Terminally Ill Adults (End of Life) Bill

Lord Bishop of Newcastle Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[The Lord Bishop of Newcastle]

My Lords, this is not the first country in which I have lived and worked during such a debate as this. I was a Bishop in New Zealand ahead of the referendum on a similar Bill there five years ago. I witnessed the arguments, heard the reassurances and have since followed its implementation, including the pressures on healthcare professionals and the unforeseen consequences from a lack of clarity around process.

Only recently, New Zealand published its five-year review of the Act, highlighting significant practical challenges, concluding that the review committee is ineffective as an oversight body and recommending reforms. Five years on from the passing of a Bill much like the one before us, it would be irresponsible not to take its findings seriously. Most strikingly, the report highlights confused principles for the service and even recommends that the New Zealand Government establish specific principles to underpin the Act. This is no small matter—to be five years into providing the service without clarity on the principles on which it was built. For legislation where the consequences of poor drafting are so high, it is alarming that such principles were not defined from the outset. Yet, almost a year into the passage of this Private Member’s Bill, we are still discussing core concepts, without sufficient detail on how a state-sponsored suicide service would be implemented. That should trouble us all.

In that regard, I will support the amendment put forward by the noble Baroness, Lady Berger, to enable at least more scrutiny by professional bodies. While such uncertainty remains about how the Bill would operate alongside our most important end-of-life care institutions, we should not legislate at this speed or in this way. Our first responsibility must be to ensure that palliative and end-of-life care is accessible and effective for all. Last week, I visited a hospice in Newcastle. I saw and heard at first hand how an affirmation of life and dignity matters for all of us. Proponents of the Bill say that it is about choice, yet I cannot see how this is true when it is both unsafe and unworkable in its current form.

Within the Judaeo-Christian tradition, the idea of being human begins with God, as my right reverend friend the Bishop of Southwark has asserted—the sense of transcendence that informs personhood. Our obsession with selfhood and individual choice belies our dignity and respect for others. In being human, we begin not so much with selfhood but with the idea of the other and of who we are in the realisation of community and society.

Surely, the moral imperative is to help people live. I recall the words of my Bishop, growing up in the north-east, David Jenkins—words now written on his tomb:

“God is. He is as He is in Jesus. So there is hope”.


It is this that deepens and enriches my vision of life and faith, a vision of hope in humanity shared with those of other faiths and none, which are inextricably bound together. I cannot support the Bill and urge other noble Lords to resist it too.

Terminally Ill Adults (End of Life) Bill

Lord Bishop of Newcastle Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I support and have added my name to Amendment 771ZA, in the name of the noble Lord, Lord Mackinlay, which would prevent the assisted dying service being part of the NHS. I agree with the points made by my noble friend Lord Stevens.

Integration into mainstream healthcare appears to normalise the practice and lower barriers to the use of assisted dying. International evidence is instructive—where it is embedded within publicly funded healthcare systems, such as in Canada and the Netherlands, uptake rises steadily over time and eligibility criteria broaden. As we know, in some jurisdictions it is available to minors, people with non-terminal conditions, psychiatric diagnoses, and even people with learning disabilities and autism, as my own published research on the Netherlands has shown.

I agree with my noble friend Lord Stevens that assisted dying is not a treatment. That is a further reason why it should never become part of the National Health Service. The substances proposed to be used neither treat nor prevent disease; they fall outside the legal definition of a medicinal product. The drug regimens proposed are unlicensed, have not undergone appropriate clinical trials and lack international consensus. The drugs that have been used more widely and successfully to provide the much-lauded pain-free and quick death, such as in Switzerland, are not even available or licensed for human use in the United Kingdom.

My noble friend Lord Birt seems to seek to introduce similar criteria as are used in Switzerland, and not just for terminal illness—he spoke about suffering, pain, and conditions that are not eligible under the Bill. In Switzerland, non-profit organisations such as Dignitas operate within that narrow but deliberate legal space created by Article 115 of the Swiss Penal Code, which states that assisted suicide is punishable only when carried out for selfish motives. That means that if it is provided purely out of compassion, with no personal gain, it is not a criminal offence, enabling Dignitas and other similar non-profit organisations to function lawfully so long as they can demonstrate altruistic intent and ensure that the individual is acting autonomously.

Interestingly, Article 115 of the Swiss Penal Code, contained only one clause—I think just one sentence—when it became law in 1942. One wonders whether the smoke and mirrors of the 59 clauses in the Bill and the various proposed new clauses from my noble friend Lord Birt disguise a similar intent. The potential changes and development of the proposals before us today are concerning. Indeed, if something as straightforward as is provided in Switzerland is intended, I do not understand why it was not proposed in the first place. We do not want this in the National Health Service.

[The Lord Bishop of Newcastle]

My Lords, in his opening remarks, the noble Lord, Lord Birt, cited Australia. I am sure that he is aware that no Australian jurisdiction is recognised as one of the 10 comparable jurisdictions in the Bill’s eligibility criteria and the Government’s impact assessment. The most comparable are New Zealand and the United States. This discussion was resolved in our Select Committee by receiving evidence from New Zealand. We need to be consistent and mindful of the Government’s impact assessment and ensure that our comments align with it.

[Lord Sandhurst (Con)]

My Lords, I agree entirely with the noble Lord, Lord Stevens, with his vast experience, and the noble Baroness, Lady Hollins, with hers.

My point is a simple one, which, as a lawyer, has been troubling me for a long time: conflict of interest. There is an internal conflict of interest here within the health service. Are you going to spend the money on this or on palliative care? Will it affect decision-making by medical practitioners? I have talked to a number of them—one of them is a member of my family; I will not embarrass them by saying more—and know that it is a matter of real concern, because this is not treatment, but something quite different.

We do not have to have non-medical things such as, as we have heard, Department for Work and Pensions assessments done under the NHS label. That is contrary to everything the NHS stands for. There would be a conflict of interest within any trust that funds and administers this as to where the money goes. Will it be given more money, specifically? Will it be limited?

The obvious overseeing Secretary of State for this is the Secretary of State for Justice, because you are going to be dealing with the administration of life and death, not simply trying to cure people and save them from death. It is quite different. You are saying, “You can die, and we are satisfied that there are no bad people around you who are encouraging you to opt for this course”. Then there will be the selection and management of the panels, which will be performing a quasi-judicial function, like other assessment panels.

The obvious place for this, which would remove, or at least limit and reduce, the risks within the health service, would be a separate, specific budget given to the Ministry of Justice. We would then know what is being spent. Otherwise, the XYZ trust will say, “Gosh, what do we take this from?” I will not give emotive examples, but that is what will happen in practice, so we need to know that this is a specific service and that the country has said it will have hundreds of millions of pounds a year to run it, but that it will be on top of and ancillary to anything the ordinary health service provides to people who actually want to live, or at least live in comfort.

Terminally Ill Adults (End of Life) Bill

Lord Bishop of Newcastle Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, for the reasons given, mainly by the noble Lord, Lord Empey, and despite what the noble Baroness, Lady Gerada, has just said, it seems to me highly desirable that there should be face-to-face contact if such an enormously important decision is being made. I therefore support face-to-face contact at both stages, other than for reasons where it cannot happen.

[The Lord Bishop of Newcastle]

My Lords, taken together, the amendments in this group highlight the importance of contact with people at the hardest time in their lives—a time when we must be most vulnerable, clinically and personally. This must not be a process in which anyone is made to feel rushed or that can be completed entirely online.

If we are content to enable access to a slick service as quickly as possible, an online service may be acceptable, but if we are to continue to take seriously our duties of suicide prevention, of assessing and meeting unmet need and of safeguarding, the human contact of being face to face is part of that.

During the Select Committee sessions, we heard evidence from the chief executives of Mind and Standing Together Against Domestic Abuse, who said that an online or pre-recorded consultation was not an adequate safeguard to assess a person’s emotional state. This must be especially true in complex cases. I remind your Lordships that prisoners are still eligible under the Bill. As we engage with every group, we must consider how the particular issue might play out in a prison context. All the challenges that we are worried about, including the assessment of unmet need and the presence of an undiagnosed mental disorder, are more difficult in a prison environment. So I would be grateful if the noble and learned Lord, Lord Falconer, could outline whether he thinks in-person assessments should be even more important in a prison context.

Terminally Ill Adults (End of Life) Bill

Lord Bishop of Newcastle Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, it is usually necessary to have a rather greater capacity to make a will than to get married, which may perhaps be rather surprising. I am concerned about two groups of people: those with intermittent dementia who from time to time appear to be entirely normal and then the next day cannot remember anything that has happened, and people who are sectioned under mental health legislation.

Some years ago there was a famous case about someone who was sectioned. It was intended, in his best interest, to amputate his leg, but he absolutely refused. He was allowed to have the capacity to make that refusal, and in the end it was not necessary to amputate his leg. Consequently, it is quite tricky to determine whether that group of people who have been sectioned under mental health legislation will be seen to have sufficient capacity under the Mental Capacity Act.

It would be extremely helpful if the noble and learned Lord, Lord Falconer, could provide us, before Report, with what he sees as the changes that might be achieved to give special status. If he does not do that, we will spend a lot of time, all over again, on an issue that probably could be dealt with fairly quickly.

[The Lord Bishop of Newcastle]

My Lords, I will speak to Amendment 108, to which the right reverend Prelate the Bishop of Lincoln has added his name. He regrets that he cannot be in his place today, as he is interested in this amendment as lead bishop for the L’Arche community in the UK. With the Church of England, L’Arche strives to provide a positive and inclusive residential community in which adults with and without learning disabilities can live and grow together.

Health inequalities come into focus for much of the Bill. As we heard in the Select Committee on the Bill, people with learning disabilities experience significant inequalities in health outcomes. The learning disabilities mortality review found that 40% of the deaths of individuals with learning disabilities in 2023 were linked to avoidable, treatable or preventable causes—double that of the general population. As we heard from Ken Ross on behalf of the National Down Syndrome Policy Group, people with Down syndrome are likely to die 27 years earlier than their peers. He highlighted

“a systemic direct and indirect bias shown within the health service, which could also be linked to a lack of understanding of the needs, wishes, health, learning and communication profiles of this particular group”.

That bias is linked to what other people feel a life worth living is like, sometimes pejoratively described as a life without dignity.

We have heard about the high suggestibility of some people with learning disabilities, and the discrimination they face both in and outside the healthcare system. This is closely linked to capacity. It is clear that additional protections are needed for this group, which is why due consideration should be paid to this amendment.

[Viscount Colville of Culross (CB)]

My Lords, I apologise: this is the first time I have spoken on the Bill. I have added my name to Amendment 115 in the name of my noble friend Lady Finlay. My concern is that, as other noble Lords have told the Committee, the Mental Capacity Act has the presumption that, if in doubt, the doctors making the assessment of the patient’s mental capacity have to assume that they have the capacity unless proved otherwise.

As other noble Lords have also said, if the patient is deciding whether to go into a residential home or what to do about their financial affairs, that is fine. But I am convinced that a terminally ill patient should have to prove that they have the mental capacity to make the gravest decision possible: that of ending their own life. I would like their doctors to have to decide that the patient has the mental capacity to make such a huge decision. Amendment 115 sets out a list of tests to help the doctor come to that conclusion.

To find out the importance of the changes to the Bill put forward in Amendment 115, noble Lords have only to look at jurisdictions where the default position is the presumption of mental capacity. Canada has already been raised by the noble Baroness, Lady Berger, with very good reason. In some provinces, such as Quebec, 8% of all deaths are by assisted dying, and on Vancouver Island, which has lamentable palliative care, the percentage rises to 11%. These, in my view, are big numbers.

I am concerned by the Canadian definition of mental capacity, which, as with our own Mental Capacity Act, emphasises that every person is presumed to have mental capacity unless proved otherwise. In the early stages of dementia, this can lead to cases of people being assumed to have mental capacity for assisted dying, or MAID as it is called in Canada, even when they are confused about the implications of the decision.

I have spoken to a number of Canadian doctors and psychiatrists, who gave me worrying examples of this happening. One doctor told me they had a male patient in his mid-70s with prostate cancer who had been diagnosed with mild dementia. He was admitted to hospital for worsening confusion. Medical investigations were undertaken to determine whether this was delirium on top of the dementia or worsening dementia. During the admission, and before the cause of the worsening condition had been determined, he stated that he wanted to be left alone and that he wanted to die, so the MAID team were called.

The MAID team deemed him eligible for the process, but then the palliative care team were also called. The doctor I spoke to was the patient’s consultant on this team. She interviewed the patient and he told her that he wanted hospice care and palliative treatment. She concluded that he could not differentiate between being sent to a hospice for palliative care and having a lethal injection to immediately end his life. But the MAID team still assumed that he had the mental capacity to go ahead with his first decision to have assisted dying. When they asked him subsequently whether he wanted medication to help him to die, he agreed to it. MAID was carried out shortly afterwards.

I would like the Bill to ensure that there is no confusion about whether such terminally ill patients have the capacity needed for this huge decision. I suggest that Amendment 115’s proposed subsections (1) and (2), which would reverse the presumption of mental capacity, would prove a much better safeguard.

I also draw your Lordships’ attention to whether having a doctor raising the option of assisted dying to a terminally ill patient is regarded as treatment, a matter on which the Minister in the other place said the Government were silent. Proposed subsection (6)(g) of Amendment 115 states that

“the self-administration of such a substance is not a medical treatment for their terminal illness but a personal choice concerning life and death”.

I know that amendments to Clause 5, if accepted, would have the same effect, but I argue that it would be a belt and braces to have the concept that the doctor cannot, unprompted, raise the option of assisted dying in the mental capacity clause of the Bill. It is important that the request for assisted dying is initiated by the patient and is not seen as a treatment initiated by the medical team.

Once again, I turn to the experience in Canada, where doctors and healthcare professionals are duty-bound to raise assisted dying as an option for any patient admitted to hospital who suffers from a condition that makes them eligible for MAID. I spoke to the doctor of a Canadian patient who was found to be eligible for MAID and went into hospital. Each medical professional who visited him offered the option of MAID, alongside the option of drugs to alleviate his condition. This meant that on the day of going into hospital, he was offered MAID six times by six different medical professionals. Each medic was aware that if they did not offer the option, because MAID is classed as a medical treatment, they would be sued for negligence. I fear this will put unnecessary pressure on patients.

Obviously, the eligibility for MAID in Canada is very different from that proposed in the Bill, but Canada is still an important lesson for us. In this country, it is imperative that it is left up to the eligible patient to initiate the request for assisted dying. The amendment would ensure that doctors are not forced to initiate the request, which would avoid the patient feeling any pressure to end their own life. I hope that the amendment will be accepted. It would provide safety rails for patients eligible for assisted dying.