Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, it has been an extraordinary two days. After last Friday’s debate, I went to a Beatles tribute band with my learning-disabled son, and we sang “All You Need Is Love”. Compassion is love, and it means journeying alongside someone, even at the end of life, as I did when my husband died from motor neurone disease earlier this year.

I nursed him with the help of fast-track NHS continuing healthcare funding, alongside hospice and district nurses and the brilliant Epsom rapid response team, which aims to keep frail and dying people at home. MND is often called the most feared disease. Martin just smiled and told his grandchildren and his friends that he was fading away as his paralysis increased. Some want the Bill to pass because they are afraid of dying, even though most of us will die peacefully, as my husband did.

During my 40-year career as a doctor in the NHS, I worked on the front line as both a general practitioner and a psychiatrist, two of the specialties most affected by the Bill as it stands today. As a medical student, I was taught by Dame Cicely Saunders, the founder of the hospice movement. Hospices should be our pride and joy; we are world leaders in palliative care. However, the evidence from the Association of Palliative Medicine is that growth in palliative care slows in countries with assisted dying services. Can the noble and learned Lord give us details of the anticipated impact on the availability of palliative care services of introducing assisted dying in this country? What measures would need to be put in place to prevent that happening?

In highly centralised healthcare systems such as the NHS, the integration of assisted dying would risk subtle systemic coercion. Institutional endorsement would normalise its practice and implicitly shape patient decisions. The existence of statutory powers can, over time, drive their own use beyond original policy intentions. Just look at what has happened in psychiatry, where an increase in coercive measures cannot just be explained by clinical demand. It must also be understood in terms of the institutional and cultural momentum generated by the availability of the powers in the Mental Health Act.

Can the noble and learned Lord explain what safeguards will prevent coercion by doctors? Does he support the contention by doctors that assisted dying is not a treatment? Alternatively, if he thinks that it is a treatment, why are there no plans to license and regulate the experimental lethal substances that will be used, rather than leaving it to the Secretary of State?

I will correct an earlier assertion about suicide rates. There is substantial evidence in 10 US states that legalisation is associated with a significant increase in suicide.

I support the Select Committee proposed by the noble Baroness, Lady Berger, and we must listen carefully to the evidence and not rush it. The evidence taken in the other place was partial—at first attempting to exclude even the Royal College of Psychiatrists, despite psychiatrists being given a key role in the Bill.

The lawyers and campaigners have left their mark on the Bill, but there is considerable and more relevant expertise in your Lordships’ House: Members who could competently question witnesses on areas such as capacity assessments, coercion, psychological issues at the end of life, the role of doctors, the licensing and monitoring of lethal substances, and more. There is expertise that could be harvested to see how and if the Bill can be amended to make it fit for purpose.

The other place has left us a lot of work to do. The Bill is neither safe nor workable as it stands today.

Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, the Mental Capacity Act 2005 assumes capacity until proved otherwise. However, many people with learning disabilities have neither the ability nor the capacity to make life-changing or even death-making decisions. Under the Bill, because they are chronologically adults, they are not permitted to have anybody with them when the subject of assisted suicide is raised. This is something I will be discussing later in Committee.

[Baroness Hollins (CB)]

My Lords, I am glad to be able to follow the noble Baroness, Lady Monckton. I declare my interests as a past president of the Royal College of Psychiatrists, and I have a parliamentary scholar, a psychiatry trainee who is appointed by the Royal College of Psychiatrists to work one day a week with me. I was a member of the post-legislative scrutiny committee on the Mental Capacity Act. I also founded and chair a visual literacy charity called Books Beyond Words, which is relevant in a way.

I was listening to the noble Baroness, Lady Lawlor, speak about communication. It reminded me that 18% of the adult population in this country are functionally illiterate. This is really important when we think about making decisions of such importance. I have an amendment later proposing a different framework for assessing capacity, and I will obviously talk about that then, but I want to reflect on how the charity Beyond Words creates really difficult stories in pictures, without any words, to try to help people who struggle with words to understand and make decisions about such things as the care and the treatment that they might require. We currently have about 80 stories, all about the whole story that people can discuss with their peers, their healthcare professionals and their families, to help them to understand an issue, so that they will not be left out but will truly understand. It is very easy to think that somebody understands when you have explained something in words, in simple words, and that the person is compliant with it, but when you explain in pictures and enable the person to say what they have read in their own words, then you get an idea of whether they have understood.

I have been trying to think about how I would be able to create a story in pictures to explain this Bill. It would be several stories. It would take an awfully long time and an awful lot of work to be able to do it. I just wanted to respond to what the noble Baroness, Lady Lawlor, said; I thought it was very important.

[Baroness Andrews (Lab)]

My Lords, at the heart of this debate is the question of safety. It is very impressive to hear all the experience around the House and I know that people shared my experience when we took the Mental Capacity Act through the House in 2005. That Act had been years in the making. It had most profound and serious consideration in this House and, most unusually, it then had post-legislative scrutiny, where we went into every aspect of the Act. The noble Baroness, Lady Browning, is quite right; there were many concerns raised about the practice and the absence of proper training, but no one, to my knowledge, challenged the definition of “mental capacity”, recognising the huge complexity of the term, the different circumstances in which it is implemented and people’s responses to it.

The noble Lord, Lord Pannick, said that we have a framework. Safety, I think, relies on and is expressed in the 20 years of practice in the way the Mental Capacity Act has been implemented and has benefitted so many. The assumption that there is mental capacity was in itself a huge and very important statement of a positive right in the law. The Bill before us is another statement of a positive right in the law, where there has not been one, and where so many people are desperate for us to find a route through this urgently.

We have the experience of that Act, the experience and expertise that this House put into reviewing that Act and confirming it with the recommended improvements, and the way the Act is understood—as my noble friend has said, not least by Chris Whitty—as well as its unknown interpretations. We have just heard about the complexity of defining “ability”. We already know of the huge, unframed and unknown complexity of creating another concept in law in the context of a Bill which, itself, has to be so carefully understood, implemented and communicated. We have to stick to what we know, even though it is still a work in progress, because it can still be improved. I hope it will be improved, in the course of this Bill. But it will be immensely dangerous, unless I hear a completely conclusive explanation as to why “ability” is better, if we were to depart from “capacity”.

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[Baroness Fraser of Craigmaddie (Con)]

I thank my noble friend for saying what I wish I could have said myself. I will end, because we have had a very long debate on this. I just want to emphasise that from my experience of dealing with people, with families, versus what professionals think, it is a very different landscape when we compare those who do it every day with those who are faced with these difficult decisions for the very first time.

[Baroness Hollins (CB)]

My Lords, I want to add a correction for the noble Lord, Lord Winston. The Royal College of Psychiatrists voted on the principle and it was a 50:50 split. The issue of this Bill is different. The college has taken the view, after a great deal of consultation, that it does not support the Bill.

[Baroness Grey-Thompson (CB)]

My Lords, may I clarify that? I have just checked the information. My noble friend is correct in what she says, in that the support was 50:50, but the majority of respondents—64%—opposed expanding eligibility and 65% of them were not confident that consent could act as an adequate safeguard against unfree choices, such as those resulting from coercion or psychopathology.

Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I rise to speak to Amendment 50 in my name and that of my noble friend Lord Goodman. It is a pleasure to follow the noble Lord, Lord Carlile. I would not describe him as a nasty lawyer at all. The noble Lord is a Burnley fan. I do not know any nasty Burnley fans, but I do know a lot of Arsenal fans. There is one thing I would say about some phraseology the noble Lord used early in his speech. He used the words “final solution”. I encourage the noble Lord to think of other phraseology to describe that.

I agree with a lot of what the noble Lord, Lord Carlile, said. I am grateful to my noble friend Lord Deben for following the noble Lord, Lord Pannick, because I, too, am not a lawyer, but like my noble friend, as a former Member of Parliament, I experienced lots of constituents who were under coercive control. Lots of MPs do surgeries for their communities and take on these cases. Not being a lawyer, as a layperson trying to fathom out coercive behaviour is notoriously difficult, and that is why I have come up with Amendment 50.

The existing language limits the coercion pressure bar to cases where it causes the person to make a decision, which creates evidential difficulties. This amendment excludes all cases of coercion and pressure without requiring finding out whether in fact it causes the person to make the decision to end their life. It is easier to see whether someone is being coerced or pressured than to know whether the coercion or pressure is the operable cause that leads a person into making the decision. A doctor should exclude all cases where a person is being coerced or pressured to make a declaration rather than engage in causation analysis. Similarly, offences ought to be focused on the wrongful act of coercing or pressurising regardless of the outcome.

At trial, the Crown, with plenty of resources, would have trouble proving that the coercion or pressure resulted in someone making the decision. How is a doctor on their own supposed to find out? Asking a patient is no help given that the frail or vulnerable person may not even know that they are pressurised or may have been intimidated by coercion. Doctors can see pressure from, say, the person accompanying the patient but cannot read the patient’s mind. This amendment would stop doctors being required to be detectives.

The closest analogy in existing law to this rule against coercion or pressure to do a potentially fatal action is Section 2 of the Suicide Act 1961, “Criminal liability for complicity in another’s suicide”. It does not require any attempt at suicide or even a decision to commit suicide and provides that

“D may commit an offence under this section whether or not a suicide, or an attempt at suicide, occurs”.

Section 184 of the Online Safety Act 2023 titled, “Offence of encouraging or assisting serious self-harm”, provides in subsection (5) that

“D may commit an offence under this section whether or not serious self-harm occurs”.

Compare also Section 65 of the Serious Crime Act 2007, which refers to pressurising someone to commit an offence and does not require the outcome be causative.

In recent years, the Crown Prosecution Service has pursued manslaughter charges against men who subject women to domestic abuse that is believed to have driven their suicide. These are criminal offences where there is a much higher bar to action, given that a person’s liberty is at stake. However, Clause 1 is addressing when civil authorities and doctors should draw the line at a patient’s autonomy. Why does the Bill have a higher standard? There is no statutory precedent for “pressured into making it”. The Government have claimed that the Online Safety Act 2023 and the Serious Crime Act 2007 are analogous, but the distinction is making the pressure all that is needed for an offence. Meanwhile the threshold for excluding a person in Clause 1 requires more than is necessary for a criminal offence under these Acts.

Without this amendment it would be lawful to progress a person towards an assisted death even though the person is living in a household where family members are actively making it difficult to live. All that is needed is to see that the person is not pressured or coerced into making the decision. The leading cause of death in domestic abuse victims is now suicide. We work to stop this, but this Bill is opening a door to help perpetrators. It is estimated that three women a week take their own lives. The Government view addressing this as a priority, and the CPS will now prosecute for manslaughter men whose abuse is seen to have contributed to the suicide of a woman. Those men have not had directly to coerce their partners into death, the facts of the abuse are sufficient pressure, but with assisted deaths there will be no coroner’s inquest to address foul play.

The UK leads the world in now recognising coercive control in law, but a regime of total control is poorly understood and insidious. As Cherryl Henry-Leach of Standing Together Against Domestic Abuse told the Lords Committee:

“Coercion is an incredibly complex phenomenon and by its very nature it is difficult to identify and respond to. A perpetrator of coercion will ensure that a person is dependent on them by isolating them from support, exploiting them and depriving them of their independence and autonomy to make decisions freely. As a result of this, we are extremely concerned ... When I think about pressure, I also am mindful of a pattern of coercive control that can be insidious and subversive. Pressure can be a tactic by a perpetrator to enforce a regime of coercive control. That is very complex and I get that, but it is important to be mindful that pressure can be a tool that indicates a pattern of coercive control”.


Studied neglect and coercion are naturally notoriously difficult to detect, and as it stands now, this Bill is a suicide charter. My amendment is intended to improve the Bill.

[Baroness Hollins (CB)]

My Lords, I have amendments in this group, and I have added my name to other amendments. I start by adding my support to Amendment 460, tabled by my noble friend Lady Finlay. Safeguarding measures are not optional; they are essential. To ensure that each individual requesting assisted dying is properly safeguarded, it is essential that all relevant information is gathered so that a full and thorough picture of their circumstances can be formed. We know that poor mental health, inadequate care support or unaddressed social vulnerabilities can profoundly affect a person’s decision-making and ultimately their capacity and understanding of an assisted death. When safeguarding is insufficient or overlooked, the risks of coercion, subtle pressure or abuse increase, and these are risks that may be difficult to detect or are deliberately concealed. This amendment seeks to ensure that such dangers are neither under-estimated nor ignored.

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[Baroness Coffey (Con)]

I think the noble Baroness’s amendment about videoing affects Clause 25, which is considerably later, when the Act is about to happen. I wonder whether she would consider whether it should be done earlier in order to reduce that because, by the point of her amendment, the certificate of eligibility has already been issued. I would be interested to hear her thoughts on that and on whether video recording, as proposed in Amendment 612, should be considered at a much earlier stage.

[Baroness Hollins (CB)]

I thank the noble Baroness. I thought about that, and it could indeed be brought back in a different way later in the debate, but I feel that the prevention of coercion is really important, so thinking about it at this stage is really helpful.

[Lord Winston (Lab)]

My Lords, I want to ask this question of the noble Baroness, Lady Hollins, but it applies also to the noble Baroness, Lady Berridge: she mentioned various things that are cited as causing pressure, but does she not agree that being in palliative care also causes pressure?

[Baroness Hollins (CB)]

There is no suggestion in anything that I have said of imposing palliative care—none at all. I have listened to the debate, and I was not going to speak personally but I will now, since the noble Lord has challenged me on that. My husband was dying with motor neurone disease last year. He felt under immense pressure from this debate in the House of Commons, the other place. He found it very difficult. It made him ask questions, such as, “Am I still entitled to palliative care? Am I really entitled at a time when the NHS is so short of staff and short of time?” He worried about that, and I had to offer him a lot of reassurance so that he could make his own decision. He was not ready to die. The idea that offering palliative care applies pressure is really not to understand the whole nature of the dying process and the way in which, as we come to realise that our life is coming to an end, we need time to understand, reflect, heal and make sense. The pressure not to be a burden is huge, and the pressure of not having access to services that are in short supply is much worse.

[Lord Winston (Lab)]

I do not wish to extend this conversation but, given what the noble Baroness has said, can she explain why in Australia—I am sorry, in New Zealand—where there is very good palliative care, three-quarters of the people requesting assisted dying, something like 2,000 patients, had been in palliative care at the time of the request?

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[Baroness Hollins (CB)]

My Lords, we are going to address palliative care in detail in a later group. We are going to make a distinction between palliative care of a general kind and specialist palliative care, and we are going to think about specialist palliative care at its best. Again, we hear day in, day out about how hospices are closing or having to make staff redundant— I think there is a hospice in Hertfordshire that is just starting its redundancy programme this week because it does not have the money to provide for people’s needs—yet we are relying on our hospices to provide that care, which is not sufficiently available.

When I asked my husband’s GP who was going to co-ordinate his care, because there were several different teams involved, said, “Oh, the hospice nurse will do that”. I thought: the hospice nurse or the community nurse who does not have access to all his notes and records? I was surprised that hospice nurses would take precedence over the GP and the district nurses. They did and they were brilliant but, golly, were they short-staffed.

[Lord Griffiths of Burry Port (Lab)]

My Lords, this has been an extraordinary and wide-ranging debate. I will limit myself, in a very short speech, to Amendment 3, which would take out the indefinite article and replace it with “an independent”. We have heard two poles of the considerations that are facing us. One is the need for autonomy for the person concerned—the person whose life is in danger and whose future we are considering—to make a choice with dignity and independence. Then there are the wide-ranging ways in which we have discussed coercion and pressure, which suggest that autonomy is not an easy thing to concentrate on. If there is this range of possible ways of expressing coercion, applying pressure or whatever it is, autonomy must be considered quite a difficult thing to achieve. I honestly believe that.

As I said at Second Reading, since the Enlighten-ment we have concentrated so heavily on the individual, but we need to rescue from that discussion of the individual the fact that we are individuals in community. From my experience as a Methodist minister—we are surrounded by people with all kinds of disciplines and experience—all I can say is that being with people, those who are clustered around the person who is to die, continuously from the time the news of an impending death is broken until the funeral, and indeed beyond the funeral, has made me aware of all kinds of pressures, subtle and otherwise.

I was taken by the list of possible pressures given by the noble Baroness, Lady Finlay, and the indirect or unthought-of ones: the groan, the body language and so on. What is more, the noble Baroness, Lady Thornton, asked whether witnesses were brought who were themselves facing an imminent death. I have sat with people facing an imminent death again and again, and I have heard them spell out both their hopes and their fears about their legacy, about someone who is whispering in their ear and about how it will play out among their children, who have quite different views between them. It is all indirect; it is real and contextual. Autonomy is a difficult thing to conceive of, and all these other indirect things need to be thought of very carefully indeed.

How many times have I counselled families for whom there was a rogue element who has fled the family home—for doing something or other years ago that was considered to be very nasty—on whether they should be brought into the picture about this imminent death, or invited to the funeral or beyond the funeral? They say, “Did we do the right thing?”, “How can we live with our conscience?” or “You shouldn’t have pushed me to say what I said”—all those things are said all the time.

Finally—I promised a short speech—just 16 years ago, I was diagnosed with a serious bowel cancer. After having very low blood levels and a total lack of energy, I was immediately rushed into hospital for a serious piece of surgery. It was a large tumour, and I had to face all kinds of things myself. As it happens, the letter that spelled out the seriousness and urgency of the case arrived when my wife, bless her, was with her mother, who was dying up in the Midlands, so I received it on my own. I cannot tell noble Lords what range of things my mind ranged over as I coped with that news: “How shall I tell?”, “Who will want to know?”, “Can I keep it secret?”, “What will the options be for me if I have this serious surgery?”, “Will I have to wear a colostomy bag?”, “Will I have to have invasive and extensive chemotherapy?”, and so on. It was surgery in the end and, mercifully, when we had the tests done and I went back later, they traced not an element of cancer in the rest of my body—and here I am to bore your Lordships with a five-minute speech all these years later. This is simply to say that the indirect subtlety—the stuff beyond the stuff you can be categorical about or put on a statutory basis—is what really comes into play when you are talking about the end of a life.

John Donne, long before the Enlightenment, reminded us that no man is an island—

“send not to know

For whom the bell tolls,

It tolls for thee”.

We are all caught up in this together. Somebody in the Times picked up a remark I had made casually to describe me. It was that I am now a semicolon on his way to his full stop.

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[Baroness Hayter of Kentish Town (Lab)]

I do not have to give way. I have been speaking for three minutes, and I have listened for some hours. I am sure the noble Lord can come back; it is Committee stage, so he can speak again.

People have talked personally. Both my parents died when I was a child. People know that one of them died tragically and very suddenly; the other did so in enormous pain at the end. As a child, I went through that, so I understand about bereavement and grief, and seeing someone die in great pain. We have all been through that, and some of us come to a different conclusion. We come to a conclusion that no matter how we define pressure or coercion—the discussions we are having—what we want is the ability to move forward and help those who want help to bring things forward a few days earlier. I do not know whether the noble Lord, Lord Deben, has been through probate when trying to sell a house, but for someone who is already dying and may be a month off, bringing it forward a month or a couple of weeks would not make that much difference. We are finding excuses.

I am sorry not to have given way, but I have listened for some hours, and it is only appropriate that someone who supports the Bill also gets the chance to speak today.

[Baroness Hollins (CB)]

Before the noble Baroness sits down, can I just ask which amendments she was speaking to, because this is Committee and not Second Reading? Every amendment that I have tabled is designed to make the Bill better and I feel quite concerned to be accused of time-wasting.

[Baroness Hayter of Kentish Town (Lab)]

I was talking to the debate on coercion, because there is no check on it for the existing way of ending one’s life early, which is to go to Dignitas. I was asking whether, if the Bill is changed in the way that, for example, the noble Lady, Lady Hollins, would like, she would then support it.

Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Stroud (Con)]

My Lords, I want to speak in support of the noble Baroness, Lady Berger. I will limit my remarks because some of them have already been made by previous speakers. I think the reality is that maturity is a scale and choosing to proceed with assisted dying at the age of 18 poses difficult questions, which we must grapple with, about the neurological maturity required for true, settled and informed consent on a matter of such gravity, and not just particular circumstances. I intend to speak in a subsequent group to Amendment 22 in the name of the noble Baroness, Lady Grey-Thompson, but some of the points I will make then are also relevant to this group.

I note that research undertaken by the Sentencing Council in 2024, which focused on aggravating and mitigating factors in sentencing guidelines, has this to say about age and maturity:

“Age and/or lack of maturity can affect … the offender’s responsibility for the offence and … the effect of the sentence on the offender. Either or both of these considerations may justify a reduction in the sentence”.


The report goes on to note:

“In particular young adults (typically aged 18-25) are still developing neurologically and consequently may be less able to: … evaluate the consequences of their actions … limit impulsivity … limit risk-taking … Young adults are likely to be susceptible to peer pressure and are more likely to take risks or behave impulsively when in company with their peers”.


I do not want to cross over into debate on the subsequent group, but this seems highly relevant to our deliberations on the appropriate age for assisted dying. Of course, age and maturity are mitigating factors only, and therefore discretionary, but it seems extraordinary to me that the principle of maturity is one which is accepted in a legal context, and there remain calls for dedicated sentencing guidelines for 18 to 25 year-olds in recognition of this, yet the Bill as drafted does not seem adequately to account for this in a similar manner with regard to the permanent decision to end one’s own life. I would be grateful if the noble and learned Lord, Lord Falconer, could comment on this when he responds to the debate.

The autonomy on which the Bill is purportedly built must be grounded in safeguards commensurate with the irreversible nature of the proposed act. With regards to the age of eligibility, I do not believe the Bill as drafted meets this standard. For these reasons and more, I support the amendments in the names of the noble Baronesses, Lady Berger and Lady Lawlor, as well as those in the name of the noble Baroness, Lady Goudie, and the noble Lord, Lord Moylan.

[Baroness Hollins (CB)]

My Lords, I have an amendment in this group and I support the noble Baroness, Lady Berger, in this. I just want to add to earlier comments. The transition from children’s to adult services at 18 is well known to be a very confusing and destabilising period during which key clinical relationships are lost and important elements of a young person’s history may not be carried forward. These factors are directly relevant to assessing decision-making capacity and identifying safeguarding concerns for individuals aged 18 and above who may seek assisted dying. I think that raising the minimum age would allow for any medical advances—for example, with emerging new treatments that might change a young person’s prognosis. It is important not to be too hasty.

I also want to comment on the Scottish Sentencing Council and to add that, again, there is something about the developmental process which is still under way which can increase susceptibility to influence, vulnerability to risk-taking and the likelihood of short-term, emotionally driven decision-making. We have only to think about the fact that in that age group, the biggest cause of death is actually accidental death. Research done by the Sentencing Council and other research shows that maturity may be delayed by adverse childhood experiences. It is therefore reasonable to assume that some young adults with serious illness may carry such developmental vulnerabilities into their decision-making around the end of life. The Sentencing Council guideline suggesting lower culpability and a greater capacity for change than in older adults endorses the suggestion that we should change the minimum age to 25. This is an irreversible decision. We need enhanced safeguards for this age group, and I support the amendments.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, let me just state that, for very different reasons, although I have a great deal of respect for both the noble Baronesses, Lady Lawlor and Lady Berger, in this instance I have serious qualms about these amendments in relation to raising the minimum age for receiving assistance to end one’s own life to either 21 or 25. I think we need to hold on to the standard age where we consider adult responsibility to begin—that is 18—as the Bill does. I worry that we are already getting ourselves into a tangle on age issues. For example, the proposal is now to lower the voting age to 16. I wonder how the sponsor of the Bill will hold the line at 18 when those newly enfranchised 16 to 18 year-olds start demanding equal entitlements from 16. Logically, those teens will have a point when they argue, “If you trust us to decide on the future of our country, why not trust us to decide on the future of our own fate if we fit the other eligibility criteria?” I would like some reassurances from the noble and learned Lord, Lord Falconer, that this age slippage will not happen, but also that 18 is a watertight age in terms of eligibility, and there are other amendments later on.

Conversely, I ask the noble Baronesses whether there is a danger of unintended consequences in using the argument that the young brain has not developed sufficiently at 18 to make such important decisions. It makes me anxious when neurodevelopment research is cited about cognitive development and a lack of maturity about anyone under the age of 25. That is used to challenge the decision-making capacity of anyone below the ages of 21 or 25. I fear that it could be used regressively. How can we trust 18 to 25 year-olds to vote, or be asked to take on any adult responsibilities, if their brain is still developing? Where are we going to end up? I think we need to avoid unintentionally institutionalising state paternalism that robs young adults of their individual rights and limits the choices on their own fate in various ways. The cultural shift to infantilise the post-18 cohort, which is a broader problem, is, in my opinion, regressive.

Finally, I am very sympathetic to the concerns that have been raised here already. It might be worth considering some kind of carve-out for 18 to 25 year-olds on EHCPs, but that would be an exception, not a rule. Viscerally, the idea of any young person of 19 or 20 having a terminal diagnosis and then being offered the choice of an even earlier death fills me with horror, gives me the chills and is tragic. But I still think that 18—if tightly protected by the sponsors of the Bill—is adequate in relation to age safeguards. There are plenty of other safeguards that I am worried about without adding to them.

I also think that there is a problem of the Bill creating a culture, for the young in general, of suicidal ideation. However, these amendments do not resolve those broader problems.

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[Lord Moylan (Con)]

My Lords, I rise to speak briefly to my Amendment 9 in this group. Before I do so, I thank the noble and learned Lord, Lord Falconer of Thornton, for making clear his intentions as regards moving his amendments in Committee. I wrote to him twice about this without getting a clear answer, but there has been a clear answer today, which is that he is not going to press amendments to which there is objection. It is good to know what his intentions are because otherwise we could end up in a situation, which I think would not be convenient to the Committee and would certainly contradict our normal practice, of having to hold Divisions in Committee that normally would be deferred, very properly, to Report. I welcome what he said.

My Amendment 9 is fairly easily disposed of because the noble and learned Lord has explained that both he and I, and indeed the noble Baroness, Lady Goudie, in her Amendment 8, have identified one of a number of blatant errors in the Bill where it says two different things in two different places, and we have drafted amendments to correct that. That is essentially what they do. We have drafted them differently. I think the sensible thing would be if the noble and learned Lord did not press his Amendment 6 today because it would pre-empt mine. Instead, I think the sensible and normal thing, the courteous thing, would be to say that he will discuss the drafting with the noble Baroness, Lady Goudie, and me outside the Committee between now and Report so that we have agreement on the appropriate amendment. I prefer not to have my amendment pre- empted, since I say, with some humility in front of the noble and learned Lord, that I think mine is better drafted than his.

[Baroness Hollins (CB)]

My Lords, I will speak briefly to Amendment 405 because the Equality Act is relevant to it. It provides a legal duty to provide reasonable adjustments for disabled people, which is defined quite broadly and I think would include a person who was terminally ill. The amendment is currently worded that the doctor must

“take all reasonable steps to ensure that there is effective communication”.

Will the noble and learned Lord consider changing his drafting to say that the doctor must “ensure reasonable adjustments are provided to ensure effective communication”?

[Lord Shinkwin (Con)]

My Lords, I rise to speak on Amendment 405. It is a pleasure to follow the noble Baroness, Lady Hollins, and to echo some of the points she touched on. I clarify that of course the amendment is in the name of the noble and learned Lord, Lord Falconer of Thoroton. I do so because, as a disabled person who was on the National Disability Council in the late 1990s developing codes of practice and advising the then Government on the importance of language—a point that the noble Baroness has just mentioned—I fail to see how changing the Bill’s wording from

“must first ensure the provision of adjustments for language and literacy barriers”,

which was the language of the amendment adopted by the other place, to “take all reasonable steps” can do anything other than weaken this Bill.

The noble and learned Lord would have us believe that this is just a drafting change; indeed, he said in his opening remarks that it makes it “clearer”. I contend that this is no drafting change because, yes, it changes the sense of meaning. The amendment would take us backwards because it would fundamentally weaken one of the Bill’s safeguards, such as they are, which was inserted as a result of Jack Abbott’s Committee amendment in the other place, and which the Bill’s sponsor in the other place described as “very sensible”—she was happy to support it.

I have a few questions for the noble and learned Lord that I would be grateful if he could answer in his closing remarks. Is this Committee being asked to believe that today the Bill’s sponsor in the other place is happy for the noble and learned Lord, in effect, to overrule her? Can he confirm in his closing remarks that she and Mr Abbott have been consulted, or is it that, together, the noble and learned Lord and Ms Leadbeater have decided to water down one of the few safeguards in the Bill because, well, it is only the House of Lords so no one is going to notice? The whole point of the Bill is to make it as easy as possible for people to have assisted dying, so let us minimise the constraints.

I began my career at the Royal National Institute for Deaf People during the first Blair Government. It was an exciting time. To the credit of Tony Blair and the noble Lord, Lord Hutton, who was Health Secretary, digital hearing aids were introduced on the NHS. The RNID, when I worked there, was listened to, and it should be now. So could the noble and learned Lord explain why this amendment implicitly ignores the finding made this year by the RNID and SignHealth in their report that some patients did not understand their diagnosis or treatment?

As a disabled person, I thank our Labour colleagues most sincerely. I know that I owe a debt to the Labour Party’s long-standing and noble—in the true sense of the word—commitment to advancing disability rights. However, this amendment underlines an inescapable but painful truth. The Bill makes a mockery of that fine, noble and honourable tradition. It shreds a tradition that deserves to be preserved, not sacrificed in such a profoundly cynical and misleading way as to make out, as the amendment does, that this is somehow only a drafting change.

There is a reason why not one organisation of or for disabled people supports the Bill; they know that disabled people need the Bill like a hole in the head. I marvel that the noble and learned Lord does not seem to realise that the Bill is dangerous enough already without the removal of provisions that would at least acknowledge the obligation to first ensure that communication adjustments were made; for example, for people with learning disabilities or users of British Sign Language.

The last thing that we as a House should be doing is endorsing an attempt to make the Bill an even poorer piece of proposed legislation than it already is. Noble Lords could be forgiven for thinking that that was not possible, but, as the noble and learned Lord’s Amendment 405 clearly states, he is perfectly capable of making his poorly drafted Bill even worse.

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

I would not be able to accept the amendment as tabled because I have numerous other amendments on disability, language, BSL, different levels of interpretation and Makaton that are all important when having these conversations. Following the offer that the noble and learned Lord made to the noble Lord, Lord Shinkwin, I would be delighted to join the meeting as well, to see how the noble and learned Lord’s amendments can be improved to move further down the road. What we are trying to do is to make sure that people go into this decision-making process clearly understanding the decision they are taking.

[Baroness Hollins (CB)]

If such a meeting were to take place, I would be delighted to ask the noble and learned Lord to consider the alternative wording I proposed when I spoke to the amendment.

[Lord Falconer of Thoroton (Lab)]

First, both noble Baronesses would be very welcome to attend this meeting, which is expanding all the time. Secondly, the language the noble Baroness, Lady Hollins, proposed was “reasonable adjustments”, which is in the first draft but not the second. The reason we have not used the wording “reasonable adjustments” is that it comes from the disability Act. We want to do that and then go wider, and our amendment therefore gives greater width.

[Baroness Hollins (CB)]

It is the Equality Act, not the disability Act. I suggested that the definition of “disability” in the Equality Act, with respect to something like this, would in fact include someone with a long-term condition or mental illness, as well as any other disabling condition that the noble and learned Lord may be referring to.

[Lord Falconer of Thoroton (Lab)]

The noble Baroness is right that it is the Equality Act, not the disability Act; I apologise for that. If we were to restrict it to that, we would restrict it to a particular thing, and we think that it should be wider that. Again, we can talk about that at the ever-expanding meeting.

On Amendment 416, the noble Lord, Lord Ashcombe, was particularly exercised by the fact that the second doctor would not see the report of the first doctor; he would have some degree of problem with that. The noble Lord will know that, where a second doctor is brought in—where a referral is made to a new practitioner—the co-ordinating doctor must provide the new doctor with a copy of the previous report. If the new doctor is satisfied as to all the matters mentioned in Clause 11 on capacity et cetera, he or she then has to say why he or she disagrees with the previous doctor. The noble Lord’s legitimate sharpness in relation to that point was based, I think, on an improper understanding of Amendment 416, which will allow this to happen only once the new doctor sees the report of the previous doctor.

In the light of my exchange with the noble Lord, Lord Moylan, which was right for us to have, I will not move my amendment. Although the noble Baroness, Lady Coffey, was kind enough to indicate that she will withdraw her amendment to my amendment, because the noble Lord, Lord Moylan, thinks his drafting is better, we will have to wait and see what happens on Report. Do not hold it against me when I come back with the same amendment on Report.