In 1518 he was present when Wolsey was made a papal legate, and was one of the commissioners when the Princess Mary was betrothed to the Dauphin, Francis III, Duke of Brittany. He was at the Field of the Cloth of Gold in 1520, and was again at Calais with Wolsey in 1521. When Buckingham was examined by the king, Ruthall was present as secretary. A hardworking official, he did a great deal of the interviewing necessary in diplomatic negotiations. Brewer represents him as Wolsey's drudge, and Giustinian speaks of his "singing treble to the cardinal's bass." He died on 4 February 1523 at Durham Place, London, and was buried in St John's Chapel, Westminster Abbey.