Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Deben (Con)]

My Lords, the House will know that I have a moral position on this, but I am not going to talk about that.

This has been a most remarkable debate, and all of us from both sides have learned from what has been said. What has come out of it seems to be, first, that this is a very difficult issue. Secondly, although other countries have tried to do this, no one has produced an example of saying, “That’s where it works”. Instead they say, “That needs to be changed” or “There’s a problem”. Yet we are trying to debate this serious matter on a Private Member’s Bill that was inadequately dealt with in the Commons and has been criticised seriously by two of our expert committees.

What we are trying to do is momentous because we are seeking to depart from what has always been our attitude—apart from the question of capital punishment, which I fought against for many years—by empowering the state to kill. You can argue that, but let us realise just how serious it is.

I was an MP for 40 years and met wonderful people in both my urban and rural constituencies, but I also met people who felt that their old relations were a terrible burden and were spending money that would be much better left to them. I do not think we can ignore that fact, and I disagree with my friend, the noble Lord, Lord Dubs, when he suggested that somehow or other this was inconceivable. I put it to the House that not only is it conceivable but it is increasingly dangerous, because many families who have never seen any real money now see an aged relative who has a house worth £200,000 and more. There is a temptation for those people, whom I know and have met, to say to that person, “You really have a duty to save this money for your family. You know that Roger’s got a real problem and you can help him. This is what you should do”. No doctor is going to be able to analyse what has happened over a long time; the incident that we are discussing is very often at the end of a long period, when people come to that decision with that kind of pressure.

I am sorry that that is the case, and it is the case in a society that has far too many people about whom it has been suggested, because they do not work, are not worth anything. We must recreate the worth of all of us and the place that we all have in society. I am an individualist and a Tory, but I have to say that I see individuals as living in a society, and that means that we have responsibilities. It may be—I say this with due humility—that the contribution to society that someone in great pain may make is to protect vulnerable people by bearing that, in order that they will not be destroyed.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

The noble Lord knows that I am not a proposer of the change of words. I am dealing with capacity. Therefore, I am also dealing with the fact that professionals within the field have stated that to use the Mental Capacity Act for a decision to end one’s life is an entirely novel test and uncharted territory for which there is no experience or precedent. That is not my statement; that is the statement of professionals within the field. They say also that to decide to use it for the decision to end one’s life is an entirely different and more complex determination requiring a higher level of understanding than assessing capacity for treating decisions.

Capacity can fluctuate in terminally ill patients due to physical fatigue, illness, medication or delirium, making the irreversibility of the decision risky under this framework. Therefore, I ask this Committee to think carefully in trying to base its whole argument on this being good legislation because mental capacity is the deciding factor.

[Lord Deben (Con)]

I wonder whether I can help the Committee. I think we may be discussing two rather different things, so I suggest that we decide which of them to discuss.

There is the discussion as to whether the word “capacity” really includes all the things that people are pressing for when they use the word “ability”. That is the point that the noble Lord, Lord Pannick, was clearly making when he expressed the nature of the word “capacity” as used in law. It is perfectly understandable that people would want to say, “Here is a word that we use. It’s a word which is defined and has been defined over a long period of time. Therefore, it’s stood the test of time”. I understand the noble Baroness, Lady Andrews, who rightly mentioned the amount of time that had been taken to deal with that.

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[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Baroness for her intervention. Every suicide is a tragic situation, and I am sure that all of us would wish to help that person. But that is not what the Bill is about. It is about whether we find a method where they have a settled will to make a decision—to make a choice.

[Lord Deben (Con)]

Is the difference not absolutely fundamental? The Bill allows the state to enter into this discussion and allows somebody in fact to kill somebody else. That is wholly different from suicide, and the noble Baroness is wrong.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Pannick (CB)]

My Lords, there is a profound irony in this group of amendments, because the Bill introduces far greater protection for vulnerable patients than exists under current law. Terminally ill people are currently vulnerable to all sorts of pressures from family members and others who may have their own agendas in seeking to persuade the patient not to continue with their treatment, to die or just to give up on life. The Bill introduces in statutory form a whole range of new statutory protections that simply do not exist in the standard cases of vulnerable people being encouraged not to continue with their treatment.

We see that in Clause 1(2), which summarises what the Act provides in some detail. Steps are to be taken, and they are taken under the Bill, to establish that the person concerned

“has a clear, settled and informed wish to end their own life, and … has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it”.

Those seem to me to be very strong and very appropriate protections. The idea that we should proscribe encouragement will inevitably lead to the family members and friends of the person concerned, the person in the terminally ill condition, being worried that, if they discuss this difficult, important subject with their loved one or friend, they will be vulnerable to all sorts of sanctions under the law. That, I would have thought, is the last thing that we want. The application of these principles—and they are the right principles in Clauses 1 and 2—will inevitably depend on the facts and the circumstances of the individual case, so I, for my part, do not see the need for any of these amendments.

[Lord Deben (Con)]

My Lords, I am not a lawyer, and it is dangerous to follow the noble Lord, Lord Pannick, but I think on this occasion he is mistaken. The fact that this kind of protection is not there until this Bill does not actually mean anything—perhaps it should have been there in any case—but, if we are going to have this protection, it needs to be proper protection.

I say to those who, at least today, live a privileged life that they ought to remember that there are many people in this country who, for the first time, are within touching distance of large sums of money, because the housing situation means that there are many old people who have houses of a value that those families have never seen ever before—grandma’s £200,000. I say to the noble Lord, Lord Pannick, that, as somebody who was a Member of Parliament for 40 years and works now in a community, that this is a very real fact, and we just have to accept that some people in this House are a long way away from those people. I was brought up in a slum parish by a clergyman. I have spent my life trying to deal with the very people we are talking about. I think these amendments are crucially important, because we are talking about circumstances which we are about to change deeply.

The fact is that the Bill itself changes the way in which we think about old age and infirmity. I desperately want people to know that they are always valuable and always got something to give, even at the end of life. This Bill removes that. If we are going to have it— I hope we will not, but if we are going to—we must make sure that people are protected not just from coercion but from encouragement, which I am afraid is sometimes driven by a sort of misunderstanding of what we can give. I can see people who will say, “You know that your grandson is in some real difficulty. You have a last opportunity to do something worthwhile. If you die now, your house will save his marriage, will save his firm and will look after his future”. That is what will happen. We, who are in happier circumstances, should just remember that we have a deep responsibility for those people.

[Baroness O’Loan (CB)]

My Lords, these amendments seek to prevent and/or identify coercive behaviours and pressure which may fall short of coercion, and situations in which vulnerable people may be encouraged to make what is actually an involuntary decision to end their own life that they would not otherwise have made. There is no definition of coercion or pressure in the Bill, although new offences are created by Clause 34. That is unfortunate.

Arrangements made did not enable the taking of evidence from those with disabilities until the recent Select Committee on the Bill. Liz Carr said in evidence to that committee:

“The absence of our … involvement has led to disability rights organisations making a formal complaint to the UN Convention on the Rights of Persons with Disabilities”.


That is very serious. We know that 40% of those who die by assisted dying in Canada have lived with disabilities.

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[Baroness Hayter of Kentish Town (Lab)]

My Lords, this has been something of an unbalanced debate, so I hope it might be possible to hear from someone who supports the Bill. I was particularly anxious to come before the noble Lord, Lord Polak—for whom I have a lot of respect; we agree on many other issues—to respond very soon after the right reverend Prelate the Bishop of London. She was very honest when she said that she did not support the Bill, and I think she said that it was unamendable. Here we are, however, discussing amendments.

The noble Lord, Lord Carlile, spoke earlier about whether we should discuss a form of wording on which we could all agree. The question then would be: if we can agree a form of wording, would he then support the Bill? My feeling is that these amendments are not about making the Bill acceptable so that those putting them forward could then support it but are a way of trying to stop our discussion and proper scrutiny, because they do not want the Bill to go ahead.

[Lord Deben (Con)]

My Lords—

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[Lord Goddard of Stockport (LD)]

Unfortunately, you can, because that is how this country works. It is called democracy. When 650 elected Members, representing 70 million people by a majority, send it to this House, we have a duty and the honour to treat that Bill with respect, not disdain, not threatening to derail it or run it out of time—

[Lord Deben (Con)]

Could I just put this to the noble Lord? He is suggesting this approach, however bad a Bill is, however many people are damaged by it, and whatever the mistakes in it. The Government say that, at the moment, the Bill is not suitable as legislation. We cannot go on discussing it until we get it right. As noble Lords know, I am not in favour of this Bill, but I am even more not in favour of a Bill that gets it wrong and does terrible damage. He surely is not saying that we should just pass anything and that that is okay, when we think of the people who are going to be damaged if we get it wrong.

[Lord Goddard of Stockport (LD)]

The noble Lord is on completely the other side of the argument, and I respect his views on that. This Bill has been scrutinised for over 100 hours in the other place. Evidence was taken from over 500 people. This is not just a piece of paper sent up here for us to determine.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

First, on there being no need to question someone about why they are withdrawing, if there is material relevant to it, I need to check the Bill to see that it should be recorded. But the Bill contains regular provisions that state that everything must be recorded. If it is not adequately covered—if somebody says, “I’m withdrawing because I think you’re being coerced”, obviously that should be recorded—I will make sure that it is covered.

On Amendment 405—

[Lord Deben (Con)]

I genuinely want to understand this. The worry we had about this being a drafting difference is simply because when you could withdraw only on grounds of illness or death, the situation about why you withdrew did not arise. When you remove that, people can withdraw without giving notice of why. Therefore, there ought to be something—the noble and learned Lord has rightly said that he will look at it—to make sure that if somebody withdraws because there is some serious issue in connection with the decision, they have to say what it is. If we do not have that, this very much becomes a weakening point. I know that the noble and learned Lord does not want it to become that, but without something that insists on the information being given, it does become much weaker. This is not a drafting point until that is put right; when it is, it is a drafting point.

[Lord Falconer of Thoroton (Lab)]

I do not accept that it is not a drafting point, but that may be dancing on the head of a pin. The point that both the noble Baroness, Lady Fox, and the noble Lord, Lord Deben, are making concerns making sure that if you are leaving for a reason that will give rise to problems, it is properly recorded. I completely accept that and we will make sure that that is the position, because it is a valid point.

In relation to Amendment 405, the noble Lord, Lord Shinkwin, said that it is a watering down. It is not a watering down at all, with respect. The current draft says:

“When carrying out an assessment in accordance with subsection (2), the assessing doctor must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters”.


The new draft says that the relevant doctor must

“take all reasonable steps to ensure that there is effective communication between the assessing doctor and the person being assessed (including, where appropriate, using an interpreter)”.

The noble Lord, Lord Shinkwin, is shaking his head; I am more than happy to talk to him about how that could be a change, and if there is some change that he would like in relation to it, let us put it in. But it is, in legal terms, to my eye, wider. It covers a much wider ambit without providing any inadequate protection. Maybe the right course is for me and the noble Lord, Lord Shinkwin, to sit down and for him to identify the changes that he would like. At the moment, I cannot see them.

Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Harper (Con)]

My Lords, this is a very sensible group of probing amendments, and it is a pleasure to follow the right reverend Prelate. I will speak to them because the issues raised in this group concerning the difference between where somebody resides and where their GP is registered are exactly analogous to the situation regarding England and Wales, which I raised in an earlier group but have not received a satisfactory answer to.

I will remind the noble and learned Lord of the situation and he can, I hope, respond in a positive way. There are two issues, one of which is the difference between where you reside and where your GP is registered. There are a significant number of people living along the England-Scotland border and the England-Wales border whose place of residence is not the same as where their GP is registered. Therefore, it is very important that the legislation makes it clear that the rules through which you access assisted suicide are governed by where you live, not where your GP is registered. That is important for the reasons my noble friend Lady Fraser set out—in England and Scotland there will potentially be very different legal situations.

As we know from the earlier debate, although the Bill covers England and Wales, the rules governing the detail of how an assisted suicide service will work in Wales will be set by the Welsh Senedd, not the UK Parliament. Therefore, it is important that the Welsh rules apply only to people in Wales, who are governed by a body that is democratically accountable to them, not to people who live in England; otherwise, there would be a massive democratic deficit. It is very important that the noble and learned Lord is clear about how that is going to work.

Secondly, I think the noble and learned Lord said in response to our debate on England and Wales that he and the honourable Member for Spen Valley had had some detailed discussions with the devolved Governments. However, I was not clear from his responses whether those discussions had covered this point. Obviously, they need to take account of the views of not only the devolved Governments but the UK Government—which, for these purposes is actually only the English Government. We need to understand how this is going to work in practice.

As I have said, and in conclusion, this must be got right now, in primary legislation. If we do not get it right now, somebody will have to spend months and years clearing up the mess afterwards, which is one of the things that I had to do when I was the Member of Parliament for the Forest of Dean to deal with the cross-border issues that had not been properly thought through then. This is a valuable set of amendments. I was pleased that that the noble and learned Lord acknowledged, I think last week when the noble Lord, Lord Beith, spoke about this briefly, that these are valid issues that need proper answers. I look forward to hearing them now.

[Lord Deben (Con)]

Could I be vulgarly practical about this, because of a point the noble Baroness mentioned, which is the parallelism with the deposit return scheme that got into terrible trouble? I declare an interest as chairman of Valpak. We had to work through that, so it is burnt into me how extremely damaging it was because it was not decided beforehand. I know that we are talking about much greater issues here but, as I hope the noble and learned Lord will accept, this is a really serious issue; it brought about enormous cost and a vast misunderstanding, and it ended up destroying what the Scottish Government wanted to do. It is a very dangerous precedent. I am sure that the noble and learned Lord will want to make absolutely sure that we do not have a repetition of something that cost vast sums of money, in both the private and public sectors, and that has undermined an important measure ever since.

[Earl Howe (Con)]

My Lords, this group of amendments covers two distinct but connected questions. The first question, posed by Amendment 17, is, in my judgment, a very helpful one, because the answer will clarify the role—or lack of role—played by a person’s GP in the process being pursued by that person in seeking an assisted death. It seems to me, from reading the Bill’s provisions, that the involvement of a person’s GP in that process, although very likely, is not legally necessary provided that the patient fulfils all the conditions set out in Clause 1(1). Clarification from the noble and learned Lord would be very helpful.

The second question, posed by my noble friend Lady Fraser’s Amendment 62, is also one that I hope can be answered very simply by the noble and learned Lord. Am I correct that it is implicit in Clause 5 that the preliminary discussion between the patient and the registered medical practitioner need not involve a doctor physically situated in England and Wales and need not be face to face? Equally, am I correct that it is unnecessary to state in Clause 1(3)(b) that the steps set out in Clauses 8 and 19 must be taken

“by persons in England or Wales”,

because Clauses 8 and 19 already explicitly provide for this?

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[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, but I would like to press on. There are other GPs who want to see the same patients; they want to build up the patient relationship over time because they say it makes for better diagnosis, care and treatment for their patients. We should not put up with the worst-case scenarios simply because it does not happen or because we think a multi-doctor practice works well. It may work well in some cases, but there is no replacement for knowledge of a patient over time.

The letter gives the multidisciplinary panel an assessment of the patient’s illness and state of mind by someone who knows them. If anything raises suspicion that there has been pressure or that the patient is not in a state of mind to make the decision, the panel can investigate further. Moreover, unlike the other matters and activities in the process, the letter is not a matter of ticking boxes. The demand is for something that doctors are used to doing; to write a coherent letter about one of their patients is something that requires thought and careful concern for the individual case. It is standard practice in referring a patient to a consultant for specialist care where there are letters passed to and from. Doctors and consultants write letters.

If the Bill is to have real safeguards in the form of coherent and analytical evidence from a doctor who has known a patient over time, such amendments are needed. I ask the sponsor of the Bill to require it.

[Lord Deben (Con)]

My Lords, we are supposed to be making the Bill more practical; it does not make it more practical to ask for something that is manifestly impossible. I could not demand assisted dying, because I have not seen my registered practitioner in Suffolk for many years. I do not have a particular practitioner because that is not how the local system works. We are not in a sensible position if that is what we are going to ask for.

But the noble Lord, Lord Rook, has an important point that I do not want us to lose because of the suggestion that all people have the kind of National Health Service that we would all wish to be the case. We have to take his point rather differently. I was surprised that the noble Lord, Lord Winston, suggested that the proposition is that the general practitioner or the team—in normal circumstances it is the team—could in some way stop the application.

The point is—and I ask the Committee to think about this seriously—that if someone has a general practitioner, it is important that the GP and his or her team are informed of the request in case they are able to contribute to a sensible decision. The fact that this is assumed in the Bill, as was put forward by the noble Baroness, Lady Fox, does not prevent us insisting that they should at least have the opportunity. If we do that, we will be doing a very valuable thing.

[Lord Scriven (LD)]

It is not an assumption. It is in the Bill that if the co-ordinating doctor is not the GP of the person seeking the assisted death, under Clause 10(3)(b)(ii) the co-ordinating doctor has to write to the GP practice to make it aware of the request.

[Lord Deben (Con)]

I agree with that, but the point of the amendment from the noble Lord, Lord Rook, is to tie together a period of someone being in the National Health Service. I agreed with the comments made by the lawyers about “normally resident”, rather than other words. The noble and learned Lord who introduced the Bill might consider that this amendment will give some confidence to those who had a concern because it means that “normally resident” has been underlined by the fact that someone has in fact been in a general practice of the National Health Service. I cannot see that it does any harm, given that there is a year in any case. It underlines what the noble Lord reminded us of: the idea that this should be a part of the normal way in which people are dealt with.

I do not like the Bill very much, but it is our job to make it work. To do that, it is more valuable to fix it within the National Health Service as we have it, rather than trying to invent a service that we might well like to have—and I am old enough to remember when we did have it. Let us not pretend, when things are not as they ought to be.

[Baroness Gerada (CB)]

My Lords, if a patient is at the end of their life in any practice in the NHS, that patient will be discussed at a multidisciplinary team meeting. The patient will be put on an end-of-life pathway and will have a named clinician within the practice to do their care. This would include assisted dying. There is absolutely no way that a patient, unless in an extraordinary situation—and I take the point about Wales, which has a desperate problem with GPs—would not be cared for in that way. That is how our contract is; that is how we want to care for our patients. We would code it on the notes so that every single person consulting with that patient would know that this patient was an assisted dying choice, and they would get the care that I have just described.

With respect to the arbitrary 12 months or 24 months, many patients choose to move at the end of their life. They choose to move to the place where their loved ones are. Many choose to do something such as go abroad to the countries that they may have come from and come back right towards the end of their life. To put in an arbitrary barrier of 12 or 24 months is not putting the patient first; it is putting an arbitrary time limit first.

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[Lord Carter of Haslemere (CB)]

My Lords, I want to make a very brief intervention in relation to the prison population. It is only the second time I have spoken on the Bill. I declare an interest as a trustee of the Prison Reform Trust.

The suicide rate among male prisoners is four times as high as that of the general population. In the year to 2024, 89 male prisoners committed suicide. The Prison Service has a duty of care towards the prison population to protect them from committing suicide—to stop it. The Government run the Prison Service, so they must have a view on what to do about a prisoner whose suicide the Prison Service has correctly thwarted under its duty of care but who then requests an assisted death under the Bill. How will the Government balance those two conflicting things?

That is my short intervention—to ask that question. I wholly support all the comments made by the noble Baroness, Lady Fox, the noble Lords, Lord Moore and Lord Farmer, the right reverend Prelate the Bishop of Gloucester, and others on this crucial issue. I am genuinely interested to know what the noble and learned Lord, Lord Falconer, makes of this dilemma for the Prison Service and the Government.

[Lord Deben (Con)]

My Lords, the moments in the Bill that most concern me are when it gets nearest to saving money. There are several occasions on which that appears to be the case, particularly when talking about people for whom many have no sympathy at all, and when you are talking about a service in which we all know we are failing. It cannot be true that any Member of this House believes that our prisons are as they should be. Yet we imprison more and more people. We imprison twice as many people as the French or the Germans. I still do not understand why we cannot take this seriously, but we still go on doing it.

First, can one really think that someone in prison circumstances finds it possible to make the same kind of decision as people who are not? Just simply, those circumstances are the pressures, the crowding and the fact that you are not in any company that you would have chosen. I do not believe that those are the circumstances in which the Bill’s proponents meant for decisions of the sort we are talking about to be made.

The second issue is: what about the pressures there? We have been talking about the concerns of those who find themselves under pressure. Do we really believe that there will not be many prisoners for whom the whole issue will be presented as, “You will be better off and we will be better off if you make this decision”?

The third issue is surely this: we know that prisoners have much worse healthcare than people outside prison. Therefore, the fact that they are told that they have but six months to live is much more difficult than it would be if they were in normal circumstances. I put it no more sharply than that, but it does seem to be true.

Fourthly, earlier on, we were talking very strongly about the difficulty that the Government are willing to fund this when they are not funding palliative care for very large numbers of people in the country. I therefore come back to my deep concern that it will become so much easier for people to die than to continue.

The right reverend Prelate, whose experience is remarkable and whom I admire enormously for her work in the prisons, has reminded us of how old the prison population is and how much older it is becoming. I just do not think that those of us in this House who really believe that our major job in this Bill is to protect the vulnerable can possibly agree that people in prison should be included under the Bill. We should take them out.

[Lord Markham (Con)]

May I just offer a different perspective on this? It has been an interesting debate. One of the main reasons I am supportive of assisted dying is kindness—kindness to the people who are scared about the inevitable end of their life and kindness in that they face a lot of pain. They see assisted dying as a way of relieving themselves from that pain.

In this debate, are we saying that people in prison are not deserving of that kindness? People in prison have been deprived of their liberty because of the crimes they committed, and that is the punishment that they have been given in the face of the law. That is the debt being paid to society. But are we saying at the same time that they do not deserve the same kindness that we would give to others and that they should face pain because they are in prison, whereas others should not? That is my perspective on this.

[Lord Falconer of Thoroton (Lab)]

The noble Baroness is intervening on somebody who made an intervention on somebody else. We got a very severe talking to about that before, so I do not think that is allowed.

[Lord Deben (Con)]

I did not realise that the noble Lord was intervening on me, but I will just say that, for me, it is very difficult to have that argument. Kindness is absolutely the central point of everything that I believe in, so I am very vulnerable to that question. But the truth is, the Bill does not talk about pain at all. There is nothing in the Bill about pain. This is about a totally different circumstance. One of the problems in the country as a whole is that many people who support the Bill do so because they think it is about pain.

We could have a Bill about pain, but then we would come back to the point made by the noble Baroness, Lady Berridge, that that is not what the Bill should have been. The Government should have said that they would give a free vote on a government Bill on this subject, rather than slipping it in in a wholly different way.

However, we are faced with what we have, and in that case it does not seem kind to say to people who are under all sorts of pressures and who are particularly vulnerable that this is a choice they should make. If we want kindness, we should be saying to the Government, “Get the Bill withdrawn and introduce a government Bill that is properly thought through where we can have the real debate that the public as a whole want us to have. You can still have a free vote”, but it should never have been put through in this way.

[Lord Markham (Con)]

If I may respond on the pain point, I have spoken to lots of people who are terminally ill and heard their evidence. Again, I recommend that as many people as possible hear them because they have heartwarming stories. For them—not all the time, but a lot of the time—it is because they want to have that choice at the end so they do not have to face that pain. That is a key reason for them. The Bill says that you have to be within six months of the end of your life, but then you have the choice within that. For some people, the thought of that pain, and the experience of that pain, is the real reason why they want an assisted death. My point is that I believe prisoners should have exactly that same right so that they have the possibility to avoid that pain.