Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Friday 30th January 2026 Lords Chamber

I therefore have to say that I am very unhappy about the proposals in the Bill. I have put my name to some of these amendments and support the comments made by the noble Baroness, Lady Coffey.

[Lord Evans of Rainow (Con)]

My Lords, I will speak to my Amendment 376. It is a pleasure to follow the noble Lord, Lord Empey. Last Friday, like many of your Lordships, I sat here all day and did not say a word. My amendment was in the following group, but sadly we did not get to it. However, there was an excellent discussion, and I want to pay tribute to some of the contributors: my noble friend Lord Deben, the noble Lord, Lord Mawson, and indeed the noble and learned Lord, Lord Falconer.

The noble and learned Lord said something that rang a bell; he referred to studied diligence, and how healthcare professionals and the whole system will study how best to conduct these assessments. When he said “studied diligence”, it reminded me of some experiences that I had as a Member of Parliament in helping people in very distressing circumstances with the healthcare of loved ones and trying to navigate the system. The thing that struck me was studied neglect. Studied neglect is quite difficult to detect, because it is not always obvious.

Many of us in this House have a routine, which is what makes us get up every day, and as you get older, that routine becomes very important. You have a good night’s sleep, you wake up in the morning, you shower, you clean your teeth, you exercise and you go to work, or to functions in the community. You eat well—you eat healthily. You can lead a normal life, as many of us do in this House, but something may happen to you—you may slip, trip and fall, and you may find yourself in hospital. That is when things can go wrong, because you are out of that routine of a good night’s sleep and getting up in the morning. For every week that you lie in bed, you lose 10% of your muscle strength. You do not get up, you do not do your routine, you do not shower and you do not clean your teeth. Things start happening to you, and you can go downhill very quickly.

Those things can happen through daily life—but the thing that really concerns me about this Bill, and the reason why I tabled this particular amendment insisting on face-to-face diagnosis from the healthcare professionals having to make this decision, is based on my experience as an MP. Close family and friends can have a malign influence by slowly but surely—this is why I referred to it as studied neglect—not encouraging a loved one to get out of bed in the morning, so that routine declines. They stop showering in the morning; they do not go for their manicure or pedicure or to get their hair done, and they start to decline. People who we always regard as very smart for their age can decline very quickly. The loved ones around them can engineer that, so that when social workers and healthcare professionals meet those people, it is not obvious what is happening. They are not sleeping properly, not looking after themselves properly and not eating properly, and therefore they decline. Nutrition is very important. You also have medication, and there can be no clear care plan; as one grows older, we take lots more medication, and that medication can be increased when it does not need to be increased or indeed not given at all.

That is why I am using the phrase “studied neglect”, to the “studied diligence” of noble and learned Lord, Lord Falconer. We really have to look very carefully at the malign forces that, I am afraid, are out there in society. They look at granny and, as my noble friend Lord Deben says, the £2 million house sitting there, and can slowly but surely—but still relatively quickly—see the demise of granny and realise those capital assets. That is the reason why I put this amendment forward.

Crucial steps in the assisted dying process should be undertaken with direct, in-person interaction, to increase the likelihood that the individual’s request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly through face-to-face contact, is driven by the importance of rigorous safeguards and scrutiny, and of upholding patient autonomy in a process that culminates in an irreversible outcome, called death. I could use many more examples but, in the interests of time, I beg to move this amendment.

[Lord Blencathra (Con)]

My Lords, I will speak to my Amendment 320B and three others in my name in this group. The first clinical gateway in this Bill is the most important moment any of us will ever legislate for: the moment a doctor begins the process that can lead to a life being ended. That gateway must be treated with the utmost care; it should not be reduced to a convenience-driven video call.

My amendment is simple and proportionate: it creates a presumption that the co-ordinating doctor’s first assessment takes place in person, and it asks only that, if the presumption is displaced, the doctor records why an in-person meeting was not possible for medical reasons. That is not micromanagement; it is common sense. It is the minimum standard of human contact that we should expect before opening a pathway that is irreversible.

Why does this matter? First, capacity and voluntariness are relational judgments. Clinicians do not assess capacity from words alone: they read people’s faces; they notice the hesitation; they observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide: a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception.

Secondly, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons. It recognises that there will be rare cases where a patient is too frail to be seen in person; in those cases, the co-ordinating doctor must set out the reasons. That requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels, the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside.

Thirdly, the evidence is clear: leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible. Telemedicine studies and the experience of courts show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Some will say that this amendment would delay access or over-engineer the process, but I disagree. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay. If the system cannot, then speed is being prioritised over safety, and that would be a real problem.

Finally on this amendment, will the noble and learned Lord, Lord Falconer of Thoroton, accept that a life-ending pathway should begin with human contact, with a clinician who has seen the person in the flesh—smelled the room, so to speak—and observed the context in which that wish has arisen, or does he prefer a default of pixels on a screen? When the outcome is death, convenience must never trump clinical rigour. I urge the Committee to support my Amendment 320B.

My Amendment 347A would ensure that the second assessment—the final medical safeguard—is conducted in person. The Bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life-ending decision. Experts told the House of Lords Select Committee that assessing capacity remotely is, as I said, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person. Remote assessment hides the environment. Who is in the room? Who is influencing the patient? What pressure are they under? Kim Leadbeater MP herself said she was uncomfortable watching Oregon’s remote assessments, describing them as “tick-box”. If the sponsor is uncomfortable with death by Zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding.

If remote assessments are permitted at all, my Amendment 406A would introduce the bare minimum safeguards: the doctor must verify that the patient is alone and speaking freely. Coercion, as we know, is often silent. Abusers can sit off-camera, and patients are coached. A Michigan prosecutor famously spotted a domestic abuse victim being coerced during a Zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? My amendment would not ban remote assessment but simply prevent the most obvious and dangerous form of abuse. Without it, the Bill’s coercion safeguards are meaningless.

My Amendment 415B would ensure that remote assessments are tightly controlled, used only when appropriate and subject to independent oversight. The Bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the commissioner would ensure consistency, transparency and accountability. It would prevent remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest, the Bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible.

In summary, my four amendments form a single, focused package of safeguards to ensure that human judgment, not administrative convenience, governs a life-ending pathway. Amendment 320B would make the first assessment face to face by default—the minimum human contact needed to test capacity and spot coercion. Amendment 347A would extend that presumption to the independent second assessment so that the final clinical check is equally robust. Amendment 406A would require a simple verification when assessments are remote—a recorded confirmation that the patient is alone and speaking freely. Amendment 415B demands a statutory protocol for remote or pre-recorded assessments so that exceptions are tightly controlled and independently verified.

These are modest, proportionate measures. They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequence is irreversible. If this Bill is to be the safest system in the world, will the noble and learned Lord, Lord Falconer of Thoroton, accept these targeted protections so that speed and convenience never replace clinical judgment and human scrutiny? I urge the Committee to support my amendments.

--- Later in debate ---

[Baroness Pidgeon (LD)]

My Lords, it is essential that, as we debate this group of amendments, we keep in mind the fact that the systems that we are creating are for people in the last six months of their lives. We must balance the demands that we place on them at this very vulnerable time with what really matters to them during that time. We should stop talking about microprocess and start really thinking about the individual. In her evidence to the House of Lords inquiry in November, Dr Jessica Young said that

“a system that is too onerous creates stress among the people it aims to serve”.

We must not create a system that is too complex and too protracted for someone who is at the end of their life to deal with.

We have made incredible progress in recent years on facilitating video consultations. That came on hugely in the pandemic. Are we not in danger of taking a retrograde step with these amendments? I fear in particular that we in this House must be careful about standing in the way of technological process. Reading some of these amendments, I wonder whether people might want to add in that we write with feather quills and ink, because it seems that that is what this is really about.

Amendment 65 would mandate a whole range of steps beyond clinical assessments to be undertaken face to face. It also seems to disapply the flexibility provided in the Bill with regards to the person meeting the panel. Is it the intention of this amendment that a person who cannot travel to appointments, whether physically or because of the risk of infection, must be denied a choice over how they die? These amendments will affect hugely those who live in rural areas and far from their GP, let alone a hospital with a relevant specialist. They will affect those whose immune systems have been compromised as a result of extensive chemotherapy and those whose mobility is affected by their terminal illness and who find it impossible to travel. Are we not at risk of denying access to these people when such challenges are not unusual, given the nature of what they are experiencing with their terminal illness? Is it the intention that someone who is, for practical medical reasons, unable to meet the independent advocate or the panel, but is able and willing to do so via video link, will immediately be ineligible even if they fulfil all the other criteria? It is difficult to see a basis on which that can be justified.

[Lord Evans of Rainow (Con)]

Will the noble Baroness give way?

[Baroness Pidgeon (LD)]

I am coming to the end of my speech; I do not think I have to take an intervention, so I would like to finish my point.

It seems to me that this is about making the choice of an assisted death difficult or impossible. We need to think carefully about the checks that we are putting in place for people in the last six months of their lives. We need to make sure that the system really will work for them.