Britain’s Terminally Ill Adults (End of Life) Bill remains in the House of Lords.
Its fifth Committee reading took place on Friday, January 9, 2026.
I watched the final three hours of the debate and was not surprised at what I heard. Unless something dramatic happens, this legislation will be rushed through. The fact that it is a Private Member’s Bill originating in the House of Commons via Kim Leadbeater MP (the late Jo Cox’s sister) and a fortuitous (for some) Speaker’s lottery draw placing it first guarantees it will not have the desired scrutiny to protect vulnerable members of the public from legislated death.
Lord (Charles) Falconer is the Lords’ sponsor of the legislation. Those of us who are long enough in the tooth will recall that Charlie was not only a former flatmate of Tony Blair in their younger years but also the only known person to have served as Solicitor General as a peer. My late nearest and dearest was suspicious of Blair and all his cabinet because a number of them, Falconer included, were Scots: ‘They’re out to destroy our constitution through legislation’. And, lo, nearly 30 years later, so it would seem. There is no way we can easily undo what New Labour did, particularly to England. Charlie Falconer played a big part in that.
Supporters of this euthanasia bill, as I call it, fear that it will be filibustered in the Lords and not make it into legislation before the current parliamentary session ends.
January 8: Lord Falconer’s motion
To this end, on Thursday, January 9, Lord Falconer put forward a motion in the Lords requesting that everyone get a move on. Excerpts from Hansard follow (emphases mine):
Over 1,000 amendments in Committee have been tabled, arranged into approximately 84 groups. So far, we have spent in total some 32 hours in this House scrutinising the Bill, and we have another 50 hours scheduled. However, in four days of Committee—about 17 hours—we have considered only 10 groups. If we continue at the rate we are going, this House will fail to complete the process of scrutiny. We will reach no conclusions on the Bill as to how it should be amended or whether it should return to the Commons. Instead, the Bill will fail through lack of time—this despite the fact that it came to this House in June of last year after extensive scrutiny in the Commons and received in this House an unopposed Second Reading after a two-day debate with 110 speakers …
This House works best when we work together, exercise self-restraint and undertake scrutiny that reaches conclusions on legislation. For self-regulation to retain respect—and I most certainly believe it should continue—this House has to be effective in reaching conclusions.
The Government are neutral on this Bill and will, I know, remain so. As sponsor of the Bill, I am grateful for the time that has been made available so far for consideration of it. But, as I have said, if we continue at this pace, we will fail in our responsibility to scrutinise the Bill.
The purpose of my Motion today is to give the House the opportunity to express a view on whether your Lordships want this House to complete its scrutiny and, if the Bill passes Third Reading in this House, to send it back to the Commons in time for it to complete all its stages before the end of this parliamentary Session …
If the Motion passes, I would hope that all sides can be brought together through the usual channels to achieve a reasonable, informal but effective process to complete the passage of the Bill through this House—taking into account, of course, the needs of the House staff. This remains a Private Member’s Bill, and extra time should not involve any time that would otherwise be for government business.
Baroness (Angela) Smith of Basildon is the Leader of the House of Lords and Lord Privy Seal. She said, in part:
… on timings, colleagues will be mindful that the House is due to sit again at 10 am tomorrow morning further to consider amendments to the Bill. Noble Lords will need to come to a decision this evening on the Motion of the noble and learned Lord, Lord Falconer. In light of tomorrow’s sitting time, I hope that the House will not sit too late. If necessary, the Chief Whip or I may return to the Dispatch Box to advise colleagues if it looks as if proceedings are not coming to a timely conclusion.
She did so on Friday, more about which below.
Conservative peer Lord (Kevin) Shinkwin, who is disabled and opposed to the proposed legislation, contributed remotely because of the bad weather:
… I suggest that the Motion overlooks the reason why we have had to spend so much time to date considering amendments, for surely, as with any Bill, we can only ever work with what we have been given—in this case, by the other place. The volume of amendments and the time taken to consider them therefore reflect the quality, or lack thereof, of the Bill that was sent to us.
… We should surely be heartened by how much it is appreciated that we take our duty to scrutinise so seriously. We are simply doing our job without fear or favour as Parliament’s revising Chamber.
In conclusion, I am reminded of a wonderfully wise Scottish saying from the 16th century, which I believe this Bill shows has stood the test of time: “You can’t make a silk purse out of a sow’s ear”. Our procedures are being followed appropriately and reasonably. If any Bill is so poorly drafted and so unsafe, surely the question is not so much whether the Bill deserves more time, but whether yet more time could transform it.
Indeed, over 400 amendments to this bill have arisen in the Lords. Surely, something is wrong.
One peer suggested not repeating what had been said before during other debates — and rightly so.
Lord (Simon) Stevens, head of NHS England during the pandemic (take that how you will), uttered words quoted again on Friday. The Government has no intention of publishing a plan for palliative care until this legislation is passed. Surely, the timeline should be the other way around, in order to avoid unneccessary deaths:
… over the first few days of Committee, some pretty significant matters of substance have arisen. We are not going to rehearse them now, but they are around capacity, choice, vulnerable groups and eligibility. While agreeing with the noble and learned Lord, Lord Falconer, the sponsor, that we need to find a way of coming to some judgments on these questions, what process does he envisage for that? The guidance that those who have put down probing amendments in Committee have got back from the Government—precisely because the Government do not want their fingerprints all over this Bill—has been, shall we say, Delphic or elliptical. The phrasing that Ministers have used time and again has been, “If you are contemplating coming back with an amendment such as that on Report, then you will need to do further work to make sure it is fully workable, effective and enforceable”, but then there is no subsequent work to bring that about. If we are going to have a substantive debate on Report, so we can get these safeguards in place, we are going to need to see that.
Finally, I would like to ask a question of the Government. For those of us who have concerns about the interaction between this legislation and the state of the health service, social care and palliative care, it would be very helpful if we could have more clarity soon from the Government on how they see those interactions happening. Yesterday, in the House of Commons Health and Social Care Committee, the Minister responsible for palliative care said that the Government would not publish their detailed modern framework for palliative care until, in effect, after this Bill had supposedly already passed through Parliament, which seems to me a dangerous reversal of the timetable that we require. It would be excellent to hear from the sponsor of the Bill and from the Government how they can help the House constructively engage on Report on some of the safeguards which are, in my judgment, clearly needed.
We then saw another Blairite appear — Baroness (Margaret) Jay of Paddington — daughter of the late Prime Minister James Callaghan. She also served (just as the aforementioned Baroness Smith of Basildon) as Leader of the House of Lords and Lord Privy Seal (1998-2001). I am a fairly regular viewer of the Lords’ proceedings and have not seen Baroness Jay participate in recent years until now:
… I hope that this Motion will be accepted, that we will go through with our very important work, that we will send the Bill back to the Commons in time for it to be appropriately considered there and—it is very important to say—that we regain our reputation for honest, lengthy, astute scrutiny and great authority on this subject.
Hmm.
Lord (Kenneth) Baker of Dorking, former Conservative Home Secretary and Education Secretary in the Thatcher and Major years, was next to speak. He signalled that times had changed since the Lords first debated euthanasia some years ago:
I support the Motion in the name of the noble and learned Lord, Lord Falconer, because I remember debates in this House on assisted dying over 20 or 25 years ago—the noble Baroness [Jay] spoke in them, as did the noble Baroness, Lady Finlay. We have always taken a great interest in it.
It is very clear that in this House there is a small group who are passionately for assisted dying and a small group who are positively against it. As the noble Lord, Lord Carlile, said, it is very difficult to bring them together. The speech that he made today was very similar to the speech that he made about three weeks ago, asking for common sense to prevail and that we should discuss what the amendments should be. I applaud that approach, but it appears that the people moving the amendments do not want that to happen. They do not want the Bill to pass at all. That was very clear in the early debates I remember of 25 years ago. They are just not going to accept amendments; they want the Bill to be blocked …
… people do know that we are being subjected to a filibuster in this House by a relatively small number of Members. It goes back to those early debates. The main argument against assisted dying, way back 25 years ago, was the sanctity of life. That has virtually disappeared, apart from the fact that two bishops mentioned it at Second Reading.
Then it was said, “No, palliative care is the answer to assisted dying”. No party, in its next manifesto, is going to commit to spending a huge amount of money on palliative hospitals. That would be at the expense of capital expenditure on the health service. So it is up to the House to find a way of coming to a conclusion.
Sadly, it appears as if he could be correct, although the assertion that palliative care costs more than it saves came up for debate on Friday.
Interestingly, however, Baker reminded everyone on how parliamentary debates went on until the wee hours of the morning, if not overnight — incidentally, something else that Blair put paid to, to make Parliament ‘family friendly’ as more young mothers had entered the Commons by 1997:
When I was a junior Minister in the House of Commons, a Bill was being filibustered and I sat not only to midnight but to breakfast, and to lunch the following day. Eventually, we got the Bill through. So it is in the hands of the House, even if the Front Benches are quite reluctant, because they do not like to take their sticky claws off controlling the agenda of the House. But, if they cannot find a way, there are other ways in which the debate can be reasonably finished and addressed this time.
The Conservative peer Lord (David John Maclean) Blencathra laid the blame at Charlie Falconer’s feet — and rightly so. Falconer has done nothing constructive to address the amendments against the Bill:
… tomorrow, we will be discussing major amendments on palliative care, and many of them are quite different. If the noble and learned Lord were to stand up early on and say, “I like the principles of Amendments X, Y and Z, and I promise to go away and come back on Report with a better version of them”, I suspect we would make rapid progress. So it is in the noble and learned Lord’s hands to get this done in the next 10 days, and he should not blame those who are willing to talk about amendments which he gives the impression he would never accept in a month of Sundays.
Crossbencher Baroness (Sheila) Hollins called the peers’ attention to the unusual structure of the Bill and suggested that a Royal Commission be established to work through it first:
… With the help of the House of Lords Library, I have been looking at balloted Private Members’ Bills from the House of Commons ballot that reached First Reading in this House in the 10 years from the start of the 2015 Session. It is very interesting.
In the other place [the Commons], of course, ballot Bills are introduced by title only, with the full text appearing or changing at later stages. But the full text version as brought from the Commons provides a consistent and analytically robust basis for comparison. The average length of the Bills in that 10-year period was 8.8 pages, with a mean of five clauses. In contrast, this complex Bill, heralding major social and societal changes, has 51 pages, with 59 clauses. So it is hardly surprising that it needs lengthy scrutiny.
Eight of these pages were actually added by the sponsor [Falconer] on Report, with little or no discussion. In the other place, 92% of the amendments tabled by Members other than the sponsor were not even debated, and just seven were put to MPs for decision. This data refutes the misleading impression being given in the national media, which suggests that your Lordships’ House is delaying progress by tabling and debating amendments, as in reality they are needed to improve the safety and care of patients.
I suggest that counting the number of amendments is misleading, because many are consequential on the change proposed. As my noble friend Lord Carlile suggested, there are about 10 major issues. The noble and learned Lord has not said which amendments, if any, even those recommended by the royal colleges and patient advocacy groups, he is willing to accept. Members are waiting for his active engagement and for a bit of give and take.
In the past 10 years, only 66—about a third—of all balloted Private Members’ Bills have become law. Of these successful Bills, the vast majority were government handouts or had explicit government support. Nobody can argue against scrutiny, and I am glad that the noble and learned Lord [Falconer] has recognised that a Bill of this length and complexity does not fit the usual model of a Private Member’s Bill. I have concluded that the kindest thing for the Government to do would be to seek to establish a royal commission to give this weighty issue the attention that it deserves. We cannot do it justice through the Private Members’ Bill process, but I agree that it needs time.
The Conservative peer Lord (Edward) Garnier, former Solicitor General for England and Wales, asked:
… perhaps the daft laddie question. Is he, or are the Government Front Bench, able to tell us how many days and what dates they think will be required for the Bill to get through its passage in Committee, on Report—bearing in mind that there may well be Divisions on Report—and then at Third Reading, so that proceedings here will be completed in adequate time before the end of the parliamentary Session, before it goes back to the other place?
… it would be enormously helpful if he could put some meat on the bones of “reasonable time”—the phrase he uses in his Motion. That would inform us in a very helpful way. If he cannot do it, perhaps the Government Front Bench could do so instead.
Another Conservative, Baroness (Elizabeth) Berridge, also said, as had others, that Falconer had not put forth any countering amendments to those with which he disagreed:
… I have looked at the Order Paper under Clause 43 and there are a number of amendments, but still none from the noble and learned Lord in relation to these matters, so I am now going to have to go to the Public Bill Office to get my amendments drafted not knowing what the noble and learned Lord’s position was when he gave that evidence before Christmas. That is the type of issue of process that is causing more time to be used in your Lordships’ House. I have about 15 amendments down, so I am concentrating on a handful of the issues, which I believe is the way I have behaved with any Bill before your Lordships’ House to date.
In the end, the motion passed — regardless of what peers think about the legislation. Nearly everyone wants a decision one way or the other.
The disconcerting element in all of this is Falconer says that if peers wish to discuss points of disagreement with him, they are welcome to do so. However, that would be privately. Surely, a subject of this magnitude should be debated in public so that we all have an understanding of what is happening throughout.
January 9: fifth Committee session
Incredibly, Hansard’s transcript of Friday, January 9’s proceedings was online by the end of the afternoon.
I will go through the major issues of the debate which might not enable any finalised legislation to work as billed, so to speak.
Judges, not panels: Amendment 120
Our court system is on overload. Justice Secretary David Lammy wishes to abolish trial by jury in some cases in order to work through the backlog. That is wrong, but is another subject for another day. Euthanasia legislation would see the backlog worsen.
Crossbencher Lord (Alex) Carlile of Berriew, a barrister, discussed the difference between judges and/or recorders (part-time judges) or ‘panels’ — a psychiatrist, social worker and judge — reaching a decision on the right to terminate one’s life in case of serious illness. Lord Carlile points out that judges were shifted to panels early on in the proposed legislation:
The issue of principle is whether permission for assisted suicide should be given by the court or via a panel. The promoters’ original intention was very clear: it was to be a court-based process. But by amendment they moved their choice to the panel procedure that currently appears in the Bill. I believe that they had two main reasons. First, the courts may not have enough judges to deal with the volume of applications they expect. The court in question at that stage was simply the High Court of Justice Family Division. Secondly, it might prove more difficult to obtain permission from a court than from the panel as now described.
As to the judges, Amendment 120 offers a simple and sound solution that I am surprised had not been thought of before. It would broaden the range of judiciary who would be designated to reach these momentous decisions, which involve the deliberate participation of one individual in bringing about the death of another. That a judge should be involved is, I suggest, self-evidently appropriate and what we should expect, given that third-party participation in a death would otherwise involve the offence of murder. I remind your Lordships that murder is defined as being involved in bringing about the death of another with the intent to kill or do grievous bodily harm.
Decisions about whether life support should be switched off are regularly heard by judges of the Family Division of the High Court, as are other extremely important decisions concerning family life, including matters affecting contact between parents and their children. There are, however, only 20 High Court judges in the Family Division, including the president. But, around the country, there are more than 40 designated family judges: specialist circuit judges who deal with the most difficult and important cases. By adding those 40-plus designated judges into the cohort of judges who would decide cases envisaged by this Bill—they were not envisaged as part of the process originally—there would, I suggest, be an ample supply of skilled and diverse expert judiciary, who would provide confidence-inspiring judgment in this important and difficult new area of the law.
The training of judges is very important in this context. The Judicial College provides expert training for all judges, including in specialist jurisdictions. There are those in this Chamber who have acted both as students and tutors in the work of the Judicial College. I add that there is a cohort of recorders, who are part-time judges, who could fill any listing gaps caused by this new jurisdiction …
The experience of judges, honed in practice in which, from time to time, they all encounter examples of the most egregious and devious behaviour, together with the forensic nature of the court process, promises a reasonable prospect of fair and proper decision-making …
Lord Shinkwin was concerned that, even with the addition of specialist circuit judges, the system would be even more overwhelmed than ever. He also objected to the word ‘may’ in one of the clauses, which could be used adversely:
… the word “may” in subsection (2) of the proposed new clause in Amendment 120, and how this could be interpreted. It currently says:
“The President of the Court may direct that the application may be heard and directions given by a judge of the Family Division or by a circuit judge who is a designated family judge”.
… “may” is an ambiguous word implying optionality, so it is always a red flag … in this context it might simply mean “This law would permit” …
I am sure I am not alone in believing that the slightest risk of assisted dying applications being nodded through over time has to be strenuously guarded against, not least given that Sir Nicholas Mostyn cautioned against the High Court’s involvement in a previous incarnation of this Bill being no more than a symbolic rubber stamp.
Defining ‘assisted suicide’ and ‘assisted dying’: Amendment 120
Baroness Hollins raised the difficulty in defining suicide and assisted dying in today’s ethics:
I am aware that many people would prefer the term “assisted dying” because of the stigma associated with the term “suicide”. The Bill rather contradicts itself by adopting the term “assisted dying” while attempting to modify these other statutory provisions that concern assisted suicide. That creates both conceptual and legal ambiguity. If Parliament is being asked to authorise assisted suicide, then it follows that such decisions fall within the proper domain of the courts. For that reason, among others, I support my noble Lord, Lord Carlile’s amendment that would replace the assisted dying review panel with a court-supervised process.
Amendment 120 appropriately moves decision-making from the medical to the legal sphere. Assisted dying is not a medical treatment; it is an act with profound societal implications, and it therefore requires, I suggest, judicial rather than clinical oversight. For that reason, I believe that it does not belong in the National Health Service. Under the proposed model, doctors would continue to provide expert medical evidence confirming diagnosis and prognosis, but the final authorisation would rest with a judge. That judicial scrutiny provides a stronger safeguard against errors, and enhances transparency and public confidence in the system by placing responsibility for these irreversible decisions in the courts, where I believe they properly belong.
Lord Garnier posited whether Lord Falconer would accommodate Lord Berriew’s proposal of adding more judges:
There are plenty of very bright and capable judges in the other divisions who, if required, could apply themselves to these sorts of cases. So, we are not going to be short of personnel; what we are short of is a decision of this House to agree with the position of the noble Lord, Lord Carlile, or something like that. It may well be that the noble and learned Lord, Lord Falconer, will come up with a way of dealing with the gap between him and the noble Lord, Lord Carlile, as one of these 10 thematic discussions, so we get a workable, just and publicly respected system which, if we are to have a Bill, allows the public to feel confident that it will work properly.
Arriving at an informed choice: Amendment 26
Baroness (Ilona) Findlay of Llandaff, the first Consultant in Palliative Medicine in Wales, spoke about the importance of arriving at an informed choice for the patient:
The amendment ensures that all terminally ill persons seeking to take up assisted dying support have had their needs assessed by a multiprofessional specialist palliative care team and met to the extent necessary to enable them to decide whether such care would affect their wish to end their life.
My Lords, we move on to a group of amendments that are extremely important and, in some ways, complementary to those in the previous debate. Autonomy is the lodestar of the Bill. The amendments in this group are designed to reinforce and respect that patient autonomy; they do not block access to an assisted death but aim to ensure that people have accurate information to make informed decisions. For a decision taken, people must have three things, whatever that decision is: accurate information, the capacity to make the decision and to be making it voluntarily. Those are the fundamentals of respecting a person’s autonomy.
These amendments are to ensure that the patient has the opportunity to know what is available. They do not force a patient to be looked after by a palliative care team, and they do not stop a patient from proceeding with an assisted death. There is clear evidence from studies that underserved groups have poor access to palliative care, and there is poor understanding generally of what palliative care is and can do. General doctors often do not understand palliative care, so how can an assessing doctor give good, accurate information to a patient if they themselves have a deficit in their knowledge? It is worth noting that in a five-year medical training course it has been estimated that the average time spent on learning about palliative care is only 20 hours, and only recently has palliative care come into the finals questions. So there are thousands of doctors out there with almost no education in palliative care.
Many patients and the public do not understand palliative care either. A significant number think that assisted dying is palliative care or hospice care, while others think that palliative care simply hastens death. Sadly, misunderstandings are widespread. When patients access appropriate specialist palliative care, the desire for a hastened death is often alleviated, and they experience an improvement in quality of life that they never believed possible. But that does not apply to everybody. The role of this amendment is simply to give everyone the best opportunity to access the care that they need, whether or not they continue to pursue an assisted death and whether or not they decide to take up the opportunities that may be revealed by such an assessment. The processes relating to an assisted death can occur in parallel with, but not as an integral part of, palliative care provision.
There has been concern that palliative care teams could not cope with a sudden influx of referrals, but currently any palliative care team prioritises a patient who is in such despair that they want to die. That is basic care, a core part of the job. Palliative care will not turn its back on patients who are in despair; teams want to deliver gold standard care …
In the hospice, I used to always have the care assistants as part of our weekly multidisciplinary review of patients. They had valuable insights and much to contribute. A mandatory assessment would ensure that people knew what was available. It is up to the person to decide whether to try one route or another.
Why make this mandatory? Unfortunately, the amendment to the Health and Care Act 2022, which I pushed for very hard and was glad to see come in, and which stated that palliative care is a core service, has not resulted in commissioners adequately commissioning services, in part because they themselves are ignorant of what to commission. If assessment is mandatory, commissioners must make sure that patients seeking an assisted death have a service that can provide a proper needs assessment and give them information. The patient can choose whether to try or not try.
I know that my noble friend Lady Hollins has an amendment about this, and there is indeed a definition in an amendment that has also been tabled in relation to what specialist palliative care is. To try to summarise that very quickly, it is about having the appropriate specialist skills in every setting, with advice available at all times of the day, every day, equipment and medication available, and a point of contact so that people can go back and explore and discuss things as they think more about the complexities of their situation, and they can access the support that they need.
Equal access versus lack of specialists: Amendment 51
Labour’s Baroness (Lyn) Brown of Silvertown discussed her Amendment 51, which involves the disparity of specialists across the country:
My Lords, my Amendment 51 and others would require the providers of assisted dying services to ensure that all persons seeking such services have discussed the range of end-of-life options available to them with a palliative care specialist.
The Government and proponents of the Bill have promised that end-of-life care will not suffer in order to accommodate assisted dying. I have significant reservations about whether this would be possible, and I fear a push factor, particularly for those who are vulnerable, those who are without family and, to be absolutely frank, those who are poor and cannot fund their own care. When done right, as we know, palliative care can provide a dignified end of life and alleviate the desire to hasten one’s death. Equitable access to options for end-of-life care must be a cornerstone for this Bill, which is why I have laid these amendments. I want to ensure, as far as humanly possible, that all people have and know that they have equal access to palliative care, to treatments that may extend life and to specialist teams to manage the symptoms and pain and to provide dignity.
This Committee must accept that equal access to these services, as for many public services, is not guaranteed and is rarely delivered. I give just one example, due to time. A Liverpool resident with the terrible asbestos-related mesothelioma cancer can undergo a specialist injection that has a high chance of abolishing the pain, whereas a resident of the Midlands, who may be unfit to travel to Liverpool, simply cannot because there are so few specialists trained to take this work on. Therefore, access is obviously limited.
Clauses 5 and 12 require doctors to have discussions about disease prognosis, treatments and symptomatic alleviation with patients. Clause 5 includes an offer to refer them to a specialist. Although these are important discussions, which must be had, they have to be conducted by somebody properly trained and experienced in such matters. For conditions that are specialist care cases, such as motor neurone disease, most doctors will have minimal involvement in the management of that condition and will likely not have the skills and training to adequately fulfil the duties that the Bill places on them. A specialist referral is absolutely necessary to that ensure patients are able to reach an informed decision about their care with somebody who properly understands the disease, how that disease will progress and what can be put in place to alleviate their distress and pain.
A person seeking assisted dying will be worried about their future, losing their independence and dignity and placing a huge burden on their families. A dedicated palliative care specialist would have the expertise, skill and training to provide the highest level of information and support, tailored to the individual needs of each patient, and have specialist knowledge of the condition that the patient is experiencing.
… You can reach a clear, informed decision to end your own life only after having the advice and support to truly be able to weigh your options. That guarantee should absolutely be in the Bill.
Baroness Hollins echoed that assessment:
Before introducing assisted dying on a national scale, we must ensure equitable access to high-quality specialist palliative care across the country. As part of the multidisciplinary palliative care assessment, I propose that every individual applying for assisted dying should be considered for NHS Continuing Healthcare through the fast-track funding process. This is an existing, well-established process, although perhaps not well understood within primary care or perhaps even within your Lordships’ House.
Continuing healthcare provides fully funded health and social care support, including assistance with medication, mobility and activities of daily living, but it can be slow to arrange. However, the fast-track pathway exists precisely to ensure that people with rapidly deteriorating or terminal conditions can access this support within 48 hours of their request. It works in practice. It is already there; the architecture already exists.
This can make an enormous difference, enabling people to choose their place of care, arrange nursing support, secure equipment or home oxygen, and relieving families of both emotional and financial burdens at a critical time. Encouraging fast-track access to continuing healthcare within the Bill would ensure that individuals receive timely, holistic support and are not driven towards assisted dying by unmet care needs. Furthermore, patients approved for fast-tracked continuing healthcare funding are more likely to have an accurate prognosis of six months or less. Taken together, these amendments would place specialist palliative care where it belongs: at the centre of end-of-life decision-making, ensuring dignity, compassion and genuine informed choice.
Difficult circumstances affect decisions
Baroness O’Loan made excellent points about everyday, outside circumstances which could drive someone to choose euthanasia:
Very small matters can tip people into making a decision for death. Sometimes, people just give up living because their circumstances feel so difficult to them, and they may feel, in this situation, that they have no option but to opt for assisted death, when they do not want to burden their family and friends with excessive costs, including the cost of care homes. Some of these costs may seem trivial to those of us who do not have to count our money so carefully but, for those who are very poor, as I once was, getting to hospital or a hospice to visit someone who needs to be visited and whom you wish and need to visit can be very difficult. It can cost money that you do not have, and it can take time. People may have young children, and those children need to be looked after. There are all sorts of complications which ensue from the situation in which terminal illness occurs. People may not have a car, and things such as fares and buying coffee, lunch and a gift all cost money. For poor people, given the current cost of living, every penny counts. Money spent on hospital visits and other expenses is not available for food and heat. The terminally ill person may know this and may wish to spare their family.
Myths about pain relief
Baroness O’Loan also discussed myths about pain relief:
I once asked palliative care experts what the longest time was that it had taken them to bring what seemed to be untreatable pain under control when a patient was admitted to a hospice. They told me the longest it had taken them was 12 hours.
Baroness (Claire) Fox elaborated on the subject:
It is important for the Committee to note that research has shown that those who wish to hasten their own death often change their mind when they receive more information. Palliative care can mean that people who want to die then want to live, and that is important if we are going to talk about choice. It is possible that you might want to die, that you are determined you want to die in assisted death terms, having had your terminal diagnosis. But why is it that you want to die? That is the motivation behind the discussion in this group [of amendments].
One of the things that happens is that many people are frightened and fearful, and one of the things they are fearful of is pain and terrible symptoms, which by the way are often graphically described by supporters of the Bill, and I think that they can scare people. It is the idea that your pain and symptoms cannot be controlled. When I talk to supporters of the Bill—some of my friends, colleagues and members of the public—they are completely compassionate in talking about how the Bill will help people who are suffering intolerably and in excruciating pain. None of us wishes that on anyone—or, indeed, on ourselves. It is a frightening prospect.
That is actually often a fear and a dread that the right kind of care can mean will not be realised. Patients are understandably frightened of being in that kind of pain, so they need to know that …
We all know family and friends and so on who have died and who have had terminal illnesses. People will say that morphine is simply not enough to control the pain. That is the kind of thing that I would say, because I know nothing about medicine. So, it is a great relief to discover that palliative medicine resident doctors say that morphine is the tip of the iceberg for pain management. There are countless other options available, but to know this requires training and experience, which I have not got. When you are having a chat in the pub with mates—or indeed, when I was in hospital pumping in the morphine—it is good to know that somebody, somewhere, has got the experience. That is the palliative care specialist and every terminally ill patient should at least be offered the option to go to see one. This is a modest but meaningful addition to the Bill and I hope that the noble and learned Lord, in the spirit of listening, accommodating and compromise that we heard about last night, will make changes to the Bill accordingly.
Lord Stevens’s words about palliative care policy being delayed
Baroness Fox made reference to Lord Stevens’s aforementioned comments about a palliative care policy being delayed until this Bill passes Parliament:
In relation to the point made by the noble Lord, Lord Stevens, yesterday, it was a shocking revelation that the Minister responsible for palliative care said that the Government would not publish their modern framework until after the Bill had passed through Parliament …
I was not trying to imply some conspiratorial holding back; it is just that the noble Lord, Lord Stevens, said this was
“a dangerous reversal of the timetable we require”.—[Official Report, 8/1/26; col. 1416.]
‘Pressure’ missing from legislative terms in the Bill
Baronesses Berridge and Grey-Thompson (Tanni), the former Paralympian, had an exchange on the change of wording, which removed ‘pressure’ from the Bill.
Berridge observed the change then asked:
The noble Baroness used the phrase “moral pressure”. I mentioned in my speech that this is a fundamental change. If Clause 3 has gone, not by way of clause stand part, then actually, “pressure” has now gone from the test here. We now have “undue influence or coercion”, not “dishonesty, coercion and pressure”. Does she have any view—I mentioned domestic abuse victims—on whether that makes any change to the safety of the Bill for disabled people?
Grey-Thompson responded:
Oh, absolutely: I think pressure is something incredibly important that we have to assess. Certainly, from the huge number of disabled people I have spoken to, pressure comes in many different ways, and it is very difficult to detect. If we do not take that seriously, I think people will be coerced into thinking that this is their only option, rather than that they have a range of options.
The impracticality and impossibility of people — and money
Crossbencher Baroness Nuala O’Loan raised the vital questions of where the people and money would come from to make this work:
There are only 29,500 social workers in England and Wales, according to the impact assessment. There are quite simply not enough of them to care for and protect children and vulnerable adults now, so what element of the crucial and challenging work of child and vulnerable adult protection would be sacrificed to support the existence of assisted death panels? This is a very real question. The Royal College of Psychiatrists has said consistently that it cannot support the Bill, and there is a major shortage of registered psychiatrists.
As the noble Lord, Lord Pannick—and, indeed, the noble Lord, Lord Carlile—said, the Bill requires that the legal member of the panel holds high judicial office, is a KC, etcetera. But there are currently only 107 High Court judges, 20 Family Division judges and 41 designated judges, and our KCs tend to be fairly well occupied. Nearly 104,000 children were trapped in the family court backlog during 2023. The average time for dealing with cases involving children—very important cases—is 43 weeks, and there are currently thousands of couples and nearly 20,000 children waiting for hearings. Given the delays, and despite the intervention of the noble and learned Baroness, Lady Butler-Sloss, I do not believe that family court judges would be available to act as legal members—yet the decisions by the panel required by the Bill must be subject to time pressure, because there is the requirement of death within six months. Even if we allowed only three hours a case, at the lowest figure of 6,000, we would need 54,000 hours of members’ professional time. If the figure was 5%, it would rise to 270,000 hours.
How is this to be funded? How are these professionals to be trained, supervised and managed? What will be the cost of the panel members and the administration of the panels? The impact assessment provides no answers to these questions. Where is the money coming from? It is not coming from savings in care, because most palliative care is actually provided by donations from the public; only 30% is funded by the state. Therefore, the system now in the Bill is simply unsafe. It provides virtually no protection for the weak and vulnerable; it is not workable.
She also said:
There is also a problem about the cost of lawyers. The current fees for the family court range from £579 to £200 per solicitor per hour. Noble Lords can calculate what this would cost a family seeking to be represented in the court. The assumption must be that this will not be publicly funded. The PAC recently published a report about access to legal aid. It states that about 24% of the population, often those most in need of legal assistance—disabled people or those living in poverty—are excluded from the remote access now provided by digital means.
These matters should have been considered in a public consultation, but there was none. There should have been an assessment of risk and cost, but there was none. If judges are to make these decisions, we need more judges. It is not enough to say that judges will deliver if we tell them to. The reality, as we know from examining and observing the operation of the courts, is that cases are delayed. There are 80,000 cases alone waiting in the criminal justice system for trial. Rape cases are being listed for hearing in 2029. How are we to care for rape victims and other litigants when we are also providing this extra urgent need to make determined applications for assisted death? I therefore ask the Minister: how do the Government propose to resource even the panels’ work? Is the intention to designate other judges who sit largely in the Crown Court? A person making an application will have six months to live, so this is going to be urgent in any situation.
Opponents cut off at the end
At 2:30, a half-hour before the expected adjournment, things got tense.
Labour’s Baroness (Margaret) Wheeler, the Labour Lords’ Deputy Chief Whip, did not wish to allow any further comments so that the House could adjourn comfortably at 3 p.m. She said:
We are very short of time.
The newish Conservative peer, Lord (Paul) Goodman, wasn’t having any of it:
I have an amendment to which I have not yet been able to speak. Surely it is right and proper that those of us who have tabled amendments should be able to speak—especially where, as is true in my case, a noble Lord was a member of the Select Committee that examined this Bill. If the Committee will allow it, I would like briefly to quote some of the evidence that we heard …
I will be extremely brief but, as I said, I have tabled an amendment and have been waiting patiently to speak to it, if I may. My Amendment 394 would require the assessing doctor to arrange, and require the person to attend, a consultation with a palliative care specialist. Like the noble Baroness, Lady Finlay, who moved the lead amendment in this group, and the noble Baroness, Lady Smith, who spoke earlier, I was on the Select Committee. I will not repeat the evidence that the noble Baroness, Lady Smith, quoted, but I shall very briefly quote a little more, because the merit of having these Select Committee reports is that the House hears them …
I could quote more, but because of the time constraint, I will come to a conclusion, as requested.
My conclusion is this. When the noble and learned Lord, Lord Falconer, gave evidence to our committee, he stressed at the start that the guiding principle of the Bill is autonomy, but autonomy is compromised if there is not real choice. To those who say that you cannot have real choice between assisted dying and palliative care because the palliative care is not available, my response is that that is precisely why this should have been considered by a royal commission, rather than being brought into this Bill, which has been so heavily criticised by two Select Committees of this House. However, we are where we are, this is the Bill as we have it, so I wait to hear from the sponsor of the Bill which of these amendments he is prepared to accept and, if he is not, which amendments he himself will bring forward in due course.
Supporters of the Bill shouted ‘Front Bench!’ in an effort to subdue not only Lord Goodman but also Lord (Donald) Curry of Kirkharle and Baroness Grey-Thompson.
Then, Lord (Mark) Harper, a recent Conservative Secretary of State for Transport, rose, with other peers shouting, ‘No!’
He, too, mentioned Lord Stevens:
No, I am sorry, there is no requirement in the Companion that you can speak in a debate only if you have tabled an amendment. If we want to finish at 3 o’clock, we can either go slightly past 3 o’clock or we can stop at 3 o’clock and resume this group next week. I wish to make one point that has not yet been made and which I think is pertinent to the debate, and I believe I am perfectly in order doing so.
The point is this. Two Members have raised the valuable contribution made in yesterday’s procedural debate by the noble Lord, Lord Stevens of Birmingham—a man who knows what he is talking about on the NHS, as he ran it for a number of years—about the timetable for the Government to publish their modern framework for palliative medicine. He said that, at the moment, that framework is likely to be published after Parliament has considered the Bill, and he felt that that was the wrong way around. The reason that matters is that the Government have published a 10-year plan for the NHS, and nothing in that plan will significantly change the provision of palliative care in England.
We know that only about half the people who require specialist palliative care are able to get it, and that the Bill’s sponsor, the noble and learned Lord, Lord Falconer of Thoroton, believes—or believed and still believes—that good palliative care is a prerequisite for there to be assisted suicide, so I think it very important that the Minister answers the question and confirms that the Government will at least think about publishing the modern framework for palliative care before we get to Report on the Bill, so that this House can make a properly informed decision about the amendments before it on palliative care.
Then Lord Blencathra stepped in, also saying that the guidelines for Lords debates were flexible. One could terminate the day’s debate and resume it next week:
My Lords, this is a self-regulating House, and that does not mean that a Government Whip can regulate who can speak and who cannot. I echo the point made by my noble friend. If the only way one can speak in these debates is to sign amendments, I know what to do in future.
I spoke for five minutes on the Friday before Christmas and said not a peep in the debate earlier today because it was not my speciality. I have been waiting here for two hours to make a speech on palliative care, and we seem to have been refused the right to do so because the Government Whip wants us not to say anything so that we can finish at 3 o’clock. I agree that we can finish at 3 o’clock—it is a simple matter for the House to adjourn and come back to polish off this matter next Friday morning—but it would be absolutely outrageous for noble Lords who have not had a chance to speak at all on palliative care to be refused the right to do so because the Government have imposed an arbitrary timetable on us.
Baroness Wheeler retorted, seemingly contradicting herself:
My Lords, it is not an arbitrary timetable. Many people have spoken on palliative care both at Second Reading and today, and I respect that totally. I am just saying that we need to respect the rules of the House to be able to adjourn. It is better if we finish this amendment so that we can start the next session with a new debate.
Another peer reminded Blencathra of last night’s motion.
Blencathra was not moved:
I respect what the noble Baroness has said, but it is also the case that it is disrespectful to Members who have prepared speeches, wishing to say something on palliative care, and who deliberately stayed quiet in previous debates so that they could make a point on a subject in which they are interested. They are now being deprived of the opportunity to do so.
Disappointly, the Conservative spokesman, Lord (Syed) Kamall, agreed with Labour! He then did his summing up for the Conservatives.
Baroness (Alison) Levitt, who is married to Lord Carlile (formerly a Liberal Democrat), responded for the Government. Essentially:
The Government have workability concerns in relation to these amendments. First, it is unclear what the full assessment is intended to cover and what is required for it, potentially making it difficult to demonstrate compliance. Secondly, the amendments would require repeated referrals at different stages in the process. It would be resource intensive to repeat the same full assessment three times in addition to the existing assessments in the Bill. This might cause delays in the assisted dying process. The Government do not have a detailed delivery model, so we are unable to comment on the point at which the process cannot be delivered within a reasonable timescale. Finally, I note that it is unclear what happens if the individual declines any of the referrals, including if the individual has, in fact, undergone such assessments. That might result in ambiguity for those seeking an assisted death or for the assessing doctor and panels in fulfilling their duties under the Bill.
Amendment 182 and Amendments 261 to 264 in the names of the noble Baroness, Lady Grey-Thompson, and my noble friends Lady Ritchie and Lord Hunt would require someone seeking an assisted death to have their palliative and end-of-life care needs assessed and care provided by an appropriate health or social care professional if the person requests it. These amendments would also place a duty on the Secretary of State and Welsh Ministers to make regulations about the provision of palliative and end-of-life care. There would need to be justification for the different levels of palliative care being offered, on the one hand, to terminally ill patients seeking an assisted death and, on the other, those in comparable situations where patients are not seeking an assisted death. The Government have some concerns, as I said earlier, about creating unequal access to palliative care, with the potential effect of prioritising resource for those who wish to pursue an assisted death rather than for those with the greatest clinical need …
Other amendments were deemed unworkable.
As for Lord Stevens’s comments the day before, she said:
I can confirm that the Minister for Care said this week that we will publish an interim report in the spring and a final modern service framework by the autumn. We want to get this right, so we are not going to rush it. I remind all noble Lords that this is not a government Bill; it is a Private Member’s Bill.
Lord Falconer, being very lawyerly, gave his concluding remarks, saying that whatever peers had been discussing in proposed amendments was … already in the Bill:
… First of all, should you be properly informed? Yes, you most certainly should be properly informed of what palliative care is available to you, and the Bill should make that clear. I submit that the Bill makes that clear and does so in a reasonable way. I draw your Lordships’ attention to Clause 5 …
All the palliative care options that are available to you have to be discussed with you by the doctor in the preliminary discussion and, if you want, you can be referred to a specialist in palliative care as well. In addition to that, I refer your Lordships to Clause 12(2)(c)—I am grateful to the noble Lord, Lord Kamall, who took us through the provisions very helpfully …
Therefore, there are three occasions on which the detail of the palliative care available to you is explained to you …
The various amendments are all twists on those themes. My view is that we should make sure that they have the right information, and they should have access to a specialist who will tell them it if they want it, but I think the Bill does that.
Baroness Findlay of Llandaff withdrew her amendment, but said:
I believe that we must—not just will but must—come back to this on Report, with all those people who have shown an important investment in time to consider the needs of the individual who is in such distress that they want an assisted death. We cannot accept that some people are potentially going down that road simply because care is not available.
For those wondering when the Lords adjourned, it was at 3:13 p.m.
More to follow next Friday. Unfortunately and ultimately, Labour will get their way and approve this ill-considered ethical abomination.
The three-year Lectionary that many Catholics and Protestants hear in public worship gives us a great variety of Holy Scripture.
The three-year Lectionary that many Catholics and Protestants hear in public worship gives us a great variety of Holy Scripture.
The three-year Lectionary that many Catholics and Protestants hear in public worship gives us a great variety of Holy Scripture.
Churchmouse Campanologist 
