Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Coffey (Con)]

My Lords, sadly, over 1,500 people will die in the UK today. Of those, nearly 500 will be from cancer. Death comes to us all, and of course we want to make sure that people have as comfortable a death as possible. But in the legislation before us, we are being asked to agree that someone be enabled to be given and use a concoction of chemicals to take their own life, and we are being asked to require the Government to provide services for that to happen.

I recognise that we have heard a lot of distressing stories of people suffering pain, intolerable pain, at the end of their life, and the suggestion is that by introducing assisted dying, or controlled suicide, that pain could be avoided. There is no reference to pain or suffering in the Bill. We have heard in the debate about polling. In other surveys, when it is explained that the assisted dying in the Bill is effectively controlled suicide, support falls. The BMA survey this year shows that support from GPs has fallen. The royal colleges have expressed their concerns.

I do not want to extend life unduly. In a week when the Government have introduced the Hillsborough law, I think of the legal case of Tony Bland, the 96th Hillsborough victim. That decision to stop artificially keeping him alive was the right one. I also support the concept of DNR. However, without going into too much detail, I have seen first-hand how the clinician/patient relationship can be frighteningly coercive, even for something as simple as sedated surgery for a broken hip.

I also think back with a shudder to the Liverpool care pathway. What an awful way to die. It had become commonplace. I raised this when I first entered Parliament, and gathered enough support from other MPs to get the Government to review and end that practice.

I have serious doubts about how, or indeed whether, we can get this legislation right to cover indirect coercion in particular. This indirect coercion is real: the feeling of being a burden; knowing you could save money for the NHS if you went that bit earlier; knowing you might be able to leave more money to your children, rather than pay care home fees. As such, I am genuinely concerned about how this may become commonplace here, as it is already in Canada. I will also raise other concerns in Committee, including the provision in Wales, given that the Welsh Senedd has voted against this—but I have to say that indirect coercion is my biggest concern.

I have followed the proceedings of the Bill since it was introduced in the Commons, and it has changed considerably since it was first introduced, so I welcome the proposal for a short, targeted Select Committee ahead of our consideration in Committee. One change that the Commons made on Report, which I welcome, was not to allow doctors to raise this option with a child, which the promoters of the Bill opposed. It got through against their desire.

Addressing the amendment of my noble friend Lord Forsyth, which I am pleased he has already indicated he will withdraw later, I need not dwell on the differences in processes between the Commons and Lords and their consideration, but I do not agree that this Private Member’s Bill should get particularly special treatment in your Lordships’ House. It has already received substantial support from civil servants. I am not questioning that, because I appreciate that they have to get this in a way that can be delivered, but as has been exposed by the two Select Committees that have already considered the Bill, that has led to an extreme number of regulations and unlimited powers. Both the MoJ and the Department of Health and Social Care have rejected my FoI requests asking which specific areas they had helped on.

I take noble Lords back some time, to a much shorter Bill of five clauses, with a majority of 275 in the Commons—not just the 23 this Bill enjoys—which, by the way, fell from Second to Third Reading; your Lordships stopped consideration in Committee. The Government then put that Bill in their manifesto at the election, and it passed eventually through both Houses. This Private Member’s Bill should not be turned into a government Bill now. It is going to take a lot of fixing, so I hope we will ask the Commons to start again, rather than let the Bill pass. But I assure noble Lords that I will be doing my best to scrutinise and to try to get something that may work—but I fear it may not.

Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

Moved by

[Baroness Coffey]

1: Clause 1, page 1, line 3, leave out “or Wales”

[Baroness Coffey (Con)]

My Lords, group 1 is perhaps not the ordinary place to start when we are considering the issue of Wales, but I have tabled 40 amendments with specific reference to Wales for a reason. We will get into aspects of this in more detail and I am grateful to the noble Baroness, Lady Smith, and the noble and learned Lord, Lord Thomas, for degrouping some of their amendments, because I think it is important that we have a considered debate about how the Bill could potentially apply in Wales. I am also conscious that the Committee will want to get on to the key principles that we will cover in later groups.

My reason for raising this is that the Bill started as a judge-led process, with quite a focus on, in effect, decriminalising parts of the Suicide Act. I am in no doubt that that is a reserved competence: having the one judicial system. I completely accept that. That is not what I am seeking to get into. However, what has happened in the Commons, and even more now in Committee in your Lordships’ House, with the amendments that have been tabled, has basically flipped the Bill into being a Bill on NHS-provided assisted dying—or “assisted suicide”, or “assisted help”; I have forgotten the varieties that are now being proposed on what it is going to be called—and without doubt, health is devolved to the Welsh Government, and therefore the Welsh Senedd.

There have been a number of debates in the Welsh Senedd, and the Welsh Senedd has consistently said that it does not want assisted suicide to go ahead, particularly in Wales, under its devolved elements. That vote was actually taken fairly recently and, as a consequence, I am concerned that aspects of the Bill will, in effect, potentially be breaking the Sewel convention, although I accept that the Welsh Government are now on to their second legislative consent Motion and will have more.

When I have asked the Government questions, I have tried to do it through freedom of information requests, just trying to understand what concerns the Government have had about the Bill and why it has needed, I think, 11.7 full-time equivalent civil servants working in the Department of Health and more than three in the Ministry of Justice to work through and understand the issues that have made the Government decide, “That’s not workable”, “That’s not practical”, “Let’s think about the legal element”. I have been blocked at pretty much every turn. I have been told, on FoI elements, “It’s going to take too long to answer you”. Indeed, I am still waiting for an answer from the Department of Health, but I got another one just saying, in effect, “Well, the Minister mentioned it basically in Committee in the other place, you can look it up yourself”. I am not sure that that is the attitude that is going to help us get through this detailed understanding of where we are.

Returning to Wales, the Government have been having weekly technical meetings with Welsh Government officials. It has not been possible to get information about what has been discussed. Recognising that both Governments are supposed to be neutral on this, this is not a case of government policy formation, which is protected under the Freedom of Information Act, but nor do I feel it is in the spirit of considering the most important Bill of this entire parliamentary Session, indeed of this entire Parliament.

The other aspect I am concerned about is what is happening in the Welsh Senedd. There is clearly a difference of view between the Welsh Senedd and the Welsh Government, and information is not currently being released. I am not trying to get into a whole debate on Wales, but can the Minister give us an understanding of what is happening? I appreciate that the sponsor of the Bill may have the answers, but let us be candid: it is the civil servants who have been doing all the technical work and the sponsor has been doing the more general policy ideation—at least, that is what Ministers told the Select Committee. I know the Select Committee had limited time and I tried to get a discussion about Wales during it, but it was not possible.

I am not going to delay debate on the first group, but it needs some careful consideration. I could make lots of references to reports, which are online, but there is a huge difference in what the Welsh Senedd believes should be devolved and what needs a legislative consent Motion. I am still awaiting an answer from the Government about whether they have requested the legislative consent Motion.

There are many more clauses the Welsh Senedd believes should be in here, and I am looking for a straightforward response from both Ministers on the clauses that they believe are not devolved and why. Ideally, I would like to hear it on the Floor of the House but if the information is not available today, I would be grateful if it could be responded to in a letter to be laid in the Library so that everyone has a proper understanding of what is the responsibility of this House and what is the responsibility of another Parliament. We need to be transparent about what that means, because we should not assume that we have the opportunity to ride roughshod over what other devolved Administrations and Parliaments believe. I beg to move.

[Lord Weir of Ballyholme (DUP)]

My Lords, I rise to support the amendment standing in the name of the noble Baroness, Lady Coffey. Some people may detect from my accent that, although I hail from the great city of Bangor, it is not the great city of Bangor in north Wales but the great city of Bangor in Northern Ireland. I have particular empathy with the amendments that have been put forward by the noble Baroness due to my experience as a Minister in a devolved Administration. The clarity the noble Baroness seeks goes to the heart of the relationship between the devolved Administrations and Westminster, and it is of particular relevance to this Bill.

Generally speaking, a Minister in a devolved institution will face three categories of legislation. First, there will be reserved matters, which are entirely within the purview of Westminster—national issues, which I think everyone would accept. Secondly, there will be a range of issues which, although not strictly reserved, are of such obvious applicability across the United Kingdom that a legislative consent Motion should be applied. I do not see the noble Lord, Lord Foulkes, in his place, but on occasions even the SNP Government in Scotland have been prepared to sign up to legislative consent Motions. The third category—the bulk of legislation—is situations that should be decided locally, where a devolved Government and a devolved Parliament can choose whether to follow what is happening at Westminster and in England, to take a different path in seeking either to virtually replicate or to amend, or to go in a tangentially very different direction. That is at the heart of democratic accountability in devolution.

I believe that this is an issue that should be decided in Wales. It is an issue that should clearly fall into category three. We all know that we have a very unusual constitutional set-up in the United Kingdom, where devolution to Wales, Scotland and Northern Ireland is on a slightly different basis in each case. That can produce some unusual aspects. What we have today is a certain level of anomaly, because this legislation falls into what may be described as a fourth, hybrid category. As the noble Baroness, Lady Coffey, highlighted, the distinction is between the aspects that deal with criminal justice and criminal responsibility, and those that deal with health and social policy, with the former being reserved and the latter being devolved.

It is very clear that the heart of the Bill makes major decisions that impact on health and social policy. However, we are left with a situation for Wales that means, if this goes through unaltered, that the criminal responsibility will be lifted but there will be no regulations coming from this House as to how that will actually be brought about. It is the equivalent of this House saying that we are going to bring in new road safety measures, which will not apply to Wales, but if you are caught speeding on the motorway there could be no criminal sanction against you. What we have potentially arrived at for Wales is the worst of all worlds.

We need to take a step back. We need to ensure that the wishes of the Welsh people, as exercised by the Senedd—they may change over time—are respected. Rather than, in effect, imposing something that then has to be more or less corrected in Wales by way of changes to their health and social policy, we should be allowing the issue of assisted dying to be decided by the Welsh Senedd. If they decide to make those changes, this Parliament should then reflect them by way of changes to the criminal justice system, which I think would be relatively easy to do.

In the absence of that, the importance of these amendments, as outlined by the noble Baroness, Lady Coffey, is that if we cannot get things definitively the right way round, we can at least get a level of clarity over what aspects apply to Wales, rather than a potential wall of obfuscation. This is an ideal opportunity for the Government and the sponsors to highlight where exactly the demarcation is, which will be very helpful as we move through the rest of this Bill.

--- Later in debate ---

I thank the noble and learned Lord, Lord Falconer, for inviting me to a meeting on 3 September; I found it invaluable to meet doctors from Australia. In that meeting, the noble and learned Lord said that there had been significant support. I am interested in whether it is possible to expand on that. We need to understand how many civil servants are currently working on this. Who is running the Bill team? Is it the Ministry of Justice? That would lead us into different discussions. Is it the Department of Health? Last week I met someone who works in a government department. He told me that he is working full-time on the implementation of this Bill; I am not sure he meant to tell me that. Once this Bill passes, the question of how it works absolutely will be life and death.

[Baroness Coffey (Con)]

I am very interested in that, because the response that I have had from the Minister is that nobody should be working on this beyond the Bill team, so nobody should be working on implementation. What the noble Baroness says is very interesting.

[Baroness Grey-Thompson (CB)]

I thank the noble Baroness. At the Lady Mayor’s parade, a member of the public introduced himself and told me that this is what he was doing. We agreed to disagree on the outcome of the Bill. Slightly patronisingly, he followed this up by saying how wonderful he thought I was and to keep going.

I did not mean to make a point that was amusing to the Chamber, as this is far from amusing, but these are the details that we need to understand. Is there far more going on behind the scenes? Is the presumption that very few amendments will be accepted, as happened in another place, or are the supporters of this Bill really open to making it better? I have tabled the second-highest number of amendments; my competitive edge fails in this example, as my noble friend Lady Finlay is about 30 amendments ahead of me. My amendments are to improve the Bill. Many are slight drafting changes, changes of words, which are to improve this Bill. That is our role. That is what we must remember. We have to improve this Bill. We have to make it workable.

Coming back to the point of this grouping, we have to make it work for England and Wales and we have to remember, as people who work in Westminster, that we have a responsibility to the people of Wales and should not step into areas that are not for us to step into.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I am not sure the noble Lord has quite understood what I have said. It is for the regulations in so far as they deal with the Welsh health service to be delivered by Welsh Ministers, so it is quite inappropriate for us to put them in this Bill.

[Baroness Coffey (Con)]

My Lords, I was brief at the start because I wanted to give the Minister the chance to be transparent for the benefit of this House. I am sorry to say that I hope that the letter will give that, but I am concerned that it will not. The reason I say that has been well explained in the discussions in the Welsh Senedd. In the supplementary to the latest legislative consent memorandum, it says:

“The UKG has not confirmed their position as to whether they believe the consent of the Senedd is required for this Bill as amended at the House of Commons Report stage but have acknowledged that some clauses do”.


When will the Government share with this House what they think is devolved and what is reserved? Why are they reluctant to do so? This is what I am struggling to understand. I have been asked outside this Chamber why am I bothered about Wales. I care about Wales anyway. It may not be widely known, but I went to school in Wales, I have family in Wales and both my parents are buried in Wales. But I would say that I am also here as a legislator.

Having been an MP, a Minister and a Cabinet Minister, I am used to being taken to court on details of legislation, and to the back and forth with devolved Administrations. I am not doing this simply to try to be awkward; we are trying to define the legislation. The Legislation, Justice and Constitution Committee in the Welsh Senedd believes that Clause 1 should be devolved. To give another example, people might be aware of the issue of smacking. Basically, Wales was able to use its child welfare powers and then made a request. We will come on to this later in the debate about amending the Government of Wales Act, I think. If we recognise that the only context under this Bill in which there can be help with assisted death—assisted suicide—has to be healthcare settings then surely there is something there about the Welsh Senedd having the opportunity, through later amendments, to make that determination in the first place.

I mention that now because my noble friend Lord Markham and the noble and learned Lord, Lord Thomas, said we should be deciding the principle of whether this Bill should be seen in that regard. Actually, recognising the whole, I am strongly of the view that this should be taken out of this Bill through an amendment to the Government of Wales Act. That is to some extent why I put tabled this. Will the Minister confirm the Government’s position on Clause 1? I would be very happy to have an answer from the noble and learned Lord, Lord Falconer of Thoroton, on whether he believes that. The Welsh Parliament certainly does.

Further, will the Minister put in the Library the minutes of the meetings so we can understand what is happening between the two Governments about the practicality and legality of this aspect of the Bill? I know that Ministers will, understandably, often say that it is all legally privileged. Those of us who have been in government know that you tend to get small aspects of legal privilege and lots of policy content in regarding and summarising, which is not legally privileged. That is where I hope that we can get this transparency from the Minister and, if necessary, the sponsor—I do not quite understand this; it is one of the most complicated Private Members’ Bills I have ever seen—and, actually, just an answer to whether Clause 1 is reserved or not.

[The Deputy Chairman of Committees (Lord Beith) (LD)]

Does the noble Baroness intend to withdraw the amendment?

[Baroness Coffey (Con)]

I was hoping to get an answer; we can speak more than once in Committee, because we are trying to understand. Otherwise, later days in Committee and Report could become quite painful. I hope to get an answer from the Minister today.

[Lord Falconer of Thoroton (Lab)]

I have been absolutely clear that, in so far as Clause 1 affects a change to the criminal law, it is reserved. In so far as implementation of it by the health service is concerned, that is a matter for the Welsh Government, not the Bill. If there is any lack of clarity in that answer, let me know.

[Baroness Coffey (Con)]

I would be grateful if any advice that has been given to the noble and learned Lord by officials is shared with the Committee. It is helpful, when determining legislation, to understand that, and it would be especially helpful if the Government, who have said they are getting involved only on legality and practicality, were to express their view. They will not even tell the Welsh Government what their view is, and that is very concerning.

[Baroness Merron (Lab)]

My Lords, I just emphasise my previous comments. I think it would be extremely helpful for this debate if I were to write to the noble Baroness setting it all out as she requires, following my previous Answers to Written Questions that have been laid.

[Baroness Coffey (Con)]

I hope that the department will take a better attitude in determining things such as freedom of information requests. We have already had from the Cabinet Office whether it is now in the public interest to declare information that it holds. I hope the Government—I can see that the Deputy Chief Whip is on the Front Bench—will take this away, because it is a serious matter. This is one of the most important Bills that we will consider in this Parliament, and it is important that we have transparency and a full understanding that is shared across the Chamber. With that, I beg leave to withdraw the amendment.

Amendment 1 withdrawn.

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[Baroness Hayman (CB)]

My Lords, I profoundly disagree with the argument just made by the noble Lord, Lord Blencathra. He suggested that using “ability” rather than “capacity” would end misunderstanding. I cannot agree that that is true because you would be creating an undefined and novel test and substituting that for one that has stood the test of time and is understood by the professionals who will be judged as to whether they have complied with the law when they act on that assessment. I was already committed to the view that we should keep the test that we have, but if I needed further assurance on that, the little interchange between the noble Baroness, Lady Jay, and the noble and learned Baroness, Lady Butler-Sloss, illustrated perfectly to me how one system, difficult though it is, has been used, examined and probed for many years and found to work—as against a new system, where the noble and learned Baroness, with all her experience, had not the slightest idea how that would work.

[Baroness Coffey (Con)]

I think the key difference is that, when this Bill started, it was going to be judge-led. Now it is not and, as a consequence, we are talking about one of the most experienced judges we have ever known; so I think we are comparing apples and pears.

[Baroness Hayman (CB)]

I cannot accept that. I am talking about the Bill that we have before us. The noble Lord, Lord Harper, asked: should we have a novel approach to this? My answer is no; it is safer to continue with the approach that we have.

I want to say one other thing to the Committee. I hope the Committee will accept that, given the experience that I have had here and the honour I had of being Lord Speaker, no one respects more the contribution that this House can make to improving legislation and the commitment that it should do its work properly. The noble Lord, Lord Harper, said that we were blessed in this House with many experts, and that their opinions should be listened to. The noble Lord, Lord Shinkwin, said that we should listen to the voices of those with lived experience. I am sad that the Select Committee did not do that, but I think that that is absolutely correct.

The one thing that we are not is what was said to me in 1974: “You have now been anointed by the popular vote”. I was then a Member of Parliament. It was a long time ago—in ancient times—but it was true. What has worried me slightly about the tone of this debate is that there has been a sense that this was a Private Member’s Bill introduced in the House of Lords, and that we were having the first go at any scrutiny of it. That is not true; it is not true at all. We do often get legislation from the other place that has not been scrutinised, but that is not true of this Bill. It has had much more scrutiny and I think we should have some respect for the fact that that has happened.

People say that we should not have an arbitrary timetable. Of course we do not want an arbitrary timetable. We have to do our job properly, but we should not be forced into a position where we are incapable of completing that job due to having an enormous number of amendments. We should concentrate on the important issues that we want the other place to take our views on seriously. I really think we are in danger of demeaning that process if we allow so much debate that we do not allow the other place to hear considered views on the important issues.

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[Baroness Grey-Thompson (CB)]

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

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

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

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

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

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

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

[Baroness Coffey (Con)]

The importance of the amendment in the name of the noble Baroness, Lady Finlay of Llandaff, is that, as has already been well described, there are genuine concerns about the appropriateness of the Mental Capacity Act 2005 as it stands. I think also that there has been more interest at this point because, so far, it has not been deemed to be in scope to put an amendment down to amend the Mental Capacity Act 2005—although I noticed that my noble friend Lord Goodman managed to get something in, so I congratulate him on that. That is why it is taking more time to consider aspects of this. I hear a noise—I thought it might have been someone shouting “Order!”, but perhaps it was excitement elsewhere.

I am just conscious that it is without doubt that, in the consideration in the Commons, Professor Sir Chris Whitty—who used to be one of my Permanent Secretaries when I was at the Department of Health and Social Care—suggested that the Mental Capacity Act had a higher test for basically a life or death decision, and then of course changed that evidence. However, I accept that he said, in evidence given orally to the Select Committee in this House, that having something that people are used to using is important. So one of the things that we need to judge is recognising the role of the Royal College of Psychiatrists—admittedly, it is not the Chief Medical Officer—and take its words seriously.

I was somewhat shocked by the words of the noble Baroness, Lady Murphy. I do not know if she ever used the Mental Capacity Act in her time as a professional. I know she is experienced in this in terms of psychiatry, but I was pretty horrified by the words she just used in this Chamber about the witness.

[Lord Bassam of Brighton (Lab)]

It is certainly clear that she used that test continuously as part of her career, actually. While I am on my feet, I wonder whether the noble Baroness thought of reviewing the Mental Capacity Act while she was Secretary of State for Health. Was that something she considered then? That piece of legislation has certainly stood the test of time.

[Baroness Coffey (Con)]

I will respond to that. I do not know the answer about the noble Baroness, Lady Murphy. However, I say to the Committee and to the noble Lord, Lord Bassam, that amendments have been made to the Mental Capacity Act 2005 that have not been enacted by this Government. Therefore, we are not even sure exactly which version of the Mental Capacity Act we will be dealing with in the future. The noble Lord, Lord Bassam, is babbling away, but this happened. Amendments were made in 2023. That was on slightly different matter, but it is something I will come to in Clause 3.

I come back to the attack on Dr Price. Perhaps the noble Baroness could be brave. She has used parliamentary privilege to do that. If she really believed it, she might say those words outside the Chamber and see if she gets a legal letter. I thought it was really poor to attack somebody who had been invited and to try to suggest that, somehow, for such a distinguished royal college, she was manipulating a particular report. That was unfair.

I will make one minor observation about the Select Committee. In my view, it was noticeable how distressed Dr Price started to become during that oral evidence session. I am not a clinician or a psychiatrist; frankly, I am just another woman who could see how distressed she started to become. I also spoke to her outside afterwards. We have to bear in mind that we are used to this bear pit—which is much gentler at this end than at the other end—but that is not true of the others.

I will come back to the discussion and one of the questions I wanted to understand when going through ability versus capacity. We have already heard that things such as depression and mental illness are not a disabler. We already know that having dementia is not a reason to be denied, certainly in the Mental Capacity Act 2005. We know that capacity can fluctuate, and I certainly will not repeat what others have said.

What I have not yet understood is how things such as the power of attorney might work, which can be given over for health reasons. I want to get an understanding of the view of the sponsor and the Government Minister about the application of this, before potentially laying further amendments to discuss this.

We know that the Government do not believe that the Bill is in a fit state. They would not have 16 people working on it and the amount of work that has been going on if they did. By the way, that does not include the Government Legal Department in any way.

I thank the noble Baroness for having introduced this, but there is still quite a lot of debate to be had once we get to Clause 3, if we are allowed to see that it is in scope.

[Lord Harper (Con)]

In case I am not understanding it and it would be helpful for the Minister, is the question my noble friend wants the Minister to answer on lasting of powers of attorney whether it the Government’s understanding that somebody in possession of a lasting power of attorney for health and social care would be able to use that lasting power of attorney to seek an assisted suicide for the person on behalf of whom they hold the lasting power? Is that the question she is asking? I was not entirely certain.

[Baroness Coffey (Con)]

My noble friend has put it more accurately—that is precisely the question I am trying to understand. I am trying to be a legislator rather than somebody who argues in court, but the very fact that somebody can make health decisions on behalf of somebody else is important to consider in this matter, and I am not clear that it is explicit in the Bill—yet—that that power of attorney could not apply. We know that the Mental Capacity Act 2005 does not apply to Section 2 of the Suicide Act 1961. I will not go into a history lesson about the Suicide Act at Clause 1, but at the moment everything seems silent on the use of that lasting power of attorney.

[Lord Wolfson of Tredegar (Con)]

My Lords, this is the first amendment to be introduced by the noble Baroness, Lady Finlay of Llandaff. We all acknowledge her extensive experience and deep knowledge of this issue, as both a doctor and a professor of palliative medicine. Like my noble friend Lord Shinkwin, I expect noble Lords across the House to benefit from the noble Baroness’s advice and guidance as we seek to improve this Bill through Committee.

I have listened carefully to the debate and it seems that there are two related but conceptually separate issues going on. One is a valuable, perhaps somewhat philosophical, debate about the difference between “can” and “able to”; in other words, just because you can take a decision, does it always mean that you are able to take a decision? It is an interesting debate to have.

There is a separate but related issue about how one reflects that or the conclusion one comes to in law. That is really the issue raised by the amendments to Clause 3 in the next group. As both the noble Lord, Lord Pannick, and the noble Baroness, Lady Hollins, pointed out—and as set out in the explanatory note for this amendment—Amendment 2 is linked to Amendment 115 from the noble Baroness, Lady Finlay, which seeks to replace Clause 3 with a new clause. To that extent, the debate we have just had is an hors d’oeuvre before the main course of group 3. Perhaps this is a restaurant that serves its hors d’oeuvres in larger portions than normal.

For reasons that I hope are obvious—I mean no discourtesy to the Committee—I may not be able to stay until the end of group 3, so I hope to take a quick moment now to explain this interrelationship. The proposed new Clause 3 is a considered amendment that challenges the Bill’s reliance on the definition of “capacity” under the Mental Capacity Act. It seeks to make special provision in the Bill for how the definition of lack of capacity is to be dealt with, and it touches on important information and the ability to make decisions. In particular, it builds in information relating to palliative care. I look forward to the Minister’s response to this group and I will read her response to the group of amendments on Clause 3, in due course, and the noble and learned Lord the sponsor’s response to both groups. Although we will debate these two groups separately, they seem to me to be intimately connected.

With some trepidation, I will respond to the point made by the noble Baroness, Lady Hayman. I am conscious of her experience in both this and the other House, which considerably exceeds mine on both counts. However, I touched on this point at Second Reading and, respectfully and certainly from my analysis, there does not appear to be any constitutional reason why this House should not take its time considering the Bill or even, should it wish to, reject it as a non-manifesto Bill that is also a Private Member’s Bill.

For noble Lords who are interested, there are some useful articles on this point from Professor Mark Elliott, who is a professor of public law at the University of Cambridge. I refer to him because of two important features. First, he is a professor of public law at the University of Cambridge. Secondly, when I was a Minister, he did not agree with me on anything so, if we agree on this, it is likely that we are actually right.

In all seriousness, the noble Baroness, Lady Berger, made a point that I made at Second Reading, which is particularly important in the context of this Bill. A number of Members of Parliament said, both in and outside the Chamber, that they voted for the Bill on the express basis that they relied on this House to give it proper scrutiny. If the noble Baroness wants to intervene, of course I will give way.

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[Baroness Coffey (Con)]

I want very briefly to put on record that Professor Sir Chris Whitty is not the Chief Medical Officer for England and Wales, but for England only. I will wait for another time for the answer to the question I asked about power of attorney to be given, ideally by the Minister.

[Lord Falconer of Thoroton (Lab)]

I will answer that one. No, you cannot do it by power of attorney. You have to do it yourself.

Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

A credible legislative framework must prevent institutional and societal coercion as rigorously as it guards against interpersonal coercion. The appropriate response to systemic forms of coercion is not the inclusion of particular words or phrases in primary legislation but, I suggest, the establishment of processes and structures that minimise the risk of such pressures arising in the first place. We will have an opportunity to discuss better structures later in the debate.

[Baroness Coffey (Con)]

I think the noble Baroness’s amendment about videoing affects Clause 25, which is considerably later, when the Act is about to happen. I wonder whether she would consider whether it should be done earlier in order to reduce that because, by the point of her amendment, the certificate of eligibility has already been issued. I would be interested to hear her thoughts on that and on whether video recording, as proposed in Amendment 612, should be considered at a much earlier stage.

[Baroness Hollins (CB)]

I thank the noble Baroness. I thought about that, and it could indeed be brought back in a different way later in the debate, but I feel that the prevention of coercion is really important, so thinking about it at this stage is really helpful.

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[Baroness Rafferty (Lab)]

My Lords—

[Baroness Coffey (Con)]

My Lords, I still have tabled amendments to speak to, but I will let the noble Baroness, Lady Rafferty, go first.

[Baroness Rafferty (Lab)]

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

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

[Lord Ashcombe (Con)]

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

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

[Baroness Coffey (Con)]

My Lords, I have tabled Amendments 47 and 49. It should be no surprise to noble Lords that this group is going to take some time, because it is probably one of the most important elements of our consideration of the Bill.

I also gently point out that it feels like coercion is being applied, but I am not going to be bullied by people into not raising my concerns at this point. I point out that it is the Department of Health and Social Care that proposed the groupings, and I believe it was passed by the sponsor. Therefore, we have had over 18 amendments from 14 people grouped together. If the concern is that we are taking too long with big groups, that will actually encourage people like me to degroup even further. That is not necessarily fruitful in addressing some of the concerns of the Bill, when we need some joined-up conversations.

The noble Lord, Lord Pannick, and the noble Baroness, Lady Hayter, have talked about existing safeguards. There is an obvious one at the moment: it is against the law to help somebody to go to Dignitas. The person who wrote the guidelines on whether to press charges is of course now the Prime Minister. There are amendments made in Committee that reinstate the element of the DPP undertaking that.

In answer to questions that I tabled to the Government, the Justice Minister fortunately replied, basically indicating how many people had had proceedings against them. On average it was one a year for the last decade, and only two people have been convicted. But I am still waiting to hear about the arrests and charges made, never mind the proceedings. I will give an example. Sean Davison, who was in the papers in the summer, was arrested for helping 29 people take their own lives by going to Switzerland—not to Dignitas but to another place. This is the same man—he is well known—who had already been convicted of helping his own mother take her life, which was against the law, in a different country and jurisdiction. This is why I was interested in tabling questions: to understand what is actually going on.

The figures of people going to Switzerland are quite small—it is about 40 people. One of the things that worries me—and, I think, worries a lot of people—is how this whole situation could start to become commonplace. The Liverpool care pathway became commonplace—what a horrible way to die. I specifically mentioned at Second Reading that my greatest concern of all is indirect coercion. I appreciate that some other noble Lords have already spoken to this, so I hope to bring a slightly different angle with some of my concerns.

If I have time, I will try to explain why I strongly support several of the other words being used, particularly “encouragement”, which appeared in the speech by the noble Baroness, Lady Fox of Buckley, and got support in certain parts of the Committee. That is interesting, bearing in mind that the campaign group Dignity in Dying, anticipating the passage of the Bill, has now initiated a new element by creating a conversation guide on how to start to bring up assisted dying in conversations with people. Never mind the coercion that very obviously exists in the medical profession in trying to coerce people into “do not resuscitate” orders. That is already happening in our medical system today, which is why several Peers, I think, are generally worried.

Turning to my amendments, I will start with Amendment 49. As the proposer and sponsor of the Bill put forward, it started off as a judge-led process, which is why I support what the noble Lord, Lord Carlile of Berriew, seeks to do in amendments in later groups. We have a situation here where this is turning into a sort of commissioner/panel. We need to make sure that the legislation is as simple as possible to the ordinary man and woman on the street. I appreciate that there are some legal niceties about what the word “person” means in law—I believe it can mean almost anybody—but we need to be more explicit, which is why I have suggested talking about

“body corporate, institution or organisation”.

I hope that might start to cover some of the online issues that my noble friend Lady Berridge raised; I do not know whether the Online Safety Act can cover this.

I respect what some noble Lords may think: “What is she going on about? These people are dying anyway. We have the general approach of trying to prevent suicide, so what would be different in hastening that?” This is where I turn to Amendment 47, which talks about both external and internal coercion. We have had a considerable debate about external coercion, with some suggestions about that in the amendments, as well as, to some extent, the question of burden. It is that burden that genuinely worries me.

The evidence is clear. We have already heard of the 35% figure from, I think, Western Australia. Whether it is from Oregon, Canada, Western Australia or Washington, the jurisdictions that collect data on this issue show that between 35% and 59% of people cite being a burden. We then heard evidence given to the Commons from Professor Owen, who said that thinking about being a burden is

“an essential question. I work clinically in the over-65 age group, where there is a lot of terminal illness, some of it in the last six months. You have to understand the population … There can be a terminal illness, very typically with comorbidity. That comorbidity is often mental health comorbidity”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 234.]

As Dr Price sensibly said, for somebody who has found out that they have a terminal illness and less than 12 months or six months to live, it would be surprising if there was not an element of depression at that point.

This is where we get into talking about burden. That is where a group already feels burdened, and some of that may be excessive. That is when you start to get into some of these interpersonal pressures. It is also where the impairments will start to interact and amplify each other, and that in itself can have an important consequence in terms of the functional ability of mental capacity. According to Professor Owen, outside the AD context, the Court of Protection itself has been struggling to recognise that. This is where trying to get some understanding of this is really important. But it is not, to the point from the noble Baroness, Lady Rafferty, somewhere where you can just have a ready-built training manual.

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[Lord Falconer of Thoroton (Lab)]

I think I answered that; the noble Lord may not have been satisfied with my answer, but I did answer it by saying that people have to be satisfied that the decision is voluntary and without coercion. If they do not know, because they cannot read adequately the community, they could not be satisfied.

[Baroness Coffey (Con)]

The noble and learned Lord has just made a point about the risk of coercion and referred to a psychiatrist. It would be very helpful to understand what clause in the Bill he is referring to, because Clause 12(6)(b) is only about the capacity of the person; it is not talking about coercion. I am also conscious that capacity is on the balance of probabilities anyway. It would be useful to understand which clause he believes referral would be in, on the grounds of coercion.

[Lord Falconer of Thoroton (Lab)]

I will come to that in a moment, because I have to get through the amendments—we have to make progress a bit. However, I completely understand the question.

Amendment 50 is from the noble Lord, Lord Evans. He basically said that when anybody tries to behave badly, trying to coerce or pressure somebody into making the decision to have an assisted death, that should be sufficient to bar it for ever, even if it had no impact whatever in relation to it. I see the force of that; I think it would be a wrong amendment, for the following reasons. Somebody—a doctor—might go over the line, but it is absolutely clear that the person definitely wants an assisted death. I do not think they should be barred from doing that because they are concerned about what might happen to the doctor or to the person they love if it is absolutely clear that they have not been coerced or pressured into it.

On Amendment 52 from the noble Baroness, Lady Grey-Thompson, she is saying that somebody should not be subject to or at risk of coercive control. Everybody agrees that the person who is adopting the assisted death should not be subject to coercive control. If they are at risk, I would expect the two doctors and the panel to investigate that fully and, if they are not satisfied that the person is reaching a decision of their own, plainly an assisted death cannot go ahead. But I think we are all on the same page in that the risk has to be properly investigated and a conclusion reached.

Amendment 57A in the name of the noble Baroness, Lady Lawlor, says you should not be allowed to have an assisted death if someone has been

“prompted to consider ending their own life”—

presumably in the context of assisted death—by any professional person. Clause 5 leaves it to the judgment of the doctor as to whether they raise the question with the patient. If they raise it, they have to raise it under Clause 5 in the context of the treatment available to the patient and all other options available, including palliative care. I do not think that if a doctor, or indeed any other professional person, makes a judgment that it would be sensible to raise it, that should thereby debar the person from having an assisted death. The noble Baroness wants to intervene. By all means let us prolong the debate if it is a new point.

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[Lord Falconer of Thoroton (Lab)]

With the greatest respect, the noble Baroness has missed the point. If, for example, a person says to the doctor, “I’m not telling you things”, the doctor can never be satisfied. That is the protection.

[Baroness Coffey (Con)]

Would the noble and learned Lord write to me with the answer to the question I asked earlier?

[Lord Falconer of Thoroton (Lab)]

Of course, and I apologise for not answering it.

Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

Moved by

[Baroness Coffey]

7: Leave out first “a” and insert “their first”

[Baroness Coffey (Con)]

My Lords, this is a really important group, and I appreciate that the noble and learned Lord, Lord Falconer of Thoroton, has suggested that quite a lot of the amendments are drafting changes, but I think it goes further beyond that.

Speaking specifically to my first amendment, Amendment 7, the reason I put this in about it the first preliminary discussion is that we just had a significant debate about the issue of age. In the Commons, the sponsor of the Bill and the government Ministers who helped take this Bill through that House, voted against the amendment, which was agreed, and which said that this could be raised with somebody under the age of 18. That is why the debate on age has been significant and why I have put in this particular amendment.

One of my wider concerns is about how many preliminary discussions somebody will have. This is not going to be an easy decision for somebody, particularly a young person, to make, while thinking, “Is this the right time? Is it so unbearable that I actually want my life to end?”

Later in the Bill, there is quite a lot of procedure about recording medical information. The reason why I am interested in making sure it is “their first” discussion is so that we do not have, as can sometimes happen, an informal off-the-record discussion as part of this important process. I will be interested to hear what other noble Lords think about trying to be specific, recognising the concerns that amendments so far have sought to address.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I apologise for interrupting, but I think there is a profound misunderstanding. Let us look at Clause 8, because the noble Baroness, Lady Coffey, is making a very important point. Jess Asato was incredibly keen to specify that training in respect of

“domestic abuse, including coercive control and financial abuse, is mandatory”.

Clause 8(8) says:

“The regulations must provide that the practitioner must have had training about the following”,


and paragraph (d) says “domestic abuse”. Subsection (10) says that training on domestic abuse must include

“training in respect of … coercive control and financial abuse”.

That was the point that Jess Asato was keen to establish.

Noble Lords will see at the top of page 41 of the Bill that the definition of domestic abuse

“includes behaviour that is controlling or coercive or … economic abuse”.

What is happening here is not a watering down of any of that. It is simply avoiding duplication between Clause 8(10) and the wide definition of domestic abuse in Clause 56. I understand why the noble Baroness might be confused about it, because it is slightly complicated, but that is the intention. It is not for one second to water down any of the protections.

[Baroness Coffey (Con)]

My Lords, I do not think I am confused at all. I know what Jess Asato tried to get into the Bill to give her assurances, and that something has changed. I had moved on to talk about the amendment from Jack Abbot, which was very important.

The issue of illness is an example of where the Government said they had worked with the Bill’s sponsor. The challenge of this group—I am thinking about what the noble Lord, Lord Birt, said earlier—is that we are covering multiple issues on the basis of drafting changes. I would rather get into the substance of some of this when we get to later groups. However, Clause 14 says that, in the very unlikely circumstances that the doctor who agreed to give a second opinion “dies” or “through illness” is unable to continue, the person has the right to seek a second opinion elsewhere. My point is about removing “through illness”, which was specifically included the Bill. I am trying to understand why the noble and learned Lord is seeking to do that. I have already heard him say that you can just find another doctor, but I am particularly keen to hear from the Government their view, because they worked with the Bill’s sponsor in the Commons to get this phrasing about illness in.

The sponsor’s Amendment 416 is to do with independent doctors and Commons Amendment 459, and there is more than one reference to this issue. There was significant debate when Sarah Olney introduced her amendment in Committee in the Commons seeking to reduce the possibility of abuse by making sure that the second independent doctor has available the reasons why the first independent doctor concluded that the person was not eligible. My interpretation of the amendment tabled by the noble and learned Lord, Lord Falconer of Thoroton, is that that goes away and there will not be two reports, and the amendment speaks further about aspects of the reports.

This amendment brought attention from other MPs. Lewis Atkinson talked about recognising that the provision of five different touchpoints of assessment—I appreciate the effort that has gone into trying to bring in safeguards around these matters—is one of the strengths of the Bill and that each assessment should be done in a way that can be progressed with more information. On the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process, and therefore there should be an opportunity for a lot of those things to be shared with the panel, as the Bill proposes. Kim Leadbeater said that she was minded to support Sarah Olney’s amendment, but, again, some of those changes are being taken out.

I am not entirely clear about Amendment 417. I somewhat understand the disability definition, although there is only one reference to Section 6 of the Equality Act 2010 anywhere.

This group of amendments needs careful scrutiny as we go through the different groups for later discussion. One of the aspects that we need to make sure of is that the extensive concessions made in the other House do not all of a sudden, through just a few changes here and there, go away. In fact, as we know, in this House we are even considering what further safeguards there could be. One of my reasons for rising today was to bring this to the attention of the Committee. I am not suggesting that the noble and learned Lord, Lord Falconer of Thoroton, has done this in bad faith. He may well think that this is just being more efficient, but the extensive debate and the support in the other place—indeed, the support of Kim Leadbeater—for several of these amendments as they were originally drafted mean we should be asking him to think again. We will get into some of the detail in the debates on future groups. I beg to move.

[Baroness Keeley (Lab)]

My Lords, my Amendment 420 could sit beside Amendment 419 from my noble and learned friend Lord Falconer, but it has not been put in this group. This group is labelled “drafting changes” but, as we have just heard, the effect they would have goes further than that. I have tabled Amendment 420, to be discussed in a later group, to address a concern that the grounds on which a co-ordinating doctor can drop out are already too wide, but I see that the amendments in this group from my noble and learned friend Lord Falconer compound that problem by expanding the grounds even further. I therefore feel I must speak briefly in this debate, despite the fact that my amendment comes later, because your Lordships’ Committee needs to be aware of the concern I am seeking to raise, which the noble Baroness, Lady Coffey, also has.

My Amendment 420 highlights that these provisions should be limited to cases of death or illness. Clause 14 fails to define in which situations it would be acceptable for the state not to be concerned that the doctor is unwilling. As the noble Baroness, Lady Coffey, has highlighted in her Amendment 420A, the danger is that the current wording would allow the risk of changing doctors until the wanted answer is given. These probing amendments are going to be discussed later, and they will focus on the need to restrict the grounds for changing the co-ordinating doctor by excluding the word “unwilling”, which Amendments 420 and 420A both address.

It would be helpful if my noble and learned friend Lord Falconer could answer these questions on this matter. How do we distinguish between a doctor who is unwilling due to conscience and one who is unwilling due to suspicion? Without a requirement to record the specific reasons for unwillingness, is there a danger that we are creating a black box? If a doctor steps away because they are uncomfortable, for instance, with a family member’s influence, surely the system needs to capture that specific hesitation before a new doctor is appointed. Will my noble and learned friend Lord Falconer specify what circumstances cross the line where the state should be more curious about why the doctor is unwilling?

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The noble Baroness is right that it is the Equality Act, not the disability Act; I apologise for that. If we were to restrict it to that, we would restrict it to a particular thing, and we think that it should be wider that. Again, we can talk about that at the ever-expanding meeting.

On Amendment 416, the noble Lord, Lord Ashcombe, was particularly exercised by the fact that the second doctor would not see the report of the first doctor; he would have some degree of problem with that. The noble Lord will know that, where a second doctor is brought in—where a referral is made to a new practitioner—the co-ordinating doctor must provide the new doctor with a copy of the previous report. If the new doctor is satisfied as to all the matters mentioned in Clause 11 on capacity et cetera, he or she then has to say why he or she disagrees with the previous doctor. The noble Lord’s legitimate sharpness in relation to that point was based, I think, on an improper understanding of Amendment 416, which will allow this to happen only once the new doctor sees the report of the previous doctor.

In the light of my exchange with the noble Lord, Lord Moylan, which was right for us to have, I will not move my amendment. Although the noble Baroness, Lady Coffey, was kind enough to indicate that she will withdraw her amendment to my amendment, because the noble Lord, Lord Moylan, thinks his drafting is better, we will have to wait and see what happens on Report. Do not hold it against me when I come back with the same amendment on Report.

[Baroness Coffey (Con)]

I thank the noble and learned Lord for his extensive responses. They reflect that “ensure” and “take reasonable steps” are actually different in law compared with what is expected. I am grateful to him for saying that he will not press his amendments in Committee and that he will allow us the opportunity to meet him and others to discuss some of these issues, where we think the provisions go beyond what might be considered legal drafting. I am slightly concerned that the Government did not reply to one particular aspect, but I will take that up separately with the Minister. But with that, I beg leave to withdraw—

[Lord Wolfson of Tredegar (Con)]

Before my noble friend sits down, I wonder whether the noble and learned Lord might take the opportunity to respond to the point I put to him on confirming the drafting of that amendment. He must have overlooked it.

[Lord Falconer of Thoroton (Lab)]

That is in the notes, but I will write to the noble Lord on that.

[Baroness Coffey (Con)]

With that, I beg leave to withdraw Amendment 7.

Amendment 7 (to Amendment 6) withdrawn.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

I am most grateful for that intervention, because many people who work in the embassies abroad do not live in the embassy; they live in apartments, houses or whatever in its vicinity.

The wording of the Bill prompted my probing amendment, so I ask the noble and learned Lord, in the light of this, whether he is comfortable with the vagueness of the term “ordinarily” or whether he sees merit in reconsidering this wording carefully to clarify the residency requirement to avoid death tourism and ensure that others are not discriminated against. I beg to move.

[Baroness Coffey (Con)]

My Lords, I had originally tabled Amendment 15, which I withdrew, because it looked like I was trying to be nasty and stop the bucket list for people or stop them going on holiday, but that was not my intention. My intention was to think about residency in a proper way. Bearing in mind previous comments from the Minister, I have ended up replacing one amendment with four in order to be precise throughout the Bill.

In essence, I am not convinced that simply being ordinarily resident is enough. I say that because you can be ordinarily resident in more than one country. You can only be domiciled in one country. The issue here is: who is the Bill trying to cater for? I think, frankly—bearing in mind Amendment 23, proposed by my noble friend Lord Frost—that we should be looking at UK citizens and those whom the Government have decided to give indefinite leave to remain, and keep it at that. The element of “ordinarily resident” is that you can have settlement for a purpose. The single purpose could be that you just state that your settlement—your purpose for being ordinarily resident—is simply to take advantage of this Bill. I do not think that is enough.

As regards the amendments that have been tabled by my noble friend Lord Lansley, I also do not want this extending to someone being able to live anywhere in the United Kingdom. Indeed, my noble friend Lord Moylan has perhaps anticipated some of the situations where people have moved abroad and then want to come back. The essence of the Bill should be that it is focusing on providing provision in this country for people who permanently live in this country, which is why “domiciled” is a better test than simply “ordinarily resident”, because, as I say, you can be ordinarily resident in more than one country.

[Lord Lansley (Con)]

My Lords, I have not previously spoken on this Bill, so I hope that noble Lords will understand that I approach the tabling of amendments and speaking to them simply from the point of view of trying to ensure that the Bill is workable. It is of course a Bill which is intended to be provided essentially by the National Health Service, so with these amendments in this group I am entirely saying that we must make this service workable by the National Health Service. If I had to put what I have to say into one sentence it would be: let us have definitions in relation to eligibility by reference to residence that accord with those definitions that are presently used by the National Health Service and let us not try to ask the NHS to become an immigration inspector. I am afraid that there is also the longer version, but I will try to keep it as short as I can.

I have tabled Amendments 11B, 258B, 305A—with my noble friend Lord Howe—306C and 449B. From my point of view, they are not about trying to bring Scots into England and Wales for this purpose; they are about aligning the definitions in the Bill for a service provided by the NHS with the definitions that are used day by day in the provision of NHS services. This is not a bureaucratic issue; it is a practical issue. If the NHS is providing somebody with a service which, in the current circumstances, may be something of a substantial character relating to what develops into palliative or end-of-life care, it should be in a position to provide an assisted dying service, if the person is eligible for that service.

I leave aside the question of whether they come from overseas or Crown dependencies because those persons would not be ordinarily resident in the United Kingdom, and they are probably not registered with a medical practice in England Wales, so they would not be eligible for those reasons. It comes back to the term “ordinarily resident”, which, as the noble Baroness, Lady Finlay, correctly said, is not defined in statute. It is understood in the National Health Service and wherever it is used by the case she referred to, R v Barnet London Borough Council, ex parte Nilish Shah—the Shah case—in which Lord Scarman said that “ordinarily resident” is where a person normally lives

“voluntarily and for settled purposes”,

forming part of the regular pattern of their lives.

It appears in statute, in the sense that the NHS Wales Act requires that services be provided for those persons who, for the time being, are ordinarily resident in Wales, but there is no further definition of “ordinarily resident”. The charging overseas visitors legislation is secondary legislation, but it uses the ordinarily resident test.

What is interesting in this context is that, although “ordinarily resident” is in theory a test of whether one has free access to NHS services or is subject to charging, in practice, when somebody registers with a general practice—no pun intended—they complete form GMS1, which asks those from abroad to identify whether they would be subject to visitor charging outside the practice. But the form also states that:

“Anybody … can register with a GP practice and receive free medical care from that practice”.


So, as far as the NHS is concerned, primary care—essentially community care and everything other than secondary care—is available free to people who are ordinarily resident, and it does not ask or check. From my point of view, the most important thing we should absolutely have in our minds is: are we asking the NHS to change all the practices of its recent history and do something completely different?

I will turn a longer speech into a short speech. My noble friends Lord Moylan and Lady Coffey have tabled some very interesting amendments. My noble friend Lady Coffey’s is interesting, because the question of domicile is a very challenging one in this context. But we would be asking the NHS to become not only immigration inspectors but tax inspectors, since the question of where one is domiciled is a tax issue as well as an immigration issue. I do not think we need to go there at all. All these amendments would do is simply take out all the other amendments, but they also challenge what is in the Bill.

Clause 1 refers to a person who

“is ordinarily resident in England and Wales and has been so resident for at least 12 months ending with the date of the first declaration”.

In the NHS, I am not aware that anybody tests whether somebody is ordinarily resident in England and Wales. They simply ask whether you are ordinarily resident in the United Kingdom; it is a matter of whether one is charged for NHS services or not. If somebody from Scotland—a later group will examine this in more detail—registers with an English practice, they do not say, “Are you ordinarily resident in England?” They do not ask at all. If they did, they would ask, “Are you ordinarily resident in the United Kingdom”, because that is the only operative test. Further, they do not ask, “Have you been ordinarily resident for 12 months?”, less still, with apologies to the noble Baroness, Lady Grey-Thompson, 60 months, as one of the amendments proposes. They do not ask at all, because it is a matter of fact under common law that one is ordinarily resident “for the time being”.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions to this debate on the issue of residency and eligibility criteria. As I have already made clear and will now repeat, I will confine my comments to amendments on which the Government have major legal, technical or operational workability concerns.

First, I turn to the amendments which narrow the residence criteria in respect of eligibility for assistance under the Bill. Amendment 11, tabled by the noble Baroness, Lady Finlay, would change the residence criteria for assistance under the Bill from requiring a person to be “ordinarily resident” to “permanently resident”. Unlike “ordinarily resident”, “permanently resident” does not have a set definition in the context of UK immigration law. It is possible that it would be taken as referring only to those who have citizenship or indefinite leave to remain, which is a much narrower scope than the current wording of “ordinarily resident”.

Similarly, Amendments 23, 309, 300A and 306A would restrict access to assisted dying support to British citizens or people with indefinite leave to remain. This may result in migrants on long-term work or study visas who have resided in England and Wales for longer than 12 months being denied access to an assisted death, thereby potentially giving rise to indirect discrimination based on race. These amendments may be subject to challenge under Article 14 of the ECHR when read with Article 8, on the basis that this may amount to unjustified discrimination. This differential treatment would require an objective and reasonable justification.

In addition, under various international agreements, the UK has an obligation not to discriminate against EU, EEA and Swiss nationals on the basis of nationality, although the agreements do not prevent restrictions on the basis of residency. Since these amendments would prevent individuals from those countries from accessing these services on an equal basis to UK citizens in the same circumstances, they are likely to be contrary to the UK’s international obligations under those agreements.

Amendments 11A, 258A, 306B and 449A, tabled by the noble Baroness, Lady Coffey, seek to change the residency requirement from “ordinarily resident” to “domiciled”. These amendments would add complexity and potential uncertainty to the eligibility requirements. “Domiciled” refers to the determination of a person’s permanent home largely for tax purposes, meaning that a person can be domiciled in a place without being resident there. It is not a familiar concept in domestic law outside of taxation, so it is unclear how it would apply in this context. Further elaboration in guidance would be needed to make these amendments workable. It is also unclear what practical impact this change would have when the Bill would still require people to be physically present in England and Wales in respect of the steps under Clauses 8, 10, 11 and 19.

I will next turn to Amendment 14, in the name of the noble Lord, Lord Moylan.

[Baroness Coffey (Con)]

Before the Minister moves on, Kim Leadbeater specifically introduced this concept of England and Wales, and, in Committee, Stephen Kinnock did not raise any issues with it at all in terms of operability or similar. I am astonished to hear some of the other elements that are now coming out for the first time in the consideration of this Bill.

[Baroness Merron (Lab)]

I am sorry to hear of the noble Baroness’s surprise. I am simply setting out where the Government have particular concerns within the scope to which I referred. My noble and learned friend Lord Falconer may be able to comment more appropriately, if he wishes to do so, on the points that she raises.

Amendment 14, in the name of the noble Lord, Lord Moylan, would widen the eligibility criteria to include UK citizens of pensionable age who are living abroad. There are two main issues with this amendment. The first is that the UK has obligations under international agreements that enable residents of partner countries to receive certain benefits, including some health service provision, in the UK. These agreements are, as I mentioned, with the EU, EEA states and Switzerland. As I set out, these agreements prevent restrictions based on nationality, although they permit those based on residency. Therefore, the amendment would have the effect of opening access to provision of assistance under the Bill to EU, Swiss and EEA residents of pensionable age, provided that they satisfy other eligibility criteria. Widening access only to UK nationals of pensionable age would be contrary to the UK’s obligations under those agreements.

Secondly, by including those who have “moved to live abroad”, the amendment would enable pensionable-age citizens from Northern Ireland or Scotland who have moved abroad to access the provision of assistance, in accordance with the Bill, if they satisfy the other eligibility criteria.

For all the other amendments in this group, on which I make no comment, any workability concerns are less significant. For example, Amendment 10 would remove two eligibility criteria from Clause 1, while Amendment 13 would change the requirements relating to ordinary residence in England and Wales. As Clause 1 is largely descriptive, these amendments would have limited legal effect without corresponding amendments being made to operative provisions later in the Bill.

While these are choices for noble Lords, these amendments may introduce inconsistencies and ambiguity into the Bill. As noble Lords will be aware, these amendments have not had technical drafting support from officials, so the way in which they are currently drafted means that they may not be fully workable, effective or enforceable—but, of course, the issues raised are rightly a matter for noble Lords to consider and decide on.

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[Lord Falconer of Thoroton (Lab)]

I am surprised to hear that. I will make inquiries, but I am almost sure that that will not be the case with this.

The noble Lord, Lord Mackinlay, gave us an interesting tour d’horizon of the law and said how “ordinarily resident” applies in various areas. “Ordinarily resident” means the same thing in all those areas. For the reasons I have already given, I do not think it will prove a difficult thing to apply in practice. I am grateful to the noble Lord, Lord Meston, for his endorsement of the approach to “ordinarily resident”.

The noble Lord, Lord Wolfson, asked me a number of questions, such as about the citizen who was ordinarily resident here and then went to live abroad—I think that was the case raised by the noble Lord, Lord Moylan. If a person decided that they were going to move to Spain and live the rest of their days there, then when they become ill they wanted to come back and have an assisted death, under the terms of this Bill they would not be eligible because they would not have been ordinarily resident in this country for 12 months—this country being England and Wales.

The noble Lord’s second question was about somebody from Northern Ireland who comes here and asks for an assisted death. Again, they would not be eligible because the assumption under his question was that that person’s ordinary residence was in Northern Ireland. His third question was about why opinion is not satisfied. It seemed to us that opinion is enough in relation to this because it would be done basically by asking a number of questions and you would assume that the answers that you had would be honest.

[Baroness Coffey (Con)]

I notice that the noble and learned Lord has taken interventions. I do not believe that he has addressed my issue about the risk of tourism. He has used interchangeably during his explanations “permanently” and “ordinarily resident”. No distinguished lawyer here has countered the view that you can be ordinarily resident in more than one country at the same time. We have the broader issue that case law and NHS guidance can change this. It really needs revisiting. Will he try to address my issues about tourism and this Bill?

[Lord Falconer of Thoroton (Lab)]

My Lords, I honestly think that is a smokescreen. The Bill says, in a way that the law has recognised time and again—because this Parliament has to make choices from time to time about who gets benefits—that the benefits of the Bill should be given only to those who ordinarily live in this country. That phrase has not given rise to problems. The courts understand it, doctors understand it and the panels will understand it. If we in this Parliament cannot say that we will give rights only to those who are ordinarily resident, which is a phrase that means something, we will never be able to determine who is entitled to our rights. I say, with the greatest respect to the noble Baroness, Lady Coffey, that what we are trying to do in the Bill is clear. I invite the noble Baroness, Lady Finlay, to withdraw her amendment.

Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Winston (Lab)]

My Lords—

[Baroness Coffey (Con)]

My Lords, should we not hear from the noble Lords who have tabled the amendments before we—

[Noble Lords]

Order!

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[Lord Mackinlay of Richborough (Con)]

I will just come back on that, if I may. I would also say that the wording in the amendments in the name of the noble Baroness, Lady Grey-Thompson, is insufficient, because it is a far more complex issue than that. As I said, there is a world of difference between a very early embryo in the first few weeks and a close to full-term pregnancy. I certainly hope that this Committee would agree that point.

[Baroness Coffey (Con)]

My Lords, I really had hoped that we would get to the next group but, as it is clear that we will not, I will raise a couple of points and some questions. The increasing number of older prisoners has already been mentioned. This is largely driven by sexual offences, particularly those of historical sexual abuse. While we of course need to treat people appropriately, I suggest that, wrongly, the majority of the public would not care if sexual abuse offenders or murderers killed themselves. It is, however, our duty as stewards of the Crown to consider these matters carefully.

It so happens that, in the next group, we would have got to a particular situation about halting treatment, or what could happen as a result of halting treatment. There are situations in Australia where prisoners who have been diagnosed with cancer have then declined treatment and have been able to take up assisted dying. One thing that is happening is the rise in prisons of natural deaths. In the 12 months to September 2025, there were 221, and that is with the Ministry of Justice not even knowing and waiting for further information. That is a significant increase from 123 in 2010, which reflects the older age.

It is important that we have compassion, so it is surprising to me that there has been a yearly average of only 9.5 early releases of prisoners on compassionate grounds over the last 15 years. There was just one in 2022, seven in 2023 and no figures yet for 2024. The policy framework is deliberately sparing. Meanwhile, a legal ruling earlier this year allowed an applicant, Mr Khan, out. It is worth considering—it may not be possible at this stage in the response by the Minister or the sponsor—and thinking ahead to Report. Where are we going with this? It should not just be that the ECHR does not allow this.