Baroness Finlay of Llandaff:

Moved by Baroness Finlay of Llandaff

71: Clause 2, page 2, line 4, after “reversed” insert “or slowed”

My Lords, this group concerns terminal illness. It is incredibly important. It is the title of the Bill, so it is extremely important that we have proper definitions of terminal illness in the Bill that are beyond doubt. The proposal to make eligibility dependent on a clinician’s judgment that a person is expected to die within six months might appear to be a safeguard, but evidence from palliative care, primary care and prognostic research shows that predictions are highly unreliable and largely guesswork. Some national celebrities who clamoured for eligibility live for years, while others campaigning for this Bill for themselves are clearly ineligible. Do doctors need to be 95% confident or 50% confident to rule that the patient will die within six months to be eligible? No validated clinical tools or tests exist to make such determinations with sufficient reliability for life-ending decisions. This lack of reliable knowledge leaves clinicians to face pressure to make prognoses they cannot substantiate with concurrent legal risks and ethical dilemmas.

Medical science recognises broad trajectories of decline. Those dying of cancer often experience a relatively long stable period followed by rapid deterioration over weeks or months. People with advanced organ failure, such as heart or lung disease, tend to decline in an unpredictable, fluctuating pattern marked by crises and partial recoveries. Others, particularly those with multiple conditions, neurological illness or frailty, experience a slow, progressive dwindling over years with an average of 20 or more months from identification of early palliative care needs to death and, during that time, quite marked fluctuations.

While these patterns help clinicians anticipate needs for care, they do not forecast how long an individual has left to live. A six-month prognosis is not a clinical truth. Medical prognostication for terminal illnesses is based on averages. However, in the individual, marked variables influence survival, including treatment response, infections and physiological resilience. A time-based legal threshold would turn population-level averages into high-stakes individual errors, approving some who are not within six months and denying others who are. An assisted death is irreversible, amplifying the consequences of prognostic errors and litigation. A systematic review of 42 studies on clinicians’ predictions for terminal cancer patients found very low accuracy rates ranging from 23% upwards. In a multicentre study of more than 2,000 palliative care patients with advanced cancer, physicians’ clinical predictions were accurate in only 35% of cases. Tools such as the surprise question—Would you be surprised if this patient is alive in a certain number of months or weeks?—have been tried as a way to predict those likely to die. It performs poorly at six to 12-month predictions, especially for people who have multiple conditions.

The six-month rule is unsafe and unworkable. Assisted dying legislation requires criteria that are objective, transparent and as evidence-based as possible. The definition must exclude conditions that can be meaningfully stabilised or controlled for years, as in Amendment 104 in the name of my noble friend Lady Grey-Thompson. Manageable conditions must not be treated as terminal if somebody during an episode of depression or other life trauma, such as bereavement or a relationship break-up, decides to stop whatever treatment they have when they are feeling suicidal, such as the diabetic who decides to stop their insulin knowing that if they do, they will die within weeks.

The arbitrary time of six months is unverifiable. You have a less than 50% chance of being right, and the index of suspicion, as written in the Bill, is far too low. A review paper by Scott Murray and Simon Etkind, published in the British Medical Journal in March 2025, described how inaccurate prognostic tools are—as well as the importance of illness trajectories, which can

“provide broad timeframes and patterns of likely decline” to help doctors understand disease progress.

Patients with frailty have been described as being “on a tightrope”: some will stay on for years, but others may suddenly be blown off by an infection or a fall, and die rapidly. The Bill says nothing about pain, suffering or potential suffering. The only disease-related issue in it is prognosis, yet accuracy at six months below 50% is a pure guess that someone has six months to live. To tackle these problems, Amendments 71, 77 and 90 offer options to look at the progress of disease to increase the chance of being a little more accurate at six months, which is the point at which you could trigger the process of applying for an assisted death.

Amendment 79 would help clarify whether the disease is progressing because some potential disease-modifying treatments have been ignored—or, perhaps, the patient does not even know about such treatments. The progress of the illness will give a far better indication of whether you are rapidly deteriorating or are, in fact, remarkably stable.

My Amendment 444A would allow you to be monitored while you have other support, having triggered a request for an assisted death. This would allow specialist palliative care to be available to you if you wish to try out various suggestions. Then, as the disease is progressing more obviously towards death and there is a greater sense of predictability, the person would be eligible for sign-off by the panel and given the lethal drugs. The best evidence on predictability would be the point at which the palliative prognostic index score indicates that the person has a more than 50% chance of dying within six weeks.

However, Amendment 444A offers a compromise, because I am sure that many people will feel that six weeks is too short a timeframe. It suggests that the patient cannot have lethal drugs until they really are seen to be terminally ill and the clinicians are more confident in predicting that death is likely to occur within three months. The patient who is rapidly declining would not need to wait between first assessment and having an assisted death because they would be seen to be declining rapidly, but the patient who is completely stable would not risk having the lethal drugs until there was evidence that they were actually in the last phase of their terminal illness and a wrongful death could be avoided.

Some jurisdictions include frailty in their definition of “terminal illness”, but others do not. Evidence on this came up in Committee in the other place: a 2025 paper in Age and Ageing titled, “Why We Need to Consider Frailty in the Assisted Dying Debate”. With this extensive uncertainty around frailty and other multimorbid conditions, does the noble and learned Lord, Lord Falconer, include frailty in his definition of “terminal illness” or not? Also, does he accept that disease progress is critical to avoiding wrongful deaths? I beg to move.

My Lords, the noble Baroness, Lady Campbell of Surbiton, is taking part remotely. I invite the noble Baroness to speak.

My Lords, before I speak to the amendments in this group, I say that I too have not received the letter sent by the noble and learned Lord, Lord Falconer, regarding amendments he proposes to return with, so I am somewhat in the dark today, should the content relate to remarks I am about to make now. Please would he check the distribution list, as such information is crucial to our deliberations, especially when one relies so heavily on remote participation for inclusion, as I do?

I have added my name to Amendments 71, 79 and 90 in the name of my noble friend Lady Finlay of Llandaff. Amendment 71 is important because treatments which reverse or slow the effects of a terminal illness are being developed all the time. Patients who would once have feared choking due to swallow deterioration can now receive nutrition through a simple device, yet still taste food and even drink wine safely. Ventilators like mine are now commonplace and easily transportable. They offset debilitating shortness of breath and improve ability to talk.

There is much to be celebrated in medical developments and treatments which give real choices to people challenged with life-limiting and terminal health conditions. Those seeking an assisted death need to know about them. For example, why would anyone be aware of improvements in, say, ventilation unless they, a family member or friend receive that benefit? Indeed, medical professionals in other specialities are also unlikely to know about them. But knowledge is power; it eases anxiety and it offers hope. To paraphrase Donald Rumsfeld, “You don’t know what you don’t know”.

Amendment 71 seeks to add an essential safeguard ensuring that someone does not elect for an assisted death due to an unknown unknown. People with terminal illnesses will often be unaware of the latest developments, in both medical and social care. Their immediate circle and the doctors and allied professionals they turn to may also not be familiar with them. We know that fear of the future, potential pain and loss of autonomy are key factors in wanting a change in the law, but if these fears are based on lack of knowledge, that is not a good reason for an assisted death. Lack of knowledge equals lack of choice.

On Amendment 79, I thank the noble and learned Lord, Lord Falconer, for meeting me and two distinguished consultants from St Thomas’ Hospital this week; namely, Professor Nicholas Hart and Dr Robin Howard. Both are experts in treating patients with complex and progressive illnesses. They explained why diagnosis and prognosis alone cannot be reliable indicators of how and when a person can be reasonably expected to die. They also illustrated the very wide range of medical, technical, pharmaceutical, social and environmental modifying treatments that can slow down progression and alleviate symptoms. They gave powerful examples of terminally ill patients living far beyond their prognosis and thriving at home and in the community due to good-quality health and social care interventions.

There is hardly anything more important in this Bill than the determination of prognosis. Naturally, prognosis will be highly dependent on the treatment received. Disease-modifying treatments will be highly significant. Prognosis will vary greatly depending on whether the person receives no treatment, poor or inadequate treatment, or indeed best practice. Take my own condition, spinal muscular atrophy. I have been given different prognoses over the years, depending on the hospital and attending doctors. When I was admitted to my local hospital with a chest infection, the senior consultant in intensive care informed my husband that it would not be in my best interest, or even fair, to treat me as I was at the end of life. That was over 10 years ago—and here I am.

I am not alone. I can give your Lordships many examples of inappropriate prognostication of people with progressive health conditions, especially those with a neuromuscular diagnosis. I thank my lucky stars I have a consultant who has advocated life-saving operations and treatment over the years. Friends of mine have not been so lucky.

We have a responsibility to ensure that anyone seeking an assisted death has experience of the best possible care and support available to them. An assisted death should never be seen as a better alternative than sub-optimal treatment—not by Members of this House, by the individual or their family and friends, or by wider society. When you are at your lowest, help from medicine, technology, and good care and support can mean the difference between hope and despair, and life and death. That is why I support these amendments.

Finally, Amendment 90 addresses an especially important consideration for those who may not voluntarily stop eating and drinking. There is nothing voluntary about eating disorders, and people with eating disorders do not typically cease intake of fluids. People with such conditions talk of being controlled by anorexia. The mental illness is such that they feel they have no choice but to do anorexia’s bidding. Despite this, they present as articulate, knowledgeable and with mental capacity.

American-born Chelsea Roff was diagnosed with anorexia and given a few months to live. Thankfully, she got the right help, information and medical support before medical aid in dying was legalised in her country. She now lives in London, where she leads the Eat Breathe Thrive Foundation for Eating Disorders, which supports and advocates for people in this situation. She tells me that she is deeply concerned for her community, knowing that she and others like her could have ended their lives were it legal to do so.

Ms Roff has drawn my attention to Commons Amendment 14, tabled by Naz Shah MP in the other place, which was accepted without a vote. It provides that someone cannot be considered terminally ill only because they have voluntarily chosen to stop eating and drinking. Clause 2(2) is necessary to prevent individuals from, in effect, manufacturing a terminal illness through self-starvation or dehydration in order to qualify for an assisted death, something that has already occurred in the state of Oregon. It does not, however, on its own provide adequate protection for people with eating disorders. As Ms Shah herself has said, a loophole remains.

People with anorexia do not stop eating voluntarily, and many eating disorders, including anorexia, can be life-threatening without involving cessation of food and fluids. Amendment 90 would address this gap and further protect people with anorexia.

It is a great pleasure to follow the noble Baroness, Lady Campbell of Surbiton, and to say how pleased I am, as I am sure all noble Lords are, that she is very much still with us. I hope she will be for many years to come.

This is an important group because, as has been emphasised, scientific precision is of course not possible in this area. Nobody could say that a doctor can tell you that you will die within six months. But the Bill does not so provide. Its conditions require only that the doctor, and the panel in due course, are satisfied that

“the person has an inevitably progressive illness or disease which cannot be reversed by treatment, and … the person’s death in consequence … can reasonably be expected within six months”.

The term “reasonably be expected” recognises the absence of scientific certainty and absolute knowledge in this very difficult area.

The noble and learned Lord will give his view on this in due course, but why, in my view, is the Bill right to so provide? It is because—we are down to the fundamentals of this legislation—if I am told by my doctor that, sadly, I have an inevitable progressive illness or disease and my death can reasonably be expected within six months, I should have the choice of saying that I wish to end my life by taking advantage of the provisions of this Bill. Each of these amendments seeks fundamentally to undermine the core of the Bill and the philosophy that guides it. I entirely accept that its opponents disagree, but this is the core of the Bill and why it rightly so provides.

It is no answer to these provisions and this philosophy that, happily, having been given that prognosis, I may well, should I choose not to exercise the powers under this Bill, live for seven months, 12 months, two years or however long. It would be wonderful if my doctors were incorrect, but it is my choice, having been given that prognosis. That is what this Bill is about—we have taken days debating this—and it is right and proper that we ensure that that decision is made on a voluntary basis and that there is no coercion. But, once those conditions are satisfied, if I am told by my doctor that that is my prognosis, it should be my choice whether to use the provisions of this Bill.

My Lords, does the noble Lord agree with me that one of the international facts that supports entirely the position he is taking is that, in the now 33 jurisdictions where assisted dying is allowed, it is usually the case—I cite one or two—that, following that suggestion by a doctor, or prognosis or however you want to describe it, over a third of those who make the choice he has described then do not use the provision? There is no question that they want to die; they are simply using it almost as an insurance policy.

The noble Baroness makes an important point, because this Bill is concerned with providing choice. Of course there is no mandatory obligation, but, if you are given this information, you should have the right—it is your life—to decide whether you wish to take advantage of these provisions. In many cases, if it were me or my family, I would argue strongly that there are other options and other things should be done. But it is a choice, and people should have that choice. That is the philosophy and what has guided so many jurisdictions around the world. Many noble Lords do not agree with that, which is their right, but that is what this Bill is all about.

My Lords, the noble Lord rightly emphasises that choice is an essential element of this. But in so emphasising, he appears to cast “choice” in a very black and white manner as if it can suggest, not perhaps 100%, but 99% certainty, one way or another. I am sure the noble Lord is very grateful that he has never been in the situation of the patient sitting in that chair, having a conversation with a doctor, as I have, unfortunately. I can tell him that it is not a conversation with one doctor; it is a conversation across a multiple range of people, because doctors want you to have second opinions and speak to others to see if they might think of how you might ameliorate your illness, particularly in the case of cancer.

Doctors do not tend to give you that choice—telling you that it is reasonably likely that you will be dead in six months; they are more likely to say, “Let’s see if X, Y or Z treatment or drug will perhaps help you. We need to try that for a little while”. When you do that, you see what the results are. In the impact assessments, we are told that 66% of people in the two jurisdictions referenced were cancer patients. The noble Baroness, Lady Jay, is right to say that 40% of those cancer patients did not exercise their right. I said this at Second Reading, so I am not going to repeat it, but potentially one reason why they did not exercise that choice is because that certainty of choice changed. The situation changed as they went along, and perhaps that is why they did not exercise it. So much emphasis on choice perhaps is unwise in this uncertain world.

The noble Baroness began by asking about my experiences. I do not really want to talk about my personal experiences, except to say that those I have loved have faced a terminal diagnosis. I am very familiar with all of this on a personal basis, as I am sure is everyone—or almost everyone—in this Committee, and our experiences, of course, guide our view as to the merits or otherwise of this Bill.

May I ask the noble Lord a question? This is not a trick question; I sincerely want to know his opinion from a legal point of view. The Bill refers—and he has said it refers—to a reasonable expectation of death within six months. Normally, and this was a point made by the noble Baroness, Lady Finlay of Llandaff, just now—and I have some amendments later which address this specifically—a prognosis given by a doctor in a particular case would be an average of the sort that we call a median. That is, 50% of people in your position will die within six months, but 50% will live longer than six months. Which one are you? Would that 50% constitute for him a reasonable expectation, or would he expect a higher threshold to apply in a case such as this?

I do not think any doctor, any panel or any court would adopt that type of approach to a complicated issue of this sort. They would rely on the judgment of the doctor, who no doubt would be well aware, or should be well aware, of the provisions of this Bill, if enacted. The doctor will exercise his or her judgment and be able to tell the patient whether there is a reasonable expectation of death within six months. The doctor will give that judgment, and whether you are eligible under the Bill depends on that. It is as simple as that.

My Lords, the noble Lord, Lord Pannick, is quite right that autonomy is the basic principle under this Bill. In fact, the noble and learned Lord, Lord Falconer, told the Select Committee that the essence of the Bill before us is autonomy, which makes it an outlier. Terminal illness plus an autonomous decision should not be the model that allows this Bill to be engaged. That terminal illness must also be causing suffering, which is why I support my noble friend Lord Frost’s Amendment 84. Rather than this being a cruel and heartless precondition, there are many public policy reasons for this that others have mentioned.

First, it would prevent social and economic circumstances and fear of being a burden from driving applications for assisted suicide. Secondly, if suffering were included, doctors could properly discuss palliative care and pain management, and lack of care could never be the motivation. Finally, there is a democratic imperative. The publicly presented raison d’être for this Bill is always the relief of suffering. Yet, without a suffering requirement, assisted suicide can be for any reason if there is a terminal illness judged to lead to death within six months. Others, such as the noble Baroness, Lady Finlay of Llandaff, have said why this six-month rule is unsafe and unworkable. We are glad Esther Rantzen is still with us three years after she was diagnosed with stage four lung cancer. We all sympathise greatly and genuinely with the loss of control she is facing; none of us looks forward to that. Like Dame Esther, I am also in my ninth decade. It is not at all theoretical that I, or indeed anybody else in this Chamber, might be in a similar position fairly soon.

None of us can be casual or flippant about the loss of autonomy. However, neither can we be reckless about this further move into what is in fact extreme bodily autonomy. I am particularly taken by the treatment of autonomy by the late Rabbi Jonathan Sacks. The noble and learned Lord, Lord Falconer, assured the nation on the “Today” programme yesterday that he respects people of faith. Throughout Morality, the last book Sacks published while alive, he stressed that human dignity does not come from autonomy alone but from being in relationship with others and—dare I say it—with God. The thread running through it is that we are moral beings because we are not alone. Autonomy is, he said, a “significant moral principle”, but there are other values, equally significant, that limit autonomy. When it comes to life and death, society must decide whether life is something we own or something over which we are stewards. For Sacks, redefining life as private property is inherently dangerous. If life becomes seen as disposable at will, society risks weakening its shared responsibility to protect and care for the vulnerable. When autonomy is allowed to trump all other values, the moral fabric of care and duty begins to unravel.

Allowing assisted suicide to enable unfettered choice shifts dignity away from intrinsic worth towards functionality or self-sufficiency, which is a dangerous precedent. Once the boundary between caring for life and ending life is blurred, society risks losing reverence for the vulnerable. Sacks treats the enthroning of personal autonomy as symptomatic of our cultural shift away from shared moral responsibility—a “we” orientation—to hyper-individualism, the fixation on “me”, which you could also say is selfishness. Assisted suicide further skews this imbalance by treating life purely as an individual possession rather than a shared trust.

It is not surprising that Bill’s sponsors have gone down the same autonomy rather than suffering route as the US has done, because international metrics bracket us with the US in terms of how individualistic we are as a nation. Yet Australia has an even higher individualism score than the UK. States and territories within it, and other high-scoring countries such as Netherlands, Canada and New Zealand, have all resisted the siren song of extreme bodily autonomy in this area and so should we.

This is a pretty high-quality speech; it has pretty little to do with the six months. It is about the whole principle of the Bill. I am just wondering whether it is going to connect back to the six months.

I am supporting the inclusion of suffering from the noble Lord, Lord Frost, which is increasing the choice from autonomy to increased suffering. That is how it joins here. As many noble Lords have said, it is a very important area for us to discuss, and it is the underlying principle that the noble and learned Lord has said is supporting this Bill.

I mentioned shrouded attributes at Second Reading: the long-term unintended consequences of a course of action that might be politically attractive in the short term. Others have warned of the inevitable widening of the Bill through judicial review and future legislation, but I want to point out where else extreme bodily autonomy might take us. It is currently illegal to sell body materials—no money can change hands, apart from fixed compensation for expenses incurred for donating, for example, eggs, sperm or live organs such as kidneys. All that people can get for donating blood and plasma is light refreshments. Asserting autonomy and ownership over body parts would mean that people could sell one of their kidneys, perhaps to get out of debt. Do we really want that?

People with the rare condition body integrity dysphoria—BID—feel that a specific, healthy part of their body does not belong to them and that their body might feel right if it were removed or disabled. Until this happens—and, sadly, sometimes after amputation—they experience intense persistent distress, which usually starts in childhood or early adolescence and is lifelong. Again, do we really want what is illegal for doctors to perform now in this area to become legal and socially acceptable?

It is our duty and role in the UK legislative system to bottom out these shrouded attributes and long-term culture-shifting consequences. Bodily autonomy can never be treated as an absolute right. It must always be balanced against our status as moral social beings. Its primacy in the Bill is not a virtue but a fatal flaw.

My Lords, I am glad that the noble Lord, Lord Pannick, said that this was at the heart of the Bill, in the sense that I think he is right; it illustrates one of the Bill’s great problems. It has emerged from this debate—the noble Baroness, Lady Finlay, made it clear—that this is very uncertain in medical terms, yet doctors are being asked to provide it. Why is that happening? Well, because it is a necessary gateway. Therefore, it seems to set up perverse incentives in the mind of the doctor, and it creates a professional problem.

Most doctors who will wish to give such a prognosis will be in favour of assisted dying; that would seem the natural likelihood of all this. If they therefore want to give the patient, or the applicant, what he wants, they will be less likely to want to inquire about and help with all the other, possibly better, treatments that might solve the problem. The patient may be in a situation in which they want to die and do not want to solve the problem. It seems that this is putting a big burden on doctors, and it is not right, professionally.

Why is this burden being put on them? It is the result of the views of the Bill’s progenitors. I think— I am guessing here—that the reason they concentrated on six months is that they are desperate to get it through in some way and they could see how difficult it would be if you started to argue about unbearable pain, for example. What is the definition of unbearable? How does it have a scientific or objective definition?

It seems to me that, if it is passed and six months is the only medical criterion, it will quickly become obvious that it was not adequate as a reason for doing it—but, of course, by then, the Bill’s progenitors will have scored their main hit by getting it into law that autonomy triumphs and assisted dying exists. Then, later, they will say—rightly—that if we have assisted dying, this is a silly or inadequate criterion so we need other ones and more of them. I am sorry to use the tired phrase, but it seems to be a slippery slope.

My Lords, I will make a very quick point. I was not expecting to speak on this, so I apologise for not being prepared. When I was at Cambridge, I worked on many risk communication tools that were used by doctors to help calculate somebody’s prognosis, particularly of cancer, and to communicate it to patients. A standard way of communicating that prognosis was to say, “Out of 100 patients with characteristics like yours, we would expect X number to be alive in one year”, or five years, or whatever. I do not think it is unreasonable for us to be asking what “reasonable” means in terms of the number out of 100 who would survive at, say, six months.

My Lords, I will speak to Amendment 75, which I have added my name to. It addresses probably the most decisive yet hardest to confirm clinical issue, and is central to the Bill.

Prognosis is not determined by diagnosis alone. Throughout my career as a doctor, I have seen many patients whose disease sounded on paper as though death was imminent, yet their course was significantly altered by evidence-based treatment and high-quality palliative care. In evidence to the Select Committee, the Royal College of General Practitioners stated:

“It is possible to give reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months then the scope for error can extend into years”.

I agree with my noble friend that a 50% likelihood of a six-month prognosis is not reasonable.

Amendment 75 would ensure that, when we speak of an expected prognosis of six months, we do so in the context of treatment offered to them, in line with national NICE guidelines and tied to clinical reality. Without this safeguard, there is a risk that people who choose to participate in assisted suicide could start the process even where treatment is delayed, unavailable or not even offered, and where symptoms or fear of the future are instead driving a perception of hopelessness.

A three-month prognosis, as proposed in Amendment 444A, from my noble friend Lady Finlay, would be much more accurate, as there is an evidence-based assessment tool available through the continuing healthcare fast-track process. Noble Lords may be unaware that fast-track funding is available for those who have a rapidly deteriorating condition where they are approaching the terminal stage and the end of their life. This funding is used to provide much-needed nursing care, hospice involvement and support for families, and can be put in place usually within 48 hours.

NHS guidance notes that the fast-track funding tool is used when urgent care is required at the end of life. The most robust data currently available comes from a 2023 observational study published in the British Medical Journal Open Quality. It examined 439 patients referred for NHS continuing healthcare fast-track funding. The median survival for patients whose fast-track funding was approved was only 18 days, and a minority of patients were still alive at 90 days after referral, showing a much more accurate prognosis. The short survival time found in the study suggests that many referrals occur very late, sometimes limiting the ability to arrange preferred care settings. I think ignorance within primary care of this funding pathway and its usefulness in supporting people to stay at home during their last days and weeks contributes to its low take-up, and perhaps the rather unnecessarily large number of people who spend their last days in hospital.

Approval for fast-track funding helps clinicians by grounding prognosis—an already incredibly difficult task to predict—in nationally agreed standards rather than variable local practice. There must be absolute clarity that no one becomes eligible for assisted suicide because the system has failed them, especially regarding geographical variability in treatment options or lack of awareness of these treatment options.

My Lords, I will speak to Amendments 72 and 80 in my name. I will not say anything about autonomy other than to mention to the noble Lord, Lord Pannick, that although it is a philosophical concept which was drafted in recent centuries, academic philosophy is very divided on how worthwhile it is as a concept.

I begin with my Amendment 80, which would substitute some detail for the very vague requirement that death within six months can reasonably be expected. We have already heard in the Committee, from everybody—not only today but on other days—that certain diagnosis is a very inexact science, and that diagnosing someone as having six months is very inexact.

We have heard from the noble Baroness, Lady Finlay, in opening, that conditions can differ, patterns can differ and patients can differ—we also heard that from the noble Baroness, Lady Hollins. Therefore, each patient must be assessed on an individual basis.

Against that, my Amendment 80 proposes that the difficult job of assessment is done by two consultants specialising in the relevant area, and it pins down that the expectation should instead be an 80% probability. If the sponsors are in earnest that those eligible really should be those who are within six months of death, they should be pleased to accept an amendment that tries to overcome the inexactness of such judgments by requiring confirmation by two of the most qualified experts in the area, and they should accept that an 80% likelihood is what, in this context, can reasonably be expected.

I move on briefly to Amendment 72. The Bill already refuses eligibility for assisted suicide when a condition that in itself is diagnosed to lead to death within six months can be reversed. My amendment takes the next logical step by limiting eligibility to cases where the condition not only cannot be reversed but cannot be relieved, controlled or ameliorated; I am adding to what has already been proposed in that group. The amendment aims to substitute a constructive, optimistic approach to treating illness, rather than one that writes off the patient and points them on the path to suicide.

That requirement—that, when steps can be taken to relieve, control or ameliorate a disease, the patient can no longer be considered for assisted suicide—will remove many otherwise difficult cases from this murky area and allow the mechanisms to operate as best they can for those for whom the Bill, on its face, intends them: people whose deterioration is inevitable.

There is an even more pressing reason than those two to accept this amendment: unless we positively exclude from eligibility patients whose condition could be relieved, controlled or ameliorated, we set up the conditions in which the relief, control and amelioration of terminal illnesses will become increasingly rare. We have heard of some remarkable instances today, not least from the noble Baroness, Lady Campbell of Surbiton—whom I am delighted to see back. Why would an overburdened health service try to give some extra months of life, give a higher degree of relief of pain, or ameliorate or arrest the progression of the disease, when it is so much easier to direct the patient, either implicitly or by expectation, towards assisted suicide?

What about relatives—even no more than ordinarily unscrupulous or greedy ones, or merely selfish ones—for whom the speedy death of their loved one is likely to seem desirable? We may also reasonably fear an overzealous state service committed to the task of accelerating the pathways of such unfortunate cases to their ends. My amendment guards against those consequences—some of the worst of a Bill so rich and varied in its capacity for harm.

My Lords, I rise to introduce Amendment 84, which has already been touched on by the noble Lord, Lord Farmer. I am grateful to, and thank, the noble Lord, Lord Carter of Haslemere, for his support.

This group, as we have heard, is primarily about the definition of terminal illness. My amendment in this group touches on a somewhat different but related and important point, which is whether the terminal illness criterion—the existence of terminal illness—is in itself sufficient as a criterion. I am doubtful that it is, and that is why I have proposed this amendment.

As your Lordships know, there are two different models around the world for the kind of law that we are considering. Both include a terminal illness criterion. One type also has a suffering criterion, and that is the model used, as has been said, in Australia, New Zealand and elsewhere. The second type does not; it rests entirely on the concept of autonomy—the belief that if you know or have been told that you are going to die soon, you have the right to ask the state to allow you access to assisted suicide. I will say more about this autonomy point in a moment.

To state the obvious, the Bill is based on the second of those two models, but one of the problems is that much of the campaign for it is based on the first model—the assumption of a suffering criterion. Hence my amendment would introduce the concept of unbearable suffering that could not be relieved by treatment. It is probing; it aims to test the reasoning behind the preference of the Bill’s supporters for that type of model.

My amendment would do four things, and some of what I am about to say has already been touched on, so I will be brief. First, it would align the legal test in the Bill with the public justification for the Bill. It is clear that the campaign around the Bill bases much of its work on the need to deal with suffering and, if suffering is the moral foundation offered to the public, it should be in any eventual statute. It is clear from all the discussion around the Bill that many voters believe it already is in the Bill, and it should be.

Secondly, it would stop drift and the slippery slope. The problem here is that, if the real justification for access to assisted suicide is autonomy, what is the justification for the robustness of the six-month limit? We have heard that provisions in the Bill are vulnerable to court rulings, judicial review and the existence of the ECHR—although there is, of course, a way of resolving that particular problem—other broader principles and specific legislation such as the Equality Act. A suffering-led criterion would help Parliament to draw and defend a clear and principled line.

Thirdly, it is relatively—not totally, but relatively—easy to identify unbearable suffering. As has been noted, it is usually obvious from demeanour and body language when there is frequent and unbearable pain. This helps distinguish between qualifying and non-qualifying reasons for access to assisted dying, such as social pressures. This is vital given that we have already heard from the sponsor how widely drawn some of those criteria might ultimately be.

Fourthly, it has to be noted that, with a small number of exceptions, most other jurisdictions that use these Laws have a suffering criterion: Australia, the proposed legislation in France, now happily stalled for the time being, the Netherlands, Belgium, Luxembourg, Spain, Portugal, the rejected legislation in Slovenia, New Zealand, Colombia and so on all have a suffering criterion, and for a good reason.

He has touched on it before, but when the noble and learned Lord, Lord Falconer, responds to the debate on this group, perhaps he could explain in greater depth why he is so insistent on an autonomy-only Bill, whether he recognises any limits on autonomy, and whether and why he is content to rest on autonomy as a justification while allowing campaigners to make a case based on suffering.

I want to say a few words on the justification of autonomy because it is so crucial and the Bill’s sponsors have been clear on the importance they attach to it. The noble and learned Lord, Lord Falconer, has been quoted before but it needs repeating:

“the essence of the Bill is autonomy. You have a choice … Once you satisfy that requirement—obviously, the safeguards have to be complied with—that is the essence of the Bill. It is autonomy”.

We heard from the noble Lord, Lord Pannick, who is not in his place, about the importance of choice in this area. That is really another way of expressing the same issue.

Proponents of the Bill have, at times, been perhaps a little dismissive of those of us who have religious convictions and suggest that we should not bring them to this debate. But I suggest that the belief in autonomy is also an a priori conviction with no more or no less right be heard unchallenged. It is surprising perhaps to find Ayn Rand-like views of the importance of individual autonomy emanating from the Labour Benches. It is a view that one can have, but I suggest that very few people do in fact have such views in practice.

Autonomy is unsafe as a principle and must, as my amendment does, be coupled with other criteria, for one important reason. Autonomy is not, in fact, unlimited, and it never will be in any society. We all have our own moral views, but we do not have unlimited power to bring them into society. We all have to operate within a framework of laws, which are themselves ultimately based on a set of moral judgments. We do not have an overriding right to choose.

At the most obvious level, we do not allow murder, even if you believe murder to be justified. At a more prosaic level, we are not allowed to define for ourselves what the content and obligations of marriage are; they are defined in law on the basis of an understanding of the purpose of marriage. If you have a different view, that is interesting, but it does not affect the constraints that you are working in. There are many other areas and practices that a view of the absolute importance of autonomy might lead us to tolerate, but in practice we do not.

As Professor John Keown, the expert lawyer, academic and bioethicist, wrote in his magisterial work on this whole question:

“Is there a right to choose to have a healthy limb amputated, undergo FGM, take hard drugs, engage in duelling or sell oneself into slavery”?

Those are actions that many of us in this House would, I assume, baulk at, but the autonomy principle might, nevertheless, justify. So why is it so unreasonable to think that autonomy might not be insufficient as a principle in the area covered by the Bill either?

If the sponsors of the Bill think autonomy and freedom of choice is some sort of completely unqualified principle, logically they must have some sort of Nietzschean superman view of the ability to make up moral principles as you go along. If they do not think that, and I do not think they really do, they must accept there are constraints on individual autonomy. Once you have conceded that, you have conceded that autonomy is not an overriding principle; it must be seen in a context in which we choose to think that certain moral rules, societal presumptions, laws or whatever override personal judgment.

Suicide, the undesirability of dying by it, the illegality of assisting it, has so far been one of those moral presumptions. Yet the Bill’s proponents think it is obvious—not debatable, but obvious—that this particular rule can simply be cast aside. I do not agree, and Professor Keown said this idea

“is too often advanced as if it was an obvious conclusion rather than a controversial proposition”.

To conclude, this is why autonomy is not enough as the basis for the Bill. Indeed, under the guise of autonomy, and sort of sneaked into the Bill, is a subversion of the general taboo on suicide, the general societal efforts to prevent it, and the legal prohibition on assisting it. The Bill proposes to change the translation of that moral framework into legal provisions, and that is why we must be so cautious that we know what we are doing if we proceed with the Bill.

We have heard many complaints about the speed of discussion in this House. The truth is that the Bill, as it stands, is unsafe at any speed.

The noble Lord is over the 10-minute limit. Could he please wind up?

I am coming to my conclusion. It is somewhat safer with the two criteria of autonomy plus life expectancy and of unbearable and irremediable suffering. It limits the scope of the moral and legal change, or regression as I would see it, that we are undertaking here. That is why I have tabled Amendment 84 and why I think it is so essential.

My Lords, I added my name to Amendment 84 since I think the noble Lord, Lord Frost, has struck gold with this amendment. Requiring

“unbearable suffering … which cannot be relieved by treatment”, raises four critical issues at the epicentre of the Bill. First, his amendment exposes the total unreliability of a six-month prognosis of a terminal illness, as we have heard from numerous noble Lords. Trying to predict life expectancy is a hopeless exercise, especially when medical advances are improving at such a phenomenal rate. As the noble and learned Lord, the sponsor, said in relation to a prediction of six months to live, we are not dealing with certainty. I am with him on that.

Let me give the Committee an illustration from a real case. I know of somebody who was given a 5% chance of living for 10 years because he was suffering from an advanced aggressive cancer. It is not exact, but a 5% chance of living for 10 years approximates broadly to a reasonable expectation of dying within six months. That was 21 years ago and, as far as I know, I am still here—noble Lords will correct me if I have got that wrong. It does sometimes feel slightly otherworldly, listening to these debates.

Secondly, the requirement in Amendment 84 for unbearable suffering that cannot be relieved by treatment would have the obvious merit of bringing the effectiveness of palliative care into play, which is not currently the case as the Bill stands. As we know, the experts say that palliative care relieves pain in most cases and can help people who want to die to want to live. That is why a full assessment by a palliative care specialist is so important, as earlier amendments sensibly proposed. But the noble and learned Lord has said he is

“incredibly opposed to unbearable suffering as the root” of this Bill. His view is unsurprising since the effectiveness of palliative care would significantly reduce the Bill’s impact.

So the noble and learned Lord falls back on the personal autonomy argument, telling the Select Committee that the essence of the Bill is autonomy—you have a choice, it is autonomy—and it would give people the option of an assisted death if they have simply had enough of life. This is the third issue that would be resolved by Amendment 84. Should the National Health—health—Service really be assisting a person to kill themselves if they have simply had enough of life, whether or not they are in pain and whether or not their feelings relate to their terminal illness? Is that what a health service should be doing? That starts to look very much like assisted suicide.

Fourthly, I respectfully suggest that the noble and learned Lord gets on the Clapham omnibus and asks anyone who supports assisted dying the reasons why they do so. Overwhelmingly, they will say that people should not have to suffer unbearable suffering. Yet, astonishingly, you will not find the words “pain” or “suffering” anywhere in the Bill. I read it word for word last night at great length to check that point. I could not find those words. Without any reference to unbearable suffering, there will be a massive disconnect between the public’s expectation and the Bill’s contents.

Let us be clear: the vast Majority of the public are not on the edge of their seats watching our deliberations. Very few indeed will have read the Bill. They will therefore have a view of the Bill based on the common-sense assumption that people seeking an assisted death will be suffering unbearable pain. The compelling amendment from the noble Lord, Lord Frost, injects that common sense into the Bill by providing for that, and I heartily support him and Amendment 84.

My Lords, I am reluctant to involve myself in this debate, but I see this whole legislative process as being about practicalities in the end. It is good that we have had an exposition of the articulation of the motivation of the people seeking success for this Bill, but I am very concerned as a citizen because I think this is about palliative care and relief from suffering.

The Bill should have been about those very matters. However, it is not. It is about all the incentives, from government to public authorities. For those people that the legislation actually motivates, it is about promoting the idea that assisting dying—or assisted suicide—is available; whereas the medical profession prefers, and what all the medical colleges have said they want to see, is proper palliative care. We do not want a competition for the funding of one against the other. I can see that in individual and family lives—and the social life we have together, governed by a Government—the pressures are not going to be towards relief of suffering through palliative care but for assisted suicide. I do not agree with that and that is why I oppose the Bill.

My Lords, I seek the indulgence of the Committee to say a word about my Amendment. I am not speaking with my Front-Bench hat on, so to speak, because I understand that this group is going to carry on next Friday. I am in the middle of a trial and cannot attend then. I will speak to my amendment in this group now and will not summarise from the front bench but limit my comments to my amendment and the points which arise from that.

My Amendment 83B seeks to add

“despite any treatment they may be receiving”

It ties in with a point made by noble Lord, Lord Pannick, which I will come to in a moment because it is all tied together. The trigger for my amendment is in Clause 2(1), which reads:

“For the purposes of this Act, a person is terminally ill if” and then there are two conditions, both of which have to be satisfied. The first is that

“the person has an inevitably progressive illness or disease which cannot be reversed by treatment”, let us say—God forbid—one has pancreatic cancer, and it cannot be reversed by treatment. The second condition is that

“the person’s death in consequence of that illness or disease can reasonably be expected within six months”.

Two points arise out of that. First, there is the point which comes directly from my amendment, which would add

“despite any treatment the person may be receiving”.

Without this, it is unclear whether the six months is with treatment or without; in other words, you have pancreatic cancer and it cannot be reversed by treatment, so condition (a) is ticked. But when it comes to (b)—

“in consequence of that illness or disease”— does it mean that illness or disease itself untreated or does it mean notwithstanding the treatment you have been given? I suspect it is the latter that the noble and learned Lord intends, but it is far from clear. It actually reads more like the former, although I suspect that it is the latter. That is why I tables my amendment, and I respectfully invite the noble and learned Lord to consider it. As I say, I apologise to him, the Minister and everybody if I am not here next week to hear the fulsome response.

The other point which arises from the “can reasonably be expected” wording is the question of whether that is the 50% point or not. I am sorry that the noble Lord, Lord Pannick, is not here, but it seems to me as a matter of law that if I have a legitimate expectation in public law, I do not need to have a more than 50% expectation of it happening. There was authority at the highest level in the House of Lords that “legitimate expectation” means reasonable expectation. I am comforted—as always—by nods from the noble and learned Baroness, Lady Butler-Sloss.

Therefore, as a matter of law, I can have a reasonable expectation of X, even if I do not think that X is more likely than not. That is an important point which perhaps the Committee will consider going forward. People are reading that as a 50:50 mean or median. However, I can have a reasonable expectation of it raining tomorrow, for example, even if I think there is only a 30% chance of it. That is a reasonable expectation: it is not more likely than not.

I do not want to stray too far from my own amendments so I will now sit down, but I am grateful to the Committee for its indulgence.

My Lords, I would never stand in the way of a colleague who has a trial. I hope it is an important trial that will improve general knowledge.

My Lords, I am defending the interests of a Labour-supporting newspaper.

Well, there we are: we know that the noble Lord adheres to the cab rank rule.

We have heard three very cogent speeches from the noble Lords, Lord Frost, Lord Carter and Lord Taylor, about the suffering point. If we look at the discussion we have had this afternoon, we now have a clear and stark difference between assisted suicide based on suffering and assisted suicide based on choice. I agree entirely with the noble Lords, Lord Frost and Lord Taylor: the public expect this Bill to be dealing with suffering. The public understand this Bill to be dealing with great suffering. They understand that the choice to have one’s life ended is based on great suffering, although it does not say so in the Bill. That must be clarified by the sponsor.

On the other side of the argument, we heard a very eloquent speech from my noble friend Lord Pannick, with whom I have a lot of sympathy. It is not generally known that, as he said, he has very personal experience of the issues arising from this Bill. However, the choice he is suggesting comes very close to being a choice for anyone who is seriously ill, not just someone who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. I fear that those of us who, like the noble and learned Lord the sponsor, are trying to reach the end of our process in the House of Lords on the basis that there will be a Bill, so it must be the best it can be, are not focusing on what choice really means.

We are talking about informed choice, accurate choice, if we can achieve it. I bear in mind very much what my noble friend Lady Finlay said. We are talking about a protective choice: the duty of the state to protect the citizen, even when they are making a choice. We do not, as citizens, have unlimited free choices in what we do; therefore, protection is important. It must be a morally sound choice, because that is part of our polity. We do things that are morally sound, and the Government protect us from those which may not be. It must be a choice founded on medical and scientific integrity: and there is the rub, going back to the points my noble friend Lady Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.

For those reasons, I support the amendments that are focused on choice. I will mention three other amendments that I also support. The first is Amendment 76, which is not in my name but in that of the noble and learned Lord, Lord Garnier, but he is not able to be here for the latter part of today’s proceedings and I agreed to mention it at his request.

Amendment 76 would do something very simple. In Clause 2(1)(b), it would add one word, “direct”, so that a person is terminally ill if, in the amended paragraph (b), their death as a direct

“consequence of that illness or disease can reasonably be expected within six months”.

It may not be the perfect word, but it is about facts and the consequences of those facts. I agree very strongly with the noble and learned Lord, Lord Garnier, that if there is to be a death of someone through the assistance of a third party, which is what the Bill is fundamentally about, then it cannot be just a consequence, or one of the many consequences, of the illness. It has to be the, or at least a, major consequence of the illness. That is the purpose of that amendment: there has to be a bond, as it were, between the illness or disease and the death which ensues.

The next amendment is Amendment 93. It suggests leaving out Clause 2(3) altogether as it lacks clarity as to when an assisted death would be permitted. The subsection says that

“treatment which only relieves the symptoms of an inevitably progressive illness or disease temporarily is not to be regarded as treatment which can reverse that illness”.

What if the relief that is provided for an inevitably progressive illness provides not only relief from the symptoms but extra time to the person who is suffering from the illness or disease? I argue that if it allows extra time, the individual concerned will be having a new experience: they will be seeing what can happen if their symptoms are relieved. They need to discuss with their medical advisers whether they can have that relief of their symptoms again and whether it will prolong their life if they do. The relief may cause a fundamental change of heart by the individual. Therefore, I do not believe that there should be any possibility of the six-month period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given so that the person concerned can have an informed choice.

The third amendment is Amendment 96, which suggests leaving out Clause 2(4), which says:

“For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both)”, followed by an important further sentence that I will not read out because of time. This subsection fails to deal with the proportionality between the disease, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers. It is a complex little conundrum, but a very important one. I believe that proportionality needs to be clarified so that the Bill can be the best possible Bill we can have.

We have much still to learn about the issues that have been under discussion. I invite the noble and learned Lord, Lord Falconer, to consider these carefully and present some draft amendments to us before we meet again in a week’s time.

My Lords, I seek a cast-iron assurance from the Government Whip that those of us whose speeches will be delayed till next Friday are recorded by the Government and will be allowed to speak. That is all I want to say at this stage. We want an assurance that we will be allowed to speak next Friday if we delay our speeches from today.

I will shortly make an announcement to that effect.

My Lords, I will speak to Amendments 99, 102 and 105 in the name of my noble friend Lord Hunt of Kings Heath, who cannot be in his place today. For reasons that will become apparent, I have also added my name to the amendments. I declare an interest as the carer for a family member with long-term dementia.

Taken together, these amendments address a single fundamental problem in the Bill, namely the current definition of terminal illness. It is too broad, too vague and therefore too vulnerable to expansion—by interpretation, pressure and, ultimately, the courts. These amendments seek not to frustrate the Bill’s stated purpose but to clarify it. They seek to ensure that eligibility rests on being already dying, not on age, disability, long-standing conditions or cognitive decline. That clarity matters not only for patients but for clinicians, families and the credibility of the law itself.

Amendment 99 makes clear that being elderly is not of itself a qualifying condition. This should be uncontroversial, yet the current drafting risks conflating age, frailty and terminal illness. Evidence to the Lords Select Committee repeatedly warned that older patients commonly present with multimorbidity: multiple long-term conditions interacting in ways that make prognosis deeply uncertain. Professor Martin Vernon told the Select Committee that, in such cases, prognostication is “extraordinarily difficult”, particularly where frailty blurs the line between disability and terminal illness. If we do not explicitly exclude age, we will risk encoding ageism into statute.

Amendment 102 provides similar clarity in relation to dementia, confirming that it is to be treated as a disability, not a terminal illness in itself. This reflects both clinical reality and ethical responsibility. Dementia has an unpredictable course, and many people live for years with meaningful relationships and quality of life. In 2008, my father was diagnosed with mild cognitive impairment, a form of dementia. In 2010, he was diagnosed with Alzheimer’s disease. As a family, we expected that these diagnoses would dramatically shorten and limit his life. His condition has declined in the 16 years that have followed; he now requires considerable support from family members and a heroic team of carers. Despite this, he continues to live with a good degree of independence and a real quality of life. While his dad jokes continue to get worse—they should definitely be subject to a terminal diagnosis—he continues to be someone of good humour. If you had told me a decade ago that we would be sitting tomorrow at the Cherry Red Records Stadium, hoping and praying for AFC Wimbledon’s first home win since September, I simply would not have believed you.

In line with my father’s experience, your Lordships’ Select Committee on the Bill heard compelling evidence that the six-month prognosis safeguard is particularly unreliable, especially when it comes to cognitive conditions. To treat dementia as terminal by default would place profoundly vulnerable people at risk, especially given the well-documented difficulty of assessing capacity when cognition fluctuates. We will obviously come to the issue of capacity in later amendments.

Finally, Amendment 105 addresses congenital, genetic and lifelong conditions, which are present from birth and compatible with long-term survival. This is a necessary safeguard. Evidence to the Commons Bill Committee made clear that the Bill’s current language—phrases such as “inevitably progressive” and “cannot be reversed by treatment”—is worryingly elastic. Clinicians warned that, without clarity, even manageable conditions could fall within scope, particularly if treatment is refused or unavailable. We have seen this in Oregon, where qualifying conditions under a similarly broad definition have come to include arthritis and complications from a fall. This is not a path that this House should leave open.

Underlying all three amendments is a shared concern about scope creep. The Equality and Human Rights Commission, as we have heard today, warned at Second Reading that Clause 2 lacks sufficient clarity to be applied consistently by medical professionals. Human rights experts told the Lords Select Committee that the six-month criterion could itself become the basis for Article 14 challenges, precisely because it is arbitrary and weakly justified. Once Parliament establishes an autonomy-based model with clear boundaries, pressure for expansion is not hypothetical—it is inevitable.

We should listen carefully to disabled people. Disability Rights UK told the Select Committee that assistance to die should not be easier to access than assistance to live. As the noble Baroness, Lady Grey-Thompson, has repeatedly warned, disabled people could fall within scope through secondary complications if we are not careful. These are not marginal cases and they are not coincidences; they are warning signs.

The Committee is being asked to authorise a profound change in the relationship between the state, medicine and death. To my mind, this is the most consequential legislation as to the view of the state on human life that this House has considered for some time. If Parliament is so to do, it must legislate with precision. These amendments would not impose a moral view; they would set guardrails.

I encourage my noble and learned friend, Lord Falconer of Thoroton, to consider these amendments and, if not, to at least assure the Committee that we can make sure this legislation protects against ageism, ableism and a quiet drift from terminal illness to judging certain lives as less worth living. In that sense, these amendments are not hostile to the Bill’s supporters. They are an invitation to make the Bill honest about its scope, defensible in law and safer in practice. I therefore strongly support Amendments 99, 102 and 105. I urge the Committee to do likewise.

My Lords, I speak to Amendments 82 and 83A in particular, which were advanced by my noble friend Lord Polak, who could not be here after 4 pm today, and I said that I would speak in support of them. I endorse entirely what my noble friends Lord Taylor of Holbeach and Lord Frost have said—theirs were admirable speeches and every word was right.

Amendment 82—I can take this shortly, as I am conscious of the time—addresses the phrase “reasonably be expected” in defining who is terminally ill. It asks for those words to be removed and seeks to insert in their place,

“be highly probable and require dual specialist certification by independent consultants”.

In other words, it is to do with the vagueness which would otherwise occur, and which would be subjective and dangerously elastic as life goes forward five and 10 years down the road and this Bill is applied—I am assuming that the Bill will come into force.

The threshold is too low and the condition is too uncertain. Inserting these words would require two independent specialists—consultants with expertise in the relevant field. When looking at vagueness and uncertainty and the risk of people who are not really experts in the field giving this sort of advice to an individual, I was particularly moved by the powerful speech of the noble Baroness, Lady Campbell. We have heard others, as well, from those who have had similar experiences, not least my noble friend Lord Polak, who cannot be here and who would have been speaking to this amendment. I know it is that which has motivated him to bring this amendment. Amendment 82 would introduce a higher test. It would be a safeguard that is both practical and ethical. It is about introducing something which is much closer to certainty or confidence, not just vague possibilities.

Amendment 83A does not touch on the six-month timeframe. It would ensure that eligibility for assisted dying rests on rigorous and established clinical standards, not on a broad prognostic guess; it would be determined by clinical judgment, in accordance with peer-reviewed palliative care standards. It may be that someone can come up with a better way of putting it, but it is a shot at saying something that doctors in this position will understand.

I remind the Committee that my noble friend Lord Polak is living proof that such predictions can be very wrong. Amendment 83A would be a step towards a proper principle. It would retain the six-month timeframe but would insist that the judgment was grounded in peer-reviewed palliative care standards, not vague estimates. These small amendments would strengthen the Bill and safeguard our humanity, if we decide to go down the route of adopting it.

My Lords, this seems to be a convenient time to pause proceedings for the day. I move that debate on this Amendment be adjourned. If agreed, I ask colleagues in attendance to make sure at the end of proceedings that their name is registered at the Table for the continuation of the debate on 6 February.

Noble Lords will know that I have sat for the whole day waiting for amendments and have not intervened, but I want to put on record that I will not be able to be here next Friday. I therefore invite the House to consider particularly what the noble Baroness, Lady Campbell of Surbiton, said about Amendment 87. I also put on record my thanks to my noble and learned friend Lord Falconer for his willingness to look at the issues of anorexia and bulimia. I regret that I will not be able to be here then.

Debate on Amendment 71 adjourned.

House resumed.

House adjourned at 5.52 pm.