Terminally Ill Adults (End of Life) Bill

Lord Carter of Haslemere Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Meyer (Con)]

My Amendment 169 is a very modest one. It simply proposes that, if the Bill proceeds, before any doctor raises the possibility of assisted dying, the patient should first receive a psychological assessment from an appropriately qualified specialist. This is not an onerous hurdle but a basic and sensible safeguard.

As many noble Lords have said, when people are approaching the end of their life, they are often in a very vulnerable state. Feelings of sadness, anxiety or despair are not unusual and even the most resilient of individuals is affected. That vulnerability can become much more acute when patients are told that they have a terminal illness and perhaps only six months to live. Such news can be profoundly shocking and can often trigger despair and even suicidal thoughts.

The evidence reflects this reality. Research drawing on data from the Office for National Statistics, King’s College London and the University of Manchester shows that the risk of suicide rises significantly in the first six months after diagnosis. In other words, the period immediately following diagnosis is often when patients are at their most fragile psychologically. This is precisely why we must proceed with great care.

Before introducing the possibility of assisted dying, it seems only prudent to understand the patient’s mental state. Without a proper psychological assessment, we cannot know whether patients are coping as well as they appear to be or whether they may be struggling with depression and even suicidal thoughts. Studies suggest that from 20% up to 40% of patients with advanced cancer experience clinical depression. Dr Rachel Clarke, a palliative care physician, warned the Commons Public Bill Committee exactly about this situation, saying that raising the question of assisted dying can unintentionally place pressure on a vulnerable patient.

Autonomy is often far more fragile and complex than we assume. When someone has just received devastating news, even a carefully framed question may be interpreted in ways that we never intended. Both the Royal College of Physicians and the Royal College of Psychiatrists, as well as palliative care and disability groups, have warned that vulnerable patients are not adequately protected by the Bill as it currently stands.

Ordinary doctors are not usually trained to make complex psychological assessments. According to the Government’s own impact assessment, doctors involved in these early conversations may receive as little as 90 minutes of e-learning and one hour of an online interactive session. Surely that is unlikely to equip them to recognise subtle depressions or suicidal feelings in patients who are already known to be at great risk.

My son is a consultant physician at the largest psychiatric hospital in Berlin. For many years he has worked on the front line treating patients in acute crises and teaching junior doctors how to recognise mental illness. His view is very clear: depression can be remarkably easy to miss if you are not a specialist.

We assume that every human has free will, but this will be impeded by severe depression. People suffering from severe depression may appear calm, rational and composed—they may even seem cheerful—yet internally they may be struggling with profound hopelessness and suicidal thoughts that impair their judgment and decision-making. Research published in the Lancet has shown that general practitioners detect depression in only 50% of cases. This is not a criticism of them. It simply reflects the fact that recognising depression, especially in people with a serious physical illness, requires time, training and specialist experience. In the context of assisted dying, this matters enormously. A misdiagnosis is not a harmless mistake. It can have fatal consequences for a patient whose suicidal thoughts might be treatable and whose desire to die may have been only temporary.

For that reason, many psychiatrists across the United Kingdom and Europe believe that a specialist psychological assessment should come at the very beginning of the process. It is a careful, humane and responsible safeguard that ensures that a request for assisted dying reflects a settled decision, not untreated despair at a moment of profound vulnerability. If we fail to make that assessment first, we risk confusing a treatable cry for help with a settled and autonomous decision to die. To proceed without that knowledge is unfair, unethical and legally questionable, as many noble Lords have said before me. The noble Baroness, Lady Finlay, one of the most authoritative medical voices in the Lords, has warned:

“Without proper psychiatric assessment, a request to die may reflect treatable depression rather than a settled wish to end life”.


I very much hope that the noble and learned Lord, Lord Falconer, will take into account these worries and accept my amendment.

[Lord Carter of Haslemere (CB)]

My Lords, I have tabled four amendments towards the end of this group, Amendments 317, 346, 457 and 512, which are in identical terms. They are designed to ensure that a person seeking a state-assisted death is not acting out of a temporary feeling of fear, panic or anxiety in relation to their diagnosis and prognosis. I am grateful for the support of the noble Baroness, Lady Fox, and the noble Lord, Lord Farmer. I can testify that when a person is told that they have a terminal illness with only a year or so at best to live, it is difficult to think rationally. It does not occur to you that it will often be a wholly inaccurate prognosis or that specialist palliative care can deal with most pain. My amendments therefore seek to ensure that the assessing doctors are satisfied that a person seeking a state-assisted death is not acting from such feelings of panic.

The noble and learned Lord the sponsor may say in response that the Bill already requires the doctor to ascertain whether the person has a “clear, settled” wish to end their life. However, it seems to me that a person can have such a clear and settled wish as a temporary result of fear, panic or anxiety. These amendments seek to raise the threshold at which an assessing doctor can be satisfied that the person has such a clear and settled wish.

It is at moments like that, when people are at their most vulnerable, that great care needs to be taken to ensure that they do not opt to go down a path which, on deeper and longer reflection, they might decide is wholly unnecessary or inappropriate for them. Yes, in theory they can change their mind later, but many people might feel reluctant, for all sorts of reasons, to reverse their decision once they are on that track, so the initial discussions with the assessing doctor are critically important.

A full specialist palliative care assessment, which was in an amendment I previously tabled in Committee that was rejected by the noble and learned Lord the sponsor, would help to ensure that they are not acting out of despair, fear, anxiety or panic, since it would put a pause on the whole process and ensure that their wish to end their life was properly informed, as required by the Bill. Both these sorts of amendments strike me as obviously desirable in a Bill of this nature, and I urge the noble and learned Lord the sponsor to avoid the need to have to bring them back on Report.

[Lord Evans of Rainow (Con)]

My Lords, Amendments 158 and 163 are in my name. I will speak also to Amendments 157 and 164, in the name of my noble friend Lord Ahmad, who cannot be with us here today. Amendment 157 in my noble friend’s name

“seeks to ensure that a doctor may not raise assisted suicide with a patient who has ‘opted-out”’.

The statement on Amendment 158 in my name says:

“The Bill appears to permit any doctor to raise ending a patient’s life, even if they have no prior relationship with the patient. This amendment specifies that a preliminary discussion can only take place with a registered medical practitioner who has known the patient for a minimum of six months”.


Amendment 164 in my noble friend’s name would insert:

“If a person has informed their general practitioner that they do not wish to discuss the subject of the provision of assistance in accordance with this Act, that fact must be added to their medical records, and a registered medical practitioner must not discuss it with them”.


In his observations on the previous group, the noble Lord, Lord Deben, made a powerful point. He said that, based on his experience as a constituency MP, many members of the public are worried by doctors and hospitals, so when we debate medical issues in this House and put legislation on the statute book, it worries very great numbers of the population. It reminded me of my grandmother, who died 10 years ago. She lived until she was 97, but she had a theory that if you went into hospital, you did not come out alive. When I went to see her in East Cheshire Hospice—an outstanding hospice—at the age of 97, she grabbed hold of my arm and said, “What did I tell you? They’re trying to kill me. Get me out of this place”. But she died a very dignified death.

It was similar with my 90 year-old mother. There was an outstanding family GP service that knew our family, and we knew the GPs. There was good service from the local NHS, outstanding palliative care and, again, the outstanding East Cheshire Hospice. The glue that helped my family members to have a dignified death was that of a loving family. On a previous day in our debates, the noble Lord, Lord Harper, made a powerful point: it is okay if you have a loving family network around you to take care of you and think of your interests when interacting with doctors and hospitals. But he then referred to those people who are poor, lonely and ill, and without the loving network around them to look after them.

A recent case happened that was very close to your Lordships’ House. A noble friend was admitted to a regional general hospital with sepsis: a very ill friend indeed. One issue that the noble Lord, Lord Goodman, mentioned was about the NHS and the pressures on it, whether through funding or at times of stress, such as when the junior doctors are on strike. An assessment was made that my noble friend needed to be operated on urgently—a life-saving operation—but, because of the junior doctors’ strike, they were unable to get the necessary staffing for the operation, so the decision was made that they could not operate on my noble friend. My noble friend’s daughter was distraught, as you can imagine, so she contacted the Whips’ Office and asked whether they could help.

Your Lordships’ House is full of eminent clinicians. A Member of your Lordships’ House was able to find a crew that could operate on my noble friend in London. All they had to do was extract her from the NHS hospital in the regions and bring her down to the private hospital in London, which was duly done. However, they could not operate on my noble friend because she was dehydrated. The decision had been made in that regional hospital to not continue with food and liquids. The good news is that, when she was rehydrated, they operated. I am very happy to say that my noble friend made a full recovery and to this day makes a huge contribution to this House from our Front Bench.