Terminally Ill Adults (End of Life) Bill

Debate between Lord Carlile of Berriew and Baroness Hayter of Kentish Town

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

My Lords, “All’s Well That Ends Well”, and it is always a pleasure to follow such a story, particularly as it is the story of someone who told it to your Lordships himself.

I put my name to the noble Lord’s amendment and intend to address it not from the viewpoint of positivity and negativity—I tend to view that as mostly potluck— but from the viewpoint of facts. The fact I start with is an assumption: that everybody who is given a prognosis by his or her doctor desires to make an informed decision and, if they wish to make such an informed decision, that it should be based on some factual and scientific basis. All that these amendments would do —I speak not particularly to their very words but to their meaning—is require that a doctor or any other clinician who is giving a prognosis should do so on a solid medical and scientific basis: a prognosis that is founded in medicine, not stories and the last three patients they happen to have seen who had a serious illness.

I have spent a lot of time in recent weeks reading articles. There are some amazing American articles in which huge statistical samples are taken, but on this subject they all come to a similar position. For example, in one major study, only about 20% of predictions of six-month deaths were within a close range at all of ultimate survival. This is a very unscientific part of what clinicians tell their patients.

Judging the moment of death becomes very difficult the further you are away from the actual death, but it is very difficult to know how far away you are from the actual death. When my father—who was the most reasonable person I have ever known, by the way—was dying, the night before he died, the last thing he said to me was that I was to wear his black suit for the funeral because he thought mine was scruffy. He and I had been the same size at a certain point in our lives, and of course I did. We knew the moment he said that—because I knew how ill he was, the family were there, the doctor was there, we were going through his last moments and it was a very happy death, a great family deathbed scene—that he would be dead by the following day. He died the following morning.

However, when someone walks into the consulting room like the noble Lord, Lord Moylan, and is told that he is seriously ill, it is just an opinion at that stage on the part of the doctor, who may have varied experience and may actually have no scientific basis for what he or she is saying. Even what is now called GEST, the geriatric end-of-life screening tool, which uses algorithms and has tens of thousands of examples in it, still offers only varying levels of probability. I have also looked at actuarial tables because a surprising number of elderly and very ill people try to insure their lives for a relatively short period. A lot of companies insure senior directors for one year; I think it is called key person insurance. It is all based on mathematics, but it is not actually science.

So I do not think it is asking much of the noble and learned Lord that there should be a provision in the Bill that means that, in every single case when the patient asks for an informed decision, he or she is given the basis upon which that information is founded.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I am pleased that the noble Lord who moved the amendment is in remission from his cancer. On other Bills we wish he was in remission from his political views, but on this one we celebrate with him.

I used to run a cancer charity, and the truth is that on this issue not everyone is using statistics. Doctors are often using their eyes; when we are talking about the last weeks it is their eyes, rather than going to any statistical table, that will tell them. There is an assumption that all this is going to be based statistically on the six-month period, but it is not like that. My own guess is that most people who are dying will probably start thinking about this only at three months. Tonight I am going to be dining with a recent widower. His wife—a very well-known author but it does not matter who she was—had cancer. She fought it, but fighting it is not enough. It was only really in the last weeks that she realised that what she wanted was help in those weeks. It was at that point that she tried to get to Switzerland, but by then it was too late.

My judgment is that much of this, for many of the patients who will be asking for this, will be very much towards the end. I will be surprised if at that point the doctor is going to their statistical tables, because at that stage the patient’s age and underlying health and other factors will contribute as much to assessing whether it is going to be days, weeks or maybe a month as the particular type of cancer that they have. This attempt to make that process overscientific is probably not right, and we should have faith, which some people in this House do not seem to have, in doctors.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Carlile of Berriew and Baroness Hayter of Kentish Town

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

If I could just finish. It has been a long time in this debate without hearing from my side—I want to come on to something that the noble Lord, Lord Deben, said anyway.

The amendments to this Bill are about coercion or pressure. As stated by the noble Lord, Lord Pannick, the situation at the moment is that people can go to Dignitas without even proving to a doctor that they are dying, and without any check as to whether there is coercion or pressure, or whether someone is going to inherit their house. They can go, and that is the way they end their life, and they feel it is not worth living any longer. On the definition of coercion, are we really content with continuing the status quo where there is absolutely no check—from a psychiatrist, a social worker, a lawyer, or anyone else—on whether they have been coerced? That is the alternative: allowing the status quo to continue with no checks whatever.

We have to ask, therefore, whether these discussions about definition are really about that, or whether they are about trying to stop the Bill. Perhaps we could discuss whether those who want the wording changed would then support the Bill. If they would, let us get down to discussing that, but if they are never going to, they are wasting the time of those who want it to go through.

[Lord Carlile of Berriew (CB)]

My Lords—

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

I was not suggesting wasting time. I was asking whether, if these changes were agreed, people would then allow the Bill to proceed.

[Lord Carlile of Berriew (CB)]

Before the noble Baroness sits down, I have great admiration for her, but I and many others resent her waving her hands at us. The reason we wish to have the sorts of discussions that I was mentioning was so that, believe it or not, we can make a judgment as to whether we are prepared to support the Bill, or to be silent on whether we support the Bill, or to oppose it at Third Reading. It is unworthy of the noble Baroness to allege that all of us here who are expressing concerns are wasting time. It is not true, and it is what she said.

[Baroness Hayter of Kentish Town (Lab)]

I never said that about wasting time. The words did not come; I did not say them. I was asking whether the people who want a better definition will then be able to support the Bill.

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Lord Carlile of Berriew and Baroness Hayter of Kentish Town

Tuesday 7th February 2012 Lords Chamber

[Lord Carlile of Berriew]

My Lords, I, too, support the amendment, which was moved so ably by the noble Baroness, who has done a great deal of work in bringing it to the attention of your Lordships. I shall make four points briefly.

The noble Baroness, Lady Finlay, said that this is an epidemic affecting the nation. She is of course right, but it is not a new epidemic. It is absolutely shameful that this epidemic has been affecting the nation to a greater and greater extent for, perhaps, the past 150 years. My noble friend Lord McNally got into a little difficulty earlier when he mentioned Dickens to the Committee, and probably rather wished that he had not. I think I will not be controverted if I say that Dickens describes the effect of drink on young and, in many cases, very poor people in London very graphically in a way which has developed over the years. It is absolutely shameful that this epidemic has been allowed to continue for so long and it is about time that we did something about it. This proposal promises a great deal.

My second point is about the experience of the courts. The Metropolitan Police Commissioner, Mr Hogan-Howe, who supports the amendment at least in principle, came to London after a gap following a period when he was the chief constable of Merseyside. On every Monday morning—I do not wish to be Liverpoolist about this; I am merely using a city I love as an example—in the magistrates’ court in Dale Street, there is a procession of young men and some young women who have been in custody over the weekend because of mostly, but not always, relatively low-level offences committed because of uncontrolled drinking. Bridewells such as the Liverpool Bridewell on a Friday and Saturday night are a sad piece of evidence as to the effects of drink taken to excess by young people.

I do not want to sound sanctimonious about this. Teaching people responsible drinking is a very good idea. We want families to teach their children responsible drinking, which you will have seen in fairly large measure after Wales’s victory over Ireland at the last gasp of the match last weekend—I knew that that would provoke my noble friend Lord Thomas from his slumber in front of me.

My point is that in every magistrates’ court and every Crown Court—this goes to serious levels of offending —although we tend to talk a great deal about the effect of drugs, believe me, the effect of drink is ubiquitous. Any of us who has practised or has sat in those courts knows that it attracts every kind of crime and affects every class in society and every age group, but particularly the young.

Thirdly, I mention legal aid. We have spent a lot of time in this Committee trying to find ways to save money without removing legal aid. If there is one sure way to save money on legal aid, it is by reducing the incidence of serious crime by the introduction of this kind of measure. I confess my interest as president of the Howard League and feel that I can put my hand on what passes for my heart and say to my noble friends on the Front Bench: if there is one guaranteed way of saving a great deal of money on legal aid in the very serious and middling sectors of crime, it is by adopting this kind of measure.

My fourth point is about the revolving door of imprisonment. In one connection we heard earlier from the noble Lord, Lord Ramsbotham, about 3,000 people who found themselves in prison because they were in breach of an order made in respect of a non-imprisonable offence. That is just one example of a huge cohort of people who find themselves in prison for breaking the law, although not terribly badly, relatively speaking. There is no cause of that door revolving at high speed greater than the misuse of alcohol. I believe that it would be completely irresponsible if we were not to seize this opportunity provided by the noble Baroness and have some serious pilot projects of the kind described in the amendment. I respectfully suggest to my noble friend on the Front Bench that in fact Liverpool would be a very good place to have a pilot because it has the community court, which was introduced by the previous Government. It is working extremely well and has won plaudits all around the world. In partnership with the community court, this kind of system could offer something towards reducing crime.

There is an analogy here. Drug treatment and testing orders—DTTOs—administered by judges, have been extremely effective in reducing drug-taking at a relatively low level. I have spoken to a number of circuit judges who have had to administer these orders and to a man and woman they believe that this kind of measure, which seeks to reduce the level of substance misuse gradually, works really well, mainly because it ceases to be authoritarian and engages the partnership of the person concerned. It works because most people who commit violent offences when they are, for example, under the influence of drink regret it afterwards and do not want to appear before a court in the future.

On those grounds, I support the amendment as strongly as I can and I hope that we will hear a positive response from the Front Bench.

[Baroness Hayter of Kentish Town]

My Lords, I start by giving the apologies of my noble friend Lord Brooke of Alverthorpe, whose name appears on the amendment. Unfortunately, he had to leave for another engagement.

I very strongly support the initiative set out by the noble Baroness. As has been said by others, it is a real recognition of the role that alcohol plays in crime, especially in domestic violence. The link between alcohol and domestic abuse is well known, as is the link between alcohol and cases of child protection. Alcohol Concern has demonstrated how often the criminal behaviour is repeated if the alcohol abuse is not tackled. As more than one of its clients has said, “He only hits me when he’s been drinking”. But as the alcohol support worker would reply, “If you knew you were going to hit the person you most loved once you were drunk, do you think you’d have that first drink?”.

The fact that so many men continue to take that first drink shows how valuable an intervention aimed at offenders could be. The sobriety scheme could play a role in this. I do not think that it is enough on its own, as I think that there needs to be some alcohol referral work to go alongside it. People who fail to tackle their misuse themselves are likely to need some assistance to work in parallel with breath-testing. That may involve some fairly brief intervention by experienced staff, and I believe that this scheme, working in parallel with the provision of such help, could make a real difference. The running of a pilot scheme, as suggested, is just the way to see whether this would work and whether, together with some brief interventions, it could help to deal with people who have a drink problem but who, by themselves, simply cannot get it under control. It could make a difference to the continued problem drinking of those who have broken the law.

I am no longer a magistrate, unlike my noble friend, but when I was a magistrate I would have loved the possibility of a rehabilitation order to monitor alcohol consumption. I believe that we should place victims centre-stage when we assess these amendments. Not only is most domestic abuse—that is the phrase used, although we used to call it “wife battering”—alcohol-fuelled but so, as we have already heard, is violence on the streets and against property, and there would be considerably less of that without the addition of drunkenness. When are we going to take action, as this House could do tonight, and do what ordinary, decent people want, which is to reduce the alcohol-related disruption to their lives?

This is an enabling measure. It does not require courts to impose it. It is an opportunity for someone with a propensity to misuse alcohol in a way that damages others, not themselves, to have a period of sobriety with, it is hoped, help, thus improving their family life as well as the well-being of others. The amendment would allow a magistrate to do this only if alcohol caused or contributed to the offence and the offender had a propensity to misuse alcohol and was willing to comply with the requirement.

My noble friend Lord Brooke of Alverthorpe was very anxious to make the point that a sunset clause could be added to a provision for such pilots so that, if they had not taken place after a year, the provision would not be needed on the statute book. Might that help the Government to accept the proposal? I very much hope that they will grasp with both hands this excellent idea of a pilot.