Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Sandhurst

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, Amendments 430 and 434 in my name go to the practice in operation. I will introduce them by making this point. I was one of the seven people fortunate enough to be identified in the Observer a couple of weeks ago as having tabled a lot of amendments. Contrary to what the Observer—and the quite numerous hostile messages I have received by letter or email—suggested, these amendments, together with all the others I have tabled, except for two relating to the victims of industrial disease, were put forward by the Law Society of England and Wales and by the CLADD group at King’s College London. The latter, for those who were not here the other week, is a group of a distinguished psychiatrist, psychologist, social scientist and lawyer with a particular interest in this and related issues. They and the Law Society are neutral on the principle of the Bill but want to see a safe and effective Bill. Amendments 430 and 434, together with others I have tabled, are aimed at that.

Amendment 430, some will be pleased to see—others will not—is for a streamlined, non-panel basis. It would insert a new clause saying:

“This section applies where the Commissioner receives … a first declaration … a report about the first assessment … which contains a statement indicating that the coordinating professional is satisfied as to all of the matters … a report about the second assessment of the person which contains a statement indicating that the independent professional is satisfied as to all of the matters … The Commissioner must, as soon as reasonably practicable, consider the person’s eligibility to be provided with assistance”.


He or she may then

“consider the person’s eligibility personally … refer the person’s case to a person qualified to sit on the Assisted Dying Review Panel”,

or

“refer the person’s case to a multidisciplinary panel”.

In practice, this means that it would be a modified procedure where there is agreement between the co-ordinating and independent professionals. The commissioner could then consider the application alone or refer it to the panel, so it would not necessarily have to go to the panel. A full panel would be mandated only if the independent professional is not in agreement with the co-ordinating professional that the criteria are met, or if it becomes clear during the modified procedure that further evidence is needed.

Some of those who are not in favour of the Bill may be concerned that this amendment could potentially weaken the process. I remind the Committee that Dame Caroline Swift, latterly a High Court judge but formerly lead counsel in the Shipman Inquiry, has said she is afraid that safeguards on assisted dying are likely to be eroded. We have to be very careful, because Dame Caroline Swift was right at the sharp end of looking at this. That is important, as she has seen what happens with a rogue doctor. She said:

“Those safeguards may seem adequate now but they are likely to be eroded over time. As Leading Counsel to the Shipman Inquiry, I saw how this had happened with the safeguards for the issuing of cremation certificates … Over the years, the second doctor’s role became diluted, they were seldom independent of the first, rarely examined the body and the signing of the second form became little more than a ‘tick box exercise’”.


My Amendment 430 might later be at risk of leading to dilution, but I hope it is an indication that there might—in clear cases, where everyone is agreed early on—be a way of moving it on swiftly, to the advantage of someone who is really anxious to go down this course and has capacity and all the other requirements. I hope that will be seen as a positive move and not a wrecker’s move. I am surprised that no one has come to me since this was tabled and said, “That’s a good idea; we’ll stick it in the Bill”.

Amendment 434 would amend Clause 16 and is simply intended to make it clear beyond doubt that referral to the panel is mandatory wherever the independent professional is not satisfied that all the requirements are met. The Law Society believes, and I agree, that as it stands it is not necessarily mandatory, and it should be. So, I ask rhetorically, why not? Are these not both jolly good amendments?

[Baroness O'Loan (CB)]

I will speak to Amendment 146, tabled in my name and the name of the noble Baroness, Lady Eaton, but before I do so, in the interests of brevity, I say that I support all that has been said in the context of the appointment of the commissioner. This cannot be a personal prime ministerial appointment; it cannot be a matter of patronage. The role must be insulated from day-to-day politics, especially given the risk of damage to trust in nurses, doctors, the judiciary and in this new process by which the state enables the taking of life. I agree, too, with the amendments which seek to introduce some process to the actual appointment of the commissioner, and I agree with the amendments in relation to conflicts of interest and registers of interests.

Through Amendment 132, the noble Baroness, Lady Cass, seeks to establish conclusively that the commissioner’s principal functions are monitoring and reporting on the assisted dying process. Her Amendment 122 would introduce a new role, that of director, who will put the assisted dying regime into action, selecting and overseeing panels, receiving applications, and deciding on appeals and the other duties in Clause 44. Both the British Association of Social Workers and the Law Society gave evidence that an independent regulator for VAD was essential. In Amendment 128, the noble Baroness, Lady Foster, who is not able to be with us today, identifies necessary duties which would provide additional safeguards, ensuring compliance, identifying risk and identifying the circumstances in which things may go wrong with possible tragic consequences.

I want to speak to Amendment 146—the noble Baroness, Lady Eaton, is unable to be with us today—which is about the very specific risk to people in care and nursing homes, the majority of whom are vulnerable for one reason or another. The situation of care homes is a matter which the noble Baroness and I have raised repeatedly during the course of the Bill. This amendment develops an obligation which would be imposed by the noble Baroness’s Amendment 128, requiring identification and mitigation of risk. It imposes a duty on the commissioner to monitor and identify emerging risk in the operation of assisted dying in registered care or nursing homes, and to take reasonable and proportionate steps to prevent or mitigate that risk. Where such risk appears systemic, the commissioner must notify the Secretary of State for Health and Social Care, so that appropriate remedial action can be taken.

The issues of vulnerability and capacity, the risk of coercion and the risk of abuse are all particularly relevant to care and nursing homes. Can the noble and learned Lord, Lord Falconer, assure the Committee that these matters really have been properly considered and provided for? I have some difficulty, because the scope of the issue is massive. In 2023, the year for which there are the latest official figures, nearly 400,000 people lived in some 15,000 care and nursing homes in England and Wales. Some 85.7% of the total number of beds in care homes were occupied at the time of the survey. Some 70% of all care home residents have dementia or severe memory problems. The average period of residence in a care home is about two and a half years, and most of them die in the homes. Those figures will have increased in the three years since they became available. Some 120,000 people a year over 75 are diagnosed with cancer. There will therefore be a significant number, possibly the largest cohort in England and Wales, with a terminal illness—however you define it—who will have a prognosis of six months or less to live, and who live in our care homes. On the basis of these figures, it is possible to extrapolate that tens of thousands of people living in care homes will be eligible for assisted dying.