Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Goodman of Wycombe (Con)]

My Lords, others have referred to report of the Delegated Powers Committee on the Bill. I am a member of that committee, but I should emphasise that I, of course, speak today for myself personally, and not for the committee collectively. Indeed, I have no idea whether most members of the committee share my view that assisted dying is deeply problematic in principle.

But, as has been made clear, we unanimously concluded that the Bill is flawed in practice. By my count, our report made 13 main recommendations, covering vital matters such as the investigation of deaths, approved substances, the prohibition of advertising and, perhaps, above all, voluntary assisted services—in other words, the relationship between what the Bill proposes and how the NHS will dispose if the Bill comes into effect.

I quote from the report:

“There are several themes running through many of the issues we draw to the House’s attention … some delegated powers have very limited provision on the face of the Bill and leave so much to delegated legislation that there is insufficient detail or principle evident for proper Parliamentary scrutiny of the underlying policy; … in some cases, particularly where a substantial regulatory regime may be needed, this tendency results in skeleton legislation; … there are several clauses where delegated powers can be used to do anything that an Act of Parliament can do. This is a highly inappropriate formulation that gives sweeping, unspecified and unjustified powers to the Government while removing Parliament’s scrutiny role for provision that should be in primary legislation, and replacing it with the considerably more limited role of scrutinising delegated legislation”.


Noble Lords will have perceived that the main question the committee was tasked with answering was not “What does the Bill seek to do?” but “How does it seek to do it?”. I suggest that this is the key question, not just for the committee but for the whole House, which, for better or worse, tends to scrutinise legislation more exactingly than is sometimes the case in the other place. If the answer to the question “how?” is “inadequately”, a further question arises, namely, “How could the Bill be made adequate?”. Indeed, can it be made adequate at all?

I intend, as many other noble Lords intend, to table amendments in Committee and on Report, some of which will seek to effect the recommendations of our report. However, I cannot see how the Bill can be made adequate, no matter to what degree it is amended, for as Jill Rutter and Hannah White of the Institute for Government have noted, this Private Member’s Bill carries matters more weighty, profound and complex than it can properly bear, whatever the degree of government involvement and support. They write that

“a key problem with using this route to legislate is the lack of pre-legislative stages … Legislation on an issue like assisted dying would have benefited enormously from a more thorough preparation phase …a well-led review, involving many of the people on both sides of the argument, and with a mandate to engage the public, could have addressed the whole range of issues that MPs are now trying to navigate”.

I should add that this view was backed up by the Constitution Committee, which has echoed many of the criticisms of the committee that I have the privilege of sitting on.

I end with perhaps the most crucial criticism of the Bill in the committee’s report: it surely cannot be right that a matter so vital as the relationship between assisted dying services and the NHS is left to Ministers to propose by regulation. I ask noble Lords to consider whether a Bill that contains such a proposal can possibly be fit for purpose.

Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Sentamu (CB)]

My Lords, I want us to return to the amendment and my contribution will be very brief.

The wonderful joy of the English language is that it is always evolving to meet circumstances that were never perceived before. That is why it will continue to be the language of the world. The word “capacity” is no longer just a psychiatric term to assess people’s mental ability; it now applies to whether a council has the capacity to do one thing or another. The word now is no longer a very narrow word. I am quite surprised when I hear people say that the word has been used for a very long time in the medical circle. But the word “capacity” is not in the rules of the Persians and Medes that can never be changed—words grow.

When we are dealing with a new situation of assisted dying, we need to look at whether the word “capacity” is adequate to deal with the new circumstances we are discussing in our Parliament. Is it adequate for a person who is facing the question of death and saying “I want to end my life now”? What does the word “capacity” mean to them?

The word “ability” would probably come much nearer to the understanding of an ordinary person wanting to make a decision about ending their life medically. Let us not treat the word “capacity” as such a holy word which cannot be changed. Let us not be lazy but work hard and consult a lot of other people in the field who know the most adequate word to describe this. I thank the mover of the amendment. Perhaps it could be put into a melting pot with some other words and out will pop a word that makes sense, and the whole House can rally around it.

[Lord Goodman of Wycombe (Con)]

My Lords, in debating ability and capacity, I will speak briefly as a member not only of the Delegated Powers Committee that considered the Bill but of the Select Committee that also did so. Noble Lords have heard differing views from members of the Select Committee about the various goings on that took place there, but I am sure we can all agree that we heard some very fine evidence.

All I wish to do in intervening here is to quote what Professor Alex Ruck Keene, whom my noble friend Lady Berridge referred to earlier, said about capacity and the role of psychiatrists, as it is extremely relevant to the debate on this clause. He said:

“The point I am trying to make is that, if you simply say, ‘Apply the MCA. Apply the principle of the presumption of capacity. Support the person to have capacity to decide their own life’, I anticipate, if you asked very many psychiatrists, they would go, ‘How am I supposed to think about that?’ That is for a very specific reason. For psychiatrists, most of the time, their job is to secure life. Their job is suicide prevention”.


He concluded:

“We need to know—and one of my real concerns is—how this Bill sits in the wider landscape of the law. I need to be able to tell, because I am going to be one of the people writing the books here and giving the training. I need to be able to say, with absolute crystal clarity, to a psychiatrist, ‘This is the point where you are not in the suicide prevention zone, and if you do not do all steps necessary to try to secure this person’s life, you could be prosecuted or you could be charged in various different ways or be civilly liable’. I need to be able to say, with crystal clarity, ‘You’re no longer in that zone; you’re now in the zone of the Terminally Ill Adults (End of Life) Bill’”.


I quote the professor simply to draw to the Committee’s attention once again the complexity of the issues before us. Although “ability” may be flawed and legally powerless, as the noble Lord, Lord Pannick, suggested, “capacity” is deeply problematic in the context of the Bill.

[Baroness Grey-Thompson (CB)]

My Lords, there is probably one thing we can all agree on today: everyone’s frustration with the process of evidence giving. I was hugely frustrated when the committee in another place was looking for evidence but deaf and disabled people’s organisations were not able to give evidence, despite making up 25% of the population.

I hope that I speak on behalf of the whole House when I say how sad it is that my noble friend Lady Campbell of Surbiton is not able to be in her place. She has experience in politics and in the House of Lords of extensively debating capacity, on what became the Domestic Abuse Act and in previous debates on assisted dying. I would urge anyone who has time to look at her contributions on capacity.

My noble friend is an individual who, I am afraid to say, in her 66 years, has been deemed terminal more times, probably, than most of us in the Chamber combined. She has had her capacity challenged probably an equal number of times. I remember a few years ago, when I had not long been in your Lordships’ House, when my noble friend was in hospital and several of us had phone calls to say that we needed to get to the hospital right away because they were challenging her capacity. Her husband was told that she was not able to make decisions on her care because she was delusional. Why was she delusional? Because she had told the doctors that she was a Member of the House of Lords. The response was, “She can’t be in the House of Lords—she’s disabled”. I cannot remember whether her husband got away with taking her pass in; there was talk about having to take her seal in to prove that she was in the House of Lords. But this highlights some of the issues with mental capacity assessment.

I have had personal experience of it. When my father was ill and the doctors found out I had lasting power of attorney, I was taken to one side to argue that he should have a different set of treatment. He had the capacity and ability to decide what he wanted. In this case, he had to have his leg amputated, and he was told that, as a wheelchair user, he would have no quality of life—they said that to me. If there was one thing I could do for my father, I could get him a wheelchair.

More recently, I have had an experience with my husband. At the end of 2020, he had a blood clot on the brain stem—he had a stroke, and he was blue-lighted to hospital. It was a dreadful experience. My daughter was in her first year at university and had to be called home. We did not think he was going to make it, and we were not allowed into the hospital. I was frequently told by the medics that he had no capacity to make a decision on his treatment. My husband said, “Look at the notes”; I said, “Look at the notes”. What they were arguing over in terms of his capacity was his ability to walk. Looking at the notes was really important, because his lack of ability to walk was nothing to do with the fact that he had a stroke; it was due to the fact that he had had a spinal cord injury in 1984 when he crashed his pedal bike into the back of a double-decker bus.

I understand what the Chamber is saying. I have personal experience where I think the Mental Capacity Act has been used in the wrong way. We have to find a way of making it work so we are able to take care of capacity. Like others, I am not entirely sure that “ability” is the right word. I understand what I mean by “ability”; I have amendments later on around the ability to understand decisions. I have one on British Sign Language because of the case of a deaf man who was told by a nurse who could only fingerspell that he had HIV when he did not—he thought for two days that he had HIV—and I have another amendment around people with learning disabilities. So maybe “ability” is not the right word.

My noble friend Lord Pannick talks about legal definitions, and I also have a number of very minor amendments which look at a better legal definition of disabled people. Perhaps we can take this away, work on it and do something. As the noble and learned Baroness, Lady Scotland, said, we have to make it work. We have to look at the Mental Capacity Act through the prism of the Bill, not in terms of what it was designed to do.

Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Rafferty (Lab)]

I thank the noble Baroness so much. I speak as a nurse and a former president of the Royal College of Nursing. I thank the right reverend Prelate the Bishop of London for referring to the broader family of health practitioners who are impacted by the Bill.

I also note the comments made by the noble Baroness, Lady Berridge, about training. I wonder whether the noble Baroness is aware of the current intercollegiate guidance on safeguarding, which covers many of the types of abuse touched upon in our current debate. Secondly, does she agree that many of the scenarios that have been presented and portrayed in this debate could provide very helpful material for the training that would be provided were the Bill to be passed?

[Lord Goodman of Wycombe (Con)]

My Lords, I will be extremely brief. Rather than speak to my own Amendment 229, I simply suggest to the Committee that the bulk of the evidence we heard in the Select Committee suggests that the amendments that have been put forward and debated in this group are extremely important and essential. I will quote very briefly from the Select Committee’s report before sitting down. The Royal College of Psychiatrists said that every applicant should be

“holistically assessed at the stage of preliminary discussion, including for mental health need”.

Dr Luke Geoghegan, of the British Association of Social Workers, took the view that

“all applicants should have a safeguarding assessment”.

The British Geriatrics Society recommended in its evidence to us

“a requirement for all people requesting an assisted death to undergo a holistic assessment of needs”.

The next group of witnesses that produced a similar view was Standing Together Against Domestic Abuse, which called for a multidisciplinary assessment framework.

I could go on, but I recommend to the noble and learned Lord, Lord Falconer, when he replies to the debate, to take these points on. A central question in this debate, posed by the noble Lord, Lord Pannick, has been: are the protections in the Bill better than the protections we have at the moment? I suggest to the Committee that that is not the question. The question is not, are the protections better than those we have at the moment, but are they as good as they could be? The answer in many cases is that they are not, and I hope that the noble and learned Lord takes these points on board when he replies to the debate.

[Lord Ashcombe (Con)]

My Lords, I just want to raise one point. We have heard an awful lot today, but I very much support what my noble friend Lady Berridge and the noble Baroness, Lady Rafferty, have just said about training. I do not believe a doctor, or any form of medical practitioner, can spot coercion with one discussion. Training in this area is absolutely imperative to have any way of making it work reasonably. That has to be part of the overall solution to this problem.

I will just add that, while I support every one of these amendments to a greater or lesser extent, I hope that the noble and learned Lord, Lord Falconer, will consider them all very closely and not ignore them.

Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Frost (Non-Afl)]

That is certainly true. The noble Lord makes a good point. The principle that is in my amendment could be expanded to take in other well-defined categories. I will be more convinced about the Irish category than the EU pre-settled status, given this issue was not anything like an issue when we negotiated the EU treaties that created that status, but that is for discussion if the principle is agreed.

Finally, I will just note that the amendment I have put forward reflects norms elsewhere, notably in Australia and New Zealand. It is quite closely based on Section 9 of the Victoria Voluntary Assisted Dying Act 2017, which, whatever its manifold other weaknesses, is at least clear on this point. I will stop there and look forward to the discussion and the views of the sponsor. I offer this amendment as a potential way of providing more clarity and reducing the level of ambiguity in what is obviously going to be a very important provision in the Bill.

[Lord Goodman of Wycombe (Con)]

My Lords, I will speak very briefly in support of Amendment 23, which was spoken to by the noble Lord, Lord Frost, bearing in mind that amendments in Committee very often are probing amendments to test the view of the sponsor.

It is important to recognise at the start that it is, in fact, not clear from the Bill whether the NHS will provide voluntary assisted dying services. This was a point in relation to which the Bill was criticised very heavily by the Delegated Powers Committee, on which I sit. But it clearly is the intention of the noble and learned Lord, Lord Falconer, that it should, and I want to assume for the purposes of this debate, very briefly, that it will.

My noble friend Lady Coffey raised at the start of this debate a problem, which was the question of whether someone might seek to obtain residency under the terms of the Bill in order to obtain what has been referred to as death shopping. This is clearly a problem. The virtue of the amendment from the noble Lord, Lord Frost, is that it would deal with this, imperfect though the amendment may be. I would like to hear from the sponsor of the Bill, the noble and learned Lord, Lord Falconer, what his view is of the problem raised by my noble friend Lady Coffey. I think he accepts that death tourism is a problem. Is his view, like that of my noble friend Lord Lansley, that residency remains the only sensible way of determining these matters? If it is, why has he put the additional safeguard into Clause 1 of the Bill? Or, if he thinks residency is not sufficient, what additional safeguards might he be able to offer? I look forward to hearing from him when he responds to this debate.

[Lord Harper (Con)]

My Lords, before I speak to my Amendments 300A and 306A, let me just pick up, briefly, a couple of issues that have been raised in the debate.

First, I was very pleased that the noble and learned Lord, Lord Falconer, said it was very important, in response to the noble Lord, Lord Beith, that we dealt with these border issues. He will remember that I spoke on that on the first day of debate, using my experience as a former Member of Parliament for a border constituency and I raised some of the very practical issues that there will be if we do not get that right. The noble and learned Lord will remember that when I was raising these issues, there were people on the other side of the argument who tried to shout me down before I had even finished. I am pleased, therefore, that he recognises that the issues I was raising are important and valid ones. To make sure these issues work properly, we have to worry about both the England-Scotland border and the England-Wales border.

Secondly, I am very grateful to the noble Lord, Lord Pannick, for the free legal advice he provided to me in answering the question about what the courts could do about a human rights challenge. I did not get an answer from the Minister, so I am grateful to have had it from him.

Thirdly, on the point that came up in the debate about Crown servants, if you are a Crown servant, you can retain your ordinary residence status when you are posted overseas—that applies to diplomats, members of the Armed Forces and civil servants. It does not usually apply, though, to people who work for the NHS, local government and so forth, but we do not have to worry about people who work in embassies.

Let me deal with the issues raised by the amendments from the noble Lord, Lord Lansley, because they are relevant to the nature of this service. He is absolutely right that, for primary care, we do not have the same test on residence that we do for secondary care. There is a reason for that. When we were putting in place the changes for secondary care in the Immigration Act, we considered whether we should implement similar changes for primary care—that was after he was Secretary of State for Health. We did not change that position because there is a very significant community benefit for allowing people, who are physically in the United Kingdom, to have access to primary care, so that they can access all sorts of services, particularly if they have a communicable disease or illness. We absolutely want them to seek early treatment, not just for their own benefit but for the benefit of everyone else. That is why we have wider access for primary care than we do for secondary care, which we limit to people who are ordinarily resident. We allow others to access it, but only if they pay for it.

I argue that, if this is to be provided on the NHS, this service should be treated more like how we provide secondary care, rather than how we provide primary care. It is more akin to that sort of treatment than primary care. That is where I respectfully disagree with the noble Lord.

Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, it is now 2.33 pm. I suggest that the Committee might like to hear from Front-Benchers now to ensure that we can conclude proceedings in an orderly manner, as planned, around 3 pm.

[Lord Goodman of Wycombe (Con)]

I have an amendment to which I have not yet been able to speak. Surely it is right and proper that those of us who have tabled amendments should be able to speak—especially where, as is true in my case, a noble Lord was a member of the Select Committee that examined this Bill. If the Committee will allow it, I would like briefly to quote some of the evidence that we heard.

[Baroness Wheeler (Lab)]

My Lords, the House generally rises around 3 pm on Fridays. To go beyond 3 pm, we would need the consent of the Committee.

[Lord Goodman of Wycombe (Con)]

I will be extremely brief but, as I said, I have tabled an amendment and have been waiting patiently to speak to it, if I may. My Amendment 394 would require the assessing doctor to arrange, and require the person to attend, a consultation with a palliative care specialist. Like the noble Baroness, Lady Finlay, who moved the lead amendment in this group, and the noble Baroness, Lady Smith, who spoke earlier, I was on the Select Committee. I will not repeat the evidence that the noble Baroness, Lady Smith, quoted, but I shall very briefly quote a little more, because the merit of having these Select Committee reports is that the House hears them.

The Royal College of General Practitioners said:

“It is essential to ensure that every patient approaching the end of life has access to high-quality palliative care”.


Secondly, Professor Mumtaz Patel of the Royal College of Practitioners said:

“What I really fear is that people are making sometimes these choices because of the lack of provision around good palliative care”.


Thirdly, Hospice UK, in its written evidence to us, said:

“Should the Bill progress, it is therefore essential that Government does far more to ensure equitable access to and provision of palliative care ahead of the introduction of assisted dying in practice”.


I could quote more, but because of the time constraint, I will come to a conclusion, as requested.

My conclusion is this. When the noble and learned Lord, Lord Falconer, gave evidence to our committee, he stressed at the start that the guiding principle of the Bill is autonomy, but autonomy is compromised if there is not real choice. To those who say that you cannot have real choice between assisted dying and palliative care because the palliative care is not available, my response is that that is precisely why this should have been considered by a royal commission, rather than being brought into this Bill, which has been so heavily criticised by two Select Committees of this House. However, we are where we are, this is the Bill as we have it, so I wait to hear from the sponsor of the Bill which of these amendments he is prepared to accept and, if he is not, which amendments he himself will bring forward in due course.

[Noble Lords]

Front Bench!

Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Butler-Sloss (CB)]

Might I respectfully suggest to the Committee that we now hear from the Front-Bench spokesman so that we can finish this line of amendments by 5.30 pm?

[Lord Goodman of Wycombe (Con)]

It may be helpful for the Committee if I simply read, very briefly, for the assistance of considering this amendment, what the former Chief Coroner of England and Wales, Justice Teague, said about the background to the decriminalisation of suicide when giving evidence to the Select Committee. I think the Committee would want to consider it. He said that

“the reason the change was made was not a change in the public policy towards suicide; it was a change in the criminal law to decriminalise it, because the situation had developed where you could not effectively prosecute the person who successfully committed suicide. What the law was doing was prosecuting people who failed. It was manifestly improper and unjust that people should, in effect, be punished for failing to achieve suicide, but it was always made clear at the time of the debate in Parliament that it would remain an offence to assist a suicide, and that it would be the policy of the law that suicide was not something to be approved of”.

In that context, the Committee may wish to consider whether, given that the act being considered here is the assistance of a suicide, it should be plainly named as such, as the noble Lord, Lord Frost, proposes in his amendment.

[Lord Gove (Con)]

My Lords, I will take just a minute or two. Words matter. In America, in legislation similar to that which we are entertaining, it is known as “medically assisted suicide”. Similar terminology is used in Switzerland. Those are both jurisdictions that have informed this debate. Recently, in the British Medical Journal, a physician who works in Scotland made this compelling point:

“The phrase ‘assisted dying’ creates confusion and is poorly understood … just 43% of respondents”


in opinion polling

“thought ‘assisted dying’ involved the provision of lethal drugs to end somebody’s life”.

Fewer than half of the public understood what was meant by this legislation. He went on:

“The majority believed the term meant withdrawing life-prolonging treatment or providing hospice-type care”.


If so many of the public have the wrong view of this legislation, how can it possibly not be of assistance for us to use plain language on a matter of such moment?

Terminally Ill Adults (End of Life) Bill

Lord Goodman of Wycombe Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I ask the noble Lord, Lord Birt, to reflect on the equality implications of this suggestion of a special treatment service for those seeking assisted death. Following on from the previous contribution from the noble Baroness, Lady Royall, it seems to me that everybody would want, if they are a patient or for their loved ones, a personal, state-funded navigator. But maybe for care, those people on trolleys, waiting for operations, or trying to find their way into the care system would all say, “Can we all have one?” If we do not afford every patient in the country a personal navigator, is that not an unequal access to services? It seems a two-tier system, and one that I think the public would not approve of.

On another issue, I ask the noble Lord, Lord Birt, to detail the workforce demands that this service would require from the NHS, following on from the excellent contribution from the noble Lord, Lord Stevens. I note that the assisted dying help service—which, by the way, would be awarded significant regulatory powers by these amendments that would not be subject to approval by Parliament—would have the power to set training and qualifications for practitioners. That seems like a blank cheque. I would like to know what the skill set of a navigator would be and who decides that. In all seriousness, this whole new shadow service being set up, with its own qualification system and recruitment, is a bit worrying. We are not sure who they are going to be.

My final query is that I know that a lot of the Bill’s supporters are frustrated and have raised problems with some of the amendments that have been tabled on the basis that they would somehow create bureaucratic, preventive barriers to people who genuinely want to afford themselves an assisted dying service. In other words, there is an attempt to overengineer the process. Therefore, I commend the noble Lord, Lord Birt, on this creative attempt at cutting red tape. However, on these amendments, we all know that mandated timelines can mean shortcuts that could make the process unsafe. Could he comment on that?

Speed and process-driven decision-making are risky in any instance but, where careful assistance and safeguarding are contested, it seems rather dangerous that panels would have to decide within two days of referral, even sitting over the weekend or bank holidays to make decisions. By the way, I think we should apply that to everyone in the NHS: they should do operations and doctors’ surgeries should be open over weekends and bank holidays. I wish the courts would sit over bank holidays and weekends, because then we would not have to get rid of jury trials, allegedly. That would mean that a referral on a Friday evening would have to be decided by a Monday. How would a panel have time to investigate and read everything thoroughly? Surely it would just end up skimming things.

I also really worry about the reflection period being cut to 24 hours, when experts warn that initial depression after diagnosis, which is completely understandable, might well be temporary, treatable and certainly remedial. It could last a few weeks but then be replaced with a more positive attitude. In fact, the CEO of Mind told the Lords Select Committee that they have

“gone to the brink, have come back and have then been able to say three or six months later, ‘I’m so glad that that did not happen’”.

All I am saying is that saying, “Oh we’re being really efficient; we’re going to make sure that your reflection is cut to 24 hours so that you can get what you want”, might well mean that you do not get what you would have wanted if you had had a bit longer to reflect.

[Lord Goodman of Wycombe (Con)]

My Lords, there is an unreality about this debate that gives rise to a question for the sponsor of the Bill and the Minister. The unreality is this: the noble Lord, Lord Birt, has made the case for his amendments, and my noble friend Lord Harper and others have made the case against them, but there is hung on this whole debate an assumption that the NHS will deliver assisted dying. I remind the Committee that there is no guarantee of that in the Bill.

If noble Lords would kindly turn to Clause 41(4), they will see that the only reference to the National Health Service is:

“Regulations under this section may for example provide that specified references in the National Health Service Act 2006 to the health service continued”,


et cetera. That is the only reference to the NHS in the Bill. We do not know whether the NHS will or will not deliver assisted dying services. It is an extraordinary weakness in the Bill.

[Baroness Berger (Lab)]

The noble Lord and I sat on the Select Committee on the Bill. He may recall that I pressed the Minister specifically on this point: to clarify who would be delivering an assisted dying service in this country should the Bill be accepted. Only after a number of questions did the Minister acknowledge that it was the Government’s intention that the NHS would commission an assisted dying service. He could not clarify or confirm whether it would be delivered by the NHS, the private sector, the voluntary sector or charitable organisations and, if it was the private sector, whether it would be allowed to generate any profit. We are still unclear. It is very challenging to us, and I hope the Minister in her response might be able to give us further clarity on that important point.

[Lord Goodman of Wycombe (Con)]

The noble Baroness, Lady Berger, is quite correct. That is exactly what happened in the Select Committee. For my sins, I sit on a surfeit of committees, including the Delegated Powers Committee, which drew attention to this very deficit in the Bill. So the question for the noble and learned Lord, Lord Falconer, is: since the Minister was questioned in the Select Committee by the noble Baroness, Lady Berger, in the weeks that have followed, has he had any guarantee from the Government that they will ensure that the Secretary of State by regulation ensures that the NHS delivers voluntary assisted dying services? When the Minister replies to the debate, can she cast some light on this matter so that we know whether or not the proposal that the noble Lord, Lord Birt, has put forward and my noble friend has opposed really has any basis in reality?

[Lord Blencathra (Con)]

My Lords, I was delighted to hear the noble Baroness, Lady Fox of Buckley, hit every nail on the head of everything that is wrong with the amendment moved by the noble Lord, Lord Birt. I shall speak to the amendments in the names of my noble friends Lord Mackinlay of Richborough and Lord Harper, and I have signed some of them. I have done so because the Bill as drafted, and as now proposed to be amended by the noble Lords, Lord Birt and Lord Pannick, promises choice while quietly engineering speed, centralisation and a single-minded pathway to assisted death. That is not a neutral design choice. It reshapes incentives, shifts resources and narrows real options for people at the end of life.

I will give three short examples of why the amendments proposed by the noble Lord, Lord Birt, are wrong, and end with a direct challenge to the noble and learned Lord, Lord Falconer of Thoroton.

First, the amendments would turn life and death decisions into a fast-track process. From first declaration to possible assistance, the clock can run down to 30 days, or as few as 18 days if death is deemed imminent. Panels must decide within 48 hours of referral. Reports are forced within 24 hours. Reflection periods can be cut to 24 hours. That is extraordinary. Courts take months to resolve urgent life issues. Prognoses measured in months are notoriously unreliable. Rushing assessments in this way risks premature deaths, misdiagnoses and inadequate exploration of reversible causes of despair. My noble friends’ amendments, including the ones that I have signed, push back against that compression.

Secondly, as others have pointed out, the assisted dying help service and the personal navigator create an asymmetric system. The navigator is designed to shepherd people quickly through the assisted dying pathway. There is no equivalent statutory guarantee that a person will get timely access to palliative care, hospice support, social services or mental health interventions. In practice, a patient could reach assisted death faster than they could gain access to pain control, a care package, meaningful social intervention or, as the noble Baroness said, a GP appointment these days. That is a perverse allocation of scarce resources and a distortion of choice. When one option is actively facilitated and the others are not, choice becomes a funnel.

--- Later in debate ---

The normal Lord, Lord Deben, says that we should try to relieve the loneliness of that person. That is his answer. Of course we should, but what is being described is the state of somebody who has got there because of the previous parts of their life. How we react to a terminal illness will be so dependent on what we are like ourselves. For me, I put forward the Bill because you should have that choice.

[Lord Goodman of Wycombe (Con)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

If the noble Lord will let me finish, then he can come at me. The noble Lord, Lord Hamilton, refers to the question of wrong diagnoses. We will come to that in the group that starts with Amendment 71; I do not want to go into it now. However, we are dealing here with a terminal diagnosis, with two doctors and a panel who have approved it. Doctors are not perfect, of course, but this is very much a safeguarded measure.

I apologise for not taking the noble Lord’s intervention straight away.

--- Later in debate ---

[Lord Goodman of Wycombe (Con)]

Imagine I were a poor person who went before the panel and opted for an assisted death, but said, “Were I rich, I would not do this; I would take my chance on the diagnosis being wrong”. If the amendment moved by the noble Baroness, Lady Berger, was passed, I would surely be ineligible, so her amendment is meaningful. If the noble and learned Lord believes that one should be able to choose an assisted death if one is poor, that is one thing, but, as my noble friend Lord Deben argued, one should be protected from having to choose it because one is poor. That is the difference.

[Lord Falconer of Thoroton (Lab)]

The way the noble Lord has put the question to me means that, plainly, this would be because of the illness, would it not? I want an assisted death because the illness is going to kill me. That seems quite a bad example.