Terminally Ill Adults (End of Life) Bill

Lord Moylan Excerpts

Friday 27th February 2026 Lords Chamber

[Baroness Freeman of Steventon (CB)]

My Lords, I will introduce Amendment 144A in my name. It is related to my other Amendments 726A and 728A, which are grouped much later and to which I do not expect to speak. I draw attention to my registered interests.

When I was at the Winton Centre in Cambridge, I led a team that produced information for patients in the NHS, and I am still involved with that. That experience underscores Amendment 144A, which has the support of the BMA. It would make the assisted dying commissioner responsible for the provision of the personalised and balanced information that patients require when making their end-of-life decisions under the Act. I know how much is involved in producing that information, how carefully it needs to be done and how controversial it can be. It therefore needs to be properly resourced, and the lines of responsibility for it must be clear.

We have already had discussion about informed consent. I think we all agree that, during the process outlined in the Bill, people need to go through the process of consent, but they also need to go through the process of shared decision-making, which is different. For both shared decision-making and consent, eligible people need to be given the risks and benefits of the different options open to them—including of doing nothing. That information has to be as personalised to each patient as possible, and presented in a way that is understandable to them. It is rightly the responsibility of the doctors to give that information to patients and to check their understanding of it through talking with them, but where do the doctors get that information?

Increasingly, healthcare professionals are provided with tools to help them. Online risk calculators help to personalise information on prognoses or the chances of an event for a patient such as the one they are talking to at that moment. Decision aids bring together all the current known evidence on side-effects, represented in easily understood ways, and patients can take these away and refer back to them while considering their decision. To give an example, for benign enlarged prostate there are two main classes of medicines and at least eight different types of surgery available to patients. I do not think a single individual doctor would know the numbers for the average effectiveness and for each of the major side-effects for every one of those 10 options. Each specialist would know the figures for two or three of the options that they offered or were familiar with: enough to consent their patients for their favoured option but not enough to help the patient make an informed choice from all the options available. To do that, they need a decision support tool which has all that information, but also more than that. That is why these sorts of decision aids are needed—and I want to give the House a sense of what is involved in making them, because it is important to understanding this amendment.

When we make decision aids, we work hand-in-hand with patients and members of the public, with people with visual and learning disabilities and neurodiversity, and conduct academic research into how people interpret numbers and graphics representing them. I mentioned that the needs for informed consent and shared decision-making are different. What we find when we work with people is that, when making a decision, people weigh up a much broader range of pros and cons than simply risk and benefit numbers. The information they want is not just a percentage risk, which would tend to be what doctors would be able to tell them when doing informed consent; it is also information about how to access different options, including those available outside the NHS. They want to know what would or might happen, including what a certain test actually involves and why it is done. They want to know where things would happen. They need to know what their rights and options are about things such as their right to say no to something or to have someone else with them. They want prompts for questions that they might want to ask or consider asking, and spaces to write notes for themselves to be passed on, so they do not have to repeat themselves at every appointment. All these things in one place help people who are not feeling at their best to navigate an unfamiliar medical world and have more confidence that the decisions that they are making are the best ones for them. We know from working with patients and getting their feedback that this is the sort of information that terminally ill people will need to support them making decisions around their end of life.

I describe all this to illustrate that this information needs to be very carefully put together, and I know that it takes time. It takes about a year or so to do all the background research, design and test with a range of real patients and relatives—and possibly longer in this case, because it will need to be quite personalised and kept up to date because of the geographical variations and provisions of different options provided by different providers, such as those you find in palliative care. Of course, that time and that team doing that work will need to be funded, and the final versions will need to be approved and then kept constantly up to date. That is why I have proposed Amendment 144A, to ensure that this very important job is overseen by the assisted dying commissioner; with their legal background and the current job description in the Bill, they should have the means to request the right amount of resourcing from the Government to make sure that this information is produced to the right standard and well maintained.

I do not think anyone in this Chamber or outside would disagree that having balanced, personalised information about options in a suitable format for everybody, whatever their disabilities, is critical to this Bill—and I do not think that anyone will, having heard what that takes, underestimate the amount of work that it will entail. There will be a lot of people who might want to persuade patients rather than inform them around this decision, which makes it particularly important that official information is produced carefully, overseen and kept up to date. Currently in this Bill, it is not entirely clear whose responsibility this commissioning of information provision would be. When we make them, we are commissioned by a team within NHS England, but it does not just spontaneously happen, even within the NHS. It is unclear to me whose responsibility it will be when NHS England disbands, for example, and an assisted dying service may be outside the NHS. That is why it is important that this Bill specifically assigns this critical responsibility, and the best person—the only person with the specific ability to ensure funds—appears to be the proposed assisted dying commissioner.

[Lord Moylan (Con)]

My Lords, I rise to speak briefly to my Amendment 134, which is a probing amendment. The noble Lord, Lord Weir, drew our attention to Clause 4(4), which sets out what he referred to as the functions of the assisted dying commissioner. In fact, the text refers to the “principal functions”, and my amendment suggests replacing the word “principal” with “sole”. Those functions are very extensive; they are elaborated in, among other places, Schedules 1 and 2 and Clauses 16, 18 and 49. They are, as I say, very extensive. They include in Schedule 1 a general power to do anything which may be necessary or appropriate for the commissioner to do in order to be able to carry out his functions. He is not short of responsibilities and he is not short of powers to be able to carry them out, yet in the Bill these are described as his “principal” functions.

So my first question to the noble and learned Lord is: are there are any other functions? Would anything be lost by changing the word “principal” to “sole”? Does he consider that there are secondary functions that the assisted dying commissioner has? Many of us are concerned that the voluntary assisted dying commissioner could easily become an advocate for change to the framework that we are establishing in the Bill. In particular, it may be found that some requirements set out in the Bill are irksome and difficult and take time. Of course, that is quite deliberate. The noble and learned Lord has set up a structure that is not meant to be easy to navigate, quite deliberately. This is not an easy structure to navigate and it may well be that, when the assisted dying commissioner comes out with his annual report—because he has to produce annual accounts, and I am sure that the report will contain things over and above purely financial figures—he will suggest changes and relaxations, and so forth. He cannot make those changes and relaxations, mostly, on his own—but we do not want, if we establish this Bill, to which many of us are strongly opposed, an officially paid and highly regarded advocate for the relaxation of the safeguards that we have built in to be operating out there.

So I come back to the question: first of all, does the noble and learned Lord want to say whether he considers there are other functions over and above those set out in the Bill, taking account of the general power I have already mentioned? Secondly, will he give us some assurance that he does not see this role as being that of an advocate for relaxation or change?

[Lord Frost (Non-Afl)]

My Lords, I shall speak to Amendments 135 and 436 in my name. These two amendments relate to one of the specific functions just elaborated by the noble Lord, Lord Moylan. Amendment 135 would create in Clause 4 a specific duty on the commissioner of ensuring that paperwork relating to individual cases is in order and of the right quality so that the process can proceed. As the amendment puts it, the paperwork should be

“present, complete and of sufficient standard”.

Amendment 436 would create in Clause 16 an elaboration of what that duty means in practice: that is, to request further and improved paperwork if it is not in order and, in particular, if any doubt exists over whether eligibility criteria are met.

Why are these amendments necessary? It is a very specific issue, clearly, but the commissioner has a function, inter alia, to receive documents, refer cases and so on, which is obviously crucial to the working of this process. As described, that function implicitly includes ensuring that the documentation is in order, but that is not made explicit anywhere in the Bill. The purpose of the amendments is to make that requirement explicit, and to create a clear legal duty on the commissioner to ensure that the paperwork is of a sufficient standard.

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[Lord Harper (Con)]

My Lords, I have a couple of points to make on this group of amendments. Let me start on a note of agreement with the Bill’s sponsor, the noble and learned Lord, Lord Falconer, who has in this group Amendment 131A, which would require:

“Before making an appointment under this section, the Prime Minister must consult the Welsh Ministers”.


I think that is a sensible approach. We have had disagreements about whether the Bill should or should not apply to Wales but, given that it does, it is sensible that Welsh Ministers are consulted.

It is worth noting that Welsh Ministers have some views on this matter. Given that we are talking about consulting Welsh Ministers, this is probably the time to note them briefly. In the vote in the Senedd this week, Wales’s Health Minister, one of those who would be consulted, made two points clear. First, he said that the Motion in the Senedd was not a referendum on legalising assisted dying with only this Parliament able to make that decision. He also said—this is important, given that there are those outside this House who pretend that the only people who think this Bill has any flaws are a small number of Peers, when that is not the case—that he voted against the legislative consent Motion because:

“I’m also clear in my own mind that the fundamentals of the bill, as it’s going through Westminster, don’t provide sufficient safeguards for patients”.


The Welsh Health Minister, who would be one of those responsible for helping to implement it, thinks that the Bill currently does not have appropriate safeguards. He went on to say:

“Although the vote yesterday was on the devolved areas ... the net effect is to give powers in Wales to deliver a service that I don’t think I would support if I was operating over the border”.


For all sorts of reasons, it is helpful to consult Welsh Ministers. We have heard from them this week, and they are very clear that this Bill is currently flawed. Therefore, I think we are doing the right thing by scrutinising it, asking questions and putting forward amendments to improve it. We can see that it is not just Members of this House who have concerns; elected Members serving in the Welsh Government also have concerns, and it is worth getting that on the record.

The fundamental thing that I want to talk about is the prime ministerial appointment process in the Bill. I was quite surprised, not particularly that the Prime Minister was making the appointment, but that there was no other process around it. The Bill currently says that the commissioner is to be appointed by the Prime Minister. The one constraint is that:

“The person appointed must hold or have held office as a judge of … the Supreme Court … the Court of Appeal … the High Court”.


Other than that, there is no process set out that the Prime Minister has to follow.

There are two flaws with that. There is the one that the noble Baroness, Lady Fox, set out, which is that, given that this is an area of policy, the Prime Minister may have their own views about the issue and that may influence the person they choose. My noble friend Lord Markham was quite right that the person would simply be implementing the law. The worry is that if you appoint somebody who has a very strong view about the issue and is prepared to use holding this office to prosecute advancing it, which is the concern my noble friend Lord Moylan set out, that is a problem. The concern I have with the Bill as drafted is that the Prime Minister could appoint such a person, and we would have no way of knowing in advance or of testing that person’s views before the appointment was made. We would find out about it only afterwards, and that is a real problem.

Secondly, I am afraid that we have seen examples of the current Prime Minister making staggeringly bad appointments, and the rather obvious one is Lord Mandelson. I see the Minister shaking her head, but it was a shockingly bad appointment. It is an example of a decision being made to appoint somebody and the process being circumvented in order to get the right result. The person appointed to this role is responsible for life and death issues, and as my noble friend Lord Deben said, it is extremely important that they command the confidence of the public—not just people who are in favour of assisted suicide, but those who are against it and who want to see a proper process with proper safeguards, so that that person holds public confidence.

[Lord Moylan (Con)]

Does my noble friend agree that, given the surreptitious but none the less firm support that the current Prime Minister has shown for this Bill, it is almost impossible to believe that he would not be personally involved in this appointment?

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[Lord Moylan (Con)]

That point seems to me to be covered by the general power of the assisted dying commissioner under Schedule 1 to do anything that is appropriate or necessary for carrying out his functions, so I do not think that is a reason for not using the word “sole” and giving some assurance to those of us who are concerned about creep.

[Lord Falconer of Thoroton (Lab)]

I think we will have to disagree on that. It is the normal way for that to be dealt with in drafting, so I am content with it. I am sorry to disagree with the noble Lord, but that is my view.

Amendments 135 and 436 from the noble Lord, Lord Frost, would place a duty on the assisted dying commissioner to check that all the paperwork is in order. Again, I have thought very carefully about that. The role of the commissioner, as far as the panel is concerned, is to pass the two reports on to the panel once he has received them from the doctor, for the panel then to consider whether that case is in order and meets the criteria—is the panel satisfied that there is no coercion and is it satisfied on capacity? I think it is neither appropriate nor necessary to add yet a further safeguard in that respect, because that is why the panel is there. It would lead to overlap and unnecessary delay without, in practice, any additional safeguard. The noble Lord, Lord Evans of Rainow, supported that. For the same reasons, I would reject his amendment.

The noble Baroness, Lady Finlay, made a point about conflicts of interest. There would obviously be a conflict of interest if the assisted dying commissioner had a financial or commercial interest in any sort of provider of assisted dying services. That would be covered by the principles to which the noble Baroness, Lady Levitt, referred in relation to the way in which the appointment would go. I completely agree with the point by the noble Baroness, Lady Finlay, but I do not think there is a need to put anything into the Bill in relation to it.

A number of noble Lords have referred to the risk of mission creep—the idea that an enthusiast or proponent of assisted dying would operate in an inappropriately biased way. All that the assisted dying commissioner can do is act in accordance with the terms of the Bill. As the noble Lord, Lord Carlile, said, if for example the commissioner stuffed a panel with people he knew would take a biased view, he would be acting both improperly and illegally under the terms of the Bill. As the noble Lord said—and I agree with this—Schedule 1 opens the door to every sort of judicial review if that were the position and people became concerned about it. That goes to the amendment from the noble Lord, Lord Wolfson, which would provide for complaints to be made to the Prime Minister. Of course you could make complaints to the Prime Minister, but you certainly would not need the Bill to make that possible; there would be political accountability for the conduct of the commissioner, because the Prime Minister has made the appointment. Equally, there would be legal accountability in the form to which the noble Lord, Lord Carlile, referred.

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Moved by

[Lord Moylan]

140: Clause 4, page 2, line 39, at end insert—
“(f) setting charges payable for the service by those seeking assistance.”Member's explanatory statement
This amendment would provide a means whereby assistance would not be a charge on the public purse.

[Lord Moylan (Con)]

My Lords, it is a pleasure to be addressing your Lordships’ Committee immediately after the lunch break.

I have a number of amendments in this group which work together to do two things. The majority of them would prevent any public money being spent on the assisted dying service. One of them, Amendment 917, seeks to create an alternative funding structure. I will say immediately that my alternative funding structure is robust and effective, but I am not saying that there are not others that could be put forward that would have a similar effect. The main point is to say that there needs to be a justification given—and so far, none has been given—as to why this service, when it is created, should be a charge on the taxpayer.

The noble and learned Lord has made much in his comments about the Bill so far of the principle of autonomy—the right to dispose of what happens with your own body, I suppose. The principle of autonomy in this respect has been in place in law since 1961, when suicide was decriminalised. In my view, the Bill goes a great deal further than establishing autonomy. What it is, in fact, is coercive on the rest of us, and one of the ways it is coercive is by envisaging we are all going to pay for it.

The Bill does not say explicitly that the service is going to be paid for by the taxpayer, nor does it say explicitly that it is going to be free. But it is certainly the case that the Bill envisages public expenditure, because the Secretary of State is going to have to pay for the maintenance of the voluntary assisted dying commissioner and its staff and activities. It is implicit and assumed—if I am wrong about this, the noble and learned Lord can certainly tell me—that the provision of the service at the individual level is going to be free, so to speak, at the point of use, by the person applying for what is called assistance.

Why should this be a charge on the taxpayer? It is not, after all, a medical treatment—that is absolutely clear. We provide free medical treatments through the NHS, and the principle of free medical treatment at the point of use has been established for many years in this country. But this is not a medical treatment, so why should it be provided free? Giving someone permission legally to do something which has previously been prohibited—in this case, giving them permission to assist a suicide, which at the moment is legally prohibited—does not imply that the Government have to pay for the person to do what they are now permitted for the first time to do. So that argument does not follow in any sense at all.

It might be said that voluntary assisted dying is an act of compassion. However, it is not the case that the state pays for every act of compassion. There are many organisations that do—mainly charities—and individuals provide and express their compassion through donations and other acts of compassion. The Government are not the only source for that. Anyway, the truth is that many of us do not consider the Bill, or assisted suicide, to be an act of compassion—in fact, we consider it to be an act of cruelty.

My amendments would prohibit the expenditure of any public funds on any activity envisaged in the Bill, with the exception of activities related to Clauses 34, 35 and 36, which will create criminal offences. Of course we would expect the Government to pay for the investigation and prosecution of criminal offences, as that is a state function, but it would be prohibited for the other functions envisaged in the Bill.

In my Amendment 917, I have attempted to show at least that an alternative is possible. The alternative would involve the assisted dying commissioner establishing a budget at the beginning of the year. The budget might not be exactly what he ends up spending. Anyone who has been involved in a local council will know that you are legally obliged to set a balanced budget at the end of the year, but it does not guarantee that at the end of the year it turns out to be a balanced outcome. However, he would be obliged to set a budget and, on the basis of that budget and on the basis of the assessment of demand—which in the first year would be difficult but in later years should be fairly predictable, I imagine—to set a fee. That fee would be payable by those applying for assistance. Provision is made for the applicant to pay the fee in stages, so that the applicant might be charged so much at the preliminary discussion stage, so much later on and so much after that.

People already pay for assisted dying. I do not know what it will cost, but I do not see that it would be any more expensive, necessarily, than going to Dignitas—and people pay to go to Dignitas. Why should we assume the expenditure they make at the moment and put it as a charge on the taxpayer? I could be rebutted if people were to say that this is an argument about nothing and that, in fact, the Treasury will save so much money from assisted dying because we will not have all these sick and elderly people whom we have to pay to look after and that we are going to be quids in. If any noble Lord wishes to make that argument, I invite them to do so.

This is not in itself an argument about whether the service should be provided by the NHS; I know it sounds as though it might be, but it is not. I have later amendments about whether the service should be provided by the NHS. This is a question about whether it should be free. The NHS can provide services and charge for them—it already does. Many hospitals, in London at least, have private wings, where the NHS provides services for which it charges. I am making the conceptual point that this is a distinct question: should it be free or should people pay for it? Should there be a charge on the taxpayer? The case that it should be free, with a charge on the taxpayer, has not been made by the proponents of the Bill. If they wish to make it—it is a little ambivalent in the Bill—now is their opportunity to do so. I beg to move.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank my noble friend for opening this after-lunch debate and outlining that an alternative is possible. I will speak to my Amendments 835 and 868, which I added to this group because they seek to ensure that an assisted dying service is clearly separated from NHS provision, and that therefore there is clear transparency around funding for the taxpayer. Such a service could be set up and funded privately or charitably, in the same way that we currently provide and fund care provision or hospice services. Such a service would be clearly separate from the NHS but could operate, potentially, in partnership. The NHS could commission services if it so chose. It would have to share data and patient records and there would need to be a system for the regulation of such services.

Proposed new subsection (3) in Amendment 835 would require regulations on the definition of “privately funded organisations”. If such a service were to work in partnership with the NHS—as many hospices and third-sector service delivery organisations currently do—then further proposed new paragraphs would require the establishment of the means through which NHS providers can commission privately funded organisations to provide services, the data sharing arrangements to ensure the necessary sharing of records, and, most importantly, a system for regulating the provision of services by privately funded organisations.

Some noble Lords have expressed concern about the use of “private organisations” in my amendment. However, I point to the kaleidoscope of entities that currently provide health and social care already—some of which my noble friend Lord Moylan just mentioned. Many people have made a profit from care homes, many charities provide health services instead of the NHS, and private hospital care coexists with NHS provision, often with the same consultant working in both. I am a Conservative, so I do not think that making a profit per se is a bad thing; I accept, however, that making excessive profit out of death and dying is not particularly morally acceptable, hence the need for robust and transparent regulation of any services.

As I have said before in Committee, this is an area where the supporters of the Bill and those who support the principle of legalising assisted dying have missed a trick. I agree with my noble friend Lord Moylan in posing the question of why assisted dying should be taxpayer funded. It is essential to ask the sponsors of the Bill at this stage how the establishment of an assisted dying model would impact our current healthcare systems and healthcare professionals.

We know that the Secretary of State for Health has stated that there is currently no budget for such a service, and Stephen Kinnock, the Minister of State for Health and Social Care, who voted for the Bill, has said that the Government will have to reprioritise spending to fund assisted dying. Therefore, it appears that funds will have to come out of the health department’s existing budget. Stephen Kinnock also stated that, as it stands, the Bill includes the potential for the provision of assisted dying services privately, as well as free on the NHS. Therefore, in this group of amendments, we are asking the sponsors to ascertain what they intend. We are also asking how the Government feel about the requirement to reprioritise NHS budgets. What services would then be deprioritised?

The Bill currently going through the Scottish Parliament makes it explicit that assisted dying would, if that Bill is passed in Scotland, be delivered by the NHS. However, this Bill is silent. The Scottish Bill is accompanied by a financial memorandum which outlines the cost to a range of public bodies of the implementation of providing assisted dying—the majority of which will fall on the NHS and cover things such as the cost of anticipated clinician hours, staff training, the costs of the substance provided to end life, both the storage and monitoring of it, data collection, support and navigation services, and many others. All are extra costs the NHS will be expected to bear.

Do the supporters of the Bill, as my noble friend Lord Moylan referred to, expect the service to be cost neutral, as referred to in the financial memorandum in Scotland? The Scottish Bill identifies “unutilised healthcare” savings due to the obvious but rather unsettling statement that every person who has an assisted death will not require further care.

I accept that saving health and care costs is not the motivation of the sponsors of this Bill. However, there are many concerns expressed by individuals and organisations that implementing the Bill will have real cost implications and necessitate clinicians diverting time and resources from their already stretched patients to support assisted dying. We need to find a balance between what the Bill sets out to provide and what is best for our current health and care services. Creating a service that is separate from the NHS, as many hospices and care homes already are, would ensure such a solution.

The NHS is not a solution to all issues. I come to this from my experience in the third sector, where the medicalised approach to care and service provision, as would be delivered by the NHS, often does not lead to optimal outcomes for the patient—whereas a demedicalised social model can often be preferable. Hospices provide holistic care, not just medical care, and include support for emotional, social, practical, psychological and spiritual needs, as well as support for the person’s family and carers. Hospice teams may include doctors, nurses and healthcare assistants, but also social workers, therapists, counsellors, chaplains and trained volunteers. Is this not what the Bill’s sponsors want for terminally ill adults?

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[Lord Falconer of Thoroton (Lab)]

I will try to give the most reverend Primate confidence. First, decisions about treatment at the moment frequently have to be made in the context of what everybody in this Committee would think was inadequate palliative care. There is scope for coercion there with no safeguards. Secondly, people have the ability to go abroad to get an assisted death, and there is scope for coercion there. In both those situations, there are no safeguards whatever. The landscape in which those choices are made, whether about continuing other treatment or about going to Switzerland, has absolutely no protections whatever. This Bill provides five levels of protection. I am completely satisfied that this is a safer system than the current law, and I very much hope that gives the most reverend Primate confidence that the Bill is the right thing to do.

On the funding of palliative care, I very much hope that the Government and other people will provide more money for palliative care. The experience in many countries is that the introduction of an assisted dying Bill leads to an increase in the amount of palliative care, because people debate and think about how you die. I hope those things put the most reverend Primate’s mind at rest. The risk for coercion is already there, and this provides safeguards. I hope the introduction of the Bill will produce more money for palliative care, but unfortunately I cannot give the most reverend Primate any guarantees of that.

[Lord Moylan (Con)]

My Lords, I shall be very brief. I am grateful to all the noble Lords who spoke in this short and valuable debate. I tabled these amendments in the first place to give the noble and learned Lord the opportunity to explain why this proposed service should be funded by the taxpayer—the unwilling taxpayer, it might be said, in the case of those who have a principled objection to it. I listened very carefully to what he said, and he gave one reason only: failure to make it available for free would contribute to an increase in health inequalities. That proposition rests entirely on the assumption that this is a health treatment. It is not; it is poisoning people. It is completely unpersuasive that this should be justified as contributing to health inequalities or otherwise. For that reason, I would certainly want to bring these amendments back on Report and invite the House to take the view that we should not fund this from public resources. In the meantime, however, I beg leave to withdraw the amendment.

Amendment 140 withdrawn.

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In legislation on the matter of assisted suicide, the safeguards must be robust. Amendment 483 would help ensure that they are.

[Lord Moylan (Con)]

My Lords, I have two amendments in this group, Amendments 926 and 929, which are related to each other. They are probing amendments related to Schedule 2 and the operation of the panel. It is something that has been niggling away at me and worrying me. I am perfectly prepared, of course, to be told by the noble and learned Lord that there is nothing for me to worry my little head about but let me raise the question none the less.

Schedule 2 makes provision for appointments to the assisted dying review panel. As I understand it— I am sure I will be corrected if I am wrong—the commissioner can create a list of people who are eligible to serve on panels. That is, if one likes, the mega panel at the top. These people can be appointed for a term of five years and reappointed for a term of a further five years. From that large group of people, the commissioner then, in each individual case, will draw and appoint the members of a panel—the three members with the specific skills that we have been discussing—and the decision of those panels needs to be unanimous. Even an abstention would count as a negative vote, so to speak. That is how I understand paragraph 5 of Schedule 2.

That is the background. To work properly, the panel members need to be independent of each other and reach their own view. It seems quite possible that they will have different personal thresholds as to what they regard as the appropriate level of evidence required to persuade them to say yes. In that light, it is more than possible that some of them might turn out to be slightly awkward, in the sense that they tend to say no rather more often than they say yes—which is fatal to the process because one no and the whole thing is over. You have been through the preliminary discussion and the two doctors, and at the panel you are being knocked back because of one rather awkward person. There will be pressure on the system as a whole, essentially, to eliminate those people from it—those who are difficult and who generally are more likely to say no than otherwise.

Amendment 926 says that, when deciding whether or not to reappoint somebody for a further five-year term, no account should be taken of what might be called for this purpose their voting record in panels. Similarly, Amendment 929 would mean the decision of whom to appoint to a panel cannot be taken on the basis of their past voting record. Voting record may be an inappropriate phrase, but I think noble Lords understand exactly what I mean.

As has been mentioned earlier in the course of the day, the background to this is of course the Abortion Act. The principal safeguard in the Abortion Act is that two doctors separately must agree there is a threat to the woman’s health. When the Act was introduced, that was quite possibly a genuine safeguard, and there may have been occasions when doctors said they did not consider there was a threat to the woman’s health that justified an abortion, but it has become entirely routine. There would probably be a flag run up a pole at DHSC headquarters if a doctor were to say no on an abortion application nowadays.

Therefore, I have put these amendments down to prevent something like that from happening—to prevent the panels from becoming routine—and to ensure those people who have the higher threshold of evidence, the more cautious approach, the slightly more sceptical attitude, are not eliminated from the panels, either through having their term not extended or through simply not being appointed when each opportunity comes up. There may be better ways of dealing with the concern I have expressed than the ways contained in my specific amendments. They are, as I say, probing, and I am open to those improvements. But we have to ensure that this does not go the way of the Abortion Act, and that the panels are robust and say no when it is appropriate to say no, which might be quite often. That is what I would like to hear the noble and learned Lord comment on when the time comes.

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 462A in my name, which outlines that, before approving any application, the panel must be satisfied that the person requesting assistance has had the requisite assistance from the local authority in relation to the delivery of statutory services.

The amendment deals with the problem caused by the basic principles of the Bill, which is based on a very narrow concept of procedural autonomy. If it is only this that matters, then for the panel, as long as they can tick the boxes saying there is no coercion or pressure, and that the person has capacity et cetera, then the application is approved. It is approved under the current drafting of the Bill even if the panel believes and has evidence that the person is applying because, for instance, their housing is inadequate, the care package fell apart, they are actually grieving for other relatives or they are poor.

This amendment would mean that, before any such approval is made by the panel, it must be satisfied that the local authority has received a referral to look at the statutory provision of services for the person. In relation to this, I am grateful that the noble and learned Lord enjoyed his meeting with Professor Alex Ruck Keene, because he has put this a number of times in written and oral evidence about the concept of the panel and its powers, and it is worth quoting:

“You have to think … carefully about what purpose any … of this oversight is actually serving societally, if the oversight panel, whether that be a judge or a panel, cannot decline to approve an application if it considers that the reason the individual is seeking assistance in dying is because of service provision failures by the statutory bodies responsible for meeting their health and social care needs”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 96.]


I know the noble and learned Lord has answered many questions and commented about the access to this service for the poor. This is a different question. I am not saying that poor people should not be able to apply. I distinguish that from a situation where the panel has concluded on the evidence that, although the person satisfies all the tests under the Act, the evidence is that they are before the panel because they are poor. There are many instances of this from other jurisdictions, for instance, particularly in relation to homelessness. People have come forward for MAID in Canada because they are homeless, which is available because it is not just for terminal illness in Canada.

In relation to the amendment, it may be that the drafting needs to be different; it might be that this needs to be done not just before the provision but can be twin tracked, so that you approve the application but at the same time make sure the local authority deals with the provision of services. I hope the noble and learned Lord will take seriously this additional power for the panel to ensure that people are there for the reason that they are exercising their autonomy in relation to the Act and not pressured because of lack of statutory services.