Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Friday 12th September 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I declare an interest as a trustee of St John’s Hospice.

This is one of the most important Bills we will ever see. For centuries, we have protected and preserved life, which is to me, and to so many, sacred. We are now asked to change utterly and create a way to help people die. The opposition is massive, particularly among medical practitioners and their professional associations. This is a profoundly dangerous and flawed Bill. The Constitution Committee rightly affirms our right to scrutinise, amend or reject it.

The noble Lord, Lord Alton, was to speak today. He was seriously injured last week and he cannot travel. He is not permitted to speak remotely. Had he been here, he would have warned against coercion, inadequate safeguards, inevitable incrementalism and the risk posed to human rights—very important issues.

Is this Bill clear? The consequences are not known. There was no pre-legislative consultation and no proper impact assessment. The committee was selected by the Bill’s promoter. The witnesses selected largely supported the Bill. The evidence secured did not reflect a wide evidence base. Most amendments tabled on Report were not debated or voted on. Many MPs who wanted to speak were not called. The Constitution Committee said yesterday:

“The degree of deliberation, assessment and scrutiny is therefore significantly less than we would expect to see for an equivalent government bill. This is especially concerning given the subject matter of the bill”.


The Bill is a framework for assisted death, nothing more. There are 42 delegated legislative powers, including Henry VIII powers—powers which the DPRRC described as “sweeping, unspecified and unjustified”. Eligibility is very uncertain. What is a reasonably expected death? The definition of terminal illness is unclear: 36% of such diagnoses are recorded after death to be inaccurate; only 48% of prognoses are accurate at six months; and one in two prognoses will be wrong.

Is it safe? Capacity is to be assumed under the Mental Health Act. The assessment process involves two doctors, only one of whom must meet the patient. How will they determine capacity, especially in those suffering from shock, grief and depressive illness after diagnosis? How will it be assessed and monitored? Deaths may take place in hospices. Hospices have said that the Bill is not safe. In care homes, how could it be safe? In people’s homes, are doctors going to be able to manage their practices if they have to stay until the patient is dead—for up to 137 hours? What if someone does not die? It does happen.

Nobody has to check why someone wants to die. Coercion? Someone who feels they are a burden on others, or is lonely or isolated. And how will we keep our doctors and other clinicians safe? Clinicians are being asked to forget, “First do no harm”, and to provide medication to terminate a patient’s life. Many will not do it. What will be the effect of this on our doctors? Suicide rates are already higher among doctors than generally. According to the BMJ, a doctor dies by suicide every 10 days. How will we care for our doctors and keep them in practice? There is a shortage of obstetricians and gynaecologists because of the processes around abortion. The president of the Royal College of Radiologists recently said that there is

“a chronic lack of radiologists and oncologists … the outlook is bleak”.

What will be the effects of the introduction of assisted death in this situation?

Finally, is it accountable? If only 1% of people seek assisted death, that will be nearly 6,000 a year. How will the VAD commissioner find the psychiatrists, lawyers and social workers to constitute panels for 6,000 applications a year at a time when all three professions are understaffed? At only one hour a case, it would take 18,000 panel member hours a year—and, internationally, the rate is much higher than 1%.

The Bill provides little protection and no security around how death comes about. There will be no inquests. Nobody will ask about coercion, abandonment or anything else. Around 50% of those who die cannot get specialist palliative care. Why do we fund 100% of services at the beginning of life but only 30% at the end? Dame Cicely Saunders said:

“You don’t have to kill the patient in order to kill the pain”.


This Bill is ill-conceived, uncertain and unsafe. It should be rejected.