Assisted Dying Legislation: Isle of Man and Jersey

Baroness Finlay of Llandaff Excerpts

Tuesday 3rd March 2026 Lords Chamber

[Baroness Levitt (Lab)]

My Lords, I do not know how many more ways I can find to say that the Government are neutral on this Bill. My noble friend the Chief Whip has made extra days available on Fridays: we still have four more to go. How that time is used is a matter for your Lordships’ House, bearing in mind that the position of the Government consistently has been that this is a question of conscience and not a matter for the Government.

[Baroness Finlay of Llandaff (CB)]

My Lords, how are the Government considering the proposed legislation in the different areas to be safe within the European Convention on Human Rights, given that we have already heard that Jersey’s euthanasia is proposed to extend to those who are not terminally ill and that the deficits in the infrastructure of the Isle of Man Bill have already been identified? There is ongoing discussion about the Bill proposed in Scotland, which looks quite different, and the Welsh Assembly gave legislative consent to only some parts of the Bill, under the impression that, if it did not, it would have no control whatever over how the legislation was enacted, given that health is devolved to Wales.

[Baroness Levitt (Lab)]

I thank the noble Baroness for her question. She has asked for quite a lot of information and we may have to write to her on that. I can certainly speak about what happened in relation to the Isle of Man. We have the Isle of Man for assistance on the Bill’s reliance on codes of practice for the implementation of pre-death and post-death reviews. We also asked for assistance on the training and guidance of healthcare professionals, specifically around safeguarding against potential coercion. The Jersey Bill has not arrived with us yet, but I repeat that the merits of the legislation are not a matter for this Government.

Crime and Policing Bill

Baroness Finlay of Llandaff Excerpts

Report stage
Monday 2nd March 2026 Lords Chamber

297: After Clause 91, insert the following new Clause—
“Pornographic images of sex between relatives(1) After section 67D of the Criminal Justice and Immigration Act 2008 (inserted by section 90 of this Act) insert—“67E Possession or publication of pornographic images of sex between relatives(1) It is an offence for a person (P) to be in possession of an image if—(a) the image is pornographic, within the meaning of section 63,(b) the image portrays, in an explicit and realistic way, a person (A) sexually penetrating—(i) the vagina or anus of another person (B) with a part of A’s body or anything else, or(ii) B’s mouth with A’s penis,(c) a reasonable person looking at the image would think that A and B were real, and(d) a reasonable person—(i) looking at the image, and(ii) taking into account any sound or information associated with the image,would think that A and B were related, or pretending to be related, in a way mentioned in subsection (2).(2) That is to say, A being related to B as parent, grandparent, child, grandchild, brother, sister, half-brother, half-sister, uncle, aunt, nephew or niece.(3) It is an offence for a person to publish an image of the kind mentioned in subsection (1).(4) Publishing an image includes giving or making it available to another person by any means.(5) For the purpose of subsection (1)(d)—(a) the reference to sound or information associated with the image is—(i) when subsection (1)(d) applies for the purpose of an offence under subsection (1), to sound, or information, associated with the image that is in P’s possession, and(ii) when subsection (1)(d) applies for the purpose of an offence under subsection (3), to sound, or information, associated with the image that the person in subsection (3) publishes with the image, and(b) A and B are not to be taken as pretending to be related if it is fanciful that they are actually related in the way pretended.(6) In subsection (2)—“(a) “parent” includes an adoptive parent;“(b) “child” includes an adopted person within the meaning of Chapter 4 of Part 1 of the Adoption and Children Act 2002;“(c) “uncle” means the brother of a person’s parent, and “aunt” has a corresponding meaning;“(d) “nephew” means the child of a person’s brother or sister, and “niece” has a corresponding meaning.(7) For the purpose of this section—“(a) “image” has the same meaning as in section 63;(b) penetration is a continuing act from entry to withdrawal;“(c) “vagina” includes vulva; (d) references to a part of the body include references to a part surgically constructed (in particular through gender reassignment surgery).(8) Subsections (1) and (3) do not apply to excluded images, within the meaning of section 64.(9) Nothing in—(a) section 47 of the Adoption Act 1976 (which disapplies the status provisions in section 39 of that Act for the purposes of this section in relation to adoptions before 30 December 2005), or(b) section 74 of the Adoption and Children Act 2002 (which disapplies the status provisions in section 67 of that Act for those purposes in relation to adoptions on or after that date),is to be read as preventing the application of section 39 of the Adoption Act 1976 or section 67 of the Adoption and Children Act 2002 for the purposes of subsection (6)(a) or (b).(10) Proceedings for an offence under this section may not be instituted except by or with the consent of the Director of Public Prosecutions.67F Defences to offence under section 67E(1) Where a person is charged with an offence under section 67E(1), it is a defence for the person to prove any of the matters mentioned in subsection (2).(2) The matters are—(a) that the person had a legitimate reason for being in possession of the image concerned;(b) that the person had not seen the image concerned and did not know, nor had any cause to suspect, it to be an image of the kind mentioned in section 67E(1);(c) that the person—(i) was sent the image concerned without any prior request having been made by or on behalf of the person, and(ii) did not keep it for an unreasonable time;(d) that—(i) the person directly participated in the act portrayed as person A or B mentioned in section 67E(1)(b),(ii) the act did not involve the infliction of any non-consensual harm on any person, and(iii) the person is not related to person B or A (as the case may be) in a way mentioned in section 67E(2).(3) Where a person is charged with an offence under section 67E(3), it is a defence for a person to prove any of the matters mentioned in subsection (4).(4) The matters are—(a) that the person had a legitimate reason for publishing the image concerned to the persons to whom they published it;(b) that the person had not seen the image concerned and did not know, nor had any cause to suspect, it to be an image of the kind mentioned in section 67E(1);(c) that—(i) the person directly participated in the act portrayed as person A or B mentioned in section 67E(1)(b),(ii) the act did not involve the infliction of any non-consensual harm on any person,(iii) the person is not related to person B or A (as the case may be) in a way mentioned in section 67E(2), and(iv) the person only published the image to person B or A (as the case may be).(5) In this section, “non-consensual harm” has the same meaning as in section 66. 67G Penalties for offences under section 67E(1) A person who commits an offence under section 67E(1) is liable—(a) on summary conviction, to imprisonment for a term not exceeding the general limit in a magistrates’ court or a fine (or both);(b) on conviction on indictment, to imprisonment for a term not exceeding two years or a fine (or both).(2) A person who commits an offence under section 67E(3) is liable—(a) on summary conviction, to imprisonment for a term not exceeding the general limit in a magistrates’ court or a fine (or both);(b) on conviction on indictment, to imprisonment for a term not exceeding five years or a fine (or both).”(2) In section 68 of that Act (special rules relating to providers of information society services), after “67A” (inserted by section 90 of this Act) insert “and 67E”.(3) In Schedule 14 to that Act (special rules relating to providers of information society services), in paragraphs 3(1), 4(2) and 5(1) after “67A” (inserted by section 90 of this Act) insert “or 67E”.(4) In section 47(1) of the Adoption Act 1976, for “or sections 64 and 65 of the Sexual Offences Act 2003 (sex with an adult relative)” substitute “sections 64 and 65 of the Sexual Offences Act 2003 (sex with an adult relative), or section 67E of the Criminal Justice and Immigration Act 2008 (possession or publication of pornographic images of sex between relatives)”.(5) In section 74(1) of the Adoption and Children Act 2002—(a) omit the “or” after paragraph (a);(b) after paragraph (b) insert “, or(c) section 67E of the Criminal Justice and Immigration Act 2008 (possession or publication of pornographic images of sex between relatives).”(6) In Schedule 34A to the Criminal Justice Act 2003 (child sex offences for the purposes of section 327A), after paragraph 13ZA (inserted by section 90 of this Act) insert—“13ZB An offence under section 67E of that Act (possession or publication of pornographic images of sex between relatives).”(7) In Schedule 7 to the Online Safety Act 2023 (priority offences), in paragraph 29, after paragraph (b) (inserted by section 90 of this Act) insert “;(c) section 67E (possession or publication of pornographic images of sex between relatives)”.”Member's explanatory statement
This amendment makes it an offence to possess or publish pornographic images of sex between relatives (that is to say, incest).

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

Amendment 297A, as an amendment to Amendment 297, is replaced by manuscript Amendment 297AA tabled today, which clarifies where it amends Amendment 297.

Amendment 297A (to Amendment 297) not moved.

Terminally Ill Adults (End of Life) Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, my Amendment 144 relates to those tabled by my noble friend Lord Frost, who has made many of the points I was about to make. To add to what my noble friend has said, he used the word “paperwork” all the way through his remarks, and he outlined its importance. The point I would make, over and above what my noble friend has just said, is that the NHS has a notorious reputation with regard to paperwork. How many times have we heard about the loss of patients’ medical records and—as my noble friend just said—that the medical records are inaccurate?

Many hours have been spent in this House talking about the digitisation of NHS paperwork. The Bill is an excellent opportunity to say to the NHS—or whoever takes responsibility for this process—that when people go for consultations, they should be done digitally, by which I mean that we do not use a pen and paper. Doctors’ handwriting is notoriously difficult to read; it must be transcribed and digitised by second parties, so mistakes and errors will happen—that is one of the reasons why there are so many errors in medical records.

I say briefly to the noble and learned Lord, Lord Falconer, that this House should insist that the Bill requires this to be done digitally. When clinicians interview vulnerable people, that should be instantly recorded there and then on a tablet, iPad or computer, which will therefore reduce the number of errors. The paperwork is so important, and this is an opportunity for the NHS to step up to the plate and, of all things, digitise the records for people making the decision to end their life.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have two amendments in this group. Amendment 139 simply requires the commissioner to report to Parliament, and in Amendment 913 I have tried to ensure the independence and freedom from bias of the commissioner and staff. The voluntary assisted dying commissioner, as the public figurehead of an assisted death regime, must be free from any whiff of conflict of interest or perceived bias.

Conflicts of interest can be direct, such as the commissioner having shares in a provider of assisted deaths, when increased deaths are profitable. However, as NHS England’s standards of business conduct point out, perceived conflicts of interest can also present problems, and all interests must be declared. NHS England’s policy states:

“Officers should be mindful of any situation where relationships may give rise to a perception that a loyalty, credit, or responsibility is owed to another person or body”.


It goes on to say that

“previous employment with an employer which directly or indirectly provides services or products”

could be seen to be an influential factor.

The noble Lord, Lord Weir, has addressed the functions of the commissioner; I will not repeat what he said, but I will add a few points. Appointments to panels must not be biased to those sympathetic to assisted death, and they must also avoid those who have publicly expressed some scepticism. The commissioner is to review appeals, and bias can creep in here. Failure to follow statutory safeguards could be viewed leniently, and we have already heard examples of that from the noble Lord, Lord Frost. Highlighting failures in panels would reflect badly on the commissioner who had appointed them. In reviewing and reporting on the operation, the whole regime could skew reporting, because it is not clear which stakeholder groups will be consulted, or which data will be collected and what will be omitted—again, that could leave room for bias.

The amendment simply embodies the principle set out in the Cabinet Office’s Governance Code on Public Appointments that there should be

“no conflicts of interest that would call into question their ability to perform the role”.

Can the Minister confirm that these standards would be adhered to in any appointment? The governance code states that many conflicts of interest could be satisfactorily resolved and mitigated, giving the Prime Minister much discretion. Could a mitigation allow an assisted suicide organisation’s patron to serve as the commissioner? This is not purely hypothetical. In Belgium, the joint head of the Federal Commission for the Control and Evaluation of Euthanasia was one of the leading proponents of the 2002 law there. Since then, it has euthanised more than 100 patients and become something of a celebrity. That reputation has caused controversy. We have already heard about underreporting—

[Lord Markham (Con)]

Is there not a critical difference, when we talk about conflicts of interest, in that, in this case, this will be law—something that has been passed by Parliament? I do not believe that, in any public appointment, being supportive of a law of the land is deemed to be a conflict of interest.

[Baroness Finlay of Llandaff (CB)]

The point that I was trying to make, and I am sorry if I have not expressed it properly, is that there is a huge amount of discretion here and the commissioner will be the person who appoints the panels. In a way, by assessing the work of the panels, the commissioner will be marking his or her own homework. That does not provide the independence that one would require.

If I may go on, we heard too in our Select Committee hearing, which the noble Lord was present at, about problems that have occurred in New Zealand. These need to be taken as a warning: we must ensure that there is independent transparency and lack of bias in the commission, through statutory safeguards, to avoid the failures that occurred in other countries. In the case of Mortier v Belgium, the European court—

[Baroness Whitaker (Lab)]

I apologise for interrupting, but I am a little confused. It seems that there is a considerable principled difference between expertise and conflict of interest. People who have been involved in assisted dying have expertise; they do not necessarily have a conflict of interest. You can be a professional, as I am sure the noble Baroness well understands, and be independent, so why is expertise ruled out?

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Baroness for that intervention, because expertise is not ruled out. It is the way that the commission functions that is important—that that does not allow skewing and silencing. What I was going on to point out is that one of the commissioners on the Belgian commission resigned because they felt that they were being silenced whenever they raised issues about problems in reporting, that they were unable to continue to provide ethically high standards and that their own expertise was not being respected.

I would be grateful if I could just continue for a moment, because I am not trying to filibuster. I would like to make that absolutely clear, following the extremely unpleasant, vicious comments that have been made about me, both in the media and in very aggressive emails that have been sent to me. If I may continue, I would be most grateful.

I am simply asking whether a commissioner with a financial interest in an assisted death business, whatever that is and however it is commissioned, is actually truly independent. There seems to be no requirement for the appointment to be scrutinised by a committee of Parliament or for a register of interest to be published. I am sure that that would happen, because that is a normal course of action in this country, but the equality impact assessment seems silent on this. The noble and learned Lord, Lord Garnier, referred to the Constitutional Reform Act 2005 in relation to appointments, so I will not repeat that, but this commissioner’s post appears, as written, to be in the gift of the Prime Minister, and there does not appear to be verified impartiality in terms of the exercise of the functions, given the great importance of this role and the problem that if it does not work well then public confidence in the system will be lost.

--- Later in debate ---

[Lord Sandhurst (Con)]

My Lords, I shall try not to repeat what my noble friends Lord Moylan and Lady Fraser said. My amendment asks the Secretary of State to make regulations providing for

“the circumstances in which a fee is payable in relation to any of the steps set out at sections 15 to 18”.

I remind noble Lords that those are: replacing the co-ordinating or independent doctor, references to the panel, determination by the panel and reconsideration by the commissioner.

My reading is that it is not clear what is to happen. The Commons sponsor has said that the service should be free at the point of use as regards the NHS. That is laid down by Clause 41(5), but it is not clear whether that refers to the panel’s activities and ancillary services relating to that. It is possible that, given the strain on public services caused by the Bill, fees will be needed to off-set some of the costs. We need to be clear about this. The way forward is for the Secretary of State to make regulations explaining what is to be charged for, when and on what basis.

[Baroness Finlay of Llandaff (CB)]

My Lords, I added my name in support of Amendment 827, although I also support the amendments that make it clear that the delivery of the service must not be provided by the NHS, an NHS trust or any body or any agency holding itself out to be part of the NHS, as in Amendment 835 from the noble Baroness, Lady Fraser of Craigmaddie.

The amendment to which I added my name would allow a collaborative funding model for the service to be developed, based on a means-tested formula, for those who are able to pay adequately and would otherwise have paid the fees charged by Dignitas in Switzerland, whose accounts are not open for examination. The collaborative funding model could be based in part on the principles behind co-operatives. The accounts of a collaborative scheme would need to be completely open to public scrutiny. Co-operative funding models leverage shared ownership, democratic control and member investment to finance enterprises, prioritising community benefit over profit maximisation. The shared ownership would relate to those who use the service, with levels set depending on the aspects that they access, because some might access information only and others might access the whole process.

There are five interconnected component parts to a co-operative model. First, the policy and regulatory framework defined by government would give proportionate oversight and regulation. Secondly, it would ensure adequate training across the whole system. Thirdly, the clearly defined market environment would be restricted to the provision of an assisted death service. Fourthly, the culture of the co-operative collaborative would be shaped by those wishing to avail themselves of an assisted death without jeopardising their ability to access clinical care and without jeopardising the clinical care of others through the diversion of NHS funds. This could involve crowdfunding and allow specific donations in memoriam and so on.

The fifth component relates to networks of knowledge exchange to inform the criteria used in the financial assessment, based on needs. The Bill is based on the principle of choice, and that principle could run to the funding as well. People may choose to have a slightly less extravagant funeral and pay into a collaborative system, allowing others who would not be able to afford a fancy funeral to still access the service even if they could not pay for the components of the service. After all, we have people who pay high rates of tax, such as council tax, to fund our public services, equally benefiting those who are in a much lower financial bracket.

Overall, these amendments are important because they would ensure that NHS funding is not eroded. We hear consistently about NHS deficits in all parts of the system. The palliative care and hospice sector is withering under extreme financial pressures since it has no secure rolling contracts for the services it delivers. Pressures on commissioners are already resulting in difficult decisions. There is no spare money to pay for an assisted death service.

The noble and learned Lord, Lord Falconer, has tabled amendments that would require ICBs to commission this service, but the Minister has admitted that the funding will come from reprioritisation of existing budgets. How will the ICB balance its legal obligation to meet the palliative care needs of its population with the provision of an assisted death service? The noble and learned Lord’s Amendment 749B would mandate the provision of assisted deaths by ICBs, meaning that they will be fully funded by the NHS—in contrast to hospices, which are heavily reliant on donations for a major portion of their funding.

I hate to suggest it, but sometimes this looks like a way to save money. Each assisted death has been estimated to cost around £2,000 yet would save about £13,000, four months of healthcare costs, giving a net saving of £11,000 overall. The money has to be found from somewhere. At the moment, there is a serious risk of clinical services being eroded to fund the multiple payments that will need to be made to the different professionals involved; that will become particularly important when we looked at funding it in a devolved model.

[Lord Markham (Con)]

I am a bit confused. I think I heard from the noble Baroness a concern that savings of £13,000 a week would be generated if assisted dying happened. I then heard her say afterwards that there would be costs on other people. Obviously, she cannot have it each way. A few times I have heard people asking, “Where’s the money coming from?”, and other people saying, “There’s an incentive because there’s a saving in it”. Can the noble Baroness clarify that, please?

[Baroness Finlay of Llandaff (CB)]

I thank the noble Lord for asking for the clarification. I did not say a week; I said four months. Actually, with the severe deficit that we—

[Lord Markham (Con)]

I believe the noble Baroness’s general point was that there is a danger because savings would be made from an assisted death. On the other hand, she asks where the costs are going to come from. I am just wondering which she believes: that there will be savings or that there will be additional costs.

[Baroness Finlay of Llandaff (CB)]

My concern is that if you take money out of a healthcare budget that is already in deficit, you will end up with an incentive for people to go down the road of saving money by working towards promoting assisted deaths for patients for whom additional care would mean them no longer feeling in despair in any way and having their quality of life returned to them. The NHS budget appears to be in such a difficult and parlous state that we have to be very careful that we do not spend NHS money on what is not a healthcare treatment.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the amendments in the names of the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser of Craigmaddie, are very useful in making us think about what an assisted dying service would or should look like if the Bill is enacted and what the implications are for funding it—public funding or who is going to pay.

We will come to a more detailed discussion on this in later groups, but I will just raise a few things. As I understand it, and I probably need some clarification from the noble and learned Lord, Lord Falconer, the idea is that integrated care boards will be mandated to provide a fully funded assisted dying service. I would just like to get a sense of what is envisaged. If that is what is envisaged, we have to ask the question: is that reasonable?

As others have said, contrast that with hospices, which receive only a portion of their funding from ICBs and are heavily reliant on donations. I am sure we have all been to those coffee mornings and bought cakes, sold cakes and all the rest of it, trying to raise money for hospices. Meanwhile, palliative care services rely heavily on charity funding, recovering only 30% of their funds from the Government. I understand and note the important caveat from the noble Baroness, Lady Fraser. I am not trying to say that the state should run everything at all times and that anyone who is doing anything in the charitable sector is a problem, but underfunding end-of-life care at the same time as fully funding ending-your-life non-care is a bit peculiar.

The danger is that if the sponsor’s aspirations come to fruition—if I have got them right—funding for assisted dying will start competing with and risks diverting resources away from palliative and end-of-life care, and both will compete for a share of a limited health budget. I note that professional bodies, such as the Royal College of GPs and the Association for Palliative Medicine, argue that the assisted dying service must have distinct funding to avoid such competition.

It was very important that the Health Secretary, Wes Streeting, was frank with us when he noted that

“setting up this service will also take time and money that is in short supply … Politics is about prioritising. It is a daily series of choices and trade-offs”.

I would like to address a couple of questions to the Minister, who I know is confined to discussing workability, to ask how this prioritisation will work. Have the Government considered this? If funding will come from reprioritisation of existing budgets, are we not at this point being asked to legislate a direct conflict of interest, where integrated care boards will have to choose between, for example, funding palliative care and funding assisted dying? If it is not palliative care—I have overused that—which other services will be deprioritised in these choices in order to fund this? It is a limited budget. We keep being told that there is a scarcity of funds, so I want to understand that.

Finally, another reason to raise this—it is not directly to do with funding, but it counts—is that if assisted dying is to be paid for by the public purse and/or associated with the NHS, it could mean that assisted dying is treated as a standard healthcare solution. That surely could have a corrosive impact on trust between patients and clinicians, breaking their “first do no harm” contract with the public and flouting the Hippocratic oath.

Should doctors be expected to incorporate ending life into their routine roles if it is publicly paid for, when the major professional bodies explicitly warn against this? The BMA says that

“our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways—it is not something that a doctor can just add to their usual role.”

That more existential kind of question, or about medical ethics, will obviously be compromised when, if public funding and the taxpayer are paying for assisted death, those taxpayer-funded NHS doctors are surely going to be asked to do something that goes against their ethical code.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The impact assessment suggests that in year 10, assuming the highest possible cost, it would cost £37 million in total to do assisted dying. This is not by reference to any savings and it includes not just the health elements but also the panel and the assisted dying commissioner. It is plain that palliative care should get as much funding as possible. It is patchy throughout the country and it needs more funding. For me, it is not right to delay the option of assisted dying, particularly when the amount of money that we are talking about to fund assisted dying is so much less than that amount of money, which I would fully support being provided as much as possible. I understand what the noble Lord, Lord Harper, is saying. I am fully behind him if he is saying, “Let’s all put our backs into getting as much money as possible for palliative care”. But I do not accept the argument that the inadequacy in some parts of the country of palliative care is a reason for delaying the assisted dying Bill.

[Baroness Finlay of Llandaff (CB)]

Just as a point of information, does the noble and learned Lord accept that there is evidence that if specialist palliative care was available across the country on an equal basis, that in itself would result in a saving of around £800 million a year, because patients would be getting better care and unnecessary investigations and so on would be avoided? So there is a cost transfer. The problem at the moment is that we have areas without services and therefore patients do not have choice. If we are talking about patient choice, there must be equipoise in that choice argument.

[Lord Falconer of Thoroton (Lab)]

I am absolutely sure that if there were proper specialist palliative care of the highest quality—we would hope that there would be—it would lead to savings. I honestly do not think that the £37 million cost is a reason for delaying this because it would in some way hold back the provision of better specialist palliative care, which is something that we are all in favour of.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

It is Committee; the noble Baroness can come in later.

As I say, the noble Baroness, Lady Finlay, will be able to speak to Amendment 459 afterwards. One consideration has to be that the person has informed their children of their decision for an assisted death. I cannot be the only person who knows people for whom there is completely no relationship between parent and child. The child could be aged 60 and have been living abroad for years. They might not know their parent is ill and may not have been in touch with them for 40 years. But somehow we are going to have to try to track down children. Also, the ill person may not want their child to know that they are ill. We are all old enough now; we have had lots of friends go through this. I had a friend who did not want his daughter to know he was terminally ill because she was facing her own health issues at that time. But this would somehow lay down that despite the desire of a father, in that case, nevertheless that child has to be found and told that their parent not only wants an assisted death but that their parent is dying and wants an assisted death.

I really wonder about this denial of agency. If that person does not want to tell their child, according to Amendment 459, they have to make

“adequate arrangements for another person to inform the children”—

who might live abroad, or whatever—

“of the assisted death and provide bereavement support”.

I just wonder what world we are living in where, when someone is reaching the end of their life, some agency of the state demands that they tell them whether they have any children, whether they know that those children are still alive and where they are, and has to tell that child that their parent is ill and that—in a way, a smaller matter—they want to bring forward that death a little bit so that it is not too bad at the end.

Some of these ideas seem to me to exclude from our consideration the patient concerned. They seem to put everyone else in a position of taking decisions. The noble Baroness, Lady Cass, spoke earlier about the amendment that wants more and more specialist advisers brought in. Can we just sometimes revert to remembering that we are talking about seriously, terminally ill people who surely have some agency over their life? If they are refused this, they can still commit suicide but they will probably do it, as a friend’s father did, by going into the garage, blocking the bottom of the door so that no air can get through, turning the engine on and killing themselves that way. I wonder sometimes whether we are remembering that people are facing a terrible end and we just ought to have a little respect for them.

[Baroness Finlay of Llandaff (CB)]

May I intervene on that, given that my amendment is being questioned? Let me explain. When looking after people who are parents, a conversation is often about what the children know. Telling the children about someone’s impending death is extremely difficult for most parents. Usually, it is because the person who is ill wishes to protect those children; they think that, by not telling them and preparing them, they are somehow protecting them. The way children are informed needs to be age appropriate and appropriate to where that child is.

I do not suggest in this amendment that it should be an agent of the state. The amendment refers to making

“adequate arrangements for another person”.

That could be anybody. It is about asking whether they have somebody who will inform those children—or not—about the death. As for bereavement support, it might simply be about telling them in person and letting them talk about it for an hour over a cup of tea, or it might be much longer, depending on the needs of the individual—because bereavement is a very individual thing as well.

I am concerned that we could legislate and somehow believe that, by someone having an assisted death, rather than a death for which there has been preparation, the impact on any children in a family will be less, because the evidence is that it will not.

[Lord Falconer of Thoroton (Lab)]

I do not know whether I am allowed to intervene, because I do not know whether the noble Baroness is intervening or speaking to her amendment.

[Baroness Finlay of Llandaff (CB)]

I am coming to my amendments later.

[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.

--- Later in debate ---

When my father died, a psychiatrist working at the hospital that I then chaired said to me, “However old they were, and however old you are, the loss of a parent is a deeply emotional and important event in your life”. I am sure there are many different circumstances in which children are bereaved of their parents, but there are other relationships as well. The obligation in this amendment is to talk about children, but what about talking about your husband, wife or partner, or the person who has meant most to you in your life? People say, “Yes, it should be the person who meant most to you in your life”, so the panel has to find out who means most to you in your life. We seem to be going into a granularity on this that is not needed and is actually not very kind.

[Baroness Finlay of Llandaff (CB)]

My Lords, perhaps I might come in at this point. First, factually, I point out that the amendment that I have tabled does not state “bereavement services”; it states “support”. That is completely different.

[Baroness Hayman (CB)]

Will the noble Baroness accept that we would have to define “support” and how it is different from “bereavement services”? Then we will have more of these complications.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

Perhaps the noble Baroness might be relieved to note that I do not intend to move my amendment. I would like to speak to it now, but I will not be moving it.

Routinely, when you go into hospital, you are asked who your next of kin is. That is a routine question and it is entered in your medical record. That person has no legal status in terms of making medical decisions, although they may be consulted if a best-interest decision has to be taken. However, if you die, that will be the person the ward will phone to say that you are dead and your body is going to be moved to the mortuary, and that is the contact number that will go to the medical examiner to phone you later, which I think is the point the noble Baroness, Lady Berridge, was trying to extract.

It was helpful that the noble and learned Lord, Lord Falconer, described the shock of discovery of a death that you did not know about. That shock has been described by relatives who suddenly discovered that their parent had died by some form of assisted suicide or euthanasia when they had not known about it beforehand. That is documented.

It is also worth remembering that there is no evidence that suicide rates fall when these types of assisted death services come into play, but there is evidence that when people get the care they need, suicidality—that is, thinking about ending your life early—falls. So people need to have care.

I shall speak to my amendments now.

[Lord Falconer of Thoroton (Lab)]

Is the noble Baroness speaking to Amendment 459?

[Baroness Finlay of Llandaff (CB)]

I have already spoken to Amendment 459 and am finishing off speaking to it.

I will move on to Amendments 475 and 939 in Schedule 2. There is concern over the operation of the panels and safeguarding responsibilities, just in terms of the information that comes forward. Someone with relevant information would be allowed to come forward to the panel with appropriate evidence and be afforded whistleblower protection, in the type of situation described by the noble Baroness, Lady Berger, where there is a new person on the scene who others may feel has malintent, for one reason or another.

In the Bill’s current model, medical assessments that have previously gone to the panel will not be monitored contemporaneously. They could be poorly reported, they will not be reviewed and this could hide errors, unconscious bias and discrimination. The role of the panel will be to issue a certificate. In Amendment 493, I have suggested that the certificate should have validity for six months and, in the event that the person has a longer prognosis—we have many examples of that—it is renewable rather than having to start the process again because they have outlived their prognosis.

However, the appeal mechanism to a panel seems to be one-sided. The person can appeal against a refusal to give them a certificate, but there does not seem to be a mechanism for appeal. My Amendment 499 seeks to allow information to be brought to the panel that it may not have known about when it gave a certificate. This may relate to domestic abuse that had been hidden, to coercion or pressure, to any information that the diagnosis may have been wrong, to recent emotional or psychological trauma, or to depression or metabolic disturbance which might have impaired capacity.

Amendment 932 is a very practical one concerning the provision and distribution of panels around England and Wales. It has not been made clear how many panels there would be or that there needs to be fair distribution. I have suggested a minimum of three per region in England and a minimum of three in Wales. For the geography, topography and population, I think three would work for Wales. However, areas of England with high population density, or very large rural areas, would probably need more to enable the panel to visit the patient face to face for an assessment. It is completely inappropriate to expect a patient to go to see a panel when they are already ill or to rely on remote consultation rather than having the ability for face-to-face discussion. Those face-to-face discussions must be subject to the confidentiality that you would expect in any medical consultation. I hope that we will not be suggesting that this would be publicly available.

I suggest that, as has been said, these panels came in two-thirds of the way through and a panel can take testimony from others. However, in terms of getting information about the person, as the Minister of State for Courts and Legal Services said in Committee on this Bill:

“It is not a court or a tribunal … They can make the request, but they cannot compel someone to attend”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 12/3/25; col. 1102.]

[Baroness Grey-Thompson (CB)]

My Lords, I want to pick up on a couple of points that have been debated this afternoon, and those raised by the noble Lord, Weir, on the impact on disabled people. I seem to have completely failed in all the debates to get across the fear that disabled people feel with this Bill being debated.

Jennyfer Hatch in Canada had Ehlers-Danlos syndrome, experienced organ failure and was approved for MAID. It made me think of the letter that the Minister, the noble Baroness, Lady Merron, wrote to the noble Lord, Lord Moylan, this week, about the combination of illnesses that would qualify a person for this service. That is why disabled people are so worried. The combination of their disability and other conditions would make them eligible, even though we have been told that there is nothing to worry about. Can the Minister confirm what I understand the noble Baroness, Lady Merron, said when she wrote to us: that a combination of impairments would enable somebody to enter?

I strongly support the amendment from the noble Baroness, Lady Keeley. That is really important because in another case from Oregon, Joan Lucas, who had ALS, was approved for this service; her children filled out the form. There was no question about it; they just took it and she was approved, which is quite worrying.

I thought the debate on somebody dying by suicide was really interesting, and I am going to use “assisted dying” in this context. One of the reasons we are told we cannot use “dying by suicide” is because dying by suicide and this process are completely different. I am not really sure that we can have it both ways. We need to give a little more thought to that.

I get quite upset when we are constantly told that people are dying anyway. I apologise to the noble Baroness, Lady Hayter, but we have to find a better form of words. People may be dying, but the process and the experience they have as they go through that might vary considerably. Sometimes the language that we use in the Chamber can be quite dismissive of the amendments that we are trying to bring to make the Bill safer. We still never seem to hear the word “safe”, we just hear “workable” all the time.

My amendment in this group, Amendment 924, is about protecting older people and being able to make sure that any abuse or risk of coercion can be assessed. It is really about how the panels gather this information. It has already been mentioned that the British Association of Social Workers has said that the safeguarding is not enough. Hourglass has said that one in five of over-65s has experienced abuse, and on 15 June last year, which was World Elder Abuse Awareness Day, there were calls from numerous organisations to do more. The British Psychological Society has said that elder abuse is a “hidden epidemic”, and the scope is huge: it can be physical, emotional, financial or sexual; there is also neglect and self-neglect.

While the Domestic Abuse Act 2021 gives a framework, challenges persist of social isolation, caregiver abuse, power dynamics and, again, financial abuse. The role of professionals and how they report back on this is really important. I absolutely understand what my noble friend Lady Hayman is saying about not making the system overly complicated, but we have to find a holistic way of supporting people.

SafeLives has said that older people experience abuse before seeking help for twice as long as those who are under 61. Last year Age UK reported the fact that older people are overlooked by policymakers, service providers and programmes that are designed to support victims and survivors. Until 2021, people over 75 were not even asked about their experience of domestic abuse, so the lack of data means that there is an assumption about who is being abused. The ONS introduced new survey questions, which render comparison nearly impossible. Of course, the perpetrator of the abuse could be an adult child. What we found out is that women are at higher risk from their partners and men are at higher risk from adult children. Many organisations have talked about the need for professional support, which is really important.

When I am sitting in the Chamber and we talk about people becoming older at the age of 61, I wonder what the average age of the House of Lords is. I believe it is still 71, and everyone is incredibly active, but this is not the real world—on so many levels, it is not.

Victims and Courts Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Monday 9th February 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I am most grateful for the way this has been introduced by my noble friend Lord Russell. When the family discover that their relative has been murdered abroad, the problem, as has been said, is that they have no idea what has happened. Unless a service from the Foreign, Commonwealth and Development Office is rapidly responsive, there is a serious danger that evidence will not be maintained, that it will be destroyed or lost, and therefore that any processes to bring someone to justice will be seriously impaired. As written, the victims’ code seems to differentiate between victims murdered on home soil versus murders that could occur anywhere in the world. The added difficulty is that different countries around the world have different police services and processes, and the language or dialect in different areas may create difficulties.

There are two aspects to this: there is the part that occurs in this country, which is where the family may be contacting the FCDO. I was glad to see that the information on the website had been recently updated. It reads as if everything will happen smoothly but, unfortunately, that is a very rose-tinted view of reality. Some parts have not been updated for a few years. I wonder whether one of the problems lies out there with our own staff in all these different countries. They may never have experienced managing a death before, and suddenly they find they are dealing with an incredibly difficult situation with all kinds of blocks because of the politics of wherever they are.

In terms of linking between here and our staff around the world, it would seem important that there is always one designated person who has responsibility for all aspects of deaths or injuries that could occur in that country, and that this is their designation from day one of their placement in that country. They would know the different dialects, the different police systems, the different ways of maintaining evidence. This would require a fair degree of forensic training; it cannot just be written in guidelines or in a handbook. It means that people need to be prepared ahead of time in order to cope with the situation. It may well be that the families—who are completely devastated and find themselves in a terrifying and unknown situation—are at least talking to somebody with some competencies regarding that country and how its judicial systems work. Sadly, the judicial standards that we expect here are not applicable everywhere around the world. Police services are not always as well organised as ours are. It can be extremely difficult to get the right people in the right place at the right time.

It is also important that whoever has that function holds a certain degree of responsibility to make sure that evidence is not inadvertently lost and destroyed. Until you have learned about evidence that should be kept, you may not realise how important some things are: it is not only aspects of clothing and the body. It might be any of the person’s personal effects; it might involve taking photographs before anything is moved in any way. Our own staff need to be equipped with those skills. I hope from this debate that we might see a link between the Ministry of Justice, which is obviously central to the Bill, and the Foreign, Commonwealth and Development Office, and the ability for them to ensure that staff have training wherever they are, including forensic understanding. This could include junior members of staff, as long as they are fully trained.

[Baroness Brinton (LD)]

My Lords, I tabled Amendment 42 in this group to ensure that certain parts of the victims’ code apply to victims whose close relative was the victim of murder, manslaughter or infanticide outside the UK. I am very grateful to the noble Lord, Lord Russell, and the noble Baroness, Lady Finlay, for supporting the amendment, and for going into some detail. I will endeavour not to repeat what they have said.

I am grateful for the meeting with the Minister last week, during which she mentioned the new guidance that has been recently updated. It is a good document, but it gives the victims no formal rights at all and relies on two different people—the FCDO case manager and the Homicide Service officer, provided by the charity Victim Support—to help them navigate the system. I am sure that this guidance will help improve the service from its previous iteration, but the experience of families who have a loved one killed abroad is that it can be inconsistent. Some victims also receive fragmented, delayed updates about their case, and they often have to chase information themselves, not just with Victim Support or the FCDO but within the country.

Support from the Homicide Service is currently discretionary. This can leave families without dedicated help after the trauma if there are no resources. Having it in the victims’ code will ensure certainty for victims in receiving a service, despite the many differences and difficulties of dealing with the complex arrangements abroad. It is also clear from the guidance that only a certain level of financial help is available to victims from Homicide Service caseworkers. Finally, despite what is written in the guidance, many families have to find and pay for translation services themselves, and there is a risk of inconsistency in service provision. Having it in the victims’ code would ensure that the onus is no longer placed on the victim to get documents translated. This would also give families parity of support with foreign nationals who are victims in the UK, or with UK nationals whose first language is not English.

Turning to the other amendments, we on these Benches support Amendment 37, on the extension of the victim contact scheme, tabled by the noble and learned Lord, Lord Keen of Elie. This will probably be no surprise to him, given that it was tabled by Jess Brown-Fuller MP, my honourable friend in the House of Commons. I did write to the noble and learned Lord after it was tabled, asking him to withdraw the amendment, as we on these Benches had decided that we wanted to re-table it here in the House of Lords, as per our convention. The PBO told us recently that they received no such request, but that does not diminish our support for it.

I also signed Amendments 47A and 47B, tabled by the noble Lord, Lord Russell of Liverpool. The first seeks to ensure that victims of persistent anti-social behaviour have access to victim support services provided by local police and crime commissioners. These services are only available to victims as defined by the victims’ code of practice. Persistent anti-social behaviour is not just tiresome and irritating: it can have a traumatising psychological effect on victims. I am particularly reminded of the late Baroness Newlove talking about the local youths who made her and her family’s lives an absolute misery before they brutally murdered her husband. If the police cannot stop it, then surely victims should be able to get support locally. Amendment 47B proposes that each victim have a unique identifier, to be used with all the different agencies involved in their experience. Given the debate we have had today on many of the amendments, this identifier might well solve some of the problems alluded to about different parts of the system and different bodies not understanding or even knowing what was going on.

At the moment, the experience of sharing data between relevant agencies can be woeful, and this number would strengthen the system. It would mean risk assessments can work better, as well as monitoring compliance with the victims’ code and improving communication and collaboration across agencies.

I have also signed Amendments 55, 56 and 57 from the noble Lord, Lord Ponsonby, which tackle the problem that the noble Lord, Lord Russell, referred to earlier, of how hospitals ensure that they balance the needs of the victim with those of a patient who has murdered a family member of the victim. At the moment, unfortunately, because of the code of ethics that medical practitioners are bound by, the balance is in the patient is their absolute priority, which can mean that victims of the most serious crimes cannot know where the offenders, the patients, are, or if there are any changes in the care that they might need to know about, which might include such things as short-term home release. This is much less than the information that is available when an offender is in prison, and the process for the victim to ask for information involves asking a victim liaison officer at the hospital, who will ask for the information from the clinicians. That is two Chinese walls between the victim and the person providing the information. Because, once behind hospital walls, there is no evidence that the medics balance or give due regard to the safety and well-being of victims, and this is very retraumatising for the victims.

I also wonder sometimes whether medical practitioners do not get to see all the relevant data about the actual act and the consequences for the victim. From these Benches, we support proposals that would ensure that the medical professionals must take a balanced approach when deciding whether to provide information to the victim and must write to the victim to explain when they have decided not to take that balanced view. There should also be an appeal mechanism. These amendments would ensure that right 11 of the victims’ code is delivered for victims, giving them the same right of requesting that information from prisons and from other bodies where a patient might be held.

--- Later in debate ---

[Baroness Levitt (Lab)]

The noble Lord, Lord Russell, puts it very persuasively and it is extremely tempting, particularly given that I do not speak for the FCDO, to say that it sounds utterly reasonable. However, I am sure he will understand why I cannot give that kind of commitment from the Dispatch Box, but I can commit to meeting and discussing this further.

[Baroness Finlay of Llandaff (CB)]

Forgive me for interrupting again on this issue. Can the Minister undertake to discuss with the FCDO the concept that each embassy or consulate has one named lead person for when it experiences managing one of these tragic situations, and that it is handed over to another named person when they leave? They could also come together as a group to provide support for, and learn from, each other, and compare where particular difficulties have occurred so that, over the years, the training can improve for each of these people. The worry at the moment is that these cases are so unusual in some places that it is a once-in-a-lifetime experience for some of the staff.

[Baroness Levitt (Lab)]

Again, the noble Baroness puts it very persuasively and, listening to her now, it all seems to make total sense. If, as a Government, we are committed to supporting victims of crime and putting them front and centre, that does not stop at our borders. However, I do not think that I can give an answer today and it would not be right to do so. I will commit to meeting the noble Baroness and seeing whether I can find out from the FCDO at least what its approach would be to such a suggestion. If she would put it in writing to me I could then pass it on so that we can try to take matters further.

Amendment 47A, in the names of the noble Lord, Lord Russell, and the noble Baroness, Lady Brinton, seeks to add victims of persistent but non-criminal anti-social behaviour to the definition of a victim, as set out in Section 1 of the Victims and Prisoners Act 2024. The Government agree that anti-social behaviour is a blight on our communities and its impact should never be underestimated. We have committed to provide better support and information to victims of anti-social behaviour and have taken significant steps to do so. This includes the measures in this Bill that will strengthen the Victims’ Commissioner’s powers to hold the agencies that support anti-social behaviour victims to account.

Where anti-social behaviour amounts to criminal conduct, such as criminal damage, victims will benefit from the rights and entitlements within the victims’ code. However, expanding the definition of a victim to bring those affected by non-criminal anti-social behaviour within the code would, in our view, not be appropriate, as it is not an effective or efficient response to this kind of the behaviour. For example, in our view, it would be neither appropriate nor necessary for a victim of a neighbour who is playing loud music on one occasion to be brought within the scope of the victims’ code. Doing so could create unrealistic expectations and divert attention and resources from those experiencing serious criminal harm, such as victims of child sexual abuse.

In our view, there are better routes available to help these victims, including the anti-social behaviour case review, which gives the victims of persistent behaviour the right to request a multi-agency review to secure a resolution. In the proposals for the new victims’ code, on which we are currently consulting, we have clarified what victims of criminal anti-social behaviour can expect from the code and provided information about the case review process. I would welcome your Lordships’ responses to the consultation to outline in detail what further provision would be required for these victims.

On Amendment 47B, in the names of the noble Lord, Lord Russell, my noble friend Lord Bach and the noble Baroness, Lady Brinton, I begin by acknowledging the problems brought by our current inability reliably to identify the same victim or witness across the criminal justice system. We accept that this results in duplication of records, slows the flow of information and leads to inconsistent data across the agencies. In addition, this fragmentation places a significant administrative burden on staff, who must reconcile records manually and then chase the missing information. However, perhaps most importantly, it means that victims and witnesses are sometimes provided with conflicting information, which can cause confusion at best and serious distress at worst.

The Government are already working to address these issues through the cross-criminal justice system data improvement programme, jointly led by the Ministry of Justice and Home Office. This programme aims to strengthen data sharing across the criminal justice system and is actively exploring how individuals, including victims, can be more reliably recognised across agencies. We are clear that improvements to data sharing must be underpinned by robust safeguards to ensure personal data is handled lawfully, securely and proportionately, with a strong focus on minimising unnecessary circulation of sensitive information, which I know is a key concern of the noble Baroness, Lady Brinton.

The Government are open to considering legislative options to improve data sharing, data quality and the use of unique identifiers where that is shown to be necessary and proportionate. However, introducing a statutory requirement at this stage, ahead of the completion of the work of the programme, could unintentionally constrain future design and implementation choices, before we are confident it would deliver the intended benefits for victims and the wider criminal justice system. For these reasons, the Government do not believe that primary legislation at this stage is the appropriate mechanism.

Terminally Ill Adults (End of Life) Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

Finally, as the noble Lord, Lord McCrea, pointed out, there is some debate over the motivation behind the promoter of the Bill in another place choosing to abandon the original approach of asking judges to decide these cases in order to promote a panel. There are many people, including the noble Lord, Lord Pannick, who believe that that is an improvement. But it was reported, as the noble Lord, Lord McCrea, pointed out, that the promoter of the Bill decided to take that step because she had received advice from the Government that her initial proposal would place such strain on the court system that the Government could not support it. I ask the Minister at the Dispatch Box either to confirm or deny that report, and if it is the case that the Government gave advice to the promoter of the Bill, will that advice be shared with this House so that we can be better informed before we make any decision?

[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Lord, Lord Carlile, has done us all a great service. Last night, it was clear that there is a view that some really major parts of this legislation need to be addressed and debated. This is absolutely one of those major parts. It is about where decision-making finally sits. The noble Lord has provided a clarity that could improve safety in relation to the Bill—I will not say to make it safer but to make it less unsafe—and that becomes important.

The scheme that the noble Lord has proposed would reinstate a court-based model that was previously welcomed when the Bill was introduced because of the clarity of decision-making that it provided. On the process of assistance with suicide or having an assisted death, we are not going to argue about the wording here now. That is not appropriate. The clauses relating to the specifics of the lethal dosage of drugs both make the death part of the process clearer and provide better governance oversight. The process also seems to provide some protection for NHS services by putting the decision-making outside healthcare, with clarity of the roles between the two.

I added my name to the amendment to strengthen the conscience clause, Clause 31, so that no registered medical practitioner is under any duty to perform a function in relation to this Bill other than those of notification and recording matters. This avoids eroding NHS clinical services and maintains the core duties and responsibilities of the NHS. It will be particularly important if legislation is passed in Scotland, because we need compatibility of the conscience clause between England and Wales and Scotland. The legislation currently going through in Scotland will have its draft conscience clause removed at the time that the Scottish Parliament goes to vote on it, because the provision of such a conscience clause is not a devolved matter. The exercise of conscience not being a devolved matter will require a statutory instrument passed from this House, or possibly even primary legislation, for it to be then included later in the Scottish legislation.

The noble Baroness, Lady Berridge, raised concerns about the wording of proposed new subsection (1) in Amendment 116. I wonder whether the noble Lord, Lord Carlile, would consider changing that to incorporate the amendment that I have tabled—the proposed new clause would replace Clause 3—over the assessment of capacity. This amendment was developed by the Complex Life and Death Decisions group at King’s; the national expert on mental capacity assessments sits as a key member of that group and as a professor at King’s College.

I hope the proposers of the Bill will recognise that proposed new subsection (2) in Amendment 116 provides very important minimum criteria that must be provided: questions that must be asked when such a decision is to be made. The court can certainly ask for them to be provided to it. It seems as if a panel would be discretionary over whether these criteria were looked at, and it would strengthen confidence in the decision-making to know that they were there, because it would provide transparency and consistency, and a process of appeal would be available. We know that no appeal system exists in the Bill as currently written in relation to panels agreeing to an assisted death being provided, and the real concern there is that these panels could eventually become something of a tick-box exercise under quite a lot of process. As has said been said before, those with a judicial background are not acting in a judicial capacity on the panels, whereas the proposal by the noble Lord, Lord Carlile, provides judicial capacity and processes.

The amendment that seems to be key is Amendment 120: its proposed new subsection (4)(b) would require a statement of medical fact, with the decision-making being taken by the court. Again, it will be much easier for people to provide a statement of medical fact than to feel that they are taking a decision over the provision or non-provision of lethal drugs. In proposed new subsection (5)(a), I hope that the doctor has to be on the specialist register for the specific condition of the patient—I seek clarification on that—or to have been a GP principal for longer than three years. It is important to be clear that this should not be a doctor who is at a training level, even if they have been a trainee for more than three years, because the ultimate responsibility sits with the consultant or the GP under whom they are training. There could be confusion over responsibility if this is not clarified.

On Amendment 120’s proposed new subsection (6)(a), can the noble Lord, Lord Carlile, confirm that it may be not the GP at all who is involved but a hospital consultant or long-term associate specialist who has been providing medical care? These might seem like minutiae, but we are in Committee and discussing amendments that can be changed, and I think it will be important to have that clarity.

It seems that proposed new subsection (5) in Amendment 426 seeks to provide additional security with a court-appointed medical expert. This proposal seems to protect us against going down the route that Canada has gone down. It seems to really attempt seriously to detect undue influence. Allowing interveners is very important; it is all part of the desire for there also to be an appeals process and of getting all the information.

I stress that there is a clarity between decisions about whether somebody is given lethal drugs to significantly shorten their life, accepting that a prognosis of six months is not much more than a guesstimate—in fact, it is a guesstimate—and the position that has been discussed over life support decisions. When a patient is on life support, the decision to cease that intervention is based on two potential factors: one is the futility of continuing with an intervention that is not achieving a therapeutic goal, and the other may be because the patient withdraws their consent for continuing that intervention in an informed way and has capacity to do that. That is fundamentally different from somebody providing lethal doses of drugs with the deliberate intention to shorten a person’s life—which may be by days, weeks or months, but may be by years. As has already been said, we all have experience of people given a very short prognosis that turned out to be completely wrong.

I have some questions for the noble and learned Lord, Lord Falconer. I know that he has already been given a large number of questions to answer, but I think it is really important. First, in 2024 he stated that

“family judges are … completely unsupported”

and that the family justice system is—I think I can quote correctly—“literally crumbling”. Were these the reasons behind the removal of the court oversight when the Bill was considered in the other place?

Secondly, in discussing these proposals with officials, what assessment has been made of the volume of cases outlined in the impact assessment being handled by this system, and what provision has been made for recognising that the numbers in the impact assessment are almost certainly inappropriately low? The data from Australia, New Zealand and other places has shown that, by year three, the uptake will probably be about 10 times higher than written in the impact assessment, because the impact assessment was based on data from quite a long time ago, when the Oregon system was instigated.

Thirdly, what costing has been undertaken for each of the models—the model of the panels as put in with the different numbers that might be involved—and what consideration has been made for a costing over this model?

I ask the Minister: what budget has been put aside to fund the system, whichever model is adopted, and what option appraisal has been undertaken over the safety of individuals and the ability to identify coercion with a higher degree of probability than currently exists and to identify abusive relationships?

As I have said, the financial costs for each model, tested against the impact assessment numbers, appear unrealistically low. I think we all look forward to the questions being answered.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, given the number of questions that have been put to the Minister—and, indeed, to my noble and learned friend and to the mover of this amendment—I wonder whether it might be useful if we now move to the Minister and the others to answer some of these questions. There are so many that it would really help the Committee if we could hear some of the answers.

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Moved by

[Baroness Finlay of Llandaff]

26: Clause 1, page 1, line 12, at end insert—
“(e) has had their needs fully assessed by a multiprofessional specialist palliative care team, and appropriate care provided to the extent necessary to enable them to decide whether such care would affect their wish to end their life,”Member’s explanatory statement
The amendment ensures that all terminally ill persons seeking to take up assisted dying support have had their needs assessed by a multiprofessional specialist palliative care team and met to the extent necessary to enable them to decide whether such care would affect their wish to end their life.

[Baroness Finlay of Llandaff (CB)]

My Lords, we move on to a group of amendments that are extremely important and, in some ways, complementary to those in the previous debate. Autonomy is the lodestar of the Bill. The amendments in this group are designed to reinforce and respect that patient autonomy; they do not block access to an assisted death but aim to ensure that people have accurate information to make informed decisions. For a decision taken, people must have three things, whatever that decision is: accurate information, the capacity to make the decision and to be making it voluntarily. Those are the fundamentals of respecting a person’s autonomy.

These amendments are to ensure that the patient has the opportunity to know what is available. They do not force a patient to be looked after by a palliative care team, and they do not stop a patient from proceeding with an assisted death. There is clear evidence from studies that underserved groups have poor access to palliative care, and there is poor understanding generally of what palliative care is and can do. General doctors often do not understand palliative care, so how can an assessing doctor give good, accurate information to a patient if they themselves have a deficit in their knowledge? It is worth noting that in a five-year medical training course it has been estimated that the average time spent on learning about palliative care is only 20 hours, and only recently has palliative care come into the finals questions. So there are thousands of doctors out there with almost no education in palliative care.

Many patients and the public do not understand palliative care either. A significant number think that assisted dying is palliative care or hospice care, while others think that palliative care simply hastens death. Sadly, misunderstandings are widespread. When patients access appropriate specialist palliative care, the desire for a hastened death is often alleviated, and they experience an improvement in quality of life that they never believed possible. But that does not apply to everybody. The role of this amendment is simply to give everyone the best opportunity to access the care that they need, whether or not they continue to pursue an assisted death and whether or not they decide to take up the opportunities that may be revealed by such an assessment. The processes relating to an assisted death can occur in parallel with, but not as an integral part of, palliative care provision.

There has been concern that palliative care teams could not cope with a sudden influx of referrals, but currently any palliative care team prioritises a patient who is in such despair that they want to die. That is basic care, a core part of the job. Palliative care will not turn its back on patients who are in despair; teams want to deliver gold standard care.

In Oregon, 92% of assisted death patients are recorded as being enrolled in hospice services. Palliative care needs assessment gives patients options to make an informed decision. The patient may conclude that there are other options that they have not been aware of and want to try, or that they simply want to pursue an assessment for an assisted death. Evidence from Canada has shown that some patients seeking referral for medical aid in dying are actually asking for palliative care; they seek assisted dying as a way in which to get their problems sorted out.

A palliative care needs assessment must always be non-judgmental. I stress that this is not a bad faith amendment; it is to ensure that patients know what they could have and are making an informed choice, respecting their autonomy.

For every decision in life, we want the best information, whether it is knowing that the house we are buying is not full of dry rot or that a car or sales loan has not been mis-sold to us. The Bill’s processes must ensure that applicants are fully informed. This is not a costly option. There is high-quality evidence that specialist palliative care reduces the chance of dying in hospital and increases the cost effectiveness of home and hospital-based care for those with a poor prognosis.

Therefore, the adequate provision of services to ensure that every patient seeking an assisted death can have their needs assessed will decrease, not increase, costs to the NHS. Home specialist palliative care is associated with reduced costs of nearly £8,000 per person and increased quality life-adjusted years. In the hospital sector, costs also reduce but only by about £6,500 per patient, again with increased quality-adjusted life years overall. Provision of specialist palliative care to ensure, wherever the patient is, that they have the option of accurate information with which to make their decision has been estimated to reduce system expenditure by over £800 million per annum.

Unfortunately, I fear that the Bill’s proposers have rather misunderstood multidisciplinary care working, and I am afraid that my friend and colleague Dr Sarah Cox, who I respect enormously, has indeed been slightly misquoted. As the noble Baroness, Lady Gerada, said in our last debate, modern care is delivered by multiprofessional teams, which come together around an individual patient, comprising doctors, nurses, physio, occupational therapy, social work, et cetera, depending on the needs of that individual patient. Patients often communicate more readily with the lowest paid in the team, such as the carers, to whom they feel they can talk freely, as there is not the power differential that exists between patient and doctor. That multidisciplinary and multiprofessional team reviews and monitors things together. That is quite different to bringing a panel of three different disciplines together specifically to make one decision and then move away from it without that continuity of knowing people. It is important that we are clear what we mean in clinical care.

In the hospice, I used to always have the care assistants as part of our weekly multidisciplinary review of patients. They had valuable insights and much to contribute. A mandatory assessment would ensure that people knew what was available. It is up to the person to decide whether to try one route or another.

Why make this mandatory? Unfortunately, the amendment to the Health and Care Act 2022, which I pushed for very hard and was glad to see come in, and which stated that palliative care is a core service, has not resulted in commissioners adequately commissioning services, in part because they themselves are ignorant of what to commission. If assessment is mandatory, commissioners must make sure that patients seeking an assisted death have a service that can provide a proper needs assessment and give them information. The patient can choose whether to try or not try.

I know that my noble friend Lady Hollins has an amendment about this, and there is indeed a definition in an amendment that has also been tabled in relation to what specialist palliative care is. To try to summarise that very quickly, it is about having the appropriate specialist skills in every setting, with advice available at all times of the day, every day, equipment and medication available, and a point of contact so that people can go back and explore and discuss things as they think more about the complexities of their situation, and they can access the support that they need.

As my colleague, Dr Rachel Clarke, pointed out when she gave evidence previously, the moment of people having a diagnosis of severe life-limiting illness is their time of peak vulnerability. Is the patient’s request for an assisted death a knee-jerk reaction to a new diagnosis that terrifies them? Have they been plunged into a suicidal depression that might pass? Might a desire to die be replaced by a desire to live when they receive the patient-centred care that they need? Is a malign partner lurking in the background, putting insidious unvoiced pressure on the person to believe that he or she would be better off dead? In New Zealand, we hear about patients seeking an assisted death when they are clearly caught up in a cycle of despair and hopelessness, while actually they want and need to know what is available but often the services are not there for them.

I hope that my colleagues who have tabled amendments in this group will speak to them, and I have tried to lay out a background template for why the mandatory ability to have an assessment of need is important. I beg to move.

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[Baroness Finlay of Llandaff (CB)]

In the time that is left, I would have loved to respond to all the points, but I am not going to go through them in detail. I am deeply disappointed in the response from the noble and learned Lord, Lord Falconer, because it seems that he has not taken on board some of the really important points that were made. I believe that the amendment spoken to by the noble Baroness, Lady Brown of Silvertown, is the beginning of a very important statement. I believe that we must—not just will but must—come back to this on Report, with all those people who have shown an important investment in time to consider the needs of the individual who is in such distress that they want an assisted death. We cannot accept that some people are potentially going down that road simply because care is not available. With that, and with the commitment to come back later, I beg leave to withdraw the amendment.

Amendment 26 withdrawn.

Prisons: Mothers and Babies

Baroness Finlay of Llandaff Excerpts

Monday 7th July 2025 Lords Chamber

[Lord Timpson (Lab)]

The experts who work in the justice system and social services are the best placed to decide how to support mums and their babies when they are in the justice system. We have recently introduced social workers in four prisons. That is a really important role, and I am looking to see how well it is going—but so far, so good. As I said in a previous answer, the complexity of these women’s lives means that we need an awful lot of support, but in my view that support is worth it, especially in those early years.

[Baroness Finlay of Llandaff (CB)]

For mothers in those units, how is the monitoring undertaken to make sure that they are not being given drugs through illicit routes to maintain their drug addiction? Are they routinely tested for substances to try to help them come off drugs and maintain better bonding with the baby as a result? Are they also tested for viruses that might be a problem if they decided that they wished to breastfeed?

[Lord Timpson (Lab)]

I am not familiar with the exact details on testing, but I know that we have mandatory drug testing in all prisons on a regular basis. I am also aware, from having foster children at home, that when we opened the fridge we used to be careful whether we got out the Calpol or the methadone. Too many drugs get into prisons and too many people who go to prison are addicted to drugs. We need to deal with that, and we need to do it quickly.

Sentencing Guidelines (Pre-sentence Reports) Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Monday 19th May 2025 Grand Committee

Amendment 1 withdrawn.

[The Deputy Chairman of Committees (Baroness Finlay of Llandaff) (CB)]

My Lords, I should inform the Committee that, if Amendment 2 is agreed to, I cannot call Amendments 4, 11, 12 or 13 because of pre-emption.

Amendment 2

Moved by