Terminally Ill Adults (End of Life) Bill

Lord Bishop of Southwark Excerpts

Friday 27th March 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

This is meant to be a debate. I have taken a lot of opposition points. Let me finish. The worry is that civil liability protections do not cover where a duty is owed to the patients. How can doctors who do not wish to offer or discuss assisted dying be sure that they do not face liability for failing to comply with their alleged duty to raise treatments?

When I have raised such concerns with supporters of the Bill, I have been reassured that now that we have passed the workers’ rights Bill—there are parts in this Bill, too—there will be lots of protections. They point out that, if there are any problems, staff can always use employment tribunals if they feel that they have been unfairly treated, although, as I say, trade unions are quite keen on an opt-in. But as those of us who sat through the hours and hours of deliberations on the Employment Rights Bill will know, employment tribunals have huge, years-long waiting lists. Also, such tribunals put the burden on the employee to demonstrate and prove detrimental treatment, which seems completely unfair.

It seems pertinent to note, as mentioned by the noble Baroness, Lady Fraser, that as the remedy in employment cases is damages not rehiring, this could lead to driving health and care workers out of the understaffed healthcare sector—not a good result. To finish, as the noble and learned Lord is a member of the party that rightly boasts of its commitment to workplace fairness and workers’ rights, I am simply hoping that he will be sympathetic to those amendments that put workers’ rights—guaranteed—centre stage in relation to assisted dying. It is not too much to ask.

[The Lord Bishop of Southwark]

My Lords, I am glad to follow the noble Baroness, Lady Fox of Buckley, because I added my signature to Amendment 673 in the name of the noble Baroness, Lady Fraser, as did the noble Lords, Lord Carlile and Lord Hunt of Kings Heath.

Allowing for some reticence on the necessity of this amendment, I just wish to make two points. First, the Bill allows an opt-out for registered medical practitioners: a health professional, a social care professional or a registered pharmacist. Administrative tasks are specifically not excluded. The Bill defines health professionals as medical practitioners, pharmacists and nurses, but it does not define care professionals. This is a lacuna, which will cause problems should this or any Bill on this basis pass your Lordships’ House.

Secondly, matters of acute conscience are not restricted to the immediate preparation of a lethal dosage or the medical oversight of the procedure. There will be, for reasons of practicality, not least of cost, pressure on all sorts of ancillary staff, as anyone in a health and care setting will attest. If they are co-opted, either directly or indirectly, into what becomes the final procedure, when the conscience of such an ancillary participant tells them that they should have nothing to do with such a procedure, is it right that they should face sanction or inhibition of their careers, or even dismissal? I suggest not and I hope that the House will support this amendment.

[Baroness O'Loan (CB)]

My Lords, I tabled Amendments 668 and 670 and put my name to eight other amendments. I am supportive of other amendments, which I will explain. We are talking about how to protect the conscientious objections of doctors and other healthcare practitioners, as well as others, through an opt-in system, which would allow doctors and others who are willing to engage in assisted suicide to register their position and thereby provide a framework by which their rights are clear and practitioners are not subject to organisational pressure to engage with elements of the process or indeed the whole process.

We need to remember that medical practitioners need certainty about their legal and ethical obligations, especially when they are in a situation in which they may find themselves dealing with matters of life and death. In addition to this, many of those who work in healthcare have religious beliefs, which would preclude their engagement in facilitating others to kill themselves. Catholics, some other Christians and Muslims would be precluded from participation, yet may be prejudiced in their employment opportunities and prospects by this inability to engage. It is important, therefore, that this factor is considered and any such consideration should surely lead inevitably to the acceptance that the only way this can actually work is for people to opt in rather than having to opt out.

To that end, I have tabled Amendment 668, which would provide for a comprehensive conscience protection, allowing any person, not just a registered medical practitioner, to opt out of any activity that may facilitate assisted suicide, including any ancillary functions. Amendment 670 seeks to define what might be said to comprise assistance under the Bill, referring to

“any aspect of assisted dying under or in connection with the provisions of this Act, including but not limited to … administrative or managerial tasks, such as the allocation of”

duties to carry out these tasks; supervision of those to whom tasks are allocated; and

“accompanying and monitoring of a patient as they receive or after they have received the approved substance”,

the lethal drug. I also put my name to Amendment 665, which states:

“No health or social care organisation, team or professional is required or expected to participate in any part of the process of a person’s request for an assisted death”.


I added my name to Amendment 660, which would provide that

“involvement in assistance is wider than only the direct administration of lethal drugs”.

This would clarify the nature of what can be considered “assistance” under the Act.

I added my name to Amendment 679, which is similar but more specific and states:

“No company, charity, or other organisation is under any duty to participate in, facilitate, or permit on its premises the provision of assistance in accordance with this Act … No company, charity, or other organisation shall be required, as a condition of receiving funding or any other benefit from any public body, to participate in, facilitate, or permit on its premises the provision of assistance in accordance with this Act”.


This is fundamentally important to ensure that hospices, care homes, nursing homes and other similar organisations do not have to engage at all with the process of assisted suicide. It would also, I think, include prisons.

I declare my interest as a trustee of a hospice. There is a considerable fear that not providing explicitly to protect hospices in this way could lead to all sorts of difficulties. There is currently an expectation that hospices will provide care and support of many kinds and that they will not be involved in assisting people to kill themselves. To provide otherwise would change the whole ethos and purpose of a hospice.

The amendment would ensure that no financial consequences could ensue from a hospice maintaining its traditional ethos and operations and not engaging with assisted suicide. Amendment 770 would not provide that additional protection. The importance of this cannot be overestimated. Failure to protect hospices in this way may very well lead to the closure of hospices at a time when there is a huge shortage of expert palliative care, as we have heard so often.

These amendments are all tabled to ensure absolute clarity for professionals and patients and to further define the nature of the protections that professionals will have under the law should they not wish to become involved with assisted suicide. Very significant deficiencies would be created. Many potential legal challenges could be avoided if there was absolute clarity about those professionals who wish to engage with assisted suicide and equal clarity that administrative and all other NHS staff cannot be required to engage with any aspect of assisted suicide.

As has been said, the Royal College of Nursing has stated that nursing staff should have to actively choose to be involved and that it is “absolutely clear” that nurses have the right to say:

“I want nothing to do with this”.


That is the language of the Royal College.

The solution lies in the establishment of publicly available registers of professionals who do wish to be involved. I support the establishment of an opt- in system and have therefore put my name to Amendment 189, which would require the Secretary of State to establish and provide for the updating of a public register of registered medical professionals, supported by the BMA and the Royal College of GPs, who are willing and able to “conduct a preliminary discussion” under Clause 5(3).

Amendment 268 would provide that only doctors who have specifically opted in can become co-ordinating doctors, and that

“only those who positively choose to do so”

would be able to

“have the training and participate”.

Amendment 359 refers to “the independent doctor” in Clause 8, who would also have had to “explicitly” opt in. Amendment 617 would amend Clause 26(2) to provide that, where a co-ordinating doctor authorises another doctor to carry out the duties and provide the lethal drugs to enable a person to end their own life, that doctor must have expressly opted in to do so.

I support Amendment 680, which would provide for a specialist register for clinical psychologists who want to participate, to be operated by the Health and Care Professions Council, and similarly Amendment 681A, which would require a specialist register for assisted dying for pharmacists to be kept by the General Pharmaceutical Council, providing for those who are not registered medical practitioners, et cetera.

On training, the noble and learned Lord, Lord Falconer, has limited the statutory opt-in language to the bespoke training for co-ordinating doctors and independent doctors. His amendments do not provide the system-wide opt-in protection that the royal colleges have requested. Consequently, doctors, GPs who do not wish to be co-ordinating doctors or independent doctors, nurses and other front-line staff may be required to participate in basic or tier 1 training and participate in peripheral aspects of the process.

It is important to say that it would not be cost effective to train every member of the National Health Service in the provision of assisted suicide if they are not going to engage with it. We always have to remember that training has to be repeated—I will not give way, the noble Baroness can come in later—and is not a one-off. There are huge costs and extractions of staff from the delivery of services when they have to do training.