Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Markham

Committee stage
Friday 13th March 2026 Lords Chamber

[Lord Markham (Con)]

I thank noble Lords. I totally appreciate that the noble Baroness’s intention in all this is to try to make the process as robust as possible and she gave a very moving example of why she believes in it. But surely the people best placed to give evidence and understand the situation or the capacity of the person involved—their circumstances and whether there is any coercion—are the very people who she is suggesting should not be part of that panel, namely the health professionals and doctors involved. I am trying to understand why the noble Baroness would not want to involve those professionals who are closest to the case.

[Baroness Finlay of Llandaff (CB)]

Unfortunately, I am not sure that the noble Lord heard me right. The panels that we discussed previously did not include the treating clinicians—they were to look at the evidence brought to them. In the panel structure that I am proposing, the panel would have access to all the patient’s notes—with their permission—all their investigations, the full assessment of capacity and all other aspects that would be happening in routine practice during the patient’s care.

Concerns over the patient’s family and behaviours during the course of their illness would be documented in the clinical record, along with the criteria on which the diagnosis was made, and that clinical record would be available to the panel. That is why I have suggested that there needs to be an expert with knowledge of the specific disease afflicting the person who is seeking an assisted death. There are many rare conditions in medicine; common things occur commonly, but rare things are not that uncommon, and it is quite common for there to be a misdiagnosis that may lead to the patient making a decision based on the fallacy that they have an illness they may even have been treated for. We heard evidence in a previous Select Committee that, at post-mortem, around 5% of people are found to have died of something different from what had been recorded on the death certificate, suggesting that misdiagnosis is, sadly, not a very rare occurrence.

[Lord Markham (Con)]

I was specifically referring to:

“The person’s health or social care professional cannot participate in any part of the assessment for a person’s request of an assisted death”.


That is the point I am trying to understand. Yes, unfortunately there are cases of misdiagnosis—the 5% that noble Baroness mentioned—but 95% of the time these people are the best qualified to make an assessment, so I am trying to understand why we would not want them involved.

[Baroness Finlay of Llandaff (CB)]

They will not be involved in the judgment as to whether the person is eligible for lethal drugs; they are providing their clinical expertise and knowledge. It is the panel who, separately, independently and through a process that can be completely scrutinised and documented, would make that assessment. That would mean that the patient’s care could not be contaminated by pressures causing the doctor to be burnt out, financial pressures on the system in which that patient is being treated, or even administrative pressures, such as the patient’s discharge becoming difficult and the hospital needing beds because patients are being treated in corridors—which we know is happening all the time. It provides separation and a degree of clarity over the assessment and judgment.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Markham

Committee stage
Friday 27th February 2026 Lords Chamber

[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—

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[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.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Markham

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Markham (Con)]

If I may say—I hope, like my noble friend, in the spirit of helpfulness—this has been a thoughtful debate, and we all want the best decision-making framework for these decisions. I am definitely not going to pretend that I have personal expertise as to what the best decision-making framework is. However, on some of the earlier comments, Professor Chris Whitty is our Chief Medical Officer and, although he might not be an expert in psychiatry, he draws on the expertise of the many experts in that field. A number of psychiatrists wrote in to MPs and Lords as part of this process, saying that they felt the Mental Capacity Act was a good, tried and tested framework to be used on this basis, and that there are certain dangers in trying to introduce an as yet new and unknown framework.

There is also the possibility of confusing situations. There could be three patients: one with a do not resuscitate order, another with motor neurone disease and the question of whether their ventilator should be switched off, and a third being assessed under assisted dying. These are quite similar circumstances. If you were to have two different frameworks for assessing them then there is the possibility of quite a lot of confusion as to the best way to do that. I say this to ensure we are looking at all the pros and cons. I am not going to pretend at all to be an expert on this, but the Mental Capacity Act has been tried and tested for a number of years, and there are a number of expert psychiatrists who think it is absolutely the right framework in which to do this.

[Baroness Finlay of Llandaff (CB)]

I wonder whether the noble Lord, in reading the Mental Capacity Act and Amendment 115, has recognised that the wording in Amendment 115 is deliberately taken from the Mental Capacity Act in order not to create confusion and the difficult situation he is alluding to, which could have happened if somebody was trying to construct an assessment framework out of the blue.

[Lord Markham (Con)]

Where that clarity can exist then that clearly must be the right thing, but my understanding of the many amendments that have been tabled is that a lot of them seek to replace the Mental Capacity Act with a new decision-making process, which, inevitably, is not tried and tested and so could be confusing. I reiterate that I am not an expert in this—

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Markham

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Markham (Con)]

In the spirit of helpfulness on public opinion and whether people understand the question, there are numerous surveys on this. A very clear one has the wording “Do you think doctors should be allowed to end the life of a terminally ill patient at their request?”, which was supported by 75% of 18 to 34 year-olds, 80% of 35 to 64 year-olds and 78% of those aged 65-plus. I do not think you could get a question clearer than that, or a level of public support greater than that.

[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.

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[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Baroness has prompted me to return to the point made by my noble friend Lady Cass, because the chance of being right about six months has been estimated at around 48%. It is just plucked out of the air. It depends on the individual, how their body responds to whatever disease it is and lots of other factors. I was concerned when the noble Lord, Lord Markham, said that these are people who want to live. They should be having access to specialist palliative care to maintain their quality of life as high as possible, yet we have huge gaps in this country.

[Lord Markham (Con)]

I was making the point that those people—I am looking at some in that category in this very Room, I believe—want to live for the rest of their natural life for as long as possible. That is what they really want. They desperately do not want to be diagnosed with a terminal illness.

[Baroness Finlay of Llandaff (CB)]

I have looked after thousands and thousands of patients, and I have to say that I have never come across someone who said they wanted to be terminally ill and to have their metastases or whatever. No, people want to live well but accept that death is a natural part of life. That is quite different from talking about deciding that someone is going to be given lethal drugs to foreshorten their life.

The benefit of the amendments proposed by the noble Baroness, Lady Berger, is that they fit fair and square with the Title of the Bill, which is about terminally ill adults, and make it clear that this is about terminal illness and cannot be masqueraded as anything else. Yes, there will be multiple factors, because of course someone who is already seriously ill but is content with their life will not seek assisted suicide—that goes without saying. However, we also need to be clear about differentiating medication, which is where we give a substance with the intention of achieving an improvement to the person’s well-being, from the large cocktail of lethal drugs that we debated previously, and I am not going to revisit that.

I have a concern when we label all these patients as having pain and suffering. Evidence from other countries is that pain and suffering are not the prime reason why people are going for this. I see the noble Baroness, Lady Jay, nodding, and I remember well from the Select Committee that we were on that we heard repeatedly that there were multiple existential factors that made someone’s life have so little meaning and worth that they felt they wanted to go for assisted suicide. However, we have to put some boundaries around it, because literally thousands of people in this country feel exactly that—that their lives are of no worth—and they feel suicidal. As Professor Louis Appleby, the lead suicide prevention adviser to the Government, has said,

“I’m worried once you say some suicides are acceptable, some self-inflicted deaths are understandable and we actually provide the means to facilitate the self-inflicted death. That seems to me to be so far removed from what we currently do and from the principle that’s always guided us on despairing individuals, that it’s an enormous change with far-reaching implications”.

The amendments would provide a ring fence and some safety barriers. Sadly, there are literally thousands of people in society who are suicidal. We heard a lot about that in relation to young people and the algorithms on their phones that they get into with social media and so on. There are an awful lot of people who are profoundly depressed and a lot of people in poverty, and when they become ill that may take them down one further notch, and there are a lot of people who just feel unloved. We have to make sure that the Bill sticks to what it claims to do, which is to be about terminal illness.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Markham

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Markham (Con)]

May I just offer a different perspective on this? It has been an interesting debate. One of the main reasons I am supportive of assisted dying is kindness—kindness to the people who are scared about the inevitable end of their life and kindness in that they face a lot of pain. They see assisted dying as a way of relieving themselves from that pain.

In this debate, are we saying that people in prison are not deserving of that kindness? People in prison have been deprived of their liberty because of the crimes they committed, and that is the punishment that they have been given in the face of the law. That is the debt being paid to society. But are we saying at the same time that they do not deserve the same kindness that we would give to others and that they should face pain because they are in prison, whereas others should not? That is my perspective on this.

[Baroness Finlay of Llandaff (CB)]

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