Terminally Ill Adults (End of Life) Bill

Lord Birt Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Birt (CB)]

My Lords, I strongly support this Bill. Overall, it is well considered. Importantly, it benefits from the experiences of many other countries that started this journey well before us. In no sense would we be pioneers.

The carefully designed process that the Bill sets out should address the possible risks—for instance, severe coercion—that have, reasonably, been identified. We know from surveys that there is overwhelming public support for assisted dying. All of us have received heart-rending letters pleading for the passage of this Bill from individuals who have had the harrowing experience of witnessing loved ones slowly dying in extreme pain or in utterly debilitating circumstances. This Bill confers the right for such an individual facing imminent death not just to avoid intense anguish and pain—as well as the prospect of their condition progressing intolerably—but to die at a moment of their choosing, in the circumstances of their choosing, and with dignity. I want that right, and anyone who wants it should have it, too.

No doubt the Bill can be improved further. The Delegated Powers Committee makes many persuasive points which we should take on board. However, the Explanatory Notes remind us of decades of attempts to introduce assisted dying legislation that have simply failed. It is highly unlikely that any Government in the foreseeable future will seize the baton. We must therefore make this Bill work, then pass it.

I have only one personal reservation, which I share with others, including the noble Lord, Lord Forsyth. Although I entirely see the value of a process setting out two independent medical assessments, two periods of reflection and an independent review panel, in a world of constrained resources where it is hard these days even to see your GP, there may be the risk of unwelcome slippage and a prolonged delay—perhaps in August or over the Christmas period—that intensifies suffering. Should we build into this process, on the one hand, greater certainty on the total time normally taken; or, on the other, some flexibility on telescoping time when circumstances demand it, particularly for those who may enter the process at a later stage?

Finally, I strongly advise anyone who is uncertain and harbouring doubts about the Bill to watch the one-hour discussion, hosted by the Healthcare Professionals for Assisted Dying, with four Australian practitioners working in this field. Without exception, they come across as people of enormous integrity and humanity, caring, truly dedicated to their work, and entirely convincing about the necessity and effectiveness of a carefully considered assisted dying process. It is well worth watching. I have no doubt whatever that our medical professionals who volunteer—and you have to volunteer—for a role in the assisted dying process will equally rise to the challenge.

Let us further improve, but then pass, this critically important Bill.

Terminally Ill Adults (End of Life) Bill

Lord Birt Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Birt (CB)]

I just want to ask: does the noble Lord think that we should try to reach the 10th group of amendments in the course of today?

[Lord Harper (Con)]

I am trying to make a brief remark. I have been speaking for only one minute and 45 seconds; if I keep getting interrupted, I will not be able to sit down. I was going to make literally one more point, having listened to the debate. After all, this is supposed to be a debate where we listen to what noble Lords say and respond—

[Lord Birt (CB)]

Could the noble Lord please answer my question: should we try to reach the 10th group of amendments today?

[Lord Harper (Con)]

I want to try to make progress, which is why I was trying to keep my remarks very brief; if the noble Lord keeps interrupting me, they will necessarily take longer. All I was going to do was make one further point.

I was very struck by what the noble Baroness, Lady Berridge, said about the differences in the medical prognosis for a number of conditions among younger people. I suggest to the noble and learned Lord, Lord Falconer, that as well as looking at the assessment process, he should look at the extent to which clinical advice and evidence can be brought in to see whether a terminal diagnosis for a younger person is qualitatively different; from listening to the noble Baroness, Lady Berridge, that appears to be the case. That may be the appropriate way to pick up the concerns, which are widely shared. But I also accept—the noble Baroness, Lady Fox, made this point—that the law has to have some clarity to it. Like the noble Baroness, I think that having lots of different ages would be very difficult.

From listening to the points made by the noble Baroness, Lady Berridge, I think that may be a way forward; I commend it to the noble and learned Lord when he undertakes his thought process for what he may bring forward on Report.

Terminally Ill Adults (End of Life) Bill

Lord Birt Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

Moved by

[Lord Birt]

35: Clause 1, page 1, line 14, after “life”, insert “, delivered and supported by the Assisted Dying Help Service (see section (Assisted Dying Help Service)) and”

[Lord Birt (CB)]

My Lords, I shall speak also to all the other amendments listed in my name and that of the noble Lord, Lord Pannick, who, having assiduously attended our sessions on the Bill thus far, as all will have noticed, deeply regrets that he cannot be present with us today.

Our discussions to date have focused overwhelmingly on risk, and I do not for one moment dispute the necessity and the value of that. I will return to how best we can manage those risks later in my remarks. However, let us not forget that we are not pioneers. Thirty countries, states or jurisdictions across the world have already introduced assisted dying. The first did so over 80 years ago; there has been a steady stream this century and, hot off the press, just two days ago, an assisted dying Bill for the Channel Island of Jersey passed its First Reading by a two to one majority and is expected to pass into law next month. It is therefore at the very least equally important that we do not just focus on risk but lean on the well-established experience of others when considering the critically sensitive matter before us, which we know from serious studies carries overwhelming public support.

For my part, I have been exposing myself to the Australian experience, with considerable help from senior practitioners, for which I am most grateful. Without exception, those to whom I have been exposed come over as deeply caring and enormously considered. What I have learned from them, and from the copious data that is available, is reflected in the amendments before your Lordships today. Much that I have discovered has been surprising as well as enlightening. First, applications for assistance in Australia are not automatically accepted; something like one-third are turned down. Secondly, around 75% of those seeking assisted dying have cancer, and somewhere between 75% and 90% of all those who come forward are already in receipt of palliative care and are more motivated by their distress and misery than by their pain. Although I completely agree with all noble Lords who have stressed how vital it is to have effective, universally available palliative care, it is clear that it is not sufficient for many experiencing truly horrific medical conditions.

For those who have not read it, I commend Jonathan Dimbleby’s moving account in a recent New Statesman of his brother Nicholas’s harrowing final days. Nicholas had fallen victim to motor neurone disease. It became impossible for him to take solid food without choking. He then had a tube inserted into his stomach, through which he had to feed himself. Nicholas became increasingly hard to understand. He was barely able to move. He lost control of his bodily functions. He was often frightened and sometimes terrified. He gasped in vain for breath. Nicholas Dimbleby, finally and mercifully, died in February of 2024. Other UK practitioners I have met recently, simply by chance, have shared with me equally horrific accounts of deaths that they have witnessed in the ordinary course of their work.

Such experiences must explain why, in Australia, although around 10% to 15% of those seeking an assisted death apply some months in advance of their anticipated need, a significant proportion wait until their suffering is unbearable. As a result, around 25% of applicants die within nine days of their first request—I repeat, 25% of applicants die within nine days of their first request. A further 25% die within 10 to 19 days. Thus, in Australia, around 50% of applicants die within 19 days of their first request. The leading Australian practitioners who have advised me insist that sheer misery is the primary determining motivation of individuals seeking assisted dying. Further to illuminate the complexities of the process, around one-third of those who ask for and are given the death potion do not take it and choose to die a natural death.

[Lord Carlile of Berriew (CB)]

My Lords—

[Lord Birt (CB)]

No, I am sorry—I have an argument to put; I am not going to take any interruptions.

Furthermore, one of Australia’s most senior and experienced practitioners tells me that, although in theory it must be a risk, she herself has never experienced a single example of coercion. On the contrary, she says, she has on occasions experienced the very opposite: loved ones understandably pressing someone who wants assisted dying not to embark on that course of action. Overwhelmingly, her experience is of applicants who know their own minds and are perfectly able to make a considered decision.

From all my discussions, I have concluded firmly that if this Bill passes into law, it is vital that the processes are based on day-to-day realities, as well as risk, and work efficiently and sensitively for any individual of firm and settled mind coming forward in a state of deep distress. We need more flexibility in the timelines of the process than the present Bill allows and a fit-for-purpose organisational focus that delivers promptly and humanely for individuals in severe need.

In our amendments, the noble Lord, Lord Pannick, and I propose three key measures. The first is to create a new organisation, the assisted dying help service, to enable the individual easily to navigate the complex process set out in this Bill, which in essence we retain. The second is to ensure that the assisted dying process is expeditious and, when conditions demand it, flexible. The third is that the commissioner acts solely as a regulator, with oversight but without any delivery responsibility.

The process currently set out in the Bill involves a 10-stage process, with three separate medical consultations with three different doctors, a confirmatory panel and two periods of reflection, the first of seven days and the second of 14 days, the latter of which can be shortened. Absent a bespoke organisational focus, this process in a stressed NHS could take a wholly inappropriate and disproportionate period of time. Hence our proposal is that we adopt a notion present in many jurisdictions of a purpose-built organisation—an assisted dying help service—that would provide a personal navigator to take the dying person and their loved ones through the whole complex process, providing introductions, keeping to timelines and piloting the individual through their final challenging and traumatic journey. Our amendments also propose appropriate flexibility, at every stage, with safeguards for doctors to act with urgency if the individual’s condition demands it.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I will certainly try to provide that co-operation.

[Lord Birt (CB)]

My Lords, I will try not to keep us too long from our lunch. This has been a lively and helpful debate, and I think it has exposed a fair number of critical issues that are yet to be resolved.

My past has caught up with me in this debate. How many people here knew that I used to be the boss of the noble Lord, Lord Gove? It was not my fault. He was a genuinely distinguished young BBC journalist, in all seriousness, and hugely admired by his colleagues. The debate has also revealed that the noble Baroness, Lady Coffey, and I went to the same north Liverpool grammar school, so anybody who objects to anything that she or I put forward can blame the Irish Christian Brothers.

I cannot possibly deal in any detail—and noble Lords would not want me to—with the many points raised over the past three hours. I approached the construction of these amendments, with the noble Lord, Lord Pannick, with a truly open mind, and I retain an open mind. The Chief Whip often tells us that his door is always open. My door is always open—not that there is one, because I do not have a proper office—and I am completely open to discussing any issue that has been raised. I am sure that the noble Lord, Lord Pannick, and I will wish to return to these matters when we come to Report.

I will just say a few things now. I approached the Australian practitioners with a completely open mind. I was in favour of assisted dying but I wanted to understand what real-life experience was like. I am very data-driven, as the noble Lord, Lord Markham, has often pointed out, and wanted to immerse myself in the Australian data. It was my learning, and then discussions with the noble Lord, Lord Pannick, that caused us to frame our amendments in the way we did.

The central thing that emerged from those discussions, which has been lost in our debate so far, is that, actually, people are not coming forward. They already have palliative care. Their pain is more or less controlled. The central point that the Australian practitioners wanted to get across to me, over and again, was that this is about misery, and people running out of time and wanting to end their life. Hence the key Australian data I shared was that, roughly speaking, 25% of people who come forward for assisted death die within nine days.

That is why I told the Committee about the Nicholas Dimbleby experience, because I thought that was indicative of the kind of people who want it. It is at the end of a very painful, prolonged process of suffering that people want an expeditious end. That is why the noble Lord, Lord Pannick, and I have sought to retain the process that is in the Bill but tried to make it more flexible, to deal with what can be genuine emergencies. And it is an emergency. There is a part of the National Health Service that deals with emergencies on Christmas Day—it is called A&E. We are talking about a service that will deal with genuine emergencies.

[Baroness Grey-Thompson (CB)]

My apologies for intervening, but my noble friend mentioned the number of people who access palliative care. The state of New South Wales promised £743 million in extra funding for palliative care over a five-year period, but, when the law was passed, it cut that funding by £150 million and diverted money to assisted suicide. Does my noble friend accept that, although he says people are getting palliative care, big promises are being made and then ripped away from people? It limits the choice they have, because there is not as much palliative care support as they originally thought. There is a feeling that that was promised just to get the Bill across the line.

[Lord Birt (CB)]

The one issue that unites the whole Committee is that we have to have an effective service of palliative care in this country. The data in Australia, which varies from state to state, tells us that somewhere between 70% and 90% of people who come forward already have palliative care.

The noble Baroness, Lady Fox, talked about navigation. It is a complex process, even in the Bill as it stands. If you analyse the likelihood, you will find that it will probably take, without the right process involved, 30 to 60 days, which is completely inappropriate in the context of the Australia experience. By the way, the navigator is an administrative role to help the person manage a complex system with multiple practitioners, who themselves have real authority.

[Baroness Fox of Buckley (Non-Afl)]

To clarify, I am sure the noble Lord knows people who have tried to get a hip replacement or a wide range of other medical treatments. It is the most complex process that you could ever go through. Many people are vulnerable and could do with a navigator. Does he understand the two-tier nature of appointing a navigator in one instance and not in another? This follows on from the earlier question from the noble Lord, Lord Moylan. Can the noble Lord see that anything that seems to give preferential treatment to those seeking assisted dying over those who are suffering pain from a bad hip or who have a rare cancer and are terminally ill would cause political problems? Immorality might be part of the issue there.

[Lord Birt (CB)]

Believe it or not, I have had cause, at various times in my life, to navigate the NHS, as probably everybody in this Committee has, and of course it is very difficult. However, when you go into A&E, you effectively do have a navigator. I do not think this is about the hip operation example; it is about people in a genuine emergency situation.

[Baroness O'Loan (CB)]

I have been to A&E many times, particularly with my son, and I have never had a navigator. How does one have a navigator in A&E?

[Lord Birt (CB)]

I am sorry; perhaps the noble Baroness can talk to me later, as I could not take in what she said.

I am, frankly, open-minded about the NHS question and accept the strength of what the noble Lord, Lord Stevens, says. It may well be that this is an organisation that should be apart from the NHS but uses some of its services. However, I am happy to talk to others about how best to do that.

I reassure the noble Lord, Lord Harper, that the process can, and should, be designed not only to support assisted dying but to painstakingly explore the alternatives to assisted dying, and I did say this. We suggest that palliative care should be one of those services and, whatever the reasons that people have for assisted dying—there may be others beside their chronic near-death state of mind—we also propose that the organisational body should be able to help the person in other sorts of ways. We want it to be a balanced process.

[Lord Harper (Con)]

I am grateful to the noble Lord for taking my question at this stage of the debate. I listened very carefully to him when he was setting out his proposals and I welcome the fact that he said that the navigator can discuss palliative care and such issues with the person concerned. Unless I misunderstand his amendments, they do not propose to help secure those services for the person. They might set out what they are, but they do not get them, so there is an imbalance there. They will help them get the assisted suicide but not proper palliative care.

[Lord Birt (CB)]

I do not think it for us, in framing in principle amendments, to deal with that level of issue, but the noble Lord is right—that is exactly what the body should do. We are talking about highly distressed people, and it should facilitate different kinds of response and reaction to their difficulty.

[Lord Blencathra (Con)]

If I heard the noble Lord correctly, he said that anyone going to A&E gets a navigator. He was challenged by the noble Baroness, Lady O’Loan, but he did not hear her question. She said that she never experienced that in her life and neither have I. If any noble Lord has, I would be grateful to hear it. If you go to St Thomas’, the first people you meet are two security guards who are there to keep people out.

[Lord Birt (CB)]

Plainly, the NHS is a very large organisation and it offers a variety of different kinds of experience. I hope none of us uses A&E very often but, like everybody else, I have used it and, in my experience, I have found it very efficient indeed at handling everything.

As I have said already, there are many issues and if anybody wants to talk to me and the noble Lord, Lord Pannick, about them, please do. I end with a very simple point, and I address this particularly to the noble and learned Lord, Lord Falconer. I am utterly convinced that this needs a proper organisational framework. You cannot throw this complexity of issues at the National Health Service. It also needs a more flexible process than currently exists to deal with the complexity that I have outlined, which comes out of the Australian experience. Both those things need to be in the Bill, and the noble Lord, Lord Pannick, and I will be returning to these issues on Report with, I hope, as much help from across the Chamber as possible. In the meantime, I beg leave to withdraw the amendment.

Amendment 35 withdrawn.

Terminally Ill Adults (End of Life) Bill

Lord Birt Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of one of the medical royal college’s trusts. I want to speak to this group of amendments, taking into account the medical profession. I entirely agree, and I am sure that the vast majority of doctors will also entirely agree, that it is better to have face-to-face consultations in these circumstances. However, nearly all those who have spoken in favour of face-to-face consultations have admitted or agreed that there will be exceptions, and there will be quite a lot of exceptions. We have to remember that many people who are terminally ill are bed-bound; they are not able to get up and go to a face-to-face consultation, even if it is quite near to where they live. The vast majority of doctors would want to discuss with their patients whether a face-to-face appointment is acceptable, possible and desirable and, if not, to have an online consultation with them. That seems to me the right approach.

Moreover, I really wonder whether we should be putting in the Bill a clause that would constrain doctors in a way that I think is unacceptable. We must accept that the vast majority of doctors will go into this work with utter commitment to doing the best possible job they can. I find it a bit disconcerting that there is constant reference to a tick-box approach; you can have a tick-box approach face-to-face, or you can have a tick box approach in a consultation online. It does not seem to me a relevant and important point to make. I suggest that, rather than putting this in the Bill, given that I am sure that there is a very strong case for face-to-face consultations normally, it should instead be part of a code of practice for the medical profession that will certainly have to be developed if and when this Bill is enacted.

[Lord Birt (CB)]

My Lords, we are discussing one of the most important decisions that any individual might make in their lives. It is important for the individual and for the state. I think that it is appropriate to ask that the critical meetings with the medical practitioners should be face-to-face, because that allows a degree of intimacy and nuance which, frankly, the world of Teams, however valuable it is, does not. There are three doctors involved in the process set out in the Bill and, at the very least, for the second doctor who is going to co-ordinate the process, it is reasonable to require that that meeting be face to face.

[Baroness Berger (Lab)]

My Lords, very briefly, I support the amendment that is calling for face-to-face consultations to take place, rather than only in exceptional cases. I want to reflect on why this matters. We know from other jurisdictions that many of these assessments are being done online. It is a really important question for us to consider whether we would want that in our country—and if not, it should be in the Bill. In addition, my comments are informed by the evidence that we were presented with in the Select Committee and drawn from my experience of meeting a number of elderly constituents over the course of nearly a decade as a Member of Parliament.

I reflect particularly on the women I met in their 70s, 80s and 90s who shared their experiences of domestic abuse. This conversation and these amendments matter because this legislation does not happen in a vacuum. The Labour Government today are rightly concerned with addressing the public health emergency of violence against women and girls in our country and has an important landmark mission and goal of halving violence against women and girls over the next decades. The NHS is playing its part and enhancing its efforts in tackling and violence against women and girls, focusing particularly on early identification. There is a lot of other very important work going on via training and investment, and I commend the work of many colleagues who are dealing with this on a daily basis. It was the experts that told us that to identify coercion, undue influence and pressure, doctors and other professionals need to look at someone’s body language. It is not just the words we say, how we say them, the volume or the tone—it is our non-verbal cues and what our body says. It is what we do not say that often shares an important message.

I listened very carefully to the counterchallenge of noble Lords so far. I do not think there is anything to stop the Bill from stipulating that, in exceptional circumstances, the doctors, or the independent advocates or panel members can visit an individual. But I would much rather that we had legislation that supports the Government’s important aim to reduce violence against women and girls, rather than something that will exacerbate the very serious problem that we know that too many women in our country face, particularly at their most vulnerable moments, which includes the end of life.