Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Friday 27th March 2026 Lords Chamber

There are defects in the conscience provisions as written, despite the amendment from the noble and learned Lord, Lord Falconer. I suggest that in any rewrite of the Bill, an opt-in must be absolutely explicit, as required by the professional bodies. I ask the noble and learned Lord to explain why his amendment has come so late in the day, despite the fact that the evidence from the royal colleges was there from the beginning.

[Lord Carlile of Berriew (CB)]

My Lords, I speak as a signatory of Amendment 189 in the name of the noble Baroness, Lady Fraser. I am strongly in favour of it for reasons that I will explain briefly.

I am not a doctor, but I am a patient when I cannot avoid it. Let us take, for example, a situation that many of your Lordships either have faced or will face when their eyesight begins to deteriorate. You go to the optician, who says, “I’ve examined your eyes: you’ve got the beginnings of a cataract. You can choose between either continuing with your spectacles as they are now or having a cataract operation, which might even mean that you don’t have to wear spectacles ever again”. In order to decide which choice to make, you are sent to a specialist.

Since 1 January 1997, there has been a GMC specialist register, which covers all sorts of specialties, including some that do not have the high formality of gynaecology, obstetrics or orthopaedics. It works very well. It is publicly accessible. It is just the sort of register that the noble Baroness is referring to, although there would be a specific one for this.

When you face the choice of having fewer than six months to live or dying by assisted dying, and you want to make your decision, you want to go to someone who has exactly the same sort of disciplinary approach as that eye specialist who would be advising you on your incipient cataract. That is a specialism. I cannot understand why there should be any other approach to this than having a specialist register so that advice is given to you clearly by a specialist—not any old general practitioner, if I can be forgiven for using that phrase.

[Noble Lords]

Oh!

[Lord Carlile of Berriew (CB)]

I am the son of a general practitioner who, by the way, was not any old general practitioner. Even the noble Baroness, Lady Gerada, knows that the skills of general practitioners are not uniform and vary a good deal—as I say that I see that her surprise is falling, after what I said before. It is not the role of a general practitioner; it is the role of a specialist, and that specialist must be able to tell the patient their options for continuing with life: what palliative care is available and what caring systems, if they are unable to do certain things.

[Lord Winston (Lab)]

Is the noble Lord aware that virtually no specialism has 100% of those posts filled? In fact, in most cases in the UK, as can be checked using the recent figures from the Department of Health, many specialisms are down to about 30%, and many specialist areas in medicine are not covered by specialists at all.

[Lord Carlile of Berriew (CB)]

My answer to that is that they jolly well should be. I do not see at all that that is a point against the argument I am making. I would say exactly what I am saying in relation to any specialism. It is a very simple point: do I want someone knowledgeable to explain what palliative care is, or is not, available to me, or do I want it explained by a generalist, who may be extremely good, such as the noble Baroness, Lady Gerada, or rather less good? I used to be a lay member of the General Medical Council, and I have disciplined very large numbers of doctors as a result of that experience. Having this specialist care is an absolutely essential requirement of what we are discussing.

[Baroness Gerada (CB)]

My Lords, I thank the noble Lord for his “any old” comment; I am “any old” general practitioner. I will pick up a few issues. One is around the register being made publicly available. I absolutely would not want my name on a publicly available register as somebody providing the services of assisted dying—not because I would be ashamed but because of the hate mail that I would get and the distress that I would already have. That does not mean that I am against some form of register. Of course there can be a register, just as there is for doctors who do Section 12 approvals under the Mental Health Act, and for doctors who do all sorts of things, but to have a publicly available register goes one step too far.

The second issue is that we are—I am—already getting confused about the opt-in/opt-out; we saw that earlier. If this becomes law, all doctors must be trained in assisted dying, whatever that training involves; the royal colleges will determine that. Just as all doctors are trained in the termination of pregnancy, even though they may not deliver a termination of pregnancy—whether they opt out of delivering any services is up to them—all doctors must be competent in this area. I have been a GP for nearly 40 years and have worked with doctors who do not want to get engaged at all in the delivery or any aspect of the termination of pregnancy. Nevertheless, they are there to counsel their patients and direct them to a doctor who is available and willing.