Terminally Ill Adults (End of Life) Bill

Lord Falconer of Thoroton Excerpts

Friday 12th September 2025 Lords Chamber

Moved by

[Lord Falconer of Thoroton]

That the Bill be now read a second time.

Relevant documents: 32nd Report from the Delegated Powers Committee and 12th Report from the Constitution Committee.

[Lord Falconer of Thoroton (Lab)]

My Lords, this issue has been debated for years, particularly in this House. The House is full this morning; that reflects the seriousness with which your Lordships take this issue. For the first time, we have before us a Bill on assisted dying, which has come from the other place. I know that we will do what we do so well, which is scrutinise. This is a historic occasion.

The current law is confused, causes terrible suffering, and lacks compassion and safeguards. People must be at the heart of this debate. The Government’s own estimate is that, if the law was changed to introduce assisted dying, less than 1% of deaths would be assisted after 10 years. However, it is right that we allow assisted dying as an option for those who, despite the best palliative care, still want an assisted death.

Palliative care cannot alleviate the pain of everyone. Lucy Davenport’s husband, Tom, had an agonising death from bile duct cancer, despite receiving excellent care in a hospice. He died by choking on faecal vomit:

“The look on Tom’s face of terror and horror, that’s going to be with us forever. He would be horrified to think that was our last memory of him”.


For many others, it is not about pain; it is about alleviating fear or bringing to an end the terrible and continuing loss of dignity and control, which has no end, except in death.

If the patient wants to take control of the time of their own death, they are, under the current law, legally entitled to take their own life, but they must do so without any assistance, often horribly. Many of your Lordships were with me in the Archbishops’ Room in Millbank House when the widow of a man who had a lethal brain tumour described how she found her husband’s body in their garden, having stabbed himself in the heart.

Others go to Dignitas, often alone, because those who accompany them from England fear the consequences of the criminal law. Catie Fenner’s mother, Alison, had motor neurone disease and died at Dignitas in Switzerland. Catie could not join her for fear of a police investigation. She found out about the moment her mum had died by text. Catie says:

“We didn’t see her go, we didn’t hold her hand”.


The DPP’s guidelines make it clear that anyone with medical qualifications who provides assistance will certainly be prosecuted. Where the authorities learn that somebody has provided assistance or they suspect that they have, they investigate that person, invariably with compassion. But no matter how kind the process of investigation, it is an agony for the person investigated. It can go on for months, and sometimes for over a year. They fear prosecution as they grieve for the person they love.

It is right and possible to pass a law which allows those who are terminally ill to die with dignity and at a time of their own choosing, without the fear and the horror I have described and with appropriate safeguards in law, not as currently, where people, in order to have a death at their own choosing, seek to evade the law and therefore evade the protections. Some 300 million people in the world live in jurisdictions where there is such a law. There must be safeguards. The Bill we are debating today has benefited from those other jurisdictions. It is the most safeguarded assisted dying measure in the world, particularly in the light of the safeguards inserted in the Commons.

Key provisions in the Bill are as follows. The criteria for requesting assistance is that the person is terminally ill, has the mental capacity to make the decision, is 18 or over, is resident in England and Wales for the last 12 months, and is registered with a GP in England or Wales. The safeguards are designed to ensure that the patient has a clear, settled and informed wish to end their life and has made their decision voluntarily and without coercion. “Terminally ill” is defined as having

“an inevitably progressive … disease which cannot be reversed by treatment”,

with a reasonable expectation of death “within six months”.

The Bill is for the terminally ill only. It is about how you die when you are dying already. It is not for those with unbearable suffering, irrespective of their life expectancy, as in some countries, such as Canada. The Bill is clear that a person is not to be considered a person who is terminally ill if they are a person with only a disability or a mental disorder, or both.

Safeguards are layered throughout the process as set out in the Bill. First, a doctor in a preliminary conversation has to lay out all the care options, including the palliative care available in the context of the likely progress of the illness. Then two doctors, independent of each other, have to be satisfied that the illness is terminal within six months, that the patient has the mental capacity to make the decision, and finally, that it is their firm and settled wish arrived at without coercion. After that, a panel comprising a senior judge or King’s Counsel, a psychiatrist and a social worker has to be satisfied of the same things as the two doctors. If they are, then and only then can medical assistance be given.

I acknowledge that some think the process is too complicated and excludes too many people. On complicatedness, I am very conscious of the words of the Chief Medical Officer, Chris Whitty, who gave evidence in the other place that we should not create a “bureaucratic thicket”, and I very much hope we have avoided that. But it is vital that we should have a Bill that is robust in its safeguards in a matter of this gravity.

Disabled groups express fears that they may be vulnerable to being overpersuaded into an assisted death. I well understand the fears of the disabled in their dealing with healthcare providers, but the evidence strongly suggests that the disabled want the same rights as the rest of us when they become terminally ill. The Bill gives them excellent protection. There may be risks for them in other interactions with healthcare, but not in relation to this issue.

The multidisciplinary panel, which I have referred to, was added by amendment in Committee in the Commons, replacing the High Court judge alone. The panel provides a better safeguard than a judge alone because of the wider experience of the panel psychiatrist and social worker, but accompanied by the retention of the senior judge.

Beyond the current safeguards, some people have sought a compulsory psychiatric assessment for everybody. I do not believe that that is necessary or appropriate. The Bill provides that if either of the doctors have a doubt on capacity, they must refer the patient to a qualified psychiatrist. The panel includes a psychiatrist, and the panel can, if it wishes, require more psychiatric assessment.

No doctor or other person is required to participate in the provision of assistance under the Bill. Only those who opt in to participate in the work of the Bill need play any part. The Bill is explicit and wide in making that clear and provides extensive employment protections for those who do not wish to participate.

There are those who argue that it may be a terminal illness Bill now but its provisions will be expanded. Any such change would require primary legislation, and the experience of all other jurisdictions is that where they start with a terminal illness Bill such as this one, that is where they end. The Health and Social Care Select Committee in the Commons conducted an inquiry into assisted dying, ending in March 2024. Its conclusion on this issue was as follows:

“We … conclude that jurisdictions which have introduced”


assisted dying

“on the basis of terminal illness have not changed the law to include eligibility on the basis of ‘unbearable suffering’”.

It said that none of the jurisdictions which have introduced a terminal illness Bill has revoked it—and they have been there for as long as almost 30 years.

The Bill provides that for England:

“The Secretary of State must by regulations make provision securing that arrangements are made for the provision of voluntary assisted dying services”,


and that in Wales, Welsh Ministers “may” make such regulations. The difference between “must” and “may” is that we respect the devolution settlement. It is for Ministers in Wales to make their own decision in relation to that.

Concern is sometimes expressed about the cost of an assisted dying service and its effect on NHS provision. I draw your Lordships’ attention—please read the 151-page impact assessment that the Department of Health has produced—to the fact that the current budget of the National Health Service is £188 billion. On the central estimate as to what the service will cost once it is up and running, the impact assessment says it will be approximately £25 million a year. The figure does not take account of the annual savings calculated in the impact assessment, which exceed the figure of £25 million.

The NHS should have all the time it needs to introduce the service properly. It has said that it may need up to four years. The Bill has a backstop of being brought into effect after four years. We reflect what we have been told in relation to that.

The provision of assisted dying is not an alternative to palliative care. The Commons Select Committee report did not suggest that the availability of assisted dying compromised or reduced the availability of palliative care: rather, the reverse. Its conclusion was that

“we did not see any indications of palliative and end-of-life care deteriorating in quality or provision following the introduction of”

assisted dying, and

“indeed, the introduction of”

assisted dying

“has been linked with an improvement in palliative care in several jurisdictions.

The next stage is for this Bill to be scrutinised by your Lordships’ House in the normal way. I have been intimately involved with the Bill since it started its journey. This is a Private Member’s Bill, invariably and inevitably, because it is a matter of conscience. Once the Bill passed its Second Reading in the Commons, the sponsor of the Bill in the Commons, the honourable Member for Spen Valley and I, as the sponsor of the Bill in your Lordships’ House, have been provided with very substantial support from the Civil Service machine to ensure that the Bill is workable. The Government, in providing that support, did not forgo their neutrality. Rather, they provided comprehensive policy and drafting support.

I have long experience of shepherding Government Bills through Parliament. The support that I have had in relation to this Bill is second to none. The Bill passed its Third Reading in the Commons in June after more than 100 hours of debate, including 29 sittings in Bill Committee, two full days of debate on Report on the Floor of the House and a full day’s debate at both Second Reading and Third Reading.

I have to say that that compares very favourably. It is almost double the time given to scrutiny in the other place of the Children’s Wellbeing and Schools Bill, which we are dealing with now. Altogether, the Bill Committee considered and debated over 600 amendments, accepting around a quarter of them. Over 100 amendments were made in the sponsor’s name, and more than 30 amendments that had been tabled by MPs who voted against the Bill were passed.

I very briefly turn to the Motion in the name of the noble Lords, Lord Forsyth and Lord Bridges, and the amendment in the name of my noble friend Lady Berger. The noble Lords, Lord Forsyth and Lord Bridges, refer to the Delegated Powers Committee report, which I have considered along with that from the Constitution Committee. I will be tabling amendments to deal with many of the points that both committees raise. They always help us in our deliberations.

There are some amendments which I will not be able to accept: for example, that your Lordships specify the drugs to be used in the process. Medical advances come thick and fast. This legislation is designed to last for the ages. Civil Service support is mentioned in the amendment from the noble Lords, Lord Forsyth and Lord Bridges: I have already dealt with that. With regard to the availability of government time, which is also raised, I am confident, after conversations with the Government, that your Lordships will have more than enough time to scrutinise this Bill thoroughly—as long as, of course, we start our process of scrutiny in the ordinary course of business after we have given it a Second Reading.

I turn to the amendment from my noble friend Lady Berger. Unfortunately, I only got notice of this last night. I did not have the opportunity after that of talking to my noble friend, and she had not discussed it with me previously. I make no criticism of her, but these are my initial thoughts in relation to it. It is proposed that a Select Committee precede the Committee of the Whole House. It has been clear for some time that at least seven days will be required to complete the passage of the Bill: four days in Committee, two days on Report and a day for Third Reading. There will then need to be ping-pong between the two Houses. If the process cannot start until January, which is what my noble friend’s amendment suggests, and must complete by the spring—the spring is when the Government say this Session will end—we will have to fit seven Fridays in between 9 January and 31 March. Having regard to recesses, the need for the normal intervals and the fact that other business will be conducted on some of those Fridays, so it cannot be every Friday, I am afraid that it is not possible to do that. I will therefore be opposing that amendment on the basis that it is not a workable timetable. That does not rule out a Select Committee running in parallel to the Committee stage, and I would be more than happy to discuss such a proposal with my noble friend, or anybody else who has such a proposal to make. But we must do our job in this House, and our job is not to frustrate, it is to scrutinise.

The Bill has been passed by the Commons. The decision on whether to change the law in our democracy should be for the elected representatives. We should improve where we can, but we should respect the primacy of the Commons. There are so many people who have been following the debate who recall the agonising death of a loved one or, like the people I mentioned at the beginning of this speech, fear what their own death might be like. The public want this and the elected House has expressed its will. I am confident that your Lordships will now do what you have done so well in the past. Whatever view we might take on the decision that the Commons arrived at, the way the debate was conducted there enhanced the reputation of Parliament. I hope and believe that we can embark on our scrutiny in a manner that will reflect just as well on our House.

The Bill before us has already given hope to those with personal experience of the injustice of the current law. They will be looking to us to play our proper role. If we can improve it further, we should and we will have done our duty. I commend this Bill to the House and I beg to move.