Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Friday 27th February 2026 Lords Chamber

[Lord Farmer (Con)]

I speak in support of amendments on behalf of my noble friend Lady Maclean of Redditch, who unfortunately cannot be in her place at this hour on a Friday afternoon. I refer to Amendments 445, 483A, 495B and 941A. First, Amendment 445 would require the panel to consider signs of fluctuating capacity. That issue has been addressed in previous groups but needs raising again briefly here. As Professor Martin Vernon told the Lords Select Committee,

“fluctuating capacity is an extraordinarily common issue, but none the less somebody may retain capacity at some point during their dementia diagnosis sufficient to make a determination as to whether they wish to end their life”.

As has been stated, about two-thirds of people with dementia have never received a formal diagnosis, so it is incumbent on the panel to consider that possibility and take evidence on whether it could be the case. Given that the co-ordinating doctor is not required to be in the room at the actual moment of administration, fluctuating capacity could raise vital issues of consent.

Amendment 483A probes whether the panels have sufficient powers to gather all necessary evidence to decide on eligibility. It ensures that a panel can refer the patient for any further assessments that it considers necessary. Can the noble and learned Lord who is the sponsor explain why the panel does not sit within the usual tribunal structures, as doing so would give it more expansive powers to request further evidence where necessary? For example, the tribunal procedure rules for the First-tier Tribunal, in the Health, Education and Social Care Chamber, empowers the tribunal without restriction to give direction to matters such as,

“issues on which it requires evidence or submissions … the nature of the evidence or submissions it requires … whether the parties are permitted or required to provide expert evidence, and if so whether the parties must jointly appoint a single expert to provide such evidence … and the time at which any evidence or submissions are to be provided”.

It would be helpful if the Minister could confirm whether the powers given to the panel in Clause 17(4)(d) and (e) are as extensive.

Finally, my noble friend’s connected Amendments 495B and 941A would require the panel to provide a report to the person containing recommendations to address any unmet social and palliative care needs, in addition to determining whether an eligibility certificate should be granted. More fundamentally, these amendments probe what the panel is intended to be. The Bill’s sponsors previously have tried to argue that the panel is akin to a multidisciplinary team. My understanding is that on this point they have been rebuffed. After the noble and learned Lord cited the Association for Palliative Medicine’s Dr Sarah Cox in his defence on 9 January, the APM responded in a letter that the Bill’s sponsor had misrepresented Dr Cox’s position, saying:

“This panel fails to replicate a true multidisciplinary model and essential protection”.


Further, it says that the Bill’s current provisions render

“the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision-making at the end of life”.

My noble friend’s amendments are intended to help the noble and learned Lord by providing ways for his panel process to be strengthened so that it operates more like a multidisciplinary team. An important first step would be to expand the panel’s scope so that it includes explicitly the ability to provide assessments of or treatments for unmet health and social care needs. This would enable each panel member to assess, individually and then together, the holistic needs of the patient and contextualise their decision around assisted suicide. My noble friend’s Amendments 495B and 941A build on this and a recommendation of the Royal College of Psychiatrists that the panel should be able to recommend interventions addressing potential drivers of a desire to hasten death, such as depression, social isolation or difficult physical symptoms.

It should be remembered that the Bill does not guarantee that the person will ever have met a psychiatrist or social worker before this stage in the process. We cannot deny the patient the benefit of their holistic experience and expertise in favour of a rubber stamp. My noble friend would also tie her amendments to the sponsor’s commitment to consider a requirement for the co-ordinating and independent doctors, although not the panel, to ask why a person has requested assisted suicide. Ultimately, what is the point of exploring motivation unless the intent is to establish whether drivers can be addressed in another way?

To conclude, the heart of the problem is that, due to the way it was added to the Bill in the other place, the panel process suffers from a fundamental identity crisis. Are the members trying to be a kind of tribunal, or are they designed to be a kind of multidisciplinary team? It would be helpful if the sponsor could enlighten us, because currently they fall short of both.

[Baroness Keeley (Lab)]

My Lords, I will speak briefly in support of my Amendment 483, which would ensure simply that in-person hearings remain the default when assessing applications under the Bill, with remote evidence via video or audio link used only where extraordinary circumstances make an in-person hearing wholly impracticable.

Given the gravity of the decisions involved, it is essential that scrutiny is of the highest standard. An in-person hearing allows the panel to observe the applicant fully, including their demeanour and interactions, and to look for any signs of pressure. This cannot be reliably assessed over a video link, and certainly not over the phone. Indeed, California’s assisted dying law requires assessments of coercion or undue influence to take place outside the presence of any other person, a safeguard that remote evidence cannot guarantee.

The Civil Justice Council’s review of remote hearings during the Covid pandemic found that the majority of respondents considered remote hearings to be worse than in-person hearings overall and less effective in facilitating participation, a critical component of procedural justice. Many respondents found remote hearings tiring, difficult to follow and more prone to misunderstanding. The Civil Justice Council found that nearly 13% of participants in remote hearings experienced significant technical difficulties, and in a process as sensitive as this one, even a small risk of technical or technological failure is a risk too far. There is also a contradiction in the Bill as drafted. It requires live evidence while simultaneously allowing pre-recorded testimony, so that a short, pre-recorded voice note could in theory constitute the entirety of an applicant’s oral evidence, with no opportunity for questioning from the panel, and that cannot be an adequate safeguard.