Terminally Ill Adults (End of Life) Bill

Lord Falconer of Thoroton Excerpts

Friday 16th January 2026 Lords Chamber

For the other amendments in this group, on which I make no comment, any workability concerns are likely to be less significant. While these are choices for noble Lords, they may introduce inconsistencies and ambiguities to the Bill. As noble Lords will be aware, and as we discussed earlier, these amendments have not had technical drafting support from officials, so the way they are currently drafted means they may not be fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

I am grateful to all noble Lords who have contributed to this important debate. I will deal first with what the noble Lord, Lord Deben, said. Of course I have to listen and make changes; I am not Stonewall Jackson—a tactical genius who died at 39. I am a man trying to do his best aged 74, so I am in a completely different situation. However, the noble Lord makes an important point. I have to convince the House that I am listening and, if sensible proposals are put, I must deal with them. I believe that has been my attitude throughout.

I cite by way of example the very sensible proposals made in relation to involving the multidisciplinary team looking after somebody and incorporating that into the Bill. I am working to try to achieve that. Proposals were made that people between 18 and 25 might be especially vulnerable and need extra protection; I have sought to develop proposals on that. Another example is where somebody has made an application that a person’s liberty be taken away because they are seriously mentally ill or lack capacity, or a person has actually been deprived of their liberty. Again, special provision should perhaps be made for them. I mention these points only to indicate that, far from being Stonewall Jackson, I am the House of Lords trying to do its best to make sure that we improve the workability of the Bill.

In that spirit, I turn to these amendments. My noble friend Lady Merron has gone through the technical problems with Amendment 27. For example, it refers to somebody being referred to an independent voluntary assisted dying service, which might or might not be sensible. I suspect that the later proposals from the noble Lord, Lord Birt, might relate to that. The noble Baroness, Lady Finlay, was making the wider point, which she expressed very clearly, that you should not be making a decision about whether you want an assisted death until you have been fully informed about all the consequences and the processes. She referred to a number of issues, including diagnosis, prognosis and the effect of an assisted death in terms of the substance.

In my respectful submission, the Bill reflects exactly the points that she is making, namely that there needs to be proper information made available to the patient by statute. I draw noble Lords’ attention to Clause 5(5), on the preliminary discussion that has to be recorded. It says:

“If a registered medical practitioner conducts such a preliminary discussion with a person, the practitioner must explain to and discuss with that person—(a) the person’s diagnosis and prognosis; (b) any treatment available and the likely effect of it; (c) all appropriate palliative, hospice or other care, including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion”.


All of that has to be available at the preliminary discussion.

Then, noble Lords will remember that there are two doctors who have to look at it: the co-ordinating doctor and then the independent doctor. Both doctors must, pursuant to Clause 12(2)(c) of the Bill,

“explain to and discuss with the person being assessed—(i) the person’s diagnosis and prognosis; (ii) any treatment available and the likely effect of it; (iii) any available palliative, hospice or other care, including symptom management and psychological support; (iv) the nature of the substance that is to be provided to assist the person to end their own life (including how it will bring about death and how it will be administered)”.

The panel has to be satisfied that all these processes have been gone through. I completely agree with the underlying proposition of Amendment 27, which is that a person should be fully informed—though it is Amendment 42 that puts it in those terms. However, I believe that the Bill has both made provision for that and has the means of enforcing it through the panel.

[Baroness O'Loan (CB)]

I am grateful to the noble and learned Lord for giving way. Could he clarify what is meant by Clause 12(2)(c)(iii) when it refers to

“any available palliative, hospice or other care”?

We know that palliative and hospice care is available if you can travel to it or if you live in a particular area, but it is not available in a very significant number of areas. So what is meant by “available” in that context?

[Lord Falconer of Thoroton (Lab)]

“Available” in that context obviously means available in a practical sense for that particular patient. If you live in the western part of England and there is palliative care of a particular sort available in a place you cannot access, that would not be “available”.

My noble friend Lady Merron indicated what the effect of Amendment 28 is, which was again proposed by the noble Baroness, Lady Finlay. The effect is that there are two additional requirements before you are eligible for an assisted death: first, that you are eligible for certain specific benefits available at end of life; and, secondly, that there has been a home visit by a GP to consider it.

Neither of those is appropriate for eligibility requirements for an assisted death. As my noble friend Lady Merron said, you might well not be eligible for particular benefits because, for example, they are means tested and you are above the means. It would be wholly wrong for that to prevent you getting an assisted death if you are otherwise entitled to it. Again, I do not think that the purpose of the noble Baroness, Lady Finlay, advancing that provision was to say, “You’ve got to satisfy these specific requirements”, with all the problems my noble friend Lady Merron indicated.

What I think she was getting at is that you have to be sure that financial circumstance—being short of money—is not a relevant reason for an assisted death. I put forward the Bill on the basis that choice is the key thing. Your financial position might be an element in what makes you reach a decision. From the way that the safeguards are put in the Bill, they are trying to ensure it is your decision, freely made.

[Lord Harper (Con)]

I am slightly incredulous about this, so I am just going to make sure I understand the noble and learned Lord correctly. As we also heard earlier from the noble Baroness, Lady Jay, he is talking about someone’s autonomy. If you are in a financial position where you feel you are unable to live properly because you have no money, and as a result of that you decide you want to end your life, that is not a freely reached decision; that is being done because of your circumstances. Is he really saying that he is okay with poor people ending their lives, with the assistance of others, because they are poor? That is what it sounds like. All we are talking about with these amendments is putting in provisions to make sure that is not the case. That is not paternalistic; it is protecting people. Exactly as my noble friend Lord Deben said, that is what we should be doing in this House.

[Lord Falconer of Thoroton (Lab)]

I am saying that what the Bill does is allow you to make your own decision. I am strongly against saying poor people should not have that choice, which appears to be what the noble Lord, Lord Harper, is saying. The evidence from abroad is that it is people from perhaps more financially secure circumstances who make this sort of choice.

[Lord Harper (Con)]

I am going to come back once more, because the noble and learned Lord suggested why I was saying what I was saying, which is absolutely not the case. What I am saying is that if someone is making the decision because they feel pressured because of their financial circumstances, that is not a free choice; that is a choice that is being forced upon someone by their circumstances. They are not in an equal position to someone with resources. That would be very wrong, and I think people would be horrified that he is suggesting that someone, because of their financial circumstances, should be more likely to end their life than someone else.

[Lord Falconer of Thoroton (Lab)]

I am saying it is their choice.

I will go on to Amendment 31 in the name of the noble Baroness, Lady Ritchie of Downpatrick, referred to by the noble Baroness, Lady Berger, in relation to the issue. The noble Baroness, Lady Berger, is saying on behalf of the noble Baroness, Lady Ritchie of Downpatrick, that it must be their own request for an assisted death. The whole Bill is posited on the proposition that the person making the request has to be doing it as their own free choice. I draw attention in that respect to Clause 1(1)(a),

“has the capacity to make a decision to end their own life”,

then Clause 1(2),

“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”.

Then, if one goes over the page to the conditions, there is Clause 8(1):

“A person who wishes to be provided with assistance … must make a declaration to that effect”.


The only concession made is in Clause 21 on the declaration. Clause 21(1) states:

“This section applies where a person intending to make a first declaration or a second declaration … declares to a proxy that they are unable to sign their own name”.


It allows a proxy to sign their name. The noble Baroness, Lady Berger, and I are both saying that it has to be you who does it, the person who wants it, the patient. My own view, having consulted on this, is that that is absolutely clear under the Bill and that the terms of the amendment would make absolutely no difference to it legally. I make clear that the policy intent that the noble Baroness, Lady Berger, wishes to achieve is exactly the policy intent that has been achieved.

--- Later in debate ---

[Baroness Lawlor (Con)]

I thank the noble and learned Lord the sponsor for his response, and I agree with him on Clause 1(1), as I said. However, my amendment seeks to bring the same precise language to subsections (2) and (3), because the conditions are not set out in the same way as they are in subsection (1); they are more descriptive. I tabled the amendments for that reason.

[Lord Falconer of Thoroton (Lab)]

They are more descriptive, but the provisions say “must” each time. Clause 32 says that someone can escape the consequences of the Suicide Act only if they have complied with all the provisions. I in no way disagree with the point that the noble Baroness is making but, as a drafting legal matter, I think it is covered.

[Baroness Lawlor (Con)]

Is the “must” there only a “may”?

[Lord Falconer of Thoroton (Lab)]

I am sorry; I did not quite get that.

[Baroness Lawlor (Con)]

I find the “must” in Clause 1(3) a bit puzzling. The noble and learned Lord can see that it reads:

“The steps to be taken under sections 8, 10, 11 and 19 must be taken … when the terminally ill person is in England or Wales, and … in the case of the steps under sections 10 and 11, by persons in England or Wales”.


My question of clarification is whether the steps in Sections 8, 10, 11 and 19 must be taken; is it not that they only may be taken?

[Lord Falconer of Thoroton (Lab)]

It is. The reason the two are different is that Clause 1(2) describes what is coming later in Clauses 8 to 30; Clause 1(3) is a mandatory requirement that the steps that come later have to take place when the person is in England or Wales. So they do different things. Subsection (2) is descriptive, and subsection (3) is a legal requirement. I am very happy to say that the shadow Attorney-General is nodding, which is very strengthening on this.

The one point that I have not dealt with properly, or at all, is that which the noble Baroness, Lady Berridge, made about the interaction between the Mental Health Act and the Bill. I was not sure which specific amendment she was referring to; it may have been Amendment 38, but I do not know. However, as far as I can see, there is no legal difficulty in this Bill sitting with the Mental Health Act because, as long as these conditions are satisfied, the patient is entitled to have an assisted death. There is nothing in the Mental Health Act that would prevent that. I am more than happy to have a more detailed conversation with the noble Baroness and Professor Ruck Keene, if she wishes to bring him along and he is willing to come.

I hope that I have dealt with every amendment put forward.

[Lord Deben (Con)]

Just one point, as a matter of personal explanation, I did not call the noble and learned Lord Stonewall; it was the noble Lord, Lord Empey, who did so and I do not want to take his excellent comment away from him.

[Lord Falconer of Thoroton (Lab)]

I apologise. I do not know whether the noble Lord feels that he is withdrawing a compliment or withdrawing an insult, but I get what he is doing.

To the noble Baroness, Lady Cash, before she gets to her feet, I say that she is right. In relation to the ECHR points that were raised by, I think, Mr Stevenson, who was the commissioner—I have the name wrong.

[Baroness Cash (Con)]

It was Alasdair Henderson, who gave evidence to the Select Committee and raised a lot of the concerns that have been reiterated by the noble Baroness, Lady Berger, and others today. Indeed, the point that the noble and learned Lord makes about being poor and having a choice is something that is really of concern to the EHRC, which raised that in evidence orally and in writing and, subsequently, in the letter to the noble and learned Lord, Lord Hope. Indirect discrimination, because of circumstances, is one of the problems with this Bill that troubles us most greatly. That has not been addressed, which is why the EHRC, without taking a position on the principle, has asked for that clarification. I would like to know whether it needs to write formally to request that, or is its evidence before the Select Committee and its subsequent letter adequate? Can the noble and learned Lord please clarify?

[Lord Falconer of Thoroton (Lab)]

The commissioner for the EHRC raised a number of points in relation to the risk of discrimination under the convention. The Government have done an equality impact assessment and, broadly, they adopt the approach that it is unlikely that the courts will interfere in a deliberate choice made by the Government, or the legislature in this case, as to what the limits would be of an assisted dying Bill. I agree strongly with that. It is the approach that the English courts have reflected in relation to assisted dying, and it is the approach that the European Court of Human Rights has taken as well. I therefore do not think that the views expressed by the commissioner to the Select Committee are right, but I am more than happy if the noble Baroness, Lady Cash, would like to raise specific ones—or all of them—she can do so with me, and I can raise them with the Government as well.

[Baroness Berger (Lab)]

On this particular point, there is something fundamental that would equip all of us in this Committee, irrespective of our views on the principle of the Bill before us, which is the equality impact assessment—it is lacking. The equality impact assessment came forward from the Government only at the end of Committee in the House of Commons. The response from the Equality and Human Rights Commission is that that assessment is wholly inadequate and is in no way commensurate to the length and detail that we would expect on a government Bill.

We have obviously already heard from the Minister in response to the current set of amendments, but I would urge that, in future responses, we hear from the Government about whether they might be forthcoming with an updated equality impact assessment in order to inform our discussions, debates and deliberations on what we might be considering going forward. So far, what we have heard from the Equality and Human Rights Commission is that we do not have the information before us. As the commission responsible for this legislation, it has some serious concerns, particularly in terms of the societal impact of this Bill that has in no way been addressed or deliberated by the Government in the way that it would have been otherwise.

[Lord Falconer of Thoroton (Lab)]

First, I do not agree with the proposition that it was a bad equality impact assessment. Secondly, the noble Baroness, Lady Cash, legitimately raised the question of differing economic circumstances and whether that could that lead to discrimination. If differing economic circumstances could lead to discrimination—the point that she quite properly raised—then almost every single piece of assisted dying law throughout Europe would be contrary to the European Convention on Human Rights. One has to provide some degree of realism about what the limits of the law are. What the courts here and in Europe are saying is that this is a sensitive and delicate area where they will defer to legislatures.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The noble Baroness’s hands are not tied behind her back. Ultimately, whatever the EHRC says and whatever the equality assessment said, we have to decide here whether we believe that, because of problems surrounding the convention, we should make amendments. I am very happy to discuss any of them. It is clear—Stonewall Jackson is back—that I am not that persuaded that we need changes, but I am more than happy to discuss them. I would welcome a discussion with the noble Baroness, and anybody else who wants to come along, about amendments that she is particularly worried about. I am starting from the proposition, which is reflected in the equality assessment, that the courts are very unlikely to make much change here. I am fortified in believing that by what the noble and learned Baroness, Lady Butler-Sloss, said. I am happy to take any other questions.

[Baroness Finlay of Llandaff (CB)]

My Lords, this has in many ways been a fascinating debate, which has clearly illustrated the problems of this being a Private Member’s Bill and the difficulties that we are having in trying to raise issues and draft amendments to improve it. There have been a lot of suggestions about how the Bill could be made safer because of the concerns about coercion and protection for people. I will not take time commenting on every comment made, but I am grateful for all of them.

On the lasting power of attorney, I caution against dismissing this going into the Bill, given the number of complaints that go to the Court of Protection, where lasting powers of attorney have been abused by people who hold them. That needs to be looked at carefully.

I appreciate the fact that the noble and learned Lord, Lord Falconer, has begun to look at enhanced assessment for people who may be particularly vulnerable. It would be helpful to know when those amendments will be before us for us to consider them and whether that will be before we get into further rounds of amendments, which we will then be told are poorly drafted or not workable.

I am very grateful to the noble Lord, Lord Wolfson of Tredegar, for re-emphasising the criteria about having a fully informed decision, including the capacity to make that decision voluntarily. If I heard the noble and learned Lord, Lord Falconer, correctly, it sounded to me as though he is willing to accept my Amendment 42, which seeks to insert the word “fully” ahead of the word “informed”, to ensure that a fully informed decision is being taken.

I will make some comments on poverty. Unfortunately—

[Lord Falconer of Thoroton (Lab)]

Sorry, I do not want to create false hope. I do not believe that the word “fully” is necessary. The noble Baroness is right to say that I never made that clear. I do not believe that it is necessary because I went through all the provisions that required the information to be given anyway.

[Baroness Finlay of Llandaff (CB)]

That is disappointing, because the Committee, I think, would greatly welcome recognition from the noble and learned Lord that some of the things that we are trying to put down are seeking to improve the Bill. Perhaps we could work further on them.

On poverty, unfortunately, the SR1 does not happen automatically; there is no automatic trigger. The point of that amendment was that one wants to make sure that a person who may be in real financial straits and who has never known that there may be benefits for which they are eligible has someone ask them, “Are you finding things particularly difficult? Do you know that there are some benefits that might help improve your quality of life?”, irrespective of whether they do or do not wish to proceed. It is not to stop them; it is to make sure that they can access what they need.

The Ontario coroner’s review reports that there are people who, because of financial stringencies, have sought an assisted death—and been approved for one—but then dropped that request when there has been fundraising and donors have come forward to bail them out of their difficult circumstances. Saying that there are no such cases is really difficult. As I understand it, it is our duty to society to try to narrow the gaps on poverty and not just accept that, if you are in poverty, you may want to take this decision. There were some expressions of slight horror, I think, at the way in which the noble and learned Lord expressed his dismissal of poverty.

There is one final thing that I want to clarify; I feel, professionally, that I must. The noble Lord, Lord Markham, has referred on a few occasions to his mother being “helped on her way”. I am sure that the doctor was not giving the noble Lord’s mother a massive and lethal overdose of drugs, which is what would happen under this Bill. They may well have been giving her a little more analgesia or some other medication in order for her to be comfortable. That is routine clinical practice when people are dying. At that point, we as clinicians will say to the family, “Look, they don’t seem comfortable and they really are near the end”, and we will give a bit more analgesia—possibly an anxiolytic as well—which will allow the person to gently let go of life and die.

We know that pain is a potent driver of respiration and that people cannot let go of life until they are comfortable and out of pain. Sometimes it is a small dose; sometimes it is a larger dose. That is not what we are talking about in this Bill. It is important that the people out there who are listening to this debate do not think that we are going around shortening life by giving people the dose of analgesia or the anxiolytic that they need at the end of their life.

I am not going to go through all the other comments that have been made because of time—this has been a long and very informed debate—except to request that the equality impact assessment be looked at again. Although it may not be the opinion of the noble and learned Lord that it is inadequate, we have heard substantially from people who know equality impact assessments well that they are unhappy with it. I do not see the harm in it being revisited and retabled for us so that we can have an up-to-date version. Perhaps the same should go for the impact assessment, since there are concerns that the numbers in it may be inappropriately low. With that, I beg leave to withdraw my amendment.

--- Later in debate ---

[Baroness Lawlor (Con)]

My Lords, I support all six sub-paragraphs in the amendment in the name of the noble Baroness, Lady Foster of Aghadrumsee, which was moved by the noble Lord, Lord Weir of Ballyholme, and is supported by the noble Baroness, Lady Fox, and the noble Lord, Lord Empey. However, I urge that there should be an additional sub-paragraph. As they stand, the sub-paragraphs in Amendment 30 provide a checklist to help those deciding whether to allow an assisted suicide to go ahead to determine whether the person has been led to the decision by an improper type of motivation.

Some of the types of motivation listed here are improper because, if permitted, they would risk leading to a situation where people, under some circumstances, are pressed or influenced into suicide as a way of solving social problems. We have heard quite a bit about that today.

My extra subclause mentions families explicitly and would add to the idea of not being a burden on the family that of not causing distress. It is all too easy to imagine families pressing, influencing, perhaps coercing, an ill person into a suicide they do not genuinely desire by appealing to altruistic feelings that they do not want to be a burden or to cause distress, especially to those they most love. Even worse, it is all too easy to imagine how, in the dismal future of a world where the Bill becomes law—

[Lord Falconer of Thoroton (Lab)]

Just so that I can properly respond to this, which amendment in the group is this addressed to?

[Baroness Lawlor (Con)]

It is addressed to Amendment 30ZA amending Amendment 30. It is on page 2 of Today’s Lists.

It is all too easy imagine such appeals by a family to altruistic feelings. They do not want to cause distress or be a burden, especially to those they most love. In the dismal world where the Bill has become law, such ways of thinking will have become a social norm. That is very easy to imagine.

My amendment is designed to make that future a little less dismal, by putting in an obstacle to this insidious form of coercion by those the person in question may love most.

--- Later in debate ---

As noble Lords will be aware, these amendments have not had technical drafting support from officials. The issues raised are, rightly, a matter for noble Lords to consider and decide but, given the way that these amendments are currently drafted, I note that they may require further consideration to make them fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

I am grateful to noble Lords who have contributed to this debate. I will make four quick preliminary points.

First, I join everybody in welcoming back the noble Baroness, Lady Campbell of Surbiton. The noble Baroness, Lady Campbell of Surbiton, and I have been debating this for at least 20 years, or maybe longer. It is very good that she is still with us and doing it in the same way.

Secondly, I mean no disrespect to the noble Baroness, Lady Monckton of Dallington Forest, but I will not deal with the points that she made because in a sense—and I quite understand why—they have nothing to do with these particular amendments, which she acknowledged. However, I am more than happy to talk to her about the process issues and I would welcome a conversation with her.

Thirdly, the noble Baroness, Lady Finlay of Llandaff, asked whether it is a medical procedure and whether it is part of the range of treatments that have to be offered or discussed with the patient. In relation to whether it is a medical procedure, the noble Baroness will know that the Bill provides that the actual provision of assistance has to be given by a doctor. I do not know what the consequences are in relation to either the medical or the legal world, but that is the medical connection.

In relation to whether it has to be raised if it is a possible medical procedure, the answer is unequivocally not, because the Bill specifically provides in Clause 5(1) that:

“No registered medical practitioner is under any duty to raise the subject of the provision of assistance in accordance with this Act with a person”.


So the matter is put completely beyond doubt in the Bill.

I turn to the substance of the amendments, which fall into three categories. The first is the amendment ably moved by the noble Lord, Lord Weir, to the effect that certain motivations, if they exist, should ban or prohibit an assisted death. Secondly, an amendment says that the only circumstances in which you can have an assisted death are when you are acting for your own sake rather than for the benefit of others. The third category is where you are acting for the primary purpose of avoiding physical pain. All the amendments in this group are designed to try to limit it to certain permitted motivations only.

I want to adopt completely the speech of the noble Lord, Lord Markham, who described what the Bill is seeking to do: to give people who are diagnosed as having six months or less to live the choice about how their life ends in those six months. The choice they make may be motivated by a whole range of factors. The pain may be too much. They may not be able to bear the thought of being reliant on their children, not because they see themselves as a burden but because the whole change in the relationship is just unbearable. They may not want to go through that period while they await death and there is nothing else. They may find the whole sense that they are incurring expenditure for somebody else so awful for them that it makes them feel bad and they do not want to go through it.

I go through all those possibilities simply to indicate that the reasons why you may want an assisted death vary from person to person. From my own experience, it is very often what we would regard as pain and suffering that causes it, but what causes distress or unbearability to people is not always, and may not often be, the pain or the suffering; it is the whole circumstances in which they find themselves during that last six months.

There is an incredibly good article by somebody on what their mother, who had all the access to palliative care, said was awful about their circumstances. All the pain relief was there and everybody had come to say goodbye, but then weeks went by when there was nothing but staring at the wall in a period of not quite being able to engage with other people and wanting it to end. Would they qualify if, for example, pain and suffering was the requirement? No pain would be identified. The suffering would come from the unbearability of it.

The Bill is constructed on the basis that the person who has six months or less to live should have the choice. There are ideas to bring in these particular things. Do they feel they are a burden to somebody? Do financial considerations apply? They might well apply because there is only a limited amount of money to go around, so they might contribute. Is the panel or the doctor supposed to parse the precise part that every one of these motivations plays? In my view, that would be a very bad way of constructing the Bill. I am very happy to explain how I got there. I think it is a choice, and pain and suffering will often be the choice. If you are serious about putting the patient first, you have to give them the choice and not be in a position where you are trying to look into a whole range of multiple motivations.

[Lord Harper (Con)]

I am grateful to the noble and learned Lord for once again giving way. Can I just press him on this choice point? Although I do not agree with the Bill, there is an argument to be made for giving people a completely free choice, but does he accept that many people in society have many constraints on their ability to make choices? These amendments are trying to make sure they are making a free choice, not one that has been constrained by their other circumstances. Does the noble and learned Lord accept that it is a problem if someone has all these constraints on them and is not really making a free and unconstrained choice, which many people in this Committee would be able to make? Does he even accept that it is a problem that, although it may be difficult, potentially needs fixing?

[Lord Falconer of Thoroton (Lab)]

It is very difficult and would be inappropriate to try to examine exactly why people make particular choices. Look at the first Amendment 30 proposal:

“not wanting to be a burden on others or on public services”.

Why does the thought that they are going to be a burden on their children become an unbearable thing for some people to go through? They might make that choice because of what has gone on in their lives, but it is totally inappropriate, impossible and wrong in a Bill such as this to say that we have to ask why they are in that position.

The next proposal refers to a mental disorder—

[Baroness Fox of Buckley (Non-Afl)]

If the doctor was required to ask what someone’s motivation was, and the patient said, “I just really don’t want to be a burden on my family; it’s too intolerable”, but they have been told they are terminally ill relatively recently, is it not possible that there could be an intervention that would say, “Maybe you won’t be a burden” and to go and talk to their family? One of the problems is that it is assumed the endpoint is there already, whereas if you ask the question, there is a possibility that you could offer an alternative. If somebody says, “I can’t face the pain”, you can tell them there is pain relief available. This is not trying to undermine the Bill totally, but it is possible that if the doctor responds with some options, the patient would be on their way. Why not ask for the motivation? That would surely be positive.

[Lord Falconer of Thoroton (Lab)]

That is a very important question. There is a difference between excluding certain motivations, which is what Amendment 30 would do, and asking why, which the noble Baroness, Lady Smith of Newnham, raised. I see force in the proposition that somewhere in the Bill, somebody has to ask why—for two reasons. First, as was raised previously, if you ask why, it might throw some light on circumstances that suggest classic coercion. Secondly, and separately, it might deal with exactly what the noble Baroness, Lady Fox, is referring to.

Take an utterly absurd example: someone says, “I want an assisted death because I cannot deal with the noise that’s going on in my head”. The doctor could then reply, “Well, actually, that’s a building site that will stop tomorrow”. If it is something like that, one should know.

I am attracted by the idea of something in the Bill that says why. That has to be asked somewhere down the line. This also connects with our previous discussions about the multidisciplinary team engaged in looking after the person, which might well have a much better view about why.

--- Later in debate ---

[Lord Deben (Con)]

Can I encourage the noble and learned Lord in what he has just said? I was going to intervene earlier, but decided I would wait for this moment. I am afraid the noble Baroness, Lady Whitaker, almost drove me to get up; she can say that she does not want to be a burden because she will not be one and I am quite sure her family would not let her be one. The truth of the matter is that we are concerned about making sure that people are given every opportunity to put themselves in the best position in the last six months of their lives. If the noble and learned Lord can find a way of having these questions asked without the disadvantage—I understand the point he makes—it would give us a great deal of support. I would like him to do that.

[Lord Falconer of Thoroton (Lab)]

I hope I have been clear about not liking the amendments as they are and that I am keen to see whether what the noble Baronesses, Lady Smith of Newnham and Lady Fox, said can be incorporated somewhere in the Bill. It may well connect with things we have said already. I hope I have made my position clear.

[Baroness Grey-Thompson (CB)]

My Lords, I feel a sense of disquiet listening to the noble and learned Lord’s response, especially when he talked about privilege. I have a huge amount of privilege in my life. If I need a new wheelchair, I can buy one. I can put a lift in my house. I can buy a car and pay for the hand controls. When I need a van with a tail lift, I can pay for that. Is he really saying that lack of privilege plays no part in somebody choosing to end their life?

[Lord Falconer of Thoroton (Lab)]

I am saying that everybody should have the choice. The way that one makes the choice is inevitably determined by how one got to the point where one had to make it. It is an impossible question. Why do we all make choices? They are all affected. Some people make them because they are richer or poorer than others, but I am not in favour of drawing financial distinctions. I hope that, in the light of my remarks, the noble Baroness— I cannot remember who started this—will withdraw her amendment.

[Baroness Fox of Buckley (Non-Afl)]

I blame myself for this, but the noble and learned Lord was about to say something about the mental health issue when I made a point, and we have not gone back to it. That is a very distinct question, so will he reflect on it?

[Lord Falconer of Thoroton (Lab)]

This is not a technical point, but the way the amendment is drafted is very confusing. If your mental illness makes you come to this conclusion, that may well go to capacity. I am not clear what is being got at in relation to the mental health issue. However, if the position is that you may have a mental health condition but are perfectly capable of making a decision, you should be allowed to make it.

[Baroness Lawlor (Con)]

My Lords, I thank all noble Lords who have contributed to this group. I am very grateful for the attention focused on the problems that people face in their lives, particularly those who have exceptional difficulties in exercising freedoms that we, as has been pointed out, all take for granted.

This suite of amendments sought to try to restrict the possibility of others pressurising people, particularly people in this very difficult position, to take a decision to seek assisted suicide under the Bill which they might not otherwise have taken had they had the support and had they not had the disabilities which have been mentioned in these amendments. They also seek to restrict the Bill to those who wanted to relieve pain only.

I am afraid I have been a bit disappointed, if I may say, with the noble and learned Lord the sponsor. In stressing autonomy and choice by one person, he is, I fear—perhaps inadvertently—neglecting the autonomy and choice of those who may want to live with their disability, with whatever ailment they have been born with or developed over their life but are facing terminal illness. We are concentrating on the autonomy of the person, but we are not giving enough attention in the Bill, I fear, to those who feel pressure, who feel they are a burden and who wish to avoid causing distress to those they love.

In doing so, we are doing a great disservice to the men and women of this country who do not want to be a burden to those they love. That burden is increased by virtue of the cost of living and the difficulties they have in making choices. We are putting the choice of those who want it and who have firm, clear intent, over those who may not wish to do it but feel pressured for the reasons of their life and their circumstances into doing so. I shall withdraw my amendment for now, but I hope to bring it back, if the noble Baroness, Lady Foster, wishes to bring hers back, and support the other amendments in this group.

--- Later in debate ---

[Lord Frost (Non-Afl)]

My Lords, I have four amendments which constitute the entirety of this group: Amendments 34, 121, 138 and 153. I am very grateful to the noble Baronesses, Lady Fox of Buckley and Lady Lawlor, and the noble Lord, Lord Harper, for putting their name to these amendments.

I will begin by making a purely process point. Were the underlying change I propose to find favour, as the explanatory statement on the Marshalled List makes clear, a large number of textual amendments would in fact be needed to ensure internal coherence within the Bill. For the convenience of the House, I have not tabled all those amendments now. In this sense, my amendments are exploratory and probing. The four specific amendments I have chosen, which are on the Marshalled List, have been chosen because they represent the first occasion on which a particular type of change would be required.

To summarise, Amendment 34 represents the first occasion in the Bill in which the phrase

“assistance to end their own life”

occurs; Amendment 121 is similarly the first occasion in which the phrase “voluntary assisted dying commissioner” occurs; Amendment 138 is the first occasion in which the phrase “assisted dying review panel” occurs; and Amendment 153 is the first occasion in which the simple word “assistance” occurs: a word that is not in fact defined in isolation but is taken to be short for the phrase “provision of assistance to a person to end their own life”.

Let me now turn to the substance of these amendments. I put them forward for two major underlying reasons. First, it is bad for us as legislators to attempt to legislate in such ambiguous language. Secondly, such language substantively carries real risks for at least some of those who may wish to avail themselves of the provisions of this Bill or have it put to them that they should.

All these amendments have one thing in common. They would replace phrases including the word “assisted” or “assistance” with something much clearer—an explicit reference to what is actually provided for in the Bill, the provision of

“medical help to commit suicide by provision of lethal drugs”.

I was aware when I tabled these amendments—some noble Lords have subsequently mentioned this to me—that the phrase “commit suicide” raises particular wider issues. I understand that and I will come back to it, but let me first proceed with the text as tabled.

First, it is a well-understood principle in drafting legislation—the noble Lord, Lord Deben, made this point earlier today—that it should be unambiguously clear. In this Bill, we have a phrase which covers a wide range of possible meanings. The core phrase,

“assistance to end their own life”,

could be read in a wide variety of ways. It could be read as meaning making somebody comfortable in their last hours. It could be read as withdrawing food and drink in a medical setting. It could even be read as an actual act of killing by another party at the request of the individual concerned. It could be read as many other things too, including of course the thing that is actually provided for by this Bill.

The polling about this Bill and the discussion around it shows there are many misunderstandings about what it does and what it allows. Surveys and experimental research show that public responses to questions about legality and support are very sensitive to the wording chosen. That is why it is important to be clear. My amendment would do that by providing clear language. It is possibly language that would be regarded by some as forceful, but nevertheless it is clear.

[Lord Falconer of Thoroton (Lab)]

I apologise for intervening, but this is quite important to the debate. Is the noble Lord saying that his amendments—I take it they are simply exemplar ones—would change the meaning of the Bill, or are they just for the purposes of, as it were, better public understanding?

[Lord Frost (Non-Afl)]

Yes, they are intended to clarify what the Bill actually provides for. I will explain further. The provision of medical help to commit suicide by the provision of lethal drugs is what the Bill does. That is what it does and that is what it should say that it does. I would say in passing that it is particularly important, since the Bill leaves so much to delegated powers, that we should be unambiguous about the particular power that is provided for.

Secondly, this House and this Parliament should always be clear to ourselves what we are doing when we are legislating. We should try and avoid euphemism. Where we deal with difficult topics, I think it is good to avoid distancing ourselves from uncomfortable realities in legislation by using abstractions. I refer to the 2024 guidance to parliamentary draftsmen which says:

“Write in modern, standard English using vocabulary which reflects ordinary general usage”.


It goes on to say you should

“use precise and concrete words rather than vague and abstract words”.

It is noticeable the most common term in this Bill for the activity for which it provides is the single word “assistance”. The common meaning of that word, I think it is fair to say, does not include providing for the death of an individual. In this Bill, that word has become a euphemistic term of art. Indeed, it is easy to imagine it becoming a jargon word in which a practitioner says to a patient, “Have you thought of asking for assistance?”, as a comfortable way to suggest to vulnerable people that taking their own life might not be something to be too concerned about, or even in the worst case, almost hide from them in the initial discussion what is actually being discussed.

We can see the distancing function of this word, the Latinate “assistance”, if we replace it, as my amendment would, with the Anglo-Saxon “help”. If the Bill used “help”, the jarring nature of the contrast between that word and the action that is provided for by the Bill would, I think, be too great to bear. I will not go into detail for reasons of time, but exactly the same concern arises from the Bill’s use of the phrase, “approved substance” when what is meant is a lethal drug.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The purpose of making the amendments advanced by the noble Lord, Lord Frost, is clarity. We have to look at this not as some pamphlet but as a piece of legislation. The key thing is that it conveys what it means. The relevant words in the Bill at the moment are:

“A terminally ill person in England or Wales … may, on request, be provided in England or Wales with assistance to end their own life in accordance with sections 8 to 30”.


In my view, that could not be clearer. It is saying that the Bill is about providing assistance to end their own life in accordance with Sections 8 to 30.

The noble Lord, Lord Frost, wishes to change the words

“assistance to end their own life”

to

“medical help to commit suicide by provision of lethal drugs”.

The language of the noble Lord, Lord Frost, is both more technical and much looser. Simply as a matter of legal drafting, the draft as it is at the moment is much clearer and accurately describes what would happen. It is not my drafting or that of the sponsor in the other place; it is the drafting of a professional draftsman and I strongly urge the Committee to stick with the non-emotional, accurate, clear drafting that is there already.

[Lord Frost (Non-Afl)]

My Lords, I thank all those who have supported and engaged with the substance of my amendments. I think we have had a good debate. I also thank the Minister for acknowledging that these amendments would not cause significant or major workability issues—I think her words were something like that—at least on a first viewing. That is important.

I am grateful to the noble and learned Lord, Lord Falconer of Thoroton, the sponsor of the Bill, but I think we will have to disagree on what language is clear and what is not. I continue to believe that the form of words in my amendments is much clearer and sharper, whereas the language in the Bill covers a multitude of possible actions.

To conclude, I continue to believe that there is an important and dangerous ambiguity at the heart of the Bill, which we can clear up by focusing on the language. Therefore, we will probably have to return to this—if we ever get that far. I beg leave to withdraw the amendment.