Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Friday 13th March 2026 Lords Chamber

Finally, my Amendment 552A seeks to ensure that pharmacies are limited to storing and dispensing approved substances rather than preparing them. Permitting preparation risks bypassing established regulatory safeguards designed to ensure the substances’ quality, safety and efficacy. Substances used for assisted dying should be manufactured in accordance with MHRA requirements rather than being prepared locally by individual pharmacies.

[Baroness Lawlor (Con)]

My Lords, mine is an amendment to Amendment 552A from the noble Baroness, Lady Hollins, which itself is an amendment to Amendment 552 from the noble Baroness, Lady Finlay. I think that this is a very good group of amendments: they avoid the potential conflict of interest about which we have heard and they make things clear in law. To answer the noble Baronesses, Lady Murphy and Lady Jay, I prefer a law made in this House to one made by the gentleman in Whitehall down the line. I shall speak to these two amendments, to which mine is a further amendment.

Amendment 552 would require that the provision of lethal substances through pharmacies is restricted to a limited number of designated pharmacies. The substance is documented, kept under lock and key and, when unused, disposed of safely. Amendment 552A from the noble Baroness, Lady Hollins, which she introduced so well, would restrict the pharmacies further to only dispensing and storing the drug, not preparing it on the premises, under MHRA rules. My amendment would prohibit pharmacies from stockpiling or storing any quantity of lethal substance in the pharmacy: it must be ordered on a case-by-case basis.

At present, the Bill has no chain of custody for the secure storage of these lethal drugs, even though some that we know are used for assisted dying, such as benzodiazepine, have a black-market use. The measures in these three amendments go some way to addressing this problem of secure storage. I draw particular attention to the role of the Medicines and Healthcare products Regulatory Agency, the MHRA, specified by Amendment 552A from the noble Baroness, Lady Hollins. It is the body that regulates, licenses, inspects and enforces the rules for pharmacies and manufacturers, on which I have a later amendment to Clause 37. Under this body, there is an existing legal framework for looking after drugs when they go to pharmacies—the 2012 regulations outlining the legal framework for distribution and storage and the directive to prevent counterfeit medicines from entering the supply chain.

Even the tightest regulatory system is not foolproof, so other safeguards are needed to protect against theft from the premises and to ensure security so that the drug is not counterfeited. The MRHA had a great victory last month in seizing thousands of counterfeit anti-fat drugs, the drugs that people take to help them to slim. That was a very good operation which turned up trumps, linking a Lincolnshire raid on an illicit drug-making factory to one in Nottingham. The MRHA works with the police. It can seize, check and license. However, we need even greater security, because of thefts from pharmacies, a known address, and it would be better to limit the storage of these lethal substances in the pharmacies to those ordered on a case-by-case basis. Do not tell me that this does not happen now: if I have to go to Boots for a prescription, sometimes they have to order it. In the matter of assisted suicide, if there is a delay, that may help the patient to reflect further and perhaps have a second opinion.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak to two amendments in this group, Amendments 701 and 703. The noble Lord, Lord Murray of Blidworth, raised some very valid points in the earlier group on local variation. The method that my noble friend Lady Finlay has raised seeks to address some of the issues that many of us have with the Bill, in terms of having a centralised process. We need to find a way to avoid doctor shopping. The reality is that medical issues, legal issues, social issues and economic issues are not separate; they all intertwine with each other. What my noble friend has suggested is a clearer process and fills some of the gap, because there are problems with reporting in the Bill as it stands and there needs to be strict data collection. The commissioner cannot report what the commissioner does not know, and Parliament can regulate only through reporting requirements.

The noble Lord, Lord Deben, spoke about palliative care professionals. They are one of the groups that have consistently raised concerns about this Bill. We had an interesting debate about whether we should have a service separate from the NHS. It would be my preference to have something unconnected. That does not mean that doctors caring for patients cannot communicate and still provide care for somebody who wants to enter this process, but we have to think about the possibility that there may be some doctors who, for various conscientious reasons of objection, may not want to have this conversation with a doctor.

My amendments are looking at clinical trials for the drugs and the regulation of approved substances. I would be interested in the noble and learned Lord’s opinion. I recognise why a clinical trial for these drugs would be very difficult, but there may be cases where people who want to request assisted suicide would be willing to have an enhanced level of study to understand how these drugs work on a patient. It is important that we understand what drugs are going to be used. In different jurisdictions around the world, there are very different combinations, often referred to as a cocktail. In effect, the patient is being given a massive overdose, because we do not know enough about how these drugs work.

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Amendment 713C, tabled by the noble Baroness, Lady Lawlor, seeks to establish a statutory regime for companies producing and supplying substances used for assisted dying. It would restrict production, importation, distribution and supply to pharmaceutical companies registered with and authorised by the MHRA and limit the number of such authorised companies. The amendment would require the MHRA to inspect companies and be satisfied about a wide range of matters, including safety of staff, record-keeping, storage, environmental protection and other safeguards. Several inspection requirements fall outside the MHRA’s remit, including workplace safety and environmental protection. Limiting the number of manufacturers based on prior year prescriptions—

[Baroness Lawlor (Con)]

May I just clarify? I think that response was in response to my amendments to Clause 37 for the manufacture of these products. However, Amendment 552B is in respect of the limited number of designated pharmacies which were distributing these drugs. In Amendment 552, the noble Baroness, Lady Finlay, referred to three designated pharmacies. The noble Baroness, Lady Hollins, wanted those three pharmacies to be limited to dispensing and storing but not supplying. Mine was simply an amendment to that from the noble Baroness, Lady Hollins, to say that they should be ordered in on a case-by-case basis; it was not an amendment to Clause 37 at this stage.

[Baroness Blake of Leeds (Lab)]

Apologies; I thank the noble Baroness for her clarification on that point. I was mid-sentence, so forgive me if I repeat myself. Limiting the number of manufacturers based on prior prescriptions is operationally impractical and could risk supply shortages.

I turn to Amendment 713A from the noble Baroness, Lady Hollins. This amendment appears to seek to introduce a parallel approvals regime, but it does not specify how that should relate to the Secretary of State’s separate power.

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[Lord Falconer of Thoroton (Lab)]

I congratulate the noble Lord because, although I disagreed with his conclusions, in just three minutes and 35 seconds he managed to summarise brilliantly the arguments both ways and the evidence.

[Baroness Lawlor (Con)]

My Lords, I will add a word to follow my noble friend Lord Goodman’s Amendment 151, in proposing my Amendment 153A. This goes further to stipulate that a medical practitioner may not raise the subject with the patient

“unless the person has raised it first during an in-person appointment requested specifically for that purpose”.

We have spoken today about the position of trust that the doctor enjoys. He or she is trusted by the patient and by our society, and is paid for by the taxpayer who trusts him or her. That trust is breached if the position is used not for the treatment of a patient’s symptoms, to help manage them or to benefit the patient, but to suggest that the patient should instead consider killing themselves.

A doctor who is trusted to find the best medical treatment for, say, pneumonia, blood pressure or heart disease becomes an agent who leads to the medicalised death for the patient with a poison that is self-administered, as if it were just an ordinary curative medicine. Moreover, as the Bill stands, the requirement to discuss possible side-effects and complications, which we know happens in other jurisdictions, is not there. Perhaps we might also consider why doctors are in this position of trust. It is because they have special knowledge, not only of medicine and its treatment, but of access to medications. They are especially trusted when the patient is very ill, very frail or terminally ill and perhaps already feeling a burden to those who are looking after them. If we permit the doctor to raise the subject of assisted dying to those who are so suffering, we leave the door wide open to the abuse of power. It need not be deliberate abuse. The doctor may only be raising a possibility—

[Baroness Murphy (CB)]

Is the noble Baroness, Lady Lawlor, aware that, of all the countries in Europe, it is the Netherlands where doctors are most trusted? We should consider what their legislation is and how close, often, the relationship is between the doctor and the patient who is in receipt of assisted death. I am not advocating their legislation, but I note that, of all the countries that have assisted dying, the doctors are most trusted in the Netherlands.

[Baroness Lawlor (Con)]

I thank the noble Baroness for that, but I point out that the Netherlands has many significant problems to do with various aspects of its legalisation of certain medical actions and operations. I will not go into them, but other countries are suffering from a fallout of what is happening, especially those on a rail service from Amsterdam.

If we leave the door wide open, it can happen. A doctor may only be raising the possibility, but a patient may be more swayed by a doctor’s opinion than their own. Indeed, where no pressure is intended, the pressure may be there none the less. The position of trust can therefore survive only if the doctor recognises that their normal role is limited to supporting the health of the living, helping the patient to live life as fully as possible by managing an illness or its symptoms or coping through the ups and downs of treatment. Participating in assisting suicide, for those doctors who agree to do so, is an extraordinary non-doctorly role that they should enter into only at the self-initiated request of the patient.

[Baroness Hayman (CB)]

My Lords, I have found some of this discussion quite difficult to compute with my own very limited—non-doctor—experience of end-of-life care and relatives who have been dying. The noble Baroness, Lady Lawlor, spoke as if there was a very binary division between assisted dying care and palliative care. Yet the cases that I have been involved with and seen very closely have been of people very definitely frail and at the end of their lives, and where the range of options they wanted to talk about were not simply pain relief. This whole time, no one has mentioned the right of people to exercise autonomy, to stop eating and starve themselves to death. Does the doctor not consider what happens in those circumstances and talk about options then? There is the option, of course, to turn off life support. There is the option—which my mother chose—to refuse any blood transfusions. Doctors talked her through how that would reduce her life expectancy.