Baroness Berger:

Moved by Baroness Berger

44: Clause 1, page 1, line 17, after “life” insert “because of their terminal illness”Member’s explanatory statementThis Amendment and others in the name of Baroness Berger would mean that someone is only eligible for assistance in ending their own life under this Act if their clear, settled and informed wish to end their life is because of their terminal illness and not for any other reason.

My Lords, I shall speak in support of Amendments 44, 313, 341, 452, 511 and 580 in my name, which are distinct from the group that we have just addressed in a very quick fashion but are a variation on the same discussion. My amendments seek to make a simple but substantive clarification to the Bill, which is that assistance in ending life should be available only where a person’s clear, settled and informed wish to die arises because of their terminal illness, not for any other reason.

As drafted, not only does the Bill not require a causal link between a person’s terminal illness and their request for an assisted death, but it does not actually specify any reason at all. That is a significant difference from assisted dying Laws in many other jurisdictions, and that includes some of the countries whose laws have been presented to us as comparable to the Bill and as proof that we can have confidence in it.

Under New Zealand’s End of Life Choice Act 2019, not only must a person have a terminal illness likely to end their life within six months but they must be in an advanced state of irreversible decline and capability and be experiencing unbearable suffering that cannot be relieved in a manner that the person considers tolerable. In Spain, which we are told is a model for the new voluntary assisted dying panels, the requirement for an assisted death in Spanish law is intolerable suffering.

By contrast, our panel will not have to investigate or even ask why the person has chosen this route, as long as they appear to mean it. As long as the person fulfils the other requirements, medical professionals and the panel will not be expected to ask whether the person may be motivated not by the disease itself but by, for example, the shock and despair that follows a terminal diagnosis, the stress and anxiety that come with the cost of care, the sense of guilt of being a burden on family and partners, or the family breakdown that sadly can often happen next. Perhaps the person has previously struggled with suicidal ideation even before they were diagnosed with a terminal illness. None of these examples would rule the person out of eligibility under the Bill.

That is a profoundly concerning weakness in the Bill’s construction, and one that fundamentally undermines the claim that it has “the world’s strongest safeguards”. It does not have one of the most common and obvious safeguards there is, which rightly exists in other countries. Indeed, the 2012 Commission on Assisted Dying, chaired by my noble and learned friend Lord Falconer, came to the conclusion that

“it is essential that any future system should contain safeguards designed to ensure, as much as possible, that any decision to seek an assisted suicide is a genuinely voluntary and autonomous choice,

My amendments go to the heart of the balance that the Bill is trying to strike and which many of us fear may not be possible: that is, to allow dying people to decide when to end their lives but without taking any steps towards the encouragement or normalisation of suicide. This is not a theoretical concern. Make no mistake, the demand for assisted dying for other reasons does exist, and will be seen all too clearly if the Bill passes as drafted. In jurisdictions that have introduced assisted dying without a requirement for a terminal illness at all, or which have afterwards expanded beyond it, there are documented cases of people seeking to end their lives not because they were dying but because they could not access the care, housing or social support they needed to live well. That cannot be the path that we take here.

We must ensure that our law is rooted in compassion, yes, but also in moral clarity about the need to prevent suicide. Great strides have been made in doing that in recent years, both within the medical profession and in other public services. In the Select Committee on the Bill, we heard about the importance of this from witnesses, including the chief executive of the mental health charity Mind, and the Royal College of Psychiatrists. We must have confidence that, if the Bill passes, it will not be at the cost of that vital progress.

My amendments would also serve to strengthen public confidence in this legislation. Many people, including those who support assisted dying in principle, express deep unease about the possibility of eligibility criteria under this law being extended over time. By explicitly tying eligibility to a person’s terminal illness, we could reassure the public that the Bill is not a step on to a slippery slope but a specifically defined act of mercy for those who are truly at the end of life.

I have heard concerns expressed throughout the Bill’s passage that it is intrusive or humiliating to require that a person must prove a particular degree of pain or suffering. I have listened, and my amendments take a different route, asking only that doctors establish that the reason for the request is the terminal illness itself. This is not an unreasonable bar to access; it is simply making explicit in the Bill the very reason we have been given for why an assisted death is needed.

I have spoken often in this House and beyond about the importance of mental health and the need to treat mental illness with the same seriousness and urgency as physical illness. This Amendment is consistent with that principle. I am not sure that there could be any more important set of words in the Bill than those that define the purpose for which we would allow such a change to a law that has existed for centuries. I urge your Lordships to support my amendments, to make the Bill true to its purpose and bring dignity to those whose lives are ending. I commend these amendments to the Committee.

My Lords, I will speak to Amendment 44, so ably introduced by the noble Baroness, Lady Berger, and I thank her for tabling it. Today is an especially important day for me, because it marks exactly 30 years to the day since I had emergency neurosurgery in a desperate attempt to save my life following a terminal diagnosis of only six months. My neurosurgeon could not give me odds on survival, never mind recovery, so the outcome was definitely not a done deal.

The need for this amendment underlines why it is so important that no one assumes that this appallingly drafted Bill is a done deal, either. We keep being told by the Bill’s supporters that it is about people who are already dying. If that is the case, I assume that the amendment will meet with their enthusiastic support, given that it would make incontrovertibly clear in the Bill that a person’s motivation for seeking an assisted death is their terminal illness. Otherwise, as last Friday’s debate showed, we could be in the extremely dangerous situation of other motivations coming into play, such as feeling like a burden; living with a mental disorder, including depression; or living with a disability other than the terminal illness.

In her powerful speech of 12 December, the noble Baroness, Lady Gray of Tottenham, said:

“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”.—[Official Report, 12/12/25; col. 495.]

How right she was.

There was a time when I imagine the noble and learned Lord would have agreed with her, given that own his commission ruled that it was essential to ensure that a decision was not influenced by

“self-imposed pressures that could result from” people

“feeling themselves to be a burden”.

It is worth asking the question of what has changed in that time. Well, the pressures on the NHS have increased, access to GPs has massively decreased and house prices have rocketed, making owning a home a distant dream for many young people and, thus, making the inheritance from granny even more valuable. Meanwhile, social care costs have gone through the roof, thereby devaluing granny’s legacy—and, of course, as your Lordships’ House highlighted only two days ago, the insidious impact of social media has had an alarming effect on society and, many would argue, on some of its values.

So will the noble and learned Lord agree in his closing remarks that, taken together, these factors only serve to make the case even more compelling for there being a specific requirement in the Bill that the sole reason people can seek an assisted death is their terminal illness? If he does not, let him say so. To his credit, in 2012, he was clear about the danger of someone feeling a burden, and I admire his honesty and clarity then. Will he take the opportunity today to be equally honest and clear and confirm that, in changing his mind, he has moved from viewing burden as a pressure to be safeguarded against to instead viewing it as a legitimate basis of a rational choice to be facilitated? Let me say to the noble and learned Lord that I may not agree with him, but I would applaud his determination to address the question directly.

The question posed by this amendment cannot be dodged, because it goes to the heart of the Bill. Indeed, failing to accept the amendment makes sense only if there is an ulterior motive in rejecting it. I would be grateful if the noble and learned Lord, when he comes to reply, could give the Committee a categorical assurance that there is absolutely no intention by the drafters and promoters of the Bill that anyone should ever be able to cite the Bill as the grounds for saying at a later stage, “On what logical basis would we deny that same choice—assisted dying—to people with depression or those who are chronically ill, for example?” Indeed, would the noble and learned Lord not agree that accepting this amendment would actually help him, at least in part, to dispel the fears of those who suspect that, if autonomy rather than motivation is the metric that really matters here, the Bill would contain the seeds for removing barriers to a Canada-style assisted-dying free-for-all in years to come? After all, if motivation is irrelevant, how could it not?

In conclusion, the noble Baroness does the Committee a great service, because her simple amendment hits the nail on the head. It also indirectly exposes a battle that is under way for the soul of her great party. Its values, not least its commitment to disability rights, for which I have so much respect, cannot simply be suspended for the duration of this Bill. There are hard choices to be made here and now. I hope very much that the noble and learned Lord will recognise the significance of this amendment and choose to accept it.

My Lords, I put my name to Amendment 313. My concern is the whole question of misdiagnosis. My noble friend Lord Shinkwin has addressed the fact that he was diagnosed with a terminal illness some time ago. One assumption running through this Bill and through the amendments—I apologise to my noble friends who put down these amendments—is that the medical diagnosis of somebody approaching death is faultless. We know from endless examples given by your Lordships in this Chamber that that is not actually the case. There are a large number of incidents when the medics get it completely wrong. I would like to address the question of them quite innocently getting it wrong. I will deal with more malicious misdiagnosis in later amendments.

The whole basis on which we are discussing this Bill is that there has been a medical diagnosis, which must hold as the whole basis on which assisted dying takes place. We know, however, that all too often people live on for quite a long time. The noble Lord, Lord McCrea, made the point that people have lived on with diagnoses that they were going to die after six months. My wife’s uncle, a distinguished diplomat, was given six months to live and died 18 months later. So much fault is the case here that we should be very worried about how much we are going to lean on medical diagnosis as a basis for judging that somebody should be allowed to die.

Earlier on in the debate, some weeks ago, my noble friend Lord Polak described how he was given six months to live. He is not with us, but I would not describe him as a delicate flower. I would also say that he is probably not prone to bouts of depression or that sort of thing either, but let us hypothesise—

Just for the avoidance of doubt for anyone watching these proceedings, the noble Lord, Lord Polak, is no longer present in the Chamber, but he is very much still with us.

My noble friend Lord Harper is absolutely right: he is still with us, but he is absent for the moment. It might have been that, when he was given his diagnosis that he had six months to live, he was told that his final months would be very grim indeed and he would suffer terribly. He might, if this Bill had been in place, have made the decision to end his life. That was 32 years ago and my noble friend Lord Polak is actually pretty fit and doing a good job in your Lordships’ House. So we have to question medical diagnosis in this case.

I am very concerned and would like to hear from the noble and learned Lord, Lord Falconer, what he thinks about the problems of wrong diagnosis. I am old enough to remember that there was a time when we had capital punishment in this country. One of the reasons why it was abolished was because of the miscarriages of justice and the number of people who were hanged when they were innocent. That was a very serious lever used to get rid of capital punishment. What percentage of misdiagnosis of terminal illness would the noble and learned Lord, Lord Falconer, think would be right before he thought about whether the whole basis of this Bill was to be questioned? I do not think we have any statistics on misdiagnosis—maybe he has some—but it really undermines the whole basis of this Bill if we have doctors who quite innocently say that they think a person has only six months to live but then find that they have not and they live on much longer. This is a matter of tremendous concern to people in this country.

I thank the noble Lord for giving way. It might be helpful, in the context of this conversation, for noble Lords to be aware that the data that the Department for Work and Pensions has on people who are in receipt of a benefit that comes during the six months towards the end of life shows that 23% of people who were given a six-month prognosis are still alive three years later.

If I understand the noble Baroness correctly, that is 23% of people who die well beyond the six-month sentence they have been given. That is an extraordinarily large figure, and I am grateful to her for it. I think that makes us question the whole basis of this Bill which is talking about medical diagnosis that gives people a limited life but turns out to be wrong. This could be very disturbing, if we are going to go ahead on the basis of information that could be wrong in quite as many cases as that.

My Lords, the noble Lord asked about data. During the Select Committee that was held on Lord Joffe’s Bill on this subject, the Royal College of Pathologists told us in evidence that, at post-mortem, one in 20 people were found to have died from something different to what was written on the death certificate. That underlines the point that he makes: errors in diagnosis are the fundamental problem, happen quite often and result in the wrong treatment being given—not through malpractice, but just because medicine is a very inexact science.

I am very grateful to the noble Baroness. That just illustrates my point that misdiagnosis can very easily be done, and we are putting an enormous weight on it in this Bill and it can so often be wrong. We should be very disturbed and concerned about that because it means that we may be passing legislation which is based on faulty information.

My Lords, this may be a convenient point to speak to two amendments in my name in this group. My Amendment 320ZA complements Amendments 39B and 39C, which I briefly touched on in the last debate, by making explicit that non-medical motivations cannot drive an assisted death. It draws a distinct line between medical suffering and social abandonment. International evidence shows that non-medical motivations dominate assisted dying requests. In Oregon, “being a burden” is cited by nearly half of all applicants. Parliament must decide whether it is comfortable legislating for that. This amendment ensures that England and Wales do not drift into a model in which existential distress, loneliness or, in the words of the noble and learned Lord, “sheer misery” or lack of care become accepted reasons for state-facilitated death. It also responds directly to the Equality and Human Rights Commission, which warned that subtle pressures from lack of services can drive people prematurely towards death. This amendment ensures those pressures are addressed, not endorsed.

My other Amendment 332AA operationalises the “ask why” concession. The noble and learned Lord, Lord Falconer, said he is “attracted” to requiring clinicians to ask why a person wants to die but unless the answer has consequences, the question is meaningless. This amendment ensures that when the answer is, “I am a burden” or “I cannot afford care,” or “I am alone”, “I am fed up” or “I am miserable”, the process pauses and support is provided. It reflects the evidence from the Royal College of Psychiatrists and British Geriatrics Society, both of which emphasise the need for holistic assessment. It ensures that treatable depression, unmet care needs or social pressures are addressed before an irreversible decision is made. This is safeguarding, not obstruction. It ensures that assisted death is not used as a substitute for care.

My amendments matter because, first, they protect genuine choice. A decision driven by lack of heating, housing or social care is not the same as one driven by intractable physical decline. These amendments stop the law becoming a backdoor response to social failure.

Secondly, I believe they are a practical safeguard, not a veto. This is not a blanket ban; it is a procedural pause to address fixable problems—social support, benefits, palliative referrals—before a final medical judgment is made. Thirdly, clinicians need clarity. Doctors must be able to ask why and act on the answer. These amendments would give them a clear statutory duty to do so, reducing moral and legal ambiguity. If the noble and learned Lord, Lord Falconer of Thoroton, truly believes this Bill is about free, informed choice, will he oppose leaving people to die because the state failed to provide basic support or will he back these modest, targeted safeguards?

The main point here is that, by definition, you are eligible for assisted death only if you have been diagnosed to be within six months of the end of your life through a terminal illness. That is the reason that you are applying for an assisted death. That is motivation for doing it, because clearly it is not like those people want to die. We have talked to many people, and I am sure a lot of people have, and they desperately do not want to be in this situation.

I am very sorry to interrupt my noble friend, but even the sponsor of the Bill, the noble and learned Lord, has been very clear in saying that the six-month prognosis is a trigger that gives you admission to the process, if you like, but it does not have to be the reason, so it is not by definition the case that if you have the prognosis, that must be the reason. They are two quite different concepts.

As I said, these are not people who want to die; they are people who absolutely want to live. The only reason they are entering into this process, and the only reason they would be eligible—

I completely sympathise with the point made by the noble Lord, Lord Markham, that these people do not want to die; they want to live. Would he then agree with some of the amendments that I tabled last week and spoke on? If, for example, they want to die and are then diagnosed with a terminal illness, that would be relevant to not allowing them into the process; that is, they want to die, and then the trigger of terminal illness allows the state-sanctioned administration of lethal drugs so that they can commit suicide, which is why people have raised problems about suicide ideation and mental illness. I therefore hope that the noble Lord will back some of the amendments on safeguarding that I tabled.

The noble Baroness is talking about a slightly different circumstance where there are prior reasons, which could be mental health or other reasons, and why that could be a cause. What we are talking about here is basically the criterion on which you can first be assessed for assisted dying, which is, of course, that you have been diagnosed in the first place. To the point that, of course, people might then live longer, my experience is that they are delighted by that. Just because they have been assessed as being able to have assisted dying does not mean that they will take the medication. Again, evidence shows strongly that they will take the medication only right near the end when the pain, the loss of dignity or whatever the reason is becomes unbearable. My experience is that those people would be delighted if it was a misdiagnosis, and if they are fortunate enough to be living 30 years later, as per some of these examples, that would be fantastic. Of course, they will not have taken the medication. The point is that they take it only right at the end where there is no other choice, so to speak.

Within that, accepting that these are the people we are talking about, of course there are all sorts of different motivations why, when they are unfortunately at the point where they are looking at such a death, they might want to go ahead with it. Research shows that there are multiple reasons; it is impossible to put it down to just one. Loss of autonomy, less ability to engage in enjoyable activities, loss of dignity, loss of control of bodily functions, burden, inadequate pain relief or finances are all part of the reasons. They are all part of the research, and, on average, you will find that there are three or four reasons to do it.

So it is quite wrong to say, “No, we’ll only allow you to go ahead with this if you only have that single motivation”. As I said before, they would rather not be there in the first place, but given that they are in that unfortunate circumstance, surely they should be allowed the choice of why they wish to die.

My Lords, I put my name to the amendments of the noble Baroness, Lady Berger, and I will not repeat what she said. She opened the debate on these amendments with superb clarity, characteristic of her contributions to your Lordships’ House.

I have been shocked by what I have just heard from the noble Lord, Lord Markham. I ask him just to reflect on two contributions made earlier in this afternoon’s session by my noble friend Lord Mawson, who, from his own experience, described what happens in poorer neighbourhoods, which he has experienced very directly, in which people face different problems and are more likely to want to die for reasons to which their terminal illness is just an ancillary point.

I have been involved in these debates since I came into your Lordships’ House at least. I was on the Joffe Bill Committee with my noble friend Lady Finlay. In the Committee on that Bill, in all the other Bills I can remember since, and particularly in all the case law that I have followed over the years—mostly very celebrated cases—the purpose of asking for assisted suicide has been to alleviate terrible suffering. That has been the sole purpose for demanding a change in the law: to alleviate terrible suffering. I do not believe that the noble and learned Lord wishes to achieve anything different from that. It is just that it does not say in the Bill that the purpose of having assisted suicide should be to alleviate terrible suffering.

Of course, there may be other issues at work in that person’s mind when they ask for assisted suicide—we cannot read every synapse in their brain—but we are here to legislate to save people from terrible suffering, if the Bill is to pass. I am very concerned that the Bill should be amended so that the capability to have assisted suicide does not arise as an opportunity to commit suicide. The reason to commit suicide, the absolute cause, should be the intolerable suffering.

Would the noble Lord accept, however, that it would be deeply unfair if somebody whose major wish was to end their terminal illness, and the pain and intolerable suffering that was coming with it, was to be denied that right because they were also concerned about numerous other things? Very few people have a perfect life, even when they are close to death. To deny that person the right to an assisted death because they might have concerns beyond their suffering would seem to be cruel in the extreme.

I do not think there is much difference between what I am saying and what my noble friend is saying. I am saying that, if this law is passed, people should be able to obtain assisted suicide because of intolerable suffering. I am not seeking to exclude other matters that might be in their mind, but the cause of asking for assisted suicide should be that suffering. The medical profession, lawyers and judges in particular—if we have the judicial option rather than the panel option—are perfectly capable of reaching a decision on the facts that would lead to the appropriate conclusion.

My Lords, I was only going to say to the noble Lord that, as I am sure he will remember, I too was a member of those earlier Select Committees. I am sure in that context he will remember that the arguments, discussions and vagueness, frankly, about how one would ever define “intolerable suffering” in a legal sense, or an Act of Parliament, were even more intense than the ones we are having today. That was because there is even more subjectivity about the concept of “intolerable suffering” than there is about any other.

I do not agree with the noble Baroness, much as I admire her contributions to this House. I believe that, as a legal concept, what I am suggesting is absolutely clear and could be defined properly if we were to use the courts to make the determinations.

My Lords, this is the point where we come to the heart of the reason why I find this Bill so difficult. I know what sort of society I have spent my life trying to produce and work for: a society that cares, particularly for the vulnerable. I was accused by the noble Baroness of being patronising the other day. If it is patronising to defend the vulnerable, I plead guilty.

My Lords, I must respond to that. I certainly did not accuse the noble Lord of being patronising. I said that I thought there were difficulties in health policy when we accepted some of the old—and, now, more old-fashioned—concepts in which the medical profession seemed to be patronising. I was not referring to parliamentarians.

I will not take it, therefore, as I did on the occasion when she mentioned it.

What I want to say to the Committee is simply this: many people in many institutions will be tempted to look at the price of death as against the price of life for those who are very seriously ill. There is no doubt at all that all the countries that have already enacted Laws of this kind have found this to be a problem. They have all found the difficulty that, for people who have been given about six months to live—even if that is a false diagnosis—there is a tendency to say, “Well, they’re going to die anyway”. A number of noble Lords and noble Baronesses who support this Bill have said that.

I want a society that cares about those people right to their last moment in which they die. That is what I think we are here to do. I hope that does not sound too sentimental, but this is about the difference between kindness and love. Love is something with a backbone that cares for people right to the end and makes sure that they do not feel a burden. We cannot do that for everybody, but the trouble with this particular Bill is that it does not make it absolute and determined that we do look after people and that we find out whether they feel a burden and help them not to feel a burden.

Any of us who has had loved ones who are ill know that, even if they are not seriously ill, the very first thing they do is feel a burden—a burden on their spouses and on other people. That is what decent people do. Other decent people spend their time trying to make sure that they do not feel a burden. Other decent people try to see what is at the heart of their misery—that is the phrase that is used. We should be here to try to remove the misery from people in their last six months, just as we should throughout the whole of their lives. Those who are proposing this Bill seem so committed to getting it through somehow that they think we must not in fact consider what the rest of society is.

I know that the noble Baroness, Lady Blackstone, hopes to interrupt me, but, before she does, I will just say this. I am not one of those Conservatives who believes in the kind of free market operation where you do not deal with things at all. I am, in that sense, a socialist; I believe in the individual in society. The whole problem with this emphasis on autonomy is that it is not acceptable unless you see the individual in society. The trouble with the Bill is that it tempts those who find it more convenient to allow people to kill themselves because it is more expensive for them to continue to live.

I was not going to interrupt the noble Lord, but his last remark does lead me to interrupt him. I do not think there is anybody who backs the Bill because they think it is more expensive for people to continue to be treated. Nor do I think it is the case that those people who back the Bill are in some way unaware of the societal context in which people live and die. We are all aware of that.

Moreover, some of the comments from those who oppose the Bill or are trying to introduce more amendments to it neglect the fact that most doctors—nobody is perfect, of course, but most doctors—are fully aware of their obligations as members of society and of a caring profession. They spend a lot of time trying to help and advise their patients not just about their immediate medical needs but their other needs. It is certainly the case that most general practitioners will help a patient who is suffering because of poverty. They will find ways in which they can access funding and support the patient in terms of their worries about being a burden. So I do not think anybody who supports this Bill suggests for one moment that we should accept that a patient who feels they are a burden should die just for that reason. The reason they do think they should die, if they want to, is that their suffering is intolerable. That is what lies behind those who back this Bill’s motivation.

I hope the noble Lord will accept that and understand that there is nothing in what we are saying which suggests that we simply want people to be able to die because they need to be autonomous. We want them to have the choice to be able to die, if that is indeed their choice and if the circumstances which they are in are such that their suffering is enormous. Most of us who back the Bill have experienced this in our own lives and seen what happens in those circumstances. I have sometimes wondered, in listening—I have done a lot of listening and not much speaking on this Bill—that some of the people who raise all these amendments have not had the experience of seeing the terrible suffering of people who have already been diagnosed as terminally ill.

I agree with everything that the noble Baroness said. That is not what I was saying. I was saying that many people, in seeking to get the Bill through, are not facing up to the fact that there are many people in society who will see this as an opportunity to find the better thing for them if their old grandmother decides to take her own life.

Some of us have spent many years working—albeit not as effectively as the noble Lord, Lord Mawson—among people who, frankly, are wonderful and have dealt with huge difficulties in their lives. But we have also found people who would be happy for the death of their grandmother for a matter of a very few pounds—and if their grandmother has a house worth £200,000, the situation becomes much clearer. They know what they want and they know what the pressure would be. In asking whether people have seen that, I must say to the noble Baroness that I have seen that—more times than I would really like to go through with her. Those of us who have worked all our lives in those circumstances—I think the noble Lord, Lord Mawson, will support me—will recognise that that is the case.

All I am saying about this Amendment is that it helps to protect people against that, and it does so by saying that we, as a society, should be concerned that, if somebody thinks they ought to end their own life, even if they have only six months to live, because their housing is so bad, because they feel a burden to their family, or because they think the National Health Service should not be spending the money on them, we ought to do what is necessary to remove that reason. If, because of intolerable pain, they still wish to end their life, the Bill will be a proper means of doing it.

I will end with a simple point. The noble and learned Lord has explained why he does not want a reference to intolerable pain in the Bill itself. I understand that. That is why the noble Baroness, Lady Berger, has produced this answer, which is crucial not just because of the sort of society in which we live but because, if you do a public opinion poll, you see that people think that this Bill is about allowing people in intolerable pain to end their life. But it is not about that. What the noble Baroness is trying to do is to make sure that it is about that and that we do not become a society for which this becomes the cheaper way or the way in which people can use their influence to gain their own ends. The best way to add to that support is to support what she said. It is also a way for us, as a House, to say to the world that we are not concerned with this assisted suicide for any reason other than as an autonomous choice about real, terrible suffering.

My Lords, we know that people may have many of the problems that proponents of the Bill have described as reasonable justifications for why someone may want to end their life. They may already be a burden, as they see it, or incontinent, or under financial duress, or have pain from arthritis, or have a whole host of other things going on in their life. They may have fallen out with members of their family. There is a multitude of things. We have heard endlessly about that. Then, randomly, they get this ticket—the ticket that nobody wants—that says that they have only six months to live. Prognostic predictions such as that are based on averages, and the shocking fact, as we know, is that 50% of people are above average, so there will be a huge range. If you have been given a six-month prognosis, it could be anything from one month to 32 years, as we have heard.

To say that that is your ticket to be allowed to have an assisted death, and then completely disconnect that fact from the reasons for your assisted death, makes no sense at all. There is no internal logic in that. The Amendment from the noble Baroness, Lady Berger, is brilliant in getting us past the intolerable suffering to something that is plausible, tangible and clear. As I have said previously, doctors make judgments all the time. The judgment about the six-month rule is hugely inaccurate, as I have just described, but the one thing that the doctor can usefully do is determine whether there is plausibility that the symptoms that are distressing the patient are related to that illness. They do not have to be the only reason; there can be all those other factors going on. But if there is plausibility that there are symptoms related to that illness—be it pain, breathlessness, incontinence or whatever else happens to be distressing to that individual—that seems to me to be acceptable. However, personally, I would prefer it to be limited to pain, breathlessness and things that may not be amenable to treatment.

None the less, that still gives the doctor some yardstick to determine that this is not just about coercion, even some internally driven coercion that the patient feels that it is their job to end their life. Anything else, and you are asking for somebody to make a judgment that is just not feasible. I cannot see—I have said this before —how it is feasible to assess whether the patient is feeling coerced in the way that the noble Baroness, Lady Fox, described in earlier discussions just because of the tutting and the head shaking at having to bring something to the patient or the person once again. This would give us something that is concrete, clear and defensible, which I think is what the public believe this Bill to be about.

My Lords, I 100% support the motive behind the Amendment from the noble Baroness, Lady Berger, and what the noble Baroness, Lady Cass, and others have just said, but my question is this: will it make any difference? If you want an assisted death, would you not be able to get it simply by saying that it is related to your terminal illness? You have your terminal illness and you have the prognosis, and you will therefore be advised by anybody who wants to assist you in your death that that is what you must say. How is this therefore a protection for the problem that we are discussing?

My Lords, in this group of amendments—the two parts of it, if you like—I support the Amendment that the noble Baroness, Lady Berger, has brought forward, which sets out that the primary motivation for seeking assisted death is terminal illness. That is important because, otherwise, the terminal illness is simply a trigger.

One reason why I think this is important is something that I am very nervous about. I am not saying, by the way, that this is the motivation of the sponsor of the Bill, but he will be aware that many people think that this Bill is just a first step—there are campaigners outside this House who absolutely think that. One problem with the way that it is drafted at the moment is that, because the terminal illness is simply a trigger, it would be very simple, if this Bill were on the statute book, to simply remove that qualification, so that the rest of the structure and processes in the Bill would then allow anybody for any reason, without having a terminal illness, to seek an assisted suicide. With the amendment that the noble Baroness, Lady Berger, suggests—that the reason why you are seeking an assisted suicide is your terminal illness—then you could not do that. If you were to remove the terminal illness piece, there would be no motivation, so you would have to do a lot more work. Those of us who are nervous about this Bill as a Trojan horse would be more reassured if that motivation were in place.

The second part to this goes to what my noble friend Lord Deben said about what the public think that this is about. If we look at the opinion polling on what the public think should be reasons why someone should be able to seek assisted suicide, the powerful reasons that many members of the public—not all, but significant numbers—support is to relieve suffering and pain. People are broadly compassionate and think that that is a good idea. What they do not support is people being able to seek assistance to kill themselves because they are poor or for other reasons. They think that that is a terrible reason. The amendment from the noble Baroness, Lady Berger, and other amendments in this group would more closely align the way the Bill is structured and what it would do with what many members of the public think that it should do.

I also support Amendment 320ZA from my noble friend Lord Blencathra, which explicitly says that the purpose of seeking assisted suicide cannot be various societal factors, such as housing or financial circumstances. That is important. The noble and learned Lord, Lord Falconer, and I had an exchange last week where he made it very clear that he thinks that, if those things are the drivers for you wanting to end your life, he is okay with that. I am not, and the polling evidence is that the public are not okay with that either.

Choices should be proper choices. My noble friend Lord Deben set out very well the sort of society that I think people want to see. If people want to end their life because of something not to do with their terminal illness or their pain or their suffering—because they do not have enough money or they have poor housing, or they have other things that they are not happy about—then those things are remediable. They may be expensive, but they are fixable and we can do something about them. I want to live in a society where we do something about them and we make people’s lives better—even if it is only for the last few months of their life, that is still worth doing.

My noble friend Lord Deben is right. He is not saying that the sponsor or those who support this Bill are thinking like this, but he is absolutely right that people make decisions all the time based on weighing up financial consequences. Noble Lords have talked about NICE today. When it assesses approving drugs, NICE looks at quality adjusted life years against the price of the drugs to the health service. It literally weighs up how much valuable quality life you are buying versus how much money we are spending. My worry is that, if you do not exclude people wishing to end their lives for these other reasons, we will get ourselves in a terrible place where we are not prepared to spend the money on improving people’s lives but rushing them towards ending their life in a way that is not necessary.

That is a big choice for Parliament to make and there are different views. The noble and learned Lord, Lord Falconer, set out his view last week. I have set out mine and my noble friend Lord Deben has set out his—we are in agreement. That is a decision for the House. I hope that noble Lords will support the amendment tabled by my noble friend Lord Blencathra and make the decision that you can only seek assisted suicide if it is because of your terminal illness, not because of your other circumstances. I think that that is the right sort of society we would be creating. The package of amendments in this group would improve the Bill. They would also reassure many people who are concerned about the Bill to not be concerned about it, which would be helpful for everybody. I commend them to noble Lords.

My Lords, I completely agree with the noble Lord, Lord Deben, on the society that we are seeking to have. We agree on so many things. We are on different Benches, but we agree on many things. However, the pre-eminent reason for this Bill is a terminal illness for six months. I understand what the noble Lord opposite is saying—that one cannot be sure—but we are talking about six months. As other noble Lords have said, one might aspire to have access to the drugs so that one could take one’s life if one had a terminal illness and it was thought that it was going to last for six months, but it does not mean to say that people are going to use them. It is important to remember that all the time. Six months and a terminal illness is the important thing to keep in the forefront of our minds at all times.

My Lords, the noble Baroness has prompted me to return to the point made by my noble friend Lady Cass, because the chance of being right about six months has been estimated at around 48%. It is just plucked out of the air. It depends on the individual, how their body responds to whatever disease it is and lots of other factors. I was concerned when the noble Lord, Lord Markham, said that these are people who want to live. They should be having access to specialist palliative care to maintain their quality of life as high as possible, yet we have huge gaps in this country.

I was making the point that those people—I am looking at some in that category in this very Room, I believe—want to live for the rest of their natural life for as long as possible. That is what they really want. They desperately do not want to be diagnosed with a terminal illness.

I have looked after thousands and thousands of patients, and I have to say that I have never come across someone who said they wanted to be terminally ill and to have their metastases or whatever. No, people want to live well but accept that death is a natural part of life. That is quite different from talking about deciding that someone is going to be given lethal drugs to foreshorten their life.

The benefit of the amendments proposed by the noble Baroness, Lady Berger, is that they fit fair and square with the Title of the Bill, which is about terminally ill adults, and make it clear that this is about terminal illness and cannot be masqueraded as anything else. Yes, there will be multiple factors, because of course someone who is already seriously ill but is content with their life will not seek assisted suicide—that goes without saying. However, we also need to be clear about differentiating medication, which is where we give a substance with the intention of achieving an improvement to the person’s well-being, from the large cocktail of lethal drugs that we debated previously, and I am not going to revisit that.

I have a concern when we label all these patients as having pain and suffering. Evidence from other countries is that pain and suffering are not the prime reason why people are going for this. I see the noble Baroness, Lady Jay, nodding, and I remember well from the Select Committee that we were on that we heard repeatedly that there were multiple existential factors that made someone’s life have so little meaning and worth that they felt they wanted to go for assisted suicide. However, we have to put some boundaries around it, because literally thousands of people in this country feel exactly that—that their lives are of no worth—and they feel suicidal. As Professor Louis Appleby, the lead suicide prevention adviser to the Government, has said,

“I’m worried once you say some suicides are acceptable, some self-inflicted deaths are understandable and we actually provide the means to facilitate the self-inflicted death. That seems to me to be so far removed from what we currently do and from the principle that’s always guided us on despairing individuals, that it’s an enormous change with far-reaching implications”.

The amendments would provide a ring fence and some safety barriers. Sadly, there are literally thousands of people in society who are suicidal. We heard a lot about that in relation to young people and the algorithms on their phones that they get into with social media and so on. There are an awful lot of people who are profoundly depressed and a lot of people in poverty, and when they become ill that may take them down one further notch, and there are a lot of people who just feel unloved. We have to make sure that the Bill sticks to what it claims to do, which is to be about terminal illness.

My Lords, in other groups last week, I covered issues of why I was concerned about people requesting assisted suicide because they feel like a burden, so I will not seek to rehearse those, but we should care about the other reasons why people’s decisions might be impacted, not least because in 2022 Marie Curie said that when someone is given a terminal diagnosis they are quite often financially impacted by that. So not only do you have the trauma of the diagnosis but other things happen and fall apart very quickly around you.

I know that Members of the Committee from all sides have worked on welfare reform and on the Legal Aid, Sentencing and Punishment of Offenders Act—all designed to provide better support for people who may need it. It is great to hear that there are GPs who will offer support on benefit claims and to put other things in place, but I cannot quite understand and work out where in the process people would be signposted back to the GP. We know that there is often a long waiting list for people to get a GP’s appointment; would one or both of the two doctors actually help somebody with a benefits claim or who would they signpost to? That is an important part of understanding the process.

Very briefly, I have found many cases of misdiagnosis around the world in relation to assisted suicide. I will pick just three. Dr Stephen Child, who was chair of the New Zealand Medical Association, gave evidence to the other place last year in which he said that 10% to 15% of autopsies show an incorrect diagnosis. We should be worried about that number.

Canada has a huge number of cases; I will give just one. A gentleman was in hospital who had diarrhoea. The nurses were constantly complaining that he smelled and his room smelled, and he was told that he had COPD. He died by injection and the post-mortem found no sign of COPD.

Closer to home, last year, Peter Sefton-Williams talked in the media about being diagnosed with MND. He signed up to Dignitas and was preparing all his affairs to go, then found out that he had been misdiagnosed and actually had a very treatable condition.

These three cases just show how difficult it is trying to pin down a six-month diagnosis, but also the danger of misdiagnosis for somebody making a decision. Mr Sefton-Williams was told that he might live five years or he might live two to six months. If this Bill were to pass, all he would have to do is find a doctor who accepts the six months and he would be pushed towards ending his life.

Finally, the reason that I am concerned about this Bill—I am pretty sure most in this Chamber have lost loved ones—is because I have lost my parents and a number of disabled friends, and I am worried about how people are treated in the system as it is. I do not think the system works to support people as well as it could, and the Bill will just push people, who could have a good end of life and the right support, to think that they have no other choice but to sign up for this.

My Lords, it has been a long day at the end of a long week for many noble Lords, so I do not seek to make a long speech. But before I respond to the debate on this group of amendments, I want to thank all staff from across the House who have worked extra hours to ensure that we could be here today and at this late hour. We really do appreciate it.

I thank the noble Baroness, Lady Berger, for introducing the amendments in such a clear and, more importantly, concise manner. As my noble friend Lord Blencathra said, the principle behind this group is very similar to that behind the last group: what is being sought is that doctors should seek to establish whether those who are terminally ill, and who have been given a prognosis of six months or less to live, are seeking an assisted death for those reasons only—their terminal condition—and not material factors.

My noble friend Lord Markham explained why other motivations are relevant, could be relevant or could be reasons for people wishing to die or seeking an assisted death. Contrary to that, the noble Lords, Lord Mawson and Lord Carlile, referred to misunderstandings and pressures, particularly on people from black, Asian and other minority ethnic communities. It reminds me of a comment that the noble Lord, Lord Rees of Easton, made at Second Reading—a man who spent all his life working with black communities in Bristol—who said he was concerned about the impact of this Bill on black communities.

The noble Baroness, Lady Grey-Thompson, has also spoken of her own very real experience and concern for people in the system, if the motivation is not purely because they are terminally ill but might be because of other factors. I know that my noble friend Lord Deben shares these concerns. I just gently remind him that he is not as unique a Conservative as he believes he is; all Conservatives want a better society. In fact, most politicians from all parties go into politics because they want a better society. We are on different Benches simply because we disagree on how to achieve that. Conservatives would probably say that the state is not the same thing as society.

I am sorry if I misled my noble friend. I merely meant that you can believe in the individual but you have to believe in the individual in a society, and you cannot take the extreme view that suggests that the individual is on their own. No man is an island.

Indeed, and in fact many classical liberals and libertarians understand the individual’s role in a wider society. But that is not the basis of this debate, and I digress too much. I will return to the group of amendments.

I know that the noble and learned Lord, Lord Falconer, understands the concerns of those who have raised issues about minority communities and people being stuck in the system. But I also know that he has already made his view clear about the principle of seeking to exclude some of those other principles—if I am incorrect, I am sure he will correct me. So I suspect that, given the strength of feeling, we will return to these amendments on Report.

Given that—I understand that the Minister may not be able to answer all the questions now and we accept that he or one of his colleagues will write to us—we have to understand how the Government envisage how a person’s motivation beyond their terminal condition could be established. That is the crux of the matter. How do you establish that if you can justify it only on the grounds of terminal illness, not other motivating factors?

For example, what work, if any, have the Government or NHS England done to try to understand that? One assumes they may have to draw up guidance for this one day. Have the Government, or anyone in government, looked at how other countries have handled this issue, whether they do handle this issue, and what would have to change? We spoke earlier about the foundations of the National Health Service and what might have to change in guidance for many of the practitioners. Indeed, what training would be required?

As my noble friend Lord Deben has often said, this goes way beyond just the Bill. It will affect the Department of Health, the practitioners and the legal system. These are questions we need the Government to answer. They can still take a neutral position, but they have to understand that noble Lords seek to understand the implications here for government, the costs to government, and how that will change.

I understand these questions are in depth and recognise that the Minister may feel it is slightly unfair. I do not expect all the answers now. But it has been a constant theme throughout the debate and the many days in Committee that we need better answers from the Government. That is not a party-political point; it is purely that we want to see the implications of this on government: what extra costs there will be, what guidance will have to change and, however the Bill finally turns out, and in whatever form it reaches the statute book, how the Government will deal with that. I suspect that, for many noble Lords who are torn the Bill, that might be the deciding factor on how they vote at the end of the day.

I thank noble Lords for their considered contributions on the motivation for assisted dying. Before I go into the meat of my comments, I join the noble Lord, Lord Kamall, in thanking the House clerks and staff for all their efforts and dedication in allowing us to sit for longer on a Friday to consider these weighty issues properly.

I also share the noble Lord’s comments about our wider motivations across the House, and about generally in politics wanting a better society. For what it is worth, I find myself in agreement with the noble Lord, Lord Deben, that, indeed, no man is an island. Whether that makes me a classical liberal or not, I am not sure—probably not.

These amendments seek to amend the eligibility criteria for assisted dying, to require that the person’s wish to end their own life is due to their terminal illness rather than to other reasons. I will keep any detailed comments limited to the amendments on which the Government have major legal, technical or operational workability concerns.

Amendments 320ZA and 332AA, tabled by the noble Lord, Lord Blencathra, seek to prevent people being eligible for an assisted death if they are motivated by non-medical factors such as loneliness, poverty or lack of services. There are various workability issues with these amendments, which I will briefly outline to aid noble Lords’ consideration. First, it could be challenging to establish whether someone is seeking an assisted death as a result of specified factors, given that a person’s motivations could be complex. Furthermore, a wide range of factors could be deemed as non-medical, given that the term is not defined and the list given is non-exhaustive. It is also unclear how the patient or doctor are meant to proceed if these factors are present.

I raise no major workability issues with the other amendments in this group, which are rightly a matter for your Lordships’ House to decide. However, I would like to set out their potential effects, which noble Lords may wish to consider. The amendments would require a person’s terminal illness to be a motivation for them seeking an assisted death, but, as drafted, they do not require it to be the only or primary motivation. It is arguable that every person seeking an assisted death under the Bill would be doing so in some way because of their terminal illness, so it may be that, in practice, the amendments would not impact on who is eligible.

The noble Lord, Lord Kamall, asked me some questions. I would push back on his first question around how the Government envisage a process or system for establishing motivation beyond condition: we genuinely think this is a policy decision, and that is one for my noble and learned friend Lord Falconer, the Bill’s sponsor, and those others who support the Bill. On his question about any work or research that NHS England has undertaken, I do not have that answer at my disposal, but I am very happy to take it back and write to him.

Finally, I would just like to mention that none of the amendments in this group has had technical drafting support from officials, so the way they are currently drafted means that they may not be fully workable, effective or enforceable.

My Lords, I join with the noble Lord, Lord Kamall, and my noble friend Lord Katz in thanking the staff for staying for so long this evening. I also congratulate the Committee on what was a very high-quality debate at the very end. We did incredibly well to have such a high-quality debate in the last hour or two at 6 pm. Thirdly, this is not in any way to denigrate the debate; it has been threaded through the whole of these Committee stages. Indeed, we had a quite similar debate last week, which the noble Lord, Lord Harper, referred to.

I will make three specific points about the Amendment. There is a group of amendments, but at the heart of the lead amendment is that you should be entitled to an assisted death only where your motivation is

“because of the terminal illness”.

My noble friend Lord Katz adverted to this, but it is almost impossible to see that that has any real meaning in the context of a person who is, in fact, terminally ill. If any of us became terminally ill, it is almost impossible to imagine that the terminal illness would not have an effect on any decision that we would take, in particular a decision on whether we wanted an assisted death. The noble Lord, Lord Moore, touched on this. I do not know that I would put it in exactly the same way, but, to “Why do you want an assisted death?” they might say, “Well, obviously, I am terminally ill, and I have other factors as well”. So I am not sure that the amendment has any real impact.

Secondly, there is an underlying issue. I ask the noble Lord to let me finish—then, by all means, he can come at me at the end.

Secondly, there is an underlying issue. The noble Baroness, Lady Cass, said that perhaps breathlessness and pain should be the only justification, because that is all that doctors could properly measure. Again, that indicates a significant disagreement between us about the principle of the Bill. I do not shy away from saying that the principle of the Bill is that, once you are diagnosed with a terminal illness, then, subject to the stringent safeguards being satisfied, you should have the option of deciding for yourself how you die. If you go down the route that my noble friend Lady Berger, in her amendment, wishes us to go down, this, in my respectful submission, would be an impossible task.

What is your reason for wanting an assisted death? I might say, “I want an assisted death because I live alone, I have a terminal illness and there is literally nothing for me for the next month or week except not feeling great. The pain is dealt with, but I just cannot bear it”. You speak to a preliminary doctor, a co-ordinating doctor, an independent doctor; you are offered an appointment to take it up with palliative care, but you are terminally ill and just do not want those next few months. Should you be allowed an assisted death in those circumstances, even though the prime driver may be what your life is like in that respect? I say yes.

The normal Lord, Lord Deben, says that we should try to relieve the loneliness of that person. That is his answer. Of course we should, but what is being described is the state of somebody who has got there because of the previous parts of their life. How we react to a terminal illness will be so dependent on what we are like ourselves. For me, I put forward the Bill because you should have that choice.

My Lords—

If the noble Lord will let me finish, then he can come at me. The noble Lord, Lord Hamilton, refers to the question of wrong diagnoses. We will come to that in the group that starts with Amendment 71; I do not want to go into it now. However, we are dealing here with a terminal diagnosis, with two doctors and a panel who have approved it. Doctors are not perfect, of course, but this is very much a safeguarded measure.

I apologise for not taking the noble Lord’s Intervention straight away.

Imagine I were a poor person who went before the panel and opted for an assisted death, but said, “Were I rich, I would not do this; I would take my chance on the diagnosis being wrong”. If the Amendment moved by the noble Baroness, Lady Berger, was passed, I would surely be ineligible, so her amendment is meaningful. If the noble and learned Lord believes that one should be able to choose an assisted death if one is poor, that is one thing, but, as my noble friend Lord Deben argued, one should be protected from having to choose it because one is poor. That is the difference.

The way the noble Lord has put the question to me means that, plainly, this would be because of the illness, would it not? I want an assisted death because the illness is going to kill me. That seems quite a bad example.

I appreciate that the noble and learned Lord is saying that we have covered a lot of this ground before, but there is one reason that people keep coming back to similar threads. The noble and learned Lord has in many instances said, “I’m listening to you. I’ll think about that”, and nothing happens. It is not reassuring and there are different ways of approaching this. I thought I had made some inroads. The noble and learned Lord was quite positive about the question of motivation being relevant.

A patient arrives at the doctors and says, “I’ve got a terminal illness”. The doctor says, “Why do you want an assisted death?” The patient says, “I’m costing my kids a fortune—their inheritance. The care home costs tens of thousands of pounds. I’m a burden”. The noble and learned Lord just suggested to the noble Lord, Lord Deben, that you would say, “That’s your choice”. As in an earlier discussion in relation to the NHS, we are talking about NHS doctors, whom you would think would say, “Let me have a chat with you about that” and challenge them. They cannot just say, “If that’s what you want, carry on”.

All those examples I gave—I will not go over the millions of better ones used in the past—show that this undermines autonomy and suggests that the state is indifferent to somebody, in effect, asking for help in a different way but the form it takes is, “I might as well have an assisted death”. If you listen to them, they might be asking for something else that the state can intervene and help them with, whereas we just go, “Assisted death? We can provide that. Any of that other stuff you want, like financial help or help with loneliness and all that—we can’t afford that. That’s not happening, but assisted dying? You’re on your way”. That is why we are worried, and it is why these amendments are worth taking seriously. The noble and learned Lord needs to come back with written amendments that will reassure some of us so that we do not keep repeating ourselves.

That was not really an Intervention; it was just a statement. I should have said to the noble Baroness, Lady Fox, that, as I said last week, I will make an Amendment so that the question of why will be asked, but I do not depart from the proposition that autonomy should be the leading reason for it. We disagree about that, and the House can reject that view on Report, but I am explaining what my position is.

I want to pick the noble and learned Lord up on the progress that I thought we had made last week, which he has just confirmed a bit, when he accepted that asking the question was valid. The problem is, if the result of asking that question is that nothing changes, it is just cosmetic window dressing. He may not have intended to, but he illustrated beautifully the point of asking the question. If we talk to somebody and it is clear that the reason they do not wish to go on is that they are lonely and they have no one there, we can do something about that. There are organisations and people who would provide that companionship. I see the noble Baroness, Lady Hayter, shaking her head. There are organisations and people who would do something about that.

It comes down to the point I made last week. We are saying that, if your life is terrible and you get a terminal illness diagnosis, under the Bill, you are more likely to want to end your life with assistance than someone whose life is great. That is a terrible thing for us to do. The noble and learned Lord does not agree with me; that is fine. The House will have to make a decision, and I think that the position that we have set out with these amendments would lead to a better Bill and a better society than the one he is setting out. We will keep making that point and attempting to move him to that position.

My Lords, we are meant to be having brief questions here; these are not brief questions.

That was the very thought going through my mind as I listened to the noble Lord, Lord Harper, and the noble Baroness, Lady Fox. They just made the same speeches again. On the point that he is making, the question of why is worth asking for two reasons: first, it might go to the question of coercion; and, secondly, it might throw up something that can be remedied, but, in the example I gave about loneliness, it may well be that meeting an organisation in those circumstances is simply not enough and does not change the person’s view. That is why I say that autonomy, rather than parsing the reasons, is the right course. In those circumstances, I invite the noble Baroness to withdraw her Amendment.

May I just correct something? The noble and learned Lord said that I wanted it to be only things that doctors can measure. It is not so much about things that doctors can measure. I was saying that it is about whether it is plausible—a doctor should have good judgment of this—that the distress the person is experiencing is in any way related to the illness with which they have been diagnosed. There is a subtle but significant difference because that is what helps you distinguish between it being that or coercion.

I will think about what the noble Baroness said. Perhaps it is my fault for not getting it. I will not write, but I will talk to her and listen to what she says.

I have a short question, if I may. If I heard it right, the noble and learned Lord said that he would bring forward an Amendment to put asking the question of why in the Bill. Whereabouts in the Bill does he intend to put it, and when will we see it?

I do not want to commit myself to where it will be. It will come somewhere, but I assume the best place for it, subject to advice, would be either with the co-ordinating doctor or the independent doctor, or the panel or all three, having to ask why.

My Lords, I also extend my thanks to the staff of the House for all their diligence in looking after us, particularly at this late hour. I thank all those who have participated in this important debate which, as I said at the start, goes to the heart of what this Bill sets out to do. While I am mindful of the time, I want to acknowledge the fact that there are a number of colleagues who wanted to participate in this debate but were prevented from doing so because of where they live across the UK. I myself would not be here right now if it was not for the fact that I am leading on this group of amendments. I would be with my family, acknowledging the Jewish Sabbath, as I do on a customary basis every single week.

I think it is worth rapidly reflecting on the contributions which build the case for these amendments. We heard from the noble Lord, Lord Shinkwin, about his lived experience of being told that he was going to die, and he is obviously still with us—we are delighted he is still with us—decades later. The noble Lord, Lord Hamilton of Epsom, talked about the challenges of a six-month terminal prognosis and errors in diagnosis. That point was echoed by others during our debate. The noble Lord, Lord Blencathra, talked about the challenges of non-medical motivations dominating the reasons for choosing an assisted death in some other jurisdictions, which really is the prompt for the amendments that we have discussed this afternoon. The noble Lord, Lord Carlile, said that the capability to have an assisted death alone should be due to the terminal illness itself. It was illuminating to hear from the noble Lord, Lord Deben, about his socialist ideals. However, the context in which we consider this Bill is that we are not just individuals; we exist within a society.

I am very grateful to the noble Baroness, Lady Cass, who corroborated how these amendments in a medical context ensure that the motivations for an assisted death are concrete, clear and defensible. I listened closely to the challenge from the noble Lord, Lord Moore of Etchingham—I do not think he is in his place. He asked how these amendments will make a difference, and this was a point echoed by my noble and learned friend. These amendments cement the principle of this Bill. It makes very clear to the public that it is your terminal illness that has to be the reason why you are pursuing an assisted death. Currently, the requirement is that doctors have to assess the patient and, instead of just establishing a clear, settled and informed wish to die, they must, via these amendments, establish that the terminal illness is the reason. That is not to say that there is no risk of someone being misled—that is the inherent risk to this entire Bill, in particular because of the lack of training that will be available to doctors as set out currently in the impact assessment.

The points made by the noble Lord, Lord Harper, showed us how these amendments connect to meeting the public’s expectations of this Bill. The noble Baroness, Lady Finlay, made it clear that the motivation to have an assisted death should be because of terminal illness and we should set that out in the Bill. This is yet another issue that is not clear and we need those clear boundaries. I am grateful to the noble Baroness, Lady Grey-Thompson, for setting out some real-life case studies and examples of why these amendments matter.

I believe that this debate, and, indeed, how my noble and learned friend set out his conclusion just now, has confirmed that there is a real difference at play in how we understand what the Bill sets out to do. For some—I hope I am not mischaracterising, but this was certainly in the contributions of the noble Baroness, Lady Blackstone, and alluded to by the noble Lord, Lord Markham, and my noble friend Lady Royall—it is about autonomy: allowing those who are already dying to exercise choice over the timing and manner of that death. For others, like me, it is primarily about compassion in seeking to prevent or minimise the suffering associated with their illness. These are related positions but they are distinct. My amendments have sought to establish which is the position of the Committee.

For myself and, in particular, those with a strong interest in mental health and suicide prevention, it is the latter that offers the stronger consideration for introducing a system that I am concerned is fraught with obvious risk to the vulnerable and those at risk of pressure. That means that we must do more than simply establish that a person is terminally ill and that they genuinely wish to end their lives; we must have a means of establishing the link between those two questions so that we do not open the door to having the state, which should protect vulnerable people, instead becoming complicit in their premature deaths.

None of these amendments, I believe, prevents there being additional motivations for seeking an assisted death. I intend to revisit this fundamental issue at the next stage and, indeed, through my engagement with this enormously consequential legislation. I will certainly consider the Government’s assessment of the wording as set out by the Minister, and I hope that the sponsor will also consider the profound concerns that have been raised during the course of the debate when we return on Report. For now, I beg leave to withdraw my Amendment.

Amendment 44 withdrawn.

Amendments 45 to 59 not moved.

House resumed.

House adjourned at 6.02 pm.