesy to those who have tabled amendments not to hear their explanation for them.

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, while we are on the subject of interventions, I remind the Committee that a Member who is speaking may be interrupted with a brief question of clarification. A Member may justifiably refuse to give way. Let us try to stick to the people who have their names on the amendments and make progress.

[Baroness Grey-Thompson (CB)]

My Lords, my Amendments 13 and 309 are probing amendments. I recognise that the 60 months and the 12 months in my two amendments do not quite tally, but they were tabled at quite different times.

Amendment 309 is quite simple. It looks to open a discussion and seeks to protect asylum seekers, immigrants without indefinite leave to remain, and anyone in the asylum system.

On Amendment 13, it was very interesting to listen to the noble Lord, Lord Lansley. I recognise that 60 months will have raised some eyebrows. It was my clumsy attempt to talk about death tourism and look at how we can provide consistency within the Bill. One of the reasons that we are consistently given for needing the Bill is that those who can afford it can go to Dignitas, which promotes inequality. However, if we do not get this section of the Bill right, that inequality will still exist.

My noble friend Lady Finlay raised some important points on where someone is able to die, and I have other amendments on certification of those areas. This needs more thought because, in many of the letters I receive, individuals who want the law to change talk about wanting to end their lives at a time and place of their choosing. They may get roughly the time that they want, but they may not get the place.

We have been talking about people living in different countries. The latest statistic that I can find online is that at any one point there are between 4.5 million and 5.5 million British people living abroad, and they need clarification about how the Bill could affect them.

I am concerned about the possibility of different processes existing in different parts of the UK and the Crown dependencies, because it could be possible that, if you have money, you could purchase or rent a small property in another jurisdiction to enable you to access this. That might be totally fine, but people need to understand what this is going to bring, and that inequality could still exist.

The phenomenon of death tourism represents a documented concern internationally. The Isle of Man explicitly incorporated a five-year residency requirement into its assisted dying legislation, following recommendations from scrutiny committees examining the Bill’s clauses. That is why I picked 60 months. However, we have to be careful that we are not turning jurisdictions into destinations for accessing end-of-life services. Such relocation could create several problems. It might indicate that the person’s wish to die is not deeply rooted in their established community context. It could create practical and ethical difficulties for healthcare systems, which are unprepared to provide end of life to transient populations. It also raises questions about whether individuals are making decisions in isolation from their established support networks.

Whatever we end up with in terms of what residency looks like, we have to take into account what has happened in other jurisdictions. I was pleased that the noble and learned Lord said in the previous debate that in the Bill the age will not drop below 18. It is important that we get the residency right, because in other jurisdictions over time it has changed. In 2014, Belgium removed any age restriction and Vermont lifted its residency requirements in May 2023. At least 26 people have travelled to Vermont to die who were not resident there. Vermont is a tiny US state, but that represented nearly 25% of reported assisted deaths in the state from May 2023 through to June 2024, as listed in Vermont Department of Health data.

In Oregon, the same thing has happened: the residency requirement has been lifted, and around 6% of those choosing to end their lives in Oregon have been from out of state, according to official Oregon Health Authority reports. The oncologist Charles Blanke, whose clinic in Portland is devoted to end-of-life care, has said Oregon’s total is likely an undercount and he expects the numbers to grow.

Adequate residency duration enables meaningful healthcare relationships to develop, and I have amendments on relationships with GPs in a later group. For me, it is about providing appropriate healthcare and the right information. It is about being able to look at patterns of depression, changing wishes, family dynamics and coercion, which we have already debated. It is about providing stability and the authenticity of the person’s desire for assisted dying. It is also about whether the correct palliative and psychosocial support is there.

I do not think 60 months is the right number, but we have to be careful and clear about what will happen in terms of people being able to access this service. Finally, longitudinal research on end-of-life preferences demonstrates significant variability in expressed wishes over time. That is why we have to be really clear that we get this right.

Terminally Ill Adults (End of Life) Bill

Baroness Wheeler Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Noble Lords]

Shinkwin!

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, we will hear from the noble Lord, Lord Shinkwin, and then the noble Baroness, Lady Cass.

[Lord Shinkwin (Con)]

My Lords, an enormous amount of time was given in the other place to blocking safeguards. I support the vital amendments in this group and thank all those who tabled them. It is a pleasure to follow the noble Lord, Lord Dodds of Duncairn, who made some incredibly important points about vulnerability. Some of us have been there. This is proper scrutiny; it is the House of Lords at its best. On whichever side of the divide we find ourselves on this Bill, we should all be very proud of that.

As someone who speaks from one patient’s perspective, I would never presume to know exactly how the pain another person experiences might feel to them as an individual. But I think that the sense of incredible loneliness, compounded by a sense of disorientation, are both parts of total pain, as defined by the pioneer of specialist palliative care, whom the noble Baroness, Lady Finlay of Llandaff, mentioned—Dame Cicely Saunders. That makes these amendments dealing with coercion and pressure crucial.

When I have been drowning in a pool of pain, the sides of which, in that moment, seemed so steep and slippery, I would have clutched at almost anything in an attempt to pull myself out. I appreciate how coercion and pressure are so nuanced and subtle and how much each of us in this House, at some point in our lives, may need to be protected from them. My noble friend Lady Coffey is absolutely right, in speaking to her Amendment 47, to mention the Royal College of Psychiatrists and, in her explanatory notes, its reference to the sense of being a burden as an internal coercion. I can testify from personal experience that in some cases the sense of being a burden, or the burden of pain, whether physical and or emotional, can be simply too great to bear on your own. This can be the most powerful and damaging form of coercion and perhaps the one from which we most need protection. We need to recognise that in the Bill.

I note that the Bill does not require any questions to be asked about why a person may wish to die. It is because Rebecca Paul’s Amendment 468 on precisely this issue was rejected in Committee in the other place that Amendment 3, moved by the noble Baroness, Lady Finlay of Llandaff, and Amendment 181, in the names of the noble Baronesses, Lady Grey-Thompson and Lady O’Loan, are so important. As the noble Baroness, Lady Ritchie, and the other sponsors of Amendment 48 have argued, we cannot divorce this internal coercion from the circumstances in which, for example, a disabled or older person might find themselves. We have to factor those in. It is not just coercion or pressure by any other person that may prove the tipping point.

I hope that your Lordships’ House will give very careful consideration to the amendments on financial pressures, such as Amendment 462, which I thank the noble Lord, Lord Hunt of Kings Heath, for tabling so ably. As we know, these pressures are exacerbated when a person is living with a disability.

In closing, I particularly welcome Amendment 846, tabled by my noble friend Lady Berridge, and Amendment 58, tabled by the noble Baroness, Lady Grey-Thompson, because the subtlety of pressure, particularly as it relates to disability, can definitely stem from cultural attitudes, whether institutional—for example, in terms of access to appropriate care—or societal. I give one example. I was laughed at in the street outside my home as recently as last weekend because of how I look as a result of my disability. That is not good for morale, to put it mildly.

It could be argued that mockery goes with the territory of being disabled, particularly when the anonymised vitriol on social media encourages teenagers, for example, to view disabled people as fair game. My question in relation to the Bill, and specifically Amendment 58, is, how can being subject to such prejudice not affect a person’s mental well-being or their sense of self-worth? How could such a structural disadvantage, in terms of the cumulative effect of being constantly exposed to such negative and discriminatory attitudes, not affect a person in a vulnerable situation who is considering assisted dying? It is inevitable, but how many non-disabled people factor that in?

--- Later in debate ---

[Lord Goddard of Stockport (LD)]

I have moved my seat. I wish to speak briefly as a member of the Select Committee who has not spoken.

[Baroness Wheeler (Lab)]

We will hear from the noble Lord, Lord Goddard.

[Lord Goddard of Stockport (LD)]

I moved from my position at the front, because there was a presumption that I was the Front-Bench spokesman trying to force something. I apologise; I was not. This House has a free vote, and nobody is whipped. I happened to be sitting on the Front Bench, and I have moved back; I understand the alarm I may have caused by standing up then, but I was not trying to derail the debate. I was just trying to be helpful, because lots of people have spoken, and I respect every single person who is doing so in the House—for and against. Within my own party we have the same difficulties.

It is about evidence. I want to help the House today, on the specific premise of coercion. Sir Max Hill, the former Director of Public Prosecution, said that

“throughout the time that I served as DPP … we did not have the coercion offences created by the Bill, which I suggest would be a significant advance, and nor did we have a legal system in which the investigation was taking place before the death. … The major advantage of the Bill, if I can put it that way, is that … scrutiny will be before death”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 86.]

That comes to one of the points the noble Baroness, Lady Grey-Thompson, made—that when you are dead, it is too late to find out what has gone on.

In the other place, mandatory specific training on domestic violence, including coercive control and financial abuse, was introduced into the Bill and agreed through an amendment tabled by Jess Asato MP. Participating doctors and members of the multidisciplinary panel will have to undergo specific training in this area, as well as in assessing mental capacity. I believe there are now safeguards in the Bill—I think that was what the noble Lord, Lord Pannick, was alluding to.

It seems to me that we in the House think this is the first time this has ever happened, but the fact is that 300 million people across five continents have some form of assisted dying legislation. Not one of those countries has ever repealed it. It is right that we make it the safest and the best, and that the amendments be debated at length.

Noble Lords should forgive the cynicism of those who support the Bill—one Member said last week, causing some humour in the House, that they were sorry they came second to another Member in getting amendments down. This is not a competition; this is about getting the Bill right and fit for purpose.

I find it quite amusing when I see the noble Lords, Lord Pannick and Lord Carlile— it is worth the admission fee just to see the interaction. The points from the noble Lord, Lord Carlile, were right about trying to come to a conclusion and move forward. It is right that everybody speak, but that we speak to the amendments and try to get to a conclusion.

The noble Lord, Lord Dodds, is right: we should give it time. But we do not have time. We have four Fridays and no more. The Government have said they are not going to give way. If we do not finish the debate on these amendments, which are increasing every day—I believe we are up to 1,500 now—the Bill falls. Somebody—not me but someone else—might say, “Well, it is somebody’s objective that we run out of time; then we can stand here wringing our hands and say that we were just trying to make it the best Bill we could but we ran out of time and are very sorry”. That is not acceptable. Our role here is to ensure that legislation goes back to the other place, fit for purpose and the best we can make it. Somehow, we have to distil these amendments into something understandable.

Social Care Reform

Baroness Wheeler Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Andrews (Lab)]

My Lords—

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, it is the turn of the Labour Party.

[Baroness Andrews (Lab)]

My Lords, can the Minister tell us what progress has been made on addressing the problem faced by many unpaid carers who have been penalised, through no fault of their own, for having been paid too much because of technical failures in DWP? Are we making progress on addressing those very serious issues?

Musculoskeletal Health

Baroness Wheeler Excerpts

Thursday 30th January 2025 Lords Chamber

[Lord Pannick (CB)]

My Lords—

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

We will hear from the noble Baroness, Lady Donaghy.

[Baroness Donaghy (Lab)]

I am a member of the APPG on osteoporosis, and we are very worried that fracture liaison services have been deprioritised in the recent NHS planning guidance. We know that the pump-priming transformation fund works because we have seen it working in Wales. It saves lives, as the noble Lord, Lord Black, said, releases people into the labour market, releases beds in hospitals and improves quality of life for thousands of people. Can the Minister give us an assurance? If this milestone has been missed in the planning guidance, we need urgent clarity on how the 2030 target will be reached.

Hospices: Funding

Baroness Wheeler Excerpts

Thursday 24th October 2024 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I, too, thank my noble friend Lord Farmer for initiating this important debate. For most of my professional life, I have been associated with hospices such as St Christopher’s, the Mildmay in the East End of London, the Mildmay in Uganda and the Phyllis Tuckwell Hospice in Surrey. I have learned a lot working in these places.

I remember, for instance, a lady of 28 with an inoperable cancer of the throat. She was in pain and a lot of respiratory distress and needed relief from these symptoms. I explained to her that I could put a needle into her vein and titrate her with analgesics until all her symptoms had gone. She agreed to this. I gave her a surprisingly large dose of heroin, which not only did not kill her but relieved all her symptoms and gave her three weeks of symptom-free life. During that time, she was able with a clear mind to say goodbye to her friends and to tidy up all those loose ends. Some people accused me of hypocrisy, saying, “You’re really killing them and just saying that you’re relieving their pain”. Well, anyone who thinks they know what is in my mind has delusions of grandeur.

Cicely Saunders and I were contemporaries as medical students. Her work on relieving symptoms in hospices was very important indeed. She established without any doubt that the right way was to keep a constant level of analgesia in the blood rather than give patients doses only when they had the pain. If you do this, you require less of the analgesics overall and so the patients are more awake and able to enjoy life. That was a very important contribution. The present laws against euthanasia and assisted dying are like a huge dam preventing great enthusiasm for euthanasia and assisted dying. That dam can sometimes develop a crack for those who want to legalise euthanasia. Once you have a little crack in the dam, the whole thing can give way. Cicely Saunders’s work was an extremely important aspect of this.

As far as the funding of hospices is concerned—

[Baroness Wheeler (Lab)]

Can the noble Lord wind up, please? His three minutes are over.

[Lord McColl of Dulwich (Con)]

There is an urgent need for more funding, as has been said many times, and a partnership between government, charities and local authorities is required.