Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Friday 20th March 2026 Lords Chamber

[Lord Gove (Con)]

My Lords, I am introducing six amendments in the name of my noble friend Lord Frost. My noble friend sends his apologies to your Lordships’ House. He is unavoidably detained but hopes to join us during the debate before 6 pm. In his absence, given that these specific amendments relate to the role of neutral advisers and are bracketed along with the debate on independent advocates, I am taking his place.

The role of neutral advisers is different from the role of independent advocates, and it is important to draw that distinction. So far, we have been discussing the provision that independent advocates can make to ensure that those living with a series of conditions that may impair their ability to be full participants in the process of deciding on their fate are assisted along the way. It is to the credit of the noble and learned Lord, Lord Falconer, that he has listened to the concerns that have been expressed and has put forward his own amendments, which are there to ensure that people living with disabilities or other conditions can have the support that is believed necessary at that stage in the process. A number of concerns have been expressed by noble Lords about whether the amendment from the noble and learned Lord meets the requirements that have been expressed, but nobody can be in any doubt that he is sincere in his desire to meet those concerns.

Neutral advisers relate to a separate part of the process. They relate to Clause 5(6), which states:

“A registered medical practitioner who is unwilling or unable to conduct the preliminary discussion mentioned under subsection (3)”—


that is the preliminary discussion with someone who may seek an assisted death—

“is not required to refer the person to another medical practitioner but must ensure that the person is directed to where they can obtain information and have the preliminary discussion”.

This raises a profound concern. The expectation generally would be that the point of contact and the point of authority for anyone seeking this immensely significant procedure would be a qualified medical practitioner with academic expertise and who is bound by the ethical codes of medical practitioners. Quite understandably, there will be many medical practitioners who will not wish in conscience to fulfil that function. We know that, as it happens, not a single royal college endorses the Bill—some are studiedly neutral—but it is undoubtedly the case that there is, at the very least, a substantial minority of medical professionals who do not wish to discharge that function.

Who will someone be directed to at that stage? The Bill does not specify that whoever is in receipt of that direction should be appropriately qualified. Indeed, in the original legislation as introduced, it was not intended to be the case that the person was “directed” to where they could obtain information but referred. “Refer” was taken out, not because it was a minor quibble on the part of those who objected to the word but because representative medical organisations, including the GMC and others, said that it is quite wrong to talk about referring. A GP refers you to a consultant when it is in the GP’s view that your medical and health interests are best served by another medical professional. Direction is something else; it is a less authoritative and less safe process. That is why the word is there. In his amendments, the noble Lord, Lord Frost, seeks simply to ensure that those to whom the patients or petitioners are directed are individuals who have the authority, neutrality and detachment to offer unbiased and authoritative advice.

It is important that they have not only that expertise but that independence, because a number of the amendments that my noble friend Lord Frost has laid down are there specifically to chart the operation of those providing that advice and to ensure that there is a proper log or register of their operation and the advice given because, as he has pointed out at other times, if we look at other jurisdictions, we can see that sometimes there are some doctors and some figures who become, as it were, the most energetic, determined, implacable advocates of assisted dying and the most generous providers of that service. One of the concerns of my noble friend, which I share, is that some of those to whom individuals are directed will be ideologically committed to a particular end, rather than those governed first and foremost by patient care.

There may be appropriate ways in which those who are in receipt of direction can be held to a high ethical code, be required to be independent and be mandated to have certain expertise, but the Bill is silent on what the qualifications or the monitoring mechanism would be. On a previous occasion, I asked the noble and learned Lord whether the provision in the Bill for regulations would allow the future creation of a national assisted death planning or advisory service. The noble and learned Lord said that they might, but that he did not envisage that. We might consider the provision of such a service a terrible step forward, or we might consider it to be a necessary adjunct to the freedoms that the Bill seeks to create, but at the moment we have a gap. We have the promoter of the Bill saying, “I don’t see the need for such a national service. I don’t see the need for any means by which we can govern, control or support the provision of advice”, yet, at the same time, the Bill explicitly states that people will be directed to those who will provide that advice, who are guided by no code of ethics, who are not held to any particular professional standards and who could be advocates for an ideological outcome that is not in the patient’s interest. I would be fascinated to know the noble and learned Lord’s view of the amendments tabled by my noble friend Lord Frost. I know that he will respond with appropriate consideration.

[Baroness Lawlor (Con)]

My Lords, I would like to follow my noble friend Lord Gove’s able introduction of the series of amendments in the name of the noble Lord, Lord Frost, and add a few words about why they are particularly important, giving a little more detail on some of the individual amendments to supplement that given by my noble friend. The amendments from the noble Lord, Lord Frost, hang on there being a neutral adviser to whom a person is directed if the general practitioner, the medical practitioner in the Bill, does not feel willing or able to discuss assisted dying with them.

The amendments would ensure that the information was provided by someone neutral. Under Amendment 195, they must keep and report a record of the advice or information given, and the date, to the commissioner within five days; and under Amendment 196, they must be an organisation designated as such by the Secretary of State, by regulation, in consultation with the commissioner. They must also be required to make a declaration, as we have heard, that they have no potential conflict of interest as an organisation by virtue of either employing people or having volunteers on the books who have in some way or another been associated with promoting assisted dying—I am glad to see the noble Lord, Lord Frost, here; I stand ready to be corrected by the teacher—for instance, if the organisation supports assisted dying in principle, if it does so politically or ideologically, or if it does so by means of advocacy or employment, or in any way makes money from it. We can think of lobbyists and PR firms who are acting for such organisations.

Neutrality matters and it must be established, particularly since we are dealing with a publicly funded service in the name of, and provided by, the state. As it is, the Bill stands open to an ever-expanding bureaucracy. Bureaucracy itself is likely to be self-perpetuating. There is a danger that those involved may be fervent advocates of assisted suicide. They may be, or may have been, associated with those organisations advocating it, or they may be lobbyists. The Bill as it stands allows the GP to initiate the prospect of an assisted death with a patient suffering from a terminal illness, and perhaps to plant the idea. However, if the GP does not want to enter into discussion of an assisted suicide, the Bill opens the prospect of the patient being referred to someone who will.

The amendments of the noble Lord, Lord Frost, would ensure that, if the Bill becomes law, assisted suicide in the UK does not become a state dying service, as has happened, as some feared, in Canada, including many physicians over there. In some cases, medically assisted dying becomes the default option, with nearly one in 20 deaths now resulting from assisted dying, and 5% opting for this step because of direct pressure from medical professionals—as is well documented, and we have spoken about some of these cases in Committee—or because of indirect pressure such as a lack of housing, of the support needed at home, of financial support or of palliative care. These amendments would ensure that in this country, the person to whom a patient was directed, when a doctor does not want to discuss the issue with them, was neutral and did not have an interest in promoting assisted dying.

[Lord Brooke of Alverthorpe (Lab)]

My intervention will be brief and is addressed to the noble and learned Lord. Does he believe that his amendments will ever be adopted and incorporated into a piece of legislation that will be passed in this Session? If in fact, as we read in many newspapers and in other media, it is unlikely to be adopted, I therefore address a question to my noble friend the Minister: why are we permitting more time to be given to a pointless exercise, when the country can ill afford to be spending money on pursuing legislation that will never be implemented?

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[Lord Falconer of Thoroton (Lab)]

Absolutely not. Indeed, the way the Bill is drafted makes it absolutely clear that the independent advocate is there to assist in the process of obtaining the consents and making sure that the person, as they go through that process, understands the whole process. The people to whom the amendment seeks to provide the assistance of an independent advocate are defined specifically as people with a mental disorder under the Mental Health Act or people, as I have gone through already, with particular difficulties understanding, communicating or using or weighing that information.

I will pick up the point that the noble Baroness, Lady Cass, raised: if someone has a difficulty in understanding or retaining information, it cannot be envisaged that they would have a firm and settled view. I broadly share that view—but remember that the independent advocate comes right at the beginning of the process. If there are question marks in people’s minds, people should have an independent advocate. It may very well be that, if someone cannot understand relevant information, they cannot possibly have a clear and settled view. I do not think that they should be deprived of somebody to help them through the process right from beginning. That is why the range is there—because it takes place right from the beginning. I also express gratitude to the noble Baroness, Lady Cass, for broadly supporting the approach that we have taken on the words “independent advocate”.

I will go through the particular changes. First, in her Amendment 168, the noble Baroness, Lady Grey-Thompson, states that everybody should have an independent advocate right from the start. No, I do not think that that is right. An independent advocate should be restricted to those who are qualifying persons, because that is what the role is trying to deal with.

Amendment 300 says there should be an advocate for disabled people. That is also reflected in Amendment 553B, which refers to anybody with a disability under the Equality Act. Again, I say no. The purpose of the independent advocate is to help somebody who has an understanding difficulty or a mental health problem. We have therefore restricted entitlement to an independent advocate to the specific group of people who have an understanding difficulty. I was also struck by the point made by the Minister that very many people who are terminally ill—for example, with cancer—would fall within the category of “a disabled person”. It is not intended that everybody who qualifies needs an independent advocate.

I have dealt with the amendments on the purpose of the independent advocates. I have dealt with the questions raised by the noble Baroness, Lady O’Loan, on what the role will be, including in relation to the word “or”.

A point was made about consulting bodies—I cannot remember who made it; perhaps it was the noble Lord, Lord Jackson—and that we should consult before making regulations under my Amendment 549(2)(b). Section 55 gives the Minister power to consult with anybody he or she thinks appropriate, and that is probably okay in relation to that.

The noble Baroness, Lady Coffey, proposed an amendment that would require that no independent advocate could deal with more than 10 cases in a year. I do not see that that is a sensible or necessary provision. Many people who are qualified as independent advocates will be doing this full-time. I do not see why the number should be restricted to 10.

The noble Lord, Lord Goodman, suggested that the regulations should be subject to an affirmative resolution. I agree. My Amendment 862A does that.

The noble Lord, Lord Gove, spoke to the amendments tabled by the noble Lord, Lord Frost, who we are very happy to see in his place. We had had bad news that he was not available before 6 pm, so we are very glad to see him now. His amendments were ably advocated for by the noble Lord, Lord Gove, and the noble Baroness, Lady Lawlor. I am against the proposal that he is making. The proposal, as I understand it, is that where the registered medical practitioner says that they are not willing to conduct this primary discussion—obviously, the main reason would be because they were against it—we should set up a group of neutral advisers for this specific group, to which you have to be referred for the purpose of getting another Clause 5 conversation.

Noble Lords will recall that the Clause 5 conversation has to be conducted in a way that gives rise to all of the options. The preliminary discussion—the explanation to the person—must not be conducted in isolation, referring only to assisted dying, but must refer to all the options, the prognosis and the treatment. What is being proposed, as I understand it, is that a system of neutral advisers should be set up for when somebody refuses to conduct that consultation so that the person is not sent to somebody who might be biased. Remember, this is taking the person from somebody who refuses to do the preliminary discussion to somebody else. I understand the point, but that seems both unnecessary and inappropriate.

[Baroness Lawlor (Con)]

Say we have a medical practitioner who does not, for the reasons the noble and learned Lord has given, want to discuss this. What is to make sure that the person, the organisation or whatever it is, the vague entity under the Bill, to which the person will then be referred, is not part of a, if you like, mafia of employees—because it does not necessarily have to be a doctor to whom the person is referred—who are in the vanguard of protagonists of assisted dying? This is the concern that that seeks to deal with in a state service.

[Lord Falconer of Thoroton (Lab)]

What I understand the noble Baroness to be saying is that a doctor who will not conduct the conversation because, for example, he or she is against it on conscience grounds, might refer somebody to what she describes as a pro-assisted dying mafia. First, that seems to me to be unlikely. Secondly, the Bill cannot prevent people talking to anybody they like about assisted dying. We have free speech in this country. Thirdly, the Bill provides that before you can have an assisted death, you have to have a Clause 5 conversation, which requires the doctor—legally—to put every option before you. What is being proposed is a network of neutral advisers to ensure that before you get to the second Clause 5 doctor, you have not talked to somebody who might be pro it, who you are not prevented from talking to anyway by the law. No, I am not in favour of it.

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[Lord Hamilton of Epsom (Con)]

All right—they could apply, if that helps the noble Baroness, Lady Hayter.

We have to think closely about this, because this is the essence of the Bill. I do not understand how we can be comfortable with the whole idea that some of these diagnoses will be completely wrong and, as a result, there will be people who will apply for assisted dying who might have lived for years. This strikes me as being a disturbing element of the whole Bill. We should be seriously considering whether something should be done to address this problem. I am glad it is not my difficulty.

[Baroness Lawlor (Con)]

My Lords, my noble friend Lord Moylan and the noble Lord, Lord Carlile, have told us about the uncertainty of the statistical evidence, and indeed the unreliability. That points to a flaw at the heart of the Bill, for which a condition for eligibility is that death must be reasonably expected within six months in consequence of that illness. What then is at the heart of the Bill, if I may develop the point a bit, is a process for managing assisted suicide in consequence of something which is not at all certain.

I have to say that, in the areas we know about where the state has a process for providing a service, particularly in education, we see that a state service is not geared to the individual case. One of the points that my noble friend Lord Moylan explained was the individual case, and most noble Lords agree with this. How are we going to have a state service, as is proposed by the sponsor’s Bill, for a general cohort, and not the specific individual case, that is reliable for individuals? We see in education and other areas that exceptions continue to have to be made—for instance, for children with special educational needs, particularly autistic children. These are exceptional cases which do not fit the general application of a state service.

[The Earl of Effingham (Con)]

My Lords, it is a hallmark of the noble Lord, Lord Moylan, to make valuable contributions to debates in your Lordships’ House, and today is no different. The noble Lord is living proof that an average, median or mean life expectancy is incredibly difficult to predict, as is the third standard deviation of the bell curve, which he rightly referenced.

I believe that the noble Baroness, Lady Finlay, said that she never gives prognoses due to the complexity of the answer. Other noble Lords touched on the way a prognosis is calculated in previous debates. Taking such a monumental decision of life or death based on a medical prognosis derived from a median life expectancy raises questions. That said, it is difficult to see what other measure should be used as the test for eligibility.