Terminally Ill Adults (End of Life) Bill

Lord Falconer of Thoroton Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Levitt (Lab)]

I am going to have to write to the noble Baroness about this, because I do not think I can answer it. My noble friend the sponsor will deal with the question of panels. If this question is actually about the assistance given by the Government, I refer to my previous answers, but I will write to the noble Baroness on her specific point.

[Lord Falconer of Thoroton (Lab)]

My Lords, in the course of this debate, the noble Baroness, Lady Coffey, referred movingly to the death of her parents. I pay tribute to her courage and her contribution.

I will deal with the groups of amendments in themes. First, I will deal with appointments to the panels. The noble Lord, Lord Murray of Blidworth, through his Amendment 925A, said that there should be a proper appointments procedure. I agree with him that there should be a proper appointments procedure. The Bill currently places the obligation of the appointment of panel members on the voluntary assisted dying commissioner. That is in Clause 4(4)(b) and in paragraph 2 of Schedule 2. I believe that that is adequate. The voluntary assisted dying commissioner must have a proper process. I have faith that he will do that, and the law will require him to do so.

The noble Lord, Lord Murray, also proposes that the Judicial Appointments Commission make the legal appointments. Remember that one of each of the panels would have to be either a judge or King’s Counsel. I am not in favour of that. My noble friend Lady Levitt indicated that there were problems with that, but I have a more principled objection: we are dealing here not with judges but with members of a particular panel, so I do not think that this is either appropriate or necessary.

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[Baroness Coffey (Con)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

Can I just finish so that questions can be asked at the end? The noble Baroness, Lady Coffey, tabled Amendment 921ZB about King’s Counsel. The choice of who should be within the legal grouping is for the sponsors, not the Government. My noble friend Lady Levitt is right when she says that it is a question for me, not the Government. The Government are not saying that it is unworkable. They are saying that it is for the sponsor to decide. The choice of King’s Counsel and specified judges or former judges is to provide a wide enough pool from which to draw legal advisers.

As far as King’s Counsel are concerned, we think that by becoming King’s Counsel they have proved that they have sufficient quality to be the chair of such a panel. It is intended to mean King’s Counsel from England and Wales. I do not think it allows for people from other jurisdictions, but I will check, and if it does allow for other jurisdictions, I will restrict it to England and Wales because that is the intention.

In her Amendment 932A the noble Baroness, Lady Coffey, suggests that it should not necessarily be the lawyer who chairs the panel. The reason why the lawyer is put in the driving seat as the chair is because the panel has to comply with the duties imposed on it by the statute. Lawyers are certainly not necessarily the best chairs, but putting a lawyer in the chair will make sure that the panel focuses on its legal requirements. Those are my limited comments on the whole thing. The noble Baroness, Lady Coffey, had a question for me.

[Baroness Coffey (Con)]

One of my questions has been answered by the noble and learned Lord in his comments, but I want to briefly go back to Amendment 483C. The amendment is about pre-recorded audio or video material for the purposes of subsection (4). The noble and learned Lord has said that if a co-ordinating doctor is off ill, there are other provisions through medical exceptions. There is also provision in the Bill for the co-ordinating doctor to delegate any of their functions, but I am going back to the concept. For someone who is near the end of their life, why is it that any other doctor, witness or proxy should be allowed to have pre-recorded audio or video material? I want to get an understanding of that.

Separately, I think there was a slip of the tongue earlier by the noble and learned Lord. He said that the default was that the panel would be expected to sit in private but that there was then allowability for it to sit in public. I know he did not mean that, and he later said that the default was to sit in public. I want to clarify something about Amendment 933A. My amendment suggests that the only bit in private should be the interaction with the applicant. Could he explain why, if somebody has requested for that to be in private, all the other interaction should not continue to be in public?

[Lord Falconer of Thoroton (Lab)]

On the noble Baroness’s first question, Clause 17(5) says that:

“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material for the purposes of subsection (4).”


Subsection (4) relates to all of the material that the panel is dealing with. Subsection (5) is saying that the panel can use pre-recorded audio material if it thinks it is appropriate. I think it should be given that direction—I cannot see any reason why the panel should be restricted in relation to that.

Turning to the privacy point, paragraph 6 of Schedule 2 says that:

“Panels are to determine referrals in public”—


so the default is that it is in public, not private—but that

“this is subject to sub-paragraph (2)”,

which says that a panel can sit in private if that is what the person wants. The question from the noble Baroness was, basically, why should everything then be in private. It is because everything is about the patient. The whole thing is about the patient. If I want the circumstances of my illness and why I want an assisted death to be private, I should have that option. It is unrealistic to say that we can chop this up into the bits that are about the patient and the bits that are not.

[Baroness Berridge (Con)]

The noble and learned Lord is correct that the amendment refers to the wrong person at the local authority. However, the substance of what I said two weeks ago about Amendment 462A is this: does not the panel need a power to ensure it can ask a local authority to meet unmet needs of the person in front of it, such as if their care package has fallen apart or there is a problem with their benefits? At the moment, it has no power to do anything other than approve, if the boxes are ticked. I am not saying that poor people should not apply, but I am asking the noble and learned Lord whether the panel should not have a power to ensure those needs are met when it has that evidence in front of it.

[Lord Falconer of Thoroton (Lab)]

The panel has the power. Clause 17(4) says that the panel

“may ask any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate.”

That power would include a power to ask the local authority to provide any information it wants.

[Baroness Fox of Buckley (Non-Afl)]

I thank the noble and learned Lord for a comprehensive and useful set of answers. I asked a rather more banal question—it was a long time ago—about workforce challenges. What if the social workers or the psychiatrists cannot be found? We are already acutely short of psychiatrists and social workers in general, and that is problematic in particular geographic areas. Could the noble and learned Lord comment on what will happen if the legal expertise, social workers or psychiatrists are not available in one part of the country? Will it be a postcode lottery?

My second question is this. Has the noble and learned Lord consulted the likes of the Royal College of Psychiatrists and the British Association of Social Workers about what the Bill will do to workforce pressures? It seems to me that it will affect workability. If these panels are so important and there are not enough people to sit on them, I am worried that there will be a watering-down, with the grabbing of any old social worker who wanders past. Maybe the noble and learned Lord could clarify that.

[Lord Falconer of Thoroton (Lab)]

If there are not enough people with the requisite expertise to people the panels then there will not be panels to do the job. That is why the broad categories have been adopted in the Bill. The Royal College of Psychiatrists has expressed views in relation to this, as has the British Association of Social Workers. However, it is necessary for us to find people to do this process, because the workability of the scheme depends on it, and we believe it is possible to do that. We recognise the concerns that have been expressed, including by the noble Baroness, who is right to say that if we do not have people who can people the panels then we cannot do the process.

On the broader issue of what happens if we have people in one part of the country but not another, it will be for the voluntary assisted dying commissioner to ensure that, when a panel is required, it can be provided.

[Baroness Berger (Lab)]

I have listened closely to all of my noble and learned friend’s responses and remarks on this sizeable group of amendments—by my count, there are 105 amendments. While a handful have been presented by the sponsor, my noble and learned friend, the overwhelming majority have been put forward by noble Lords on all sides of the Committee, largely informed by the evidence that we heard at the Select Committee and by representations made by professional bodies and medical colleges outside of this place that wish us to improve the Bill. That is the job we were tasked to do by the other place and by our colleagues.

I have listened closely to every single word of my noble and learned friend’s response and heard every reason why every single one of these amendments should not be accepted. I did not hear what could come forward to make the changes that people think should be made to this Bill to make it safe, particularly for vulnerable groups, and to ensure we do not see coercion. Reflecting on his response, does my noble and learned friend intend at a future moment to come forward with anything that would put in the Bill things that would make the material differences that are the reason and impetus behind noble Lords putting forward these amendments?

[Lord Falconer of Thoroton (Lab)]

I have thought very carefully about the amendments we have gone through. I am sure they are all based on attempts to improve aspects of the process, such as the appointment of the panels, how the panels operate and the privacy issues. I should say that very considerable thought went into those issues before the Bill was drafted and as it went through the other place. I have given detailed reasons as to why I think the amendments we have debated would not really improve the position. For those reasons, after giving it considerable thought, I think that the Bill probably reached a better conclusion on, for example, the “must” and “may” issue that the noble Baroness raised and the need for special extra expertise. I have given it careful thought, but I do not think any of the amendments we have gone through would improve the Bill.

[Lord Harper (Con)]

I want to pick up a point made by the noble Baroness, Lady Berger, and the noble and learned Lord’s response to it. There are two aspects to what she said: whether the noble and learned Lord thought that any of the specific amendments might need bringing forward in a different form, and whether he thinks any of the issues raised, or concerns expressed, by any of the professional organisations that gave evidence raise any issues at all that he thinks need improving in the Bill, even if he thinks none of the amendments is acceptable. Does he think that all of those professional bodies’ concerns, and the evidence they gave about them, are misplaced?

[Lord Falconer of Thoroton (Lab)]

Professional bodies have raised a whole range of concerns. That has informed the drafting of the Bill, and certain changes have been made in the light of a variety of those concerns. I certainly am not saying that we know better on everything than the royal colleges. Their thoughts since the Bill has been published have been taken into account.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I will now speak to this rather large group of amendments, many of which were simply consequential, so I have withdrawn those to focus the debate. I ask noble Lords who may have questions to kindly allow me to explain the whole process rather than interrupting the sequence.

We took extensive evidence in our Select Committee and had many briefings critical of the panel process as written in the Bill. The Royal College of General Practitioners clearly stated that any legislation must ensure that:

“Any assisted dying service should be seen as a standalone … service … and … not be deemed core GP work”.


It is clear that:

“Any assisted dying service would need to be separately and adequately resourced and … not, in any way, result in a de-prioritisation of core general practice, or palliative care services”.


The promoters of the Bill themselves have said that the voluntary assisted dying service must be clearly defined and not complicated. The model proposed here would meet those essential criteria and improve safety, providing legitimacy with an expert multidisciplinary panel. Bureaucracy is simplified; it avoids burdening family or treating for clinicians, and it provides statutory separation between assessment and the process of causing death.

The effect of the scheme is to provide clarity by strengthening the process so the request goes directly through a genuinely multidisciplinary panel involving rigorous assessment, strong conflict of interest rules, clear statutory guidelines and clear norms for the collection of data—and, in the event of doubt, there is potential court involvement. This creates a higher level of professionalism and greater legitimacy for the person. There is also a clear framework for the panel procedure. Unlike the proposed ADR panels that we previously debated in the Bill, these panels are genuinely multidisciplinary across relevant specialties. The major effect of this is to remove individual doctors assessing in isolation and the risk of “doctor shopping”. There is also a new scheme for licensing and regulating assisted death services, as well as strict regulation of the lethal substances used to bring about an assisted death. This would decrease the risk of dispensing errors, as the process of dispensing approved lethal substances is closely monitored.

These amendments move the provision of accurate information to the patient and the assessment of eligibility up front in the Bill. The assessment is all undertaken by a defined group with expertise across different disciplines. Clinicians looking after the patient, irrespective of whether they support or do not support the provision of assisted dying, would continue with their duty of care to the patient and family throughout the process. Thus, the patient would continue to have their usual clinicians look after them, as always, while in parallel they could be assessed for eligibility against the criteria to be established in a statutory code of practice.

Let me explain: Amendment 143 would require the independent commissioner to support the new multidisciplinary panel workings, retain records for at least 10 years, support research and report to Parliament. Amendment 266 would ensure the panel members’ independence. Amendment 192 would signpost the person to the panel, because an assisted death is not a medical treatment. The person can obtain accurate, up-to-date information including, in Amendment 232, how to initiate the process.

Amendments 333 and 334 describe the panel’s make-up and its process. The panel would have a lawyer, a social worker or psychologist, a specialist in end-of-life care—all of whom would have at least 10 years’ clinical experience—and an administrator, plus a consultant specialist in the disease of the person and, if required, the option to co-opt up to seven members. Their statutory duties relate to licensing, or declining, the provision of lethal drugs or poisonous substances. They can refer to the High Court if in doubt. Amendment 233 would clarify that two panel members conducting a documented hearing must go to the patient.

The proposed new clause in Amendment 615 explains how the assisted dying service that comes into operation when a person’s assisted death has been approved would execute its functions in complying with a person’s wishes, including the safe transport of dispensed substances. Amendment 551 describes a neutral professional of experience who, once an assisted death was approved, could help the patient by ensuring that all correct processes were followed, deal with complications, collect all data and notify relevant persons of the death. This would avoid the difficulty of a doctor being tied up waiting for the person to die after ingesting the lethal drugs. The Oregon data shows that sometimes this can be prolonged.

Amendments 552 and 702 would determine a designated regional pharmacy to link to the assisted dying service to improve safety in the dispensing and transport of lethal drugs or other poisons and the disposal of any unused substances. Amendment 552A in the name of my noble friend Lady Hollins improves my Amendment 552 by seeking to ensure compliance with regulatory safeguards.

Amendments 704 to 706 relate to the limits on regulation-making powers, and Amendment 707 covers devices. We do not know what these devices are, but they are referred to in the Bill. Amendment 698 would require all lethal substances to be compliant with MHRA regulations and the Misuse of Drugs Act. Amendments 556 and 643 would require the GP to be notified of the process. Amendment 654 would ensure completeness. Amendments 667, 760, 761 and 767 would make it clear that the involvement of a health or social care professional in the assisted death service was separate from their health or social care employment and that their employer must know of their involvement. This is a separate service that must not jeopardise the care of other patients.

However, Amendment 710 to the clause on the regulation of approved substances would give effect to the recommendation of the Delegated Powers and Regulatory Reform Committee, on which I sit—although I should say that I am not speaking on behalf of the committee—to remove the most sweeping of the Henry VIII powers in the Bill. I do not consider the amendment of the noble and learned Lord, the sponsor, to my amendment to be adequate. Others may wish to comment.

All my remaining 56 amendments in this group are consequential and have been written to ensure that there is clarity throughout the Bill as to the effect of these changes. This is not vexatious.

[Lord Falconer of Thoroton (Lab)]

I am grateful to the noble Baroness for describing her scheme. Could she explain to the House what eligibility requirements would need to be satisfied in order to give a certificate and where one can find them in her amendments? Secondly, could she explain what the role of the High Court is?

[Baroness Finlay of Llandaff (CB)]

My Lords, first, I asked noble Lords to wait until I had completed. Secondly, I apologise to the House if I cough and my voice gives up in the process—so be it. Thirdly, if these amendments were all written into the Bill, which is what I am trying to do, the noble and learned Lord would see that the eligibility criteria would remain as he has put them in the Bill.

Let me summarise. A person wanting to seek an assisted death would be signposted to the panel for their area. The panel would give them accurate information and, if they wished to apply, they would be helped to ask for their clinical record to be available to the panel to assess all information. Normally, two panel members would meet the person, without pressure, listen to them, assess capacity and, if they agreed, advise the panel, who would decide whether to issue a licence to end life. The navigator would then make sure that lethal drugs were available to the person at the time of the person’s choosing, collect them from the designated pharmacy and deliver and oversee the whole process, documenting it carefully. If the person changed their mind, unused drugs would be removed by the navigator. If the person died, the navigator would verify, not certify, death and ensure that all who needed to be informed were duly and sensitively informed of the death. But throughout the initial information-seeking and assessment, the period of reflection and the assisted death being arranged, the person’s health and social care would continue in parallel—it would not be diverted away from its core role in care.

Let me illustrate. Thirty-six years ago, a GP referred a distraught young man whose prognosis, as estimated by the GP, a surgeon and an oncologist, was about three months. The GP said, “He is the most clear-cut case for euthanasia I have ever seen”. The man was in total pain and desperate for lethal drugs, and, with his youngest child only six weeks old, his care was challenging, particularly in the first fortnight. Eleven years after that visit, and after many periods of complex care, David phoned me. His beautiful young wife was dying of advanced cancer. By then a wheelchair user, he and his three children were with her in the hospice as she died.

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[Baroness Blake of Leeds (Lab)]

I would be happy to write to the noble Baronesses with clarification on that point; I thank them for their interventions.

As I was saying, Amendment 713A appears to introduce a parallel approvals regime, but it does not specify how that should relate to the Secretary of State’s separate power under Clause 27 to specify the list of approved substances. This could lead to operational uncertainty. Although the amendment could be delivered, establishing a dedicated regulatory pathway would likely require adjustments to the MHRA’s remit and internal processes.

I turn finally to Amendments 887A and 888A from the noble Lord, Lord Empey, which would amend Clause 57 by removing the reference to Northern Ireland. This would mean that regulations made under Clause 37 would not extend to or apply in Northern Ireland. As medicines regulations are UK-wide, should this amendment be accepted, it might create legislative divergence across the UK. This does not mean that assisted dying would be legalised in Northern Ireland.

As noble Lords will be aware, many of these amendments have not had technical drafting support from officials. If your Lordships support these amendments, the Government will need to revisit the drafting of amendments and the Bill as a whole to ensure that they are workable and coherent, both internally and with the wider statute book.

[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful to the noble Lords who have participated in this debate. I will divide my responses thematically under four headings.

I turn first to the new scheme proposed by noble Baroness, Lady Finlay of Llandaff, in relation to how one deals with safeguarding here. The scheme would involve not having two doctors, then the panel, and then a doctor again at the point of administration; instead, the person who wants an assisted death would have to apply to a separate organisation, where a panel of up to seven people would consider their application. That panel would consider whether the safeguards are satisfied, as well as a number of other questions. If it were satisfied, it would give a provisional certificate of eligibility. The drugs could not then be delivered—I use that word without meaning “delivered to the person”—because an application for fast-track care and support would have to be made. If that application were granted, then—and only then—could the drugs be administered.

If there were doubt in the mind of the seven-person panel, the matter would be referred to the High Court. The provisions put forward by the noble Baroness do not specify what the role of the High Court is. The panel has to satisfy itself that a number of questions have been addressed, although those questions do not determine whether or not somebody is entitled to an assisted death. That is the proposal from the noble Baroness, Lady Finlay. The current proposal in the Bill is that the co-ordinating doctor has to satisfy themselves of seven or eight strict matters, and then the panel considers the case. The co-ordinating doctor then, satisfied that the conditions have been met, provides assistance to the person who wants to die.

Underlying the distinction between the two proposals is the wish of the noble Baroness that the whole process of assisted dying be kept completely separate from the care that is being given to the patient. I am sorry that neither the noble Baroness, Lady Cass, nor the noble and learned Baroness, Lady Butler-Sloss, is here, for they both highlighted that, under the scheme in the Bill, the people who will be going through the checks—the co-ordinating doctor and the independent doctor—will have to have opted in to specialist training. To some extent, they will be specialists themselves in assisted dying.

If one wants to give as much help as possible to the person who wants an assisted death, it must be better that the person providing the assistance can work within the team that is already providing care. It does not mean that they should be in any way pressing for a particular result. But, if we introduce assisted dying, and we want somebody to do the assessment and give the assistance, we are probably going to have ask somebody with some experience. We do not want to force the patient into an over-complex, entirely separate process.

I note that the noble Lord, Lord Stevens of Birmingham, said that he wants the process kept separate from the NHS, but I am absolutely sure that he does not want the patient to embark on a very complex bureaucratic procedure. He has given reasons why he wants it kept separate from the NHS. As sponsor of the Bill, whether it is precisely separate or not is, for me, not the key question; the key question is whether, if a patient wants an assisted death, there is a practical and safe way of doing it that does not place an undue burden on them.

The proposal from the noble Baroness, Lady Finlay of Llandaff, is overengineered and much too separate from the care of the patient. It leaves out so many aspects. In particular, the drafting of her proposal does not indicate what her seven-person panel has to be satisfied of. The idea that seven people have to be satisfied is, in my respectful submission, much too onerous. Having two specialist doctors and a panel of three examining the case is, with respect, a much better proposal. I have thought very carefully about the noble Baroness’s proposal, but I have to say that the proposal in the Bill is so much better, so much more workable and so much more focused on the patient.

[Lord Harper (Con)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

May I just finish? The noble Lord, Lord Stevens, refers to proposed new paragraph (m) in the scheme. Under the scheme proposal, the panel of up to seven persons has to be satisfied, or the “assessment must ascertain”, that the person

“has experienced the involvement of a specialist palliative care team and, if not, whether this was because of availability, unsatisfactory care or patient choice”.

I am very supportive of the idea—and I think this was in the noble Lord’s mind—that as much information is available as possible. As I understood the noble Lord, the more we know about the shortcomings of palliative care, the better.

However, I wonder whether the best way to deal with that is not to make a requirement in proposed new paragraph (m) for what a seven-person panel must investigate but to make that the sort of issue that the voluntary assisted dying commissioner should be looking at in his monitoring, which is required specifically by the statute. That is just the sort of thing that might help him.

We all support the point that the noble Lord, Lord Stevens, made that the more we know about palliative care—its funding, where it is good and where it is bad—the better. But is the assisted dying Bill the right place to try to lever in a whole range of informational requirements, of the sort that he referred to from the Mental Health Act, which we would all support?

[Lord Stevens of Birmingham (CB)]

Even if the noble and learned Lord does not adopt the scheme put forward by the noble Baroness, Lady Finlay, would he nevertheless accept that, for the co-ordinating doctors, it would be valuable to ascertain the information contained in proposed new paragraph (m) in this amendment? We would therefore be accumulating real-world evidence from every case and not looking at just the aggregate national position that the voluntary assisted dying commissioner might be able to adduce.

[Lord Falconer of Thoroton (Lab)]

Yes, and I cannot imagine a situation, in particular because it is specifically required under the Bill, in which the co-ordinating doctor does not raise the question of what palliative care the patient has had and what is available. Indeed, the Bill requires him or her to do that. Whether the co-ordinating doctor should then provide that information to the voluntary assisted dying commissioner is a matter for the commissioner, as it is up to him or her to decide what information to collect. In principle, it seems a good thing, but the noble Lord has referred to vastly bigger issues that we might need to consider, not in the context of the assisted dying Bill but in relation to how proper information is available about the availability of palliative care. We are all supportive of that.

[Lord Harper (Con)]

I wanted to ask the noble and learned Lord, on his comments about the contribution from the noble Lord, Lord Stevens, about the role of the NHS. As noble Lords know, that this is to be provided by the NHS is not set out in the Bill. It is allowed for, and there are powers to amend the founding principle of the NHS to make it possible, but I had understood and Ministers indicated that, if this legislation were passed, this would be done by the NHS.

The noble and learned Lord said that this question is not of enormous importance to him; it is more about the process, which comes back to the point that the noble Baroness, Lady Jay, made about it being workable. However, I should like the noble and learned Lord just to set out his view about where assisted suicide should be provided, because the question about whether it will be provided by the NHS or not is really important. Whatever view the noble and learned Lord takes, the Committee deserves to know which of those two scenarios it is, before it makes a decision on whether it wants to support the Bill.

[Lord Falconer of Thoroton (Lab)]

When I said that I am really focused on how to provide a proper assisted death and that that is not a technical question about whether the NHS will provide it, I did not mean to say that it is not important for this issue to be resolved. If I did, I misspoke, but please do not read me as saying that. That is an issue on the way to the Bill providing a compassionate and workable way of providing an assisted death to those who want it.

As to the second part of the question asked by the noble Lord, Lord Harper, about my view in relation to it, it is that it is ultimately for the Secretary of State for Health to decide how it is provided. The power is given to the Secretary of State to decide that in Clause 41, with the amendments that I have put down in relation to it. It gives him power to commission it himself or through a variety of other bodies. That might involve some body other than the NHS providing it. Ultimately, it is for the Secretary of State to decide how that is done. I think I have said enough on the scheme proposed by the noble Baroness, Lady Finlay.

I will go on to substances. There is a range of amendments in relation to substances. We shall come back to substances in relation to Clauses 27 and 37. They are in this group because they relate in part to the scheme proposed by the noble Baroness, Lady Finlay. She proposes designated pharmacies so that only particular pharmacies can do it. It is again—this is the wording of the Bill—for the Secretary of State to decide how substances are to be selected, how drugs and devices are to be approved, and then how they are to be dealt with. Subject to my amendments, which give more limitation to Clauses 27 and 37, I think the right principle in relation to that is that it is for the Secretary of State to decide how properly to regulate and choose the substances, and he or she is to do it only after taking proper advice.

[Baroness Berger (Lab)]

On that very point about Clause 37, I am sure my noble and learned friend is aware of the updated Delegated Powers and Regulatory Reform Committee report alluded to by the noble Lord, Lord Stevens, a moment ago. On that clause, it states that there are still “highly inappropriate” provisions in the Bill, particularly on Clause 37, specifically in relation to the substances that would be used for an assisted death. I heard what my noble and learned friend said, but it is the complete opposite of what the report released yesterday says and what remains in the Bill. The amendments that my noble and learned friend has brought forward do not yet address the concerns expressed by that very important committee in its report.

[Lord Falconer of Thoroton (Lab)]

I accept what my noble friend says. I hope she has read my note to the committee, which it published, in which I accept that further work is required, in particular on Clause 37. I accept in principle that I have to come back with further amendments in relation to Clauses 27 and 37.

The noble Baroness, Lady Hollins, has made a series of creative suggestions. She is addressing this in a way that is separate from the proposal from the noble Baroness, Lady Finlay of Llandaff. She says that her proposals on substances should apply irrespective of which scheme it is. I need to consider some of them in detail. My noble friend Lady Blake has indicated why some are difficult to integrate into substances for assisted dying. I am particularly interested in the relationship between the Medicines and Healthcare products Regulatory Agency and the approval of these drugs; that needs further thought on the sponsor’s part. In addition to the amendments that I am proposing to Clauses 27 and 37, I should consider them as I think they are valuable.

For the reasons given by my noble friend Lady Blake, I do not support the amendments proposed by the noble Baroness, Lady Grey-Thompson, in relation to clinical trials. Although the MHRA has a part to play, I also accept the limitations on that put forward by my noble friend Lady Blake.

I have seven amendments in this group: Amendments 624A, 708A, 708B, 710B, 862B, 877B and 878A, all of which relate to limiting the power in Clauses 27 and 37, and include a requirement for consultation in respect of the Minister. I do not think that they are contentious, although I accept that people think that I should go further. In the respect that I have mentioned, I am more than willing to think about going further. If and when we reach those amendments, I expect the Committee to agree to them.

I deal finally with the question from the noble Lord, Lord Empey, in relation to Northern Ireland. He asks why the Bill extends the power of the drug regulator in this respect to Northern Ireland. The noble Lord will know that drug regulation is a matter for the whole of the United Kingdom so must be dealt with by a statute in this House. We are not suggesting that Northern Ireland should change its current law, but if there was a law change then there would be no reason why the drugs authorised in whatever process the Secretary of State agrees to should not apply to Northern Ireland. That is why it refers to Northern Ireland.

[Lord Deben (Con)]

Does the noble and learned Lord agree with the noble Baroness, Lady Murphy, that assisted dying is part of palliative care?

[Lord Falconer of Thoroton (Lab)]

Assisted dying is about giving somebody a good death. Palliative care is about exactly the same thing.

[Lord Empey (UUP)]

I thank the noble and learned Lord for his explanation. However, I said that it was a probing amendment. Other clauses are also extended to Northern Ireland, not simply Clause 37. Because it was just probing, I reserve the right to reflect on that and perhaps come back at a later stage.

[Lord Falconer of Thoroton (Lab)]

It is my fault for not dealing with it adequately. Of the two other clauses that apply, one is about advertising and is concerned with advertising into England and Wales. Nobody wants the advertising of assisted death services. We have drafted it on the basis that if you do it from Northern Ireland into England and Wales then there should be a means of enforcing that. The other is detriment to employment rights. Employment law covers the whole of the United Kingdom, which is why this applies to that one as well.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to all who have spoken in this debate. I am concerned that some things that were laid out in my scheme appear to have been misinterpreted. I would like to get those out the way first.

I did not say that the panel must have seven people who approve an application. I pointed out that two people would meet the patient and go to the person seeking an assisted death, but the panel could be “up to” seven people. It could co-opt people as it felt necessary to make a decision.

There is a fundamental question here as to whether this is within or separate from NHS services, which is the request that has been made by the royal colleges. It is of concern that this remains unanswered. I am most grateful to the noble Lord, Lord Stevens, for having laid it out so clearly and clarified it. It is not only about funding but about how people behave within a service and what they do.

On the statement about palliative care—I am sorry, the noble and learned Lord seems to be laughing; does he find this amusing?

[Lord Falconer of Thoroton (Lab)]

No.

[Baroness Finlay of Llandaff (CB)]

On the question of palliative care and stating that it is about a good death, palliative care is far, far more. When the patient dies, that is an end point of care which has been aimed to improve quality of life right the way through.

I have already provided evidence to the Committee that an optimum time really should be a minimum of knowing the patient for three months to be able to have an input, and care should go on to those who are bereaved after the death. That is quite different from seeing the term “euthanasia”, which was translated into a “good death” and is a single point in time. Palliative care is used to people having a fluctuating wish to die, to seeing people who are in despair and to having to deal with some very complex problems, which was what I tried to illustrate with my patient, who gave permission for me to tell his story.

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[Lord Goodman of Wycombe (Con)]

My Lords, I will speak to my Amendment 151, which is supported by the noble Lord, Lord Carlile, and the noble Baronesses, Lady Fox and Lady Hollins. It was also referred to approvingly by the noble Baroness, Lady Campbell, in her earlier remarks. My amendment would prohibit medical professionals from raising assisted dying as an option, unless explicitly requested by the patient.

I will be very brief in introducing this amendment, by pointing out to the Committee that it goes to the heart of a juxtaposition suggested by the Bill. On the one hand, we have an increasingly large, frail, vulnerable, often elderly population, who may not have the full autonomy that the sponsor of the Bill suggests. On the other hand, we have a National Health Service that, by the nature of events, is almost always underfunded and feels that it will be underfunded. If you put those two things together, there will be an inevitable pressure to cut costs and present the cheaper option to the patient who is seeking guidance.

I have carefully read the sponsor’s words in Clause 5 and it is true that, on paper, the patient must be offered the option of palliative care as well as that of an assisted death. However, in these circumstances of financial restriction, I am concerned about the patient being steered in a certain direction. I will not regale the Committee with horror stories from abroad, usually from Canada, about precisely this taking place. Were I to do that, the sponsor of the Bill and others would, quite rightly, point out that there are safeguards in the Bill that are not present in Canada. I would point out in return that safeguards can be whittled away over time. In making that point, I mean nothing to the detriment of the sponsor of the Bill; I am sure that he does not mean it to happen but, over time, people can make amendments and changes to legislation.

I will step back from this amendment and look at it in this way. I believe that assisted dying is intrinsically problematic and, if the Bill ever got further, I would vote against it at Third Reading. However, my concern while we are here is to improve the Bill. If we are to have such a Bill, I want it to be in the best—I should say the least bad—condition possible. Noble Lords know that nothing in the amendment would alter the basic architecture and structure of what the sponsor of the Bill has proposed—in relation to the first doctor, the second doctor, the panel, proxies, the regime for regulating substances or any of that. The amendment would do nothing whatever to prevent anyone seeking an assisted death. All it would do is to prevent a medical professional raising it.

Therefore, I suggest to the noble and learned Lord the sponsor that, if he wants to make some progress with the Bill, he might accept this amendment or one of the many others in this group to a similar end. I look forward to hearing him when he replies but, whether he does accept it or not, this amendment would write a safeguard into the Bill that is not there, and I commend it to the Committee.

[Lord Falconer of Thoroton (Lab)]

I congratulate the noble Lord because, although I disagreed with his conclusions, in just three minutes and 35 seconds he managed to summarise brilliantly the arguments both ways and the evidence.

[Baroness Lawlor (Con)]

My Lords, I will add a word to follow my noble friend Lord Goodman’s Amendment 151, in proposing my Amendment 153A. This goes further to stipulate that a medical practitioner may not raise the subject with the patient

“unless the person has raised it first during an in-person appointment requested specifically for that purpose”.

We have spoken today about the position of trust that the doctor enjoys. He or she is trusted by the patient and by our society, and is paid for by the taxpayer who trusts him or her. That trust is breached if the position is used not for the treatment of a patient’s symptoms, to help manage them or to benefit the patient, but to suggest that the patient should instead consider killing themselves.

A doctor who is trusted to find the best medical treatment for, say, pneumonia, blood pressure or heart disease becomes an agent who leads to the medicalised death for the patient with a poison that is self-administered, as if it were just an ordinary curative medicine. Moreover, as the Bill stands, the requirement to discuss possible side-effects and complications, which we know happens in other jurisdictions, is not there. Perhaps we might also consider why doctors are in this position of trust. It is because they have special knowledge, not only of medicine and its treatment, but of access to medications. They are especially trusted when the patient is very ill, very frail or terminally ill and perhaps already feeling a burden to those who are looking after them. If we permit the doctor to raise the subject of assisted dying to those who are so suffering, we leave the door wide open to the abuse of power. It need not be deliberate abuse. The doctor may only be raising a possibility—

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[Baroness O’Loan (CB)]

I accept the noble Baroness’s intervention, but they certainly thought it was a bad idea, and there is further discussion in South Australia about the issue.

If I may go on: as drafted, the Bill will permit discussion about assisted dying before discussion about palliative care. It would come as something of a shock—

[Lord Falconer of Thoroton (Lab)]

I think the position was that there was an Act in Victoria, Australia. After the five-year review of the operation of the Act, the Government recommended that the prohibition on raising it be removed as it was found to be impeding access and undermining patient-centred care. The Royal Australian College of GPs welcomed the recommendation as a sensible step and the law was changed.

[Baroness O’Loan (CB)]

I accept that, no problem.

It would come as a shock if a doctor came to one’s bedside and said, “In these circumstances, you may wish to consider an assisted death”. Experience would tell us that a patient might not hear much more of any discussions about treatment and palliative care, given the shock and their already vulnerable state.

Can the Minister explain why the Bill is drafted as it is in this context, permitting a discussion about assisted dying without requiring a previous discussion about palliative care? Can the noble and learned Lord, Lord Falconer, assure your Lordships that there will be a genuine choice?

[Lord Falconer of Thoroton (Lab)]

The noble Baroness will know that Clause 5 specifically says that if a registered medical practitioner raises the question of assisted death, he

“must explain to and discuss with that person … all appropriate palliative, hospice or other care”

that is available. It says:

“Accordingly, such a preliminary discussion may not be conducted in isolation”


of, among other things, palliative care. I am not sure of the basis on which the noble Baroness is saying that that should come before rather than at the same time.

[Baroness O’Loan (CB)]

I am saying that it should come before, because Clause 5, as drafted and as the noble and learned Lord read it out to the Committee, says it is to be part of a discussion about assisted death. I suggest to the Committee that if a doctor mentions assisted death, that will focus one’s mind in a way that may cause distress, shock and all sorts of things.

There is another problem: the issue of the doctor raising the issue despite the fact that the patient has given no indication that he wants to talk about it. The Bill is said to be a matter of autonomy, but it cannot be denied that there is an unequal relationship between the patient and the doctor. Doctors are perceived as knowing and acting in the interests of the patient. Under the constitution of the National Health Service, it is provided:

“It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives”.


Even where a patient may have autonomy, were a doctor to initiate a discussion about assisted dying, he or she would fundamentally undermine patient autonomy. Offering assisted suicide is not the same as offering palliative care, cancer treatment or any other care. These are all directed to the treatment of a living person. Assisted suicide is about killing the person.

When doctors raise assisted suicide or assisted dying, patients may interpret this as an implicit recommendation or, indeed, a judgment about the value of their life, not a neutral option. That undermines agency. A choice influenced by authority, fear or deference is not a free choice. There is a huge risk of a doctor exercising undue influence and exposing patients to pressure at the most vulnerable point in their lives. I heard the noble and learned Lord, Lord Falconer, acknowledge that doctors hold exceptional authority over patients. He should reflect on that.

The solution to these problems, as in Amendments 150, 151 and 154, is to amend Clause 5 to provide that there would be no discussion with the patient until the patient says that they want the discussion. Amendment 156 would delete Clause 5(2) and is consistent with the other amendments. Amendments 159 and 160 would clarify the meaning of the Bill to state specifically what is to be discussed: the death of the person sitting or lying in a bed before the doctor, not any other matter. All these amendments would bring clarity and additional protection.

Amendments 157 and 164 would protect the patient even further by providing that, where a person has told their GP they do not want a discussion about assisted dying, this should be recorded in their notes. That should provide an audit trail of the wish of the patient. This must then be complied with by any registered medical practitioner.

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[Baroness O'Loan (CB)]

My Lords, I would like to clarify something that the noble and learned Lord, Lord Falconer, said in response to my statement that assisted dying was not something that doctors could suggest in Australia. The website of the Department of Health, Victoria, states:

“It is against the law for a medical or other health practitioner to suggest voluntary assisted dying as an end of life option to one of their patients. A medical practitioner cannot talk about voluntary assisted dying unless a person asks them about it first”.


If I can take noble Lords to New Zealand—

[Lord Falconer of Thoroton (Lab)]

Before the noble Baroness references New Zealand, I was saying that that was the position. There was then a five-year review in Victoria and the law was changed.

[Baroness O'Loan (CB)]

It has not changed on the Government’s contemporaneous website. If I go to New Zealand, it says that the doctor cannot advise or discuss assisted dying with you unless you ask for it first. Those are both government websites today. I accept that there may be changes due and that they may come, but they are not there, as far as I can see.

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[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, for the benefit of the Committee, I will let noble Lords know that when we have heard from my noble and learned friend Lord Falconer of Thoroton, I intend to bring the Committee to a conclusion. It would be wiser to wait to start the next group next week, rather than to get half way through it and have all the problems about who was or was not here, and so on. If colleagues are thinking ahead to the next group, it will not be called until next week.

[Lord Falconer of Thoroton (Lab)]

My Lords, I pay tribute to the noble Lord, Lord Jackson of Peterborough, for telling us about the circumstances of his father’s DNR, to the noble Lord, Lord Evans of Rainow, for telling us about the circumstances of the deaths of his mother and his grandmother, and the noble Baroness, Lady Fraser of Craigmaddie, for telling us about the circumstances in which her father became ill.

I also pay an especial tribute to the noble Baroness, Lady Monckton of Dallington Forest, whose speech was incredibly powerful and moving, and obviously requires a detailed answer from me in policy terms, about people who have learning disabilities and what may happen to them. It also has relevance not just for those whose parents are still alive, but much more significantly, for when their parents are gone. There therefore needs to be a solution beyond simply ensuring that a family member is there. I pay tribute to the influential nature of the speech that the noble Baroness made in relation to this. Whatever happens to this Bill—and I very much hope it becomes law—what she said will, I am absolutely sure, have an influence on its terms, and we should respect that.

There are three categories that I need to deal with in relation to this. First, what is the position in relation to people who do not have a disability? Secondly, what is the position for those who do have a disability? Thirdly, what is the position for children?

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[Baroness Cass (CB)]

I am still not sure what a person is supposed to do if they cannot access a doctor who is in possession of the full information. If the GP, for example, has a conscientious objection, that potentially puts a hurdle in that will stop them being able to move on to the next stage—they will have to cast around to find a doctor who can have that full discussion. I would have thought that the proponents of the Bill would not want that to happen.

[Lord Falconer of Thoroton (Lab)]

I completely understand what the noble Baroness is saying. Suppose you cannot find a doctor with that information about you—the noble Baroness, Lady Cass, is not talking about the sorts of cases that many noble Lords were talking about, where, by raising it, you are leading to a situation where somebody might be persuaded when they otherwise would not—the answer would be that you would have to consent to all your records being given to a doctor with whom you could have the conversation.

Noble Lords should remember that Clause 5(6) says:

“A registered medical practitioner who is unwilling or unable to conduct the preliminary discussion mentioned under subsection (3) is not required to refer the person to another medical practitioner but must ensure that the person is directed to where they can obtain information and have the preliminary discussion”.


So you can get assistance from a doctor who is not willing to have the discussion. The noble Baroness is absolutely right that, in order to have the discussion, the doctor has to have all the information I referred to. If no doctor in possession of that is willing then you will have to consent to it being given to somebody else—and a patient can consent to their records being given to another doctor.

I turn to the position for those with a disability and, in particular, will deal with the point so powerfully raised by the noble Baroness, Lady Monckton. My Amendment 548A would require that anybody providing a relevant activity under the Bill—new subsection (8) defines “relevant activity” as including “conducting a preliminary discussion”—must not carry out that relevant activity unless the person seeking assistance has an “independent advocate”.

The amendment says that

“‘qualifying person’ means … a person with a mental disorder (as defined by section 1(2) of the Mental Health Act 1983) … a person who (in the absence of support) would experience substantial difficulty in doing one or more of the following … understanding relevant information … retaining that information … using or weighing that information as part of the process of making relevant decisions, or … communicating their views, wishes or feelings”.

Where there is to be a preliminary discussion, the person has to be accompanied by an independent advocate, unless—this is in new subsection (3) to be inserted by the amendment—the person

“seeking assistance informs the relevant person that they do not want an independent advocate, or … where the relevant activity is conducting a preliminary discussion, the person seeking assistance informs the relevant person that they are content for the preliminary discussion to be conducted without them having an independent advocate”.

What the sponsor of the Bill is aiming at there is as follows. If there is any question about one’s ability to process information—what the noble Baroness, Lady Monckton, said about the suggestibility of people with Down syndrome is incredibly resonant—I would envisage the position to be that you have to have an independent advocate but you may not need to have one if it is known to the doctor, or if it becomes apparent, that a family member would be adequate. That would be a reason for not having an independent advocate. But, if there is no family member—for example, if the person suffering from a disability has no parents, siblings or whatever—there has to be an independent advocate.

It may be that the area I should focus on in the amendment on independent advocates is this: you can say no to the need for an independent advocate, maybe because you have nobody else, but is that too risky? I need to consider that, given the point on suggestibility raised by the noble Baroness, Lady Monckton, and Mr Ross of the Down syndrome advisory policy group, whom I have discussed that with.

The points made about people with a learning disability are, I hope, addressed in my amendments on an independent advocate. Ultimately, where there may be no family, the independent advocate has to be the rock-bottom protection.

I move on from that to children. I remind noble Lords that, as the noble Baroness, Lady Coffey, made clear, Clause 6 says:

“No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18”.


It cannot be raised, and I completely stand by that. What happens if it or something like it is raised by a person who is under 18? I found what the noble Baroness, Lady Finlay, said, to be resonant and insightful. You have to deal with it in a sensible way. You cannot just say, “I’m afraid I can’t talk about that. That’s the end of it”. You have to treat the person with a degree of maturity.

The noble Baroness, Lady Finlay, supported Amendment 211, in the name of the noble Lord, Lord Rook, which says:

“If a person under the age of 18 raises the subject of the provision of assistance under this Act, the medical practitioner must refuse to discuss the subject and shall inform the person that such assistance is not available to individuals under the age of 18”.


I am sure that the medical practitioner should say that it is not available to persons under the age of 18, but I am not sure that it would be wise for the Bill to prescribe that no further discussion is appropriate—particularly for 17 year-olds, who are often quite perceptive. The idea that you cannot have any discussion about this is just not practical or sensible and it would drive people to other sources, which may be more dangerous.

[Lord Harper (Con)]

I will press the noble and learned Lord on that point. The ability for medical professionals to discuss this with patients is prescribed in the first part of Clause 5, but only

“in accordance with this Act”.

If you were a medical professional and a child raised this with you, and you started discussing it, would you not be obliged, under your legal and professional suicide prevention duties to that child, to take steps to protect them? Under the Bill, they would not be eligible to have an assisted suicide. I do not understand this—and the noble and learned Lord has not answered my question about what happens with adults—but if a child goes to a medical professional and starts suggesting that they want to end their life, that medical professional is under a clear duty to take steps to protect the life of that child and even to take steps to force that to be the case. Unless I am missing something, nothing in the Bill will change the legal and professional duties on that medical professional.

[Lord Falconer of Thoroton (Lab)]

The noble Lord is right. The point I was making was that, if it is raised, it is not sensible to just close down the discussion altogether. There has to be an informed discussion, which is completely consistent with the duties that the noble Lord referred to. The idea that there cannot be any discussion about it, which is what I think the amendment in the name of the noble Lord, Lord Rook, says, is, in my submission, neither practical nor wise. It is for the doctor to decide how to deal with it, of course in the context that the noble Lord mentioned.

Finally, if the Bill passes, Parliament will have decided that the option of an assisted death for those who are terminally ill is an appropriate option. It may well have come to that conclusion because it thinks that it is a compassionate option to give people, as has occurred in so many other countries in the world. Once Parliament has said that that is the position, those people who are in a position to access assisted dying should be given appropriate assistance to do so. That is why, in my view, it is perfectly acceptable for it to be discussed by doctors as an option for people who are terminally ill, because they will look to those who are caring for them for assistance to determine how their life ends. I am not sure whether the noble Lord, Lord Moylan, was saying this, but I do not believe that adopting that option is morally abhorrent.

[Lord Harper (Con)]

I will press the noble and learned Lord because I genuinely want to understand what is going to happen. This is quite a big deal for the health service and other professionals in this area. When, under the Suicide Act, which the Bill amends, somebody trying to take their own life stopped being a criminal offence, we did not suddenly say that we thought that was an acceptable thing for them to do; we recognised that making it a criminal offence did not make a lot of sense. Therefore, just because we make assisted suicide lawful—getting assistance to take your own life—in itself that does not change the suicide prevention duties.

I want to understand, if the Bill were to become law, what steps the Government would have to take on the legal duties that medical professionals have under the suicide prevention duty and their professional duties; otherwise, I do not think we are being very consistent here. I do not want medical professionals, who we are asking to do this work, to be conflicted or to think they are at risk. Organisations such as the Medical Defence Union think we are in great danger of putting those medical professionals in that invidious position, and the noble and learned Lord has not really answered my question satisfactorily—or certainly not to my satisfaction.

[Lord Falconer of Thoroton (Lab)]

The point of this part of the Bill is that it is a legitimate option. If the noble Lord is saying that because we have suicide prevention policies in other areas, we should still treat it as something that we should not in any way encourage or help people to access if that is what they want, that is wrong. The true position is that, once it becomes an option, subject to the safeguards being gone through, it is something that people should know about and make their own judgment about.

[Baroness Berridge (Con)]

I do not think we have fully understood these two categories. I was grateful to the noble and learned Lord for the meeting with Professor Ruck Keene. It is clear, particularly when you are talking about the Mental Health Act, when there are two different statutes you can choose from, that we need to be clearer about that for clinicians. So, unfortunately, even at this late stage, I am afraid I will have to lay some amendments so that we can really talk about this in detail, because it is a matter of concern, particularly to psychiatrists.

On the points I have made about children, I accept the point from the Minister that the probing amendment is probably too wide. However, we have not even had the comments on the categories of people who can now raise this with children, such as schools, et cetera. I also raised the point—I am grateful that the noble Lord, Lord Tarassenko, is now in his place—that I believe we also now have this gap with regard to what advertising prohibits. You have medical practitioners unable to raise it with under-18s, but then you have a whole wealth of technology in between that, which can, as we know, even with a mistaken question, raise this issue with under-18s. What does the noble and learned Lord envisage will happen in those scenarios, which are at the moment subject to legal cases in other jurisdictions?

[Lord Falconer of Thoroton (Lab)]

A whole range of issues is covered to a large extent by the Online Safety Act in relation to the promotion of suicide, particularly to young people. That, in a way, is a separate issue from this issue. I fully encourage and support all attempts to try to reduce the risks to young people, but I am afraid that the Bill cannot take that on, on its own.

[Baroness Grey-Thompson (CB)]

My Lords, I thank all those who have contributed to the debate on this group of amendments on raising AS in conversation and preliminary discussion, including training.

I thank the Minister for her response to my amendments. However, given the government response and the question about funding, it lays open the bigger question of the whole Bill that many of us are grappling with: who pays for this and what that final bill may be.

The debate has gone in a slightly different direction from what I expected. It is interesting that the noble and learned Lord, Lord Falconer, differentiated in his response between non-disabled and disabled people. Independent advocates will come up in a later group, but I think it is really important that it is understood, as part of this group, when we are talking about learning disabilities, that it may be very difficult for someone with a learning disability to understand what an independent advocate is and what their role is. They may say that they do not need it but not really understand what they are saying yes or no to. We will cover that next week.

I am slightly worried that there may or may not be guidance from the GMC and/or the Secretary of State. I will be very interested to discuss that with the noble and learned Lord away from this Chamber. This is where we probably disagree. Those who support this Bill will talk about Victoria and say that it gives greater access; I say it is a slippery slope and that it is making it easier for a wider group of people to enter this process. We have covered in previous amendments the use of language. “Person with a disability” is not used in the Equality Act. I had hoped, through my contributions to previous debates, that there was some understanding of it and why organisations of and for disabled people are worried about this Bill. It is not just about the contents of the Bill; it is about the language of the Bill. Organisations of and for disabled people use the social model. I will not go through that again, but the language they choose to use is “disabled people”.

The noble Lord, Lord Weir, has apologised for having to leave, but he raised the issue of how disabled people are treated. I am going to raise a difficult question, not to anyone in particular but to the whole Chamber. It is rhetorical. How many in your Lordships’ Chamber have ever felt sorry for me because I am a wheelchair user? My previous career as an athlete negated some of that feeling because, if you like sport, competing for Great Britain is a privilege: of course it is. In my second career, however, I consider the way that I am treated every single week. I am a long way from my sporting career now but, if I am rushing to a meeting, I luckily do not hear “It is not a race” too often these days. I know: I am not in my racing chair and I am not wearing Lycra. I am not sure sometimes, when people say this, whether they think they are being kind, sweet or funny. I did not have a traumatic or dramatic accident; I was a wheelchair user from a very young age. There were a few points in my life when I had three spinal surgeries and experienced terrible pain, but I am healthy.

The noble Lord, Lord Weir, raised the different views that doctors have of people. I have said before that my husband had a traumatic accident at 21. He broke his back and spent nine months in hospital. Many people assumed that it irreparably changed his life. It did not. He went on to complete his PhD. He changed sports; he went from cycling to wheelchair racing and he met me. But the way that he was and is treated is very different depending on whether he is walking with his crutches or is occasionally using a wheelchair. If he is walking, people like to think that he has had a skiing accident or something quite cool but, when he is in his wheelchair, people talk down to him. His colleagues have completely forgotten that he has a PhD and have talked to him differently.

He had a stroke in 2020 and I was really worried about him going into hospital because I was not sure of the outcome. I had calls with doctors telling me about the impact of the stroke. The noble and learned Lord talks about doctors needing to know all the information. It was really clear in his patient notes that he had a spinal cord injury, but the doctors rang to tell me that both of his legs were really badly affected, and I was saying, “Well, that would be the spinal cord injury”. They then told me that his grip strength was really good. Well, 30 years of doing wheelchair racing and cycling and walking with crutches would make that happen; they had no idea what his grip strength was like before he had the stroke. So the information they were giving both of us was not very helpful at all.

All our experience of healthcare is very different. I had a doctor in a spinal unit ask me, “How did you catch spina bifida?” I laughed. I have been asked it several times. I think the first time was when I was in my early 20s, and I said I had caught it with a butterfly net—humour does not always go down very well, either in the Chamber or outside. I was really shocked that a doctor in a spinal unit was asking me how I caught a congenital disability. Because of my scoliosis, my internal organs are all in rather strange places in my body. Every time I go to the hospital for a kidney scan, I am asked, “Do you have one kidney?” I say, “I have two kidneys; look at the notes”. “Are you sure?” “Yes. I haven’t had an operation to remove one of my kidneys”. Every time you are measuring what you say because you do not want to offend doctors and you do not want to be rude or flippant. I sit there and say, “I have two kidneys. My right kidney is somewhere up under my arm”. “It can’t be there”. “Look at my notes”. Eventually, they find my kidney somewhere up underneath my right arm.

This is the frustration that disabled people feel. It is lovely to say that doctors will read all the notes and understand them, but actually something as basic as “I have two kidneys” is often misunderstood. So I challenge your Lordships’ Chamber. Have you ever pitied me? Do you think I am brave? Do you ever think, “Well, at least it’s not me?” Am I brave as a wheelchair user or brave because I was an athlete? How many people consider that, because of my impairment, I suffer? I apologise for sighing when the noble and learned Lord talked about the suffering of disabled people. My phone started pinging. I cannot read out any of the responses or the messages I have had on that, as all the language is unparliamentary. This is why disabled people are scared. The assumption is that we suffer. I do not suffer.

Disabled people are worried. That is why they are fighting this Bill. It is not kind, it is not sweet, it is not being understanding, it is not being compassionate. We are constantly having to try to fit into a version, an idea, of what non-disabled people think of us. If we dare challenge that, we have a chip on our shoulder, and we are one of those funny disabled people who just do not understand that we are meant to deal with people being kind to us. We have to deal with being patted on the head, literally and figuratively. It once happened to me in this building. It was a Peer who did it to me. I was with colleague who was a wheelchair user and we were chatting about a Bill that we were working on. The Peer came up to us and said, “Are you having a nice time?”—in that tone. We said, “Yes, actually, we’re debating the Bill that we’re working on at the moment”. The Peer ruffled my hair. This is patronising. This is ableist. It is not kind. How does the noble and learned Lord assume that people like me “suffer”? I am really squeamish about the word. So many people are frightened because of the assumptions that are constantly made. I want to take my challenge further. How do you see disabled people who might be on the streets? Are we deserving and undeserving disabled people? That happens between Paralympians and non-Paralympians.

My noble friend Lady Campbell of Surbiton talked about DNRs being put on healthy disabled people. By virtue of how people who speak remotely are able to contribute, my noble friend and the noble Lord, Lord Shinkwin, were not able to come back into the debate. My noble friend wanted to make it clear that she has to rely on doctors for everything in terms of her well-being. We put huge trust in those people. My noble friend has been in hospital many times, and it is important to listen to her experience of what it is like. I will keep raising this in terms of how I am able to contribute in debates. I can sit in one place—well, three places—in the Chamber. I cannot sit with my colleagues. Those speaking remotely cannot come back and ask questions. There was one time in the time that I have been here when five wheelchair users wanted to speak in a debate. We had to tag-team in and out of the Chamber. How many other noble colleagues have had to do that?

My noble friend Lady Campbell wanted to reiterate the unequal nature of the system. She also wanted to draw attention to a BMA survey looking at doctors and medical students who are disabled or have long-term health conditions. It was published on 3 December 2025. The author, Natasha Wilcock, is deaf. It raised the ableism that exists in that profession. The assumption is that the barriers are from patients, but actually there are deep-rooted issues in the experience of doctors who are disabled. A huge amount of prejudice comes from other doctors.

The noble Lord, Lord Shinkwin, again, was not able to come back in, but he wanted to raise a couple of points. He asked me to say that the noble and learned Lord did not answer any of his questions and that he would be happy if he could write to him.

If you treat your disabled colleagues with prejudice and contempt—sorry, I am again referring to the BMA survey—how do doctors treat disabled patients? The equity of treatment of staff and of patients is inextricably linked.