Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble and learned Lord, Lord Falconer of Thoroton, for the comprehensive way in which he presented this Bill. In opening the debate for the Official Opposition, let me be clear that, as a Front Bench, we have no collective view on either the principle of terminally ill people receiving interventions to end their lives early or on the drafting of the Bill. Noble Lords on this side of the House will have a free vote both on the Bill and on the Motions we are debating. The Official Opposition do not have a collective position on those Motions.

Given this fact, I will speak neither in favour of nor against the Bill. But, as the noble and learned Lord said, this is a historic occasion. It is not hyperbole to say that this Bill may be one of the most significant pieces of legislation ever to be considered by this Parliament, with far-reaching implications for our society and the sort of society that we want to live in. Noble Lords will appreciate this significance simply from the sheer volume of correspondence received. Those speaking on both sides of the debate will be informed by their own experiences, whether that be professional or personal experience. We will hear many moving stories in these debates, and perhaps even shed a few tears. But, as a revising Chamber, I know that noble Lords will respect those experiences and reflect on them in good faith as we work to properly scrutinise and improve the Bill where necessary.

As the noble and learned Lord, Lord Falconer, said, we have received a clear signal from the elected House on the principle of the Bill. While that does not prevent noble Lords opposing the Bill per se, it is the duty of your Lordships’ House to do its work as a revising Chamber diligently. This Bill has received much scrutiny in the other place: over 100 hours across all stages, more than other Private Members’ Bills. But we should also not forget that 174 amendments were made to the Bill in Committee, and further amendments were made at Third Reading, not all of which have been properly scrutinised. So the Bill your Lordships received in this House is much changed since its introduction and is in need of thorough scrutiny.

The arguments around this Bill are finely balanced. A noble friend of mine who, let us put it this way, is not exactly known for sitting on the fence, said to me that he attended the last time we debated this and that, after almost every speech, he found himself agreeing with the speaker. To this day, he remains torn. It just shows how finely balanced these arguments are.

Let me attempt to frame the debate and touch on some areas that noble Lords may wish to probe in Committee. In debating this Bill, we must have in mind the well-being and dignity of those for whom it was originally proposed: the terminally ill who want to end their lives early. We will hear powerful arguments based on compassion and bodily autonomy from the Bill’s supporters.

The noble and learned Lord, Lord Falconer of Thoroton, has indicated his openness to amendments to the Bill. We on these Benches welcome that openness. I expect amendments to come from supporters of this legislation who want to make it the best Bill possible. We have seen that in some of the emails noble Lords have shared with each other; we also saw it in Committee in the other place, where the Bill’s sponsor, Kim Leadbeater, tabled 142 such amendments.

On the other side of the debate, there will be noble Lords who oppose the Bill on principled grounds. For some, it will be based on their faith. Others may support the principle behind the Bill but not the current drafting, either because of insufficient safeguards or because of limited access to palliative care, which denies patients a meaningful choice. They too approach this Bill with compassion. This is a matter of conscience, and as the Government Chief Whip said, we should respect the views of noble Lords who disagree profoundly with this Bill just as much as we respect the views of those in favour of it. Those who oppose the Bill will also choose to bring amendments to improve it, despite their overall view. So, whether an amendment is tabled by a supporter of the Bill, an opponent of the Bill or someone who has yet to make up their mind, those watching the debate from outside your Lordships’ House should not mistake amendments to this Bill for outright opposition.

A number of organisations, including the Law Society, the Complex Life and Death Decisions group at King’s College London, the Royal College of Pathologists and the Royal College of Psychiatrists, have proposed amendments to address some serious concerns over the drafting of the Bill as it stands. As the noble and learned Lord, Lord Falconer of Thoroton, has himself acknowledged, both the Delegated Powers and Regulatory Reform Committee and the Constitution Committee have recommended amendments to the Bill, highlighting that there are now 42 regulation-making powers in this version of it—the version that came to this House. Both the Hansard Society and the Constitution Committee have pointed out that, as it is a Private Member’s Bill and the Government remain neutral as to its purpose, it is unclear how these powers will be used. These are all important challenges that we must take the time to consider carefully.

There are noble Lords with strong views on both sides of this debate, but all approach it in good faith. My opening comments are not meant to persuade your Lordships to vote one way or the other or to support certain amendments over others; they are an attempt to frame the overall debate and to touch on some of the issues that may need to be probed in Committee. The decisions we take are not easy and the consequences are not always clear, but I have no doubt that the Bill will receive the scrutiny needed in this House—whether we are in favour or against—with all the emotions and concerns that will be expressed. No matter how challenging that may be, let us work together to examine the Bill in detail and do our work diligently.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Berger (Lab)]

My Lords, I have spoken already about how my experience as a Member in the other place has made me very concerned about this Bill, and more determined that it must not be a cause of further harm to vulnerable people. Many unanswered questions about the Bill before us have been raised during the course of this important debate. This is why I have tabled the amendment and the following Motion to hold a Select Committee before Committee of the whole House begins.

This is a significant and complex piece of legislation by any definition. It demands a process that can withstand the weight, but it is clear that there are serious shortcomings, as both the Constitution Committee and the Delegated Powers and Regulatory Reform Committee noted in their reports last week. Indeed, I am concerned that the legislative process is being asked to compensate for the absence of robust policy-making before the Bill was published: no comprehensive review; no public consultation or prior engagement with professionals and other stakeholders; no Green Paper or White Paper, which we would have seen had it been a government Bill—I understand the case made for why it is not a government Bill, but that has diminished what is before us today; and no published analysis of international experiences. Instead, Parliament has been asked to grapple with questions about implementation, safeguards and NHS implications without this groundwork, which we would usually turn to for a law change of this magnitude.

Back in March, Jill Rutter of the Institute for Government—which is neutral on the principle of assisted dying—said:

“We’re expecting Commons scrutiny to do far too much—things it simply can’t do … Commons scrutiny is being left to solve a whole range of problems it isn’t equipped to deal with”.


We have seen the dropping of key but expensive safeguards, such as the review by a High Court judge, and whole new clauses and schedules introduced to replace them with very little opportunity for thorough scrutiny.

It was a clear pattern in the other place that when significant concerns were raised that had not been anticipated, the response was often to add another delegated power. There are now, as we know, 42 delegated powers contained within the Bill: 42 areas where government will work out the detail later, with Parliament largely excluded from the conversation. The result is a Bill that is today substantially different from when the Bill Committee in the other place took evidence in January this year, but now with less clarity.

I do not wish to detain the House any longer than is necessary, but I have been asked many questions on the process about what is before us, which I will seek to address. My amendment ensures that we can have some evidence, expertise and insight on the Bill before us today. We need this information before we commence line-by-line scrutiny.

Noble Lords will have received a letter setting out a condensed list of witnesses that I and other supporters believe this House must hear from, including my noble and learned friend Lord Falconer of Thoroton and those who will bear the responsibility for delivering the Bill, should it pass, and setting out how they would use their delegated powers. These witnesses are to include the Secretary of State for Health and Social Care, the chief executive of NHS England, the Secretary of State for Justice and the Chief Secretary to the Treasury.

We must also take evidence from the professional bodies whose members will be asked to carry out the functions that the Bill sets out: the Royal College of Psychiatrists, the Royal College of Physicians, the Royal College of General Practitioners, the British Association of Social Workers and the Law Society.

We are, of course, not able to hear from serving members of the judiciary, but may hear from the former Chief Coroner of England, Thomas Teague KC, and Sir James Munby, President of the Family Division of the High Court. We must also ensure that we understand the impact of the Bill on our hospices and care homes, through Hospice UK, the Association for Palliative Medicine and Care England.

A previous suggestion of a Select Committee in parallel, alongside a Committee of the whole House, would not achieve—

[Lord Kamall (Con)]

I apologise, I do not want to detain the House any longer than is necessary. Just to clarify, will all the evidence before the Select Committee be published?

[Baroness Berger (Lab)]

I am very grateful for the intervention, and I was just about to come on to that, but I will answer that now. The answer is yes, absolutely. The intention is that all the evidence accumulated and amassed during that time will be published for everyone in the House to interrogate and consider in advance of us going into Committee of the whole House. To confirm, this Select Committee cannot take place in parallel in order that we can receive evidence on vital parts of the Bill before we go into debate, so that we are not in the unenviable position of knowing what is wrong with the Bill but being unable to amend it.

My Motion provides that a Select Committee would be intended as a focused piece of work, hearing vital expert oral evidence, as I have just set out, rather than it being a more time-intensive open exercise. It may report by simply publishing that evidence before we go into Committee of the whole House, in order to inform our detailed consideration of the Bill. As I understand it from the clerks, the revised timetable allows the committee to hold six meetings over three weeks, with two panels of witnesses on each of the days, to begin the week commencing 20 October and allowing it to conclude by 7 November. The revised timetable ensures that the Bill can progress to its next stage and maintain the opportunity for four sitting Fridays before Christmas.

We have, over the past two Fridays, shown the determination of your Lordships’ House to discuss the Bill in a considered and constructive way, and it is my strongest hope that we can continue to do that. If my amendment is accepted, I do not intend to speak on the Motion that will follow, which contains the detail that I have just set out. I am grateful to my noble and learned friend Lord Falconer of Thoroton—

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Noble Lords]

Front Bench!

[Lord Kamall (Con)]

My Lords, I hesitate to rise as I want to ensure that everyone feels that their voice has been heard in this debate. We do not want to make law on a basis on which people look back and say that we did not properly debate a particular issue. If all noble Lords who wish to speak in this debate have spoken, I am very happy to make my contribution, but if there are any other noble Lords who wish to make their point, I should give way.

Well, that answers that question; I tried my best. I want to make that point clear. It is really important that everyone who feels they want to speak can do so, but I also say to noble Lords, including my noble friends, that it is also important to respect the rules and conventions, to speak to the amendments and not to repeat Second Reading speeches or make wider debates. I hope we can get that appropriate balance. I have taken time making those points, so I will try to be brief.

I pay tribute to the noble Baroness, Lady Berger, especially for the way in which she delivered the Select Committee process that preceded our deliberations in Committee. The evidence submitted to that committee will be invaluable to noble Lords as we continue our work to scrutinise the Bill.

Without making a long speech, I will reflect on the specific amendments on changing the minimum age. I was talking to a noble and learned friend about this, and he said that, frankly, the law around age is a mess—and that has come out in some discussions. Sometimes we are speaking from our own experience. My two children are in their 20s, and I wonder whether they would really have the capacity to make this decision. But at other times, I sit in awe of them and the decisions they make. They express maturity way beyond 20 years, and, in fact, more maturity than much older people.

It very much depends on the individual in these cases. We have to look at whether there is a way to achieve that right balance; otherwise, we will just be making another age limit. You can join the Army at 16 but you cannot serve in combat until you are 18. The Government are talking about reducing the voting age to 16, but then we are hearing debates on neurological competence and capacity. It is important that we understand and express these points.

The point that came out for me in this whole debate about neurological development is that there is no such thing as “the science”. Science is contestable. We heard this from noble Lords who are experts in their field. We must be very careful about saying that “the science says this”. It also has implications for other decisions.

I turn to a couple of points which may already be treated in the Bill. I want to check the understanding of the noble and learned Lord, Lord Falconer of Thoroton, on what is in the Bill. The noble Baroness, Lady Hollins, asked: what happens if a new treatment is available? Clause 2 says

“which cannot be reversed by treatment”,

which probably takes care of that point, but I would like the noble and learned Lord, Lord Falconer, to share his interpretation and say whether it addresses her concerns. The noble Baroness, Lady Hayter, said that we should think about these young people who will be suffering and in pain, yet nowhere in Clause 2 are the words “pain” or “suffering”. We must be very careful to read what is in the Bill when we are making these points.

I welcome the intervention by the noble and learned Lord, Lord Falconer, that while he is quite clear about 18, he is sympathetic to the idea of cognitive development and maturity between 18 and 25, and there might be some discussion. Who knows—I cannot speak for the noble and learned Lord, who has looked into this issue very deeply—but perhaps in those discussions he may be persuaded. He is saying 18 at the moment, but clearly he is open to enhanced measures for those aged between 18 and 25. That is something that I hope the whole Committee will welcome.

There are many other points that I could make, but it is important to hear from the Government and what the noble and learned Lord believes in response to the points that have been raised.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am grateful to noble Lords for their contributions to this debate on the age of eligibility for those who are provided with assistance under the Bill. I have made it clear previously, and reiterate, that I will keep my comments limited to the issues on which the Government have major legal, technical or operational workability concerns.

The amendments tabled by the noble Baronesses, Lady Berger, Lady Lawlor and Lady Hollins, seek to raise the age at which an individual would be eligible for the provision of assistance under the Bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the decision-making of noble Lords, but the underlying policies are rightly a matter for Parliament. Under the convention, the amendments in this group could give rise to legal challenge; for example, that excluding people who are under 21 or 25 from accessing assisting dying may not be justified under Articles 2 or 8 of the EHCR, or that this amounts to unjustified discrimination under Article 14.

Noble Lords will be aware that differential treatments, such as raising the age of eligibility, may be lawful if it is possible to persuade the courts to agree that the age limit is justified, necessary and proportionate. There would need to be a reasonable justification for restricting access to assisted dying to people aged either 21 and over or 25 and over. Noble Lords will want to consider this in relation to these amendments.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Kamall (Con)]

As I set out last week and will repeat if noble Lords will forgive me, I completely agree with what the Government Chief Whip said about noble Lords ensuring that they speak to the amendments and do not give Second Reading speeches, but, at the same time, I think it is important that all noble Lords who want to speak to an amendment are given the opportunity to do so.

I thank the noble Baroness, Lady Finlay of Llandaff, for her amendment in this group. It seeks to ensure that someone who currently is or has recently been deprived of their liberty will not be eligible under the Act. This amendment refers to the Mental Capacity Act 2005, which is also the Act underpinning capacity for the purposes of this Bill. I appreciate the underlying logic behind the amendment, which has opened up a valuable discussion of who exactly should have access to assisted dying services. I am sure that all noble Lords would agree, whatever their position, that there should be robust provisions and safeguards in the Bill and that it should be available only to those who are suffering from terminal illnesses who are of sound mind, so that we do not inadvertently open it up to those with issues related to their capacity.

I am also grateful to the noble Baroness, Lady Berger, for her contribution in place of the noble Baroness, Lady Keeley. It is very important that, given the backlog in the system, not just those who have DoLS but those who have made an application for DoLS are deemed not to have capacity when seeking to end their lives. It would be very interesting to hear the Government’s perspective on this and that of the noble and learned Lord.

These questions all fundamentally ask whether the Bill is right to use the Mental Capacity Act 2005 as the basis for defining capacity. I am very grateful to the noble and learned Lord, Lord Falconer of Thoroton, for offering to meet those who have tabled these amendments. That is very constructive and helpful and should be acknowledged. I also look forward to hearing the noble and learned Lord’s responses to some of the issues that have been raised.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am grateful to noble Lords for their contributions on this group. To echo the comments of my noble friend the Chief Whip, the Government remain neutral on the principle of assisted dying and on the passage of this Bill. Whether the law in this area should change is a matter for Parliament. As before, any comments that I make will focus on amendments where the Government have major legal, technical or operational workability concerns.

This group relates to deprivation of liberty and eligibility for seeking an assisted death. I thank the noble Baroness, Lady Finlay, and my noble friend Baroness Keeley for tabling the amendments in this group. Amendments 16 and 114, tabled by the noble Baroness, Lady Finlay, seek to prevent individuals who have been deprived of their liberty within the last 12 months under the Mental Capacity Act being eligible for an assisted death. In the case of Amendments 16A and 114A, tabled by my noble friend Lady Keeley, someone would be ineligible as a result of an application for deprivation of liberty having been made, irrespective of the outcome of that application.

Noble Lords may wish to consider that the amendments would introduce a departure from the Mental Capacity Act framework by linking a lack of capacity in one area—capacity to consent to care and treatment arrangements that amount to confinement—to lack of capacity in another area, that being capacity to make the decision to end one’s life. Amendments 16A and 114A go further and would make a person ineligible on the basis that only an application for deprivation of liberty had been made. This may result in a situation where the application was unwarranted, but that person would still be ineligible for assisted death.

Regarding the European Convention on Human Rights—

--- Later in debate ---

[Lord Kamall (Con)]

The question that a number of noble Lords are concerned about, when discussing this amendment, is that the Mental Capacity Act was passed in 2005. Of course, the guidance has been updated, but it might be helpful to those in the Committee who are concerned that this Act is 20 years out of date to talk about any guidance that has been updated, so that it is not seen as out of date—if that makes sense. This is just to clarify that we are not dealing with an Act that was set in stone in 2005, as things have changed since then.

[Baroness Merron (Lab)]

I am grateful to the noble Lord and feel that this would probably be a very appropriate point to move on to my noble and learned friend.

--- Later in debate ---

[Noble Lords]

Front Bench!

[Lord Kamall (Con)]

I have never been so popular; it will not last, I know.

I thank the noble Baroness, Lady Grey-Thompson, for her amendments. I pay tribute to her for her sincere and long-standing commitment to protecting the most vulnerable in society. If we cast our minds back to Second Reading, many of the contributions made and concerns raised were regarding those who are the most vulnerable in our society. I remember at Second Reading being particularly touched by the words of the noble Lord, Lord Rees—he is not in his place now—who raised concerns about the vulnerability of some ethnic-minority communities, particularly those from disadvantaged communities as well.

Let us quickly rush through some of the points. On Amendment 22, which would make prisoners ineligible for end-of-life services as envisaged by the Bill, I completely understand the underlying principle. Many have spoken, rightly, about the vulnerability of prisoners. While for some it might seem wrong, as the noble Lord, Lord Farmer, has suggested, that a prisoner who has a terminal illness may have a way of cutting short their sentence by means of this Bill, as my noble friend Lady Coffey alluded to, others may say “Good riddance”. I also recognise the argument that prisoners with a terminal illness should be treated with the same compassion and care at the end of their lives as other terminally ill people subject to the Bill, as my noble friend Lord Markham recognised.

We also have to recognise some of the concerns over moral hazard. I do not know how large the incidence of this would be. Would it really encourage those who are terminally ill to commit crime? No studies have been done, but I am open to that concern. There is also the idea about higher levels of suicidal ideation, as raised by the noble Baroness, Lady Fox. These are really important points that we have to take account of.

The right reverend Prelate and my noble friend Lord Deben spoke about the pressure of reducing the prison population, while the noble Lord, Lord Carter, spoke about the higher rate of suicide among male prisoners. These are all reflections that should give us cause for concern, and things we should take account of as we consider what we will do between Committee and Report.

I thank the noble Baroness, Lady Grey-Thompson, for raising the issue of those who are pregnant. As the noble Baroness said, this was not debated in the other place, so I am grateful that the noble Baroness was able to give us the opportunity to debate it. I am also grateful to the noble Baroness, Lady Berger, for sharing statistics about expectant mothers. It was important that we heard those stats. I cannot begin to imagine the difficulty an individual in those circumstances may face. I understand the concern that it does not seem right that the safety of an unborn child may be endangered under the provisions in the Bill. I also understand that there might be precedence in other legislation. I wonder what the noble and learned Lord’s reflections on that are, given his expertise.

I note the amendment tabled by the noble Lord, Lord Farmer, on access to this for those who are awaiting trial. Once again, I would be very interested in the noble and learned Lord’s legal experience on whether that seems relevant and should be within this Bill. During the debates on the Mental Health Bill, my noble friend Lady Berridge was assiduous in spotting gaps in legislation or inconsistencies between different Acts. My noble friend has done the same thing here by raising concerns over the vulnerability of those with education, health and care plans. I think this needs further consideration.

I also thank the noble Baroness, Lady Grey-Thompson, for her amendments relating to those who are homeless or who live in insecure and temporary accommodation. I welcome the experience of the noble Baroness, Lady Gray. I still remember a conversation I had with one homeless charity that we are all one or two unlucky events or bad decisions away from homelessness. I heard from homeless people who told me that they had a great job and a great family life and that everything was going their way. They lost their job, which then led to them losing their marriage. After incidents of sofa surfing and testing the patience of their friends, they ended up homeless. It could happen to anyone. It is important that we do not dismiss the homeless as people who cannot be bothered or are idle. It could happen to anyone. Any noble Lords who have met those in homeless communities will know that some people had been incredibly successful but, after two or three bad decisions or unlucky things that happened in their life, they suddenly found themselves homeless. They are also judged by the way they look when they are homeless.

I remind all noble Lords that the Bill relates only to those who are suffering from a terminal illness and those who have been given an expectation that they will not live for longer than six months. We have to be very careful that, although we have sympathy for the homeless and prisoners, the Bill relates only to those who have a terminal illness. I know there are concerns that the Bill may be widened beyond that, but that is the debate at this stage. We should be quite clear that we are focusing on those with a terminal illness. So, much like on the question of prisoners and others, I recognise the arguments on all sides, but this is an opportune moment, not only because of time but because of the noble and learned Lord’s legal experience, to hear his reflections—after the Minister, obviously.

[Baroness Merron (Lab)]

I am most grateful.

My Lords, I thank all noble Lords for their contributions to the debate on this group. As is my consistent introduction, my remarks will focus only on issues where the Government have major legal, technical or operational workability concerns. Many of the points that follow relate to the European Convention on Human Rights. These are risks that I am raising to inform noble Lords’ decision-making, as I said on the first group. I wish to be clear that the underlying policies are a matter for Parliament. I say to noble Lords who referred to my ministerial colleagues in the other place that it is the role of Ministers, whether in your Lordships’ House or in the other place, to flag the risks to the Bill, including potential legal challenges. As I said, policy decisions remain a matter for the sponsors. Decisions in this regard rest with Parliament.

I begin with Amendment 22, tabled by the noble Baroness, Lady Grey-Thompson, and Amendment 30C, tabled by the noble Lord, Lord Farmer. These amendments would make prisoners, a defendant on remand, a defendant on bail or those detained by a hospital order ineligible for assisted dying services, even if they have a terminal illness and meet all other criteria. Aside from the right to liberty—Article 5—the ECHR requires that prisoners, a defendant on remand or a defendant on bail should have the same rights as those who are not. The rights engaged by this amendment are Article 8 on the right to respect for private and family life and Article 14 on prohibition of discrimination. Noble Lords may wish to note the risk that making these groups ineligible for assisted dying would, on the face of it, lead to a difference in treatment, which would need to be objectively and reasonably justified in order to comply with ECHR obligations.

Likewise, making ineligible hospital in-patients who are under a hospital order would lead to a difference in treatment. Without sufficient justification for the discriminatory treatment, this may be a breach of the ECHR, which could lead the courts to issue a declaration of incompatibility.

The noble Baroness, Lady Grey-Thompson, has also tabled Amendments 24, 458, 308 and 347. The purpose of Amendments 24 and 458 is to exclude those who are pregnant from accessing assisted dying, while that of Amendments 308 and 347 is to make persons who are homeless, or living in supported or temporary accommodation, ineligible for assisted dying services. As I have previously noted, the reasons for this difference in treatment would need to be adequately justified to avoid the risk of a successful challenge under the ECHR.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

In his evidence to the Select Committee, Alasdair Henderson referred to the lack of services and how that might influence choice. I would not in any way want people to think that, because of a lack of social support, poor housing or myriad other reasons, this is the only option they have. If we are going to do this Bill it properly, it must be based on a genuine settled wish, with people being given the best possible choice available to them.

[Lord Kamall (Con)]

My Lords—

[Lord Harper (Con)]

My Lords, I just want to make one point—

--- Later in debate ---

[Lord Blencathra (Con)]

I respect what the noble Baroness has said, but it is also the case that it is disrespectful to Members who have prepared speeches, wishing to say something on palliative care, and who deliberately stayed quiet in previous debates so that they could make a point on a subject in which they are interested. They are now being deprived of the opportunity to do so.

[Lord Kamall (Con)]

My Lords, one reason I was reluctant to get up is that I believe very strongly that all who want to speak in these debates should be allowed to do so, but I ask noble Lords to please bear in mind that there are many others who may want to speak to the group, and we should not make Second Reading speeches. We should repeat what the Chief Whip reminded us of a number of times: please can we speak to the amendments and keep to the point? I will try to do so in summing up very quickly.

It is quite clear that these amendments relate to palliative care and whether people who seek assisted dying services are offered a meaningful choice—not just a choice in theory or on paper because it says it somewhere in the current version of the Bill but a very real choice. I pay tribute to the noble Baroness, Lady Finlay. When I was the Minister taking the Health and Care Act 2022 through the House, she came to speak to our officials in the Department of Health and Social Care who did not know as much as her. She held a teach-in. She did not have to do that, but many officials in the department said that they welcomed the opportunity to learn from such expertise. That is why I think it is important that we learn from all noble Lords, whatever their expertise. We should also thank everyone, especially specialists, currently working in the palliative care sector, which is under pressure.

This refers to a point made early on at Second Reading, when the noble Lords, Lord Hunt and Lord Stevens, said that we know how government works and how money is shifted around government. I do not want to argue about the merits of the Bill—personally, I am torn on it at the moment and am listening to the debates to make up my mind—but the noble Lords said that, if it goes through, the money has to come from somewhere. They feel, having been in government—one having run NHS and one having been a Health Minister—that that money will come at the expense of palliative care. I think that that concern is behind many of the amendments in this group.

It seems that the principle is that anyone who is making that decision, or who seeks that help, should make a meaningful choice, so I welcome the intent of all those who laid amendments in this group—I will not waste time by naming them all; they know who they are, and I thank them. But I point out to them that, as some noble Lords have said, palliative care is mentioned in the current version of the Bill. We see it in Clause 5, on preliminary discussions with registered medical practitioners; in Clause 12, on doctors’ assessments; in Clause 39, on codes of practice; in Clause 40, on guidance about the operation of the Act; in Clause 47, on reporting on the implementation of the Act; and in Clause 50, on review of the Act.

Surely, the crucial question at this stage to both the sponsor of the Bill—the noble and learned Lord, Lord Falconer—and the Minister, are whether they believe that these clauses in the current version of the Bill, as entered this House, address the concerns raised by the many probing amendments discussed in this group. That is the crucial question to the sponsor of the Bill and the Minister.

I have a further question for the Minister, and I know that it is a little unfair because it is probably more a question for the Department of Health and Social Care and perhaps the Treasury, so if the Minister does not have the answer to hand, we understand that she will write to us and place a copy in the Library. Are the Government confident that palliative care will be sufficiently funded so that those who seek assisted dying services are offered a real as opposed to theoretical choice on palliative care, so they can make a more informed decision, understanding what is available to them? I recognise that that may be a difficult question and may put the Minister on the spot, but I hope that she can go back to the Government and ask for an answer that can be shared with your Lordships.

I look forward to the answers from the Bill’s sponsor and the Minister.

[Baroness Levitt (Lab)]

I shall be as quick as I can on this group. My comments are restricted to those amendments on which the Government have major legal, technical or operational workability concerns.

I make one preliminary point very quickly at the beginning. Pursuant to Section 3 of the National Health Service Act 2006, the provision of palliative care is a statutory requirement. Integrated care boards must arrange for palliative care to meet the reasonable needs of their populations. This can be delivered through universal services, such as GPs and community nursing, or through specialist services where appropriate. Importantly, not all patients will require specialist palliative care.

With that in mind, I turn first to Amendments 53, 54, 64 and 221, in the name of the noble Baroness, Lady Hollins. While many people at the end of life may benefit from specialist input, this would normally be based on clinical judgment and patient need, rather than being a blanket requirement. The Committee should note a workability concern in relation to these amendments, in that they diverge from this person-centred and needs-based approach. It should also be noted that these amendments conflict with current NHS statutory requirements on the provision of palliative care.

Whatever the intention, the Government’s view is that the effect of these amendments as drafted is to exclude someone from eligibility for assisted dying if they refuse the additional assessments. Consenting to, or refusing, medical treatment engages Article 8 of the convention. The Committee may wish to note that these amendments could give rise to legal challenge on the basis that excluding that group of people from eligibility might not be justified under Article 2, or might amount to unjustified discrimination under Article 14. Any differential treatment would need to be objectively and reasonably justified.

Amendment 178A in the name of the noble Baroness, Lady Lawlor, would introduce an additional requirement on the preliminary discussion stage. Every person who wants to have a preliminary discussion with their doctor about an assisted death, irrespective of whether they are eligible for an assisted death, would have to be referred to a consultant physician in palliative medicine for a full assessment and care plan. However, preliminary discussion could take place before a person met all the eligibility criteria, and it could happen more than once. Therefore, including an obligation to refer anyone who has a preliminary discussion to a consultant physician in palliative care would create a significant resourcing burden. This appears contrary to usual clinical practice, whereby the involvement of such specialist services depends on an assessment of need and on the wishes and preferences of the person, rather than via a mandatory requirement. This amendment removes the patient choice in this decision. Finally on this amendment, the phrase

“for the purpose of a full assessment and care plan”

is broad and undefined.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I tabled Amendments 56 and 57. Amendment 57 is to do with

“acting for the primary purpose of avoiding physical pain”,

while Amendment 56 is about someone

“acting for their own sake rather than for the benefit of others”.

The two amendments are distinct, although they are linked somewhat because, to some extent, the issue of physical pain—or avoiding it—is a clear-cut way of limiting the scope. I accept that my noble friend Lord Markham does not think that the scope should be limited in this way; indeed, many others may well think the same. I also bear in mind what the noble Baroness, Lady Royall, said about the fact that people are dying anyway. However, this is about a new way of accelerating death rather than the situation that we have at the moment, including, for example, “Do not resuscitate”; as I say, I am relieved that we no longer have the Liverpool care pathway.

Without revisiting the entire palliative care debate, one thing I was struck by in the words of noble Lord, Lord Stevens of Birmingham, is that element of choice—that is, whether this is a real choice and can be considered objectively, in terms of the primary purpose being avoidance of pain. If palliative care were widely available—I know that there are people who feel that palliative care may still not be enough—Amendment 57 would still allow for that.

Where the second element comes in—I appreciate that noble Lords may feel, “We’re back here again talking about coercion”—is in relation to motivation. I was struck somewhat by what the noble Baroness, Lady Whitaker, said, which was almost, “I don’t want to be a burden—my children know this—so let’s just get on with it”. However, this issue keeps coming back, I am afraid.

I thank the noble Lords who signed my amendments; one of them, the noble and right reverend Lord, Lord Harries of Pentregarth, has left because we have gone past 3 pm. I was motivated to table them by the debate in the name of the noble and learned Lord, Lord Falconer of Thoroton, in this Chamber on 7 November 2014, with the same Peer, going back to this understanding of what “voluntary” is. Back then, the noble and learned Lord referred to the aspect of people not wanting to be a burden. I intend to quote him, if that is okay; I appreciate that he may not have the Hansard to hand. Another Peer asked the noble and learned Lord, “How do you know?” The key thing is that, although that Bill was admittedly about a judge-led process, it was also about conducting

“in-depth discussions with the patient and the other doctors”

where the voluntary bit had to be voluntary, with

“he or she … not being forced into it either by coercion or by the sort of guilt that we referred to earlier”.—[Official Report, 7/11/14; cols. 1955-56.]

The “earlier” was that feeling of being a burden. So, my question for the noble and learned Lord, I guess, is: has something changed? Is it just that society has moved on and that autonomy is now more important than our concerns, which are still there, around why people want to accelerate the end of their life even though they know that it may come quite soon?

I am still concerned with making this issue clearer. Most of the stories that have led to the debates and Bills that we have had have been about pain and suffering; that is why, to be candid, I prefer Amendment 57, to avoid the issue highlighted in Amendment 56.

[Lord Kamall (Con)]

My Lords, this has been another rather long but interesting debate. It is important that noble Lords who wanted to speak had their voices heard. It touches on something we touched on very early. Noble Lords will remember when we debated another version of motivation and talked about coercion. A number of noble Lords put forward amendments to talk about encouragement. In that debate, we saw how difficult it was to distinguish between encouragement and coercion, to say whether encouragement is a form of coercion, and to legally define something such as encouragement.

Now we have the very same issue with motivation. In some ways, as the noble Baroness, Lady Cass, said, motivation is the internal version: it is self-encouragement or self-coercion, not wanting to feel a burden. We have debated what it means to feel like a burden. It is important that we understand the motivation. As the noble Baroness said, professionally, doctors need to do that to understand what help or assistance that patient could be given. It could be, if this Bill passes, that they are allowed or helped to progress to assisted dying, but it could be that they are offered something else that they feel very comfortable with that gives them a bit longer to live and to have that quality time that the noble Baroness, Lady Fox, talked about having with her family. When I was a Health Minister, one of the things that I learned about palliative care from the noble Baroness, Lady Finlay, when I first spoke to her was that people who live longer, even though they may have wanted their life to end “now”, appreciated that extra time with their family, once they entered palliative care, to close those unclosed things, to make up with friends and family they may have fallen out with, and to bring closure to their life before they went. It is important that we recognise that. I do not want to go back into the whole debate about palliative care, but it is important that it is seen as an option to give that closure to people, even if they do not want it and they decide, “I’ve made my mind up”. That is probably a more informed choice.

We need to be very careful about trying to define exactly what the one word that sums up the debate is. If it is about choice and only choice, pretty soon after the Bill reaches the statute book, people will say, “I only have 12 months to live. Why can’t I have the same choice as people who have six months?” Surely it is about not just choice or suffering but a combination of factors. That makes it incredibly difficult for the lawyers, but also for the medical people, to determine. We need to unpick some of that.

Noble Lords who have spoken on this group have picked up a number of issues: people feeling like a burden, mental health disorders, disabilities, and remembering that not all disabilities are visible. On that point, I welcome back the noble Baroness, Lady Campbell of Surbiton—I should know her title because she lives down the road from me; next time she sees me on the high street, she will probably prod me on that. There are also financial considerations, self-motivation and avoiding physical pain. The Bill does not require a specific motive as part of the eligibility criteria. Obviously, the whole Bill is about eligibility—the first few words are about who is eligible to seek assisted death services or terminally ill adult services—but it would be helpful if the noble and learned Lord, Lord Falconer of Thoroton, could expand on the thought process behind his very tight definition of “eligibility”.

I must say to noble Lords who have teased the noble and learned Lord a little bit about things that he may have said in the past that we are all entitled to change our mind when we learn new facts or hear a different view. I do not see it as a weakness in an argument if someone changes their mind when they have heard new facts. I find myself defending the noble and learned Lord, but I do not think we should be too harsh. I should remind people that I am personally very torn on this Bill, and I have not made up my mind. I am waiting to see the outcome of this debate before I make up my own mind about how I vote on this.

We also heard about dignity. I teach at a Catholic university, and dignity is a very important concept in Catholic social teaching. But what is dignity? It can be subjective. One person could be told that they have to wear incontinence pads for the rest of their life, and someone else could be told, “I’m sorry, you can’t walk for the rest of your life”, but other people have quite a full life even if they face those challenges or find themselves disabled. It is really difficult to define dignity; in many ways, it is subjective.

I have read many of the papal encyclicals about all this. By the way, I am a Muslim teaching at a Catholic University; in many ways I am the diversity, if you like. It is important that we consider what we really mean by dignity. We all think we know what it means, but we all have a different perspective on what it is.

A point that has come up many times in the debate is that we hear the words “pain” and “suffering”, but they are not in the Bill. We have to ask the noble and learned Lord, the sponsor of the Bill, about the thought process behind why he decided not to put “pain” and “suffering” in the Bill so that we can all understand, given that many noble Lords have asked that question about pain and suffering, why they are not explicitly there.

I ask the Minister this very carefully. A number of times during Committee, we have put questions to the Government but they have constrained themselves as to what they answer. It is important that the Government tell us what the implications would be if the Bill were to pass into law and what that would mean for resources in the department and for decisions that the Department of Health may have to make, as well as what it might mean for other departments of government. That is important. We cannot just say, “I’m going to confine myself to these few clauses”, because this will have implications. Some will say that it may have implications for wider society—a society that allows people to take their lives earlier or encourages death. It changes the sort of society we live in. Many people will welcome that and will say it is a society of choice, while others will say, “No, we don’t want to live in that sort of society”. We have to remember the implications of this Bill.

I ask the Minister to set out the Government’s considered view. I know that the Minister will say that some of these amendments as drafted are not legally sound—we understand all that—but these are probing amendments. This is a Committee stage and the amendments are not meant to be completely technically sound. We need to know, if they were to pass and were to be tidied up by the government lawyers or the officials, what that would mean for the workability of the wider health and care system and not just in respect of these issues that we are debating or the individual clauses in the Bill. We need to have a clear view of how this will change things and of the challenges that any Government will face when a new Bill comes in. That would be helpful.

I will stop there. I have asked a few questions to the noble and learned Lord, Lord Falconer of Thoroton, about the motivations for some of the decisions that he made in drafting the Bill, but also to the Minister speaking on behalf of the Government to answer the very real implications for resources, et cetera, not only in the Department of Health and Social Care but more widely across government.

[Baroness Merron (Lab)]

My Lords, I, too, welcome back to the Chamber and to this House the noble Baroness, Lady Campbell. It is a pleasure to see her back with us and I thank her and other noble Lords for their contributions in this group of amendments.

I once again make it clear that I will keep any detailed comments limited to amendments on which the Government have major legal, technical or operational workability concerns. It is important to remind your Lordships’ House of that. I say to the noble Lord, Lord Kamall, that the Government are doing only what any Government would do, which is to be scrupulously neutral, as your Lordships would expect us to be, and to handle it in that way. If Parliament passes the Bill into law, of course we will ensure its safe and effective implementation, but until that point I am afraid that I will be sticking scrupulously to what the role of any Government would be. I am sure that the noble Lord understands.

Amendment 30, tabled by the noble Baroness, Lady Foster, was spoken to by the noble Lord, Lord Weir, and Amendment 30ZA, in the name of the noble Baroness, Lady Lawlor, seek to prevent a terminally ill person in England or Wales from being eligible for an assisted death if they are motivated by certain specified factors. These amendments would introduce uncertainty around definitions and concepts, such as what constitutes “adequate housing”. They would also create an internal inconsistency in the Bill, as they are not reflected in later provisions that set out the assessment process. Drafting difficulties and internal inconsistencies are likely to result in confusion on eligibility, and significant further consequential amendments and policy development would be needed to produce predictable legal effects.

The Government also have some further practical operational concerns, which I will note for the Committee’s consideration. The amendment’s exclusion of those

“substantially motivated by… a disability”,

while excluding terminal illness from “disability”, would be potentially complex to operationalise. It may also be that somebody has multiple motivations. It is unclear how these could be separated or who would be able to make a final judgement.

--- Later in debate ---

[Noble Lords]

Front Bench!

[Lord Kamall (Con)]

My Lords, I have been very clear throughout this debate that any noble Lord who wants to speak and participate should be allowed to do so.

[Lord Kennedy of Southwark (Lab Co-op)]

As I said earlier, it is absolutely fine to break mid-group on these amendments.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

While that is absolutely a legitimate thing to discuss, and I would always defer to doctors on that, it makes no difference to this part of the argument of whether we call it dying. The noble Lord may well want to raise the question of whether we can ever be sure that someone is dying, although I have to say that I cannot be the only one who has been with someone where it is jolly clear that they are not going to live till the end of the week. There are times when you absolutely know that someone is going to die. While he may well be right that there are other cases, that is not the issue of this word. This word in the Bill is to give to the public the understanding that we are talking about whether there is a way of helping either the final timing or the way of those final days. We are not talking about someone who just decides to commit suicide for some other reason; we are talking about people who are dying from some sort of terminal illness.

[Lord Kamall (Con)]

My Lords, I remind the Committee that I am one of those who are still balancing the arguments on the overall Bill, and where I get put off some arguments is when people heckle those who are trying to make a point. I do not think it helps their cause. On the other side of the argument—I am trying not to sound as if I spend my life sitting on the fence—those who speak much longer than they need to in making a point also make it difficult to support some of the points that are being made. On future Committee days, I would like to see a bit more mutual respect between the different sides of the debate, with shorter points made but also less heckling of those who want to make a point. It is important, if we are going to say that we are doing our job in scrutinising the Bill, that everyone who wants to make a valid point, relevant to the amendments, is allowed to make it.

I thank my noble friend Lord Frost for tabling the amendments in this group. I recall that at Second Reading my noble friend Lord Moylan spoke about the importance of language. Language is important, especially clarity of language, so I understand my noble friend’s intentions in tabling these amendments. One could argue that there is a distinction to be made between the terms “assisted dying” and “assisted suicide”. “Assisted dying” on its own, before you even consider the Bill, does not necessarily mean consent on the part of the person whose life is being ended. The Bill introduces that element of consent, but “assisted dying” on its own does not mean consent, whereas it could be argued that the term “assisted suicide” conveys some form of intent—that it is a person seeking to end their own life, they want to do so and are not being assisted to die, regardless of whether or not they want to die. That may seem to be a philosophical point, but it is important that there is a distinction between assisted dying and assisted suicide. As the Official Opposition, we have no collective view, but it is a legitimate challenge by my noble friend to the language of the Bill, seeking clarity or, as the noble Baroness, Lady Fox, said, transparency.

Noble Lords have argued that people in this country should be able to access the services that people can access from Dignitas in Switzerland. However, Dignitas is described as offering physician-assisted suicide. Looking at the Dignitas website—not because I have lost the will to live after trying to get through a day of debates, but to look at the language—I see that it uses the phrase:

“Legal assistance for suicide with DIGNITAS”.


So we have to ask ourselves: if we are trying to be consistent with Dignitas, why is it okay for Dignitas to use the language of “suicide” but, when people want that same service in this country, we cannot use that language?

[Baroness Hayter of Kentish Town (Lab)]

That is exactly because it will take people who are not dying. This is not what this Bill does.

[Lord Kamall (Con)]

That is a fair point to be made. It is why the question was asked, and I thank the noble Baroness for answering it.

I thank my noble friend Lord Frost for provoking this debate, because there are still other arguments for using the phrase “assisted suicide”, particularly in terms of clarity. I look forward to the consideration of the arguments made by my noble friend Lord Frost from the noble and learned Lord, Lord Falconer, and the Minister.

[Baroness Merron (Lab)]

My Lords, I will be very brief. The amendments tabled by the noble Lord, Lord Frost, do not present significant workability concerns. As noble Lords will be aware, the amendments have not had technical drafting support from officials. Therefore, further revision and corresponding amendments would be needed to provide consistent and coherent terminology throughout the Bill.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Markham (Con)]

Let me answer that, then I will be perfectly happy to be intervened on—

[Lord Kamall (Con)]

I am sorry to interrupt. If I am correct, the noble Lord can speak again, but he cannot intervene on an intervention.

[Lord Markham (Con)]

I believe I am answering the question. Once I have finished answering, the noble Lord can intervene on me and say what he would like to say. If he is willing to wait a few moments, that would be the appropriate point.

We spoke earlier about how palliative care is a way for people to choose to ease the way they die. I would say that assisted dying is also giving people the choice to die in a way they want to. In birth services, people have a birth plan. I remember going through this recently and there was a midwife who played a role very similar to that of a personal navigator, helping us talk about what sort of birth plan we wanted: whether we wanted a home birth and what we wanted to do about pain relief. It was very similar to many of the things that the noble Lord, Lord Birt, was talking about. The fundamental point here—the noble Lord, Lord Winston, is free to intervene at any point now I have answered that—is that it is giving people choice and autonomy. I believe that choice in the way you wish to die and when you want to die, if it is certain that your diagnosis is that you will die within six months, is a fundamental choice and a health choice.

--- Later in debate ---

We hear a lot about the Bill being enforceable and workable. We have been told it is the safest Bill in the world. I would like the noble and learned Lord to commit to making the Bill safe, not just safer.

[Lord Kamall (Con)]

My Lords, this has been a long and comprehensive debate, and a number of points have been raised. I will try not to hasten it—

[Noble Lords]

Oh!

[Lord Kamall (Con)]

Sorry, I will try to hasten it, actually, in many ways. Maybe we should slow down.

I start by thanking the noble Lord, Lord Birt, for the amendments in the group and the whole idea of establishing the assisted dying help service. As the noble Lord said, it is based on well-established experience. It seeks to address a number of important questions that the current draft of the Bill does not address. How will important services, such as care for the families of those who are seeking assistance under the Bill, be provided? Who will publish the appropriate information about the provisions of the Bill in the public domain? How will those seeking assistance be supported throughout the process? These are thoughtful amendments, but a number of noble Lords have quite rightly raised concerns about the potential downside to speed and efficiency in this case.

The amendments in the name of my noble friend Lord Mackinlay seek to ensure that when a personal navigator is allocated to the person seeking assistance—that sounds like a good suggestion—there must not be a presumption that, when they appoint that navigator, the person will necessarily continue with the process to its end. That gives the person who seeks it the option of changing their mind.

A number of the issues that we have discussed today have been discussed throughout the passage of the Bill. I have a number of questions; they are more for the Minister than the Bill’s sponsor, but I think that many noble Lords have questions for the Minister.

On the specific matter of the assisted dying help service, as well as the duty to publish information on the Act’s provisions, what consideration have the Government given to the interaction between the legitimate dissemination of information about assistance with ending one’s life and the encouragement of suicide, as prohibited by law under the Suicide Act 1961? I know that this issue came up very early on but, in this specific context, it is worth repeating.

A number of noble Lords have rightly asked about the workability of the help service, including what the cost of managing the service and the other running costs might be. Do Ministers feel that resourcing the service adequately might undermine the effective delivery of other parts of government? As a number of noble Lords have said, the Government have not really answered those questions about the available resources and where the money will come from. Once again, I am taken back to Second Reading, when the noble Lords, Lord Stevens and Lord Hunt of Kings Heath—the latter being a former Health Minister—both said, “We know how the system works. This money will come from somewhere, and it will be at the expense of palliative care”. We are assured by those who support the Bill that that will not be the case; indeed, Ministers have themselves said that sufficient money will be made available. However, a couple of weeks ago, I asked almost the same question as my noble friend Lord Deben asked—albeit in a less eloquent way—of the Minister from the Ministry of Justice, and, last week, of the Minister from the Department of Health. To be fair to the Government, I received an answer from the Minister; if noble Lords allow me, I will touch on a few extracts from that letter and paraphrase where possible. The Minister’s letter to me said

“you sought confirmation that the Government is confident that palliative care will be sufficiently funded, so that those who may seek assisted dying services are offered a real, as opposed to theoretical, choice on palliative care to support them making a more informed decision”.

So far, so good. As my noble friend Lord Gove said, the letter talks about support for the hospice sector, including £100 million for adults and £80 million for children—I almost sound like a Minister responding here, I know, but we have to be fair when we challenge the Government on this. The Minister also mentioned the all-age palliative care and end-of-life care modern service framework for England to improve the services. The noble Baroness, Lady Berger, said that it would be published in spring 2026, but the letter says that it will be published in autumn 2026—I think the Minister answered that; let us be fair: that is better than the answers that many Ministers from all parties have given over the years, where they often say “at pace” or—what is the other phrase?—“in due course”, but at least this gives us a real timeframe. The Minister also talked about the framework being aligned with the ambitions of the 10-year plan.

[Lord Harper (Con)]

On that point, I also got a copy of that letter. It is worth saying that, in the 10-year plan, there is no ambition for high-quality, universal palliative care. It is not there. So, if the plan the Government are going to publish in the autumn is aligned with it, I think we can see that they do not plan on making universal, high-quality palliative care available in the next 10 years. That is a real problem for decisions taken under this Bill.

[Lord Kamall (Con)]

I thank my noble friend for that intervention. Before commenting on the content of the Bill, I was seeking, just to be fair to the Government, to lay out what they have told me.

[Lord Stevens of Birmingham (CB)]

May I pursue the important point that the noble Lord is making? The Minister for Care, Stephen Kinnock, was before a Commons Select Committee on this very point that the noble Lord, Lord Harper, has discussed. He declined to give any commitments about the content of the modern service framework for palliative care and declined to say that resources would be made available to fill the gap; the only specific commitment he gave was that a new 24/7 phone number would perhaps be put in place in 2027, I believe.

[Lord Kamall (Con)]

I thank the noble Lord for that intervention, as well. It reinforces the points I am going to come to—if that makes sense.

The Minister, the noble Baroness, Lady Merron, ends the letter by saying:

“Through these actions … we hope to ensure sustainable funding for palliative care and end-of-life care sector in the long term”.


This is the Government’s stated intention. The next bit says:

“I hope this letter has provided clarification on the queries you raised”.


I will let noble Lords be the judge of whether it provides clarification. To be fair, the Minister copied the letter to all Peers who tabled amendments, as my noble friend Lord Harper said, and put a copy in the Library. I urge all noble Lords to read that letter to see whether they believe that it provides the clarification that many are seeking. If we feel that it does not, we should come back to this point in future weeks and raise these issues with the Government again.

I hope the Minister, the noble Baroness, Lady Blake, will take that on board when she answers. If she does not have the answer to many of these questions, we should wait for other noble Lords to read that letter, then maybe raise the questions again and ask whichever noble Baroness is on duty as the Minister in future weeks to answer questions on areas where we still believe there are gaps.

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Lord for referring to that letter and quoting the amounts of money in it. Does he recognise that that is one-off and not recurring funding, and there is no intention for funding to increase as cost of living and so on increase, and to meet the gaps in services that we have been talking about?

[Lord Kamall (Con)]

I have to be very careful because I am not answering for the Government; I am just trying to reflect that letter. However, the Minister did make it clear that the children’s hospice funding is over the next three years and that it will account for £80 million in total. We all know how Governments work, and I not sure that any Government could give a commitment beyond three or four years or beyond another election. To be fair to the Government, I believe that they have answered the question about how much resource they will be allocating. It is up to noble Lords to decide whether they believe that that is sufficient, but if, whichever side of the debate they are on, they feel that the Government have not answered those questions, it is up to them to come back in future weeks and press the Minister on duty.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

I thank noble Lords for their thoughtful comments, particularly those on the amendments proposing an assisted dying help service and a minimum timeline for the assisted dying process. I thank the noble Lords, Lord Birt and Lord Mackinlay, and the noble Baroness, Lady Coffey, for their amendments in this group.

I also thank the noble Lord, Lord Kamall, for his helpful comments on the detailed letter that has been sent to noble Lords. I hope that noble Lords can therefore accept that that is in train and that they will refer to the letter. Of course, there will be other opportunities to come back on particular details if required.

The amendments tabled by the noble Lord, Lord Birt, aim to set up a new statutory body entitled the assisted dying help service, which would be part of the National Health Service. From a workability perspective, these amendments would create many new concepts and relationships that would conflict with the current provisions of the Bill. I note that considerable further policy development and legal drafting would be required to create a workable system should noble Lords support these amendments.

Amendments 287A and 287B tabled by the noble Baroness, Lady Coffey, would create a new role for the General Medical Council—GMC—to set the requirements for training, qualifications and experience, and introduce new licensing, for assisted dying. Although the GMC has a function to set standards for doctors and recognise specialisms, it does not set requirements for training and qualifications for specific services, or license doctors to provide them. This would be a significant departure from the way that the GMC operates and would require it to identify a new process to identify the doctors on this register who are licensed to provide this service.

--- Later in debate ---

[Lord Blencathra (Con)]

My Lords, I will speak relatively briefly to the amendments in this group. I degrouped them for a technical reason. They are quite narrowly drawn. I know there is a group coming up, led by the noble Baroness, Lady Berger, that is wider ranging and more important than mine. If any noble Lord wishes to speak on the principle of these amendments, they might be better off waiting for the noble Baroness’s group.

The purpose of my Amendment 39B is to ensure that a person who wishes to die is driven by their illness, not by poverty, loneliness, lack of care or other remedial pressures. This would restore the link between the justification for the Bill and its operation. The political case for assisted dying has always been framed around unbearable physical suffering caused by terminal illness, yet the Bill contains no requirement that the person’s motivation must arise from that illness. Without this amendment, the Bill becomes a general choice in adversity scheme, where any reason—financial distress, lack of care, fear of being a burden—can drive the decision.

The noble and learned Lord has now explicitly said:

“I am strongly against saying poor people should not have that choice”.—[Official Report, 16/1/26; col. 2020.]


That is an admission that the Bill permits assisted death for reasons of poverty. My amendment would correct that. It would ensure that the motivation must be principally attributable to the illness itself, not to the state’s failure to provide care, housing or support. This is not about denying autonomy; it is about ensuring that autonomy is real. A decision driven by poverty or abandonment is not a free choice. The amendment would ensure that the Bill remains what the public believe it to be: a response to suffering caused by terminal illness, not a response to social failure.

My Amendment 39C would draw a clear line: financial distress, lack of housing or lack of social support cannot be the primary motivations for an assisted death. Without this safeguard, the Bill risks becoming a mechanism by which poor and unsupported people are offered death instead of help. The Bill is presented to the public as a response to the unbearable physical suffering caused by terminal illness, yet it contains no requirement that the person’s motivation must arise from that illness. Without these amendments, the Bill permits assisted death for a whole host of reasons that Parliament never intended, such as loneliness, poverty, lack of housing, lack of care or feeling like a burden on the state or your dependants.

The noble and learned Lord has now accepted that these motivations are valid choices. That is a dramatic shift from his own 2012 commission, which said that motivations were never legitimate and that safeguards must prevent them. Peers are entitled to ask what has changed other than the political need to keep the Bill workable. International evidence shows that non-medical motivations dominate assisted dying requests. Pain is not the primary driver. We hear that being a burden is a driver, as is the loss of autonomy. Parliament must decide whether it is comfortable legislating for that.

Finally, these amendments ensure that asking “why” has consequences. If the answer is poverty, loneliness or lack of care, the response should be support, not a lethal prescription. These amendments restore coherence, safeguard autonomy and prevent the Bill from becoming a general choice in adversity scheme. I beg to move.

[Lord Kamall (Con)]

In the interests of being brief, rather than repeating everything that my noble friend said, I look forward to the answers from the sponsor of the Bill and from the Minister.

--- Later in debate ---

Finally, the reason that I am concerned about this Bill—I am pretty sure most in this Chamber have lost loved ones—is because I have lost my parents and a number of disabled friends, and I am worried about how people are treated in the system as it is. I do not think the system works to support people as well as it could, and the Bill will just push people, who could have a good end of life and the right support, to think that they have no other choice but to sign up for this.

[Lord Kamall (Con)]

My Lords, it has been a long day at the end of a long week for many noble Lords, so I do not seek to make a long speech. But before I respond to the debate on this group of amendments, I want to thank all staff from across the House who have worked extra hours to ensure that we could be here today and at this late hour. We really do appreciate it.

I thank the noble Baroness, Lady Berger, for introducing the amendments in such a clear and, more importantly, concise manner. As my noble friend Lord Blencathra said, the principle behind this group is very similar to that behind the last group: what is being sought is that doctors should seek to establish whether those who are terminally ill, and who have been given a prognosis of six months or less to live, are seeking an assisted death for those reasons only—their terminal condition—and not material factors.

My noble friend Lord Markham explained why other motivations are relevant, could be relevant or could be reasons for people wishing to die or seeking an assisted death. Contrary to that, the noble Lords, Lord Mawson and Lord Carlile, referred to misunderstandings and pressures, particularly on people from black, Asian and other minority ethnic communities. It reminds me of a comment that the noble Lord, Lord Rees of Easton, made at Second Reading—a man who spent all his life working with black communities in Bristol—who said he was concerned about the impact of this Bill on black communities.

The noble Baroness, Lady Grey-Thompson, has also spoken of her own very real experience and concern for people in the system, if the motivation is not purely because they are terminally ill but might be because of other factors. I know that my noble friend Lord Deben shares these concerns. I just gently remind him that he is not as unique a Conservative as he believes he is; all Conservatives want a better society. In fact, most politicians from all parties go into politics because they want a better society. We are on different Benches simply because we disagree on how to achieve that. Conservatives would probably say that the state is not the same thing as society.

[Lord Deben (Con)]

I am sorry if I misled my noble friend. I merely meant that you can believe in the individual but you have to believe in the individual in a society, and you cannot take the extreme view that suggests that the individual is on their own. No man is an island.

[Lord Kamall (Con)]

Indeed, and in fact many classical liberals and libertarians understand the individual’s role in a wider society. But that is not the basis of this debate, and I digress too much. I will return to the group of amendments.

I know that the noble and learned Lord, Lord Falconer, understands the concerns of those who have raised issues about minority communities and people being stuck in the system. But I also know that he has already made his view clear about the principle of seeking to exclude some of those other principles—if I am incorrect, I am sure he will correct me. So I suspect that, given the strength of feeling, we will return to these amendments on Report.

Given that—I understand that the Minister may not be able to answer all the questions now and we accept that he or one of his colleagues will write to us—we have to understand how the Government envisage how a person’s motivation beyond their terminal condition could be established. That is the crux of the matter. How do you establish that if you can justify it only on the grounds of terminal illness, not other motivating factors?

For example, what work, if any, have the Government or NHS England done to try to understand that? One assumes they may have to draw up guidance for this one day. Have the Government, or anyone in government, looked at how other countries have handled this issue, whether they do handle this issue, and what would have to change? We spoke earlier about the foundations of the National Health Service and what might have to change in guidance for many of the practitioners. Indeed, what training would be required?

As my noble friend Lord Deben has often said, this goes way beyond just the Bill. It will affect the Department of Health, the practitioners and the legal system. These are questions we need the Government to answer. They can still take a neutral position, but they have to understand that noble Lords seek to understand the implications here for government, the costs to government, and how that will change.

I understand these questions are in depth and recognise that the Minister may feel it is slightly unfair. I do not expect all the answers now. But it has been a constant theme throughout the debate and the many days in Committee that we need better answers from the Government. That is not a party-political point; it is purely that we want to see the implications of this on government: what extra costs there will be, what guidance will have to change and, however the Bill finally turns out, and in whatever form it reaches the statute book, how the Government will deal with that. I suspect that, for many noble Lords who are torn the Bill, that might be the deciding factor on how they vote at the end of the day.

[Lord Katz (Lab)]

I thank noble Lords for their considered contributions on the motivation for assisted dying. Before I go into the meat of my comments, I join the noble Lord, Lord Kamall, in thanking the House clerks and staff for all their efforts and dedication in allowing us to sit for longer on a Friday to consider these weighty issues properly.

I also share the noble Lord’s comments about our wider motivations across the House, and about generally in politics wanting a better society. For what it is worth, I find myself in agreement with the noble Lord, Lord Deben, that, indeed, no man is an island. Whether that makes me a classical liberal or not, I am not sure—probably not.

These amendments seek to amend the eligibility criteria for assisted dying, to require that the person’s wish to end their own life is due to their terminal illness rather than to other reasons. I will keep any detailed comments limited to the amendments on which the Government have major legal, technical or operational workability concerns.

Amendments 320ZA and 332AA, tabled by the noble Lord, Lord Blencathra, seek to prevent people being eligible for an assisted death if they are motivated by non-medical factors such as loneliness, poverty or lack of services. There are various workability issues with these amendments, which I will briefly outline to aid noble Lords’ consideration. First, it could be challenging to establish whether someone is seeking an assisted death as a result of specified factors, given that a person’s motivations could be complex. Furthermore, a wide range of factors could be deemed as non-medical, given that the term is not defined and the list given is non-exhaustive. It is also unclear how the patient or doctor are meant to proceed if these factors are present.

I raise no major workability issues with the other amendments in this group, which are rightly a matter for your Lordships’ House to decide. However, I would like to set out their potential effects, which noble Lords may wish to consider. The amendments would require a person’s terminal illness to be a motivation for them seeking an assisted death, but, as drafted, they do not require it to be the only or primary motivation. It is arguable that every person seeking an assisted death under the Bill would be doing so in some way because of their terminal illness, so it may be that, in practice, the amendments would not impact on who is eligible.

The noble Lord, Lord Kamall, asked me some questions. I would push back on his first question around how the Government envisage a process or system for establishing motivation beyond condition: we genuinely think this is a policy decision, and that is one for my noble and learned friend Lord Falconer, the Bill’s sponsor, and those others who support the Bill. On his question about any work or research that NHS England has undertaken, I do not have that answer at my disposal, but I am very happy to take it back and write to him.

Finally, I would just like to mention that none of the amendments in this group has had technical drafting support from officials, so the way they are currently drafted means that they may not be fully workable, effective or enforceable.