Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

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.