Baroness Grey-Thompson:

Moved by Baroness Grey-Thompson

22: Clause 1, page 1, line 12, at end insert—“(e) is not a serving prisoner, and(f) is not detained by a hospital order,”

My Lords, I will speak to Amendments 22, 24, 30C, 308, 347 and 458. I tabled these amendments after looking at data from other jurisdictions and listening to debates in Another place. These amendments are probing. I want to be clear that they are here to invite debate not on the death penalty, abortion rights or who can become pregnant but merely on the groups and how they are impacted by the Bill.

With regard to my amendments on prisoners, those on remand and defendants on bail, there could be seen to be a conflict between prisoners’ rights to autonomy and the state’s duty to administer punishment. I was privileged to visit a young offender institution recently with the Duke of Edinburgh’s Award, which I chair. It is always very interesting to visit prisoners in young offender institutions and see the life that they live. UK staff are trained to spot prisoners who are at risk of bullying, suicide or self-harm. But I would like to understand—including in the context of what the right reverend Prelate the Bishop of Gloucester raised about prisoners’ access to primary care—how this would work in practice and which doctors would be allowed to have a conversation with prisoners.

Those deprived of liberty can be very vulnerable and prone to suicide. As we have heard, they could also experience a lack of care and palliative care. Yoann Della Croce argues that while prisoners in Switzerland should have the same level of care as the general population, assisted dying is a liberty that should not be extended to prisoners.

There are many international examples. Peter Vogt, a prisoner with kidney and heart disease in Switzerland, applied for euthanasia in 2023 due to physical and mental suffering, citing a life of “vegetating behind walls”. As of August 2020, three prisoners in Canadian federal prisons had received MAID. The process for these cases is complex, involving unique barriers such as bureaucratic hurdles and concerns about voluntariness and confidentiality in correctional settings.

This issue is not without controversy. Quadriplegic Marin Eugen Sabau requested euthanasia in 2022 after being shot and paralysed by police while being arrested. Due to the Spanish Government’s wording of the assistive Bill around incurable and unbearable permanent conditions, he was successful in requesting euthanasia. After initiating procedures in July 2022, and approval by the guarantee and evaluation commission of Catalonia, the process was suspended as a result of private and public prosecutors filing several appeals. Despite this, these were dismissed and the man’s euthanasia was carried out a month later.

In Belgium, Frank Van Den Bleeken asked for approval for euthanasia. It was initially granted, but the decision was later reversed. Similarly, in 2018, a Swiss inmate made a request to die through the EXIT society, because of an incurable lung disease and mental illness, arguing that refusing him access to assistance constituted psychological torture.

We have discussed vulnerabilities in other groups, but Professor Chris Whitty published a very useful report on the health of people in prison, on probation and in the secure NHS estate in England. It highlights some of the challenges and vulnerabilities that we have in debating these groups. At the end of life, there are processes for early release or temporary licence, but a prisoner’s decisions could be impacted by their experience, such as having nowhere to live or to go when they are released.

Briefly on the hospital order, it is issued when two doctors determine that the individual requires hospital-based treatment. I ask the noble and learned Lord whether these two doctors should be allowed to be part of the process.

I move on to my amendments on pregnancy, which I have to say have caused quite a lot of interest. A search of PubMed, looking for papers discussing cancer and pregnancy, produced 88,264 hits, of which 13,565 were published in or after 2020. A recent paper in 2022 on the epidemiology of cancer in pregnancy found that it occurred in approximately one in 1,000 pregnancies. Was there an Intervention? No—I am really sorry to say this, but I can hear really well in this position in the Chamber, and it is quite hard to concentrate while I can hear a lot of noise around me. I will just go back slightly to make sure that my points are able to be listened to.

A search of PubMed for papers discussing cancer and pregnancy produced 88,264 hits, of which 13,565 were published in or after 2020. In 2022, a paper on the epidemiology of cancer in pregnancy found that it occurred in approximately one in 1,000 pregnancies, which would be more than 500 cases a year in England. Of course, not all these cancers would be terminal; although, if terminal illnesses included treatable illnesses where treatment is refused, it could be a larger proportion. Of course, we do not know until a pregnant woman is given a diagnosis what treatment she may choose to have or not have. We know that cases can be aggressive due to hormonal changes.

Looking at the data, there is an awful lot about faecal vomiting, but there is not a lot about data around pregnant women. Dr Tony Duffy said in the BMJ on 8 April that it is

“frequently mentioned, but rarely seen”.

In terms of the numbers who could be impacted by the Bill, this is a really important group of amendments.

I recognise that my wording could have been better. Asking someone whether they are pregnant happens in a wide range of medical procedures, usually for women and girls between the ages of 12 and 55. It was absolutely not my intention to ask a 74 year-old to provide a negative pregnancy test. When I was pregnant and getting an MRI to assess the pregnancy, I was asked whether I was pregnant. It is not unusual that people are asked whether they are pregnant when they are going into operations or procedures.

These amendments are definitely probing, but they were not debated in the other place. The equality impact assessment says that a pregnant woman who also meets the eligibility criteria would not be excluded from the process. The EHRC, in its additional letter, which was sent in November to the noble and learned Lord, Lord Hope, who chaired the Select Committee, referred to the equality impact assessment and said that it lacked information in this area. I ask the noble and learned Lord: how does this Bill interact with the Abortion Act? Recognising that there may be conscientious objections in one part of this process, we cannot assume that someone’s view on abortion is the same as their view on assisted dying.

We know that, physiologically, drugs impact pregnant women differently and this needs to be taken into account when the drugs are being prescribed. Suicide is also the leading cause of maternal death during pregnancy in industrialised countries and the leading cause of maternal mortality in the first 12 months after childbirth. Professor Mark Taubert, hospital consultant and clinical director in palliative medicine at the Velindre University NHS Trust in Wales, has raised this issue many times. It would be useful for further information to be provided on the impact of the Bill on pregnant women or those who have recently given birth, particularly given the risk of postnatal depression and other pregnancy and maternity-related mental health conditions. This might include, for example, information about the importance and availability of mental health services, including for those with a terminal illness.

In the New Statesman on 13 November, Hannah Barnes wrote that when a woman enters a maternity unit

“she places her life – and that of her baby – in the hands of medical staff. But in Britain today, that trust is being broken”.

The CQC reports that half of maternity units require improvement or are rated inadequate. These are all things that can have an impact on somebody making a decision.

A woman may or may not know that she is pregnant. She may be more or less than 24 weeks pregnant. A woman may prefer to terminate the pregnancy prior to requesting assisted death, or she may not; she may just choose to carry on to end her life. But having information available is a really important part of making an informed decision. We need to know and understand whether there may be some sort of fast-track system for pregnant women who choose to enter this process.

Very briefly, on the drugs, my noble friend Lady Hollins has co-authored a paper on the drugs to be used. We will be debating this in later groups, but it is really important that we have time to do that. We also need to understand the impact, because we hear a lot about the length of time it might take someone to die. We have to be really careful that the right amount of drugs are prescribed and it does not elongate or cause more suffering in the death of a pregnant woman.

Looking at international jurisdictions, this is where the real complication comes in. In Canada, which has much more permissive practices than the UK, despite the lack of a statutory ban, pregnancy creates major ethical and practical barriers. The Canadian Medical Association and provincial regulatory bodies, including the College of Physicians and Surgeons of Ontario, emphasise foetal protection, treating viable pregnancies of more than 24 weeks as involving a separate patient. In practice, we cannot find data involving pregnant women under MAID in something like 40,000 procedures, but it is really important to understand the interaction and how it might work out.

In the Netherlands, euthanasia and assisted suicide are permitted for patients over 12, but pregnancy is explicitly discouraged and, in effect, prohibited for viable foetuses. Late-term abortions after 24 weeks are criminalised under the termination of pregnancy legislation, unless the foetus is non-viable or poses severe maternal risk. If we look at Belgium, euthanasia is allowed for adults and has been since 2014 for minors, but pregnancy triggers mandatory feticide and ethical reviews, making it, in effect, prohibited without foetal termination.

Other jurisdictions, such as Oregon, have no explicit pregnancy exclusion in assisted dying Laws, but advance directives and living wills often include them. Luxembourg, Spain, Colombia, New Zealand and Australia have very similar policies to Belgium and the Netherlands, where euthanasia laws prioritise foetal viability, requiring feticide or outright refusal. Colombia’s constitutional court ruling of 1997 protects life in formation, barring prenatal euthanasia without termination. These are really important things that we need to have much more clarity on.

Finally, I turn briefly to my amendments on homelessness. In Ontario, the chief coroner has reported that insecure housing disproportionately impacts people who are more likely to request assisted dying. They require two forms of ID and need to have an understanding of unmet need. In November 2024, More in Common found that only 6% of people thought it was okay for homelessness to be a reason. We have to understand the impact that homelessness might have on people’s decision-making abilities. Kit Malthouse in another place said that services such as St Mungo’s try to encourage people to seek support. But I have spoken to many people who are sleeping out and they are so distrustful of these services and fear going to them to ask for support. I would much rather that support was put in place to enable people to make a sensible decision.

We have heard a lot of noble Lords talking about the reality of the situation. I have given cases and information that show the reality of the assisted dying Bill and of the life in which we live. I believe that the public need more clarity on all the different examples in these cases, to understand truly whether they support the Bill. I beg to move.

My Lords, in giving support to Amendment 22, tabled by the noble Baroness, Lady Grey-Thompson, I will also speak to Amendment 30C in my name and hers. These amendments would prevent serving prisoners—those on a hospital order and remanded— and bail defendants accessing legally assisted suicide.

This group is about people in vulnerable categories having access to assisted suicide, but it must be said that anyone with a terminal illness is, by virtue of that, in a vulnerable group. I frequently came across that word in relation to female offenders when I was asked by the previous Government to chair a review on how to strengthen their family and other relationships to prevent reoffending and intergenerational crime. Hence, it seemed very important to define it. From the Latin vulnerabilis, it means wounding or being susceptible to physical harm or damage and emotional injury, especially in being easily hurt and subject to attack.

We can argue about relative vulnerability, but my now rather extensive experience of visiting men’s and women’s prisons has brought home to me that many male prisoners and men on remand are also highly vulnerable, for similar reasons to women. Without excusing criminality and overstating causality, I know that a very large proportion have had multiple adverse childhood experiences. Three-quarters of boys in the youth estate grew up with only one parent, typically an overworked mother, and one-quarter of adult prisoners spent time in local authority care. I know that adversity can develop a deep seam of resilience in a young person or adult, but research shows that it is far less likely to happen without healthy supportive relationships. This is the very ingredient lacking in the lives of very many of those sitting in our prisons. A conservative estimate is that around half of prisoners do not receive visits from anybody outside.

Few of us can imagine the despair that settles in when people enter prison: the inner turmoil and the sense that their life has been ruined. Those on remand can feel stuck in limbo for months, given the severe backlogs in our criminal courts. Sentenced prisoners at least have some certainty. Detention in prison is the punishment, and the state has a duty of care while people are detained, which is why levels of self-inflicted death are of such concern to the Prison Service. The suicide rate for prisoners on remand is approximately 1.8 deaths per 1,000 prisoners, while the rate for sentenced prisoners is less than half of that—approximately 0.8 deaths per 1,000 prisoners. My review team worked out that the cost of the inquiry that followed each suicide was around £2 million in 2017’s money. In 2024, people on remand accounted for about 34% of all self-inflicted deaths in custody, despite being 20% of the population.

Noble Lords might ask: what does that have to do with assisted suicide? The duty of care we owe to remand and sentence prisoners should disallow a death sentence being carried out when they are already far more likely to be in the frame of mind that says that they just want to end it all when a terminal illness is diagnosed. We have an ageing prison population, and one that is full of historical sex offenders. That is the compassionate reason. We should be able to promise them excellent palliative care and not play into an understandably exaggerated desire to end it all quickly on their terms—their last act of control in a life that has spiralled out of control.

But there is a more hard-edged reason: compassion to victims. We do not want sentenced prisoners or people remanded in custody while awaiting trial to have access to assisted suicide to avoid justice. Jeffrey Epstein was officially ruled to have died by suicide in his cell while awaiting trial. There is also the famous case of Goering after the Nuremberg trials. Conspiracies abound, but the principle remains that, if terminally ill adults know they can be assisted with their suicide, this implies a possible moral hazard if the cost of committing a crime is dramatically lowered.

Why did I include defendants on bail? The events leading to the tragic death of Caroline Flack have been in the news again this week because of the media pile-on she endured while awaiting trial for domestic abuse. She could see no good outcome and the coroner ruled that she died by suicide at the age of 40. Her boyfriend had not wanted to press charges, but another victim would have felt cheated of justice.

An impending trial, whether one is bailed or remanded, or the sense of hopelessness a prison sentence can induce are particularly confounding factors when a person receives a diagnosis of terminal illness, in terms of what steps they wish to take. We cannot ignore the extent to which these factors will profoundly compromise their applications for assisted suicide, so barring them from the provisions of this Bill would be compassionate to both them and the alleged or proven victims of their crimes.

My Lords, I have put my name to Amendments 22 and 24 in the name of the noble Baroness, Lady Grey-Thompson, and support the other amendments in this group, which relate to the fact that prisoners, people detained under a hospital order, homeless people and those who are pregnant require special care because of their situations.

Suicidal ideation and depression as a result of incarceration, with limited ability to access outside resources due to imprisonment, are very common among prisoners. One study found that 61% of elderly male prisoners had a mental disorder. Primary care mental health services are still being developed in prisons to provide for conditions such as depression, anxiety, post-traumatic stress disorder and learning disabilities. That vulnerability, combined with a terminal illness and probable lack of access to good palliative care, means that their welfare is a special responsibility of the state. Special arrangements must be made to ensure that they do not feel they have no option other than to opt for assisted death.

Suicidal ideation is also very common among the homeless. The noble Lord, Lord Bird, recently spoke eloquently in your Lordships’ House about the problem of poverty, which so often results in homelessness and the hopelessness which accompanies poverty. Solutions to things such as poverty and homelessness should not involve offering people assisted death rather than a home, possibly in sheltered accommodation, in which they may be able to flourish.

The noble Baroness, Lady Grey-Thompson, spoke eloquently about pregnancy. I want to add just a couple of things. Pregnancy is not an illness, but pregnant women are at a higher risk of mental illness. The Maternal Mental Health Alliance reported that at least one in five women develops a mental illness during pregnancy or within the first years after having a baby and that maternal death due to mental health problems is increasing and suicide remains the leading cause of death in the first year after birth.

I declare an interest as chair of the Maternal Mental Health Alliance. The figures have been updated; currently, one in four women experiences a mental health condition in the perinatal period, either during pregnancy or in the two years after birth.

I thank the noble Baroness for her Intervention. I also want to raise the risk of domestic abuse, which is much higher during pregnancy. The Maternal Mental Health Alliance says that up to 30% of domestic abuse cases begin during pregnancy.

Ending someone’s life with lethal drugs while they are pregnant raises additional layers of moral, legal and medical concern—for example, consent, the viability of the baby, conflicts of interest, et cetera. Pregnancy causes drugs to be processed differently. The rate of absorption is affected by physiological changes. That could mean a slower or more prolonged death from the approved substances for both mother and child. Women are particularly vulnerable, and the safeguards just do not seem to be in the Bill at present.

The amendments from the noble Baroness, Lady Berridge, in this group relate also to those up to the age of 25 who have an EHCP, which may be provided to vulnerable children, including those with special educational needs and mental health concerns.

Finally, the noble Baroness, Lady Hollins, has told us that young people with complex needs may be at a higher risk of internalising negative societal values about their disabilities. The National Down Syndrome Policy Group states that people with learning disabilities can be highly suggestible and prone to acquiescence bias, agreeing with authority figures to please them.

There may also be diagnostic overshadowing, the risk that a young person’s desire to die might be as a consequence. In this context, a young person with an EHCP, for example, might request assisted dying not because their condition is intolerable but because the social care and support legally promised to them has failed to materialise, making their daily life situation unbearable. That could be misinterpreted by clinicians as a rational choice due to their disability. It is therefore the case that special provisions, such as those identified in these amendments, are necessary to ensure proper support, and that the various vulnerable groups of people do not feel that they have no choice.

My Lords, I want to speak specifically to Amendment 22, about why prisoners should not be eligible for assisted dying. The amendments from the noble Lord, Lord Farmer, are also pertinent here.

The right reverend Prelate the Bishop of Gloucester raised the real and specific safeguard issues from the lack of medical records of prisoners, and I am sure we will hear more about the problems of medical care for prisoners. The terrible terminal diagnosis that one might get as a prisoner would be particularly frightening, I would think, because of the lack of medical care.

That is actually not my concern. Regardless of where one stands on assisted dying in general, I really hope that, when it comes to this Bill, noble Lords will consider the very particular circumstances of those incarcerated by the state. I hope the sponsors of the Bill will still be open to excluding prisoners and keeping them out of the Bill, on the basis, if nothing else, of their lack of autonomy.

I have to confess that I was rather taken aback when I heard Minister Stephen Kinnock in the other place state that excluding prisoners from this Bill would lead to a difference in treatment between prisoners and non-prisoners, an inequality, citing Article 8, private life, and Article 14, discrimination, of the ECHR. He noted that differential treatment would require objective and reasonable justification. It seems a bit shocking to me to have to explain this to a Minister, but my objective and reasonable justification is that, if you are in prison, you do not have the same rights as if you are not in prison. I did not make that up—although I know the Sentencing Bill has gone a bit liberal.

Actually, I think that, you know, you are deprived of your liberty. Many of the arguments made by the advocates of the Bill about autonomy and giving people choice towards the end of life, in particular circumstances —which I completely understand, philosophically and politically—are entirely appropriate for free people. But when you are not free and do not have autonomy, it brings with it a whole new range of ethical dilemmas.

The purpose of prison is, as I have said, to suspend certain rights from people to protect the public, to ensure deterrence and to uphold a sense of justice in society—I could go on. When the state has deprived an individual of so much autonomy, for all the criminal justice reasons we know, offering the option of an assisted death does not increase their autonomy in a meaningful way. It is saying, “Oh, well, we’re giving them choice”—but their real choice would be being able to leave. In other words, we have limited their choices.

Why does this matter? It is because, when the state decides to deprive somebody of their liberty, it is a very serious decision. For me, it is the worst possible punishment you could give: you are limited in being free, which I obviously consider to be very important. Prisoners, inevitably, are depressed: and often they are vulnerable in the first place. That is why they are prone to suicidal ideation.

Those of us who have had the privilege of doing some work with prisoners will know that we spend a lot of time tackling self-harm, with people hating themselves and the circumstances they are in. We do a lot of work on that. I and many others have worked on IPP prisoners, who are, ridiculously unfairly, still in prison indefinitely based on an abolished sentence, often for minor breaches of the law in the past. It is always shocking when you hear of another IPP prisoner who has taken their life. It is particularly horrible, as many noble Lords here have articulated far better than I can, because it is almost like it is on the state’s conscience. That is the reason why coroners make such a fuss about it. Those prisoners should not be there; they are in prison because the state made a mistake with the sentencing regime that it will not resolve and then they take their life. The state is somehow implicated in those suicides and we make a particular point of that.

Those of us who have worked in prisons will also know that suicide prevention is something we take very seriously. It does not matter how heinous the prisoner’s crime is. They could be a child abuser, a rapist or a murderer, but, if there is even a hint that they might commit suicide, there is suicide watch. We do all sorts of suicide prevention. The reason is that, as a humane society, we do not think that people should be allowed to take their own life, if at all possible. We have suicide watch in prison because the state has somebody incarcerated. Therefore, as a humane society, you take seriously not letting them kill themselves: otherwise, you could just say, “Carry on boys, it doesn’t matter”. We do not do that because we think that we have to protect those prisoners in the state’s care.

Right, I will finish. Letting prisoners have access to and be eligible for assisted death would be very close to reckless state abandonment of those prisoners to something very deeply dark. Philosophically, if a penal sentence in Britain ends up with the state effectively putting a prisoner to death via lethal drugs—I do not want to go on, but that is what would have to happen: they would be locked up in a prison, in the state’s care, the state would then make them eligible to ask for assisted dying, with limited autonomy, and would then hand them lethal drugs—that is far too like capital punishment, which I have long opposed and do not approve of. Therefore, even if you do not agree with me on the rest of the Bill being a completely difficult challenge to humanity, which I think it is, I none the less suggest that, if we pass it, we should absolutely exempt prisoners from it.

My Lords, I support these amendments, particularly those relating to prisoners and, indeed, what the noble Baroness, Lady Fox, so eloquently expressed. Just before I do, I will also support something that the noble Lord, Lord Blencathra, who is now not in his place, said earlier, when he complained about some of the exterior noise around those of us who are debating this Bill.

I declare an interest as a general practitioner, not of medicine but of journalism. I know very well what happens and how to recognise when we are being pushed to do a story. In the past two weeks, all the British media have been pressed very hard by lobbyists in favour of this Bill to produce a series of highly contentious arguments that attack anybody who tries to debate the Bill fully. This is very much at odds with the spirit of legislation of this sort, and with what the noble and learned Lord, Lord Falconer, keeps trying to do. He says at the end of each group what a valuable debate it has been. He does not say, “What a waste of time this debate has been”; he says it has been valuable, which it has been. I have learned a lot today, for example, about GPs and their difficulties, and we are learning more about prisoners. There was a virulent article in The Times by Nicholas Boles, who was an informal—

Forgive me. What the noble Lord is saying is very interesting, but could he possibly keep to the Amendment? The amendments are quite tricky and really do need discussion.

I am grateful to the noble Lord. As I said, I will come on to the Amendment soon, but I want to emphasise this point because I think that it matters a lot in this debate and will matter in the coming weeks. A particularly virulent article in The Times, written by Nicholas Boles—he was, until recently, an informal adviser to the Prime Minister—put these arguments in a way that was quite inappropriate for the type of discussion on a conscience issue that we are having.

On prisoners, I want very much to pursue the point about autonomy, which is absolutely right. It goes to the heart of this Bill, because the Bill’s supporters are those who give precedence to autonomy over all other things. The people who are more questioning of the Bill do not necessarily do that—at least, they think that there are many qualifications to the right of autonomy.

As the noble Baroness, Lady Fox, pointed out so eloquently, this issue very much applies to prisoners, who have a double loss of autonomy in prisons. First, their autonomy has been taken away from them by the decision of the state, as expressed in the quaint phrase “at His Majesty’s pleasure”; it is not “at the prisoner’s pleasure” but “at His Majesty’s pleasure”, which is an expression of the power of the state and the prisoner’s loss of autonomy. Secondly, prisoners lose autonomy in another way because of their vulnerability and the situation they are in.

The point I wish to add to this argument is to do with the Government, rather than the movers of the Bill, although it affects them, of course. In evidence to the Select Committee, the relevant Minister at the Ministry of Justice, Sarah Sackman, said that, as far as the Government are concerned:

“The policy choice that the option of a voluntary assisted death be extended to those in prison is just that. It is a policy choice on which the Government are neutral”.

I do not understand how the Government can be neutral on a matter that is entirely within their purview, and I would like to hear what the Minister has to say about that.

My Lords, I will speak to Amendments 30A and 119A in my name, which relate to children and young people who are under an EHCP. I offered to withdraw these two amendments in order to shorten proceedings; by putting that on the record, I will shorten the meeting offered by the noble and learned Lord, Lord Falconer, but not necessarily these proceedings.

I am grateful to my noble friend Lady Coffey for spotting a typo in Amendment 119A—ECHP instead of EHCP. Please may we not create any more quangos with that combination of letters?

The Select Committee heard from Dame Rachel de Souza, the Children’s Commissioner for England, about the basic policy reason behind some vulnerable adolescents and those with additional needs being under her jurisdiction until they are 25: they need the extra support to transition into adulthood. Amendment 30A would remove all young people under an EHCP from the Bill; Amendment 119A on this policy ground would mean them falling under the Act, but with additional conditions. Such an issue may be additional subject matter for the promised meeting. Would these be the right conditions, were we to accept Amendment 119A?

The Children’s Commissioner’s jurisdiction also covers anyone under the age of 25 who has ever been in care. She has a specific responsibility for children up to the age of 25 who have an EHCP. I note that, in law, it is not 18 for all purposes. You cannot adopt children until you are 21. So, at the moment, the Bill does not produce a cliff edge at the age of 18.

Some of the young people on EHCPs may lack capacity and are, therefore, outside the scope of the Bill. As the noble Baroness, Lady Hollins—she is no longer in her place—has often said, assessing the capacity of people with learning disabilities is a complex matter. However, many young people are on an EHCP because of other additional needs or considerable childhood traumas; they will have capacity and will, therefore, come under this Bill. It is again relevant to think of them at 18 years and one day old, and with a life-limiting condition. Sadly, due to the lack of the usual pre-legislative processes of consultation, a white paper and scrutiny, we are without the data on these vulnerable groups showing how many in the EHCP or under High Court DoLS also have life-limiting conditions. That data would give us an idea as to the priority of conditions for different groups.

In the Select Committee, Ken Ross of the Down’s Syndrome Association stated that people with Down’s syndrome cannot always fully comprehend complex decisions and have very suggestible minds. This is why there are additional safeguards in the EHCP, but if they have capacity, they are under the Bill currently without any additional safeguards.

Again, due to the process of the Private Member’s Bill, it is not clear how this legislation sits with other legislation and safeguards. Has the Bill been considered by the Department for Education, which has responsibility for children under the 1989 Act? Has the noble and learned Lord met with those Ministers? For instance, just to give an array of possible problems, in many cases local authorities legally still have a role for those under an EHCP after the age of 18. How will that fit with the processes outlined for assisted dying? Will there be a clash of decision-making from the EHCP special educational needs panel and the TIA panel?

What legal authority does the local authority have on safeguarding grounds to intervene in the panel’s process for a young adult on an EHCP if it disagrees with the assessment by the panel that the young person is making the request for assisted dying due to peer pressure or, as Ken Ross suggested, an enhanced susceptibility to pressure from white coat syndrome for those with Down’s syndrome? Is it mandatory for the TIA panel to get information from the SEND panel? Can the SEND panel appeal the decision to grant assisted dying? It seems not, so the family and the local authority will be left with the expensive and difficult remedy of judicial review.

Has the noble and learned Lord considered the evidence from the British Association of Social Workers? It states that the panel needs the power to do its own safeguarding assessments, or the power to close a case a local authority is seized of under Section 42 of the Care Act 2014. Otherwise, assisted dying could be granted and there could still be an open safeguarding case at the local authority unless the panel has the power to investigate and close it. These issues would have been flagged on a government write-round or during proper pre-legislative scrutiny. I am disappointed at the lack of meetings so far, as we need a proper process to consider the position of many vulnerable 18 year-olds on the day after their 18th birthday.

Bearing in mind Amendment 22, which the noble Baroness, Lady Grey-Thompson, mentioned, I wonder whether she, the noble and learned Lord or the Minister are aware of whether the policy decisions made for pregnant women in other jurisdictions are based on policy alone or on clinical evidence. If there is clinical evidence that drugs can promote and induce labour, is that why other jurisdictions have taken pregnant women out? That is relevant, because I have amendments later in the Bill about warning relatives of complications, especially if there is going to be a person under 18 present while assisted dying is being given.

Finally, on the points raised at the start of the proceedings by the noble and learned Baroness, Lady Butler-Sloss, I did not have the benefit of listening to the “Today” programme, but we are dealing with so many groups of vulnerable people. That is because of the lack of pre-legislative steps that we usually have. Groups would have been consulted and there would have been a White Paper. I have been exchanging optimistic emails with the noble Lord, Lord Carlile, but for me personally it is an open question, bearing in mind the lack of pre-legislative scrutiny, whether the Private Member’s Bill process actually fix that.

I know that the noble and learned Baroness worked with the noble Baroness and that she is very fair-minded, but I have had cause to look at the evidence from the Jersey States Assembly, a small Parliament. It was drawn to our attention in the Select Committee by Alex Ruck Keene KC that some instructions went to 200 pages, so I asked the Library to do some research and the Jersey parliament’s process is gold-plated. Not only that, but its website is much easier to use than parliament.uk and one can look at the process and timetable from 2021. When the States Assembly approved what it was going to do, the Executive—the Minister for Health and Social Affairs—gave drafting instructions to parliamentary counsel. To write a piece of legislation fit for purpose, they ran to 201 pages. We say that we are the mother of Parliaments in the Commonwealth context, but that is the way to legislate. I keep open in my conscience whether this process can fix the problems with the Bill which are such that none of the royal colleges is currently supporting it.

My Lords, I speak to Amendment 22 in the name of the noble Baroness, Lady Grey-Thompson, to which I have also added my name. I declare my interest as Anglican Bishop to prisons in England and Wales.

There are many reasons why I believe that assisted dying may not be a fair choice for the general population, as things stand, but today I am shining a spotlight, as has already been said, on the prison population. I do not think that there has been enough attention in the debate so far on how the Bill would function for those in prison. I do not apologise for having spoken about prisons in the previous group, because this Amendment 22 is about excluding prisoners from the Bill, but the previous group of amendments assumed that prisoners would still be in the Bill. Therefore, we still need to look through that lens when we are discussing issues about GPs and medical records.

The prison population is in worse health than the general population. We have heard that. However, the reports from both the Health and Social Care Select Committee in the other place and the Chief Medical Officer paint a more concerning picture than that. Age-related illnesses, dependency and frailty can begin at an earlier age than in the general population. The prison population is ageing faster, and when I am visiting prisons I never cease to be shocked by the number of extremely elderly and frail people in prison. In most places, the prison system is not able to meet their needs properly—and that is not to criticise the prison staff, who are doing their best.

Nacro reported that, in 2019-20, people in prison missed 42% of scheduled hospital appointments. The Health and Social Care Select Committee goes as far as to say that

“so-called natural cause deaths, the highest cause of mortality in prison, too often reflect serious lapses in care”.

As has been said by the noble Lord, Lord Farmer, there is a lack of palliative and end-of-life care in prisons and, although there are some examples of excellent practice, action to improve this is voluntary and not supported by the commissioning of services.

Noble Lords may well say that prisoners should have equal access to care under the law, including assisted dying but, as has already been said, they do not currently have equal access to care. For me, this is not simply about the prison system and healthcare; it is about the perspectives and sense of well-being among those in prison. I will not rehearse everything that has already been said, but will just reiterate that the prison population experience high levels of hopelessness. We have frequently and rightly spoken about IPP prisoners in this House.

Again and again as I visit prisons, I hear about and see evidence of the high levels of self-harm in our prisons; it is particularly high in the female estate. Self-inflicted deaths in prison are predicted to continue to rise disproportionately compared to the general growth of the prison population. We need to be cognisant of the fact that, during the special Select Committee on the Bill, the Royal College of Psychiatrists talked about how a person’s wish to hasten their death can be impacted by what their life is like.

Although compassionate release is an option, it is rarely taken up. Crucially, according to Macmillan Cancer Support’s A Guide for Prisoners at the End of Life, it also requires a three-month prognosis. How does that interact with the Bill?

I visited a prison recently where there were discussions about a very elderly, sick, frail man being released from prison. Ironically, his family said, “Please don’t”, because they felt he would be too vulnerable being back in the community where he committed his offences. What options are there for him?

I want to reiterate the question: are we keeping our prison population in mind as a vulnerable group in the Bill? Particularly when our prisons are overcrowded and, to be extremely frank—although I think the noble Baroness, Lady Fox, was franker—the desire to remove people from the system is high. I fear how the Bill could play out among the prison population and hope that noble Lords will give further consideration to this important issue.

My Lords, I want to make a very brief Intervention in relation to the prison population. It is only the second time I have spoken on the Bill. I declare an interest as a trustee of the Prison Reform Trust.

The suicide rate among male prisoners is four times as high as that of the general population. In the year to 2024, 89 male prisoners committed suicide. The Prison Service has a duty of care towards the prison population to protect them from committing suicide—to stop it. The Government run the Prison Service, so they must have a view on what to do about a prisoner whose suicide the Prison Service has correctly thwarted under its duty of care but who then requests an assisted death under the Bill. How will the Government balance those two conflicting things?

That is my short intervention—to ask that question. I wholly support all the comments made by the noble Baroness, Lady Fox, the noble Lords, Lord Moore and Lord Farmer, the right reverend Prelate the Bishop of Gloucester, and others on this crucial issue. I am genuinely interested to know what the noble and learned Lord, Lord Falconer, makes of this dilemma for the Prison Service and the Government.

My Lords, the moments in the Bill that most concern me are when it gets nearest to saving money. There are several occasions on which that appears to be the case, particularly when talking about people for whom many have no sympathy at all, and when you are talking about a service in which we all know we are failing. It cannot be true that any Member of this House believes that our prisons are as they should be. Yet we imprison more and more people. We imprison twice as many people as the French or the Germans. I still do not understand why we cannot take this seriously, but we still go on doing it.

First, can one really think that someone in prison circumstances finds it possible to make the same kind of decision as people who are not? Just simply, those circumstances are the pressures, the crowding and the fact that you are not in any company that you would have chosen. I do not believe that those are the circumstances in which the Bill’s proponents meant for decisions of the sort we are talking about to be made.

The second issue is: what about the pressures there? We have been talking about the concerns of those who find themselves under pressure. Do we really believe that there will not be many prisoners for whom the whole issue will be presented as, “You will be better off and we will be better off if you make this decision”?

The third issue is surely this: we know that prisoners have much worse healthcare than people outside prison. Therefore, the fact that they are told that they have but six months to live is much more difficult than it would be if they were in normal circumstances. I put it no more sharply than that, but it does seem to be true.

Fourthly, earlier on, we were talking very strongly about the difficulty that the Government are willing to fund this when they are not funding palliative care for very large numbers of people in the country. I therefore come back to my deep concern that it will become so much easier for people to die than to continue.

The right reverend Prelate, whose experience is remarkable and whom I admire enormously for her work in the prisons, has reminded us of how old the prison population is and how much older it is becoming. I just do not think that those of us in this House who really believe that our major job in this Bill is to protect the vulnerable can possibly agree that people in prison should be included under the Bill. We should take them out.

May I just offer a different perspective on this? It has been an interesting debate. One of the main reasons I am supportive of assisted dying is kindness—kindness to the people who are scared about the inevitable end of their life and kindness in that they face a lot of pain. They see assisted dying as a way of relieving themselves from that pain.

In this debate, are we saying that people in prison are not deserving of that kindness? People in prison have been deprived of their liberty because of the crimes they committed, and that is the punishment that they have been given in the face of the law. That is the debt being paid to society. But are we saying at the same time that they do not deserve the same kindness that we would give to others and that they should face pain because they are in prison, whereas others should not? That is my perspective on this.

My Lords, I put a question to the noble Lord who has just spoken. I am really concerned—

The noble Baroness is intervening on somebody who made an Intervention on somebody else. We got a very severe talking to about that before, so I do not think that is allowed.

I did not realise that the noble Lord was intervening on me, but I will just say that, for me, it is very difficult to have that argument. Kindness is absolutely the central point of everything that I believe in, so I am very vulnerable to that question. But the truth is, the Bill does not talk about pain at all. There is nothing in the Bill about pain. This is about a totally different circumstance. One of the problems in the country as a whole is that many people who support the Bill do so because they think it is about pain.

We could have a Bill about pain, but then we would come back to the point made by the noble Baroness, Lady Berridge, that that is not what the Bill should have been. The Government should have said that they would give a free vote on a government Bill on this subject, rather than slipping it in in a wholly different way.

However, we are faced with what we have, and in that case it does not seem kind to say to people who are under all sorts of pressures and who are particularly vulnerable that this is a choice they should make. If we want kindness, we should be saying to the Government, “Get the Bill withdrawn and introduce a government Bill that is properly thought through where we can have the real debate that the public as a whole want us to have. You can still have a free vote”, but it should never have been put through in this way.

If I may respond on the pain point, I have spoken to lots of people who are terminally ill and heard their evidence. Again, I recommend that as many people as possible hear them because they have heartwarming stories. For them—not all the time, but a lot of the time—it is because they want to have that choice at the end so they do not have to face that pain. That is a key reason for them. The Bill says that you have to be within six months of the end of your life, but then you have the choice within that. For some people, the thought of that pain, and the experience of that pain, is the real reason why they want an assisted death. My point is that I believe prisoners should have exactly that same right so that they have the possibility to avoid that pain.

My Lords, I support Amendments 308 and 347 regarding the availability of assisted dying services to people who are homeless.

The intention and the fundamental principle behind the Bill are that terminally ill individuals are able to exercise their autonomy and end their lives on their terms and at a time of their choosing. But, as many noble Lords have articulated during the passage of the Bill, that is a vision of autonomy that simply does not exist for far too many people. We do not live in a society where everyone is equally able to make decisions without being constrained by external influences, whether that is in the form of other people or simply follows from one’s own life circumstances. Indeed, the noble Baroness, Lady Grey-Thompson, has highlighted the ways in which society does not always afford even her that degree of autonomy despite her extraordinary career and achievements, from physical obstacles that prevent her having equal access to the public transport that is supposed to serve everyone to people who are not disabled telling her that, were they in her position, they would not keep on going.

Not only are people who are homeless by definition cut off from and invisible to key public services, including healthcare, but they often have complex further needs, such as abusive relationships, poor mental health and addiction. How can we imagine that they will not be at risk of being offered an assisted death simply because those needs are judged too hard to meet, or because someone else has decided that their lives are not worth while? We have seen that happen in jurisdictions such as Canada, where the parameters for an assisted death were widened soon after the law was passed, and we duly saw examples of individuals dying by Medicaid explicitly because they were affected by isolation and homelessness. Yes, the Bill differs from the law in Canada in that it requires a terminal diagnosis, but as soon as that threshold is crossed there is nothing in the Bill that would stop a person accessing an assisted death for reasons that were nothing to do with their illness but simply because they had been too worn down for too long by problems that could have been solved with the right care, attention and funding.

This year, Crisis and Pathway reported that almost 80% of health professionals say that homeless people are discharged from hospital with unmet health needs, and 92% of homeless people find mental health care difficult to access. The average age of death is 46 for a homeless man and just 42 for a homeless woman. Their circumstances deprive them of autonomy because they remove meaningful choice. That applies just as much to the gravely ill person sleeping rough or isolated in temporary accommodation as it does to the one who cannot afford proper palliative care at the end of life.

While I have other reservations about the Bill and the pressuring effect it will have on disadvantaged groups, I am especially concerned that we are looking to introduce it at a time when the cost of living means that homelessness has reached critical levels throughout the UK. Only yesterday, the Government published a national plan to end homelessness, and I commend my colleagues in the Government on that, but there are some shocking statistics in that plan about the numbers who are homeless. It paints a picture of utter despair and isolation for some of the most vulnerable in our society. It is wholly impossible to justify leaving out safeguards that would prevent homeless people being coerced into an assisted death, whether through abuse, absence of choice or simply their despair. I urge noble Lords to support Amendments 308 and 347.

My Lords, I rise very briefly to support my noble friend Lady Berridge’s Amendment 30A on EHCPs, and I declare my interest as founder of a special educational needs college. All our students have EHCPs, and all of them, in their various ways, are vulnerable. What I have learned in the years that I have been campaigning for people with learning disabilities is that they are always at the bottom of the heap when it comes to making legislation. I can only think that, once again, in drafting this Bill, this cohort has been forgotten. People with an EHCP should not be included in the Bill.

My Lords, I support Amendments 22, 308 and 347, tabled by the noble Baroness, Lady Grey-Thompson. Amendment 22 rightly seeks to exclude serving prisoners and those detained by a hospital order from accessing assisted dying under the Bill. As we have heard, the Bill speaks the language of choice, autonomy and settled intention, yet this group are, in effect, the group least likely to have choice, autonomy and settled intention. Nevertheless, these are men and women living in overcrowded, often violent environments, cut off from family contact and support networks, access to services and meaningful work—those things that provide a context for someone’s life. Many are traumatised, mentally ill or struggling with addiction.

Prisoners, as we know, are an exceptionally vulnerable population. In a report published in July this year, the Prison Advice and Care Trust—PACT—warned of the mounting mental health crisis in prisons, where mental ill health is the norm and not the exception. It goes on to note that rates of self-harm in prisons have more than trebled in the last decade, from nearly 26,000 in 2014 to just over 79,000 in 2024, and reflects that recent data shows that, among prisoners, 56% of men and 74% of women report having mental health problems. In the year to June 2025, government statistics show that there were 86 self-inflicted deaths per 1,000 prisoners.

Behind these statistics lies a culture that breeds hopelessness. It is into this context that we are proposing to make serving prisoners eligible for an assisted death. I am deeply concerned that, terminal illness aside, if you design a scheme in which a person’s own sense of despair may well be a key trigger, and there is no requirement for asking someone what their motivation is for engaging in this act, those who feel most hopeless will be the most susceptible. By any objective measure, prisoners are perhaps among the most hopeless within our society.

I note that in response to a question during the Select Committee evidence sessions, the Minister of State for Courts and Legal Services, Sarah Sackman KC, MP, commented that, as we have already heard, this is a policy choice on which “the Government is neutral”. But she went on to say that much will depend on its interaction

“with the wider prison regime and some of the challenges that lie therein”, and that there would be a need to ensure that the Bill operates in a way that

“does not lead to abuse or is not misused”.

I would like to learn from the noble and learned Lord, Lord Falconer, precisely how he intends to ensure that this is not misused within the prison system.

I wonder whether the Minister and indeed the noble and learned Lord have considered the 2021 Hospice UK report Dying Behind Bars. The authors note that

“up to 90% of older incarcerated people have at least one moderate or severe health condition, with over half having three or more”.

I have great sympathy for the comments made by the noble Baroness, Lady Fox; clearly, the state has already taken from these individuals their liberty as a punishment to protect the public. The state is of course also responsible for the delivery of healthcare within prisons. In such an imbalanced power dynamic where the state has such overwhelming power, the shift this legislation represents as drafted, whereby the state may say to a prisoner who otherwise meets the eligibility criteria, “We will help you die”, is a profound challenge. I am concerned that if we fail to exclude prisoners from the remit of the Bill, we risk undermining the comprehensive suicide prevention programmes operating in our prisons.

Providing access to assisted dying in prison sends a chilling message that where the state has failed to provide adequate care, resources or meaningful autonomy, its final offer is death, which is why I support this amendment. I am conscious of time, though, so will speak only briefly in support of Amendments 308 and 347 in the name of the noble Baroness, Lady Grey-Thompson.

Noble Lords will perhaps be aware that I ran community projects for homeless people for the better part of two decades. I will not repeat what others have said, but the complexity of the lives of people who are homeless cannot be overstated, and I am deeply concerned that the Bill fails to account for their specific needs and risk factors. People experiencing homelessness already face significant obstacles to accessing the healthcare they need. The NICE guidelines for integrated health and social care for people experiencing homelessness note:

“Barriers to access and engagement with preventive, primary care and social care services can mean that problems remain untreated until they become very severe and complex”.

It seems entirely reasonable to reflect the complexity of the lives of people experiencing homelessness, as the amendments in the name of the noble Baroness aim to do.

I accept that the legislation is based upon the premise of autonomy, but autonomy is not absolute, and we do not live as isolated individuals. It is reasonable and appropriate to ensure that this legislation is as safe as possible, with vulnerable populations in mind. To that end, I also strongly support Amendments 308 and 347.

My Lords, before we proceed, I will just say that we are getting to the point where we should begin to think about Front-Bench replies to this group of amendments so we can finish at around 3 pm. I do not want to break mid-group because that, of course, is very difficult for the House, Members and the clerks, as it will have to be recorded. Perhaps your Lordships can just bear that in mind, as I am conscious that the time now is nearly 2.40 pm.

My Lords, I want to make a practical point. It is obvious that this will be the first Act in relation to assisted dying. Clearly, it is unjust because it does not deal with people with motor neurone disease and so on. Why does the House not accept that the issue of prisoners should be in the next Bill and not the present one?

My Lords, I will keep my remarks very brief. I rise to speak in support of Amendments 30A and 119A in the name of my noble friend Lady Berridge. I thank her most sincerely for tabling them and thank my noble friend Lady Monckton for her supportive remarks. Disabled people and people with Down’s syndrome should know that this House would never treat them as bottom of the heap.

Given the evidence provided to the Select Committee by the National Down Syndrome Policy Group, the question to my mind is not so much why we would want, but why would we not want to support the provisions in these amendments? We are talking about vulnerable young adults who deserve and need extra protection on account of their disability. I say that as a disabled person who has been involved in championing disability rights for almost 30 years. Such protection as would be afforded by these amendments is neither patronising nor discriminatory. On the contrary, it is our duty to strike the correct balance between rights and protection. I believe these amendments do so.

My Lords, I will speak for just a couple of seconds as I am very mindful of time. I support Amendments 24 and 458 in the name of the noble Baroness, Lady Grey-Thompson. We have had very little debate about the issue of pregnancy. I am quite shocked by that, given that there are administrations around the world with many years of experience, such as Oregon, which had similar legislation in 1997, and Belgium, which had it in 2002. They considered the issue of pregnancy during these very delicate discussions on assisted dying.

I am somewhat disappointed and concerned that the noble and learned Lord, Lord Falconer, has not addressed this, and I really hope that this can be addressed on Report. There is a world of difference between a very early pregnancy and a baby close to full term, which is reflected in our Abortion Act. May I therefore give the noble and learned Lord some advice? When this does come back on Report, the issue of pregnancy should be addressed, as it has been in other jurisdictions.

My Lords, as Amendment 24 has been tabled and pregnancy has been spoken about, I now feel that I ought to just make one point very quickly. The noble Baroness, Lady Grey-Thompson, quite rightly presented a lot of statistics about cancer, but that she did not address the issue of cancers of the pregnancy itself. That is a serious issue. Choriocarcinoma, for example, is a fatal disease; it is rapidly metastatic, can cause issues all over the body and is not easily treatable. It could easily be that somebody who was pregnant with that, who would test pregnant with that condition, would be eligible. I therefore ask the noble Baroness to consider not pressing her amendment and to reconsider the wording of it, because I do not think that it would be an acceptable amendment later on. Both early in pregnancy and in late pregnancy, this would be a real risk.

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.

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.

We have been there before on issues with prisoners. We did it on voting. We found a messy compromise but basically prisoners are not allowed to vote. I fully understand why people believe prisoners should not be able to take advantage of assisted dying, whatever the reason, but it is clumsy at the moment if we rely only on what the Health Minister in the Commons said. I believe he had the Justice Minister next to him during the debate. I hope that today we will actually hear from the Justice Minister, considering that the majority of this debate has been about prisons and the ECHR. With that, I express concern about where we might go with this group of amendments.

Noble Lords:

front bench!

I have never been so popular; it will not last, I know.

I thank the noble Baroness, Lady Grey-Thompson, for her amendments. I pay tribute to her for her sincere and long-standing commitment to protecting the most vulnerable in society. If we cast our minds back to Second Reading, many of the contributions made and concerns raised were regarding those who are the most vulnerable in our society. I remember at Second Reading being particularly touched by the words of the noble Lord, Lord Rees—he is not in his place now—who raised concerns about the vulnerability of some ethnic-minority communities, particularly those from disadvantaged communities as well.

Let us quickly rush through some of the points. On Amendment 22, which would make prisoners ineligible for end-of-life services as envisaged by the Bill, I completely understand the underlying principle. Many have spoken, rightly, about the vulnerability of prisoners. While for some it might seem wrong, as the noble Lord, Lord Farmer, has suggested, that a prisoner who has a terminal illness may have a way of cutting short their sentence by means of this Bill, as my noble friend Lady Coffey alluded to, others may say “Good riddance”. I also recognise the argument that prisoners with a terminal illness should be treated with the same compassion and care at the end of their lives as other terminally ill people subject to the Bill, as my noble friend Lord Markham recognised.

We also have to recognise some of the concerns over moral hazard. I do not know how large the incidence of this would be. Would it really encourage those who are terminally ill to commit crime? No studies have been done, but I am open to that concern. There is also the idea about higher levels of suicidal ideation, as raised by the noble Baroness, Lady Fox. These are really important points that we have to take account of.

The right reverend Prelate and my noble friend Lord Deben spoke about the pressure of reducing the prison population, while the noble Lord, Lord Carter, spoke about the higher rate of suicide among male prisoners. These are all reflections that should give us cause for concern, and things we should take account of as we consider what we will do between Committee and Report.

I thank the noble Baroness, Lady Grey-Thompson, for raising the issue of those who are pregnant. As the noble Baroness said, this was not debated in the other place, so I am grateful that the noble Baroness was able to give us the opportunity to debate it. I am also grateful to the noble Baroness, Lady Berger, for sharing statistics about expectant mothers. It was important that we heard those stats. I cannot begin to imagine the difficulty an individual in those circumstances may face. I understand the concern that it does not seem right that the safety of an unborn child may be endangered under the provisions in the Bill. I also understand that there might be precedence in other legislation. I wonder what the noble and learned Lord’s reflections on that are, given his expertise.

I note the amendment tabled by the noble Lord, Lord Farmer, on access to this for those who are awaiting trial. Once again, I would be very interested in the noble and learned Lord’s legal experience on whether that seems relevant and should be within this Bill. During the debates on the Mental Health Bill, my noble friend Lady Berridge was assiduous in spotting gaps in legislation or inconsistencies between different Acts. My noble friend has done the same thing here by raising concerns over the vulnerability of those with education, health and care plans. I think this needs further consideration.

I also thank the noble Baroness, Lady Grey-Thompson, for her amendments relating to those who are homeless or who live in insecure and temporary accommodation. I welcome the experience of the noble Baroness, Lady Gray. I still remember a conversation I had with one homeless charity that we are all one or two unlucky events or bad decisions away from homelessness. I heard from homeless people who told me that they had a great job and a great family life and that everything was going their way. They lost their job, which then led to them losing their marriage. After incidents of sofa surfing and testing the patience of their friends, they ended up homeless. It could happen to anyone. It is important that we do not dismiss the homeless as people who cannot be bothered or are idle. It could happen to anyone. Any noble Lords who have met those in homeless communities will know that some people had been incredibly successful but, after two or three bad decisions or unlucky things that happened in their life, they suddenly found themselves homeless. They are also judged by the way they look when they are homeless.

I remind all noble Lords that the Bill relates only to those who are suffering from a terminal illness and those who have been given an expectation that they will not live for longer than six months. We have to be very careful that, although we have sympathy for the homeless and prisoners, the Bill relates only to those who have a terminal illness. I know there are concerns that the Bill may be widened beyond that, but that is the debate at this stage. We should be quite clear that we are focusing on those with a terminal illness. So, much like on the question of prisoners and others, I recognise the arguments on all sides, but this is an opportune moment, not only because of time but because of the noble and learned Lord’s legal experience, to hear his reflections—after the Minister, obviously.

I am most grateful.

My Lords, I thank all noble Lords for their contributions to the debate on this group. As is my consistent introduction, my remarks will focus only on issues where the Government have major legal, technical or operational workability concerns. Many of the points that follow relate to the European Convention on Human Rights. These are risks that I am raising to inform noble Lords’ decision-making, as I said on the first group. I wish to be clear that the underlying policies are a matter for Parliament. I say to noble Lords who referred to my ministerial colleagues in the other place that it is the role of Ministers, whether in your Lordships’ House or in the other place, to flag the risks to the Bill, including potential legal challenges. As I said, policy decisions remain a matter for the sponsors. Decisions in this regard rest with Parliament.

I begin with Amendment 22, tabled by the noble Baroness, Lady Grey-Thompson, and Amendment 30C, tabled by the noble Lord, Lord Farmer. These amendments would make prisoners, a defendant on remand, a defendant on bail or those detained by a hospital order ineligible for assisted dying services, even if they have a terminal illness and meet all other criteria. Aside from the right to liberty—Article 5—the ECHR requires that prisoners, a defendant on remand or a defendant on bail should have the same rights as those who are not. The rights engaged by this amendment are Article 8 on the right to respect for private and family life and Article 14 on prohibition of discrimination. Noble Lords may wish to note the risk that making these groups ineligible for assisted dying would, on the face of it, lead to a difference in treatment, which would need to be objectively and reasonably justified in order to comply with ECHR obligations.

Likewise, making ineligible hospital in-patients who are under a hospital order would lead to a difference in treatment. Without sufficient justification for the discriminatory treatment, this may be a breach of the ECHR, which could lead the courts to issue a declaration of incompatibility.

The noble Baroness, Lady Grey-Thompson, has also tabled Amendments 24, 458, 308 and 347. The purpose of Amendments 24 and 458 is to exclude those who are pregnant from accessing assisted dying, while that of Amendments 308 and 347 is to make persons who are homeless, or living in supported or temporary accommodation, ineligible for assisted dying services. As I have previously noted, the reasons for this difference in treatment would need to be adequately justified to avoid the risk of a successful challenge under the ECHR.

Can the Minister give her perspective on whether the arguments laid out today would be justifiable as reasons for a different form of treatment between the two categories: prisoners and non-prisoners?

It is important I reclarify that that is a policy decision. What I am doing with your Lordships’ Committee is advising on risks, to assist noble Lords to make their decision regarding this policy.

Amendments 30A and 119A, tabled by the noble Baroness, Lady Berridge, would exclude any person with an education, health and care plan from being eligible for an assisted death, except in cases provided for in regulations made by the Secretary of State. As drafted, these amendments could impose unclear and potentially undeliverable legal duties on the Secretary of State and are potentially not aligned with how EHCPs work in practice or in law. The amendments give rise to a number of unresolved operational questions that do not work with other provisions of the Bill and they are not drafted with sufficient specificity. That could lead to confusion for those interpreting the legislation and unintended outcomes.

We are about to have a meeting to outline special additional conditions, so can I clarify that the Minister is not saying that that is not possible and just that the particular conditions outlined in Amendment 119A are not possible?

First, I am referring to the amendments before us. Secondly, I am advising on risk and workability, again for the assistance of your Lordships’ Committee, which, as is correct and proper, will make the decision.

These amendments appear to treat people with EHCPs differently from those who do not have them. This could give rise to potential incompatibility with Article 14 of the ECHR, when read with Article 8, and would require reasonable justification for differential treatment.

Finally, as noble Lords will be aware, the amendments in this group have not had technical drafting support from officials, so the way they are drafted means that they may not be fully workable, effective or enforceable. However, as I have said, the issues raised are rightly a matter for noble Lords to consider and decide.

My Lords, the Minister referred to a number of articles of the ECHR, but she has not referred to Article 2, which is the duty on a state to protect life. That is why the courts have imposed a duty of care on the Prison Service and the Government to protect prisoners from committing suicide. My question goes back to what I said earlier: how do the Government reconcile that duty with a vulnerable prisoner applying for an assisted death? How does that square with the duty under Article 2 and the duty of care to prisoners?

I refer the noble Lord to the provisions within the Bill. His earlier question was very much about policy. I am sure that my noble and learned friend will also refer to this, but this is a matter of policy and therefore it is for Parliament to decide.

I am obliged to noble Lords for all their questions. I will deal with the four issues that this group raises: prisoners, pregnant women, homeless people and those who are the subject of an education, health and care plan.

Turning first to prisoners, I declare my interest as chair of a prison charity, Liberty Kitchen. I have been involved in prison issues for a very long time; indeed, I was once the Minister responsible for prisons. When I was in that role, every time a prisoner committed suicide, it was deemed a failure of the Prison Service and something that we took incredibly seriously.

As far as prisoners are concerned, I will make two points. First, this is about people who are terminally ill and have six months or less to live. The question that the sponsors address is whether prisoners should be treated differently from the rest of the population. The posit is: if you are a prisoner and get a terminal illness, is the condition of the prison so terrible that you should never allow a prisoner ever to have that right?

As all those who are involved in and regularly attend prisons will know, as I am sure the right reverend Prelate will, prisoners range from being somebody who has just arrived on remand who is 24 years old to somebody who has been in prison for a very long time and is very accustomed to the situation. My own view is that prisoners should be entitled to exactly the same position as everybody else. The reason I take that view is because the safeguards in the Bill—the Clause 5 discussion, the two doctors, the panel, then the doctor again at the moment of the administration of the drug—are sufficient safeguards. It would be wrong to exclude prisoners from this right.

I was very struck by the statement made by Sir Chris Whitty, acknowledging, as the right reverend Prelate says, that medical care in prisons is worse than outside them. Nevertheless, he said that we should try to give prisoners the same medical options as other people have. I am very conscious of what noble Lords have said, but, in my view, the safeguards are sufficient to deal with that point.

The second—

I thank the noble and learned Lord for giving way. I will comment on the other side of the argument, which is the moral hazard. This could be an extreme case, but I will give the example of somebody who has lung cancer and has within a year to live. They also have some very difficult relationships and have wanted to get rid of a certain person for a long time. If they get rid of them, they will be sent to prison but will be within having six months to live and can have an assisted death, which takes away from the victim, the victim’s family and others any concern that justice is done. By giving them an assisted suicide, justice would not be done in that case.

I am not quite sure I understand the point. If the position is that I have six months to live and I want to kill somebody, which appears to be the example given, I am entitled to an assisted death whether I am in prison or not. It would probably take six months before the trial took place anyway. I am not quite sure what is the moral hazard that the noble Lord, Lord Farmer, has in mind, because the right to an assisted death would be there inside or outside of prison. So, I do not see what benefit would be obtained by excluding it from somebody in prison.

If I may try and answer that, the moral hazard is that the victim would have seen a criminal convicted, but the criminal would not serve the sentence given to them by the courts and would instead have an easy way out. You could say that he has six months to live, but as we know, in many cases —Esther Rantzen, for instance, is one of them—it can go on for years. To end his punishment would not give justice to the victim—that is the point I am making.

It is just such an obscure proposition that we should not determine our policy in relation to it.

Moving on to pregnant women, the amendments say that no pregnant woman should have the right to an assisted death and that everybody who wants an assisted death must have a pregnancy test. The noble Baroness, Lady Grey-Thompson, made it clear that the second was a probing Amendment and not a serious proposition. In relation to pregnant women, I completely accept what is being said, particularly by my noble friend Lady Berger, about what the statistics show. Again, safeguards can adequately deal with this and I am not in favour of any change in relation to it. We should remember that what we are dealing with here is somebody who has only six months to live. Homeless people—

There is a big issue here. Other states around the world which have had assisted dying for some time have differences of view. In Oregon, which has had assisted dying since 1997, there is a requirement to keep the mother alive for as long as possible, particularly when there is a viable foetus. The Netherlands takes a completely different view, with foeticide—where the foetus must be terminated by one means or another, often by intracardial injection of potassium chloride—before the mother can be euthanised.

At which end of the scale does the noble and learned Lord prefer these things? The royal colleges are against this whole system, yet we will be relying on them to fill in the gaps in this legislation. It is incumbent upon us to fill in those gaps for them, because they are not keen on this.

The noble Lord puts it accurately. Some countries have taken one view and other countries have taken another. It is clear from the choice that I am supporting that we take the view that pregnancy should not be a bar to it, though inevitably, as the noble Baroness, Lady Grey-Thompson, said, there should be questions in relation to appropriate people, whether they are pregnant or not, which may have an effect on the result. On the more detailed questions, based on what I am saying, they would not arise in the Bill.

Going on to the third category, homeless people, again with six months to live or less, will very frequently, as my noble friend Lady Gray said, have complex needs and complex lives. I am very strongly against that right to an assisted death being taken away from them, but the safeguards will apply, to be sure that it is their clear and settled view and not the product of coercion.

Finally, the noble Baroness, Lady Berridge, raised the education, health and care plan. The range of people with an EHCP is very wide, as everybody knows. I am again very against excluding everybody from the significant provisions of the Bill, because the protections are there. They can go up to the age of 25 and, as I indicated last Friday, for people aged 25 and under we should think of whether there should be enhanced protection. That would include everybody up to the age of 25, including those under an education, health and care plan. In the light of those indications, I hope—

My Lords, I spoke at Second Reading but have not yet intervened in Committee. I have the greatest respect for the noble and learned Lord. However, would he not agree that there is a special vulnerability about all the categories that we have been discussing this afternoon? Are there any provisions that he can build into the Bill to address this? If you took a homeless person who only had six months to live and said, “Come and live in a five-star hotel and have good palliative care”, would they then still choose an assisted death? If you took somebody out of prison who had only six months to live and said, “We’re giving you early release, you can live in a five-star hotel with good palliative care”, would they still choose an assisted death? There is a particular vulnerability about these people. It is no good simply talking about their rights. They do have their rights, but they are vulnerable. I hope that the noble and learned Lord might be able to build something into the Bill to protect these categories of people.

I completely accept that there are vulnerabilities in these groups. The question is whether we should exclude everybody within those groups from this right. Should we exclude every single homeless person or prisoner? We can disagree on this, but I am saying that I do not think that is right because the protections are sufficient.

Finally, the noble Lord, Lord Carter of Haslemere, asked how we deliver our Article 2 duty to protect people from death when they are in prison and we are offering them an assisted death. We are protecting them through the detailed safeguards there are before the individual prisoner is entitled to have an assisted death. In my view, that will be an adequate protection and give adequate effect to Article 2. In light of my remarks, I hope the noble Baroness will feel able to withdraw her Amendment.

My Lords, I thank all noble Lords for this thoughtful and considered debate. As ever in your Lordships’ Chamber, the debate did not go quite the way I was expecting. This has been quite a catch-all group trying to cover a number of very complicated issues. I thank the noble Lord, Lord Kamall, for summing up. I will not seek to sum up all the contributions, but I will pick up a few points.

The noble Baroness, Lady Berridge, asked me about pregnancy. There is very little data on the numbers and one of the challenges is that recording and reporting are very different in different jurisdictions. In somewhere such as Oregon, where the data is destroyed a year after death, it is hard to follow up and interrogate the information. Many jurisdictions around the world do not require a pregnancy test, but that puts a lot more pressure on doctors as it is then up to them to assume or guess whether or not a woman is pregnant. Whether she is showing or not, do they accept the request for assisted dying? It is really worrying for those doctors, because if it is later found out that the woman was pregnant in jurisdictions where there is a penalty for the doctors, they might find themselves less likely to want to carry out an assisted death.

Does the noble Baroness not accept that there are certain cancers that will give a positive pregnancy test and also be killing the patient, in a very serious condition?

I thank the noble Lord; I will cover that later in my summing up, if that is okay, but I will come to back it. What happens in other jurisdictions makes it really difficult for doctors, which means that we need clarity in this Bill about what would happen in those situations.

Many noble Lords discussed the vulnerability of prisoners. This debate has shown that it is not that simple. I have visited many prisons and young offender institutions over the years and they are all very different places. I have met many people who have hope and some who do not. The noble Lord, Lord Deben, articulated my thoughts on the circumstances in which prisoners find themselves very well.

I debated long and hard whether to use this example. The noble Lord, Lord Farmer, talked about moral hazard. There is the case in Australia of Daniel Hume, who was six years into a 30-year sentence for paedophilia. He had a terminal condition and exercised his right to die. His daughter said that she and other victims felt robbed by him being able to access assisted dying. This highlights the complexity of the issues we are dealing with. I hope I am a kind person—I believe in rehabilitation for prisoners—but these are not easy things that we are trying to sort out or get to the bottom of. I have very complicated views on all these issues, as I know many noble Lords do. It is absolutely something that we have to come back to.

I was probably expecting the answer from the Minister on Articles 8 and 14. I am not convinced that we have Article 2 quite right. I thank the noble Lord, Lord Winston, for his Intervention and I would be very happy to take his advice. I tried to keep my Opening Speech very close to 10 minutes, rather than the 15 minutes I am allowed, so there are lots of areas I was unable to discuss in my opening speech. I accept what the noble Lord said—he has far more experience of pregnancy than I do—but that just throws another complication into the mix in respect of what we are trying to sort out. I will welcome his advice on rewording my amendments, should I choose to come back with them.

I would like to thank the noble and learned Lord, as well as the honourable Member for Batley and Spen, who I am meeting next week to discuss some of my amendments. I hope that we can get a bit more clarity in that meeting on the amendments we are discussing. I thank the noble Lord, Lord Mackinlay, for his intervention. I think there is a line—I am sorry, I am jumping back to pregnancy—when it comes to what we do and at what point we do it. I believe that the noble and learned Lord and I have agreed to disagree on the safeguards in the Bill.

I would like to make a correction. I am serious about my amendments, although I could have worded them better. I did not intend for men to have a pregnancy test, and I did not intend to get into a debate about age and the pregnancy test. The reason why I tabled the Amendment on a pregnancy test was to allow women to understand all the implications of what they are getting into and to be able to make a choice. They may or may not choose to do something differently with that information.

I thank all noble Lords who have contributed to the debate this afternoon. With that in mind, I beg leave to withdraw my amendment.

Amendment 22 withdrawn.

Amendments 23 and 24 not moved.

My Lords, we have completed four groups of amendments today, which in my opinion is still slow progress. It means that, in four days of Committee, we have completed only 10 groups of amendments. Before we return to Committee in the new year, I think that all noble Lords should reflect on that fact.

The one thing I have achieved today is a run on copies of the Companion. There are now only two copies left in the Printed Paper Office. I draw to the attention of the House page 15, pararaph1.54, which makes clear that:

“The House does not recognise points of order”.

We are a self-regulating House. This is the reason why we say “My Lords” in the House and do not address either the noble Lord on the Woolsack or the noble Lord at the Table. Being a self-regulating House is something we all treasure, but it does call for some self-regulation by all noble Lords.

I will talk again next week to the usual channels. I will also email all noble Lords, to their parliamentary email accounts, with the various references, relevant paragraphs and page numbers. I can recommend chapter 8 as very good festive season reading.

I want to ask a question about timing. I have read that, somehow, in the calculation of time allocated for Committee, it is expected that we would have one and a half times the number of Committee hours on a Bill than the other place. My understanding when I was in the usual channels was that we tried to provide, roughly speaking, the same number of Committee hours in your Lordships’ House as they do in Another place. I wonder whether the noble Lord could clarify that point.

I can confirm that I had never heard of the one and a half days figure until I saw the letter that arrived yesterday. We are a self-regulating House. There is no formal algorithm that we use for Committee days. I talk to the usual channels to try to get agreement on the number of Committee days; sometimes I am successful, and sometimes not. There is no formula or algorithm that we use, so I do not recognise the one and a half days comment that was made in the letter circulated yesterday.

House resumed.

House adjourned at 3.19 pm.