Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Friday 27th March 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

I will be equivalently concise. It is important to connect Amendment 657, which specifies that assisted dying

“is not to be regarded as medical treatment”,

with our debate on the broader conscience protections that the Bill needs to include. The reason is not just that regarding assisted dying as a treatment is a conceptual error. As Wittgenstein pointed out:

“Death is not an event in life”.


We are talking about a personal existential choice. It is in no sense a treatment, but the Bill is silent on that question. As the noble Baroness, Lady Fox, and others have pointed out, that matters in the real world because, notwithstanding the employment protections included in the Bill, the professional duties on a doctor are potentially in play if assisted dying is determined to be a treatment. That will give rise to questions on the obligations of a doctor to raise assisted dying as a possibility, even if that doctor’s conscience is against participating. It will give rise to consent questions—we talked previously about the McCulloch test—and negligence questions from surviving members of the family. It is therefore important that we put this beyond doubt.

Given the understandable desire of the House to move on to the next group, I will just commend to fellow noble Lords an article in the BMJ from 9 June last year, written by Professors Gareth Owen, Alex Ruck Keene and Katherine Sleeman, which sets this all out beautifully. Their conclusion was:

“Statutory ambiguity serves neither professionals providing assisted dying, nor patients requesting it. Parliamentarians must consider this question”.


That is what we are doing. Amendment 657 would put it beyond doubt, and I hope that the noble and learned Lord the sponsor will accept it.

[Baroness Grey-Thompson (CB)]

My Lords, I have Amendments 673A and 679 in this group. Amendment 673A would provide that a medical practitioner who had opted into the process could choose to opt out at any time, and Amendment 679 would insert a new clause.

I will start with a number of questions for the noble and learned Lord. In a letter to Peers on 28 January, the noble and learned Lord said that he had had very productive discussions with Hospice UK on institutional protections, and that he would table amendments as soon as possible. I think that three amendments have been tabled, but I am not sure that they solve the problem that we are trying to solve. There is nothing in those amendments that requires any training to be kept up to date, there nothing about revalidation, and there is no requirement to be trained and up to date to enter the assisted suicide process.

Can the noble and learned Lord provide an update on his statement that he is working with officials to address Hospice UK’s concerns? Does he accept that the red line for many care homes is that they are not willing to tolerate this process on their premises? In the other place, the honourable Member for Spen Valley resisted a blanket institutional opt-out, arguing that it could lead to “stress and distress” for terminally ill patients if they are forced to move out of their “so-called home” on their final day. But what about the stress and distress of those who share that home, should the process take place on the premises?

Does the noble and learned Lord accept that it will be very difficult to extricate care home staff from involvement—such as organising appointments connected to the provision of assisted dying, assisting in the organisation and sending of documentation connected to its provision, or accommodating the doctor who must remain with, although not necessarily in the same room as, the resident until they die—were assisted suicide to take place on the premises? Do the noble and learned Lord and the Minister recognise the seriousness of a situation where hospices feel forced to close, which could cost around £8.4 billion a year to the public purse?

It has been very interesting to talk about the number of people who may be trained. However, if the equality impact assessment is anywhere near correct, the estimated number of patients in year 1 will be somewhere between “273 and 1,078”, and in year 10 it could be between “1,737 and 7,598”. This does not sit alongside the 310,000 people who accessed hospice care last year. Therefore, if there is no expectation of overwhelming demand from people wishing to end their life, why is there need for mass enrolment?

There might be a number of different reasons why organisations with principled opposition might want to be exempted: freedom of association in law for charities, legal rights guaranteeing patients a choice of their place of care, the cost to the public purse, freedom of religion and belief in law, and the public benefit of faith-based charities.

We currently have a fragile workforce. In 2024, the Royal College of General Practitioners surveyed GPs, 42% of whom said that they were unlikely to be working as a GP in the next five years. This brings us back to the number of people who we may need to have trained. Whatever we think the Bill says, I am concerned that it is not clear enough. We also cannot underestimate the pressure on doctors and medical practitioners who may choose to opt out. If they work in an organisation that feels very strongly that this process should take place on its premises, someone’s career might be in jeopardy if they are not willing to sign up to it.

The noble Baroness, Lady Fox, raised issues around porters. Although we have discussed prisoners in previous groups, we have not discussed prison officers in this group. There is another group of individuals—not just doctors—who might want to exercise a conscience clause. It might include administrators as much as anybody else who works in the system.

My noble friend Lady Watkins of Tavistock rightly said that many people would choose to have excellent palliative care. The reality, as we have discussed, is that it is a postcode lottery. It is a great shame that as part of this Bill we were not able to discuss the provision of palliative care—it was ruled out of scope—because I think it would have given many of us a level of reassurance if we could have debated that at the same time.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

Amendments 422 and 423 are to create a regulatory power to allow co-ordinating doctors or independent doctors when they step down in certain circumstances not to have to give notice; for example, if they are too ill. It is a practical drafting change.

[Baroness Grey-Thompson (CB)]

My Lords, in addressing the noble Lord, Lord McCrea, I think the noble and learned Lord was actually answering one of my questions on Amendment 679. I think the noble and learned Lord suggested that there might be a differentiation between NHS and private providers in the hospice sector. Does he see a scenario where people may feel reluctant or frightened to enter into an NHS hospice because it may be provided there? Will this not put more pressure on private providers?

The noble and learned Lord has rejected many of our amendments, arguing that they are not necessary because there should be totally equal access to the process. But is this not going to create a two-tier system where those who do not want to discuss assisted suicide and might be able to afford a private provider will be able to stay away from any discussions, whereas someone with less money will be forced to go into NHS provision?

[Lord Falconer of Thoroton (Lab)]

No, I do not think it will because the nature of the safeguards in relation to everybody is such that the idea that an assisted death will be forced on people is wrong.

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

My Lords, I have 12 amendments in this group, and I am going to speak also to Amendment 241, which is in the next group but which probably fits better in this one, because it is about the time period for recording information.

The words “as soon as possible” appear eight times in this Bill in relation to the recording of information. I believe that that is a little too vague; it feels like a non-binding term without a strict or official definition. It makes me think of the parliamentary term “soon”, often used by Ministers to suggest something may be coming soon—next week, next month or possibly never.

I think about this process in what might be a busy hospital. It is important not only to gather data correctly but to record it accurately and at pace. The lack of a precise timeframe makes it feel as though we are giving busy staff too much flexibility, which might end with it slipping down the list of things that they need to do when there is a lot of call on their time. It is about providing and recording information that can be open to scrutiny, but the phrase could be used to deflect an immediate challenge or an urgent question, and cannot be followed up in an appropriate way.

On my Amendment 214, I expect there to be some pushback and to be told that I am being overly prescriptive. However, it is important to understand why the person wants to enter this process and whether there are other events, family issues or anything else that could possibly impact it, such as a lack of health and social care. I have other amendments on support, which have been discussed in other groups.

Amendment 214A is about having a witness present—someone who can record the conversation. My noble friend Lady Cass in the earlier group talked about the importance of having a person there; someone who can watch facial expressions, take the mood of the room and possibly look out for coercion. That would allow those doing the initial recording to actually listen to what the person is saying, rather than necessarily having to record every part of the conversation. Amendments 217 and 218 are about recording in a timely manner.

Amendments 562, 563 and 564 are about how we record the cancellation of the process. I was interested in the amendment proposed by the noble Lord, Lord Wolfson of Tredegar, which looked at recording the cancellation immediately. That is a better version than the one that I proposed. If someone decides to stop the process, everybody needs to know that straightaway, rather than something getting lost in reporting or a medical practitioner or a doctor assuming that the person still wants assisted dying.

It is also important to record how many times somebody may have entered and dropped out of the process, which is covered in another group. That would check that someone is not being guided by mental health issues, suicide ideation or pressure. These things are important. We need a minimum standard, and doctors and patients need to know what to expect from each other. When the Delegated Powers and Regulatory Reform Committee looked at the Bill, it said that it lacked definition and that there was lots of unknown information being recorded.

We also have to think about non-compliance. I have read the Bill many times, and there is not enough in it about what happens if this information is not reported correctly. In Oregon—which has been mentioned many times—we know that around 70% of information is not recorded in the paperwork, so we do not know if people are having a good death or not. The Delegated Powers and Regulatory Reform Committee recommended that the Bill needed amendment. The timely reporting of information avoids any sanitation of the notes. It is very easy to forget—I do all the time. I scribble notes and come back to them, even just a day later, and cannot necessarily read what I have written. So this is crucial to how the process will work.

Proper recording should also be there to protect the clinician. This is the complication of the Bill. I have 13 amendments that I am talking to. Actually, I am asking for very little change to the Bill, but the Bill has to be amended in so many different ways. This group also fits with the previous group. In another place, the honourable Member for Batley and Spen, Miss Leadbeater, said:

“I agree that, under the provisions of the Bill, the doctor will have a duty to lay out options available to the patient, if they meet the eligibility criteria—absolutely. That is the whole purpose of the Bill”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 4/3/25; col. 663.]


That is why it is so important that the information is recorded properly.

One of my passholders, Dr David Prosser, is a specialist in forensic psychiatry who works within NHS secure services and His Majesty’s Prison and Probation Service. We have spent a lot of time discussing the Bill: I have been talking to a doctor who could be at the very sharpest end of this. His view is that a doctor has to have very clear criteria against which any assessment is made.

It is also important to achieve operational consistency and quality, because we do not want information being recorded in a different way in different hospitals in different areas. A small business might have to provide more documentation to HMRC than a doctor working in this area. These amendments are not to overcomplicate the process; contemporaneous documentation is really important. This also fits into how the commissioner might oversee compliance with the process if the records are all kept in a different way.

When, in previous groups, we debated face-to-face discussions, the noble and learned Lord, Lord Falconer, said, in that situation:

“It is wrong and dangerous to try to use a phrase such as ‘reasonably practicable’”.—[Official Report, 30/1/26; col. 1214.]


Can the noble and learned Lord therefore explain why it is it okay to use that phrase when we are talking about recording data?

[Baroness Lawlor (Con)]

My Lords, I will speak to my amendments in this group. They aim to tighten the recording rules in Clause 7 and would make them even tighter than the seven-day limit proposed by the noble Baroness—to whom I am very grateful for her remarks. I propose that, where the discussion is with a practitioner in the patient’s own GP practice, the record of the relevant discussions and assessment is written and saved online on the same day; and that, in other cases, the practitioner must submit the record to the patient’s medical practice, and the commissioner, within a week. My amendments would also require the practice to include this in the patient’s online records. My amendments would impose similarly tight time limits for the submission of the co-ordinating doctor’s assessment.

Speed in recording discussions is of the essence. My experience as a historian, often working with hundreds of documents over a period of a week or even a day in history, suggests speed is important. These are government documents or the private records of officials and politicians. My work suggests that every hour that passes between a conversation and the recording of it brings a loss in accuracy and nuance. In the matter of deciding to take your own life, it is particularly important that the record is as accurate and precise as possible. The same-day requirement should make for greater accuracy, including details that might otherwise be lost if more time elapses. Even insignificant details can turn out to be important.

By contrast, allowing a period of time—the Bill says “as soon as practicable”—will tend to mean that details can be blurred into a general pattern that a doctor may form as a result of having seen a number of patients seeking an assisted death. The individual nature of the case may be lost. A report written up and submitted on the same day is less likely to be affected by hindsight or a desire to tailor the report to ensure that the practitioner will not be held responsible should a breach occur. These amendments in my name leave the medical practitioner the choice of writing a handwritten note at the time or just after the appointment, or keying it later that day into the computer. Although it may be argued that a doctor needs a longer period to see to the paperwork or that the medical practitioner should be allowed more individual choice about how they handle the recording, the obligation for speed and a formal process is imposed by these amendments and is justified, since a person’s life is at stake.