Contribution
My Lords, I will move my Amendment 39A and speak to my Amendments 238B and 553G. The purpose of Amendment 39A is to require that the patient’s understanding is demonstrable, not assumed.
Before I continue, I wish to thank the Chief Whip for his very wise decision to have a 40-minute lunch break but, as the average age of this House is 71, it was more like a loo break. It was very convenient, whatever it was. I move on to the subject of the amendment.
This amendment goes to the heart of autonomy. The Bill repeatedly invokes autonomy as its moral foundation, yet it does not require that the patient’s understanding be demonstrated. In every other area of medicine, informed consent requires evidence that the patient has actually understood the information. Here, where the outcome is irreversible, the evidential threshold should be higher, not lower.
The Bill currently requires doctors to “explain” and “discuss” certain matters, but it nowhere requires confirmation that the patient has absorbed or understood them. That is a fundamental flaw. NICE guidance, GMC guidance and the Montgomery judgment all emphasise that consent is valid only when the patient understands material risks, uncertainties and alternatives. The Bill omits these requirements.
International comparators—Oregon, California and Victoria—all require explicit discussion of risks and complications. England and Wales would be an outlier if we did not require demonstrable understanding. This amendment simply aligns the Bill with established medical ethics and legal precedent.
My final point on this amendment is that it protects clinicians. Without a demonstrable understanding requirement, a doctor could comply with the Act while failing to meet professional standards. That is a recipe for litigation, confusion and moral hazard.
My Amendment 238B would introduce a safeguard that is standard in every jurisdiction where assisted suicide is legal. A written acknowledgement would ensure that the patient has been informed of the risks— including prolonged dying, vomiting, seizure or failure of the drugs—and that they understand them. Without this, the Bill creates a parallel medical system where the usual rules of consent simply do not apply.
The Bill currently requires doctors to discuss
“the nature of the substance”
and what to do in the event of “complications”, but it does not require doctors to explain that complications may occur or what they are. That is a glaring omission. A patient cannot meaningfully consent to a life-ending drug without knowing that it may not work as intended.
Those noble Lords who have experienced cancer treatment or chemotherapy know that, before one gets it, one has to spend about an hour with a clinician or the oncologist ticking boxes on a form, explaining and saying that they understand all the potential downsides. I recall having to complete a seven-page form to do so. It is important that patients consent.
This amendment would also protect clinicians. The Bill grants civil liability exemptions for doctors acting in good faith but, without a written acknowledgement, there is no evidential record that the patient was informed of the risks. This exposes clinicians to professional risk and undermines public trust. Finally, this amendment is modest, proportionate and entirely consistent with the principle of autonomy.
I turn to my Amendment 553G, which is a Montgomery compliance clause. It would require doctors to apply the principles of Montgomery v Lanarkshire when informing patients of material risks. The amendment would embed that leading case on informed consent into the Bill. Montgomery requires doctors to inform patients of material risks and reasonable alternatives. The Bill does not currently require this. That omission is extraordinary in a process that ends in death. Without this amendment, the Bill creates a parallel medical system where the usual rules of consent do not apply. That is ethically indefensible. If anything, the standard should be higher than in ordinary medicine, not lower. This amendment would also protect clinicians by ensuring they are not forced to choose between complying with the Act and complying with their professional obligations. Finally, I believe that this amendment would align the Bill with international best practice.
These three amendments together would make the policy clearer, leaner and fairer. By tightening rules and strengthening enforcement, amendment 1 would remove ambiguity and speed decisions, reducing disputes and legal exposure. My amendment 2 would lower operational friction and cost by streamlining processes and clarifying responsibilities, which would improve efficiency and predictability during implementation. My third amendment would enhance fairness and future readiness by embedding equitable principles and scalable mechanisms, increasing stakeholder buy-in and adaptability as circumstances evolve. The result would be a more enforceable, cost-effective framework that better serves stakeholders today while remaining flexible for tomorrow. These amendments are practical, complementary—