Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

Moved by

[Lord Carlile of Berriew]

As an amendment to the amendment in the name of Lord Forsyth of Drumlean, to leave out “and to provide full support at ministerial and official level to the peer in charge of the bill for its remaining stages in the House of Lords”.

[Lord Carlile of Berriew (CB)]

My Lords, I should make it clear at the outset that I am opposed to this Bill in principle but, above all, I am opposed to it because it is not an adequate Bill to deal with all the issues raised and does not provide anything like sufficient protection for those vulnerable people who might be persuaded, against their real will, to accept assisted suicide.

I agree with the words in the amendment tabled by the noble Lord, Lord Forsyth, apart from his bold bid that, in effect, this Private Member’s Bill should be treated as a government Bill. That was not what the noble and learned Lord, Lord Falconer, said was happening; I am sure that he would confirm that civil servants are insisting on their neutrality being maintained, even when they are looking at the feasibility of the Bill—I see him nodding in agreement. The noble Lord, Lord Forsyth, asks for

“full support at ministerial and official level to the peer in charge of the bill”.

That would put the noble and learned Lord in the position of a Minister. Such support is inappropriate for a Private Member’s Bill of this kind. It does not pretend for one second to be neutral or even-handed.

If the last 27 words of the amendment tabled by the noble Lord, Lord Forsyth, were removed, I would agree with it completely, but he seeks to take the steps that I have just described. Indeed, despite the large resources supporting the purposes of this Bill and the involvement of many experts, including the noble and learned Lord, Lord Falconer, one of our most respected and knowledgeable legislators, this Bill earns a D-minus for its draftsmanship, even after all those committee meetings in the other place. It needs to be dismantled if it is to be an effective and proper Bill, to give it what I would, as a shortcut, call legislative legitimacy.

What evidence is there for the propositions that I make? I will cite two pieces of evidence that emerged from your Lordships in the last two days. First, the Delegated Powers and Regulatory Reform Committee, chaired by the noble Baroness, Lady Ramsey of Wall Heath, produced a report a couple of days ago which there is no time to read out. I will simply summarise that, by the calm standards of that committee, its criticism is excoriating. I was on that committee for a considerable period, and I never saw any Bill criticised to that extent. It says that the Bill is simply not fit for purpose, breaking several standard rules of draftsmanship. It is incompetently drafted, after all the time that has been spent on it, with the steersmanship of the noble and learned Lord, Lord Falconer. Then yesterday, the Constitution Committee reported and endorsed the views expressed by the other committee, saying, in effect, that the Bill was not fit for purpose.

We must remember that this Bill would allow a citizen deliberately to perform acts which are intended to cause the death of another citizen. Since the end of capital punishment, no such act is allowed in our law to any citizen other than in war. That is the weight of the change which this Bill seeks to make. We must be given time, the space and the methods to amend the Bill if that can possibly be done, hence my support in due course for the amendment tabled by the noble Baroness, Lady Berger, which would allow a Select Committee to hear evidence which the Commons committee chose not to hear and would have been very persuasive. I beg to move.

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[Lord Pannick (CB)]

My Lords, I will focus on the content of existing law relating to end-of-life issues. I do so to make the point that the current law recognises the fundamental importance of autonomy. It rejects the absolute sanctity of life, about which we have heard much from the Bishops’ Benches and noble Lords, and the Bill will introduce greater dignity and greater safeguards than currently exist.

There are two basic legal principles. The first is that you have a legal right to end your life. Since the enactment of the Suicide Act 1961, attempted suicide is no longer a crime. You do not need to satisfy a panel of doctors or psychiatrists. There is no special protection against your relatives. If you are a competent adult, the doctors cannot require you to eat, to have a blood transfusion or chemotherapy, and they cannot stop you going to Dignitas. Why is that? Because the law recognises that it is your life, and so it is your decision, and because the law rejects the absolute sanctity of life.

There is a second legal principle that follows from this, and it is that the health system has a legal duty in some circumstances to take positive steps to implement your wish to end your life. I will give noble Lords an example: the case of Re B (Adult, refusal of medical treatment) [2002] 2 All ER 449. This was an adult woman who was paralysed from the neck down. She was dependent on an artificial ventilation machine to breathe. She wanted the machine turned off: she wanted to die because of the poor quality of her life. Her doctors declined to do so, so she applied to the courts for an order that they do so. The noble and learned Baroness, Lady Baroness Butler-Sloss, then the president of the Family Division, granted that order. She said the woman was an adult; she was of sound mind; it was her decision whether to live or die.

Parliament has intervened in this area. We made provision by the Mental Capacity Act 2005, Sections 24 to 26, to allow an adult of sound mind to make an “advance decision” refusing treatment to prolong their life, should the occasion ever arise, and should the person at that time lack the capacity to indicate their wishes.

I have one other example. When Tony Bland, a victim of the 1989 Hillsborough football stadium tragedy, was in a persistent vegetative state with no prospect of recovery and could not express a view about whether to live or die, the Appellate Committee of this House decided in 1993 that because he had no quality of life, there was a legal duty on the health authority to end his life support—to pull the plug. That is what the doctors did, and there have sadly been many similar tragic cases since.

For this Bill to authorise doctors to assist a person to end their life by providing a drug so they can die with dignity is entirely consistent with well-established legal principles which respect autonomy on end-of-life decisions. The Bill contains many more safeguards than already exist. It enables terminally ill people to end their life in a less painful and more humane manner than starving themselves to death or otherwise committing suicide, or travelling to Switzerland.

[Lord Carlile of Berriew (CB)]

My Lords—

[Lord Pannick (CB)]

I cannot take questions.

[Lord Carlile of Berriew (CB)]

Why not?

[Lord Pannick (CB)]

Because we are restricted to four minutes.

I support the Bill. I look forward to debate—including debate with the noble Lord, Lord Carlile—in Committee. Thank you.

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[Lord Carlile of Berriew (CB)]

Before the noble Lord sits down—

[Noble Lords]

No.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

My Lords, I do not know if I am alone in being frequently asked by people, from time to time, “What is the point of an unelected House of Lords?” I now have the absolutely mind-blowing answer, which is to refer them to these two days of debate on this really difficult subject and the range of expertise which we have heard.

I am speaking because I tabled an amendment. That was last Friday, so some noble Lords may have actually forgotten what it said. It called

“upon His Majesty’s Government, in the light of the 32nd Report from the Delegated Powers and Regulatory Reform Committee, to ensure sufficient time is available for consideration of amending stages of this bill, and to provide full support at ministerial and official level to the peer in charge of the bill for its remaining stages in the House of Lords”.

Despite the differences that we have heard in these two days of debate, there is a clear and absolute consensus across the House that the Bill is in need of amendment and further scrutiny.

I listened very carefully to the speech of the noble Baroness, Lady Berger, and I see her amendment. I am a little doubtful about how a Select Committee—which is not really a Select Committee because it is not going to produce a report; it is simply going to hear evidence—is going to change or alter the noble Baroness’s opinion on this matter, or indeed anyone else’s. However, it means we cannot actually start that task until 7 November, so we have lost some time.

As many speeches pointed out, none of us knows when and how we are going to die; none of us even knows when the end of the Session is going to be. So, between 7 November and the end of the Session, having listened to all the speeches and thinking of the number of issues that are going to have to be addressed, I venture to suggest that four Fridays for private Members’ legislation, unless we are going to completely destroy the prospects of other people with Private Member’s Bills, are not going to be sufficient time. It therefore seems essential that the Government provide time.

I understand why they do not want to do that: if I were in government and in the Prime Minister’s Office, I would be saying, “But that means we won’t have time for this, that or the other”. But this is an absolutely life-and-death issue and it is important that it is considered properly and put on the statute book, if it is to be put on the statute book, in a way that will satisfy my noble friend Lord Wolfson of Tredegar in his brilliant speech. He showed that what we are doing here is making legislation and we should put legislation on the statute book that has been properly thought through, which means that there has to be government time.

I happen to know that the Cabinet Secretary advised the Government that this should be treated in the way that all Private Members’ Bills dealing with matters of conscience are. Abortion, the death penalty and the decriminalisation of homosexuality were Private Members’ Bills that the Government took on board in order to ensure that they had proper time and were properly supported, and I do not—I was going to say “for the life of me”—understand why that should not apply to this Bill, having listened to these two days of debate. I suspect it might be because the Health Secretary and the Justice Secretary were opposed to the Bill—but we are told that the Government are neutral, and therefore I do not see why they should not provide that time in order to satisfy those people who have written to us on both sides of the debate.

I say to the right reverend Prelate the Archbishop of York, who threatened to vote down the Bill at Third Reading, that I hope he will think again about that. The expectations are sky high and to vote down a Bill that had not been properly considered or given enough time would put this House in a very awkward position, for no good reason. Our duty is to scrutinise the Bill, send it back to the House of Commons and ensure that we have the time to do a proper job.

[Lord Carlile of Berriew (CB)]

My Lords, noble Lords may recall—but I will remind them in case they have forgotten—that I tabled an amendment to amend the amendment from the noble Lord, Lord Forsyth, because it seemed to me that the noble Lord wanted to turn this Bill into a government Bill and give it all the authority of a government Bill, with a Minister in charge, or by putting the noble and learned Lord in the position of being a Minister. However, I have listened to the noble and learned Lord and he has said—absolutely rightly, and I totally agree with him and the noble Lord, Lord Wolfson—that this absolutely should be, and should remain, a Private Member’s Bill.

I have also looked at the potential effect of the amendment to the commitment Motion from the noble Baroness, Lady Berger, who I think has approached the Bill with great energy, superb intelligence and good judgment, and has done great credit to the House. Having considered that and the state of play as it is now, I think it is right that I should withdraw my amendment so that we can move quickly on to other, more substantive matters. I beg leave to withdraw the amendment.

Amendment (to the amendment) withdrawn.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Berridge (Con)]

I will just reply to the noble Baroness, then, that within the Bill that is not necessary. I have outlined Clause 10. This applies to the people who are verifying in the process, not to the individual. It was not in the Motion your Lordships’ House approved that that evidence should be taken.

To continue, Dr Annabel Price said:

“Pressure has a broader definition of perhaps strong encouragement, expectation or the worry of letting somebody down”.


The noble Lord, Lord Patel, joined in this mini focus group and asked:

“If I were to use the word ‘pressure’ and if I were to use the word ‘coercion’, how would you interpret the two?”


Professor Mumtaz Patel from the Royal College of Physicians—again opposed to the Bill—said, “It is grey”.

Amendment 846 also reflects the view of the Law Society, which is neutral on assisted dying but opposed to the Bill. Kirsty Stuart said:

“I think it is really difficult because there is not a definition at the moment … in the Bill”.


That is why Amendment 846 is based on the statutory guidance principle from the offence of coercion under the Serious Crime Act. I note that the Home Office has recently had to issue 91 pages of statutory guidance on that offence. It seems the courts are struggling with it.

Even if Thomas Teague is right that you look at the dictionary, are we talking about economic pressure, emotional pressure, financial pressure, spiritual pressure, reputational pressure, internalised or externalised pressure, or pressure of circumstances—for instance, no one provides you with a hospice bed? As Dr Suzanne Kite, from the Association for Palliative Medicine, said:

“We know that there are pressures of, ‘Can we afford the electricity for the oxygen supply?’ … Yes, these are issues”


that people face “on a daily basis”. The Bill is silent as to what kind of pressure is meant.

To move from individual sources of pressure, there can also be group sources of pressure. Alasdair Henderson, from the Equality and Human Rights Commission, spoke to the Select Committee about

“this wider issue of coercion or pressure at a societal level or an attitudinal level”

and

“the broader trends or cultural issues”.

He said that

“pressure is not always applied directly by another individual, but can result from attitudinal barriers, particularly around disability, and lack of services and support in society as a whole”.

Could pressure come from NICE refusing you, on value-for-money grounds, the drug that you think will wipe out your metastasised cancer? Indeed, the pressure could emanate from the Chancellor of the Exchequer in her Budget, or from the Secretary of State for Health and Social Care, to encourage vulnerable people to take assisted dying, a matter I put to the Government Minister, Stephen Kinnock.

Caroline Abrahams of Age UK said:

“The context again for this is a system in which adult safeguarding is under acute pressure because local government is under such acute pressure”.


The British Association of Social Workers also said that unless these statutory services

“are adequately resourced, that may bend people’s decision a certain way … much of social care is self-funded now. If you are poor and you cannot have access to those personal resources, even more pressure is applied to you”.

I look to the noble Lord, Lord Pannick: how does a medical practitioner sign to say that this kind of pressure—from culture, society or attitudes, or lack of statutory services—is not being put on the individual?

There was unanimity in the Select Committee when we started asking the professionals about training. I said that pressure

“is not defined in the Bill, so I am afraid I cannot help you. We have no definition in the Bill. You are going to need training, though, in pressure. Has any of you received any training like that?”

Professor Nicola Ranger from the Royal College of Nursing, Professor Mumtaz Patel of the Royal College of Physicians and Dr Michael Mulholland from the Royal College of GPs all said no. So we now have additional costs added to the Bill, because we have to devise training in pressure and deliver it to a whole raft of professionals, care staff, et cetera, so that they understand it, in particular bearing in mind the vulnerability to criminal prosecution that exists in Clause 34.

I am going to give the noble and learned Lord, Lord Falconer, this opportunity to shorten Committee proceedings. Deleting “pressure” from the Bill, when it has not been consulted on and has not been subject to pre-legislative scrutiny, would aid the Committee in evaluating the Bill.

[Lord Carlile of Berriew (CB)]

My Lords, in a group such as this, which has so many conceptual, linguistic and semantic alternatives on offer, it is very difficult to see how a Committee stage such as this is going to help very much in determining a final solution to the matters under consideration. Therefore, it could become very tempting to enter into the nice and easy solution suggested by my noble friend Lord Pannick, to the effect that the Bill is quite enough and provides sufficient protection. It is right to say that the Bill certainly seeks to provide sufficient protection, and I do not in any way attribute anything other than good motives to those who sponsor the Bill, in particular the noble and learned Lord, Lord Falconer.

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[Baroness Hayter of Kentish Town (Lab)]

If I could just finish. It has been a long time in this debate without hearing from my side—I want to come on to something that the noble Lord, Lord Deben, said anyway.

The amendments to this Bill are about coercion or pressure. As stated by the noble Lord, Lord Pannick, the situation at the moment is that people can go to Dignitas without even proving to a doctor that they are dying, and without any check as to whether there is coercion or pressure, or whether someone is going to inherit their house. They can go, and that is the way they end their life, and they feel it is not worth living any longer. On the definition of coercion, are we really content with continuing the status quo where there is absolutely no check—from a psychiatrist, a social worker, a lawyer, or anyone else—on whether they have been coerced? That is the alternative: allowing the status quo to continue with no checks whatever.

We have to ask, therefore, whether these discussions about definition are really about that, or whether they are about trying to stop the Bill. Perhaps we could discuss whether those who want the wording changed would then support the Bill. If they would, let us get down to discussing that, but if they are never going to, they are wasting the time of those who want it to go through.

[Lord Carlile of Berriew (CB)]

My Lords—

[Noble Lords]

Order!

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[Baroness Hayter of Kentish Town (Lab)]

I was not suggesting wasting time. I was asking whether, if these changes were agreed, people would then allow the Bill to proceed.

[Lord Carlile of Berriew (CB)]

Before the noble Baroness sits down, I have great admiration for her, but I and many others resent her waving her hands at us. The reason we wish to have the sorts of discussions that I was mentioning was so that, believe it or not, we can make a judgment as to whether we are prepared to support the Bill, or to be silent on whether we support the Bill, or to oppose it at Third Reading. It is unworthy of the noble Baroness to allege that all of us here who are expressing concerns are wasting time. It is not true, and it is what she said.

[Baroness Hayter of Kentish Town (Lab)]

I never said that about wasting time. The words did not come; I did not say them. I was asking whether the people who want a better definition will then be able to support the Bill.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, and I certainly will consider it, but I think it is important that we have a discussion about what I regard as a compromise Motion, which may be useful in the discussions noble Lords have with the sponsor or those who wish to proceed in that way.

[Lord Carlile of Berriew (CB)]

Would the noble Baroness, for whom I have a great deal of respect, consider whether she is really adding anything at all to the debate by continuing? We can read her amendments; we know the difference between 18, 21 and 25. I and the noble and learned Lord, with whom I do not disagree on the fundamental principle behind the Bill, are both of the view that we should have proper discussion on it and get through Committee in the way that is expected of us as the House of Lords, so when the noble and learned Lord intervenes and says he is willing to hold meaningful discussions, we should do that and move on to the next business.

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The noble Baroness, Lady Coffey, commended a test of domicile. Domicile is one of the most complex legal concepts that we have. There is domicile of origin, domicile of choice and domicile of operation of the law. In my opinion it would be disastrous for us to incorporate such a concept into this legislation, not least because I can have domicile in this country simply because it was the domicile of my parents when I was born. I could have lived my entire life in the United States, France or wherever, but would be able to come back to this country to benefit as a health tourist and take advantage of this Bill if enacted. That is exactly what we all want to avoid. Domicile should be ruled out. I hope that the noble and learned Lord, when he responds, will confirm that.

[Lord Carlile of Berriew (CB)]

My Lords, I agree with my noble friend Lord Pannick. The concept of residence is clearly understood. I recommend to the noble Lord, Lord Moylan, that he might need a criminal lawyer just in case he was prosecuted for doing something wrong. I would be very happy to act for him, of course.

I recommend that all of us who are considering this matter should have a good look, as I have, at the National Health Service ordinary residence tool, which was revised in March this year. It gives a very clear outline of all the possibilities and where they fall in the ordinary residence judgment. What concerns me about the example that the noble Lord, Lord Moylan, gave, which we will come to on another group, possibly even today, is that if somebody has been living in Spain and wants to come back to their former country of ordinary residence for an assisted dying, if this Bill becomes law, it will prove extremely difficult to detect where there has been undue influence, particularly within a family. It would be extraordinarily difficult to investigate that evidence, whether it was done by a court or by a panel. I would be opposed to it on those grounds.

[Baroness Butler-Sloss (CB)]

I also entirely support, including the word “disastrous”, the points that the noble Lord, Lord Pannick, made. As he said, domicile is complex. You would end up in court dealing with the issue of domicile. It really is not a good idea.

Under Clause 1(1)(c), there are two requirements. One is “ordinarily resident”. I say to the noble Lord, Lord Moylan, that if I was trying the case I would have no problem at all. If it says “ordinarily resident”, that is what I would accept, so long as there was the evidence to support it. I do not think we need to be caught up in the Human Rights Act in dealing with such an issue. What worry me are the two requirements,

“ordinarily resident … and has been so resident for at least 12 months ending with the date of the first declaration”.

That seems to be a complete bar for someone who is in an embassy. It is very difficult if they are not ordinarily resident. It looks as though the noble Lord, Lord Carlile, does not agree.

[Lord Carlile of Berriew (CB)]

I hesitate to interrupt my noble and learned friend, whom I regard as being of almost biblical correctness in almost everything. If she were to take a look at the NHS tool that I referred to, which sets out all the requirements to prove ordinary residence, she would find that people who work in embassies, for example, are excluded because they are given fixed-term contracts for a certain time, even though that contract may be extended at some time. It also specifically refers to people who work for charities and who go to work abroad for a temporary period fixed by a contract. I do not think the issue that she has raised is very worrying.

[Baroness Butler-Sloss (CB)]

I am delighted to hear it in relation to embassies and charities, but the other example given was the person living in Spain who wants to come back to die here. It seems to me that needing to be resident in this country for the last 12 months would not allow that person to do so. The noble and learned Lord might just look again at that particular element of residence.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

Moved by

[Lord Carlile of Berriew]

25: Clause 1, page 1, line 12, at end insert—
“(e) has had their application for assistance under section (Application for assistance with suicide order) approved by the Court,”

[Lord Carlile of Berriew (CB)]

My Lords, I welcome what the noble and learned Lord has just said, which I am sure will be welcome to most Members of the Committee.

Amendment 25 stands in my name and those of my noble friend Lady Hollins and my noble and right reverend friend Lord Harries of Pentregarth. As is obvious, Amendment 25 is part of a large group. I apologise for the number of amendments and clause stand part notices in my name in the group. I was given excellent help by the Public Bill Office, and many of those amendments and clause stand part notices are simply designed to fit my proposals into the architecture of the Bill as it arrived in your Lordships’ House from the other place.

Amendment 25 is entirely dependent on Amendment 120, which is the key amendment in this group. That is also supported by my noble friends Lady Hollins and Lady O’Loan and my noble and right reverend friend Lord Harries of Pentregarth. I suggest that they are a formidable Cross-Bench group of medicine, the Church and the law, to which all will wish to pay close attention.

Amendment 120 sets out a matter of some principle which, if not conceded by the promoters, will have to be determined on Report. The conclusion on Amendment 120 reached on Report may well affect how some noble Lords will vote if there is a vote at Third Reading, because Amendment 120 is all about the safety of the proposed legislation.

Early in my remarks, I want to mention a very important point that may shorten the debate on this group. The promoters have rightly enjoyed assistance from neutral officials, including parliamentary counsel, in the drafting and structure of their revised proposals. Before we reach Report, or shortly after if successful with the principle I am raising, I am sure that those of us who support these amendments will receive and welcome comparable access. I invite the Minister to confirm that there would be equality of arms in perfecting the proposed clauses and amendments.

The issue of principle is whether permission for assisted suicide should be given by the court or via a panel. The promoters’ original intention was very clear: it was to be a court-based process. But by amendment they moved their choice to the panel procedure that currently appears in the Bill. I believe that they had two main reasons. First, the courts may not have enough judges to deal with the volume of applications they expect. The court in question at that stage was simply the High Court of Justice Family Division. Secondly, it might prove more difficult to obtain permission from a court than from the panel as now described.

As to the judges, Amendment 120 offers a simple and sound solution that I am surprised had not been thought of before. It would broaden the range of judiciary who would be designated to reach these momentous decisions, which involve the deliberate participation of one individual in bringing about the death of another. That a judge should be involved is, I suggest, self-evidently appropriate and what we should expect, given that third-party participation in a death would otherwise involve the offence of murder. I remind your Lordships that murder is defined as being involved in bringing about the death of another with the intent to kill or do grievous bodily harm.

Decisions about whether life support should be switched off are regularly heard by judges of the Family Division of the High Court, as are other extremely important decisions concerning family life, including matters affecting contact between parents and their children. There are, however, only 20 High Court judges in the Family Division, including the president. But, around the country, there are more than 40 designated family judges: specialist circuit judges who deal with the most difficult and important cases. By adding those 40-plus designated judges into the cohort of judges who would decide cases envisaged by this Bill—they were not envisaged as part of the process originally—there would, I suggest, be an ample supply of skilled and diverse expert judiciary, who would provide confidence-inspiring judgment in this important and difficult new area of the law.

The training of judges is very important in this context. The Judicial College provides expert training for all judges, including in specialist jurisdictions. There are those in this Chamber who have acted both as students and tutors in the work of the Judicial College. I add that there is a cohort of recorders, who are part-time judges, who could fill any listing gaps caused by this new jurisdiction.

As to the second objection—that it might prove more difficult to obtain permission from a court than from a panel—I suggest four cardinal points. First, it should not be easy to permit third-party involvement in someone’s death—nor should it be impossible, which is not the aim of these amendments. These amendments are predicated on the assumption that assisted suicide becomes lawful. It should be the subject of a procedure proportionate to the great legal change involved. In some cases, that may make an application more challenging, but those are exactly the cases in need of increased scrutiny and protection.

Secondly, where do we expect difficult issues of this level of seriousness and complexity to be tested and adjudicated upon? Generally, the answer is: in the courts, of course. There is no comparable precedent in which a matter affecting life and death is handed to a panel, even one chaired by a senior or retired lawyer. There are good reasons for that expectation. The court has special powers, which include, importantly, ordering the disclosure of documents, such as relevant correspondence and medical records, and the power to examine in a balanced way the arguments and evidence of both sides of a question, and to make a reasoned decision about what evidence to accept or reject. An example of such an issue might be whether, for example, an applicant is ordinarily resident in England and Wales or the UK—not necessarily an easy question to answer.

The court procedure allows the intervention of what are called interested parties—close relatives, for example, between whom there may be important and relevant issues—if the court regards the interventions as of potential value. Every day of the week, courts consider whether interveners should be allowed in a particular case, on the merits. Another thing that courts do is produce reasoned judgments in which clear findings of fact and law are set out. This is part of the everyday work of judges in every court around the country.

My third cardinal point is the appeal process. An appeal process is well understood and would be available through the courts. The court has a very good reputation for efficiency and prompt action in cases that clearly require it. Where real urgency is required, the courts respond, in a familiar jurisdiction that does not have to be designed from scratch and commands as much public confidence as any process that we have in our polity in this country.

My fourth cardinal point is that courts are familiar with the concept of individual capacity, with hearing and deciding upon expert evidence, and—above all in this context—with dealing with allegations of undue influence. The greatest worry I have about this new jurisdiction is that undue influence, often financially motivated, may feature heavily in some cases. There is some evidence—from Canada, for example—that that has been a real issue in a significant number of cases. Rooting out undue influence after the event offers absolutely nothing in this jurisdiction because the individual whose life is being discussed will already be dead.

The experience of judges, honed in practice in which, from time to time, they all encounter examples of the most egregious and devious behaviour, together with the forensic nature of the court process, promises a reasonable prospect of fair and proper decision-making. It may be of interest to note that, yesterday, we welcomed into our House a new Member—the noble Lord, Lord John—who has spent his legal practice dealing with just that issue of undue influence as a distinguished probate lawyer. That is just an example of the way in which lawyers and the courts deal with these issues. In addition, the recruitment of judges is statutory, well tested and very successful. The recruitment process suggested for the panels has none of those known qualities. Indeed, it is an unknown quantity.

I promise your Lordships that I do not propose these amendments in a way that is intended to undermine the Bill. My aim is based on the presumption that a Bill of this kind will be passed. My amendments are intended to make it safe—an aspiration I know is shared by the noble and learned Lord, Lord Falconer. Confidence in his proposals would be greatly increased by his acceptance of the principles behind these amendments. I beg to move.

[The Deputy Chairman of Committees (Lord Geddes) (Con)]

My Lords, the noble Lord, Lord Shinkwin, is taking part remotely. I invite him to speak.

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[Lord Carlile of Berriew (CB)]

I am very grateful to the noble Lord. If he just looks again at paragraph 5 of Schedule 2, it may be that there is a wholesale ambiguity. Sub-paragraph (2) says:

“Decisions of a panel may be taken by a majority vote; but this is subject to sub-paragraph (3)”,


which the noble Lord has read out. Do those two paragraphs contradict one another?

[Lord Pannick (CB)]

No, they do not, because the majority vote does not apply to the question of whether a certificate of eligibility applies. There may be a majority vote on other issues; for example, whether to have a hearing or to require documents, or something of that sort. But on the fundamental issue—the noble Lord is shaking his head, but that is what it says—a majority vote is not permitted on the crucial, core issue of whether a certificate of eligibility is required.

Paragraph 9 addresses another of the concerns the noble Lord, Lord Carlile, has mentioned. It says, in paragraph 9(1), that panels must—I emphasise must—give reasons in writing for their decision.

Finally, it is not irrelevant—and these were points made very powerfully by the noble Baroness, Lady Berridge, if I may say so—that our courts are currently massively overburdened. Of course, judges do their best to hear urgent cases as speedily as they can, but delays are a serious problem in our court system. The Minister will no doubt have something to say about this. When the Committee considers what is the best, most effective and efficient way to address the real issues of independent assessment, it is important to bear in mind that the provisions of the Bill will apply only to those with six months or less to live. To have a system that builds in delays is going to damage the whole purpose of the Bill.

--- Later in debate ---

On the essence of the amendment, as the noble Lord described it, he in effect says that the expanded number of judges should say “Yes” or “No” to an assisted death. The material they have to work on is the evidence they think appropriate. I think he is saying—I am not clear about this—that the High Court judge decides and there does not need to be the two doctors dealing with issues such as firm and settled view. As I read his proposal, the only requirement for the two doctors is that they have to give evidence or have a view in relation to the terminal illness aspect. That is why he objects to the various clauses standing part which involve the first doctor and second doctor.

[Lord Carlile of Berriew (CB)]

I do not want to take up unnecessary time, but the purpose of the judges’ role is to receive the evidence relevant to the issue under consideration. There are many tribunals, such as mental health tribunals, on which doctors serve, but in my view and that of many, where critical issues are being considered, a more satisfactory process, on the whole, is for the judge to hear the evidence and adjudicate on it. To pick up a point made by the noble Lord, Lord Hamilton, as the noble and learned Lord knows, judges are perfectly capable of rejecting medical evidence that is put before them and do so with reasonable frequency.

[Lord Falconer of Thoroton (Lab)]

I take that to be a yes. The position the noble Lord is proposing is that the judge hears the evidence of the doctors on issues, for example, of coercion, capacity and firm and settled view, and then makes the decision. The comparison we have is between what is in the Bill—two doctors each forming a view on the terminal illness decision and the issues of capacity and whether the person has reached a voluntary decision as to whether to have an assisted death, and the panel either endorsing it by giving the certificate or rejecting it—and, as the noble Lord is suggesting, letting the court in effect decide the whole thing. I reject that view because I am absolutely satisfied, although I accept that this issue requires a lot of work and thinking about, that you are much better off having a multidisciplinary approach to somebody making an assisted death decision. It is much better to let the social worker, the psychiatrist, the doctor and the legally qualified person look at the situation and then decide whether somebody should make that decision on assisted death.

The evidence given in Committee—

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[Lord Falconer of Thoroton (Lab)]

Can I answer what the noble Lord, Lord Taylor, whom I greatly respect, has said? I have answered in some degree of detail the main substantive points and I believe that I have dealt with them in a way that is appropriate for Committee. One of the things that one has to do in Committee is focus on the things that really matter and avoid the other things—that is what I have done. I am open to anybody coming to see me. I started this process by writing to individual Peers to say, “Come and see me to raise anything you’ve got.” If there is anything that they want to talk about, I am more than willing to talk about it. However, I very much believe that I have answered in detail the substantive application made for an amendment.

[Lord Carlile of Berriew (CB)]

My Lords, I am very grateful to everybody who has taken part in this debate. I hope your Lordships would agree that, although this debate has taken over three hours, it has been conducted in precisely the spirit that was discussed in the short debate yesterday and that it has justified taking that time. I said yesterday that I thought we should move more quickly in this process and I believe we will be able to do so in the future. This has been an example of doing so on a very important subject.

May I express my grateful thanks to both Front Benches for the way in which they summarised their particular interests in this debate? I thought both were extremely helpful. For those who have seen my noble kinswoman, the Minister, during the year she has been here, I think they will be reassured and understand that she is perfectly capable of erecting Chinese walls that put the Great Wall of China to shame.

A point that particularly caught my attention was made by my noble friend Lord Empey. He happens to be a very valued member of a Select Committee of this House that I chair and I can confirm that he is an expert in labyrinths. He is an expert in finding his way out of labyrinths and it is just possible that, from time to time, he is quite good at making labyrinths longer— I hope he takes that in good heart. He raised a question about whether, as he put it, there should be a “special chamber”. It occurs to me that, given that the purpose of my amendments is to ensure that this is a judicial process that falls into our judicial architecture, there may be room for the sort of discussion that we talked about in yesterday’s debate with the noble and learned Lord, Lord Falconer. One might be able to find a hybrid form of what the noble Lord, Lord Empey, and I have proposed that falls within the legal, judicial architecture.

--- Later in debate ---

My other concern is that a lot of people who work in palliative care have deep religious beliefs and do not wish to discuss assisted dying with their patients. We have to find a way round that in order to ensure that patients are given options but we do not lose important people from our healthcare teams because they are expected to do something that makes them very uncomfortable. We have dealt with that in relation to abortion; we need to think about it in the longer term. I am not proposing an amendment now, but I really felt that I had to speak.

[Lord Carlile of Berriew (CB)]

My Lords, I will speak very briefly in relation to Amendments 186, 251 and 380, all of which were tabled by the noble Lord, Lord Hunt of Kings Heath, and two of which are supported by me. The noble Lord has asked me to give his apologies to the Committee; his wife has suffered an accident and he is, quite rightly, looking after her at home.

I know that the noble Lord, Lord Hunt, would have agreed, as I do, with many of the speeches that have been made to the effect that palliative care knowledge must be a prerequisite in any person’s decision-making. There have been many excellent speeches. I simply refer to two as examples: one from the noble Baroness, Lady Brown of Silvertown, and the other from my noble friend Lord Carter.

I represented a constituency in rural Wales that consists of 839 square miles with no general hospital. I absolutely take the point made by my noble friend Lady Watkins that a great deal of the skill and knowledge in relation to palliative care does not depend on there being a general hospital and can be supplied by nurses; for example, those who work in the area concerned. However, it is extremely important that nobody—whether they live somewhere remote, or they live somewhere populous but feel remote—should be deprived of a contribution from, and knowledge of, palliative care before ever making such a decision.

[Baroness Wheeler (Lab)]

My Lords, it is now 2.33 pm. I suggest that the Committee might like to hear from Front-Benchers now to ensure that we can conclude proceedings in an orderly manner, as planned, around 3 pm.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

I apologise for interrupting the Minister, who is being extremely helpful, but one point needs to be clarified as a result of what she just said. I understood the Government to say that, if an amendment is passed on Report, assistance will then be available of the same kind that was available to the sponsor, so that the amendment can become workable in the context of the Bill and other law by the time the Bill is passed. That was a very clear understanding given to me in various quarters. Are we hearing now that that facility will not be given if an amendment is passed on Report? If so, why?

[Baroness Merron (Lab)]

I am not sure that there is that difference, but I will review the Hansard of this debate and ensure that I come back to the noble Lord and place a copy of my response in the Library. I am not entirely clear about the point the noble Lord is making. I realise that that is disappointing for him.

[Lord Carlile of Berriew (CB)]

I will intervene only once more. It seems to be fundamentally necessary that, if an amendment is passed on Report that changes something put in the Bill by the sponsor, who has had the advantage of the consultation process we have discussed at length in these proceedings, the same attention should be given to it—and I am sure that is exactly what the noble and learned Lord expects. Otherwise, we run the risk of asking people like the noble and learned Baroness, Lady Butler-Sloss—if there is anyone like her—to move the goalposts, rather than do what she really does, which is be extremely nimble between the goalposts.

[Baroness Merron (Lab)]

I am grateful for the clarification on goalposts moving. What the noble Lord is saying is correct, and there is not going to be any change to what has been said previously. I hope that he and your Lordships’ House will forgive me if I have not put it as clearly as certainly the noble Lord would have liked. I will still make a review of the words and ensure that everything is clear. I hope that will be helpful.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Birt (CB)]

My Lords, I shall speak also to all the other amendments listed in my name and that of the noble Lord, Lord Pannick, who, having assiduously attended our sessions on the Bill thus far, as all will have noticed, deeply regrets that he cannot be present with us today.

Our discussions to date have focused overwhelmingly on risk, and I do not for one moment dispute the necessity and the value of that. I will return to how best we can manage those risks later in my remarks. However, let us not forget that we are not pioneers. Thirty countries, states or jurisdictions across the world have already introduced assisted dying. The first did so over 80 years ago; there has been a steady stream this century and, hot off the press, just two days ago, an assisted dying Bill for the Channel Island of Jersey passed its First Reading by a two to one majority and is expected to pass into law next month. It is therefore at the very least equally important that we do not just focus on risk but lean on the well-established experience of others when considering the critically sensitive matter before us, which we know from serious studies carries overwhelming public support.

For my part, I have been exposing myself to the Australian experience, with considerable help from senior practitioners, for which I am most grateful. Without exception, those to whom I have been exposed come over as deeply caring and enormously considered. What I have learned from them, and from the copious data that is available, is reflected in the amendments before your Lordships today. Much that I have discovered has been surprising as well as enlightening. First, applications for assistance in Australia are not automatically accepted; something like one-third are turned down. Secondly, around 75% of those seeking assisted dying have cancer, and somewhere between 75% and 90% of all those who come forward are already in receipt of palliative care and are more motivated by their distress and misery than by their pain. Although I completely agree with all noble Lords who have stressed how vital it is to have effective, universally available palliative care, it is clear that it is not sufficient for many experiencing truly horrific medical conditions.

For those who have not read it, I commend Jonathan Dimbleby’s moving account in a recent New Statesman of his brother Nicholas’s harrowing final days. Nicholas had fallen victim to motor neurone disease. It became impossible for him to take solid food without choking. He then had a tube inserted into his stomach, through which he had to feed himself. Nicholas became increasingly hard to understand. He was barely able to move. He lost control of his bodily functions. He was often frightened and sometimes terrified. He gasped in vain for breath. Nicholas Dimbleby, finally and mercifully, died in February of 2024. Other UK practitioners I have met recently, simply by chance, have shared with me equally horrific accounts of deaths that they have witnessed in the ordinary course of their work.

Such experiences must explain why, in Australia, although around 10% to 15% of those seeking an assisted death apply some months in advance of their anticipated need, a significant proportion wait until their suffering is unbearable. As a result, around 25% of applicants die within nine days of their first request—I repeat, 25% of applicants die within nine days of their first request. A further 25% die within 10 to 19 days. Thus, in Australia, around 50% of applicants die within 19 days of their first request. The leading Australian practitioners who have advised me insist that sheer misery is the primary determining motivation of individuals seeking assisted dying. Further to illuminate the complexities of the process, around one-third of those who ask for and are given the death potion do not take it and choose to die a natural death.

[Lord Carlile of Berriew (CB)]

My Lords—

[Lord Birt (CB)]

No, I am sorry—I have an argument to put; I am not going to take any interruptions.

Furthermore, one of Australia’s most senior and experienced practitioners tells me that, although in theory it must be a risk, she herself has never experienced a single example of coercion. On the contrary, she says, she has on occasions experienced the very opposite: loved ones understandably pressing someone who wants assisted dying not to embark on that course of action. Overwhelmingly, her experience is of applicants who know their own minds and are perfectly able to make a considered decision.

From all my discussions, I have concluded firmly that if this Bill passes into law, it is vital that the processes are based on day-to-day realities, as well as risk, and work efficiently and sensitively for any individual of firm and settled mind coming forward in a state of deep distress. We need more flexibility in the timelines of the process than the present Bill allows and a fit-for-purpose organisational focus that delivers promptly and humanely for individuals in severe need.

In our amendments, the noble Lord, Lord Pannick, and I propose three key measures. The first is to create a new organisation, the assisted dying help service, to enable the individual easily to navigate the complex process set out in this Bill, which in essence we retain. The second is to ensure that the assisted dying process is expeditious and, when conditions demand it, flexible. The third is that the commissioner acts solely as a regulator, with oversight but without any delivery responsibility.

The process currently set out in the Bill involves a 10-stage process, with three separate medical consultations with three different doctors, a confirmatory panel and two periods of reflection, the first of seven days and the second of 14 days, the latter of which can be shortened. Absent a bespoke organisational focus, this process in a stressed NHS could take a wholly inappropriate and disproportionate period of time. Hence our proposal is that we adopt a notion present in many jurisdictions of a purpose-built organisation—an assisted dying help service—that would provide a personal navigator to take the dying person and their loved ones through the whole complex process, providing introductions, keeping to timelines and piloting the individual through their final challenging and traumatic journey. Our amendments also propose appropriate flexibility, at every stage, with safeguards for doctors to act with urgency if the individual’s condition demands it.

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[Lord Carlile of Berriew (CB)]

My Lords, my noble friend Lord Birt was, of course, perfectly entitled to refuse my attempt to intervene in his speech. I am, however, disappointed that he chose to defy the determination of this House that we should not have repeated Second Reading speeches. Every one of us here can stand up and make a Second Reading speech on any of these amendments if we defy that determination, and I hope that he will not do it again. I am sure it was a misunderstanding on his part about the way in which he was able to move his amendment.

As to his amendment, I am afraid that I am suspicious about his group of amendments, and I think he gave the game away in the way in which he later turned to and referred to them. It is clear that he is very keen on there being a more extensive provision for assisted suicide—that people far beyond the scope of the noble and learned Lord’s Bill should be able to claim and achieve assisted suicide. Some of his amendments I agree with—I would love to see better care for people who are facing the end of their lives—but behind his amendments is a death service. As the noble Lords, Lord Deben and Lord Harper, said, what he is providing is a way to death, not a way to enjoy and make the most of the rest of your life. I would urge noble Lords not to support these amendments, because I regret that their motivation is not even consistent with that of the sponsor of the Bill.

[Lord Stevens of Birmingham (CB)]

My Lords, I speak specifically against Amendment 771, which would require the Secretary of State to establish an assisted dying help service as part of the National Health Service. I believe that that is a conceptually misplaced proposition in that, if we cast our minds back to last Friday, it was completely evident that the sponsor of the Bill does not intend that only in cases of unbearable pain or suffering would a person be eligible for the assisted dying service. Instead, concerns about your finances or being a burden on your family would be defined as legitimate bases for making the choice to opt for an assisted death.

It is not the proper function of a national health service to deal with financial burdens or pressures on people’s families in that way: that is a category mistake. Indeed, the founding charter for the NHS, the National Health Service Act 1946, is quite clear, and all successive health Acts have laid out the purpose of the NHS, which is

“to promote the establishment … of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”.

Assisted dying does not fall within the scope of that purpose. In fact, I think that must be evident indeed to the drafters of the Bill, because somewhat camouflaged at Clause 41(4) is the suggestion that, by regulations, that founding charter for the National Health Service could be amended to include assisted dying. They reference the fact that change is probably required to the most recent iteration, the 2006 Act, to bring that about. I do not think it can be said legitimately that this is a part of the purpose of the National Health Service, and it is unnecessary in practice, organisationally.

Just because doctors, like lawyers and social workers, are proposed to be involved in this, it does not mean it is inherently part of the National Health Service. Doctors do DWP assessments, but that does not mean the National Health Service runs the benefits system. Doctors are involved in driving licence assessments, but that does not mean the National Health Service runs the DVLA. Doctors are involved in the criminal justice system as forensic medical examiners, but that does not mean the NHS needs to run the court system.

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[Lord McCrea of Magherafelt and Cookstown (DUP)]

I thank the noble Baroness. I realise that my time is up, but I draw to a close by asking noble Lords to notice the emphasis on GMC guidance. Guidance is not the law. The GMC itself states in its preamble that its guidance is intended to help doctors

“practise ethically and in line with law”—

it cannot make the law. It goes on:

“If you’re not sure how the law applies in a given situation, seek advice through local procedures, consult your defence body or professional association, or seek independent legal advice”.


It says finally:

“The professional standards describe good practice, and not every departure from them will be considered serious”.


That is equally true for NICE guidance as well.

[Lord Carlile of Berriew (CB)]

My Lords, as a former, if somewhat historic, member of the General Medical Council, I can confirm that the GMC has no guidance relating to ending someone’s life because it is, at the present time, simply unlawful to end someone’s life.

I hope that I can try to simplify what is being discussed. I agree with the noble Lord, Lord Blencathra, that there is a need to add something, though possibly not very much, to this Bill to ensure that consent, as consent, is included. We are talking about four stages. The application is not consent; it is just an application. Capacity is measured and is not an application. The discussion described in Clause 12 is a discussion, and I say to the noble Lord opposite that it is most definitely not the obtaining of consent. Then there is the issue of obtaining consent, which includes the effect of any drugs to be used, and that is what I think the noble Lord, Lord Blencathra, is seeking to add to this Bill.

Let me briefly give an example from my own experience. I had an extraordinarily formidable and occasionally difficult mother, and on one occasion she had a heart attack, not long before her death. She was taken into a very good cardiology unit in Blackpool, so I rushed up to Blackpool at high speed and found myself on the ward with my mother—whose eyesight and hearing were not good, but her brain was as good as any in your Lordships’ House—and a consultant. The consultant explained that he could do an operation which he had done once on a male patient aged 91, but he was prepared to try it on my mother. She was very enthusiastic to have any medical treatment that might prolong her life, which, after all, had by then lasted for only 98 and a half years.

Once we had had the discussion, the cardiologist proffered a consent form to me. My reply, which I will abbreviate, went something like, “Not likely; she is perfectly capable of consenting herself. But it must be explained to her so that she can hear it clearly. So, why don’t you sit down while I explain what you have said to me, and you correct me if anything is wrong?”

In due course, she signed the consent form and had the operation. Happily, the operation was entirely successful. Sadly, the effect of the operation gave her such a pounding heart that the rest of her bodily functions could not cope with it. She died a few weeks later. When she said to me during the period before her death, “Darling, I never thought it would end like this”, I thought to myself, thank God she signed the consent form, not me.

Consent has a conspicuous and real meaning. It requires full understanding from the patient. It can go horribly wrong, as it unfortunately did for my mother. I wish we had been able to celebrate her 100th birthday. But that element of consent, consent, consent—a bit like “education, education, education”—is not clearly set out in the Bill. It is not a major change to be made, and I would invite the noble and learned Lord to incorporate it.

[Lord Wolfson of Tredegar (Con)]

My Lords, the amendments in this group seek to establish a higher bar for reaching eligibility by requiring that informed consent be demonstrably shown. There are also amendments in the group tabled by my noble friend Lady Lawlor that seek to ensure that the patient has been made to understand the physiological effects of the drugs used. I will deal with each of these points, but fairly briefly, given the time.

Demonstrable consent is primarily a question of workability. It is the view of everybody, so far as I have heard, that a person must consent to receive assistance. The Bill allows assistance only if the person themselves takes the final step, which is in itself an important safeguard. But these amendments pose important questions for the Minister. What work have the Government done to date on establishing a process to ensure that all those receiving assistance under the provisions of the Bill will in fact have consented? What checks will there be on the service providing this assistance? How will Ministers and others respond to complaints or allegations of malpractice in relation to a person’s consent? All those questions touch on the key point: the practical day-to-day implementation of the Bill and ensuring that its provisions are complied with.

Most of the speeches in this group have dealt with the second issue—the amendment from my noble friend Lady Lawlor. It stands to reason that a person in receipt of assistance should be given all the information they need to ensure that they are making an informed choice. Certainly, that would seem to include the physiological effects of the drug they will take. When patients receive any drug or have any medical treatment, a doctor will explain the proper dosage and how it will affect them, and they will also advise on potential side effects. One would assume that the same level of explanation would be provided by doctors in this case, but I am interested to hear whether the Minister and/or the noble and learned Lord the promoter of the Bill will confirm that in due course.

My noble friend Lady Berridge threw me something of a curveball when she asked what the duty on a doctor is. That is a detailed question and, given the time, I will not give a very detailed answer, but it is notable that—this is an important point because it shows how things have changed over the years—if you go back, quite a long way, to the Hippocratic Corpus in the fourth to fifth centuries BCE, it advises physicians to reveal nothing to the patient of their present or, indeed, future condition,

“for many patients through this cause have taken a turn for the worse”.

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[Lord Falconer of Thoroton (Lab)]

The noble Lord makes a good point: how do you, in dealing with a wide range of cultures, establish that it is the informed wish of the individual that they want an assisted death? You cannot prescribe in a Bill how you would do it in every case, but there is absolutely no doubt, as far as the Bill is concerned, that the establishment of that informed wish is the basic foundation before you get there. Therefore, in each case, if it involves a different culture or a different language, that must be gone through before you can be satisfied.

[Lord Carlile of Berriew (CB)]

My Lords—

[Lord Carter of Haslemere (CB)]

I am very grateful to the noble and learned Lord for his explanation of informed consent. There is a little doubt as to whether giving people lots of information, leading to an informed wish, actually encapsulates them fully understanding it. I was wondering: is the answer to this not to put in a definition of informed consent? Would that not be sensible? Then it is there in black and white. I have it here—AI is very helpful sometimes, is it not? “Informed consent is a process where a person voluntarily agrees to medical treatment, research, or a procedure after receiving and understanding all relevant information, including risks, benefits, alternatives and consequences, and they have a capacity to decide and are free from pressure”. There is a beautiful little definition that you could put straight into the definition section, and everyone would be happy.

[Lord Falconer of Thoroton (Lab)]

I thought carefully about that. The language concerns whether it is the person’s clear, settled and informed wish. Interestingly, the law—the Supreme Court—over a period of years constantly changes what in individual cases informed consent, or informed wish, as it is in the Bill, might be. The essence of the word “informed” is that you have enough material to make the decision. I hear what the noble Lord, Lord Carter, says, and I see what AI says about it, but I think it is better just to say, “informed wish”.

[Lord Carlile of Berriew (CB)]

I apologise to the noble Lord, Lord Carter; I did not see him behind me. The noble and learned Lord, Lord Falconer, has been using the phrase “informed consent”—

[Lord Falconer of Thoroton (Lab)]

“Informed wish” is in the language of the Bill.

[Lord Carlile of Berriew (CB)]

The noble and learned Lord has been using the phrases “informed consent” and “informed wish” as though they are definitely synonyms. I just wonder why we do not se “consent” with “informed” next to it in the Bill because, as the noble and learned Lord has let slip, informed consent is a well-understood concept. Putting it in the Bill would take away most of the doubts that some of us have expressed. What is the problem?

[Lord Falconer of Thoroton (Lab)]

The format of the Bill asks: “Is it your wish to receive assistance?” It has to be an informed wish. It seems to me that there is no need to add in another concept—that of informed consent —when we have “informed wish”, which is perfectly adequate.

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[Lord Markham (Con)]

The noble Baroness is talking about a slightly different circumstance where there are prior reasons, which could be mental health or other reasons, and why that could be a cause. What we are talking about here is basically the criterion on which you can first be assessed for assisted dying, which is, of course, that you have been diagnosed in the first place. To the point that, of course, people might then live longer, my experience is that they are delighted by that. Just because they have been assessed as being able to have assisted dying does not mean that they will take the medication. Again, evidence shows strongly that they will take the medication only right near the end when the pain, the loss of dignity or whatever the reason is becomes unbearable. My experience is that those people would be delighted if it was a misdiagnosis, and if they are fortunate enough to be living 30 years later, as per some of these examples, that would be fantastic. Of course, they will not have taken the medication. The point is that they take it only right at the end where there is no other choice, so to speak.

Within that, accepting that these are the people we are talking about, of course there are all sorts of different motivations why, when they are unfortunately at the point where they are looking at such a death, they might want to go ahead with it. Research shows that there are multiple reasons; it is impossible to put it down to just one. Loss of autonomy, less ability to engage in enjoyable activities, loss of dignity, loss of control of bodily functions, burden, inadequate pain relief or finances are all part of the reasons. They are all part of the research, and, on average, you will find that there are three or four reasons to do it.

So it is quite wrong to say, “No, we’ll only allow you to go ahead with this if you only have that single motivation”. As I said before, they would rather not be there in the first place, but given that they are in that unfortunate circumstance, surely they should be allowed the choice of why they wish to die.

[Lord Carlile of Berriew (CB)]

My Lords, I put my name to the amendments of the noble Baroness, Lady Berger, and I will not repeat what she said. She opened the debate on these amendments with superb clarity, characteristic of her contributions to your Lordships’ House.

I have been shocked by what I have just heard from the noble Lord, Lord Markham. I ask him just to reflect on two contributions made earlier in this afternoon’s session by my noble friend Lord Mawson, who, from his own experience, described what happens in poorer neighbourhoods, which he has experienced very directly, in which people face different problems and are more likely to want to die for reasons to which their terminal illness is just an ancillary point.

I have been involved in these debates since I came into your Lordships’ House at least. I was on the Joffe Bill Committee with my noble friend Lady Finlay. In the Committee on that Bill, in all the other Bills I can remember since, and particularly in all the case law that I have followed over the years—mostly very celebrated cases—the purpose of asking for assisted suicide has been to alleviate terrible suffering. That has been the sole purpose for demanding a change in the law: to alleviate terrible suffering. I do not believe that the noble and learned Lord wishes to achieve anything different from that. It is just that it does not say in the Bill that the purpose of having assisted suicide should be to alleviate terrible suffering.

Of course, there may be other issues at work in that person’s mind when they ask for assisted suicide—we cannot read every synapse in their brain—but we are here to legislate to save people from terrible suffering, if the Bill is to pass. I am very concerned that the Bill should be amended so that the capability to have assisted suicide does not arise as an opportunity to commit suicide. The reason to commit suicide, the absolute cause, should be the intolerable suffering.

[Baroness Wheatcroft (CB)]

Would the noble Lord accept, however, that it would be deeply unfair if somebody whose major wish was to end their terminal illness, and the pain and intolerable suffering that was coming with it, was to be denied that right because they were also concerned about numerous other things? Very few people have a perfect life, even when they are close to death. To deny that person the right to an assisted death because they might have concerns beyond their suffering would seem to be cruel in the extreme.

[Lord Carlile of Berriew (CB)]

I do not think there is much difference between what I am saying and what my noble friend is saying. I am saying that, if this law is passed, people should be able to obtain assisted suicide because of intolerable suffering. I am not seeking to exclude other matters that might be in their mind, but the cause of asking for assisted suicide should be that suffering. The medical profession, lawyers and judges in particular—if we have the judicial option rather than the panel option—are perfectly capable of reaching a decision on the facts that would lead to the appropriate conclusion.

[Baroness Jay of Paddington (Lab)]

My Lords, I was only going to say to the noble Lord that, as I am sure he will remember, I too was a member of those earlier Select Committees. I am sure in that context he will remember that the arguments, discussions and vagueness, frankly, about how one would ever define “intolerable suffering” in a legal sense, or an Act of Parliament, were even more intense than the ones we are having today. That was because there is even more subjectivity about the concept of “intolerable suffering” than there is about any other.

[Lord Carlile of Berriew (CB)]

I do not agree with the noble Baroness, much as I admire her contributions to this House. I believe that, as a legal concept, what I am suggesting is absolutely clear and could be defined properly if we were to use the courts to make the determinations.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

My final point is another question to the noble and learned Lord, which I would be grateful to him for answering. I do not want to assume his answer, but I expect him to say that the criminal law is there to punish coercion. However, surely our job is to prevent coercion, not to put someone through the court system when coercion is suspected or spotted. Will the noble and learned Lord, either in the Bill or by answering today, explain how coercion will be prevented and how we can make sure that people do not, unwittingly or through force, choose to end their lives when it is not what they want?

[Lord Carlile of Berriew (CB)]

My Lords, I want to make two points about whether these consultations should be face to face. First, I remind the Committee of the General Medical Council’s remote consultation diagram, which is in the GMC guidance. It is not absolutist about whether doctors should see patients remotely or face to face, but it sets out guidance. It starts:

“Remote consultations may be appropriate when… The patient’s clinical need or treatment request is straightforward”.


We are not talking about straightforward clinical needs or treatment requests here. The other side of the diagram says:

“Face to face consultations may be preferrable when… The patient has complex clinical needs or is requesting higher risk treatments”.


As I have said previously, and it is historic, I was a lay member of the General Medical Council for 10 years and I was involved in helping to draft GMC guidance as well as dealing with conduct and health cases. It is unimaginable to me that the General Medical Council would create guidance in which it accepted the proposal that, save from the most exceptional circumstances based on the clearest evidence, such consultations should be done remotely.

Secondly, the medical profession is not the only group of people who have to give important advice to their patients, clients or customers. Like a few other Members of your Lordships’ House here, I have often had to give advice to people in critical situations when they faced spending possibly the rest of their lives in custody. I recall one case when, in the middle of a longish murder trial, the client asked to see me to ask a very simple question, “How do you think it’s going, sir?” The answer had to be robust and realistic, and it was very difficult. It changed the whole course of the case, which came to a quick end shortly afterwards. The result was a minor advantage to the client: he did not spend the rest of his life in prison, just a substantial proportion of it, but that was very important to him.

I would say to your Lordships that it is quite difficult to see a doctor these days, unless you go to a private doctor. Even if you have seen a doctor, it is quite difficult to see the same one twice. There are remote hearings in the legal profession in certain circumstances, but for the sort of important decisions that I have been describing, it is unthinkable—to us, the professional lawyers who do these cases—that such consultations should not be face to face. That is a qualitative analysis based on two examples, but I hope your Lordships found it convincing.

[Lord Sandhurst (Con)]

My Lords, I can be truly short here and it is further to a point made by the noble Baroness, Lady Grey-Thompson. Many of us are concerned about subtle pressure and coercion. It will not appear in all cases, but it will in some and these are legitimate concerns. If this is online, doctors are unlikely to know whether there is someone else present in the room or whether the door is open for someone to listen, nod and encourage the applicant—if I can call the person that—to make their request. If at least one of the panel is present in the room, they would be able to see and counter that. It is really important that there is at least one of those people, preferably the panel, in order to prevent that. That is an important safeguard and, if it is done online, such things could be missed. My recollection is that, in Canada, there have been instances where people, including coroners, have raised legitimate questions afterwards.

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[Baroness O’Loan (CB)]

My Lords, I have put my name to Amendment 66, in the name of the noble Baroness, Lady Coffey. At present, the Bill makes no allowance for any restriction on the possibility of the use of non-human assessment and automated administration devices during the application and decision-making process for assisted death. Obviously, AI will be used for recording meetings and stuff like that—I am not a quill and paper person to that extent—but AI has already been proposed for use in killing patients in the Netherlands, where doctors are unwilling to participate.

The Data (Use and Access) Act 2025 established a new regulatory architecture for automated decision-making and data interoperability in the NHS. It provides that meaningful human involvement is maintained for significant decisions—decisions which may affect legal status, rights or health outcomes. Of course, assisted death would come within that definition.

That reflects the purpose of the NHS. We have talked about its constitution. I looked at the constitution and the guidance. It says that the purpose of the NHS is

“to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives”.

I know that the noble and learned Lord, Lord Falconer, is going to put down an amendment suggesting that the constitution and guidance will have to be amended, but the current situation is that that is the purpose of the NHS. The assisted suicide of patients is certainly not provided for in the NHS, nor should AI be used in the crucial assessment and decision-making process for assisted dying, given the extreme difficulties in identifying coercion and assessing nuanced capacity, and the irreversible nature of death. What plans does the noble and learned Lord have to address these issues?

In the Commons, amendments were passed allowing the Secretary of State to regulate devices for self-administration. The amendment was not put to a vote; in fact, only seven votes were permitted by the Speaker on the more than 80 non-Leadbeater amendments. The Commons have accepted that devices will be used for self-administration. Of course, the assisted suicide Bill requires self-administration. Nothing in the Bill prohibits a device that uses AI to verify identity or capacity at the final moment. If a machine makes the final go/no-go decision based on an eye blink or a voice command, have we not outsourced the most lethal decision-making in a person’s life to technology? I have to ask: is this safe?

Public education campaigns on assisted suicide are explicitly allowed for in Clause 43. The Government have said that there will be an initial education campaign to ensure that health and social care staff are aware of the changes, and that there would likely be a need to provide information to a much wider pool of people, including all professionals who are providing or have recently provided health or social care to the person, as well as family members, friends, unpaid carers, other support organisations and charities. That controls only government activity. The other observation I would make is that I presume the public education campaign will inform families that they have no role in a person’s decision to choose assisted death, and that the first they may know of an assisted death is when they receive the phone call telling them that the person is dead. It is profoundly important that people know this.

There is nothing to prevent an AI chatbot or search algorithm helpfully informing a patient about assisted dying services and prioritising assisted dying over palliative care search results. By legalising this service, the Bill will feed the training data that makes these AIs suggest death as a solution. I would ask the noble and learned Lord, Lord Falconer, how he intends to police that situation.

There is also a risk of algorithmic bias. If prognostic AI is trained on biased datasets—we know the unreliability of the prognosis of life expectancy—it could disproportionately label certain demographics as terminal, subtly influencing the care options, including assisted dying, presented to them. The National Commission into the Regulation of AI in Healthcare established by the MHRA in 2025 is currently reviewing these risks to ensure that patient safety is at the heart of regulatory innovation. I ask the Minister: will that work cover assisted dying?

The AI Security Institute’s Frontier AI Trends Report in December 2025 highlights that:

“The persuasiveness of Al models is increasing with scale”,


and:

“Targeted post-training can increase persuasive capabilities further”.


In a healthcare context, this raises the risk of automated coercion, where the person interacting with a chatbot or an AI voice agent might be subtly persuaded towards certain end-of-life choices. The AISI has said that safeguards will not prevent all AI misuse. We have to remember that there will be financial incentives to provide assisted suicide; after all, the CEO of Marie Stopes received between £490,000 and £499,000 in 2024. There is big money, even though this will be charitable or NHS work. Clause 5 allows doctors to direct the person to where they can obtain information and have the preliminary discussion. That sort of information could be an AI or a chatbot at the present time.

Dr Sarah Hughes, giving evidence to the Lords Select Committee, said there was a real risk of “online coercion”. With newly developed AI functions and chatbots, we already know there are cases all around the world of individuals being coerced into all sorts of different behaviours, practices and decision-making. There is also an issue of misinformation around diagnosis and prognosis. Hannah van Kolfschooten questioned who has ultimate responsibility if the technology fails. She said:

“In traditional euthanasia settings, a doctor is accountable, but in AI-driven scenarios, accountability could become ambiguous, potentially resting between manufacturers, healthcare providers, and even the patient”.


AIs also have a record of encouraging suicide. We know that, and we have seen terrible cases among young people; they have no regard for human life.

Evidence shows that doctors suspect only 5% of elder abuse cases. Detecting subtle coercion requires, as was said in the previous group, professional judgment to interpret things such as non-verbal cues, body language and discomfort. AI systems are ill-equipped to handle these nuanced, non-quantifiable elements. It is imperative for trust in the system that the individual circumstances of each request for assisted death are recorded and are available for interrogation, or even potentially a criminal investigation, by the panel or another regulatory authority. The only insight as to what happened in the consulting room will come from these records. The patient will be dead. The current provision in the Bill does not provide any protection against the use of AI, which has algorithmic bias, to protect an individual in these circumstances. Can the noble and learned Lord, Lord Falconer, explain how he proposes to deal with these concerns?

[Lord Carlile of Berriew (CB)]

My Lords, I will add only a very short sentence to my noble friend’s excellent speech, and it is what AI says about AI. It says: “AI is technically capable of providing advice or information relating to suicide, but it is critically dangerous to rely on it for this purpose”. Enough said.

[The Lord Bishop of Hereford]

I thank the noble Baroness, Lady Coffey, for raising a very important issue in this amendment. However, I am concerned that, as it stands, as the noble Baroness said, this amendment is too blunt an instrument. It is important that we distinguish between AI tools and the more dangerous artificial general intelligence, or superintelligence. The use of AI in medical diagnostics in patient care is already commonplace. AI tools are currently used to read scans and X-rays and will frequently perform as well as, if not better than, clinicians. To exclude the use of AI altogether might deprive patients who are considering assisted dying of valuable diagnostic assistance and care at a very vulnerable time.

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[Lord Blencathra (Con)]

My Lords, I am very concerned by my noble friend Lord Harper’s amendment to extend the Bill’s definition of terminal illness to include simply the one word, “injuries”. I agree entirely with my noble friend Lord Sandhurst and with what the noble and learned Lord, Lord Falconer, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. I support entirely what the noble Lord, Lord Hendy, said on that, but I disagreed with his general thesis that the Bill should be extended to include all other injuries, because that could take us in a rather dangerous direction.

We all know that some injuries are awfully catastrophic, relentlessly painful and leave no prospect of meaningful recovery. For those individuals, the desire for control over the timing and manner of their death is understandable and deeply felt. If the law permits assisted death for terminal illness, it is in some ways emotionally coherent to ask why a grievous and irreversible injury that will inevitably lead to death should be treated differently. I think the amendment from my noble friend and the suggestion of the noble Lord, Lord Hendy, is born of a humane impulse: to extend compassion to a group whose suffering can be as severe as that of the terminally ill. However, compassion must be married to clarity and caution when Parliament contemplates measures that permit an irreversible outcome. Extending the definition to “injuries” raises serious legal, clinical and ethical problems. I will set out the principal flaws and risks that I see flowing from the proposed change.

First, the term “injury” is legally and clinically vague. What counts as an “injury”? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long-term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort the amendment’s proponents intend. Vagueness at this threshold invites inconsistent application and litigation.

Secondly, I suggest that the proposed threshold—that the injury be “reasonably expected to result in death”—is problematic. Prognosis after severe injury is often uncertain, as it is with terminal illnesses, and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside. Using “reasonably expected to result in death” without a clear evidential standard hands clinicians wide discretion and risks premature decisions made on the basis of an evolving clinical picture.

Thirdly, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contexts where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes. Allowing assisted death on the basis of an early prognosis risks decisions taken before full treatment options have been explored and before the patient has had the opportunity to adapt to new circumstances or to benefit from specialist rehabilitation.

I will not talk about civil law and compensation, because that has already been expertly covered by my noble friends and the noble Lord, Lord Hendy. My noble friend also mentioned the coronial and investigatory consequences which arise, so I will not elaborate on those.

There is a “slippery slope” argument here. Once “injuries” are included—just that one, simple word—pressure may grow to widen eligibility further to chronic disability, psychiatric consequences or non-combat trauma. Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed.

The clinical complexity of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require trauma surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The Bill’s processes must ensure that such expertise is mandatory before any irreversible step is taken, otherwise we risk decisions being made without the full range of clinical knowledge that these cases demand.

In conclusion, if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, higher evidential standards, mandatory specialist review, and explicit protections for families and compensation rights; only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect carefully on the human impulse behind this amendment and on the legal and clinical realities that make adding it to the Bill as currently drafted—with just one word, “injuries”, as my noble friend proposes—deeply problematic.

[Lord Carlile of Berriew (CB)]

My Lords, I return us to Amendment 829, to which I put my name and which was moved by the noble Lord, Lord Sandhurst. I added my name because I share experience with the noble Lords, Lord Hendy and Lord Sandhurst. We have all seen cases in which a potentially huge claim arises under the Fatal Accidents Act which will provide a family with a payment for their dependency on the deceased for many years to come, so these are very substantial claims.

Probably all three of us have done cases for both claimants and trade unions on the one side, and for insurance companies on the other. Insurance companies are very business-like and accurate, but they are not social services organisations. One question they ask their counsel—particularly their leading counsel, their KC—in such cases is, “Are we liable to pay? Is there a point we can make, saying that it does not arise because the death was caused by some other means?” There have been many cases in which novus actus interveniens, which the noble Lord, Lord Harper, referred to earlier, has been cited as a reason for not paying.

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[Lord Carlile of Berriew (CB)]

My Lords, I would never stand in the way of a colleague who has a trial. I hope it is an important trial that will improve general knowledge.

[Lord Wolfson of Tredegar (Con)]

My Lords, I am defending the interests of a Labour-supporting newspaper.

[Lord Carlile of Berriew (CB)]

Well, there we are: we know that the noble Lord adheres to the cab rank rule.

We have heard three very cogent speeches from the noble Lords, Lord Frost, Lord Carter and Lord Taylor, about the suffering point. If we look at the discussion we have had this afternoon, we now have a clear and stark difference between assisted suicide based on suffering and assisted suicide based on choice. I agree entirely with the noble Lords, Lord Frost and Lord Taylor: the public expect this Bill to be dealing with suffering. The public understand this Bill to be dealing with great suffering. They understand that the choice to have one’s life ended is based on great suffering, although it does not say so in the Bill. That must be clarified by the sponsor.

On the other side of the argument, we heard a very eloquent speech from my noble friend Lord Pannick, with whom I have a lot of sympathy. It is not generally known that, as he said, he has very personal experience of the issues arising from this Bill. However, the choice he is suggesting comes very close to being a choice for anyone who is seriously ill, not just someone who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. I fear that those of us who, like the noble and learned Lord the sponsor, are trying to reach the end of our process in the House of Lords on the basis that there will be a Bill, so it must be the best it can be, are not focusing on what choice really means.

We are talking about informed choice, accurate choice, if we can achieve it. I bear in mind very much what my noble friend Lady Finlay said. We are talking about a protective choice: the duty of the state to protect the citizen, even when they are making a choice. We do not, as citizens, have unlimited free choices in what we do; therefore, protection is important. It must be a morally sound choice, because that is part of our polity. We do things that are morally sound, and the Government protect us from those which may not be. It must be a choice founded on medical and scientific integrity: and there is the rub, going back to the points my noble friend Lady Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.

For those reasons, I support the amendments that are focused on choice. I will mention three other amendments that I also support. The first is Amendment 76, which is not in my name but in that of the noble and learned Lord, Lord Garnier, but he is not able to be here for the latter part of today’s proceedings and I agreed to mention it at his request.

Amendment 76 would do something very simple. In Clause 2(1)(b), it would add one word, “direct”, so that a person is terminally ill if, in the amended paragraph (b), their death as a direct

“consequence of that illness or disease can reasonably be expected within six months”.

It may not be the perfect word, but it is about facts and the consequences of those facts. I agree very strongly with the noble and learned Lord, Lord Garnier, that if there is to be a death of someone through the assistance of a third party, which is what the Bill is fundamentally about, then it cannot be just a consequence, or one of the many consequences, of the illness. It has to be the, or at least a, major consequence of the illness. That is the purpose of that amendment: there has to be a bond, as it were, between the illness or disease and the death which ensues.

The next amendment is Amendment 93. It suggests leaving out Clause 2(3) altogether as it lacks clarity as to when an assisted death would be permitted. The subsection says that

“treatment which only relieves the symptoms of an inevitably progressive illness or disease temporarily is not to be regarded as treatment which can reverse that illness”.

What if the relief that is provided for an inevitably progressive illness provides not only relief from the symptoms but extra time to the person who is suffering from the illness or disease? I argue that if it allows extra time, the individual concerned will be having a new experience: they will be seeing what can happen if their symptoms are relieved. They need to discuss with their medical advisers whether they can have that relief of their symptoms again and whether it will prolong their life if they do. The relief may cause a fundamental change of heart by the individual. Therefore, I do not believe that there should be any possibility of the six-month period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given so that the person concerned can have an informed choice.

The third amendment is Amendment 96, which suggests leaving out Clause 2(4), which says:

“For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both)”,


followed by an important further sentence that I will not read out because of time. This subsection fails to deal with the proportionality between the disease, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers. It is a complex little conundrum, but a very important one. I believe that proportionality needs to be clarified so that the Bill can be the best possible Bill we can have.

We have much still to learn about the issues that have been under discussion. I invite the noble and learned Lord, Lord Falconer, to consider these carefully and present some draft amendments to us before we meet again in a week’s time.

[Lord Blencathra (Con)]

My Lords, I seek a cast-iron assurance from the Government Whip that those of us whose speeches will be delayed till next Friday are recorded by the Government and will be allowed to speak. That is all I want to say at this stage. We want an assurance that we will be allowed to speak next Friday if we delay our speeches from today.