Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Friday 27th March 2026 Lords Chamber

[The Lord Bishop of Southwark]

My Lords, I am glad to follow the noble Baroness, Lady Fox of Buckley, because I added my signature to Amendment 673 in the name of the noble Baroness, Lady Fraser, as did the noble Lords, Lord Carlile and Lord Hunt of Kings Heath.

Allowing for some reticence on the necessity of this amendment, I just wish to make two points. First, the Bill allows an opt-out for registered medical practitioners: a health professional, a social care professional or a registered pharmacist. Administrative tasks are specifically not excluded. The Bill defines health professionals as medical practitioners, pharmacists and nurses, but it does not define care professionals. This is a lacuna, which will cause problems should this or any Bill on this basis pass your Lordships’ House.

Secondly, matters of acute conscience are not restricted to the immediate preparation of a lethal dosage or the medical oversight of the procedure. There will be, for reasons of practicality, not least of cost, pressure on all sorts of ancillary staff, as anyone in a health and care setting will attest. If they are co-opted, either directly or indirectly, into what becomes the final procedure, when the conscience of such an ancillary participant tells them that they should have nothing to do with such a procedure, is it right that they should face sanction or inhibition of their careers, or even dismissal? I suggest not and I hope that the House will support this amendment.

[Baroness O'Loan (CB)]

My Lords, I tabled Amendments 668 and 670 and put my name to eight other amendments. I am supportive of other amendments, which I will explain. We are talking about how to protect the conscientious objections of doctors and other healthcare practitioners, as well as others, through an opt-in system, which would allow doctors and others who are willing to engage in assisted suicide to register their position and thereby provide a framework by which their rights are clear and practitioners are not subject to organisational pressure to engage with elements of the process or indeed the whole process.

We need to remember that medical practitioners need certainty about their legal and ethical obligations, especially when they are in a situation in which they may find themselves dealing with matters of life and death. In addition to this, many of those who work in healthcare have religious beliefs, which would preclude their engagement in facilitating others to kill themselves. Catholics, some other Christians and Muslims would be precluded from participation, yet may be prejudiced in their employment opportunities and prospects by this inability to engage. It is important, therefore, that this factor is considered and any such consideration should surely lead inevitably to the acceptance that the only way this can actually work is for people to opt in rather than having to opt out.

To that end, I have tabled Amendment 668, which would provide for a comprehensive conscience protection, allowing any person, not just a registered medical practitioner, to opt out of any activity that may facilitate assisted suicide, including any ancillary functions. Amendment 670 seeks to define what might be said to comprise assistance under the Bill, referring to

“any aspect of assisted dying under or in connection with the provisions of this Act, including but not limited to … administrative or managerial tasks, such as the allocation of”

duties to carry out these tasks; supervision of those to whom tasks are allocated; and

“accompanying and monitoring of a patient as they receive or after they have received the approved substance”,

the lethal drug. I also put my name to Amendment 665, which states:

“No health or social care organisation, team or professional is required or expected to participate in any part of the process of a person’s request for an assisted death”.


I added my name to Amendment 660, which would provide that

“involvement in assistance is wider than only the direct administration of lethal drugs”.

This would clarify the nature of what can be considered “assistance” under the Act.

I added my name to Amendment 679, which is similar but more specific and states:

“No company, charity, or other organisation is under any duty to participate in, facilitate, or permit on its premises the provision of assistance in accordance with this Act … No company, charity, or other organisation shall be required, as a condition of receiving funding or any other benefit from any public body, to participate in, facilitate, or permit on its premises the provision of assistance in accordance with this Act”.


This is fundamentally important to ensure that hospices, care homes, nursing homes and other similar organisations do not have to engage at all with the process of assisted suicide. It would also, I think, include prisons.

I declare my interest as a trustee of a hospice. There is a considerable fear that not providing explicitly to protect hospices in this way could lead to all sorts of difficulties. There is currently an expectation that hospices will provide care and support of many kinds and that they will not be involved in assisting people to kill themselves. To provide otherwise would change the whole ethos and purpose of a hospice.

The amendment would ensure that no financial consequences could ensue from a hospice maintaining its traditional ethos and operations and not engaging with assisted suicide. Amendment 770 would not provide that additional protection. The importance of this cannot be overestimated. Failure to protect hospices in this way may very well lead to the closure of hospices at a time when there is a huge shortage of expert palliative care, as we have heard so often.

These amendments are all tabled to ensure absolute clarity for professionals and patients and to further define the nature of the protections that professionals will have under the law should they not wish to become involved with assisted suicide. Very significant deficiencies would be created. Many potential legal challenges could be avoided if there was absolute clarity about those professionals who wish to engage with assisted suicide and equal clarity that administrative and all other NHS staff cannot be required to engage with any aspect of assisted suicide.

As has been said, the Royal College of Nursing has stated that nursing staff should have to actively choose to be involved and that it is “absolutely clear” that nurses have the right to say:

“I want nothing to do with this”.


That is the language of the Royal College.

The solution lies in the establishment of publicly available registers of professionals who do wish to be involved. I support the establishment of an opt- in system and have therefore put my name to Amendment 189, which would require the Secretary of State to establish and provide for the updating of a public register of registered medical professionals, supported by the BMA and the Royal College of GPs, who are willing and able to “conduct a preliminary discussion” under Clause 5(3).

Amendment 268 would provide that only doctors who have specifically opted in can become co-ordinating doctors, and that

“only those who positively choose to do so”

would be able to

“have the training and participate”.

Amendment 359 refers to “the independent doctor” in Clause 8, who would also have had to “explicitly” opt in. Amendment 617 would amend Clause 26(2) to provide that, where a co-ordinating doctor authorises another doctor to carry out the duties and provide the lethal drugs to enable a person to end their own life, that doctor must have expressly opted in to do so.

I support Amendment 680, which would provide for a specialist register for clinical psychologists who want to participate, to be operated by the Health and Care Professions Council, and similarly Amendment 681A, which would require a specialist register for assisted dying for pharmacists to be kept by the General Pharmaceutical Council, providing for those who are not registered medical practitioners, et cetera.

On training, the noble and learned Lord, Lord Falconer, has limited the statutory opt-in language to the bespoke training for co-ordinating doctors and independent doctors. His amendments do not provide the system-wide opt-in protection that the royal colleges have requested. Consequently, doctors, GPs who do not wish to be co-ordinating doctors or independent doctors, nurses and other front-line staff may be required to participate in basic or tier 1 training and participate in peripheral aspects of the process.

It is important to say that it would not be cost effective to train every member of the National Health Service in the provision of assisted suicide if they are not going to engage with it. We always have to remember that training has to be repeated—I will not give way, the noble Baroness can come in later—and is not a one-off. There are huge costs and extractions of staff from the delivery of services when they have to do training.

--- Later in debate ---

[Baroness Gerada (CB)]

On a point of clarification, we have heard it said several times that the Royal College of GPs is in favour of a publicly available register. To the best of my knowledge, and having just checked, the Royal College of GPs is not in favour of a publicly available register. It is in favour of opt-in, but not of a publicly available register.

[Baroness O'Loan (CB)]

I said that there should be a publicly available register and that the Royal College of GPs is in favour of an opt-in.

[Lord Mohammed of Tinsley (LD)]

On a point of clarity, having sat and listened and wondered whether I should intervene, the noble Baroness mentioned a number of faiths and the fact that people from those faiths do not believe in assisted dying. But people from those faiths also do not believe in childbirth before marriage. Is there any evidence to suggest that people are opting out of midwifery because of that reason? Or is it just your opinion that people from those faiths may not want to take part? I am from one of those faiths and although, as noble Lords may have heard, assisted dying might not be for me, I am not here to stop others. I am sure that others in medical professions might also share that view.

[Baroness O'Loan (CB)]

I am not sure of the logic of what the noble Lord is saying. I apologise to the House; I am struggling slightly. We are talking about assisted dying here and nothing else. I am saying that there has to be a conscience clause: that people of faith—I do not know how many faiths are involved—must have the right not to go against their conscience. That is one of the human rights that we absolutely must have.

[Baroness Watkins of Tavistock (CB)]

My Lords, I am broadly supportive of tightening the issue of ensuring that people’s conscience and beliefs are recognised and I support people who are prepared to work with patients who are, I remind the House, terminally ill adults wanting an end-of-life story that is different from full, extensive palliative care. I am completely supportive, as is the Royal College of Nursing, of full palliative care being what the majority of people will choose. However, there is a small proportion of people who would choose the principles of the Bill because of the nature of their particular illness, or personal choice.

I have talked before about all healthcare professionals’ responsibility to try to talk with patients about the choices that are available to them. The thing that has upset me most this morning is thinking about patients whom I have worked with and done everything, together with the multidisciplinary team, to keep alive who have taken their own lives because of severe enduring mental illness. I wish that we could stop referring to this as an assisted suicide Bill. It is terribly hard on people who have relatives and friends who have died through their own hand, usually in great distress. The whole purpose of the Bill we are talking about today is to reduce stress and distress for the small proportion of people who want this as an option.

[Baroness O’Loan (CB)]

I assume that the noble Baroness is aware that one of the reasons why we need to be absolutely specific about what we are doing is that 42% of people think assisted dying is palliative care. We need to make clear what we are talking about.

[Baroness Watkins of Tavistock (CB)]

I accept that. There was a helpful article in one of the newspapers this week talking about using the term “assisted death” rather than “assisted suicide”. I am pleased that I have had the opportunity to say it in the Chamber.

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[Lord Falconer of Thoroton (Lab)]

There is a difference between expectation on the one hand and opt-in on the other. We take the view, after discussions with the BMA, that opt-in is sufficient to make it clear that you have to actively take a step before you are required to participate. The fact that you have to opt-in means there is no expectation, one way or the other, that you need to opt-in. I take the view that that is an adequate response. I do not know whether the Royal College of General Practitioners had a chance to look at our amendments, but I suspect that they will be adequate in relation to that point.

From there, I go on to Clause—

[Baroness O’Loan (CB)]

I thank the noble and learned Lord for giving way. This really is the most important point. There are elements of the delivery of health service that require an ability to understand what a doctor is doing and what his views are. If we only have doctors opting in, we will not know which doctors have opted in, and they will not know which doctors have opted in. They may wish to do the training and then, after, to not participate in the process. That may change their views. Therefore, it is not sufficient to make a clause that says, as Amendment 669A does, that the doctors will opt in and therefore that deals with the problem of opting in, because it does not. The reality is, with great respect to the noble and learned Lord, that we need a specific provision for opting in in the Bill, as suggested by the noble Baroness, Lady Finlay.

[Lord Falconer of Thoroton (Lab)]

There is a specific provision for opting in. I am not quite sure what the noble Baroness is saying. It is absolutely clear that that is the provision.

I move on to the amendments to Clauses 5 and 31 on the width of the opt-out. As far as Clause 5 is concerned, as I indicated to the noble Lord, Lord Harper:

“No registered medical practitioner is under any duty to raise the subject of the provision of assistance in accordance with this Act with a person”.


A number of noble Lords, including the noble Lord, Lord Stevens, made the point, and he referred to Professor Ruck Keene and others’ articles on the problem. We have approached the question of whether it is a treatment or not on the basis of what provides a practical answer to doctors and medical professionals. If you say that it is not a treatment, I do not see why that would necessarily obviate the need, if you are worried about doctors or health professionals having, in particular circumstances, to raise it. The key thing for the doctor to know is there can never be a legal duty on him or her to raise it or to become a participant in the system.

What more could—