A ‘Licence to Kill’? The Assisted Dying Bill passes its second reading in the House of Lords

The Terminally Ill Adults (End of Life) Bill (the ‘Bill’), sits before the House of Lords, where a second reading debate over 12 September 2025 and 19 September 2025 revealed deep divisions. The house approved the Bill without a vote, but a select committee will be established to scrutinise key aspects of it and may attempt to make significant changes.

The Bill, which seeks to legalise assisted dying in England and Wales, has already travelled a difficult parliamentary path. It survived an unexpectedly close second reading in the House of Commons, before clearing the third reading by only 23 votes.

Background

From its introduction, the Bill has been described as establishing one of the most limited assisted dying regimes in the world. To be eligible, applicants must be at least 18 years old, have lived in England or Wales for a minimum of 12 months, be registered with a general practitioner, and have a diagnosis from two independent doctors confirming a terminal illness with a prognosis of six months or less. The process also requires that mental capacity is confirmed on two separate occasions, and that applicants sign two witnessed declarations.  Following a reflection period of 14 days (reduced to two days if death is imminent) the patient is required to self-administer the prescribed life-ending medication.

The Bill's safeguarding mechanisms have proved contentious. Initially, the Bill required High Court approval before any prescription for life-ending medication could be issued. However, concerns were raised regarding the practicality and effectiveness of this safeguard, particularly given existing pressures on the court system and the risk that judicial involvement could become a formality. In response, the Commons replaced this requirement with a new model involving a statutorily-appointed Voluntary Assisted Dying Commissioner, supported by review panels that include a senior lawyer, a consultant psychiatrist, and a registered social worker. These panels would be responsible for certifying voluntariness, mental capacity, and the absence of coercion. The Bill also contains provisions such as a conscience clause for healthcare professionals, a prohibition on advertising assisted dying services, the removal of automatic coroner referral to reduce stigma and delay, and a four-year implementation period, which means the earliest possible commencement of assisted dying would be in 2029.

Despite the inclusion of these safeguards, the Bill has been the subject of more than 500 proposed amendments. Critics have expressed concern that ongoing pressures within the NHS, inconsistent access to palliative care, and the lack of precise definitions regarding coercion may leave some individuals at risk. Supporters, on the other hand, argue that the current prohibition on assisted dying in England and Wales leads patients to pursue options abroad, and point to public opinion polls indicating strong support for some form of legalised end-of-life choice.

Second Reading in the Lords

The second reading in the House of Lords featured wide ranging and emotive debate. Lord Falconer, who previously introduced an Assisted Dying Bill in 2014, stated that the Bill is a “historic occasion” to allow terminally ill, suffering people to end their life with dignity. Drawing on international data, he argued that there is little evidence supporting concerns about a gradual expansion of eligibility. He addressed concern about costs, arguing that the number of assisted deaths would be very small relative to overall mortality and would not adversely affect palliative care services.

A high-profile challenge came from former Prime Minister, Baroness May. She expressed strong opposition to the Bill, suggesting that it presented the state a “licence to kill”, creating a culture whereby “some lives are less worth living than others”. Her words proved controversial within the house - but were echoed by others. Lord Deben stated that the bill “empowers the state to kill”, whilst Lord Patten warned that death may become the “default solution to perceived suffering”.

Concerns were raised about specific measures in the Bill. Baroness Grey-Thompson noted the absence of coroner involvement as a weakness in the Bill’s oversight, arguing that “if there is nothing to fear from the Bill, there is nothing to fear from accurate reporting”. Lord Grabiner pointed out that the legislation does not require applicants to be experiencing pain or unbearable suffering, though this is often cited as an ethical rationale for allowing death. He also questioned the effectiveness of the new panel process, suggesting that brief interactions with applicants may not be sufficient to detect coercion, particularly in complex family or financial situations. As a result, he raised doubts about whether the Bill’s safeguards are as robust as intended.

Concerns about coercion and the vulnerability of applicants were raised by several peers, who noted that the lack of a clear statutory definition of coercion could become a legal issue. The potential role of the NHS in delivering assisted dying services was also contentious, with some peers warning that it could become a cost-saving measure versus the cost of delivering good quality palliative care. Lord Evans illustrated this point, stating that the Bill creates “the implication, if not outright declaration, that ending your life early is a suitable course of NHS treatment”.

Despite the Lords expressing misgivings, the Bill moves forward from the second reading. Lord Carey may have expressed the majority view within the house, questioning: “do we really want to stand in the way of this Bill?... It has commanding support from the British public and passed the elected House after an unprecedented period of scrutiny”. Following an agreement between the sponsor of the Bill, Lord Falconer, and a key opponent, Baroness Berger, a special committee will be established to scrutinise the Bill and report back to the house by 7 November 2025.

Next Steps

Following the second reading, the Bill moves to the committee stage in the House of Lords, where its clauses will be examined in detail.  Nearly 200 amendments have already been proposed, addressing issues including:

• Strengthening the investigative powers of review panels;
• Providing a clear statutory definition of coercion and criminalising inducement;
• Demanding the development of a robust palliative care strategy before the law comes into effect; and
• Mandating comprehensive data collection on assisted deaths, including compulsory referral to the coroner.

The committee is likely to consist of around a dozen peers and will hear expert evidence. This evidence is expected to focus on the costs of implementing an assisted dying service, the role of medical professionals in the process, and the likely effect on public institutions such as the NHS. Baroness Berger stated “the introduction of a select committee is a victory for those of us that want proper scrutiny of how these new laws would work, the massive changes they could make to the NHS and how we treat people at the end of their lives”.

The Lords have already expressed many misgivings as to the details found in the Bill and may make significant changes. The key risk to the passage of the Bill is time - if the two Houses cannot reach agreement before the end of the parliamentary session, the Bill will lapse, as has happened with previous attempts to introduce assisted dying legislation.

At present, the Bill remains at a critical juncture. While there is notable support in the Lords for the principles of dignity and individual choice, there are also significant concerns regarding safeguards, the rights of vulnerable people, and long-term implications for doctor-patient relationships.

We will continue to monitor the progress of the Bill, and our team is on hand to assist with your regulatory queries.

Co-authored by Philip Gaffney, Graduate Solicitor Apprentice