Terminally Ill Adults (End of Life) Bill

Baroness Murphy Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I have often spoken in support of this and in most debates in this House on every Bill to introduce assisted dying in England and Wales since the Joffe Bill in 2005, and I will continue to support it. I hope that this Bill will make it through. For me, the principles are guided by support for the importance of respecting the autonomy of mentally competent people to make their own decisions about their lives, and that, as a matter of compassion, people should be assisted to end their lives when terminal illness means they no longer want to contemplate further existence or tolerate the possibility of a difficult death.

As we have heard, there are numerous jurisdictions that have implemented legislation on this based on the Oregon model, which is a very successful one and is tried and tested. Other jurisdictions have gone for another model, which I would broadly call the Canada model—a rather wider scheme, which I would have supported strongly. The Oregon model is the one we have before us, albeit modified, and that is what we need to get right and through Parliament; it is the one that has been approved by the Commons.

We know from good peer-reviewed research that there are no risks for the vulnerable. They are largely a rallying point for the fundamentally opposed, and that is all. There is no evidence of any undue influence impacting on the decision. The process can be part of good palliative care services and in many places where this model has been taken up palliative care services have improved. It makes people focus more on the realities of care of the dying. Yes, it would be great to see better palliative care—I would support that and always have—but not at the expense of trying to introduce another legitimate arm to it, which is part of good palliative care.

My problem with this Bill is what the Commons has done to it. As the noble Lord, Lord Forsyth, said, it is now hedged around with so many so-called safeguards that have been inserted that it might prove to be unwieldy if not unworkable. The notion that a psychiatrist should be called in to confirm capacity in some cases is probably unnecessary. All doctors are trained to assess capacity; they have to be for testamentary capacity. Of course, I love dearly psychiatrists—after all, I am one—but I think it is unlikely that my colleagues will want to be involved, except in very exceptional and unusual circumstances. Frankly, there is too much bureaucracy and oversight in this Bill. The experience of other countries suggests that the less bureaucratic the process, the better the experience for patients.

The Bill is very narrow in its criteria for eligibility. I am content to go through with this Bill as it is, but I am one who would like to see in the future an expansion of eligibility criteria to support people with irremediable diagnoses, such as Tony Nicklinson and other people with locked-in syndrome. My 100-year old mother decided to starve herself to death when her pain was excessive. She had very good palliative care support and a brilliant GP, but those three weeks in which she was determined to die—she was fully mentally competent—were the worst three weeks of my life. Nevertheless, I want to see this Bill go through, and hope it becomes legislation as soon as possible.

I am sympathetic to the amendment in the name of the noble Lord, Lord Forsyth, but I am very worried that it would create further problems for us. Let us try to get this Bill through, and then at least we can make some progress and respect the wishes of the Commons.

Terminally Ill Adults (End of Life) Bill

Baroness Murphy Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I declare my registered interest as a trustee of St John & St Elizabeth Hospital in London.

The first clause sets the tone for the rest of the Bill. It has so many deficiencies and such inherent danger that it has rendered necessary the tabling of so many amendments. Multiple amendments were, of course, tabled in Committee in the other place, but they were not permitted to be debated or voted on. Our duty is therefore to scrutinise the Bill, not to meet arbitrary timetables and a limited number of Committee days. We have to do it properly, because on this work that we do rest questions of life and death.

Clause 1 deals with the “who”; who can decide to end their life with medical support or to be assisted to end their own life when they cannot do it themselves. The definition of “who” is simple and sparse. It demands only that someone has capacity, has reached the age of 18, is ordinarily resident here and is registered with a GP. Clause 1 also deals with what is required—the process for determining. It requires that any decision made by a person who fits the definition in Clause 1 is made by someone with

“a clear, settled and informed wish to end their own life, and … has made the decision … voluntarily”,

and who is not the product of coercion or pressure. We will come to that, but it is not enough.

The decision to end one’s own life is the most profound decision that one can make. One might argue that some decisions are not as immediately serious. If, in a fit of despair or loss of hope, I decide to refuse treatment, I might still change my mind. Similarly, if I stop eating, I may choose to reverse that decision. If I decide to end my life, there is no coming back and no reconsideration, and that is why it is such an important matter.

I think the noble Lord, Lord Pannick, referred to advanced directives in these provisions, by which people can declare their future care, but the decision to refuse treatment and go for a natural death is not a proactive decision to end life. There is no precedent for the Mental Capacity Act being used for a decision to end life.

[Baroness Murphy (CB)]

I would like to briefly intervene, because every day of the week there are hundreds of decisions made in the NHS and independent care about life and death. I will give a very brief example. My brother has had renal failure for 40 years. He has been brilliantly looked after by Guy’s Hospital, and, after the failure of the last transplant, he has been on dialysis for the last five years. It has become more and more wearing and disabling for him, and he has decided that, by Christmas, he would like to make the final decision, with the help and the support that he is getting from the Guy’s team, to end his life.

He is supported in that by his wife, brother, sister and children. We have supported him to make his own decision. It is a life and death decision that he will be supported through. That is the way it happens, day in, day out, in the health service. It is a nonsense to say that life and death decisions are not made. Furthermore, what test will they use? They will use the Mental Capacity Act.

[Baroness O'Loan (CB)]

My Lords, the noble Baroness has told us a very sad story about her brother, but it really is not on the issue that I am speaking of today. It is, of course, the case that decisions about life and death are made. What I am saying is that, in this case, the decision is to ask the state to enable the person to administer that, and for the state to bring all the forces and resources available to do it. That is what we are debating today: does the Bill provide a situation in which “capacity” is the correct term to use in this clause?

I support Amendment 2. The use of the word “capacity” is undoubtedly provided for in the Mental Capacity Act. This Bill says that

“references to a person having capacity are to be read in accordance with the Mental Capacity Act”,

which is very helpful. The Mental Capacity Act was not passed to deal with the decision to end one’s own life, but rather it was formulated with the basic assumption that a person has capacity. In November 2021, the Supreme Court said in A Local Authority v JB:

“‘A person must be assumed to have capacity unless it is established that he lacks capacity’”.


It continued:

“This principle requires all dealings with persons who have an impairment of, or a disturbance in the functioning of, the mind or brain to be based on the premise that every individual is competent until the contrary is proved. … Competence is decision-specific so that capacity is judged in relation to the particular decision, transaction or activity involved. P may be capable of making some decisions, but not others”.


Therefore, there are circumstances in which capacity cannot be assumed and a person may not be capable of understanding, to the necessary extent, the information that should underpin any decision-making, or of analysing the consequences of that information or of making a decision in their own best interests. When these conditions are not fulfilled, the Mental Capacity Act requires, in particular circumstances, that a decision be made by a third party, but always in the best interests of the person. As the Royal College of Psychiatrists told us in evidence,

“an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding”

than assessing capacity for treatment decisions.

We have received very helpful evidence from Professor Gareth Owen, Professor Alex Ruck Keene, and Professor Katherine Sleeman of the Complex Life and Death Decisions group at King’s College London. They have stated quite clearly that

“the MCA 2005 was not designed to be a universal framework for determining capacity.  It is primarily a workaround for the inability of a person to give consent to actions required to secure their health and social care needs. In the MCA 2005, the principles applying to and the test for capacity apply in a context where a decision can be taken on a ‘best interests’ basis for the person if they lack capacity”.

In the context of the Terminally Ill Adults (End of Life) Bill, they state that,

“no such best interests decision could ever be made”.

Capacity is not a constant state. It may fluctuate depending on a variety of circumstances, including some illnesses, disabilities and the side-effects of medication. A person can have capacity in relation to one decision and not another. A person may have capacity at one time, but not another. It is an enormously complex issue. When the decision in question is the decision to end one’s own life, capacity to make that decision requires very significant analysis in each case at the time in question.

That is the reason why “capacity” is not an adequate word to deal with the situation in which a person is coming to make a clear, settled, and informed decision. “Capacity” cannot be the test. “Ability” is a wider test, and there will be opportunity for the Committee to consider what that might look like as we go through future groups.

--- Later in debate ---

[Lord Gove (Con)]

The noble Lord is absolutely right. Again, there has been some debate about the evidence from psychiatrists and the reasons why they expressed doubts, but that evidence is plentifully available to Members of this House.

As a number of Members have made clear, the work of Alex Ruck Keene KC and the Complex Life and Death Decisions group of King’s College, which is available to this House and was examined in the Select Committee, makes it clear that the Mental Capacity Act is inadequate. It is inadequate to deal with the concept of suicidal ideation that occurs. It is inadequate to deal with the fact that capacity fluctuates, and that fluctuation can be affected by mental health and well-being in its broadest sense, as well as by other syndromes and conditions.

The psychiatrists would not have intervened as they did if they had felt that this was a matter that could be left to one side, a matter that was entirely, as it were, within the scope of parliamentarians or legislators to shrug their shoulders and to accept. They have sent a message to us that the Bill as framed endangers those who are most vulnerable. Can we really proceed on the basis of the MCA, a piece of legislation conceived at a different time for a different purpose and rendered in the eyes of the professionals as not the correct way to go forward?

[Baroness Murphy (CB)]

My Lords, I wish to comment on the previous statement made by the noble Lord, Lord Gove. I am a fellow of the Royal College of Psychiatrists, and I must have used the Mental Capacity Act dozens of times throughout my career. Capacity assessment, and how to do one, is included in very extensive codes of practice and in the training that people have. It includes ability in those things that have been mentioned. You need to know whether somebody has understood those elements that go to make up capacity to make a specific decision. It is a tried and tested piece of legislation. I will come back to it when we get to the amendments to Clause 3, but there is nothing in the capacity assessment that excludes making an appropriate judgment or having a really good understanding of the ability of the individual to grasp what is being proposed and all those things around it. It takes account of fluctuation—remember that this has to be a settled decision, and it takes account of that.

I did not want to say this, but noble Lords should understand that there has been internal politics inside the Royal College of Psychiatrists. There has been a serious shift towards against supporting this Bill, not since it came to the House but because of a change of personnel at the top of the Royal College of Psychiatrists. The individuals who made up the report that now comes to the House, both from the GLAD group and from, for example, Dr Annabel Price. She has a personal view that she does not like the principles of the Bill and would not support it.

[Noble Lords]

Oh!

[Baroness Murphy (CB)]

It is very important that we understand where these reports come from. This one is issued by the Royal College of Psychiatrists, but it has not been subjected to scrutiny by the members. Although they have many good points, and we can look carefully at their recommendations and assess them properly, we need to make a decision ourselves.

[Baroness Butler-Sloss (CB)]

I am very grateful to the noble Baroness for giving way. I have a practical question to ask. Do other doctors get training on what is meant by “capacity”?

[Baroness Murphy (CB)]

There is never enough training—let us assess that.

[Lord Scriven (LD)]

If I may help the noble Baroness, the answer is that the Oliver McGowan training—which is a statutory requirement for all doctors—is now in place. It is high-level training on both capacity and of dealing with people who are vulnerable.

[Baroness Scotland of Asthal (Lab)]

My Lords, I have hesitated to intervene at this point because we are going to come later to talk about capacity and why the Mental Capacity Act and its definition does not fit well with this Bill. I am disappointed in the way in which the last few comments have turned this debate, not least because all of us belong to professional bodies which express collective views on our behalf and have to be respected. It is disappointing that we should have in this House an attack on a view which is expressed by a professional body in this way.

However, there are real reason as to why the Mental Capacity Act is seen as having deficiency in this context, which it normally does not have. It is a fine piece of legislation that we were very proud to introduce, and it has given liberty, capacity and the opportunity to be heard to many people who had limited capacity in the past. I give quarter to no one about the power of that Act.

But is the Mental Capacity Act perfect when we come to consider this particular issue? It is not. Why is it not? Because you can have and suffer from a mental illness and still have capacity. Yet we know that, when individuals are faced with the terrible diagnosis that they are to die, and their families are distraught, and they themselves have to face that reality, depression is not abnormal; it is normal. The fact is that some of those people, many of whom we know, some of whom are within our families, some of whom have suffered deeply, contemplate whether it would not be simpler, easier, less painful for everyone if they simply ended their lives. But what else do we know? We know that, when that depression bites, there is means of alleviation. We know that, with good palliative care, they can be enabled to make an informed decision. That informed decision may be that they still want to take a step, but the opportunity to get that support is essential.

Yet when we look at the capacity Act, the fact that someone is deeply depressed does not mean that they lack capacity within the meaning of the Act—

[Baroness Murphy (CB)]

It does.

[Baroness Scotland of Asthal (Lab)]

If we look at what Professor Foster and others have said, they say that the Mental Health Act 1983 is the sort of assessment that a psychiatrist should make as to whether they are in a position to make that decision. It is not just the MCA on its own—

Terminally Ill Adults (End of Life) Bill

Baroness Murphy Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Hamilton of Epsom (Con)]

I wish I could agree with my noble friend Lord Markham, but at the end of the day we have a National Health Service and it has to make choices, and we know that the National Health Service is desperately short of money. If it can save money by making sure that people go for assisted dying, I am sure it will do that, on the basis that then it could keep other people alive. Those are the invidious choices that the National Health Service has to make. I always assumed—I will give way in a minute—that, for the proposers of the Bill, one of their reasons was that they wanted to save money. I agree that the money concerned would not be very big, but at the end of the day there is an incentive to save money by ensuring that people opt for assisted dying, thereby saving the National Health Service money. I give way to the noble Baroness.

[Baroness Murphy (CB)]

My Lords, as a clinician for 50 years in the NHS, I find the noble Lord’s suggestions quite offensive. We have been asked to be kind today and I would ask him to be a little kinder to NHS clinicians in their decisions to try to help people at the end of life.

I just point out to the noble Lord, Lord Harper, that when you are talking about a fully funded palliative care service you are talking about millions and millions, and what has to be allocated. It is exceedingly difficult for the NHS to come to that decision, particularly in light of the fact that insufficient clinicians have been trained in that area, as I am sure the noble Baroness, Lady Finlay, will agree. Certainly, for the assisted dying service we are talking a few thousand—not anything like the sums of money that a palliative care service costs. Let us be realistic about what we are asking for.

[Baroness Royall of Blaisdon (Lab)]

I shall briefly intervene. I am sure that my noble and learned friend will answer this later, but I want to put on record that nobody who is a supporter of this Bill—an amended Bill, as it goes forward—would ever put costs as the major reason for supporting it. I just want to put that firmly on the record.

Terminally Ill Adults (End of Life) Bill

Baroness Murphy Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Cass (CB)]

To clarify, whether we take the system proposed by my noble friend or the original system with the series of doctors, it is very unlikely under any circumstance that the clinician who is providing primary care for the patient will also be in one of those formal roles specified by the Bill. The reason is that, as we have discussed, people will need to opt in to that kind of role and have very specific training for it. Given the number of people who are predicted to be required to grant an assisted death, that will be quite a small cadre of clinicians. Therefore, although I understand the aspiration of the sponsor in the other place, and certain Members here, for there to be close integration between the team providing normal care and those involved in the dying process, in practice I do not see how that would be feasible in either system.

[Baroness Murphy (CB)]

My Lords, I oppose the view of the noble Baroness, Lady Finlay, that we should have a completely separate service. That would target and isolate people who are dying. They will wish to be supported by the people who they have known through the course of their illness, so it is crucial that they be seen and examined by those people and not moved to another place. Yes, there will perhaps be separate people who take on this role, and they should be properly qualified and discuss it with the panel, but it is utterly crucial that, when patients are in the process of dying, we do not separate and reject their carers, who should be part of the palliative care provided to them.

In other countries, assisted dying usually happens as part of a palliative care service. That is how it is done, very successfully, in Oregon and Washington. We should not separate carers who are there to support patients during this process. These little nitpicking changes to the Bill will just make it worse.

[Lord Deben (Con)]

My Lords, I was not going to speak on this, but the last speaker has led me to do so. To describe the care with which this proposal has been put forward as “nitpicking” is frankly unacceptable. The noble Baroness should not have said that. The reason why this has been brought forward is that many of us feel that we should take seriously the pressures on the people who will have to carry out these arrangements, all of whom, either in principle or because of the nature of the Bill, have objections to the Bill, so one tries to find answers.

One of my sadnesses is that the sponsor of the Bill has so far not met the questions put forward by the Royal Colleges or—I say this to the noble Baroness—the committees of this House, which have suggested that the fact that this Bill is so unclear on so many things makes it unacceptable legislation, and that we need to be much more precise and much less vague.

[Baroness Murphy (CB)]

The fact of the matter is that many of the things we are discussing would, in normal medical and social legislation, be contained in codes of practice. They will certainly need to be worked up in great detail for some of these issues to be covered, but it is not necessary to put them in primary legislation. For example, the carting of medication around between a pharmacy and a doctor is in a code of practice that is quite straightforward. I agree that that needs to be done in detail so that it can be monitored and practitioners who are implementing the legislation can do it with confidence. There is no good in putting it in primary legislation that will inevitably change when processes and habits change.

[Lord Deben (Con)]

That may well be the view of the noble Baroness, but it is not the view of the Royal Colleges, and it is not the view of the Select Committees of this House that have looked at this. It is perfectly reasonable for me to suggest that there is an alternative, and I am suggesting an alternative to the noble Baroness. I am still sorry that she should think the word “nitpicking” a suitable phrase to describe people who have spent their lives working on these issues and are trying to find answers to the problems that have clearly been raised by this Bill. Most of us who have views on this subject have been extremely careful in the language that we have used. We have respected the views of those with whom we fundamentally disagree, and we have done so with great care.

I will explain why I think we should consider these amendments very carefully. I am not expert enough to say that this or that bit is the right answer to this, but this is precisely the kind of information that ought to be in the Bill, but which is not. These are the answers that most people who are expert in this matter, and have given evidence to the various Select Committees, have asked for. This should not have been needed as an amendment; it should have been presented by the noble and learned Lord and those who are putting forward this Bill, because we need to know this before we vote on it, not afterwards. That is the problem that the noble Baroness is avoiding. We are being asked to pass a Bill and leave so much to things that will be done in a way we have absolutely no knowledge of.

There is a second reason why it is important to take very seriously these amendments: the relationship between patient and doctor. My one expertise is from having spent nearly 40 years as a Member of Parliament, representing a constituency. It is all very well for those who are perhaps removed from the generality of the population, but one thing you learn in your weekly surgery, and from going around your constituency, is the degree of fear that people have of doctors and hospitals. Anyone who is concerned about this from a pastoral point of view—here is a non-religious element for bishops and ministers of all sorts—knows very well that this is a fundamental fact that you find everywhere. One problem, even for those who are in favour of the principle of the Bill, is that it increases that fear among many people. Therefore, it is hugely important to ensure that there is a service that is clearly separate from and unconnected in any way—except that necessary connection to which the noble Baroness pointed—with the care that has taken place.

--- Later in debate ---

I thank the noble Baroness for what she said, because she revealed what we have always feared: that this would become a cheap alternative to looking after people—

[Baroness Murphy (CB)]

My Lords—

[Lord Deben (Con)]

I will give way in a moment but I wish to finish my sentence—and to being a society that cares for people right to the end of their lives. I know what sort of society I want to live in: one that looks after the most vulnerable at their most vulnerable time. If they are to be given that alternative, it is clearly unconnected with the fundamental moral duty of a society: to look after those who cannot look after themselves.

--- Later in debate ---

[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.

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[Lord Moylan (Con)]

There is, indeed, a spectrum, and the doctor should be able to speak. As I say, there have been 3,000 years of thought given to this. What has resulted from that is a firm conviction that, while some medications that do you good may also do harm—and the doctor has to make careful judgments about that—the active killing of a patient, the actual administration of substances with a view solely to bringing about death, is morally abhorrent.

It may not be morally abhorrent to the noble Baroness, but she has to understand the novelty of this and the violence that she is doing to our inherited moral framework when she—

[Baroness Murphy (CB)]

My Lords—

[Lord Moylan (Con)]

Let me finish. The noble Baroness puts that forward and says that, to her, it is simply one option. It is not one option; it crosses a line.

[Baroness Murphy (CB)]

My Lords, “morally abhorrent” is quite distressing. I am a doctor; I have been a doctor for 50 years and have worked with dying people quite regularly in hospital, particularly in general hospitals. I find the notion that doctors all find this abhorrent is utterly wrong. We know that at least half support the principles of the Bill and can recognise that it is something that they would like to support. I am not talking about the medical royal colleges; they take one line—in fact, most of them are neutral about the principle. The reality is not as the noble Lord, Lord Moylan, describes. Certainly, I do not feel the way he does. I find it very offensive when somebody says that it is morally abhorrent. It is not morally abhorrent to help people when they are desperately suffering and to respond during a conversation to what they are talking about and what they are asking for.

Terminally Ill Adults (End of Life) Bill

Baroness Murphy Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Deben (Con)]

First, it is said on both sides that they want more money for palliative care, but we now know that palliative care includes assisted dying. I therefore do not accept that the demand for more money for palliative care from those in favour of this Bill is the same thing as those of us who are asking for more money for palliative care so there is a proper choice.

Secondly, the issue is not whether the people of Wales should make the decision on the issue of assisted suicide; the issue is whether decisions made on that subject—which have to be made, because the noble Lord is perfectly right that the legal issue is not devolved—should be made in circumstances in which the application and implementation of those decisions are excluded from the powers that the Welsh Government have. All we are saying here is that those are two different things. I accept entirely what the noble Lord said about the need to make a national decision because of criminal law. However, I am saying that the sponsors of this Bill have got to face that it will ask the Welsh to give up the important control they have in circumstances in which they are already impoverished by the way in which they are supported and where they have particular difficulties with what we call palliative care—not that which the noble Baroness, Lady Murphy, calls palliative care.

[Baroness Murphy (CB)]

My Lords—

[Lord Deben (Con)]

I knew I would do that. I am sorry. I will not refer to the noble Baroness, Lady Murphy.

[Baroness Murphy (CB)]

My Lords, could I make it clear to noble Lords that, in the best legislatures that have implemented similar legislation to this one—and I am thinking of Oregon, the State of Washington and so on—assisted dying is a small part, a very tiny part, of a good palliative care service, and it is best delivered when people who have been caring for somebody through the course of their terminal illness are enabled to make that final choice in their own time when they are ready. That is the point I was making then, and which holds today. I did not say that it was part of palliative care here. It certainly is not at the moment; I would like it to be, but it is not.

The only other point I would like to make is that we have been referring throughout this debate to the Scottish vote. Is it not lovely that the Scots could make a vote? We will not have the opportunity to make a vote in this House due to people going on and on about Wales and matters we have already discussed many times and have already had explained to us. It seems to me that we are just wasting time and we will never get to a vote. I realise that is what some in the House would like, but it is sadly the case that we will never get to the point where we can make a decision in this House about whether we support this legislation or not.

[Lord Deben (Con)]

I am pleased that I gave time for the noble Baroness to talk, given that she thinks all of this is nitpicking. I remind the House that is what she said about the work we are doing. The fact is—

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[Baroness Murphy (CB)]

We have discussed this issue at some length before, but I wonder if the noble Lord, Lord Moylan, has considered that the Bill does not say anything about a definite diagnosis. The phrase is “can reasonably be expected”. It does not mean that anybody has to agree with a diagnosis that it will be four, five or six months, or any particular time; it is “can reasonably be expected”.

I would like to come back on the noble Lord’s issue about people with a positive attitude. Does he accept that it is not just people with a very positive attitude who have good expectations? There are now numerous studies of people with breast cancer showing that the alternative, to totally deny it, also has a slightly better prognosis. There are different ways of approaching these bad news prognoses and people can adapt their own way of dealing with issues from them. I hope he will note that.

[Lord Moylan (Con)]

I am now precluded from taking further interventions, because there is a limit on how long I can speak and that was a very excessive intervention. I will discuss with the noble Baroness outside the Chamber what a reasonable expectation is, if it is not based on a prognosis. I do not know what the functional difference is. As for being in denial, funnily enough, an oncologist said to me that being a bit in denial is quite a good thing. In my own case, I managed to combine a positive attitude and a certain sense of denial; I agree that these things can work. It is quite complicated. But none the less, I am going to continue with what I wanted to say.

Thirdly, the title of Professor Gould’s article was, quite subtly, The Median Isn’t the Message. Yet at the heart of the Bill is a six-month prognosis—we may call it a reasonable expectation—in which that is exactly the message. It is that flawed message which we are making the heart of the Bill.

Lastly, I think we are all agreed that a positive attitude can help, even if denial can help as well, but in using this Bill, we do not inculcate a positive attitude. What we actually say is: “You have six months to live and here is the pills option. That’s another option you can take”. We should be promoting a positive attitude, and the Bill does not do that.

My Amendments 175 and 384 simply require that in the three doctor encounters that are required—in the preliminary discussion, with the co-ordinating doctor and with the independent doctor—there is an explanation of the underlying mathematics or, if you like, the underlying data of the condition that the person has as part of the conversation. The amendments would make that mandatory, so that the idea that the six-month diagnosis is a prediction is not lodged in the mind of the patient.

Professor Gould died in 2002. That was 20 years after his original diagnosis, and he did not die of mesothelioma. In my own case, I took Professor Gould’s article to my oncologist—it was our second meeting—and I said that, in the light of his experience, I was not satisfied with 18 months, that my target was 20 years and that anything less I would consider failure. It seems to have worked because, within three months of the diagnosis, I was discovered to be in complete metabolic remission, a condition I have stayed in. If you have had stage 4 cancer, they will not use the word “cured”, but I am as close to cured as you can be, and I am in complete metabolic remission. I still have 18 years to go on the bargain I struck with my oncologist.

I occasionally hear rather rude remarks about Dame Esther Rantzen—that she was given so long to live and she is still alive years later. I never share those comments; I reject that attitude completely. There are lots of people, such as her and me, who live out there in the farther reaches of the third standard deviation, with our heads hard up against the roof of the bell curve. That is natural because, as Professor Gould says, variation is the reality and the prognosis—the median—is the abstraction.

We have put something false and misleading at the heart of this Bill. There are very few conditions for a person to embark on a course that leads them to an assisted death; one is residence, one is capacity and one is this six-month prognosis. We have put this right at the heart of the Bill, and it is, as I say, false and misleading. It is a fundamental flaw in the Bill, and I would like noble Lords to reflect on that and I hope, on that basis, at the very least, agree my amendments. I beg to move.

Terminally Ill Adults (End of Life) Bill

Baroness Murphy Excerpts

Committee stage
Friday 27th March 2026 Lords Chamber

[Baroness Murphy (CB)]

I just want to comment on some of these earlier amendments, particularly from the noble Lord, Lord Shinkwin. I think the noble Baroness, Lady Finlay—I cannot remember whether it was last week or the week before that—reminded us that people who are terminally ill, or who have discovered that they are very ill and likely to die, have a range of things they want to talk about. Whether they could opt out in some way will almost always go through their head at some stage. Whether it is legal or illegal, that is the way it is, and they will often want to discuss that. But that is not quite what the preliminary discussion for the purposes of the Bill is. It is a rather more formal preliminary discussion, which must cover a number of things—I think there are half a dozen in the Bill. That is not quite the same as the very early recording being proposed for any old discussion that takes place.

Of course, multiple things get covered between a doctor and a nurse, between the nurse and the patient, and between the patient and his doctor about what they are feeling and what they want. However, when it comes to something that is considered sincerely held, it is at that point that the preliminary legal discussion comes in as the first discussion to record.

A lot of these discussions will be recorded in the medical notes. My experience of reading many medical notes is that they do not cover what you would like them to, but on this occasion they often will. Nevertheless, it is not quite the same as what is proposed in the Bill. I urge people to concentrate on what is recorded in the Bill as having to be recorded for that preliminary discussion, because that covers a huge amount more than is being proposed in some of these amendments.

[Baroness Finlay of Llandaff (CB)]

In light of the fact that the noble Baroness said this would be a formal discussion, does she agree that if we are sticking with the principle of choice, autonomy and accurate information, it becomes even more important that the patient is given, as fast as possible, a comprehensive copy of that discussion, and that it is not just left filed in a medical record but should be given to the patient for them to look at and reflect on?

[Baroness Murphy (CB)]

I do not know what the noble Baroness’s discussions with her patients are like, but I remember mine very well. A lot of discussion that goes on between a doctor and a patient does not get formally recorded but is part of the everyday conversation of a consultation. I think we must recognise that we need, as the noble Baroness, Lady Fraser, urged us this morning, to get back to the realistic issues about what patients want and what they talk about.

It is important that we remember what the Bill is about. It is about trying to do something with what we have in normal day-to-day medical practice. It is not about imposing something else on what is ordinary day-to-day practice until such time as people have expressed—probably repeatedly—a settled wish to go down this route and they are terminally ill. Then the proper discussion kicks in and they need all that information. How much of it is provided to them in written form and how much orally is a judgment between the doctor, the nurse and the multidisciplinary medical team looking after them.

[Lord Rook (Lab)]

My Lords, I thank the noble Baroness. Her points are a helpful segue to the amendments that I will speak to, which are very much about the first formal conversation that takes place between a medical practitioner and a patient who is interested in exploring the potential of an assisted death.

I will speak to Amendments 213 and 216 in my name. Like others, I am grateful for the work that has gone into strengthening the Bill; the decision to record the preliminary discussion is significant and important. That said, there remains, in my opinion, a serious gap. Although records must be made, at the moment the commissioner who is responsible for the oversight of this system does not have access to, or visibility of, these records. I recognise that we are close to the Recess and I do not wish to lead noble Lords’ minds astray to their Tube journey home, but my amendments are an attempt to “mind the gap” that has been created here. I hope, in fact, they go a bit further and maybe fill the gap.

By simply making available to the commissioner these written records of the preliminary discussion, oversight becomes evidence based rather than simply allowing regulators to assume the best. This preliminary discussion is the gateway moment in what will be, for some, their final journey. In that moment, a doctor has first sight of the patient’s capacity. In that consultation, the patient first hears their full range of options. In that encounter, there may be the first warning signs of other problems—for instance, evidence of coercion or distress. Because, rightly, this conversation will go on in private, the doctor’s written record is the only durable account of what is likely to be a determinative discussion. As it stands, that account is not available to the scrutinising body, which is the very mechanism charged with monitoring the system.

This raises two questions. First, I ask my noble and learned friend Lord Falconer of Thoroton: if informed consent is the ethical foundation of this legislation then how is this meaningfully verified by the commissioner if the primary record of what was explained, asked and understood is not available to them? Without that record, it will not be possible for a commissioner to verify consent; rather, they will simply take it on trust. Secondly, my question for my noble friend the Minister is: how do His Majesty’s Government expect the commissioner to investigate concerns, or ensure compliance within the safeguards of this Bill, if they are not entitled to see the contemporaneous written record of the very discussion that initiated the process?

We all agree on the need for safety, and if these services are not sufficiently regulated I fear they may not be sufficiently safe. A regulator who cannot see the record cannot regulate the system. A commissioner who can examine only summaries cannot give the system a complete bill of health. There are wider implications too. If a family raises concerns about coercion, what is the evidential basis for any investigation? If a clinician is accused of misconduct, what information do they have with which to defend themselves? If Parliament or the public wish to understand how this law is operating, where is the underlying data that can provide the detail and confidence they seek?

We have, sadly, seen what happens when regulators do not have sufficient sight of the systems they oversee. Between 2005 to 2009, there were serious failings in Stafford Hospital, including widespread patient harm and avoidable deaths. Despite the presence of multiple regulatory bodies, including the Healthcare Commission, the Mid Staffs’ problems were not identified or acted on in time. Why? It is because the regulators relied on aggregated data targets and self-reporting; lacked access to, and failed to interrogate, evidence; and did not have full visibility of serious warning signs and complaints. The lessons learned from Mid Staffs help us to think about how we might mind and fill the gap in this legislation.

Compliance without visibility is not protection, and this is precisely what we need to guard against. From a practical perspective, these amendments are straightforward. They would not impose a new burden on the doctors; the record is already required. They would ensure that the record is shared with the commissioner, who is already acting as the regulating authority. They would align responsibility with capability, visibility with compliance and safety with oversight.

In all legislation, let alone a Bill as consequential as this one, we want services that can be trusted. For that, we need systems that can be scrutinised. A regulator that cannot scrutinise the record cannot regulate the system. These simple amendments would correct that, and I commend them to the Committee.