Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I am grateful to my noble friend for laying such a broad amendment, and obviously I agree with much of what the right reverend Prelate said. It is interesting that this is coming straight after the debate on face-to-face conversations. We are all used to ticking the “I am not a robot” box, but AI now has the ability to create persons, and it is often very difficult if you are not face to face to judge whether the person on screen is actually a person. I cannot believe we have got there quite so quickly.

However, it is also important to consider about public confidence and understanding at the moment. This is, as we keep saying, such an important life-or-death decision. There is a lack of understanding and people are potentially worried about these implications, often with regard to employment but also other purposes. For instance, as I was preparing this, it made me reflect, as the noble Baroness, Lady Gerada, said, on how your GP uses AI. When Patchs told me recently that the NHS guidance was that I should not take an over-the-counter drug for more than two weeks, I queried it.

However, only yesterday, I thought: was that answer actually from my GP or was it from an AI tool sitting behind the system? We really need to be careful with the level of public understanding and awareness of its use. This use of AI is also one step on and connected to Clause 42, which relates to advertising. I am grateful that the noble and learned Lord is going to bring forward some amendments on that clause. I hope that the connection with AI, as well as the Online Safety Act 2023, have been considered. If I have understood the noble and learned Lord correctly, I am disappointed that we have had no assurance that those amendments will be with us by the end of Committee, when the noble and learned Lord gave evidence on 22 October last year and accepted that there was additional work to be done on Clause 42.

I said at Second Reading that the Bill is currently drafted for an analogue age. I am not wanting to take us back to some kind of quill and no-use-of-AI situation. Obviously, as other noble Lords have said, the Bill do not deal with the pressure or coercion not being from a human being. It also does not consider that coercion can now be more hidden with the use of AI. The Bill does not deal with people being able to learn to answer certain tools by watching YouTube. Therefore, we could be in a situation where someone who would not qualify if there was a face-to-face non-AI system could learn those answers and qualify.

There are also good studies to say that its use in GP practices has had some inaccuracies. In many circumstances, there is a lack of transparency and accountability in tracing where the decision has come from. We do not even understand the algorithms that are sending us advertisements for different shops, let alone how they could be connected to a decision such as this.

Finally, my biggest concern is that there will be a limited number of practitioners who will want to participate in this process. That has been accepted on numerous occasions in your Lordships House. I will quote from a public letter written on 12 June last year. All of Plymouth’s senior palliative medicine doctors were signatories to a letter warning us of the risks of the Bill and saying that the

“changes would significantly worsen the delivery of our current health services in Plymouth through the complexity of the conversations required when patients ask us about the option of assistance to die”.

That is relevant for two reasons. First, if we have a shortage of practitioners in parts of the country, such as the south-west if those doctors’ opposition to the Bill translates into not being involved, there may therefore be an increased temptation to resort to more use of AI. I hope that the noble and learned Lord or the Minister can help on this point.

Many of these systems—I am speaking as a layperson here—rely on data groups and information within the system: the learning is created from that. If you have a very small pool of practitioners and some form of AI being used, does that not affect the creation of the AI tool itself? I hope that I have explained that correctly. With such a small group doing it, will that not affect the technology itself?

[Lord Deben (Con)]

I come to this amendment with a good deal of suspicion. I am always worried when the House of Lords decides that it is getting worried about some new thing that is coming along, so we had better do something about it. The noble Baroness, Lady Coffey, explained that this was a broad demand in order that we should concentrate on the important bit. I recommend to those in the House who were not here for last night’s debate on super-clever AI to read it, because it explains why we should be concerned about this. If it will not embarrass him, I shall say that I hope the House will read with care the speech by the right reverend Prelate the Bishop of Hereford, which brought his scientific knowledge and moral concern together in a most interesting and perceptive way. If his quoting Saint Thomas Aquinas interests people, there is a remarkable book called Why Aquinas Matters Now, which is well worth reading in the context of this particular Bill.

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[Lord Falconer of Thoroton (Lab)]

On the first point, as I said, the review has to report in the first reporting period required under Clause 50. That means that it reports probably three years before the Bill comes into force, so there will be no cases. It is not doing what the noble Lord, Lord Sandhurst, was saying. On the second point about wriggling out, what the noble Baroness was describing would also be a Fatal Accidents Act case, so it would be covered, one hopes, by what the review deals with.

[Lord Deben (Con)]

My Lords, I come back to the idea of having an inquiry and a report. I do not quite understand why the noble and learned Lord does not feel that it is much more sensible for us to have it in the Bill. After all, otherwise you are in a sense dictating what the inquiry shall come up with. The only inquiry that you would want to have is one that found an answer to the problem, but you do not know that if you set up an inquiry. I would rather like to have the answer to start with in the Act so that we know that those people are protected.

[Lord Falconer of Thoroton (Lab)]

The reason, from discussing and thinking about this issue, is that the Government see the most convenient way of doing it is to have a review that can make sure every single aspect is covered. That is the argument for the review.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

This matter was the subject of comment and discussion in the House of Commons. For all concerned, the way in which these two pieces of legislation fit together needs to be considered, because it could affect the very good and hard work that has been done by the Minister on the Mental Health Act. Therefore, I hope His Majesty’s Government will come forward with amendments or offer a meeting to noble Lords and the relevant clinicians of the Royal College of Psychiatrists, Professor Alex Ruck Keene, so we can understand how these pieces of legislation will work together and avoid further amendments being laid—which is why I have taken the first opportunity to raise this matter with your Lordships.

[Lord Deben (Con)]

It seems to me that this an opportunity for the noble and learned Lord to help the Committee and speed the Bill. Here are a whole series of amendments designed to deal with the genuine concerns of the experts who are going to have to actually carry this law into effect if we are to pass it. Some of us may have strong views about the principle, but we have a duty to do our best to make the Bill work.

One of the problems people have is that the noble and learned Lord has so far not been willing to tell the Committee that he will meet concerns by proposing amendments himself. In this particular group of amendments—which is why I tried to wait until the end of it, because it is not only on an individual amendment that I speak—there are a whole series of reflections of the concerns of those who will have to deal with the Bill when it is passed.

This is an occasion in which we can overcome a lot of the concerns—I might even say suspicions—that there is no intention of changing anything, and that it will just be pushed through, however long it takes, in order that there should not be a concern at the other end of the Corridor. I am sure that the noble and learned Lord does not really think that, but he needs to reassure the Committee. We will get much further, much faster if he can look at these amendments and say he is going to bring forward amendments that reflect the concerns here, which themselves reflect the concerns of the various medical bodies in particular, in order that the Bill will be a more effective Act.

If the noble and learned Lord does not do that, there is a very serious criticism of the Bill, that we are not reflecting in this House the concerns of those who, next to the people who make this choice, matter most: the people who have to implement it. All the medical bodies have reservations. Some few are opposed to it in principle. I am perhaps more interested in those who are not opposed to it in principle but who are concerned about it in practice. If we are not prepared to make the changes that make them happy—though perhaps “happy” is the wrong word—and able in good conscience to support the Bill and follow it through, then we will not have done our job as this reforming House. I say this because I have become rather weary with the fact that what appears to be true is that there are those for whom this is so important a doctrinal position that they are not prepared to consider that this particular formulation needs alteration.

Therefore, I ask the noble and learned Lord, when he comes to answer, to consider very seriously a willingness to say, “I will go through these amendments, talk to the people outside if necessary and bring forward the kinds of amendments that will meet the real concerns of those people upon whom I am going to depend for the efficacy of this legislation if it is passed”. If the noble and learned Lord is unable to do that, more and more of us will begin to wonder whether this is really a debate in which we are trying to improve the Bill and make it the best legislation possible, or merely one that will be prolonged for as long as possible in order to put through the exact same Bill to the House of Commons. Frankly, if it is that, all of us who have doubts about it should redouble our doubts. If it is not that, we have a duty to help the noble and learned Lord to get the best Bill possible. It is in his hands, and this may well be the moment for him to show his hand.

[Baroness Jay of Paddington (Lab)]

I wonder whether the noble Lord would accept the actual evidence of one member of the medical profession who gave evidence to the Select Committee. She reflected many of the concerns that people who support the Bill agree with. She said that, when the healthcare professions

“get it wrong … it is usually because we are being paternalistic”.

A great many of the amendments in this group are very well intentioned and meaning in their concern for patients, but we must allow for the fact that they rely on an assumption that the medical professions, in their doubts, may act paternalistically.

I have been married for a very long time to a doctor. He would certainly say that the practice of medicine has changed hugely in his lifetime, and that when he first qualified as a young doctor, the field was paternalistic. However, now there is a much greater assumption that the words, intentions and wishes of the patient should be the ones that carry force. That is obviously the philosophy behind so many of these amendments, which, in a sense, seek to reintroduce the paternalistic attitude of the medical profession. In contrast, those of us who support the Bill are much more concerned to support its underlying principle of the autonomy of the individual patient.

[Lord Deben (Con)]

I hope that it was an intervention, because, if so, I am able to comment on it. If we start talking about paternalism, we will go backwards in time. We are not really talking about that at all; we are talking about the legislation of this House and the House of Commons. We are talking about how we produce legislation that works. What worries me is that there are a lot of words being used, such as “paternalism”, “kindness” and others, that are making us less precise. Law has to be precise enough for it to be properly implemented.

Frankly, the intervention of the noble Baroness sums up something else. There is a paternalism among some in this Committee who feel that they are so right about the Bill and that they can therefore ignore the comments of people who are trying very hard to overcome their own prejudices—if that is the right word—to get the Bill right. I find it a bit discomfiting to be lectured to, from time to time, as if I should not be making any of these comments because I do not seem to understand the higher views that are being presented. After being a Member of Parliament for 40 years and knowing what goes on in families in terrible circumstances, all I am trying to do is protect people. That is my job; it has been my job all my life. In response to the noble Baroness shaking her head, I say: that is not paternalism; that is the role of leadership in any circumstances. It is what decent people do, and, above all, it is what kindness demands.

[Lord Harper (Con)]

My Lords, I will speak to two blocks of amendments in this group. Before I turn to that, I just want to pick up on the points that my noble friend Lord Deben made. I strongly agree with the thrust of his speech, and I look forward to the response of the noble and learned Lord, Lord Falconer of Thoroton, to this group, not just to the specific amendments. Perhaps it will give us a sign of how he intends to respond.

I agree that if the noble and learned Lord listens to the concerns of the Committee and sets out clearly on the Floor of the House on the public record what he intends to do about some of them, that is the best way, from his point of view, to make progress. It is important that those commitments are made on the Floor of the House in public, rather than in private meetings. That is how Ministers generally conduct themselves when they discuss concerns with Back-Benchers. They might have meetings to discuss those concern, but, certainly when I was a Minister, I was always expected to set out at the Dispatch Box what I was committing to do on behalf of the Government so that people were confident that we all had an agreement and that it could not be walked back. Given that we are in a slightly different situation here, because it is a Private Member’s Bill and the noble and learned Lord is the sponsor, I would expect him to behave in the same way as a Minister piloting a Bill to give that level of public transparency, and I hope he will be able to do so.

I will pick up on what my noble friend Lord Deben said in response to the noble Baroness, Lady Jay of Paddington. I agree with her that we should not be paternalistic, but I do not agree that that is what we are in danger of doing. This group of amendments is about making sure that other people are not making decisions on behalf of the individual who is going to end up losing their life. This is about making sure it is actually their decision, that they are not being pressured into it and that someone is not making it on their behalf. Allowing somebody else to allow someone to be killed is the paternalistic thing—to turn a blind eye to it and do nothing about it. To make sure that it is genuinely that individual’s settled will is the opposite of paternalism. That is what we are trying to do in this group of amendments.

The first amendment I want briefly to refer to is Amendment 28 in the name of the noble Baroness, Lady Finlay of Llandaff. It is about setting out in the eligibility criteria that someone is entitled to benefits under the special rules, for example, personal independence payment on the grounds of terminal illness. I accept that the noble and learned Lord, Lord Falconer, may quibble with the wording, but the point is to make sure that the person has gone through that process to apply for that benefit to make sure that one of the reasons they are seeking assisted suicide is not because of financial pressure. There may be other ways of achieving that, but that is the purpose of the amendment, and that is very important.

The Committee will be aware that under our rules for personal independence payment, if you have a terminal illness diagnosis, there is a fast-track procedure, rightly, so that you can get financial support much quicker than under the normal process. That is very important to ensure that someone facing a terminal diagnosis does not have financial pressures added to all the other things they are dealing with. The amendment is a sensible way of ensuring that someone has got that financial support and to make sure that is not the reason they are seeking assisted suicide.

Secondly, I support Amendment 31 and Amendments 68 and 68A, to which I have attached my name. They would make sure that it is genuinely somebody’s own request. The reason why that is important is—we will hear from the noble and learned Lord in a minute about whether he thinks the drafting of the Bill already deals with this—that I am very mindful of the issue that we hear about pretty much every week, and I suspect we will hear it again today from the Minister, who usually has an extensive piece in her briefing that counsels us on concerns about the European Convention on Human Rights and the extent to which decisions that this Committee takes might end up being challenged under that legislation and that we should bear that in mind.

I always listen to the Minister with care, and I am effectively doing what she is asking us to do, which is to be concerned about that issue. Even if the noble and learned Lord, Lord Falconer of Thoroton, is able to assure us that, in his view, the Bill as drafted does not present that risk, I still want him to look seriously at these amendments because of my concern—which we have seen in other jurisdictions—about judicial oversight and judicial moving of the goalposts. This legislation will inevitably be challenged, and I want to make sure that we do not find judges starting to move the goalposts when there are challenges and allowing things to happen that we would not have wanted to happen.

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[Lord Markham (Con)]

Every point that has been raised is valid, and I am sure that, when the noble and learned Lord, Lord Falconer, gets up to respond, he will acknowledge those points as well. However, I think the question in each case is whether we want it to be a black or white assessment of whether that should apply.

Financial support is a very good example of where in some cases that may be very relevant and in others it may not. I remember that my mother, unfortunately, was given a matter of weeks to live and was helped on her way when there was a matter of days left. The financial circumstances just did not even come into it at that point, so having a black and white assessment saying, “Oh, she didn’t seek financial support or didn’t have it”, was not even a relevant criterion. On the question about mental health and whether someone has had any disorders, that is very relevant if it was a recent episode but I think we would probably say it was not very relevant at all if it was 50 or 60 years ago.

Therefore, in all these circumstances, are we not seeing cases where it depends on the circumstances? To me, it is a question of whether we trust the panel, and whether we trust the doctors assessing the case, who are looking into all the criteria and will have the opportunity to call for any evidence they need on it, to be able to do that.

[Lord Deben (Con)]

Does my noble friend accept that one of the problems is that the organisations of these very people whom we are trusting have said that they want clarification on these things. The issue, therefore, is that we should be giving them that clarification that they want, and then we can trust them. They say they do not want to be trusted unless they have that clarification. That is the only point we are trying to make.

[Lord Markham (Con)]

Again, it is about whether you put that financial support clarification in black and white and say, “This must be something that someone’s done”, where it might not even be relevant to the circumstances, or where the—

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[Lord Winston (Lab)]

My Lords, I wonder whether I could briefly come back to something that the noble Lord, Lord Deben, said. I have a great deal of respect for him, and I agree with a great deal of what he said in his speech just now, but I suggest that, when it comes to medical practitioners and the medical and caring profession, the word “concerns” does not mean that they are against the Bill. It is very important to understand that.

As a member or fellow of a number of these different organisations, what surprises me is how little of the correspondence from them is actually against the Bill. Sometimes there is some concern—of course, this needs reasonable regulation and proper agreement— but, overall, we must be very careful about how we understand their words. I have certainly not heard from my colleagues in many conversations over these past months that the Bill should be stopped. On the contrary; they are interested to see how it goes. I certainly think that many of them would say that they feel that this is a good Bill to look at.

[Lord Deben (Con)]

May I interrupt? I did not for one moment suggest that I was concerned about this because people were opposed to the Bill. What I said—indeed, I said this specifically—was that I was not thinking of those who were in principle opposed to the Bill. What I wanted to say was that specific concerns had been expressed, and that some of these amendments seek to meet the concerns of the very people who are going to carry this Bill through. I was not proposing this to stop the Bill; I was saying that even those of us who do not like the Bill want to do our job, which is to produce a Bill that will be at least, in the proper terms, workable. That is the only point I made.

[Lord Winston (Lab)]

I thank the noble Lord for this conversation. I am glad to hear him say that but, unfortunately, the word “concerns” is often bandied about by people who just say, “Well, of course, the doctors are against this Bill”. That is not a fair assumption; it is certainly clear from the Select Committee evidence we heard that there are various opinions.

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[Lord Falconer of Thoroton (Lab)]

It is. The reason the two are different is that Clause 1(2) describes what is coming later in Clauses 8 to 30; Clause 1(3) is a mandatory requirement that the steps that come later have to take place when the person is in England or Wales. So they do different things. Subsection (2) is descriptive, and subsection (3) is a legal requirement. I am very happy to say that the shadow Attorney-General is nodding, which is very strengthening on this.

The one point that I have not dealt with properly, or at all, is that which the noble Baroness, Lady Berridge, made about the interaction between the Mental Health Act and the Bill. I was not sure which specific amendment she was referring to; it may have been Amendment 38, but I do not know. However, as far as I can see, there is no legal difficulty in this Bill sitting with the Mental Health Act because, as long as these conditions are satisfied, the patient is entitled to have an assisted death. There is nothing in the Mental Health Act that would prevent that. I am more than happy to have a more detailed conversation with the noble Baroness and Professor Ruck Keene, if she wishes to bring him along and he is willing to come.

I hope that I have dealt with every amendment put forward.

[Lord Deben (Con)]

Just one point, as a matter of personal explanation, I did not call the noble and learned Lord Stonewall; it was the noble Lord, Lord Empey, who did so and I do not want to take his excellent comment away from him.

[Lord Falconer of Thoroton (Lab)]

I apologise. I do not know whether the noble Lord feels that he is withdrawing a compliment or withdrawing an insult, but I get what he is doing.

To the noble Baroness, Lady Cash, before she gets to her feet, I say that she is right. In relation to the ECHR points that were raised by, I think, Mr Stevenson, who was the commissioner—I have the name wrong.

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However, for the reasons I have given, I am not in favour of trying to give specific excluded motivations or saying that it has to be due to pain and suffering or for your own sake. What is “your own sake”? How do you bear thinking about what your children feel? That could be an unbearable position.

[Lord Deben (Con)]

Can I encourage the noble and learned Lord in what he has just said? I was going to intervene earlier, but decided I would wait for this moment. I am afraid the noble Baroness, Lady Whitaker, almost drove me to get up; she can say that she does not want to be a burden because she will not be one and I am quite sure her family would not let her be one. The truth of the matter is that we are concerned about making sure that people are given every opportunity to put themselves in the best position in the last six months of their lives. If the noble and learned Lord can find a way of having these questions asked without the disadvantage—I understand the point he makes—it would give us a great deal of support. I would like him to do that.

[Lord Falconer of Thoroton (Lab)]

I hope I have been clear about not liking the amendments as they are and that I am keen to see whether what the noble Baronesses, Lady Smith of Newnham and Lady Fox, said can be incorporated somewhere in the Bill. It may well connect with things we have said already. I hope I have made my position clear.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Harper (Con)]

My Lords, this is a very sensible group of probing amendments, and it is a pleasure to follow the right reverend Prelate. I will speak to them because the issues raised in this group concerning the difference between where somebody resides and where their GP is registered are exactly analogous to the situation regarding England and Wales, which I raised in an earlier group but have not received a satisfactory answer to.

I will remind the noble and learned Lord of the situation and he can, I hope, respond in a positive way. There are two issues, one of which is the difference between where you reside and where your GP is registered. There are a significant number of people living along the England-Scotland border and the England-Wales border whose place of residence is not the same as where their GP is registered. Therefore, it is very important that the legislation makes it clear that the rules through which you access assisted suicide are governed by where you live, not where your GP is registered. That is important for the reasons my noble friend Lady Fraser set out—in England and Scotland there will potentially be very different legal situations.

As we know from the earlier debate, although the Bill covers England and Wales, the rules governing the detail of how an assisted suicide service will work in Wales will be set by the Welsh Senedd, not the UK Parliament. Therefore, it is important that the Welsh rules apply only to people in Wales, who are governed by a body that is democratically accountable to them, not to people who live in England; otherwise, there would be a massive democratic deficit. It is very important that the noble and learned Lord is clear about how that is going to work.

Secondly, I think the noble and learned Lord said in response to our debate on England and Wales that he and the honourable Member for Spen Valley had had some detailed discussions with the devolved Governments. However, I was not clear from his responses whether those discussions had covered this point. Obviously, they need to take account of the views of not only the devolved Governments but the UK Government—which, for these purposes is actually only the English Government. We need to understand how this is going to work in practice.

As I have said, and in conclusion, this must be got right now, in primary legislation. If we do not get it right now, somebody will have to spend months and years clearing up the mess afterwards, which is one of the things that I had to do when I was the Member of Parliament for the Forest of Dean to deal with the cross-border issues that had not been properly thought through then. This is a valuable set of amendments. I was pleased that that the noble and learned Lord acknowledged, I think last week when the noble Lord, Lord Beith, spoke about this briefly, that these are valid issues that need proper answers. I look forward to hearing them now.

[Lord Deben (Con)]

Could I be vulgarly practical about this, because of a point the noble Baroness mentioned, which is the parallelism with the deposit return scheme that got into terrible trouble? I declare an interest as chairman of Valpak. We had to work through that, so it is burnt into me how extremely damaging it was because it was not decided beforehand. I know that we are talking about much greater issues here but, as I hope the noble and learned Lord will accept, this is a really serious issue; it brought about enormous cost and a vast misunderstanding, and it ended up destroying what the Scottish Government wanted to do. It is a very dangerous precedent. I am sure that the noble and learned Lord will want to make absolutely sure that we do not have a repetition of something that cost vast sums of money, in both the private and public sectors, and that has undermined an important measure ever since.

[Earl Howe (Con)]

My Lords, this group of amendments covers two distinct but connected questions. The first question, posed by Amendment 17, is, in my judgment, a very helpful one, because the answer will clarify the role—or lack of role—played by a person’s GP in the process being pursued by that person in seeking an assisted death. It seems to me, from reading the Bill’s provisions, that the involvement of a person’s GP in that process, although very likely, is not legally necessary provided that the patient fulfils all the conditions set out in Clause 1(1). Clarification from the noble and learned Lord would be very helpful.

The second question, posed by my noble friend Lady Fraser’s Amendment 62, is also one that I hope can be answered very simply by the noble and learned Lord. Am I correct that it is implicit in Clause 5 that the preliminary discussion between the patient and the registered medical practitioner need not involve a doctor physically situated in England and Wales and need not be face to face? Equally, am I correct that it is unnecessary to state in Clause 1(3)(b) that the steps set out in Clauses 8 and 19 must be taken

“by persons in England or Wales”,

because Clauses 8 and 19 already explicitly provide for this?

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[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, but I would like to press on. There are other GPs who want to see the same patients; they want to build up the patient relationship over time because they say it makes for better diagnosis, care and treatment for their patients. We should not put up with the worst-case scenarios simply because it does not happen or because we think a multi-doctor practice works well. It may work well in some cases, but there is no replacement for knowledge of a patient over time.

The letter gives the multidisciplinary panel an assessment of the patient’s illness and state of mind by someone who knows them. If anything raises suspicion that there has been pressure or that the patient is not in a state of mind to make the decision, the panel can investigate further. Moreover, unlike the other matters and activities in the process, the letter is not a matter of ticking boxes. The demand is for something that doctors are used to doing; to write a coherent letter about one of their patients is something that requires thought and careful concern for the individual case. It is standard practice in referring a patient to a consultant for specialist care where there are letters passed to and from. Doctors and consultants write letters.

If the Bill is to have real safeguards in the form of coherent and analytical evidence from a doctor who has known a patient over time, such amendments are needed. I ask the sponsor of the Bill to require it.

[Lord Deben (Con)]

My Lords, we are supposed to be making the Bill more practical; it does not make it more practical to ask for something that is manifestly impossible. I could not demand assisted dying, because I have not seen my registered practitioner in Suffolk for many years. I do not have a particular practitioner because that is not how the local system works. We are not in a sensible position if that is what we are going to ask for.

But the noble Lord, Lord Rook, has an important point that I do not want us to lose because of the suggestion that all people have the kind of National Health Service that we would all wish to be the case. We have to take his point rather differently. I was surprised that the noble Lord, Lord Winston, suggested that the proposition is that the general practitioner or the team—in normal circumstances it is the team—could in some way stop the application.

The point is—and I ask the Committee to think about this seriously—that if someone has a general practitioner, it is important that the GP and his or her team are informed of the request in case they are able to contribute to a sensible decision. The fact that this is assumed in the Bill, as was put forward by the noble Baroness, Lady Fox, does not prevent us insisting that they should at least have the opportunity. If we do that, we will be doing a very valuable thing.

[Lord Scriven (LD)]

It is not an assumption. It is in the Bill that if the co-ordinating doctor is not the GP of the person seeking the assisted death, under Clause 10(3)(b)(ii) the co-ordinating doctor has to write to the GP practice to make it aware of the request.

[Lord Deben (Con)]

I agree with that, but the point of the amendment from the noble Lord, Lord Rook, is to tie together a period of someone being in the National Health Service. I agreed with the comments made by the lawyers about “normally resident”, rather than other words. The noble and learned Lord who introduced the Bill might consider that this amendment will give some confidence to those who had a concern because it means that “normally resident” has been underlined by the fact that someone has in fact been in a general practice of the National Health Service. I cannot see that it does any harm, given that there is a year in any case. It underlines what the noble Lord reminded us of: the idea that this should be a part of the normal way in which people are dealt with.

I do not like the Bill very much, but it is our job to make it work. To do that, it is more valuable to fix it within the National Health Service as we have it, rather than trying to invent a service that we might well like to have—and I am old enough to remember when we did have it. Let us not pretend, when things are not as they ought to be.

[Baroness Gerada (CB)]

My Lords, if a patient is at the end of their life in any practice in the NHS, that patient will be discussed at a multidisciplinary team meeting. The patient will be put on an end-of-life pathway and will have a named clinician within the practice to do their care. This would include assisted dying. There is absolutely no way that a patient, unless in an extraordinary situation—and I take the point about Wales, which has a desperate problem with GPs—would not be cared for in that way. That is how our contract is; that is how we want to care for our patients. We would code it on the notes so that every single person consulting with that patient would know that this patient was an assisted dying choice, and they would get the care that I have just described.

With respect to the arbitrary 12 months or 24 months, many patients choose to move at the end of their life. They choose to move to the place where their loved ones are. Many choose to do something such as go abroad to the countries that they may have come from and come back right towards the end of their life. To put in an arbitrary barrier of 12 or 24 months is not putting the patient first; it is putting an arbitrary time limit first.

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[Lord Carter of Haslemere (CB)]

My Lords, I want to make a very brief intervention in relation to the prison population. It is only the second time I have spoken on the Bill. I declare an interest as a trustee of the Prison Reform Trust.

The suicide rate among male prisoners is four times as high as that of the general population. In the year to 2024, 89 male prisoners committed suicide. The Prison Service has a duty of care towards the prison population to protect them from committing suicide—to stop it. The Government run the Prison Service, so they must have a view on what to do about a prisoner whose suicide the Prison Service has correctly thwarted under its duty of care but who then requests an assisted death under the Bill. How will the Government balance those two conflicting things?

That is my short intervention—to ask that question. I wholly support all the comments made by the noble Baroness, Lady Fox, the noble Lords, Lord Moore and Lord Farmer, the right reverend Prelate the Bishop of Gloucester, and others on this crucial issue. I am genuinely interested to know what the noble and learned Lord, Lord Falconer, makes of this dilemma for the Prison Service and the Government.

[Lord Deben (Con)]

My Lords, the moments in the Bill that most concern me are when it gets nearest to saving money. There are several occasions on which that appears to be the case, particularly when talking about people for whom many have no sympathy at all, and when you are talking about a service in which we all know we are failing. It cannot be true that any Member of this House believes that our prisons are as they should be. Yet we imprison more and more people. We imprison twice as many people as the French or the Germans. I still do not understand why we cannot take this seriously, but we still go on doing it.

First, can one really think that someone in prison circumstances finds it possible to make the same kind of decision as people who are not? Just simply, those circumstances are the pressures, the crowding and the fact that you are not in any company that you would have chosen. I do not believe that those are the circumstances in which the Bill’s proponents meant for decisions of the sort we are talking about to be made.

The second issue is: what about the pressures there? We have been talking about the concerns of those who find themselves under pressure. Do we really believe that there will not be many prisoners for whom the whole issue will be presented as, “You will be better off and we will be better off if you make this decision”?

The third issue is surely this: we know that prisoners have much worse healthcare than people outside prison. Therefore, the fact that they are told that they have but six months to live is much more difficult than it would be if they were in normal circumstances. I put it no more sharply than that, but it does seem to be true.

Fourthly, earlier on, we were talking very strongly about the difficulty that the Government are willing to fund this when they are not funding palliative care for very large numbers of people in the country. I therefore come back to my deep concern that it will become so much easier for people to die than to continue.

The right reverend Prelate, whose experience is remarkable and whom I admire enormously for her work in the prisons, has reminded us of how old the prison population is and how much older it is becoming. I just do not think that those of us in this House who really believe that our major job in this Bill is to protect the vulnerable can possibly agree that people in prison should be included under the Bill. We should take them out.

[Lord Markham (Con)]

May I just offer a different perspective on this? It has been an interesting debate. One of the main reasons I am supportive of assisted dying is kindness—kindness to the people who are scared about the inevitable end of their life and kindness in that they face a lot of pain. They see assisted dying as a way of relieving themselves from that pain.

In this debate, are we saying that people in prison are not deserving of that kindness? People in prison have been deprived of their liberty because of the crimes they committed, and that is the punishment that they have been given in the face of the law. That is the debt being paid to society. But are we saying at the same time that they do not deserve the same kindness that we would give to others and that they should face pain because they are in prison, whereas others should not? That is my perspective on this.

[Lord Falconer of Thoroton (Lab)]

The noble Baroness is intervening on somebody who made an intervention on somebody else. We got a very severe talking to about that before, so I do not think that is allowed.

[Lord Deben (Con)]

I did not realise that the noble Lord was intervening on me, but I will just say that, for me, it is very difficult to have that argument. Kindness is absolutely the central point of everything that I believe in, so I am very vulnerable to that question. But the truth is, the Bill does not talk about pain at all. There is nothing in the Bill about pain. This is about a totally different circumstance. One of the problems in the country as a whole is that many people who support the Bill do so because they think it is about pain.

We could have a Bill about pain, but then we would come back to the point made by the noble Baroness, Lady Berridge, that that is not what the Bill should have been. The Government should have said that they would give a free vote on a government Bill on this subject, rather than slipping it in in a wholly different way.

However, we are faced with what we have, and in that case it does not seem kind to say to people who are under all sorts of pressures and who are particularly vulnerable that this is a choice they should make. If we want kindness, we should be saying to the Government, “Get the Bill withdrawn and introduce a government Bill that is properly thought through where we can have the real debate that the public as a whole want us to have. You can still have a free vote”, but it should never have been put through in this way.

[Lord Markham (Con)]

If I may respond on the pain point, I have spoken to lots of people who are terminally ill and heard their evidence. Again, I recommend that as many people as possible hear them because they have heartwarming stories. For them—not all the time, but a lot of the time—it is because they want to have that choice at the end so they do not have to face that pain. That is a key reason for them. The Bill says that you have to be within six months of the end of your life, but then you have the choice within that. For some people, the thought of that pain, and the experience of that pain, is the real reason why they want an assisted death. My point is that I believe prisoners should have exactly that same right so that they have the possibility to avoid that pain.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

First, on there being no need to question someone about why they are withdrawing, if there is material relevant to it, I need to check the Bill to see that it should be recorded. But the Bill contains regular provisions that state that everything must be recorded. If it is not adequately covered—if somebody says, “I’m withdrawing because I think you’re being coerced”, obviously that should be recorded—I will make sure that it is covered.

On Amendment 405—

[Lord Deben (Con)]

I genuinely want to understand this. The worry we had about this being a drafting difference is simply because when you could withdraw only on grounds of illness or death, the situation about why you withdrew did not arise. When you remove that, people can withdraw without giving notice of why. Therefore, there ought to be something—the noble and learned Lord has rightly said that he will look at it—to make sure that if somebody withdraws because there is some serious issue in connection with the decision, they have to say what it is. If we do not have that, this very much becomes a weakening point. I know that the noble and learned Lord does not want it to become that, but without something that insists on the information being given, it does become much weaker. This is not a drafting point until that is put right; when it is, it is a drafting point.

[Lord Falconer of Thoroton (Lab)]

I do not accept that it is not a drafting point, but that may be dancing on the head of a pin. The point that both the noble Baroness, Lady Fox, and the noble Lord, Lord Deben, are making concerns making sure that if you are leaving for a reason that will give rise to problems, it is properly recorded. I completely accept that and we will make sure that that is the position, because it is a valid point.

In relation to Amendment 405, the noble Lord, Lord Shinkwin, said that it is a watering down. It is not a watering down at all, with respect. The current draft says:

“When carrying out an assessment in accordance with subsection (2), the assessing doctor must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters”.


The new draft says that the relevant doctor must

“take all reasonable steps to ensure that there is effective communication between the assessing doctor and the person being assessed (including, where appropriate, using an interpreter)”.

The noble Lord, Lord Shinkwin, is shaking his head; I am more than happy to talk to him about how that could be a change, and if there is some change that he would like in relation to it, let us put it in. But it is, in legal terms, to my eye, wider. It covers a much wider ambit without providing any inadequate protection. Maybe the right course is for me and the noble Lord, Lord Shinkwin, to sit down and for him to identify the changes that he would like. At the moment, I cannot see them.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Pannick (CB)]

My Lords, there is a profound irony in this group of amendments, because the Bill introduces far greater protection for vulnerable patients than exists under current law. Terminally ill people are currently vulnerable to all sorts of pressures from family members and others who may have their own agendas in seeking to persuade the patient not to continue with their treatment, to die or just to give up on life. The Bill introduces in statutory form a whole range of new statutory protections that simply do not exist in the standard cases of vulnerable people being encouraged not to continue with their treatment.

We see that in Clause 1(2), which summarises what the Act provides in some detail. Steps are to be taken, and they are taken under the Bill, to establish that the person concerned

“has a clear, settled and informed wish to end their own life, and … has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it”.

Those seem to me to be very strong and very appropriate protections. The idea that we should proscribe encouragement will inevitably lead to the family members and friends of the person concerned, the person in the terminally ill condition, being worried that, if they discuss this difficult, important subject with their loved one or friend, they will be vulnerable to all sorts of sanctions under the law. That, I would have thought, is the last thing that we want. The application of these principles—and they are the right principles in Clauses 1 and 2—will inevitably depend on the facts and the circumstances of the individual case, so I, for my part, do not see the need for any of these amendments.

[Lord Deben (Con)]

My Lords, I am not a lawyer, and it is dangerous to follow the noble Lord, Lord Pannick, but I think on this occasion he is mistaken. The fact that this kind of protection is not there until this Bill does not actually mean anything—perhaps it should have been there in any case—but, if we are going to have this protection, it needs to be proper protection.

I say to those who, at least today, live a privileged life that they ought to remember that there are many people in this country who, for the first time, are within touching distance of large sums of money, because the housing situation means that there are many old people who have houses of a value that those families have never seen ever before—grandma’s £200,000. I say to the noble Lord, Lord Pannick, that, as somebody who was a Member of Parliament for 40 years and works now in a community, that this is a very real fact, and we just have to accept that some people in this House are a long way away from those people. I was brought up in a slum parish by a clergyman. I have spent my life trying to deal with the very people we are talking about. I think these amendments are crucially important, because we are talking about circumstances which we are about to change deeply.

The fact is that the Bill itself changes the way in which we think about old age and infirmity. I desperately want people to know that they are always valuable and always got something to give, even at the end of life. This Bill removes that. If we are going to have it— I hope we will not, but if we are going to—we must make sure that people are protected not just from coercion but from encouragement, which I am afraid is sometimes driven by a sort of misunderstanding of what we can give. I can see people who will say, “You know that your grandson is in some real difficulty. You have a last opportunity to do something worthwhile. If you die now, your house will save his marriage, will save his firm and will look after his future”. That is what will happen. We, who are in happier circumstances, should just remember that we have a deep responsibility for those people.

[Baroness O’Loan (CB)]

My Lords, these amendments seek to prevent and/or identify coercive behaviours and pressure which may fall short of coercion, and situations in which vulnerable people may be encouraged to make what is actually an involuntary decision to end their own life that they would not otherwise have made. There is no definition of coercion or pressure in the Bill, although new offences are created by Clause 34. That is unfortunate.

Arrangements made did not enable the taking of evidence from those with disabilities until the recent Select Committee on the Bill. Liz Carr said in evidence to that committee:

“The absence of our … involvement has led to disability rights organisations making a formal complaint to the UN Convention on the Rights of Persons with Disabilities”.


That is very serious. We know that 40% of those who die by assisted dying in Canada have lived with disabilities.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

My Lords, this has been something of an unbalanced debate, so I hope it might be possible to hear from someone who supports the Bill. I was particularly anxious to come before the noble Lord, Lord Polak—for whom I have a lot of respect; we agree on many other issues—to respond very soon after the right reverend Prelate the Bishop of London. She was very honest when she said that she did not support the Bill, and I think she said that it was unamendable. Here we are, however, discussing amendments.

The noble Lord, Lord Carlile, spoke earlier about whether we should discuss a form of wording on which we could all agree. The question then would be: if we can agree a form of wording, would he then support the Bill? My feeling is that these amendments are not about making the Bill acceptable so that those putting them forward could then support it but are a way of trying to stop our discussion and proper scrutiny, because they do not want the Bill to go ahead.

[Lord Deben (Con)]

My Lords—

--- Later in debate ---

[Lord Goddard of Stockport (LD)]

Unfortunately, you can, because that is how this country works. It is called democracy. When 650 elected Members, representing 70 million people by a majority, send it to this House, we have a duty and the honour to treat that Bill with respect, not disdain, not threatening to derail it or run it out of time—

[Lord Deben (Con)]

Could I just put this to the noble Lord? He is suggesting this approach, however bad a Bill is, however many people are damaged by it, and whatever the mistakes in it. The Government say that, at the moment, the Bill is not suitable as legislation. We cannot go on discussing it until we get it right. As noble Lords know, I am not in favour of this Bill, but I am even more not in favour of a Bill that gets it wrong and does terrible damage. He surely is not saying that we should just pass anything and that that is okay, when we think of the people who are going to be damaged if we get it wrong.

[Lord Goddard of Stockport (LD)]

The noble Lord is on completely the other side of the argument, and I respect his views on that. This Bill has been scrutinised for over 100 hours in the other place. Evidence was taken from over 500 people. This is not just a piece of paper sent up here for us to determine.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

The noble Lord knows that I am not a proposer of the change of words. I am dealing with capacity. Therefore, I am also dealing with the fact that professionals within the field have stated that to use the Mental Capacity Act for a decision to end one’s life is an entirely novel test and uncharted territory for which there is no experience or precedent. That is not my statement; that is the statement of professionals within the field. They say also that to decide to use it for the decision to end one’s life is an entirely different and more complex determination requiring a higher level of understanding than assessing capacity for treating decisions.

Capacity can fluctuate in terminally ill patients due to physical fatigue, illness, medication or delirium, making the irreversibility of the decision risky under this framework. Therefore, I ask this Committee to think carefully in trying to base its whole argument on this being good legislation because mental capacity is the deciding factor.

[Lord Deben (Con)]

I wonder whether I can help the Committee. I think we may be discussing two rather different things, so I suggest that we decide which of them to discuss.

There is the discussion as to whether the word “capacity” really includes all the things that people are pressing for when they use the word “ability”. That is the point that the noble Lord, Lord Pannick, was clearly making when he expressed the nature of the word “capacity” as used in law. It is perfectly understandable that people would want to say, “Here is a word that we use. It’s a word which is defined and has been defined over a long period of time. Therefore, it’s stood the test of time”. I understand the noble Baroness, Lady Andrews, who rightly mentioned the amount of time that had been taken to deal with that.

--- Later in debate ---

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Baroness for her intervention. Every suicide is a tragic situation, and I am sure that all of us would wish to help that person. But that is not what the Bill is about. It is about whether we find a method where they have a settled will to make a decision—to make a choice.

[Lord Deben (Con)]

Is the difference not absolutely fundamental? The Bill allows the state to enter into this discussion and allows somebody in fact to kill somebody else. That is wholly different from suicide, and the noble Baroness is wrong.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Deben (Con)]

My Lords, the House will know that I have a moral position on this, but I am not going to talk about that.

This has been a most remarkable debate, and all of us from both sides have learned from what has been said. What has come out of it seems to be, first, that this is a very difficult issue. Secondly, although other countries have tried to do this, no one has produced an example of saying, “That’s where it works”. Instead they say, “That needs to be changed” or “There’s a problem”. Yet we are trying to debate this serious matter on a Private Member’s Bill that was inadequately dealt with in the Commons and has been criticised seriously by two of our expert committees.

What we are trying to do is momentous because we are seeking to depart from what has always been our attitude—apart from the question of capital punishment, which I fought against for many years—by empowering the state to kill. You can argue that, but let us realise just how serious it is.

I was an MP for 40 years and met wonderful people in both my urban and rural constituencies, but I also met people who felt that their old relations were a terrible burden and were spending money that would be much better left to them. I do not think we can ignore that fact, and I disagree with my friend, the noble Lord, Lord Dubs, when he suggested that somehow or other this was inconceivable. I put it to the House that not only is it conceivable but it is increasingly dangerous, because many families who have never seen any real money now see an aged relative who has a house worth £200,000 and more. There is a temptation for those people, whom I know and have met, to say to that person, “You really have a duty to save this money for your family. You know that Roger’s got a real problem and you can help him. This is what you should do”. No doctor is going to be able to analyse what has happened over a long time; the incident that we are discussing is very often at the end of a long period, when people come to that decision with that kind of pressure.

I am sorry that that is the case, and it is the case in a society that has far too many people about whom it has been suggested, because they do not work, are not worth anything. We must recreate the worth of all of us and the place that we all have in society. I am an individualist and a Tory, but I have to say that I see individuals as living in a society, and that means that we have responsibilities. It may be—I say this with due humility—that the contribution to society that someone in great pain may make is to protect vulnerable people by bearing that, in order that they will not be destroyed.