Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, we have heard a variety of opinions, and I wish to express mine on what is a vital issue: that of life and death. As a gospel minister, I have been present at the sick and dying beds of so many of my fellow travellers to eternity. It can be a difficult and heart-breaking experience for the individual and their loved ones. But sickness is a reality for us all at some time in our lives and death is inevitable; we all must needs die. Death passes no dwelling, whether the occupant be rich or poor. It is a great leveller.

I thank those who sent me numerous letters and emails, from deeply concerned individuals, health professionals and organisations expressing various viewpoints. We in this House must made a decision about the legislation presented to us. I unashamedly state that I believe that human beings are unique among God’s creatures in being made in the image of God. When our first parents rebelled against the revealed will of God, they chose their own way and nothing has changed, for the accepted opinion of society today is “It’s my body, my life and nobody can and should tell me what to do”. As in the Book of Judges, every man did that which was right in his own eyes. I know that philosophy is very popular today. Not one of us decided when we would be born, and the cardinal question is: have we the right to decide when we should die? Again, the word of God says that it is appointed unto men once to die, not appointed by them. We live in a secular society that has pushed God out of its reckonings, and it wanders on aimlessly and hopelessly, seeing little reason or meaning in life itself.

Each of us can mention individual harrowing cases of the severe struggles endured in life and the pain of death suffered by our fellow human beings. Some conclude that the answer to these stories of human suffering is to assist the person to end their life, rather than improve the management of the end of life.

The Bill makes it a legal right for patients to access assisted dying, but does not mandate a comparable right to access other end-of-life services. We are aware that patients with a diagnosis of a terminal illness are very vulnerable and weak, and that elderly people are at serious risk of coercion and left to feel that they are only a burden to their families. I have heard that so many times in my ministry.

Estimating how long a patient will survive is also, at best, very difficult, even for specialists. I know of patients who were given a three or six-month prognosis who are still alive today three years later, enjoying life and making cherished memories with their loved ones. Were they to act on a similar prognosis using the Bill, that decision would be fatal and final.

The legislation before us is called the Terminally Ill Adults (End of Life) Bill, but, in reality, it is assisted suicide. Euthanasia is killing and, in most countries, killing another person is considered murder, even if the intention is to ease the pain or if the person has a terminal illness. Giving one category of sick people a legal right to exercise autonomy by killing themselves logically opens the door to, and creates the legal conditions for, expanding it to others. Indeed, an expansion has already been supported by some of the groups that are supporting the Bill.

It was only last Wednesday that we marked World Suicide Prevention Day. Today we are debating a Bill that creates an exception. One day we tell them, “Don’t give up”, but at the same time we make legislation to allow the NHS to give drugs to make people end their lives. Some years ago, Parliament rejected capital punishment on the basis that, if one innocent life was taken, it would be one too many. I ask: how many innocent elderly or sick people will die through this legislation if it is enacted? I have no doubt that the number will be great and I strenuously oppose the Bill.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for her amazing dedication to her patients. That is beyond question. I hope we are united as a House in paying due respect to that fact and also to the fact that her professional experience is a tremendous asset to this House.

The noble Baroness, Lady Finlay, spoke of her professional experience, and I will speak very briefly of my lived experience on the other side of the table—or the bedside—as a patient. She mentioned Dame Cicely Saunders and the reference to total pain. I simply say that I have been there. My disability has taken me there far more times than I would like to remember. It is awful. The bottom falls out of your world, and your capacity to think clearly, rationally and normally evaporates. So I simply say that it is crucial that patients have the ability to choose: the choice between assisted death and specialist palliative care—a choice that they do not currently have.

I simply finish on this point. Other noble Lords have mentioned the Royal College of Psychiatrists. I ask the Committee to take note of the fact that the Royal College of Psychiatrists states that applying the Mental Capacity Act to the decision to end one’s life is an entirely novel test—in “uncharted territory”, with “no experience or precedent”.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, earlier on in the debate, there was a discussion concerning members of the committee, on who was or was not called, or who was denied the right to be called to it. I suggest that the straitjacket of the time this House allocated probably did not allow the relevant committee the appropriate time to call everyone that it thought was appropriate. It ought to have been given more time, but it seems that it had to be rushed.

Concerning the Mental Capacity Act, Margaret Flynn, chair of the National Mental Capacity Forum, said it was designed to protect us

“when others start to make decisions about our lives … Assisted dying was not on the table during the Law Commission’s consultation which resulted in the MCA”.

Therefore, the suitability of the Mental Capacity Act 2005 as a test for a decision to end one’s life is a major source of debate. I believe the many experts and professionals arguing that it is insufficient for this specific irreversible decision.

The MCA was not designed for assisted dying. It was created to safeguard people who lack capacity in decisions about their care, treatment or finances. Assisted dying was not on the table during the Law Commission’s consultation. The Royal College of Physicians, as the noble Lord said a moment ago, said that applying the MCA to the decision to end one’s life is an entirely novel test in uncharted territory with no experience or precedent. It is a very low threshold. The Royal College of Physicians argues that assessing a person’s mental capacity to decide to end their life is an entirely different and more complex determination, requiring a higher level of understanding than assessing capacity for treatment decisions.

[Lord Scriven (LD)]

I have listened very carefully to the noble Lord and a number of others. I am still struggling to understand what the higher test of ability would be, over and above the Mental Capacity Act. Will the noble Lord let the House know what that higher test is that people would have to go through on ability rather than capacity?

[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.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Gove (Con)]

I profoundly disagree with the noble Baroness on that, but I am grateful to her for making that point, and I am more grateful still to the noble Baroness, Lady Grey-Thompson, for raising this issue. It is precisely the nature of coercive and controlling behaviour within domestic settings, as part of domestic violence and abuse, that needs to be addressed in this legislation. I have an open mind as to how it might be, but it must be.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I support the amendments in this group. They are important because, unlike the noble Baroness, Lady Hayter, I do not know what the outcome of this debate will be at the end. She might have some other knowledge of how this House will vote, but I certainly do not know the answer. Therefore, it is vital that we spend the time and debate these amendments, because words are important. If anyone ought to know the value of individual words, it is noble and learned Lords in this House, because many of them spend their lives arguing on the edge of a pin about particular words. As a matter of fact, they make a considerable amount of money out of arguing about single words. Words are important, so let us not try to pretend that words do not matter. Therefore, on “coercion”, “influenced” and “encouraged”, I believe that we need to get this right, because the Bill could pass this House.

I know that there are those who do want to shut down debate. I sat in the House of Commons on Wednesday at Prime Minister’s Questions. I noticed earlier today that for a considerable amount of this debate the person who raised it at Prime Minister’s Questions was sitting here. He is the right honourable Member for North West Hampshire. He has left his position on the Steps of the Throne, but he was here for a considerable amount of the debate. He was indignant and incensed that this House wants to look at and scrutinise this Bill because it was passed by the Commons. I was in the other House for 25 years, and I know that in those 25 years, under successive Governments, the other House got Bills wrong and had to change those Bills. I do not believe it is correct to suggest that just because the other Members have passed the Bill, somehow we must bow and surrender to their superior knowledge, and therefore I believe that we ought to spend time—

[Lord Watts (Lab)]

From the number of amendments here it is clear that this is about wrecking the Bill. It is not about improvements, it is about wrecking the Bill. I went through this with my late wife, who suffered a very long and painful death and wanted to have the opportunity of ending her life. If they wreck the Bill, Members should think about the thousands of other people who will go through that same process.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I do not believe that people are tabling amendments simply to wreck the Bill. That may be the noble Lord’s opinion, but he should remember that other people have different opinions. I respect the noble Lord’s opinion, but I hope that he will in turn respect my right to have an opinion. I believe that we must scrutinise this well. I noticed that the noble Baroness, Lady Hayter, objected to the fact that practically no one who supports the Bill has spoken. I know of no one supporting the Bill who has been stopped from speaking. They did not get up to speak, and therefore they were not stopped. If there are those who want to support this Bill and to get up to speak, they are free to do so. I certainly would like to hear their opinions just as well. I believe that I have an opinion that ought to be heard equally, as they have.

I come from a family that knows what the reality of suicide means and the heartbreak of suicide, where we examine and wonder whether something more could have been done before that person ended their own life in suicide. I know the pain of that and the loneliness that they went through. Therefore, I believe we must get this right.

In the domestic abuse and coercive and controlling behaviour context, a victim may, due to intimidation or trauma, deny that their actions are caused by wrongful coercion. Is the doctor supposed to be weighing the patient’s words against the very limited evidence that they can see in an examination room? Professor Jane Monckton-Smith OBE, professor of public protection at the University of Gloucestershire, emphasised in her testimony to the Select Committee the significant difficulties in relying solely on a person’s verbal denial of abuse when assessing coercion:

“I have worked in this area for a very long time. I have seen victims refuse medical help when they have been hit in the head with a hammer through fear. That is not an isolated example. If you speak to the other people here, I think they will probably agree with me. What I am saying is that coercive control is a serious social problem. It will impact on the people who are going to look to this Bill”.


Also in the Lords Select Committee evidence, Cherryl Henry-Leach of Standing Together Against Domestic Abuse warned

“the difficulty is the lack of insight into the impact of coercive control on somebody’s ability to make decisions, even though that has been enshrined in case law”.

I do not want to detain the Committee, but in over 50 years as a minister I have experienced people coming to the end of their life. I have been with them in their moments of their deepest pain, and, as a noble Lord said, was there with the families after the occasion, trying to minister to them. I also know what it is from my 25 years as a constituency Member of Parliament in the other House, and we should not close our minds to the fact that people can be coerced. Sometimes it is done very subtly and gently within family dynamics, and that is difficult for assessing doctors to detect in limited formal settings.

Therefore, I believe it is vital that the words put into this legislation, if it is passed, are the correct ones that cover all these possibilities. Remember, when the person takes that lethal injection or whatever potion they take, there is no return as far as this life is concerned, but they go to another.

[Lord Blencathra (Con)]

My Lords, I had intended to give my strong support to Amendments 3, 45 to 49, 52 and 58—a mere eight amendments out of the 21 in this massive group—but in the interests of time I will dump my notes on all those and speak merely to Amendment 58 in the name of my friend, the noble Baroness, Lady Grey-Thompson, who has made a crucial point with regard to that amendment.

Coercion and pressure do not always manifest themselves as direct, intentional acts by individuals. Instead, they can arise from broader and societal structures and conditions that constrain genuine choice. When a person facing terminal illness is subject to circumstances such as chronic poverty, social isolation or a systemic lack of quality healthcare, their options are severely limited. In such scenarios, the choice to pursue end-of-life options may not be a true expression of free will but rather the result of enduring disadvantage and unmet needs.

At Second Reading, my noble friend Lord Moylan made the telling point that many people contemplating suicide do not want to die; they just want their life circumstances to change for the better. Therefore, “structural disadvantage” refers to the social, economic and institutional barriers that systematically disadvantage certain groups. When terminally ill individuals lack access to palliative care, social support or financial resources, they may feel compelled to consider end-of-life options not out of genuine preference but because their suffering is exacerbated by these systemic failures.

Poverty is a profound social vulnerability. A terminally ill person living in poverty may fear becoming a burden to family or may lack the means to access pain relief, counselling or hospice care. The psychological and practical impact of poverty can create a sense of hopelessness, making the option of hastening death appear more acceptable or even inevitable. When systems persistently fail to address the needs of the most vulnerable, this neglect can be seen as a form of institutional or collective intent. Thus, the responsibility for coercion or pressure extends beyond individual actors to the structures that shape people’s lives and choices.

Many years ago, my illustrious predecessor in my constituency, the great Willie Whitelaw, said to me, “David, I was never interested in pensions until I turned 65”. The wonderful thing about this House of ours is that the average age in here is 71, I understand, and our average death age is 81. That, as we have heard from many noble Peers, gives us a unique insight into the sorts of infirmities that we and our close relatives suffer and the close experience of those near to us who have died from them.

We have heard from many noble Lords, including my noble friend Lord Polak and the noble Lord, Lord Griffiths, their experience of beating the odds because the prognosis was not right. I quoted in my Second Reading speech that Sir William Osler, the father of modern medicine, said, in about the 1890s:

“Medicine is a science of uncertainty and an art of probability”.


Because my noble friend Lady Berridge mentioned NICE, I am tempted to cite an example. I have experience of NICE. I am grateful to it in some ways and hate it in others. One of the side-effects of MS is that one’s feet feel nailed to the ground: they are as heavy as lead and do not move. Fifteen years ago, NICE approved an experimental drug call Fampridine. I was one of about 500 patients put on it at the National Hospital.

Fampridine is an absolutely miraculous drug. What does it do? You saw it in effect this morning. It helped me stagger from my chair to here. With assistance from my noble friends, I can manage to walk—not very fast—to the Dispatch Box. Every six months, I have to do a walking test. If my walking is not fast enough with the drug, they cut it off and I do not get it any more.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I did not speak last Friday, and this is the only group to which I intend to speak today. I could have spoken to the last group, as my former constituency abutted the Scottish border of Dumfries and Galloway and a mere 85 yards across the River Sark was Gretna. I was aware of our glorious 600-year history of border-raiding for cattle and women—in that order—and now it seems we can add free prescriptions to the list as well.

These amendments would strengthen the safeguards with a demonstrable, ongoing clinical relationship with a GP, reducing risk of error, coercion and administrative confusion, while supporting clinical judgment and the continuity of care. Requiring 12 months’ registration plus a minimum number of in-person contacts gives a straightforward verifiable test of recent clinical involvement. We need robust, practical safeguards and clear eligibility checks. These are essential to protect vulnerable people by evidencing local care and oversight. A sustained relationship with a local GP who has seen the patient helps ensure that the patient is informed and is acting voluntarily and free from subtle pressure. The GP’s direct knowledge of the patient’s circumstances is therefore a critical safeguard rather than a bureaucratic hurdle.

The big issue, which has already been raised today, is: who sees the same GP twice these days? I am very lucky, and perhaps some other noble Lords are as well, in that there are superb multi-disciplinary GP practices in Cumbria. I almost always see the same GP, and we can email as well. In fact, in 40 years of living that constituency, I have only ever had two GPs. However, that is not the national picture. Many patients see a different GP every time they visit. Therefore, for this part of the Bill to work, it cannot be any old GP from a practice; it has to be a GP who has treated the patient personally on a few occasions or over a period of time.

Yesterday, I had the wonderful privilege of hearing in this House from a GP who satisfied all the criteria of these amendments thanks to her deep knowledge of her patients. I was later able to congratulate the noble Baroness, Lady Gerada, a former president of the Royal College of General Practitioners, on her excellent maiden speech. I am delighted to see her here today. I understand that this morning, she was doing the day job, treating her patients in her constituency.

I know that the noble Baroness is in favour of assisted dying, but what she said in one part of her speech yesterday was directly relevant to these amendments. The noble Baroness—I am rather vexed at the right reverend Prelate the Bishop of Norwich, who stole these lines earlier this morning—said:

“I became a GP in Kennington, and I have lived and worked in the community I serve ever since … My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change”.—[Official Report, 11/12/25; col. 370.]


That is exactly the sort of GP I trust to make a decision on whether a person has a confirmed wish to opt for assisted dying—not just any general practitioner, who may never have met the patient before and has just 10 minutes to form an opinion.

I would love to find a way to include that magnificent sentence about continuity and seeing lives unfold over time giving general practice its unique moral and social power; I would love to see whether we could incorporate it into the Bill, because it sets the right moral climate.

As I say, I have a GP. However, for those millions of people who are not so lucky, these amendments would balance safeguards with practicality. Setting a modest minimum of contacts is proportionate. It is enough to demonstrate an established relationship without imposing unrealistic burdens on patients or practices.

Many noble Lords have spoken of multidisciplinary teams. Can the noble Baroness tell me—indeed, can anyone tell me—how many of all the GPs in this country are still single-practice doctors? A Google search suggests that it is around 63%. That seems terribly high; there must be more multidisciplinary teams than that. There are still an awful lot of single-practice GPs. On the rare occasion when I have not seen my own GP, the other GP has had a look at the computer and read all my clinical notes. However, he does not really know who I am; perhaps that is just his good fortune.

These amendments would support patient safety and public trust in any assisted dying regime. It needs to be visible and enforceable, and it needs to have enforceable safeguards. Clinicians must be able to attest to a patient’s circumstances. I support these amendments.

May I say to the noble and learned Lord, Lord Falconer of Thoroton, that I was dismayed to read some very hostile comments about noble Lords and noble Baronesses in the weekend press? The complaint was that some Peers had tabled a large number of amendments, and that that was somehow wrong. If they were the only Peers who spoke to them, that criticism would be valid, but those noble Lords and noble Baronesses, as professionals and experts, tabled amendments to which many of us wanted to speak. We left them to do it because those Peers have experience; scores of Peers have spoken to their amendments, so they were not abusing the House. I am absolutely certain that the noble and learned Lord was not behind that bad-mouthing, because he is a gentleman as well as a Peer, but some supporters of this Bill are trying to drown out and close down any proper scrutiny in the Lords.

Lastly, I remind the noble and learned Lord and the Committee that Dignity in Dying’s website boasts that the Bill had 29 Committee sittings in the Commons and over 90 hours of consideration. Since the Bill has come to us from the Commons, we have heard devastating criticisms of it from the Constitution Committee, the Delegated Powers Committee and experts giving evidence to the noble Baroness’s Bill Committee. Today, we are on only our fourth sitting, after, I think, 18 hours of debate. So I say this to the noble and learned Lord: please tell some of the others to call off the attack dogs because this House is doing its proper job.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, like many noble Lords, I grew up at a time when the family doctor was looked upon as a family friend who could always be depended on whenever you were ill or in a time of crisis. Unfortunately, that is not the situation today. There is a major problem across the United Kingdom: patients desiring to see a GP find themselves sitting on the telephone and ringing the surgery 120 times, perhaps, but still not getting through to someone and giving up at the end of it. That is the reality of the situation in many places.

I am sorry that the noble Lord, Lord Pannick, is not here. He posed a question to the noble Baroness, Lady Lawlor, concerning what happens if your GP retires. Let me give my small experience. My GP was in his late 50s. He was an excellent GP. During Covid, unlike many other practices, he still allowed patients to come to his surgery. Whenever elderly patients could not come, he went out to their houses and visited them in their own homes—unlike many other practices and GPs. Unfortunately, he got cancer and, in his late 50s, just recently, he passed away.

We were left with a practice in our town with several thousands of patients but nobody to take it over. So what happened to us? Our GP died, and so, without any consultation whatever, we were all farmed out to seven or eight practices around the countryside, some of them not even close—just to whoever would take us. It is unrealistic to imagine that somehow a new doctor would have any knowledge of the pressures, the problems or the complex challenges that his new patient was facing; he would not have any continuity of care whatever.

It was even worse than that, because it was several months before the notes went to the next practice that you were farmed out to. You were allotted a practice but the notes concerning any illnesses of the patients did not immediately follow; it was several months before they arrived. What has been suggested in these amendments today strengthens safeguards. Therefore, they are worthy of the support of noble Lords in this House.

[Lord Sentamu (CB)]

My Lords, I agree with the noble and learned Lord about why we are focused on GP practices, because they are the hub of information. Since I arrived in this country, I have had a lot of treatment for all kinds of conditions—I am one of those people—and all the national insurance I have been paying has being paid back to me about a hundred times, so I am a walking miracle.

An amazing thing happened to me recently. When my anaemia was so high—I did not think I would survive it—I went to see a consultant in Newcastle hospital and he called up my records from 1975. It was amazing that, apart from one GP who did not keep the record properly, he had it all; therefore, I was able to get proper treatment. Friends, the record keeping on health in this country—even if some do not do it well —really is amazing. The records are very clear. The GPs who are good will always keep up their information, which is digitalised so that they can send it quickly.

Therefore, for me, the whole picture is not just the GP doing it but GP practices, which are the hub from which a lot of information about anybody can be gathered. You sever that and put it somewhere else, and you may not actually get it. I have every confidence that in my GP practice at the moment, which has nine doctors, they will have access to that information.

I therefore think that noble Lords should stick with what is in the Bill about the GP, because it is the information that you want to get, and you get it now and I am amazed. I am therefore very thankful for the care that I have received and the records that speak about my journey, and I want to thank all those who have been involved in my health.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Meston (CB)]

My Lords, as the noble and learned Lord, Lord Garnier, said, we really have to make a choice between court-based decisions and the panel, as the Bill provides for in its present form. There is merit in both. There is a strong case for the use of the expertise and skills of the Family Division of the High Court and designated family judges—I should declare that, until quite recently, I was one of them. However, as the noble and learned Lord said, the courts will be faced with an initial rush of applications. That tends to happen with any significant change in the law, and it is likely to happen in this situation. It will take some time for the procedures to settle down, whether they are in front of a panel or the court. As the noble Baroness, Lady Berridge, said, we require some realistic assessment of the likely additional workload on the judiciary and the court system. The judiciary is of course well used to hard work and working under pressure, finding time when it is required. It should also be borne in mind that not all these cases will be complex or contested. In fairness to what was said by the noble Lord, Lord Shinkwin, there is no question of cases being nodded through or rubber-stamped, whether by the court or the panel. Family judges are used to prioritising cases when urgency is required, and they do so by underpinning their decisions with focused and robust case management.

The noble Baroness, Lady Berridge, is right, and I endorse what she said: judges are real people. I therefore endorse her call for consultation with the current President of the Family Division. I also suggest that one way through this might be an enhanced role for the independent advocate provided for in Clause 22, who will assume the role that guardians have in more conventional family cases—representing the interests of the person, whether a child or an adult, at the heart of the litigation.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I want to draw the implications for Northern Ireland into the conversation on the amendments from the noble Lord, Lord Carlile. Clearly, Northern Ireland has its own family court system, which, incidentally, has its own issues and backlog. However, that does not mean that people in Northern Ireland are entirely unaffected by court decisions in England and Wales. Each year, the family court for England and Wales hears cases involving parties on both sides of the Irish Sea, perhaps most notably applications for a child arrangements order, where one parent is living in England and the other in Northern Ireland. In such cases, delays in the English court can result in parents and children in Northern Ireland being left in limbo, awaiting decisions, with all the connected anxiety and parental conflict that goes with it. I simply present that as an example of the sort of impacts that ought to be considered, if we want to make any claim to be engaging in serious policy work.

There is no doubt that there will be even more acute impacts in England and Wales, where the strain on the court will be more direct. Catherine Atkinson MP in the other place reminded Members that:

“More than two thirds of care proceedings involving the most vulnerable children in our society cannot be completed within six months”.—[Official Report, Commons, 29/11/24; col. 1030.]


If that is the case at the moment, what can we expect if family court judges are increasingly swamped with assisted suicide cases instead?

The estimates from the former head of the Family Division, Sir James Munby, suggested that at least 34,000 hours of judicial involvement will be required each year for a proposal such as this to work, whereas the 20 judges in the Family Division of the High Court currently sit for only a total of 19,000 hours between them across all cases. Clearly, that is not something that we can ignore, and it is quite apparent that the bulk of the work will fall on circuit judges.

In saying that, I stress that I am not without sympathy for many of the concerns raised by the noble Lord, Lord Carlile. In the words of the Medical Defence Union, the current approach leaves doctors “unduly exposed”, making assessments on coercion, capacity and—as we heard a few weeks ago— residency that they feel unqualified to make. In my opinion, the Bill, as drafted, is not fit for purpose.

I have to say that I am equally concerned about the prospect of attempting to legislate on the fly, which is what we seem to be doing. What level of resource would the family court proposal require? How many additional circuit judges will be designated family judges? What impact would this have on the principle that, ideally, judges should be specialists in the area in which they are engaged? Incidentally, I believe the noble and learned Lord, Lord Falconer, has previously supported that principle. What would be the cost for an already overstretched court system?

We have been left to do policy in the dark. As former Lord Chief Justice the noble and learned Lord, Lord Thomas, warned in November,

“no one has grappled with the detail”

of the legislation’s impact on family courts. The legislative hokey-cokey on the issue of judicial involvement, which goes back much further than this Bill, has certainly not helped. It gives the impression that no one has worked out how to resolve the dilemma at the heart of the Bill—that the necessary level of safeguarding that such a Bill needs ultimately renders it unworkable. I know that the noble Lord, Lord Pannick, has said that this applies only to those who have six months to live, but no one can state categorically that a person has only six months to live. As a minister in the Church for 50 years, I have known numerous people who have been told that they have only six months to live, but they lived for years after that. Therefore, while it has been suggested that this applies only to those who have six months to live, we do not know that, and we cannot give that assurance.

In 2012, the Commission on Assisted Dying, chaired by the noble and learned Lord, Lord Falconer, considered several models for approval of assisted suicide. Those included: a medical decision-making model where doctors are solely responsible for decision-making; an NGO or volunteer-based organisation model, as they have in Switzerland or—to a certain extent—in Oregon; a tribunal model; and a court model, with the question posed whether the court should be the family court, as in the amendment, or another, such as the Court Of Protection. In 2012, the noble and learned Lord, Lord Falconer, firmly backed the medical-only model, as his report reads:

“Our assessment of the body of evidence overall has convinced us that it is health and social care professionals who have the knowledge, skills and training structures that would be needed to implement a safeguarded system to permit assisted dying in the UK. Therefore, we do not consider that it would be necessary or desirable to involve a tribunal or other legal body in decision-making”.


However, just two years later, in Committee on the Assisted Dying Bill, the noble and learned Lord made an about-turn—the court model had become the silver bullet. He told the House that

“I do not think that one can leave it to doctors alone, in particular to form two views: first, on whether it is the voluntary, clear, settled and informed wish that somebody wishes to end their own life; and, secondly, whether they have the capacity”.

In fact, he was such a convert that he made it clear in that debate that it needed to be

“the highest-quality judges to decide these issues”,—[Official Report, 7/11/14; cols. 1880-81.]

and the role for the Family Division was added into the Bill.

That position briefly persisted when the noble and learned Lord’s co-sponsor introduced the Bill in the other place, announcing it as the safest in the world due to the High Court element. But then that idea fell apart too, and the tribunal-style model, combining medical and legal elements, was adopted instead, on the claim that it would be “more robust”. At first, I thought that this was the plan all along because Dignity in Dying—the real sponsor behind the Bill—indicated this as its preferred option to the Commission on Assisted Dying in 2012. But then I read a line in the commission’s report where Dignity in Dying said:

“If there was going to be a tribunal then you would expect it to be part of the tribunal service”,


which of course the panel process currently in the Bill does not do.

This flip-flopping does not inspire confidence, and I certainly think that we should bear this in mind if the noble and learned Lord, Lord Falconer, indicates shortly that he suddenly once again thinks that the High Court judge is the way to go. It is incumbent on us to consider the reason that the High Court judge was scrapped in the Commons—again, not because I think that it was better but because it raises those questions of workability.

When interviewed by the Select Committee, Ms Leadbeater in the other place claimed that the removal of the High Court was to ensure a more “patient-centred approach”. But I am not sure that this tells the full story. In February, the Guardian reported that senior officials in the Ministry of Justice were understood to have significant concerns about the sign-off from a High Court judge in the original Bill, given lengthy backlogs in the family court. Perhaps the Minister would like to confirm these reports when she replies.

To conclude, it is important to stress that decisions around Amendment 120 are not peripheral but a central policy consideration that touches the very heart of the Bill. Is the Bill about introducing a new so-called treatment option to be overseen principally by the healthcare professionals, like other end-of-life choices, or is it more about giving the courts extraordinary discretionary power to resolve concerns about the operation of the Suicide Act in extreme cases? It is astonishing that at this late stage in the process, with the Bill having passed through the Commons, we have still not resolved this important point of principle.

[Lord Gove (Con)]

My Lords, I speak because I was persuaded by the case made by the noble Lord, Lord Carlile, but I recognise that there are inevitable questions that his case provokes, which have been reflected in the debate.

Of course, not everyone has been convinced. I am reassured by the strength of the noble Lord’s case, having spent four and a half years as an Education Minister and one and a half years as a Justice Minister with direct responsibility for liaising with the family courts, and so my respect for those who work in those courts and the judges in them is all the greater for it.

However, as the noble Lord, Lord Pannick, has pointed out, not everyone believes that judges would be the ideal people to make decisions in this case. I remind the noble Lord, Lord Pannick, with respect, of the case that he made in his wonderful book, Judges, where he said:

“So long as men and women continue to wound, cheat, and damage each other, there will be a need for judges … Judges do not have an easy job. They repeatedly do what the rest of us seek to avoid: make decisions”.


Each of us may consider either judges or a panel preferable, but there is one key question for those who agree with the noble Lord, Lord Pannick, in his current incarnation and believe that a panel is preferable. Can we know what the promoter of the Bill understands by “legal member”, and can we also understand what the Government believe the definition of “legal member” to be? What is the threshold, what qualification—

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Markham (Con)]

I believe I am answering the question. Once I have finished answering, the noble Lord can intervene on me and say what he would like to say. If he is willing to wait a few moments, that would be the appropriate point.

We spoke earlier about how palliative care is a way for people to choose to ease the way they die. I would say that assisted dying is also giving people the choice to die in a way they want to. In birth services, people have a birth plan. I remember going through this recently and there was a midwife who played a role very similar to that of a personal navigator, helping us talk about what sort of birth plan we wanted: whether we wanted a home birth and what we wanted to do about pain relief. It was very similar to many of the things that the noble Lord, Lord Birt, was talking about. The fundamental point here—the noble Lord, Lord Winston, is free to intervene at any point now I have answered that—is that it is giving people choice and autonomy. I believe that choice in the way you wish to die and when you want to die, if it is certain that your diagnosis is that you will die within six months, is a fundamental choice and a health choice.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

Part of the noble Lord’s argument is based on assisted suicide being so popular with the general public that 70% of people want it. If that is so, perhaps he can help me to understand why none of the parties in this House put in their manifesto that they want assisted dying?

[Lord Markham (Con)]

Given that I did not write any of the manifestos, I am not sure I can say. If I was writing them, it is something that I would probably put in. It is something that everyone agrees is one of personal choice, like many other issues, and of course that is why everyone has a free vote in this matter. It is undeniable that there is overwhelming public support for this and, as it is “our NHS”, it is entirely fitting that if it is the decision that money is spent in this way, it should be directed towards this service.

The question becomes one of what I believe the noble Lords, Lord Birt and Lord Pannick, are trying to do in their amendments, which is to take what we know is a complex system and make it as easy to navigate as possible. We know that it is a time of great distress. In many cases you have just been diagnosed with a terminal illness, and sometimes you will be told straightaway that you have only a few months to live, so automatically you are within the six months and it is something you want to move on quickly. It is entirely right and proper that you want to ensure that it then happens as efficiently as possible. That does not mean you do not want other services to happen as efficiently as possible in the NHS. It is not a binary choice between one and the other.

--- Later in debate ---

If these amendments are adopted, what families will see is that, while they are left in their anxiety, those who opt for assisted dying will be given a Rolls-Royce service. They will be given a personal navigator. They will be expedited through the process and have their hand held at every stage—something that the NHS simply cannot afford to do in the case of people who are suffering from cancer and want to live. I think there will be a profound sense of injustice, and indeed revulsion, if these amendments are carried and such a service is established. What is being proposed is simply unreal. It cannot advance.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I listened carefully to what the noble Baroness, Lady Royall, said, but I believe it is important that Members who feel they have a contribution to make are able to make that contribution without being cut short.

[Baroness Royall of Blaisdon (Lab)]

Forgive me. I did not realise that there were other people who wished to speak. There was a pause.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I thank the noble Baroness for that.

This has been a telling debate thus far, because we are told that some of the points are based on opinion polls. We are not an elected Chamber and therefore we do not have to be swayed by how we are to get elected next time. Therefore, it is so important that we do not make laws on opinion polls. In fact, we have to debate the issues carefully—and trust that we are therefore making mature decisions—and seek to get the Bill right, because the issue that we are debating concerns life and death.

I have found something somewhat surprising whenever the cost has been talked about. Many people are rightly demanding an answer concerning the cost. The noble Lord, Lord Markham, mentioned it a number of times. I was in this House when he was a Minister, but he is not now answering for the Government; I believe it is important that the answer comes from the Government Minister, who should give us the up-to-date cost. For any of these issues, costs do not minimise over the years. In fact, they increase—we will find at the end of the day that the costs will escalate. We heard in the debate yesterday that the cost of the Chagos Islands will be £3.4 billion, yet it was suggested on the Opposition Benches that it will be £34 billion. I am sure Members realise that there is quite a difference between those two figures—there is a dot between £3.4 billion and £34 billion. Nevertheless, we are talking about massive sums of money. We are also talking about money that could be taken from another part of the health service, which in many parts of the country, and certainly in Northern Ireland, is crying out for money; it needs every pound it can possibly get.

I believe the Bill was defective as it came from the other House, but I also believe that what has been proposed by the noble Lord, Lord Birt, would make the Bill worse. The proposal here undermines choice even more. There is no equity of access under these amendments. What genuine choice is there if you can get an assisted death within 30 days but you have to wait months for the palliative care that you need? Palliative care is not available in many parts of the country; it is certainly not equally available right across the country.

Do the supporters of these amendments accept similar amendments that require palliative care treatment options to be made available and accessible within the same timeframe as this? They might say, “Yes, we would accept that”, but it is not a reality. There is no reality in which you will get palliative care within 30 days, because it is not available in many parts of the United Kingdom. How is it fair that terminally ill people get a personal navigator to support them through the process of getting an assisted death, but they do not get a personal navigator for gaining access to the palliative care they desperately need?

There are issues that need careful reflection. In the light of what the noble Lord, Lord Empey, said, I note the following. In our debates over the past few weeks, the noble and learned Lord, Lord Falconer, has said that he would reflect on some of the issues raised, but up to now I have not heard what that reflection has brought about in changes that need to be made to the Bill. Perhaps it would speed up the debate if we could get some knowledge about the reflections that he has had and some of the changes, in the light of the debates that have already taken place, that he will actually make in order to make the Bill more acceptable to many noble Lords.

The issue that we need to continue to reflect on is the extraordinary speed suggested by the noble Lords, Lord Birt and Lord Pannick. It undermines safeguards. Mandatory timelines force decisions without proper investigation. Panels must decide within two days of referral, even over weekends. I know of no other decisions made in the health service for which you can be promised that. There is also no judicial precedent for such haste, because courts take months for life and death decisions—yet this process is so fast.

Then we come to prognosis inaccuracy, which seems to be ignored. As I said to the noble Lord, Lord Pannick, in a previous debate, I have known people who were given a six-month prognosis but continued to live three years later. Therefore, there is no consideration of prognosis inaccuracy. Rushing assisted death risks premature deaths.

Then we come to mental health risks. Reflection periods would be cut to 24 hours. Experts warn that depression after diagnosis is often temporary and treatable. Why can patients get an assisted death in 30 days but have to wait months for palliative care? Also, the amendments erode protections rooted in law and ethics; suicide prevention remains government policy.

In conclusion, I ask the Minister these questions. How can panels make life and death decisions within 48 hours without sacrificing due process? What safeguards exist against coercion when timelines are compressed, as suggested by the noble Lords in their amendments? How will the National Health Service meet these demands when GPs and social workers are already overstretched? We had and have, in past debates and up to this moment, numerous questions, but, from the noble and learned Lord, Lord Falconer, the Front Bench and the Government, we have very few, if any, real answers that we can hold on to.

[Baroness Grey-Thompson (CB)]

My Lords, I read this group of amendments with a lot of interest, in terms of whether a different way would be possible. I thank my noble friend for tabling them.

I agree with the right reverend Prelate the Bishop of Newcastle that Australia is not an accurate comparative country to look at. Actually, it makes me feel even more strongly, and the Minister will have received a letter this week from many of us asking for the impact assessment to be looked at again. One of the reasons for that is that the impact assessment looks at about the first 10 years in Oregon. If we compare data between Oregon and the state of Victoria, it took Oregon 17 years to reach the same number of deaths that was hit in the state of Victoria—not Australia, but the state of Victoria—in the first 12 months of its Bill passing.

I accept that the first voluntary aided death in Victoria was described as beautiful, but in the time that that legislation has been enacted, it has thrown up many issues. In 2023-24, there were a number of complications with intravenous injections. There were technical problems in 5% of cases. In 10% of cases, the death took longer than expected—one person took seven days. In 29 responses, the death more than two hours. In seven reported cases, it took more than six hours, and the longest was 11 hours. So, we have to be really careful about painting other jurisdictions as the sunny uplands.

There was a case reported in the Times on 22 March last year, where a man had requested the drugs to end his life. He had decided that he wanted to have longer left to live, and his wife gave him the drugs anyway, because, I presume, she decided that it was his time to go. It is a very different jurisdiction, but it again raises issues of coercion.

We also have to note with Victoria that, since its legislation has passed, elder suicide has risen by 50%. These are the things that we must take into to account when we are looking at what happens in this country.

I thank the noble and learned Lord, Lord Falconer, for arranging a meeting last year, when we were able to meet some Australian medics, but that gave me even more cause for concern, because there was a story of man who had taken a while to come to a decision to have an assisted death. The day he finally decided to have it and started taking the noxious mixture, he did not want to carry on and his family said, “But, Dad, you’ve decided to die today, you need to keep taking the mixture”. All these things worry me when we look at the speed with which these navigators might be able to push someone towards assisted suicide. In principle, a navigator sounds great, but they are only pushing people one way. We do not know enough about the training or whether, potentially, an AI bot might be used at some points. As has been raised, this could potentially just be debated in a 90-minute debate on a statutory instrument. So we have to look much more carefully at these areas. I do not think these amendments are adequate for what we want to do.

My noble friend Lord Birt raised the extremely sad case of Nick Dimbleby. But, as far as I understand, with his condition, MND, he would be not eligible for assisted suicide under the Bill. I would welcome the noble and learned Lord, Lord Falconer, confirming that.

It has been raised in different ways and on different days that our experiences of pain are very different. In other debates, we have talked about incontinence: what one person thinks is awful, another might think “I can live with it, it’s okay”. My noble friend Lord Birt talked about someone being PEG fed. Unfortunately, there is an inequality of the system in this very Chamber. My noble friend Lady Campbell is not able to respond to this group of amendments because she can only speak at the start. She cannot intervene later, so she is not able to listen to the debate and pick up points. I am sure she will be able to raise it, and I beg your Lordships’ tolerance because she might have to raise this in another group. There has been talk about being PEG fed being awful, but being PEG fed has enabled her to survive and to contribute. I worry about the inequality of this Chamber in terms of people being able to contribute properly.

Amendment 223 looks at this happening in four days. I do not believe that there is any system that will be able to, in that period of time, assess whether somebody has been coerced. Amendment 336, which says that the second assessment could happen after a period of reflection of seven days, does not even vaguely take into account the five stages of grief. There are not that many papers on people with spinal cord injuries, but one that I have read says that it can take up to seven years for a wheelchair user to get over the experience of traumatic injury. If you take that into account, people will be forced very quickly to end their life, when the ability to deal with the issue that is in front of them has not been taken into account.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

Of course patients are welcome to refuse. I am slightly worried by the noble Lord’s phrase “I just want the injection”. The Bill is very clear: this is about self-administration. The doctor has to discuss with the patient how they are going to inject themselves with the lethal dose of drugs, whether they will do it with different syringes, if there is a mixture in the syringe and the complications of trying to do that. In asking the question, the noble Lord has just illustrated the nub of the problem.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, on Friday 16 January 2026, the noble and learned Lord, Lord Falconer, defended the Bill’s provision for informed consent by arguing that the existing drafting already mandates comprehensive disclosure of information. He rejected Amendment 42 in the name of the noble Baroness, Lady Finlay, which would require patients to be fully informed. He argued that was unnecessary because the specific obligations listed in the Bill already ensure that the patient receives all necessary information. However, these amendments identify further gaps and the weakness in the noble and learned Lord’s reliance on the Bill’s current drafting to guarantee informed consent. Evidence of complications, lack of data, prolonged death risks—all these show that there are downsides and pitfalls, rather than simply a peaceful exit.

Proponents, some of whom we have heard today, tell us about prolonged and painful deaths from illness, but they seem to close their minds to long and potentially painful deaths for those who walk the path suggested by noble Lords. There are two mentions of complications in the Bill, but nowhere is there an explicit requirement to explain and discuss the risks of complications, despite this forming a standard part of GMC and NICE guidance on informed consent. I wonder why that is.

[Lord Scriven (LD)]

Will the noble Lord point out in the Bill any clause that moves away from the normal GMC duties of a doctor in terms of either consent or capacity? If the noble Lord could explain that, it would be very helpful when he continues his argument.

[Lord McCrea of Magherafelt and Cookstown]

I am very happy to address that matter. What the noble Lord, Lord Scriven, left out is as significant as what he said. I will come to that.

Clause 12(2)(d) requires a doctor to

“discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance”.

Notice that it says “the self-administration of an approved substance”. That is somewhat different to what was mentioned a few moments before—that they want the doctor giving the injection.

In Clause 39(1)(g), there is a requirement for the Secretary of State to issue a code of practice on

“responding to unexpected complications that arise in relation to the administration of the approved substance”,

and Clause 12(2)(c)(iv) requires the doctor to discuss

“the nature of the substance … (including how it will bring about death and how it will be administered)”—

but not that it may not be successful. The existing areas of medicine have guidance and case law on informed consent and risks, but the Bill creates an area of no guidance, no precedent and doctor confusion.

--- Later in debate ---

[Lord Scriven (LD)]

I am not sure whether the noble Lord is aware that the GMC duties of a doctor are a legal requirement for a doctor to practise in the UK. The doctor therefore has to go through all those, regardless of what is in this Bill, to ensure that the patient is informed and understands the decision that is being taken by them.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

If that is so, then let us put it into the Bill. Let us be sure that it is in the Bill so there is no ambiguity. I notice that the noble Lord, Lord Scriven, does not want that. That is why I am wondering—

[Lord Scriven (LD)]

My Lords—

[Lord McCrea of Magherafelt and Cookstown (DUP)]

Unlike other Members, and unlike the mover of the previous amendment, I have given way. He did not.

[Lord Scriven (LD)]

Just to inform the noble Lord, I have tabled no amendments, I have made no point about what I wish or do not wish to see, and I am not the sponsor of the Bill. In relation to what the noble Lord has said about the legal requirements of the GMC, I am pointing out the duties of a doctor and how the GMC as the regulator applies those to the individual practice of a doctor in the UK.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

And I am responding by saying that if we want to be sure that there is no ambiguity whatever—we are talking about the issue of life and death and, by what was suggested earlier on, inside a matter of days this was all to be over—there should be clarity. I would have hoped that the noble Lord would want that too.

[Baroness Cass (CB)]

The GMC guidance would need to be amended because, at present, there is specific advice on guidance around supporting patients at end of life. It says:

“Where patients raise the issue of assisting them to end their own life, or ask for information that might encourage or assist them in doing so, respect for a patient’s autonomy cannot justify illegal action … Medical professionals should … be prepared to listen and to discuss the reasons for the patient's request”,


but

“limit any advice or information in response, to … an explanation that it is a criminal offence for anyone to encourage or assist a person to commit or attempt suicide”.

The current GMC guidance precludes all this and would therefore have to be changed should this Bill go through.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

That is very helpful, and I trust the noble Lord, who is now nodding, will take that into consideration.

[Baroness Coffey (Con)]

The points that the two other noble Lords have made are due to guidance in 2020 which was put in place only as a consequence of the 2015 ruling by the Supreme Court which we discussed earlier. The guidance before 2020 was not what is being said now, and that is part of my point about putting this in the Bill.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I thank the noble Baroness. I realise that my time is up, but I draw to a close by asking noble Lords to notice the emphasis on GMC guidance. Guidance is not the law. The GMC itself states in its preamble that its guidance is intended to help doctors

“practise ethically and in line with law”—

it cannot make the law. It goes on:

“If you’re not sure how the law applies in a given situation, seek advice through local procedures, consult your defence body or professional association, or seek independent legal advice”.


It says finally:

“The professional standards describe good practice, and not every departure from them will be considered serious”.


That is equally true for NICE guidance as well.

[Lord Carlile of Berriew (CB)]

My Lords, as a former, if somewhat historic, member of the General Medical Council, I can confirm that the GMC has no guidance relating to ending someone’s life because it is, at the present time, simply unlawful to end someone’s life.

I hope that I can try to simplify what is being discussed. I agree with the noble Lord, Lord Blencathra, that there is a need to add something, though possibly not very much, to this Bill to ensure that consent, as consent, is included. We are talking about four stages. The application is not consent; it is just an application. Capacity is measured and is not an application. The discussion described in Clause 12 is a discussion, and I say to the noble Lord opposite that it is most definitely not the obtaining of consent. Then there is the issue of obtaining consent, which includes the effect of any drugs to be used, and that is what I think the noble Lord, Lord Blencathra, is seeking to add to this Bill.

Let me briefly give an example from my own experience. I had an extraordinarily formidable and occasionally difficult mother, and on one occasion she had a heart attack, not long before her death. She was taken into a very good cardiology unit in Blackpool, so I rushed up to Blackpool at high speed and found myself on the ward with my mother—whose eyesight and hearing were not good, but her brain was as good as any in your Lordships’ House—and a consultant. The consultant explained that he could do an operation which he had done once on a male patient aged 91, but he was prepared to try it on my mother. She was very enthusiastic to have any medical treatment that might prolong her life, which, after all, had by then lasted for only 98 and a half years.

Once we had had the discussion, the cardiologist proffered a consent form to me. My reply, which I will abbreviate, went something like, “Not likely; she is perfectly capable of consenting herself. But it must be explained to her so that she can hear it clearly. So, why don’t you sit down while I explain what you have said to me, and you correct me if anything is wrong?”

In due course, she signed the consent form and had the operation. Happily, the operation was entirely successful. Sadly, the effect of the operation gave her such a pounding heart that the rest of her bodily functions could not cope with it. She died a few weeks later. When she said to me during the period before her death, “Darling, I never thought it would end like this”, I thought to myself, thank God she signed the consent form, not me.

Consent has a conspicuous and real meaning. It requires full understanding from the patient. It can go horribly wrong, as it unfortunately did for my mother. I wish we had been able to celebrate her 100th birthday. But that element of consent, consent, consent—a bit like “education, education, education”—is not clearly set out in the Bill. It is not a major change to be made, and I would invite the noble and learned Lord to incorporate it.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Lord Polak (Con)]

My Lords, I support the amendments in this group, especially the one from my noble friend Lord Evans. I was not going to speak but I was moved by what the noble Baroness, Lady Smith, said about her father.

I am not a Luddite. My mother passed away in July 2023 from brain cancer, and this debate has reminded me of the Zoom call we had to look at the next stage of her treatment. I was here in London; my sister was with my mother in Liverpool, where she was lying in bed unable to speak. The nurse who was looking at the next stage of treatment for her was in Margate, had never met my mother, and was asking questions for over an hour to which mother could not reply. I have listened to this whole debate, and if we cannot put face-to-face consultation in the Bill, we are doing a great injustice to many people.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, earlier in the debate, the noble Baroness, Lady Jay of Paddington, intervened to say that she could not understand why, having talked so much, we had not actually talked about terminal illness. If the noble Baroness remains in her place, she will be here for the fifth group of amendments, on terminal illness, and there will certainly be a lot of discussion then of that issue. In fact, if we were speaking to that group of amendments now, we would be told by the Whip to address instead the amendments before us.

In the light of my experience as a minister, dealing with the general public from another side, I gently say to the noble Baroness, who was advocating for online assessments, that, if they are so perfect, why are so many mistakes made? Should we just dismiss those mistakes?

--- Later in debate ---

[Baroness Hayman (CB)]

My Lords, I will briefly follow on from the noble Lord on the issue of overengineering. I had great sympathy with the words of the noble Baroness, Lady Blackstone, and I suspect that there is widespread support in the Committee that face-to-face consultations should, in general practice and in the norm, be what happens in these circumstances. We get into great difficulty when we micro-legislate to cover every single circumstance that might occur. A code of practice is a more reasonable and flexible document to deal with this. The noble Lord shakes his head, but he just spoke about the dangers of having anyone else in the room in a consultation because of the possibility of coercion, yet the noble Baroness, Lady Smith, spoke potently about how important it was for there to be a family member, or support, or someone who could hear.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I was not speaking against someone being in the room. I am speaking about someone being in the room whenever it is on Zoom or on camera and not in person, because you do not know whether the person in the room is privately and secretly coercing that person.

[Baroness Hayman (CB)]

I understand that the noble Lord was talking about a subset of consultations, but this is my point: I think he accepted that there might, in any process, be exceptional circumstances where a consultation was not in person. I am just saying that, even in that narrow subset, there might be a reason for another person to be in the room. I am not talking about that specific point; I am trying, in general, to suggest that we should try to lay down some principles but not try to overengineer and cover every possible circumstance.

--- Later in debate ---

[Lord Hamilton of Epsom (Con)]

My Lords, I have supported AI for as long as I can remember, and I think it is the future for this country. If we are looking for improvements in productivity, there is no doubt that we should look to the National Health Service and the public sector, where we can see AI having its greatest effect and improving the health of the economy of this country.

However, we are in early days with AI, although it has been with us for some time. We must be very careful not to rely on it for too many things which should be done by human beings. The noble Lord, Lord Stevens, has already referred to the appalling rate of misdiagnosis. We can look at these statistics and say, “Well, it is only a small number who are misdiagnosed”. Yes, but my noble friend Lord Polack was misdiagnosed as only having six months to live and he is still with us 32 years later. You must think about this, because if you get the situation with misdiagnosis badly wrong, it undermines the basis of this Bill. Therefore, we must be very careful that AI does not contribute to that as well.

I pay tribute to the right reverend Prelate. AI is having a tremendous effect in the health service and helping a large number of people to get better, and it may well be that AI introduces cures for people who are being written off by their doctors—perhaps wrongly. We must not dismiss AI, but we must be very wary about where it leads us. There will be an awful lot of bumps in the road before AI is something in which we can all have complete confidence and believe will deliver better outcomes than human beings.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, there are just a few remarks I would like to make. We live in an age where it is hard to get a human to interact with any more. We lift the phone and speak to a voice that says that if you want one thing, press 1, and if you want something else, press 2. I fear that this is what we are heading for: if you want death, just press a button.

I have no doubt that if this legislation is passed as it is, in the near future we will be heading towards AI assessment procedures. My concern is not where we start in this process, but where it leads to and where it ends.

I am informed that, in the Netherlands, it has been proposed to use AI to kill patients in cases where doctors are unwilling to participate. Indeed, it is suggested that AI could be less prone to human error. Surely, in crucial assessments and decision-making processes for a person seeking assisted suicide, AI could not identify subtle coercion and assess nuanced capacity, bearing in mind the irreversible nature of the outcome. There are concerns about the risk of coercion or encouragement by AI. It should be noted that, with the newly developed AI functions and chatbots, there are already cases globally of individuals being coerced into all sorts of different behaviours, practices and decision-making.

Clause 5 allows doctors to direct the person

“to where they can obtain information and have the preliminary discussion”.

That source of information could be AI or a chatbot. Is there anything in the Bill that will prevent this?

AI undermines accountability. If the technology fails, who bears responsibility? Traditionally in the health service, the doctor bears responsibility. If AI is used, who bears responsibility?

[Baroness Lawlor (Con)]

My Lords, to add to what has been said, AI is based on large language models, which involve big datasets. I ask your Lordships to consider whether such large datasets, based on assessing a snippet of data to assist diagnosis, are a good way of assessing individual patients. They were not designed to assess individual patients. Every doctor will tell you that each individual case is different, and that diagnosis can vary. I am very grateful to the noble Lord, Lord Stevens, for sharing the results of the 98,000 cases that were assessed for accuracy. Therefore, I am not sure that it is a suitable tool to assess and diagnose individual cases.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have in this group an amendment that was recommended by the Complex Life and Death Decisions group at King’s and which builds on the clause that was proposed in the other place by the MP for Bradford West and accepted, currently Clause 2(2). It seems that Amendment 87 before us would knock that out, but it has an amendment to it that has been clearly explained by the noble Baroness, Lady Keeley.

This seems to be the start of an improvement that is very necessary, but it does not do everything. There is a concern that those with other types of eating disorder can be missed out or slip through the net, particularly those with bulimia and those who go on completely bizarre diets and end up with severe malnutritional states. I have known two examples directly: one person believed that he could live only on cottage cheese, and another was eating kilogrammes of parsnips every day in the belief that that would cure her disease, and ended up with quite severe metabolic disturbances.

The problem with the amendments so far is that they fail to exclude the voluntary stopping of eating and drinking that is designed deliberately to make you terminally ill. I mention, if I may, the problem of T1DE—that is, a type I diabetic with an eating disorder. Lesley and Neal lost their young daughter Megan at Dignitas, after years of inadequate treatment. I have permission to quote them. They said:

“Following inadequate and inappropriate in-patient and community treatment for T1DE, our daughter chose to take her own life after asking for a Dignitas referral from her care team. She clearly would have taken up the assisted dying option if available to her, however, just before she committed suicide she said ‘I don’t really want to die, I just can’t do this any more’”.


That illustrates the real difficulty for young people with disorders that are on the boundary here. I hope that we can build on these amendments on Report to make sure that they really are watertight.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I support Amendments 89, 91, 92, 101 and 103. Surely we need to demonstrate that what we term safeguards in the Bill against voluntarily becoming terminally ill are adequate and do not allow for voluntary acts to accelerate the timeline or even to create eligibility for assisted suicide. There seems to be a lack of clarity between terminal illness and eating disorders or voluntary action, which could undermine the very structure of the Bill itself.

Does the noble and learned Lord, Lord Falconer, in his Amendment 87, not row back on Kim Leadbeater’s previous amendment in the Commons? It seems that this amendment is significantly narrower. Can a suicidal person, dependent upon insulin or dialysis to remain alive, refuse that treatment and become eligible under the Bill? However, if he believes that cases of voluntarily withdrawing life-sustaining treatment such as insulin to voluntarily induce a terminal illness should not be eligible under the Bill, why does he oppose amendments that would close that loophole?

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

I draw attention to the part of my amendment that would require that the number of staff seconded into the organisation is recorded. I have seen this in other places; it is quite a smart way of making organisations look much smaller than they are. Again, this is about providing true transparency. Can the noble and learned Lord give an assurance that the size of the body will be recorded and that that will be transparent?

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I follow the noble Baroness in speaking to the issue of the commissioner. The shift from the High Court to a commissioner has been compounded. The Bill originally proposed that a High Court judge would authorise every assisted death—a feature initially championed by the Bill’s sponsor in the other place to make the United Kingdom’s law the safest in the world, with robust safeguards. That has changed dramatically and we now have a new structure, with a commissioner appointed by a Prime Minister.

The voluntary assisted dying commissioner is an important role. They will be given powers both to run and monitor the service. This creates the obvious risks of inadequate public scrutiny and independent review. It is judicial in the broad sense of involving a judge, but it does not appear to have a judicial function. The commissioner will both run the service and monitor it, which means that a highly controversial and important service will be run with little proper oversight. The commissioner will be responsible for establishing the regime and overseeing appeals as well as monitoring and reviewing its operation. In effect, as others have said, this allows the commissioner to mark their own homework.

Dr Luke Geoghegan, policy lead of the British Association of Social Workers, told the Select Committee that an independent regulator for VAD was essential. He said:

“The other thing that I think would give assurance is that no public sector organisation should mark its own homework. The voluntary assisted dying service needs robust external inspection”.


In its written evidence, the Law Society said:

“We recommend the establishment of an Independent Monitor to review and report on the operation of the Act annually”.


The commissioner could be an assisted dying campaigner or someone linked to an advocacy group. Other countries have experienced problems when the assisted dying service is run by an advocate, yet nothing in the Bill prevents this risk of conflict of interest.

In the Constitutional Reform Act 2005, the noble and learned Lord, Lord Falconer, developed a new judicial appointments process designed to guarantee an independent, impartial judicial appointments process and an enshrined statutory duty requiring respect for the independence of the judiciary by Ministers. Yet in the office of the commissioner, we see a potential patronage office in the political gift of the Prime Minister without any internal or external safeguards. Can the noble and learned Lord tell the Committee how the commissioner’s impartiality will be guaranteed? Why has he changed his mind on the importance of statutory guarantees of independence? Will the public have any right to know the commissioner’s views?

Amendment 127, in the name of the noble Lord, Lord Beith, would

“make the Prime Minister’s choice for Commissioner subject to scrutiny and approval by the House of Commons’ Health and Social Care Select Committee”.

There is a lack of accountability and transparency around the commissioner’s appointment process, which is entirely in the gift of the Prime Minister. Therefore, I ask the Minister who will respond to this group: have the Government followed Cabinet Office guidelines regarding appointments? The Cabinet Office Guidance: Pre-appointment Scrutiny by House of Commons Select Committees, published in 2019, requires:

“When establishing a new public body, departments should ensure that they consider whether any public appointments to that body would meet the criteria”


for a pre-appointment hearing. It continues:

“They should seek guidance from the Cabinet Office and also discuss this with the relevant select committee Chair in a timely manner before establishment of the new body”.


Can the Minister confirm whether the Government have discussed the matter of a pre-appointment hearing with the Commons Health and Social Care Select Committee?

[Lord Harper (Con)]

My Lords, I have a couple of points to make on this group of amendments. Let me start on a note of agreement with the Bill’s sponsor, the noble and learned Lord, Lord Falconer, who has in this group Amendment 131A, which would require:

“Before making an appointment under this section, the Prime Minister must consult the Welsh Ministers”.


I think that is a sensible approach. We have had disagreements about whether the Bill should or should not apply to Wales but, given that it does, it is sensible that Welsh Ministers are consulted.

It is worth noting that Welsh Ministers have some views on this matter. Given that we are talking about consulting Welsh Ministers, this is probably the time to note them briefly. In the vote in the Senedd this week, Wales’s Health Minister, one of those who would be consulted, made two points clear. First, he said that the Motion in the Senedd was not a referendum on legalising assisted dying with only this Parliament able to make that decision. He also said—this is important, given that there are those outside this House who pretend that the only people who think this Bill has any flaws are a small number of Peers, when that is not the case—that he voted against the legislative consent Motion because:

“I’m also clear in my own mind that the fundamentals of the bill, as it’s going through Westminster, don’t provide sufficient safeguards for patients”.


The Welsh Health Minister, who would be one of those responsible for helping to implement it, thinks that the Bill currently does not have appropriate safeguards. He went on to say:

“Although the vote yesterday was on the devolved areas ... the net effect is to give powers in Wales to deliver a service that I don’t think I would support if I was operating over the border”.


For all sorts of reasons, it is helpful to consult Welsh Ministers. We have heard from them this week, and they are very clear that this Bill is currently flawed. Therefore, I think we are doing the right thing by scrutinising it, asking questions and putting forward amendments to improve it. We can see that it is not just Members of this House who have concerns; elected Members serving in the Welsh Government also have concerns, and it is worth getting that on the record.

The fundamental thing that I want to talk about is the prime ministerial appointment process in the Bill. I was quite surprised, not particularly that the Prime Minister was making the appointment, but that there was no other process around it. The Bill currently says that the commissioner is to be appointed by the Prime Minister. The one constraint is that:

“The person appointed must hold or have held office as a judge of … the Supreme Court … the Court of Appeal … the High Court”.


Other than that, there is no process set out that the Prime Minister has to follow.

There are two flaws with that. There is the one that the noble Baroness, Lady Fox, set out, which is that, given that this is an area of policy, the Prime Minister may have their own views about the issue and that may influence the person they choose. My noble friend Lord Markham was quite right that the person would simply be implementing the law. The worry is that if you appoint somebody who has a very strong view about the issue and is prepared to use holding this office to prosecute advancing it, which is the concern my noble friend Lord Moylan set out, that is a problem. The concern I have with the Bill as drafted is that the Prime Minister could appoint such a person, and we would have no way of knowing in advance or of testing that person’s views before the appointment was made. We would find out about it only afterwards, and that is a real problem.

Secondly, I am afraid that we have seen examples of the current Prime Minister making staggeringly bad appointments, and the rather obvious one is Lord Mandelson. I see the Minister shaking her head, but it was a shockingly bad appointment. It is an example of a decision being made to appoint somebody and the process being circumvented in order to get the right result. The person appointed to this role is responsible for life and death issues, and as my noble friend Lord Deben said, it is extremely important that they command the confidence of the public—not just people who are in favour of assisted suicide, but those who are against it and who want to see a proper process with proper safeguards, so that that person holds public confidence.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Lord Moylan (Con)]

My Lords, if I may briefly answer that, I am saying that we have 3,000 years of a moral framework in which it is morally abhorrent. I am not here primarily to protect the sensitivities and feelings of doctors. I am saying what a violent novelty this is that we are embarking upon if we go down this route.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, there are a number of key objectives outlined in the amendments that we have been discussing for some time now, which are worthy of our most serious consideration. I suppose that the burden of the amendment is that doctors should be prohibited from initiating discussions about assisted dying because, if they were permitted to do so, it would fundamentally undermine the long-established patient-doctor contract and could expose vulnerable patients to undue pressure or influence at a time when they are fragile—at a fragile moment in their lives.

The raising of the issue of assisted dying surely must be strictly initiated by a patient and any discussion of the issue must be embedded in a manner that prioritises palliative or other support care over death. If doctors were permitted to initiate the issue of assisted dying, patients could rightly interpret this as an implicit recommendation on behalf of the medical profession and it could be seen as a choice influenced by authority, or even fear, and not a free choice. It must be acknowledged that, within society, doctors have an exceptional moral and social authority. A person who feels vulnerable, marginalised or devalued can easily be susceptible to pressure and influence if the recommendation or initiation of the issue of assisted dying comes from their doctor.

The moment of diagnosis of a terminal or life-limiting illness is an earth-shattering moment for most people within society. As a minister of religion for over 50 years, I have been with thousands of such people, who, when they have received the diagnosis that they have a terminal illness, feel shattered and absolutely broken. I can tell noble Lords that that leads to a multiplicity of emotions. I have also had many loved ones and friends who have faced that moment. The immediate shock of hearing those words can turn into depression and, even for a period, it can turn into suicidal thoughts and a feeling of “It’s all over anyhow; therefore, let me get out”.

However, we all know from personal experience—or many of us certainly know—that these thoughts at that earth-shattering moment can dissolve over time, whenever people are surrounded with love, aided by a loving conversation or their personal faith, or supported within the family or the community context. Indeed, the initial devastation I have seen turns dramatically into a quiet confidence: into a determination to fight for life and to live a fulfilling life, even though the person is in the midst of adversity. That is something to be cherished and praised. At the moment of despair, when a terminal diagnosis is given, how improper it would be for any doctor to raise or to suggest assisted dying as a more sympathetic way out of their pain or a free exit from life.

Sadly, the personal and deep doctor-patient relationship is no longer the reality that it used to be, and in multi-doctor practices, you may never see the same doctor again for months or even years. They do not really know you as they used to know you. To pretend that somehow it is the old way is not reality—it is living in a different world. Therefore, often no personal knowledge of that patient is held by a particular doctor. Any deep understanding of their mental health, their family life context, or societal or financial pressures that that person may be experiencing is negligible, yet it is the moment of crisis in a life.

During previous debates, some noble Lords and Baronesses have been rebuked for using the term “assisted suicide” instead of “assisted dying”. But does “assisted dying” terminology not mask the reality of what we are discussing? Normalising discussions about ending life before the natural-appointed, or God-appointed, time surely risks reframing suicide as a legitimate medical response to pain or distress, which is outside the scope of the Bill—at least, that is what we are told.

Allowing but not requiring doctors to raise assisted dying with their patient gives me no comfort, as I feel that it would lead to medical professionals being open to criticism or challenge. It will no doubt lead to inconsistency among professionals. Will patients seek to move from one general practice to another because the doctor they are moving to supports them in assisted dying? Will they have to move because their GP has a sincerely held conviction about the sanctity of life and will not participate in the practice of assisting a person to die?

A doctor permitted to discuss assisted dying with a patient surely cannot be just any registered medical practitioner. For clarification, I ask the noble and learned Lord, Lord Falconer, to confirm that the provision in Clause 5 is not limited to the patient’s GP, and that treating consultants, specialists or doctors who have a minimal relationship with the patient or none are not restricted from giving this advice. Can he also confirm that there are no restrictions on the setting in which a doctor might give this advice—a hospital ward, an out-patient clinic or elsewhere?

--- Later in debate ---

[Lord in Waiting/Government Whip (Lord Leong) (Lab)]

Order.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I am finishing with this quotation, and it is just a couple of sentences:

“We also know that when you acquire disability, which most people do … it is absolutely frightening … If doctors are not on our side because they are thinking, ‘Should we mention the fact that they could have an assisted death?’, that poses a big cultural issue for the NHS, but also for us having confidence in the NHS”.

[Baroness Stedman-Scott (Con)]

My Lords, I will speak to the probing Amendment 161 in my name. It asks the simple but profoundly important question of whether registered medical practitioners should be granted a blanket legal protection to raise the possibility of ending any person’s life or whether that protection should be carefully and responsibly limited to patients already in their care.

At the heart of this debate lies the issue of safety and trust. The relationship between a patient and their doctor is not a casual exchange. I hope it is a deeply personal, often vulnerable, bond built on confidence, continuity and professional responsibility. When someone receives a terminal diagnosis, they are not merely confronting medical facts; they are confronting fear, uncertainty and the fragility of their remaining time. In that moment, words matter immensely. To grant blanket legal protection to any registered medical practitioner, regardless of whether they have an established clinical relationship with the individual, risks undermining that trust. It risks introducing the possibility that a suggestion about ending life could come from a professional who does not know the patient’s history, values, mental state, family circumstances or vulnerabilities.

Amendment 161 does not seek to obstruct lawful medical practice or to deny terminally ill adults the autonomy that the Bill intends to provide. Rather, it seeks to ensure that conversations about assisted dying occur in the right context, within a relationship in which the doctor knows the patient, understands their condition and is responsible for their ongoing care.

We must consider the subtle power imbalance inherent in clinical settings. A doctor’s words carry authority. Look at the effect they have on the noble Baroness, Lady Fox, at times. For a patient who is elderly, disabled, isolated or feeling like a burden, even a carefully phrased suggestion can carry unintended weight. If such a conversation is initiated by a practitioner with no established duty of care, we risk normalising a culture in which ending life becomes a broadly available option rather than a carefully safeguarded patient-led request.

Limiting legal protection to practitioners involved in a patient’s care and case strengthens safeguards. It ensures that any discussion arises from clinical knowledge, not abstract eligibility; it reinforces accountability; it reduces the risk of inappropriate suggestion; and it protects vulnerable people feeling steered towards a decision at a moment of profound weakness.

Autonomy is meaningful only when it is protected from subtle coercion, even unintentional coercion. By supporting Amendment 161, we are not diminishing choice: we are strengthening the ethical framework in which that choice is exercised. In matters of life and death, precision, boundaries and safeguards matter. Amendment 161 offers a proportionate, reasonable and ethically sound safeguard. It preserves trust in the medical profession, protects vulnerable patients and ensures that, if such conversations occur, they do so within the context of established clinical responsibility. For those reasons, I urge the Committee seriously to consider the intent and spirit behind Amendment 161.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I recognise that the noble and learned Lord, Lord Falconer of Thoroton, has tabled Amendment 548A, which completely leaves out Clause 22. It could be useful to hear from him early in this group, recognising that he has not answered questions on advocates in the past because of the amendment he has tabled.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I have tabled Amendments 540B and 544A in this group. My intention with these amendments is to probe how we have ended up with the list of eligibility criteria for qualifying for an independent advocate contained in Clause 22(4). These provide that a person may qualify for an independent advocate if they have a mental disorder, including a learning disability, if they are autistic or have a substantial difficulty in understanding or communicating information. Clearly, there are obvious difficulties with an approach which attempts to list certain conditions but not others. Why, for example, is autism explicitly mentioned in the Bill when Down syndrome is not?

I see that the noble and learned Lord, the sponsor, has adjusted his approach to the eligibility criteria in his new Amendment 548A on the subject, presumably to avoid this problem and any unnecessary duplication. The criteria in that amendment centres much more on the “substantial difficulty” test extracted from the Care Act 2014. It would be helpful for the noble and learned Lord, the sponsor, to set out whether he anticipates that this new test will provide for a wider range of people to access an independent advocate. It may also be helpful and useful to get the Minister’s assessment on the same point, and on how that may affect the questions of resourcing and costing set out in the impact assessment. Currently, the impact assessment suggests that 2.5% of people may be eligible for an independent advocate. This figure has been arrived at by

“Estimating the proportion of people with a learning disability, mental disorder, and/or autism”,


though it admits that doing so is “complex”.

Statutory guidance on the use of the same “substantial difficulty” test under the Care Act 2014 seems to suggest that the net could be much wider than just those groups. It states that

“a person who is near the end of their life and appears disengaged from involvement and decision-making”

may be eligible for an independent advocate. That seems to encompass many more people than under this assisted suicide Bill. If the effects of terminal illnesses—of which we have heard a wide range over the last number of weeks, such as depression and fluctuating capacity—are likely to make us eligible for an independent advocate, it seems that the Government’s 2.5% figure is far of the mark. Equally, if I am wrong and the list of people who can access independent advocate support is narrowly defined then this would surely give rise to a human rights challenge under Article 14 of the European Convention on Human Rights, against non-discrimination. I therefore ask the Minister: how have the Government satisfied themselves that no one else will need independent advocate support to engage the provisions of the Bill?

Ultimately, for these reasons and for the ease of administration, we are likely to end up in a position where every applicant is treated as eligible for independent advocate support. After all, anyone with six months to live is deemed to have a disability under the definition in the Equality Act 2010. Given that this is where we could end up, it would be helpful if the Minister could set out exactly what the implications would be, including the resourcing challenges for already overstretched advocacy services. Is the Minister satisfied with the sponsor’s apparent solution to the costing and resourcing problem, which is to make the new advocacy role in Amendment 548A one that people have to opt in to, so that it is no longer mandatory and easily waivable?

I have some sympathy with the position of Dr Sarah Hughes, chief executive of the mental health charity Mind, who told this House’s Select Committee on the Bill:

“I think we would also say that individuals need advocates. While there is a panel and there will be various assessments, the person really does need an independent advocate at every point to be able to understand the information that they are being given, the conversations that they are having and so on”.


She is right to have this concern. We are not talking about a trivial decision, such as buying a cup of coffee; we are talking about a life and death decision, and one that is often dressed up in euphemistic language that can be misleading even to those of us who do not have additional vulnerabilities.

It is vital that people truly understand the nature, gravity and risks of any decision on this matter, but I am seriously concerned that, in practice, that is not where we will end up, particularly if we need enough independent advocates for each applicant. Where will these advocates come from? The Government’s impact assessment hopes that there will be social workers employed by the NHS, but job adverts for independent advocacy often have no training, qualification or experience requirement.

The 2023 review of advocacy found serious deficits in advocacy skill sets. It found that there was

“a lack of basic understanding of autism and learning disabilities”

and

“a lack of practical communication skills, particularly when working with a person who uses non-verbal or augmented communication”.

The same review found:

“Only one third of family carers described the advocate supporting their loved one as ‘skilled and experienced’”.


What assurance do we have that things will be different here? Such training is crucial, particularly considering that we are talking about highly susceptible individuals.

Again, I refer to an example from the evidence presented to the Select Committee. Ken Ross OBE, founding officer of the National Down Syndrome Policy Group, shared his worry at the lack of specific training on Down syndrome for health and education professions. He pointed out that the

“very complex and unique speech and communication profile”

that people with Down syndrome can have makes them “highly suggestible”, particularly to those perceived to be in a “position of authority”. Without training, how would an independent advocate appreciate this and mitigate for it?

Further, how will we ensure that resourcing independent advocates for this purpose does not draw away from the much-needed functions under the Care Act, the Mental Capacity Act or the Mental Health Act? Data suggests that, in some local authorities, fewer than 15% of people get an advocate when they should get one. Clearly, the system is already broken. Are we going to risk breaking it further and take away the little support that is designed to help people to live?

Finally, I am concerned at the risk that advocates become not advocates for the patient but advocates for assisted suicide. No doubt the noble and learned Lord, Lord Falconer, will tell us that this is not at all what happens with independent advocates, but I remind him that in connection to other independent advocacy services, NICE has said that

“non-compliance with legal duties is common”.

In other Acts that establish independent advocacy services, their specific duties and functions are set out in statute—something the sponsor has not done either in the Bill before us or in his new Amendment 548A. Without the detail—such as whether an independent advocate has a duty to help the patient understand non-fatal options—we cannot be sure exactly of the direction that such advocacy would take. Therefore, I believe that my amendments are worthy of consideration.

Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Committee stage
Friday 27th March 2026 Lords Chamber

On this group, we have not discussed the impact this might have on pharmacists. I do not believe that they are adequately protected. It is unclear what doctors and medical practitioners can actually opt out of. It is unclear what “provision of assistance” means and whether that is opting out of the conversation or of the whole process. The Royal College of GPs has been clear that it believes the Bill is inadequate. I believe it is a deeply flawed Bill that is economically risky and fails to safeguard the rights of organisations and individuals who want to conscientiously object.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I will speak to the main theme of this group, but particularly to Amendment 679 in the name of the noble Baroness, Lady Grey-Thompson, which I believe is essential if we are to safeguard the valuable work of faith-based hospices and care homes, along with other institutions, that have a conscientious objection to assisted suicide. I speak as a member of a family in which loved ones—more than one—have committed suicide, and I know the pain of what that word entails and means.

I note this particular part of Amendment 679:

“No company, charity, or other organisation shall be required, as a condition of receiving funding or any other benefit from any public body, to participate in, facilitate, or permit on its premises the provision of assistance in accordance with this Act”.


I am seriously concerned that, even after 13 days of consideration in this place, we have still not truly appreciated the scale of the crisis facing the care sector should this Bill fail to provide sufficient protection for conscientious objection. The noble and learned Lord indicated in January that he had discussions with Hospice UK on this matter, but this only scratches the surface of the consultation that ought to take place. A Care England survey in autumn last year found that 84% of care providers have not been consulted on the Bill or its implications. This has caused particular concern within the care sector.

Returning to my point, in lieu of clear protections it is clear that the sector stands on the brink. We cannot ignore the fact that, for many hospices and care homes, provision of assisted suicide on their premises is a red line that they will not cross. Mission Care is a Christian charity providing nursing and residential care in five homes across London and south-east England. Aidan O’Neill KC recently warned on its behalf that should such charities be

“required as a matter of law to allow for the provision of euthanasia or assisted suicide for residents”

within their care, they would

“no longer be able to operate in this sector”.

Mr O’Neill warns that this could

“precipitate a crisis in terms of local authority provision for care homes”.

A report from the Commons Public Accounts Committee just a couple of weeks ago found:

“The NHS is at risk of losing the huge value it gains from independent hospices beyond the provision of statutory palliative and end-of-life care”.


Given that, it is quite shocking that we are risking active withdrawal from the sector. On adult social care services, it has been estimated that faith-based organisations account for 10% to 15% of provision in the United Kingdom. This accounts for around 192,000 people. Should such organisations feel the need to withdraw, it has been estimated that it could cost £8.4 billion annually for the state to fully absorb that cost.

But it is not simply the money; it is also the special approach to care that will be lost. I will focus on Christian care homes, not because I believe they are the only group that recognises the inherent dignity of human life and they are at risk under the Bill— I believe that, deep down, we all in our conscience recognise that being is more important than having—but because, as a Christian minister for over 50 years, I have seen at first hand the distinctive benefits of what these Christian care homes can offer, and what I therefore believe is under threat from the Bill.

To take just one example of a special approach, in addition to the skills of medics and nurses, Christian care homes and hospices often provide the support of on-site chaplains and carers to treat the whole person in response to the total pain of dying. They can also offer a community that, contrary to our modern tendency to pretend that death does not exist, recognises that it does, as a part of the human condition—for we all must needs die, and it is appointed unto men once to die. Of course, that verse continues: “after this the judgment”.

In my time as a minister, it has struck me in visiting such care homes that, for many, they are much more than just the person’s own home. It is not simply a room within a facility; it is a family in which, in embracing the ethos set by the home, people can support one another in prayer, worship and investing in one another’s lives. Openness in conversation about death can be just one part of that, meaning that it is not an issue left exclusively to the person’s individual room.

That is why I struggle with the Government’s argument against care home opt-outs. The argument runs that institutional opt-outs can infringe Article 8 rights of the individual to choose to die in their home. It has been said that it would lead to stress and distress for terminally ill patients if they were forced to move. But this fundamentally fails to recognise the community aspect of life within many care homes, which is predicated on the protection of the ethos. In other words, we also must ask about the stress and distress that could be caused to other residents within the care home should things happen that fail to align with the values they have signed up for. After all, in a way it is their home too. To put it bluntly, many residents would feel a violation of the place they have chosen to be in if an assisted suicide were to take place. Many may have exercised their right under the Health and Social Care Act 2012 and the NHS constitution to actively choose a faith-based place of care because it aligns with their values, and they may not wish to be in an environment where assisted suicide is practised.

What about the impact on care staff? It is vital that we appreciate that for many of the staff working in the care sector, it is not just a job—it is a vocation. It is their life’s calling. Many offer their services free of charge. We should not just suppose that it is as simple as walking away and getting another job. I speak from the perspective of many Christian carers, not because the same depth of feeling is not true of others but because, as my community is a Christian community, I can relate to the depths of feeling. For many Christian carers, this is not a peripheral issue to their faith. Their desire to care and bestow dignity through understanding, support and relationship is driven by their belief that God is inviting man into a special relationship with Him through the giving of His Son, and has bestowed the ultimate meaning and dignity on life, which they must model in their respect, care and giving of themselves for others. In other words, it is rooted in the very heart of the Christian faith. I labour this point—recognising that this is not a perspective that many noble Lords may share—because it is vital that, in discussing conscience protection, we realise just how closely this issue draws to many people’s central identity and their expression of it.

In closing, I appreciate that the noble and learned Lord, Lord Falconer, who is responsible for this Bill, may say that he very much respects those convictions and that that is precisely why he has put protections in the Bill—so they can opt out of the most direct aspects of it. However, I question whether the current provisions are anywhere near sufficient. I do not believe that they are. Does the noble and learned Lord accept that it will be very difficult to extricate care home staff from involvement in assisted suicide were it to take place on their premises? For example, there will be organising appointments connected to the provision of assisted dying, assisting in the organisation and sending documentation connected with the provision of assisted dying, or accommodating the doctor who must remain with, although not necessarily in the same room as, the resident until they die. For many, given the centrality of this issue to their identity, these too are tasks that they may feel unable to perform. Without an explicit provision giving care homes, especially Christian or faith care homes, the option to not allow assisted suicide on their premises, I fear that we will see an exodus from that sector.

[Baroness Royall of Blaisdon (Lab)]

If my noble and learned friend were to introduce into the Bill the provisions that the noble Lord wishes, would he then be in favour of such a Bill?

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I think that the noble Baroness will be under no illusion: I am personally against the Bill, because I do not believe in it. But if there is a Bill, we have to have any protection in it—that is completely different. Therefore, in the context of the suggestion that, because I am personally opposed to it, there should be no protections, I believe that, if the Bill were to pass, we should have the proper protections for people who have faith.

[Baroness Scotland of Asthal (Lab)]

My Lords, I rise not least because it is very important for us to take a moment to understand the importance of this debate—in particular, to address the matters raised by the noble Lord, Lord Pannick. I too have sat through all the days in Committee, and noble Lords will know that I have spoken rarely, but my conclusion is different from that of the noble Lord, because there is a huge benefit in listening to all sides of this debate. I have been moved by the speeches of my noble friends who have supported the Bill and by the speeches of those who have not.

The essence of this issue, in relation to opting in, is very important. I want to agree with what the noble and right reverend Lord, Lord Harries, said, in relation to the extraordinary contribution made by those who are specialists in this area, not least the noble Baroness, Lady Cass. What this House has been marvellous about is finding agreement. We are all agreed, it seems to me—including my noble and learned friend Lord Falconer of Thoroton—that this has to be an opt-in and not an opt-out. What we are debating is how we make sure that that to which we all aspire is actually delivered in the Bill.