Terminally Ill Adults (End of Life) Bill

Baroness Cass Excerpts

Friday 27th March 2026 Lords Chamber

[Baroness Andrews (Lab)]

My Lords, with some diffidence, I first put on the record that the Bill is abundantly clear that it is an opt-in system. Clause 31, “No obligation to provide assistance etc”, says:

“No person is under any duty to participate in the provision of assistance in accordance with this Act … No registered medical practitioner is under any duty to become … the coordinating doctor … or … the independent doctor”—


I will not read out the whole clause. I do not understand why it has been described by noble Lords in the way that the noble Baroness described, about not being able to opt out.

On the point of the register, we have heard over 13 days how important it is to listen to and consult medical practitioners at every stage of the Bill. The proposition in Amendment 189 is that the register should be put in the Bill. It is a privilege to listen to the expertise of our noble friend—as I call her—the noble Baroness, Lady Gerada, who has expressed some very profound and intimate reservations. But surely there will be provision in due course for the discussion of how to register people who are willing to opt in, and to do that with a full consultation of all the medical professions so that the concerns of the noble Lord, Lord Carlile, can be addressed. Surely, as with so much of the debate we are having, this is a matter of implementation. Let us get to the point where we can make a decision in principle, but let us make sure that in implementing it we have it right. That must be done, I think, with the full consultation of all the medical professionals.

[Baroness Cass (CB)]

My Lords, I will speak to my Amendment 383. I have so far limited my speeches on the Bill to a maximum of two to three minutes but on this one occasion I would like to take more time, because this may be the only opportunity I have to discuss how we can integrate some of the approaches that have been put forward; I refer to my noble friend Lady Hollins’s amendments on multiprofessional assessment up front and her Clause 5 stand part notice, and the amendments in the name of the noble Baroness, Lady Finlay, on parallel care between assisted dying and the continuing care process. I believe that what I have to say would vastly simplify things.

My amendment focuses on what professionals who are opted in to work in an assisted dying service would be expected to do, and how it differs from what is expected of those who are not opted in. Specifically, I will talk about two individuals with completely different roles: a professional who is part of the treating team and so is not opted in, and a professional who is opted in as part of the assisted dying service. I ask your Lordships just to suspend belief and bear with me while I explain.

I believe we are all agreed on a couple of points: first, that palliative care provision is inadequate; and, secondly, that services are often fragmented, with no one professional supporting someone at end of life and helping them access all the help that they need.

Let us walk through the patient journey, which I do not believe we have done in this House so far, and start with the person who has just been given—rightly or wrongly—a six-month prognosis. There are many things they may wish to discuss and seek help with: nursing care, access to financial support, pain management or just someone to explain again what the consultant said about their terminal illness. If they are lucky, they will have an excellent general practice team which can help with all these things. But, sadly, despite the wonderful primary care described by my noble friend Lady Gerada, many do not have such a practice. A friend’s husband died recently without being able to secure a single visit from anyone in his GP practice in the last nine months of his life.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I am very grateful to the noble Lord for his assistance in relation to this matter. As far as I am concerned, precisely how one identifies who is available to do it should be worked out in the implementation because it goes to publicity and to what is the most convenient way of doing it, and I do not think that normally or sensibly this should be in the Bill.

The noble Baroness, Lady Cass, is proposing that in the course of the conversation, which is referred to in Clause 12, the person should say that this is their own choice. I think that is not necessary or appropriate where one of the things that the two doctors and the panel have to be satisfied of is the fact that this is the clear, settled and sustained view of the person. I do not think that putting words in, as it were, is appropriate.

I understand why the noble Baroness says that you should have the two doctors together, and they should refer to what is, in effect, the written record of the multidisciplinary team. If that is available, they should definitely do that, but I do not think it will be available in every case. One hopes that it will be, but I cannot be sure that it will, and that should not be a bar to doing it. I see the force of saying that the two doctors should do it together, but my anxiety is that, if you are looking for genuine safeguards, you have to have a position where the two doctors who have reached a view that the conditions are satisfied have done so independently of each other. I can see the convenience of doing it together, but I think it has to be done separately instead.

I have had the benefit of discussing with the noble Baroness, Lady Cass, many of the ideas that she has put forward; I have found that incredibly helpful. One of her helpful insights is that, in reality, this will in effect have to be some sort of specialist service. If you want somebody to help you in relation to this, it has to be somebody who has expertise in doing it. But that insight does not mean that it has to be completely separate from all the other care you are being provided with. Frequently, when someone is dying, they have a variety of specialists helping them as part of a team. If assisted dying is what the patient wants, I do not think that the specialist should feel that they have to be completely separated from the rest of the team looking after the patient.

[Baroness Cass (CB)]

May I respond to that? I have not said that they cannot be part of the team. It is likely that the person who is covering a particular area or locality will be known to the team and to the palliative care services. They may or may not be as familiar as other specialists—I hope not, by virtue of the fact that we are anticipating smaller numbers—but they would be a separate individual who comes in, like a cardiologist.

[Lord Falconer of Thoroton (Lab)]

I am sorry; I stand corrected. What I was getting at was that they should not feel that they have to separate themselves. If I wanted an assisted death, at home, I would like to think that the people caring for me would still be available to me up until it happened. I suspect that that would matter to me quite a lot.

[Baroness Cass (CB)]

They would; that is the point of it. Your co-ordinating professional, as I described them, would be with you throughout, as would the specialist assisted dying doctor, from the time you started engaging with them. You might want to check in with one or the other, depending on whether you wanted your symptoms addressed or another discussion about what the process of having an assisted death would be like.

[Baroness Lawlor (Con)]

May I check something regarding my Amendment 664? Given that the noble and learned Lord insists that no person will be under any duty to perform or provide for an act under this measure, will that apply to participation in training, since training is not a duty to do something?