Terminally Ill Adults (End of Life) Bill

Viscount Colville of Culross Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[The Lord Bishop of Newcastle]

My Lords, I will speak to Amendment 108, to which the right reverend Prelate the Bishop of Lincoln has added his name. He regrets that he cannot be in his place today, as he is interested in this amendment as lead bishop for the L’Arche community in the UK. With the Church of England, L’Arche strives to provide a positive and inclusive residential community in which adults with and without learning disabilities can live and grow together.

Health inequalities come into focus for much of the Bill. As we heard in the Select Committee on the Bill, people with learning disabilities experience significant inequalities in health outcomes. The learning disabilities mortality review found that 40% of the deaths of individuals with learning disabilities in 2023 were linked to avoidable, treatable or preventable causes—double that of the general population. As we heard from Ken Ross on behalf of the National Down Syndrome Policy Group, people with Down syndrome are likely to die 27 years earlier than their peers. He highlighted

“a systemic direct and indirect bias shown within the health service, which could also be linked to a lack of understanding of the needs, wishes, health, learning and communication profiles of this particular group”.

That bias is linked to what other people feel a life worth living is like, sometimes pejoratively described as a life without dignity.

We have heard about the high suggestibility of some people with learning disabilities, and the discrimination they face both in and outside the healthcare system. This is closely linked to capacity. It is clear that additional protections are needed for this group, which is why due consideration should be paid to this amendment.

[Viscount Colville of Culross (CB)]

My Lords, I apologise: this is the first time I have spoken on the Bill. I have added my name to Amendment 115 in the name of my noble friend Lady Finlay. My concern is that, as other noble Lords have told the Committee, the Mental Capacity Act has the presumption that, if in doubt, the doctors making the assessment of the patient’s mental capacity have to assume that they have the capacity unless proved otherwise.

As other noble Lords have also said, if the patient is deciding whether to go into a residential home or what to do about their financial affairs, that is fine. But I am convinced that a terminally ill patient should have to prove that they have the mental capacity to make the gravest decision possible: that of ending their own life. I would like their doctors to have to decide that the patient has the mental capacity to make such a huge decision. Amendment 115 sets out a list of tests to help the doctor come to that conclusion.

To find out the importance of the changes to the Bill put forward in Amendment 115, noble Lords have only to look at jurisdictions where the default position is the presumption of mental capacity. Canada has already been raised by the noble Baroness, Lady Berger, with very good reason. In some provinces, such as Quebec, 8% of all deaths are by assisted dying, and on Vancouver Island, which has lamentable palliative care, the percentage rises to 11%. These, in my view, are big numbers.

I am concerned by the Canadian definition of mental capacity, which, as with our own Mental Capacity Act, emphasises that every person is presumed to have mental capacity unless proved otherwise. In the early stages of dementia, this can lead to cases of people being assumed to have mental capacity for assisted dying, or MAID as it is called in Canada, even when they are confused about the implications of the decision.

I have spoken to a number of Canadian doctors and psychiatrists, who gave me worrying examples of this happening. One doctor told me they had a male patient in his mid-70s with prostate cancer who had been diagnosed with mild dementia. He was admitted to hospital for worsening confusion. Medical investigations were undertaken to determine whether this was delirium on top of the dementia or worsening dementia. During the admission, and before the cause of the worsening condition had been determined, he stated that he wanted to be left alone and that he wanted to die, so the MAID team were called.

The MAID team deemed him eligible for the process, but then the palliative care team were also called. The doctor I spoke to was the patient’s consultant on this team. She interviewed the patient and he told her that he wanted hospice care and palliative treatment. She concluded that he could not differentiate between being sent to a hospice for palliative care and having a lethal injection to immediately end his life. But the MAID team still assumed that he had the mental capacity to go ahead with his first decision to have assisted dying. When they asked him subsequently whether he wanted medication to help him to die, he agreed to it. MAID was carried out shortly afterwards.

I would like the Bill to ensure that there is no confusion about whether such terminally ill patients have the capacity needed for this huge decision. I suggest that Amendment 115’s proposed subsections (1) and (2), which would reverse the presumption of mental capacity, would prove a much better safeguard.

I also draw your Lordships’ attention to whether having a doctor raising the option of assisted dying to a terminally ill patient is regarded as treatment, a matter on which the Minister in the other place said the Government were silent. Proposed subsection (6)(g) of Amendment 115 states that

“the self-administration of such a substance is not a medical treatment for their terminal illness but a personal choice concerning life and death”.

I know that amendments to Clause 5, if accepted, would have the same effect, but I argue that it would be a belt and braces to have the concept that the doctor cannot, unprompted, raise the option of assisted dying in the mental capacity clause of the Bill. It is important that the request for assisted dying is initiated by the patient and is not seen as a treatment initiated by the medical team.

Once again, I turn to the experience in Canada, where doctors and healthcare professionals are duty-bound to raise assisted dying as an option for any patient admitted to hospital who suffers from a condition that makes them eligible for MAID. I spoke to the doctor of a Canadian patient who was found to be eligible for MAID and went into hospital. Each medical professional who visited him offered the option of MAID, alongside the option of drugs to alleviate his condition. This meant that on the day of going into hospital, he was offered MAID six times by six different medical professionals. Each medic was aware that if they did not offer the option, because MAID is classed as a medical treatment, they would be sued for negligence. I fear this will put unnecessary pressure on patients.

Obviously, the eligibility for MAID in Canada is very different from that proposed in the Bill, but Canada is still an important lesson for us. In this country, it is imperative that it is left up to the eligible patient to initiate the request for assisted dying. The amendment would ensure that doctors are not forced to initiate the request, which would avoid the patient feeling any pressure to end their own life. I hope that the amendment will be accepted. It would provide safety rails for patients eligible for assisted dying.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Viscount, Lord Colville, for having spoken so clearly and eloquently to Amendment 115, which I tabled because it was suggested by the Complex Life and Death Decisions group at King’s, with particular input from the eminent national expert on mental capacity law and practice, Professor Alex Ruck Keene KC.

The amendment aims to provide clarity for doctors who are going to make the decisions as gatekeepers on the process. The amendment is necessary for two reasons. Let us remember that the Mental Capacity Act was written to prevent someone from doing something to you that you did not consent to. When you are unable to decide whether or not somebody can do something to you, you fall into the best interest decision framework, but that will never apply in this situation.

The amendment is necessary, first, to comply with our obligations under the ECHR and, secondly, to make the test of capacity enshrined in the MCA fit for purpose within the scheme of the Bill. The amendment is compatible with the Mental Capacity Act. It would not create a different process but would clarify that the point made in the letter from Sir Chris Whitty, following his evidence, is adhered to. He said that

“there is a clear need to have capacity for the particular decision that is to be taken. It follows that the more complex the decision the more the individual will need to be able to weigh the consequences and an assessment of their ability to do this is a key part of assessing whether or not they have capacity”.

We must not lose sight of the fact that the decision to take one’s life is the most momentous decision and is irreversible. It therefore requires a higher standard than the myriad other decisions that people take in the context of health and social care or finance.

The state’s obligations under Article 2 of the ECHR are to

“prevent an individual from taking his or her own life if the decision has not been taken freely and with full understanding of what is involved”.

That was the verdict in Haas v Switzerland in 2022. The amended Clause 3, as tabled, would discharge the state’s obligations by ensuring proper consideration of their capacity and that they have a full understanding of what the receipt of assistance in dying involves. However, the MCA does not work in the context of the Bill, as it would mean that unresolved doubt would compel the conclusion that the person had capacity to decide to end their life and oblige those assessing the person to support the person in that decision.

Amendment 115 would maintain the test of capacity with which practitioners are familiar but enable them to apply that test within the framework of the Bill. It would therefore constitute not a further hurdle but an appropriate framing. It borrows language from the MCA where appropriate, as in subsection (2). That language is familiar to anyone who has used the Mental Capacity Act. Like other amendments in this group, it would remove the inherent dangers of the presumption of capacity that others have spoken of.

Plastics: Health Research

Viscount Colville of Culross Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I have had the opportunity to speak to the chief scientific officer in this space, so I am guided by the science here, and I have also heard the impact from the Food Standards Authority, which considers it unlikely that the presence of plastic particles in food would cause harm. Further research in this space will be reporting in March 2023, but currently there is limited evidence to suggest that there is any harm.

[Viscount Colville of Culross (CB)]

My Lords, the Environment Act includes the power to be able to charge for single-use items, including plastics, to reduce consumer consumption. Can the Minister tell the House whether or not the Government intend to use this power and, if so, when?

[Lord Markham (Con)]

I am mindful that my brief as Health Minister is fairly large but maybe not quite that large. But I note that in this space we have already replaced plastic bags, very successfully introduced a usage charge, and reduced consumption by 95% in the main supermarkets, so that is a tool that we know works. But currently there is limited evidence suggesting that it is a health hazard.

Coronavirus Bill

Viscount Colville of Culross Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Viscount Colville of Culross (CB)]

My Lords, I declare an interest as a freelance television producer.

I very much appreciate the extraordinary work that the Government and especially the Chancellor have already carried out to mitigate the effects of the present crisis on the economy and the nation’s workers. However, as other noble Lords have said, we are in an unprecedented situation, with bankruptcy and unemployment sweeping through our nation. I want to concentrate my comments on Clauses 39 to 44, which extend statutory sick pay.

Quite rightly, the Government’s efforts so far have concentrated on the job retention scheme, supporting businesses and employees to ensure that there is an economy to build on when these terrible times are over. However, my concern is for the 5 million self-employed and freelance workers, many of whom have had their contracts cancelled with only a week’s notice—if that. They have been sent home to worry about paying ongoing bills without any prospect of returning to work in the foreseeable future.

This group of freelancers and self-employed people is far-ranging. It includes 37% of people in the creative industries, who are highly skilled and highly paid and work in what is one of the fastest-growing areas of the economy. It also includes sole traders, such as plumbers, electricians and agricultural workers, as well as an increasing number of supply teachers and agency social care workers. I am also concerned about zero-hours workers who are independent contractors and are often semi-detached from companies. Many claim that they should be defined as employees and entitled to the same rights as employees, including having access to the job retention compensation scheme.

I have been told about a number of cases involving these workers. One is a cycle instructor teaching Bikeability classes in London schools. He is defined as a self-employed worker on a zero-hours contract; in reality, he does public sector work without any of the protections of a public sector employee. Normally, March to July is his busiest time, earning him up to £2,000 a month. With the schools closing, all his work has dried up. A 24-hour cancellation policy has left him with no work and no prospect of work. At the moment, he is not part of the job retention scheme and faces a very uncertain future.

I understand that supporting these people is very complicated. When I asked a question on this subject on Thursday, the noble Lord, Lord Callanan, explained that the Government were looking for a comprehensive package which was co-ordinated and coherent and would take time to roll out. Of course, I very much welcome the Chancellor going some way to help the self-employed by rolling out universal credit, allowing self-assessed tax payments to be postponed until January 2021, and encouraging interruption loans.

However, universal credit pays only £94 a week and even less if people have been prudent enough to save a nest egg. As has often been said in this House, UC takes five weeks to roll out. The tax holiday and interruption loans are also helpful but, in the end, they simply kick the problem down the road and the debt still has to be paid. We have no idea how long this crisis period will continue and, in the meantime, these hard-working people from across the country and across society face mounting debts and a very frightening future.

I know that the Government are looking at what is happening abroad and talking to stakeholders about how to support the self-employed through the crisis. Norway is paying self-employed workers grants equivalent to 80% of their average income over the past three years. Belgium’s self-employed workers will have access to an income replacement scheme.

I would like to draw the Minister’s attention to an idea supported by many across the self-employed sector, which, at the very least, would go some way to compensating for lost wages. I would like to see the Government extend their job retention scheme and pay 80% of expected earnings up to the cap of the median wage. Rolling this out will be difficult but the Government could use the person’s last three years’ tax returns to decide how much support they should be paid within this limit. It is estimated that four-fifths of the self-employed and freelancers earn less than the median wage and so would benefit hugely. Maybe the resulting grants could be made through the payment on account scheme, as is used at present for tax rebates. I quite understand that new software would need to be rolled out at HMRC to administer this system. That is often expensive and not entirely successful. Perhaps the DWP and other departments could help out.

At this time of unprecedented worry for every single person in this nation, we must think about the millions of workers who are the backbone of this country, who have lost their livelihoods—workers who are now sitting at home worrying about how they are going to get through the coming months without incurring huge debts, which could take years to pay back. Action is needed now to ensure that they do not sink into destitution and despair.

Queen’s Speech

Viscount Colville of Culross Excerpts

Thursday 9th January 2020 Lords Chamber

[Viscount Colville of Culross (CB)]

My Lords, I declare an interest as a series producer at Raw TV making content for CNN. I echo the call of the noble Baroness, Lady Benjamin, for a rapid introduction of the online harms Bill. We need it as soon as possible.

In a digital age when internet access is now a utility, without which it is almost impossible to be part of life, internet safety has never been more important. We have heard much recently about how platforms and websites have been designed to capture users. This was reinforced for me by comments from the co-founder of Facebook, Sean Parker, who now declares himself a conscientious objector to social media. He said:

“God only knows what it’s doing to our children’s brains … The thought process that went into building these applications, Facebook being the first of them ... was all about: ‘How do we consume as much of your time and conscious attention as possible?’”


The engineers of Facebook and other tech companies, he explained, ensured that the users of platforms receive a small dopamine hit when they give likes or make comments, creating a potentially dangerous “social-validation feedback loop”. Much of the concern about the internet, reflected in the White Paper, concentrates on taking down the abusive and harmful content received by users and introducing a new complaints system. That is welcome, but the sheer volume of abuse online and the ability of the perpetrators easily to move their comments across the internet makes such a regime hard to enforce.

The design issue raised by Sean Parker must be at the heart of any new legislation. I emphasise the overriding significance of a duty of care on all tech companies to build safety designs into their digital systems, making them responsible for the safety of their users, and that would need to be enforced by a regulator. The White Paper calls for steps to ensure that products and systems are safe by design, but the Bill must ensure that this is a comprehensive approach. All sites must examine whether they encourage bad behaviour and harmful content. They must examine their navigation and discovery mechanisms to ensure that their algorithms do not prioritise fake news and outrage to generate clickbait. A regulator must ask companies to exercise a risk assessment of their systems and then to enforce implementation very thoroughly.

Part of safety by design must incorporate Sean Parker’s concern about engineering potential addiction into the internet. One of my particular concerns is what is happening in the unregulated areas of online gaming. The gracious Speech has a review of the Gambling Act to include loot boxes and the use of credit cards for gambling. Loot boxes are a relatively new introduction into the gaming world. They allow users to spend money buying random and unknown selections of extra content, which, depending on what is in the box, will either enhance or diminish the player’s abilities. There is evidence that huge amounts of money are being spent by young players on loot boxes and myriad other means of paying to enhance their position in the game. At the moment, the video game manufacturers refuse to put a ceiling on this spend or self-regulate their industry responsibly.

It is good that the Government are reviewing whether the loot-box aspect of video gaming should be covered by a gambling regulator, but the problem is much wider and deeper than just loot boxes. Internet and gaming addiction is baked into the design of their systems. It should be part of a new digital regulator’s role to gather reliable evidence of the extent of this problem and, if necessary, to have the powers to enforce a safe design on gambling and video game companies limiting time and money spent on online, often by young people to the detriment of the rest of their lives.

On another matter, before Christmas the Chief Secretary to the Treasury confirmed that the Prime Minister had ordered a review into the sanction for non-payment of the BBC licence fee. This issue was looked only four years ago by David Perry QC, who concluded that there should be no change in the sanction regime. The recent report into public service broadcasting in the digital age by the Communications and Digital Committee, of which I have the honour of being a member, learned that the BBC’s licence fee revenue is already falling dramatically on an annual basis. Surely to alter the sanction regime now would only create a further reduction in revenue.

The committee pointed out that by 2022 the revenue available to public service broadcasting in the UK would be massively dwarfed by the mainly American streaming giants coming into the market. They have a global income to outspend British channels in all genres except news. The Government stated in their evidence to the committee that

“in this changing media landscape, the purposes of PSB—to inform our understanding of the world; to stimulate knowledge and learning; to reflect UK cultural identity … remain vitally important.”

I suggest that a review of the sanction regime would damage this anchor of our country’s cultural identity. Instead, the Government should follow one of the report’s recommendations: to set up an independent and transparent licensing body which would decide how one of our greatest national institutions is funded. In the post-Brexit world we must do everything we can to make sure that our great public institutions prosper and act as a calling card for this country across the globe.