Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Baroness Fraser of Craigmaddie

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have two amendments in this group. We have heard a lot of comments about the real world and what is actually going on now, today, out there in healthcare. It will be very interesting to hear how the noble and learned Lord, Lord Falconer, responds to all the criticisms and to the way the inherent dangers in Clause 5 have been highlighted.

My Amendment 201 concerns children. A little boy with advanced malignancies said to me, “I'm going to die when my goldfish dies”. He went on to talk through what he wanted when he was dying and how he would play football in heaven with another boy who had died recently. Not long after, his goldfish was found floating. My strenuous attempts to resuscitate his goldfish failed, and he gently died soon after.

That was some years ago. Today, children live off the internet, not just off what they hear from other children. They know about the debate on this Bill—some raise it in “Learn with the Lord” sessions. If a child is asking questions about this, they must be able to express their fears if they are already ill. They often speak with remarkable frankness. Children’s awareness is phenomenal. They deserve gentle, honest planning of their care that also explains why they are ineligible for assisted suicide. Hence my wording, but the wording of the noble Lord, Lord Rook, provides much clearer guidelines for clinicians involved, to allow them to listen but in no way to hint that the child will be eligible.

Assisted suicide is not a medical treatment. It falls outside McCulloch and Montgomery rulings, hence my Amendment 159. As has been said, if a doctor raises assisted death unprompted, the implication is that this is something you should consider—a tacit implication that this might be your best option. Addressing the comments by the noble Baroness, Lady Hayman, it is a doctor’s duty of care to sensitively explore with open questions and careful listening, to discuss whatever the person wishes to discuss at their initiation. That is patient autonomy and control. Mencap, the Association for Palliative Medicine and the Royal College of Psychiatrists have all warned how patients’ trust gives doctors a dangerous ability to steer decisions if the suggestion comes from the doctor.

Listening with undivided attention is crucial in gentle, honest communication in the face of patients’ anguish. Patients hang on to our every word, so suggesting it as an option signposts them in that direction. It abandons suicide prevention duties under the Mental Health Act and the state’s duty under Article 2 of the European Convention on Human Rights. The amendments overall have a common theme of making the autonomy of the patient paramount in these discussions, their being able to raise assisted death in their own time, at their own pace and at their instigation. I hope these amendments will be taken heed of.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank my noble friends Lord Jackson and Lady Monckton—whose speech was quite spectacular—for raising the example of DNRs. It is very good example when we are talking about who can raise assisted dying in preliminary discussions.

I want to give a very brief illustration. When my father was in hospital, five different medical professionals came into his room and took us, his family, aside, to get him signed up to a DNR. He did not really want that. It might have philosophically been the right medical thing to do, but he was not in the right place. He did not want to be asked, and certainly not five times by five different medical professionals. It left a rather bitter taste in our mouths, because when we were able quietly, as a family, to have that discussion with him, he did have a DNR. We were fortunate to have that time, rather than him having something put at the end of his bed with the Sainsbury’s bag.

This group of amendments is really important. They are all similar, saying that we need some guidance on who can raise the discussion and under what circumstances. If we really believe that patient autonomy is important, then something should come from this group of amendments and be in the Bill.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Baroness Fraser of Craigmaddie

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Lord for his intervention, but I think we need to stay focused on the amendments in this group and not get diverted. That is what I am trying to do.

In terms of palliative care provision, I am extremely worried that the amendments put down to the amendments tabled by the noble Lord, Lord Birt, had to be limited because palliative care is repeatedly being deemed out of scope of the Bill. That is a major problem. We hear about bad deaths, but we know that actually, if clinicians act with urgency and have a 24 or 48-hour limit before they call for specialist palliative care intervention—so there is rapid intervention, with highly specialised knowledge—all of the outcome measures show an improvement, using things such as the IPOS scale and so on. Family reported outcomes can also improve. To view bad deaths as something that we should just leave and tolerate, and to say the only solution is the proposal in these amendments, does not recognise the reality of the services that are available already.

In introducing his amendments, the noble Lord quoted extensively from Australia and painted it as everything being perfect. I would like to briefly counter that by quoting the honourable Robert Clark, who was Victoria’s Attorney-General from 2010 to 2014. He has written about the Australian experience of assisted suicide. He describes a change in “attitudes”, with the “ethos” of the medical profession moving away from the practitioner’s primary duty to solve the problems the patient has, and a grave risk that this will lead over time to doctors forming views that a patient ought to be opting for assisted suicide and becoming inclined to regard that patients should go down that road.

He also highlights that there are things going wrong. I will not detain the Committee because of time, but I think there are alternatives. He points out that there are some doctors who, when they have resisted going along with a request for an assisted death, have found their whole careers eventually becoming somewhat blighted. Although there is a clause in the Bill which tries to avoid that, there is concern that that clause is incomplete. So, when we quote international evidence, we also have to be quite balanced in it.

The proposal in the amendments from the noble Lord, Lord Mackinlay, do us a favour, because they demonstrate that this cannot be part of the NHS as it is at the moment. It begins to move us towards viewing some kind of proposal like this being completely outside NHS services but not planted in the NHS. Then, of course, the funding question arises. If funding erodes palliative care funding, which has happened in other places, we really have a problem, because recent evidence to the Public Accounts Committee showed that, if you have specialist palliative care in place and available, as it ought to be, the savings to the country would be about £800 million a year.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I was not intending to stand up today, so I apologise, but this group has not gone at all how I thought it would.

When I looked at Amendment 771 and the proposed assisted dying help service, I was confused. I had thought that navigators might take a similar role to that of independent advocates. We have a group about the importance of independent advocacy, which I am a huge supporter of, and about advising people on other care, health or treatments. That is coming up in 19 groups’ time. But it seems that Amendment 771 is illustrating the flaws of the entire Bill, whether that is geographical provision, training and qualifications, the right of practitioners to withdraw and the need to support vulnerable people.

We have also had a debate today about the funding of the proposed assisted dying help service. We have another group—group 30, which I hope we get to—on the provision of an assisted dying service by groups other than the NHS. I suggest that noble Lords opposite take the suggestion of the noble Baroness, Lady Royall, to press the Government to provide clarity, before we get to that group, on the funding of an assisted dying service and—following the point from the noble Baroness, Lady Finlay—the future funding and support for hospice care.

I have an amendment in that 30th group, which I tabled because I think that the proposers of this Bill have missed a bit of a trick. If you want to set up an assisted dying service, you should do so in parity with the current arrangements for the hospice service. If we understand what the funding for the hospice service will be, we can have our debate in group 30 on alternative provisions.