Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Falconer of Thoroton

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to those who have contributed to this discussion. I made it clear at the beginning that I was probing. I am particularly grateful to the noble Baroness, Lady Hollins, for pointing out that one of the difficulties for assessors is in knowing how reliable the information that they can access is. It seems that we need a way to make sure that people who could be particularly at risk have an enhanced level of assessment for the protections relevant to them.

I am sorry; should I not be speaking now?

[Lord Falconer of Thoroton (Lab)]

I apologise to the noble Baroness. I was being told by the Whips that my noble friend Lady Berger has to withdraw her amendment first. I apologise for the discourtesy.

[Baroness Finlay of Llandaff (CB)]

That is fine; I was hoping to sum up, and then I would willingly hand over to the noble Baroness, Lady Berger, to withdraw the amendment. I think that we need to make sure that the face of the Bill makes it clear that there is a level of particularly enhanced assessment for several groups of people—this will be only one group—who are, for whatever reason, particularly vulnerable. I hope that the number of meetings that we have will include everybody who has a concern over this, going forward to Report stage. It is of concern that the code of practice for the Mental Capacity Act has still not finished being updated. I hope that we will see an updated version next year, because the one currently in place is, in some ways, a little bit out of date, given the modern world we live in. With all that, if the noble Baroness would like to withdraw her amendment, I will be delighted to withdraw mine.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I shall speak to my Amendment 26 in this group. It is important to remember that Clause 1(1)(d) of the Bill simply states

“is registered as a patient with a general medical practice in England or Wales”.

It does not require anything more than that. I will explain why I have tabled an amendment looking at a home visit, because, as my noble friend Lady Gerada has said, patients will be looked after by many different members of a primary care team but will be legally listed and registered with the named GP, because that is how the funding flows to the practice for care delivery. We must not confuse the two, and the notes held in the practice are important.

The person may actually be receiving most of their care in secondary or tertiary care, as the noble Baroness, Lady Falkner of Margravine, has pointed out, but if this qualifying condition is to have any meaning, there must be substance in it, with a clinical record that can be drawn down in assessment. That does not mean that the GP has to have anything to do with providing an assisted death, but it seems sensible that the clinical record, which will have the record from previous GP practices if the patient moves, can be drawn down.

Data suggests there has been a fall in home visit rates over time. Most home visits undertaken by primary care team members are indeed to people who are seriously ill. The data shows that in October 2025 there were over 462 home visits by GPs, which comprised about 1.7% of all face-to-face consultations registered by a practice that month, or 1.1% of all contacts. While that percentage may seem low, particularly as care moves into the community, it is important to remember that the pressures on primary care teams have increased, with more listed patients per GP and more complexity. In addition, there is less continuity of care, with patients often seen by several different doctors in a practice, and different members of the team. During a hospital stay, patients are likely to encounter, on average, 18 to 27 different healthcare professionals. All those conversations and details should be entered in the hospital record, but they may not be well entered, and the information sent to the GP after admission may be a rather simplistic summary about more of the physical aspects but not necessarily psychosocial details that may be recorded somewhere in the depth of a hospital record.

Why does all this matter? It is because the living conditions and atmosphere in a home reveal an enormous amount about pressures and influences on a person who is ill in a way that is never ascertained in the consulting room. The well-groomed patient’s home can reveal overcrowding and poverty, where others in the household are dismissive or even verbally abusive in front of the healthcare professionals who visit. For most patients, a home visit can allow the person the confidence on their own territory to talk about their hopes and fears in depth, and about why they seek an assisted death. They are not intimidated by the hospital or GP venue, knowing that other patients are waiting outside and aware that others may notice that they have been crying when they leave through a crowded waiting room.

In evidence to the Select Committee, we heard from the Royal College of General Practitioners, of which I declare I am a fellow, that any assisted dying service should be seen as a stand-alone, specialised service that GPs and other healthcare professionals may opt in to provide. They stated that it is neither appropriate nor practical for this to be deemed core GP work, and they do not want any blurring of lines with the palliative care that they provide, which has already been described by my noble friend Lady Gerada. That position was confirmed in a motion at the RCGP Council last week. The GPs were clear in evidence to the Select Committee that they have no spare capacity in the working day to take on additional duties related to providing an assisted death. For some, a lifetime of 10-minute contacts will have built long-term relationships, but that does not apply to everyone.

As the Bill does not require any inquiry of the family about the person’s circumstances, the clinical record from the GP practice about a home visit may be the most revealing way to ascertain the true situation and decrease the risk of coercion being missed, as my noble friend Lady Grey-Thompson has referred to. The GP record must be available to whoever is undertaking the assessment and assisted death service provision.

In terms of ability to see the GP, I support the evidence that we heard from Caroline Abrahams of Age UK, who said that older people often report that better access to a GP would make a huge difference to their world, and that two in three struggle to make appointments or communicate with their GP. Sadly, I am afraid the evidence in Wales is that in 2023 two-thirds of patients said to the Older People’s Commissioner for Wales that they had difficulty in getting an appointment, and that had gone up from one-third in 2022.

The Demos commission report, which was led by the noble and learned Lord, Lord Falconer, found that a doctor supporting the person and their family

“are the key elements that … should be included in any future framework for assisted dying”.

So I ask him: is that the reason why the requirement to be registered with the GP is included as a qualifying condition? Perhaps he could clarify a bit further.

The noble and learned Lord’s commission report envisaged that the assessing doctor would know the patient well and have an established relationship. In his “Newsnight” interview, he also confirmed that if the patient was young, it would be a sensible investigation for family members such as the parents to be interviewed if that young person was asking for an assisted death. Does he recognise the importance of putting some kind of stable primary care relationship at the heart of information that is available about the circumstances of the patient?

[Lord Falconer of Thoroton (Lab)]

It might help the House if I answer those questions, because they are rather at the centre of the debate. Before I get there, I should say that, in the view of the sponsors, the requirement to be registered with a GP practice reflects the reality, which is that in some cases you will have a relationship with your GP but in other cases you will not, despite your best efforts to do so. The reason for the relationship with the GP’s practice was that it provides a central place for records to be kept. The noble Baroness, Lady Fox, rightly identified myriad references in the Bill to GP practices, and noble Lords will see that it is informing the GP of every step that is taken. As ever, though, the noble and learned Baroness, Lady Butler-Sloss, puts her finger on it: you cannot possibly rely on people having an established relationship with their GP, and that is not the protection.

The point made by the noble Baroness, Lady Gerada, seems to be key, and it is reflected in what the noble Baroness, Lady Finlay, has said. The people looking after you are those who should be putting their input into what the right course is. The wrong answer to this is ludicrous hurdles that you have to get over. I do not call the speech of the noble Baroness, Lady Lawlor, ludicrous, and I unreservedly withdraw that in relation to her, but having to have seen your GP six times in the previous years is not the way to deal with it. Surely the way to deal with it is to put in the Bill—and I am more than willing to discuss how we do that—how the multidisciplinary team, which might be GPs, oncologists, nurses, physiotherapists or social workers but it might not, get to have some input into it.

What I am taking away from this debate is this: do not think about the GP being able to provide it, because they will in some cases, but they will not in others. Think instead about how you get the multidisciplinary team who are looking after the patient who wants an assisted death to give the appropriate input. Again, the right course is to talk to the people who have some expertise in relation to this and think how we build that into the Bill. It is not in the Bill at the moment, but I think we can put it in.

[Baroness Finlay of Llandaff (CB)]

Can the noble and learned Lord clarify whether he would consider amending the Bill to ensure that information is sought from those who have provided care to the patient during the course of the serious life-limiting illness that has led them to request an assisted death, whether that is from primary care, a hospital or a private sector provider? Would that also include information from members of the family, as he suggested in the Demos commission, when the person is young and when there are circumstances that would be particularly pertinent?

[Lord Falconer of Thoroton (Lab)]

Yes, we should get the information from those responsible for the care of the individual in a health sense. However, I am not willing to commit myself to that in relation to the family. The person making the decision should think, “What should we do about the family?”—but what if the patient has not seen their family for a long time or are at odds with particular family members? I believe that it should be done very much on a case-by-case basis.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I put a question to the noble Lord who has just spoken. I am really concerned—

[Lord Falconer of Thoroton (Lab)]

The noble Baroness is intervening on somebody who made an intervention on somebody else. We got a very severe talking to about that before, so I do not think that is allowed.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Falconer of Thoroton

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

We are discussing the wording of this Bill, with due respect. I raise this as a concern for clarification. It needs clarification because, if noble Lords are anticipating that this Bill and the legislation in the other jurisdictions will pass, we cannot leave a legal loophole or difficulty that might jeopardise the care of patients coming to England from the Crown dependencies. That is why I have raised it.

I turn to Amendment 11. Currently, the Bill speaks of the person being “ordinarily resident” in England and Wales, but there is a problem with “ordinarily”. In 1983, Lord Scarman stated in a House of Lords judgment that

“‘ordinarily resident’ refers to a man’s abode in a particular place or country which he has adopted voluntarily and for settled purposes as part of the regular order of his life for the time being”.

So far, so good. However, in the healthcare context, the 2012 Review of Overseas Visitors Charging Policy said:

“The vagueness of the definition means that OR”—


ordinary residence—

“is difficult to interpret and apply on an individual case basis”.

People fell through the gaps and the NHS was not recovering its costs. Then, during his time as Immigration Minister, the noble Lord, Lord Harper, pointed out that

“we need to do a better job of making sure that front-line professionals have a simpler system”.—[Official Report, Commons, Immigration Bill Committee, 7/11/13; col. 290.]

The problem with the definition in the Bill is that it could cover someone who is now living in another country but has an address of convenience in England and Wales for whatever reason. We know that there are thousands of empty properties owned by people who are not living permanently in this country. Apart from the more than 187,000 homes that are owned by people living permanently abroad, there are 5.5 million people who are British passport holders or have residency visas to live in the UK but are living abroad permanently. What will be the position of these people if they wish to access an assisted death here? Currently, they would not be eligible for NHS treatment if it were to be funded by the NHS. If they came to live in the UK for a year, they would then become eligible for the NHS, but, with the prognosis of six months or less, they would be expected to be dead within that time. Of course, this assumes that there is any accuracy in prognostication, which there is not.

Let me put to your Lordships a scenario that is, sadly, not infrequent. A person working for the Foreign and Commonwealth Office in an embassy abroad becomes seriously and terminally ill and is repatriated to the UK. Their house is rented out and they have to give notice, so they go to live in a different area—one, they hope, with good specialist palliative care services that can provide them with support. However, not being able to be in their own home and surrounded by their own things, and without contact with people who would otherwise have a role in their lives, they easily become very depressed.

Let us look at that scenario under this Bill. Suppose they decide that they want an assisted death. They will not have been resident for 12 months prior to making a first declaration to request an assisted death. Will that person, who may have worked all their life in service of this country, now be ineligible? I see that the noble and learned Lord, Lord Falconer, is nodding that they would. I believe that, under the wording of the Bill—

[Lord Falconer of Thoroton (Lab)]

Hold on—my nods must not be misinterpreted. I understand the question. If, for example, you live in Britain and you go and become the First Secretary in the US, you do not cease to be ordinarily resident in the UK. If you are a soldier and serve for nine months abroad, you do not cease to be ordinarily resident. I was nodding only to say that I have got the question, but I would not necessarily agree with the solution that the noble Baroness proposes.

[Baroness Finlay of Llandaff (CB)]

I am grateful for that clarification and we will come back to the noble and learned Lord’s comments on these issues afterwards.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

My Lords, I honestly think that is a smokescreen. The Bill says, in a way that the law has recognised time and again—because this Parliament has to make choices from time to time about who gets benefits—that the benefits of the Bill should be given only to those who ordinarily live in this country. That phrase has not given rise to problems. The courts understand it, doctors understand it and the panels will understand it. If we in this Parliament cannot say that we will give rights only to those who are ordinarily resident, which is a phrase that means something, we will never be able to determine who is entitled to our rights. I say, with the greatest respect to the noble Baroness, Lady Coffey, that what we are trying to do in the Bill is clear. I invite the noble Baroness, Lady Finlay, to withdraw her amendment.

[Baroness Finlay of Llandaff (CB)]

My Lords, I will now sum up at the end of this very interesting debate. I am relieved to hear that people do not want doctors to be immigration officers. I am a little disappointed that the noble and learned Lord, Lord Falconer, has not accepted the amendment from the noble Earl, Lord Howe, because it is so straightforward. If, as the noble and learned Lord says, it would not be a problem for over 99% of patients, it would not be a problem to be satisfied. It would add a degree of security for doctors who are being asked to provide these assessments of eligibility.

I was also glad to hear from the noble Lord, Lord Harper, that those working for the Foreign, Commonwealth and Development Office, in embassies or wherever, are covered, and that that is not a problem. The noble Lord, Lord Carlile, raised the issue of those working as volunteers abroad for a very long time. I hope that the ability that applies to Foreign, Commonwealth and Development Office workers also applies to those working for charities, such as some of the major charities, who may be abroad for a very long time but view their permanent home as the UK.

I remain concerned about Jersey and the Isle of Man. What conversations has the noble and learned Lord had with the Public Bill Office about how to get this in scope? My attempts have failed, and I understood that here in the House of Lords we are not able to widen the scope of the Bill. I worry that without widening the scope of the Bill, we will not address it, and those doctors treating patients with all kinds of really serious illnesses, particularly in Liverpool, as referred to by the Front Bench, and in Southampton, could inadvertently find themselves in a very difficult position, which would be an unintended consequence of this legislation.

[Lord Falconer of Thoroton (Lab)]

I do not know whether the noble Baroness has discussed with the Public Bill Office the BMA’s proposal in relation to this, which is that it is not a crime under the Suicide Act if the assistance you give is not unlawful in the Isle of Man or Jersey. The idea that that is out of scope seems obviously wrong, because the Bill is crafting an exception to the Suicide Act. If the noble Baroness and I go to see the Public Bill Office and explain that, I would have thought that there would be no difficulty about the scope.

[Baroness Finlay of Llandaff (CB)]

I would be delighted to go with the noble and learned Lord, because he may have a little more success. The Public Bill Office has been unfailingly helpful. This is no criticism whatever of it; it has worked incredibly hard. With that and the promise of going to see it with a matter of urgency, I beg leave to withdraw the amendment.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Falconer of Thoroton

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I am very grateful to my noble friend for mentioning that, because that is what was being whispered to me but I did not have the statistics. I am very grateful to him for providing them.

[Baroness Finlay of Llandaff (CB)]

My Lords, this has clearly been a long debate, and I think for good reason. As one noble Lord said, coercion and pressure are a major concern for many people about the way the Bill is written. I will very briefly respond. I am well aware of the time, but a lot of points have been made. Noble Lords will all be relieved to know that I am not going to go through them all.

First, the word “encouragement” is taken from the Director of Public Prosecutions guidelines, and for good reason, because the Director of Public Prosecutions recognised the power of a person in authority over a person who is vulnerable. That is why it tends towards the prosecution of assistance coming from a person in authority. I would include doctors in that, but it was also thought to include prison staff, nurses and others employed in that role.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Falconer of Thoroton

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I will answer that one. No, you cannot do it by power of attorney. You have to do it yourself.

[Baroness Finlay of Llandaff (CB)]

My Lords, given this very long debate, I will try to respond briefly. I declare that I had the privilege of being the first chair of the National Mental Capacity Forum, which was set up following the post-legislative scrutiny of the Mental Capacity Act precisely because of the problems with its implementation. I worked in that role all through Covid. As the noble Baroness, Lady Browning, said, unfortunately, although it is a fantastically good piece of legislation, its implementation depends on the person who is implementing it. Although there has been training, and we worked very hard to get training in, it has unfortunately not always improved things as much as one might hope.

The other thing I draw to your Lordships’ attention is Section 62 of the Mental Capacity Act, which concerns the scope of the Act. It says:

“For the avoidance of doubt, it is hereby declared that nothing in this Act is to be taken to affect the law relating to murder or manslaughter or the operation of section 2 of the Suicide Act 1961 (c. 60) (assisting suicide)”.


It was with that background that I became concerned that the quality of the information the person has depends on the knowledge of the person giving that information, as well as the ability of the person to retain it. I spoke about choice at the beginning of my speech. I am sorry that the noble Baroness, Lady Thornton, is not in her place, because choice is essential if we are giving patients opportunities to make decisions, but we have to have real choices. That is why I spoke about the black holes where there is no adequately provided palliative care.

Unfortunately, although the Bill has had a money resolution—forgive me if that is the wrong phrase, but there has been a commitment to fund the provision of a service if the Bill becomes an Act—it has not been matched by concurrent funding in the long term for specialist palliative care. That is a concern, but we will come back to it later.

There is another very small point that I want to make: can we please avoid using the term “commit suicide”? It is not a crime to take your own life, and “commit” is a deeply offensive term. We are talking about people who, for whatever reason, decide to take their own lives and end their lives early. We should remember that as we go forward in our debates, out of respect for everybody who has been bereaved by the tragedy of suicide or attempted suicide.

When it comes to life and death decisions, though, I suggest to the Committee that it is fundamentally different to have the decision of accepting that your disease process is going on, that your dying is inevitable and that you wish to withdraw your dialysis or ventilation. Those are decisions in which I have been involved with patients for decades. We can now take people off ventilators very gently and calmly without any of the distress that was previously associated with that, and they die of their underlying disease.

What we are talking about is suicide prevention versus suicide assistance and the point at which you decide, as a clinician with a patient in front of you, whether you are going to be working with suicide prevention, improving quality of life, or whether you are going to stop that because you are going down a different route, and some of the evidence we had was to that effect. However, because of time and the way that things have gone on, I beg leave to withdraw my amendment.