Terminally Ill Adults (End of Life) Bill

Committee (6th Day)

Clause 1: Assisted dying

Amendment 27

27: Clause 1, page 1, line 12, at end insert— “(e) has made independent contact with their local voluntary assisted death service for information,”Member's explanatory statement An independent voluntary assisted death service ensures that the person accesses independent information relating to assisted dying support.

My Lords, Amendment 27 would ensure that the person in question has made independent contact for information from their local assisted death service provider and has not been subtly coerced or pressured by someone who thought they ought to consider an assisted death. Getting information to inform decision-making is crucial to supporting autonomy. Patients must be able to access all the details they need about an assisted death from a place that is not their primary source of care, their doctor. Having alternative independent sources of information for an assisted death gives greater latitude for patients to understand their choice, and at the pace they need.

This Bill, as the sponsors have made very clear, is about autonomy. People’s autonomy in decision-making depends on having the information they need, and in any format that they require, as they drive their information-gathering process themselves, outside of the intricacies of the relationship with clinicians. The power imbalance between the doctor or senior nurse and the patient can be a distorting influence. This amendment is designed to give the patient agency in how they learn about an assisted death.

Amendment 42 would require that the person in question is fully informed. Having an assisted death is a hugely consequential choice for someone to make. Their understanding of the drugs they will take, how the process works and the consequences for self and others is crucial. I am concerned the Bill does not include enough details about the process through which this can happen. The Bill discusses but provides very few details about how this service is to be provided and funded. It feels like a black hole in the Bill.

The Delegated Powers and Regulatory Reform Committee noted:

“One might expect the integration of the assisted dying system with the NHS to involve a substantial degree of new regulation but the powers contain next to no indication of the shape or substance of the regulatory regime that is intended for VAD services. Instead, they give Ministers almost unlimited powers to legislate in that area by statutory instrument”.

We must heed what the medical bodies have said on this. The BMA said:

“There is nothing in the Bill about how an assisted dying service might be delivered, although the possibility of a separate service is mentioned in the explanatory notes. Whilst it is not for the BMA to determine how any assisted dying service should be delivered, our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways – it is not something that a doctor can just add to their usual role”.

Dr Mulholland, from the Royal College of General Practitioners, said in his evidence:

“The shape of the service is not set out in the Bill. We would say that GPs need to have a space where they can step away from it: that is the key point that we want to get across. For those who want to take part, it may be that they decide to do it, but it would have to sit outside the core general medical services that we provide at the moment”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 277.]

Amendment 28 also aims to avoid coercion by financial stringencies. Those patients thought to have a prognosis of a year or less are eligible for additional financial support under the special rules. The medical form SR1 triggers faster, higher payments than existing benefits, such as personal independent payments and so on, for those nearing the end of life. The prognosis of a year is, of course, a pretty wild guess, so the Department for Work and Pensions allows a three-year leeway before requiring greater individual assessment.

Ensuring that people can access all the benefits that they are entitled to is a safeguard against a person seeking assisted dying because of poverty. Evidence to the committee in the other place highlighted that people with a prognosis of over three months, and who are ineligible for fast-track funding, are often concerned about their savings being rapidly depleted by the higher costs of care and its impact. Dr Luke Geoghegan, policy lead at the British Association of Social Workers, stated in oral evidence to our Select Committee on the Bill:

“We have been clear from the outset that social care in this country is in crisis and people are not getting the services that they are entitled to. If you are not getting the care services and support services that you are entitled to, an assisted death may be something that you would not have considered otherwise”.

Financial pressures are real. Six months of care costs could equate to £25,000 to £40,000 of expense borne by an individual paying for their own residential care. Annual data from Oregon consistently shows that almost half of those dying by ingesting lethal drug doses are influenced by feeling a burden to others.

I must apologise to the Committee for failing to spot that Amendment 36 should not have been put in this group, hence I am not speaking to it now.

In responding, I hope that the noble and learned Lord, Lord Falconer, will explain how information to patients will be monitored for accuracy and impartiality. When the Minister dismisses amendments that have been drafted with the extensive help of the Public Bill Office, can she please explain how we can access the technical drafting support needed to ensure that amendments are workable, effective and enforceable? I beg to move.