Terminally Ill Adults (End of Life) Bill

Lord Rees of Easton Excerpts

Friday 12th September 2025 Lords Chamber

[Lord Rees of Easton (Lab)]

My Lords, I, too, begin by thanking the many members of the public and Members of this House for the letters I have received, as many others have, and for the power of the personal testimonies that have been brought to me. I have been particularly struck by the hand-written letters which have been sent, which speaks about people’s real dedication.

I find this a difficult debate, not because I do not have clarity on my position, but because I absolutely hear the legitimacy of those in favour of the Bill: the very real pain in people’s lives. I am thinking about some of the key words that have floated around today. We have talked about choice, fear, pain and protection. The reality is that those things do not land equally in different people’s lives. They mean different things, people have different degrees of vulnerability to them, and they have different sources.

I bring two areas of experience to this discussion. The first is my time as mayor of my city for eight years. One of the reflections we had at the end was that good things can have negative consequences for some people. That is a very real danger. One of the things we grappled with in Bristol was that there was a 10-year life expectancy difference and a 16-year healthy life expectancy difference. People on lower incomes, born into poor backgrounds, were destined to become unwell to the point of being unable to work 16 years before the wealthiest. That means that those people from those backgrounds will be more likely to end up in situations in which they feel the pressures towards the end of life.

The second is that I was the manager of race equality in mental health—the noble Lord, Lord Stevens, was head of the NHS at the time—and we looked at the reality that, from determinants to access to experience to outcomes, people from black and minority ethnic backgrounds were disproportionately getting the bad end of the stick in terms of our mental health services. One of the things we recognised was that services designed by people in positions of power are designed for people in positions of power, not for vulnerable people. If you are not one of those people, you do not have the resources to navigate those services. Even if those services are good, you can fall into the cracks between those services if you do not have the personal assets to navigate those limbos.

The social, political and economic inequalities within which this Bill would be put, if it were to pass, are not inconsequential. What this service means is not just what exists on paper and how it is designed; it is the product of its interaction with those inequalities. I fear that, landing on such an unequal society as we have today, the circumstances and consequences could be quite dire for some communities.

It is also true that we have not tackled inequalities in NHS services—from access to experience to outcomes. I fear that putting a terminal service into an organisation that, to all intents and purposes, has not solved health inequalities will mean that both the context within which it will work and the outcomes for our population will be incredibly risky.

The challenge of palliative care has been raised. While I absolutely agree with the principle of dignity in dying, that cannot be detached from an absolute commitment to dignity in life and dignity in sickness. That means tackling the social, economic and political context in which people experience life.

Finally, because the consequences are so big, we cannot afford to try to fix this on the move. It has to be sorted before the legislation goes through.