Terminally Ill Adults (End of Life) Bill

Debate between Lord Hunt of Kings Heath and Baroness Finlay of Llandaff

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, we come to a key concern in this Bill—the very real risks of coercion and pressure to seek an assisted death. While the Bill acknowledges coercion, it does not fully address the dynamics of domestic abuse at the end of life nor the intersectional risks faced by women, those who are disabled, whether long-term or through illness, and those from ethnic minority backgrounds.

ONS data showed that, from March 2023 to March 2024, 2.3 million people over 16 were subject to domestic abuse. This equates to one in 20 of the population between 16 and 65 years old, yet only 45,000 of them in England and Wales are known to the police. In the older population, the incidence is even higher. Hourglass has estimated that one in five experiences some sort of abuse. Since the start of the Covid-19 pandemic, incidences of domestic abuse reported to third sector and statutory agencies have increased by over 60%. A systematic review by Michelle Myall and colleagues covering 2000 to 2021 found that the incidence of abuse increased in terminal illness. These results resonated with Jamilla Hussain’s findings in Bradford.

People with life-limiting illness experience a range of abusive behaviours in three broad categories: coercive and controlling behaviour, emotional and physical abuse and neglect, and financial abuse. Financial abuse is particularly rife in its many forms. Take the relative who goes to the cash machine for their relative who is ill and quietly pockets some of the cash or quietly steals valuables, or the family keen for their relative to die before a fixed-term life insurance runs out. Yes, I have seen it. They wanted a new car.

Emotional abuse includes telling the person that they are a burden—directly, or indirectly through conversations that are designed to be overheard by the person who is ill. Some are told that they are not dying quickly enough. Abuse affects treatment decisions and can lead to people missing out on curative treatment through making adverse decisions about their care. For some women, death is the only way out that they can see from their situation. It reflects the national data, where suicide is now the commonest cause of domestic abuse-related deaths.

The Oregon data shows that feeling a burden to family or carers has been stated as an end-of-life concern by over 47% of people having an assisted death. This was higher than the under 30% who cited inadequate pain control or concern about it as a reason. After the noble and learned Lord, Lord Falconer, gave evidence to the Select Committee, I rechecked the official reports. Oregon does not collect data to understand whether there have been problems with coercion or report on those who are turned down for lethal drugs.

This Bill has been publicised as being about pain but does not mention pain at all. Specialist palliative care can deal with pain. Detecting the coercive threats, humiliation and intimidation, which are usually subtle and consistently maintained out of sight of anyone in authority, is far harder. It is the complaints about the heating bills, family carers being fed up with having to prepare drinks and food, groaning when asked for something—there are so many ways to give the message that you are a nuisance and would be better off dead. Abuse impacts patients’ mental health and well-being and leads to feelings of loss of control, entrapment, powerlessness and depression.

However, health and care professionals lack confidence in identifying abuse. It is rarely detected by doctors. Why? Because dependence limits disclosure. Illness increases women’s dependence on the perpetrators, making disclosure harder in the last months, weeks and days of life, even when professionals ask directly. Disclosure requires time to build trust with the same professional, who understands how abuse presents at the end of life in different cultural contexts and who can offer practical support such as safe housing, financial help and, if needed, support for dependents. Without this, disclosure is too risky.

Most women in Dr Hussain’s group said that they would not dare to disclose abuse during an assisted dying assessment as currently set out. They felt that the process was too brief, too medicalised and too uncertain to guarantee their safety. I recall a patient whose pain was not controlled on 1,000 milligrams of morphine per day. After a few days in our hospice, she disclosed to a care assistant at night the years of worsening abuse that she had endured. Total distress from hidden abuse had given her total pain. Social work intervention and safeguarding in place was the solution. She went out to a new home needing only 60 milligrams a day.

Disclosure is more likely in a trusted relationship with someone whom the person can know, whom they can look in the eye, knowing that they will work hard to improve their situation. In today’s NHS, continuity of care is not the norm. It is fragmented, with inadequate transfer of information between sectors. Patients do not see the same person time and again, whether doctor, nurse or other professional. That is why it is essential that information is sought, from police callouts to a domestic disturbance, local authority records to reveal any safeguarding issues in the household, clinical teams who have been involved, social care, community carers and family members who may well be aware of abuse but had not known how to disclose it.

Another type of subtle subliminal pressure is also addressed in this group of amendments—that arising from whatever the doctor suggests. Under the Montgomery and McCulloch rulings, patients must be informed of all possible treatments which are appropriate to that condition. If a doctor says that there is also the option of an assisted death, the patient will hear that as, “I know what lies ahead for you and you should consider ending it now”. A Canadian lawyer told me of his friend who had a stroke. On being taken out of the ambulance, he was asked whether he wanted treatment or MAID—medical assistance in dying—Canada’s term for assisted death. He also told me of patients being repeatedly asked by different doctors in the hospital about MAID, and the corrosive effect that this has.

The amendment in the name of the noble Baroness, Lady Fox of Buckley, and others, is particularly important. It does not prevent conversations but it would stop subtle coercive influences from doctors, who may be under pressure, who may feel that they have to raise this—just as the problems of DNR orders arose during Covid—or with some of the abuses of medical power and inappropriate surgery that were in the headlines not that long ago. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have a few amendments in this group. My Amendment 118 seeks to introduce

“an independent financial review and background check on close relatives before eligibility can proceed. It aims to block eligibility where there is known financial abuse risk”.

My Amendment 462 aims

“to make coercion/financial abuse checking a shared statutory duty of both the Commissioner and the multidisciplinary Review Panel”.

The noble Baroness, Lady Finlay, has set out some of the issues and concerns about coercion, which I do not need to repeat. I am a long-standing supporter of Hourglass, an amazing organisation devoted to combating the abuse of older people. It is neutral on the Bill, but its chief executive said in evidence to the House of Commons that

“there is an epidemic of abuse against older people at the moment. Some of it is due to the economic climate that we are in, with people just wanting to have their inheritance now, and some of it is due to the fact that older people feel like a burden”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 29/1/25; col. 160.]

Great British Energy Bill

Debate between Lord Hunt of Kings Heath and Baroness Finlay of Llandaff

Report stage
Tuesday 11th February 2025 Lords Chamber

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

My Lords, for clarity, we are debating Amendment 45.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord, Lord Vaux, particularly for his patience because I think this was originally in the first group, so he has done great service. We have had a very constructive discussion with the noble Lord. I am happy to confirm that the Government will bring forward an amendment on an independent review of effectiveness at Third Reading.

I am also aware, as the noble Lord said, that his amendment includes an additionality element. I am happy to confirm that additionality will be an important principle of Great British Energy—I said that earlier this evening, or this afternoon or many hours ago—particularly in respect of its investment activity. As such, we expect that it will be covered for the requirement for the independent review to consider the effectiveness of Great British Energy and to have regard to the stated strategic priorities in doing so. I look forward to bringing an amendment to the House at Third Reading.

Energy Costs for Businesses

Debate between Lord Hunt of Kings Heath and Baroness Finlay of Llandaff

Tuesday 17th December 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I think there is rather something in what my noble friend says. We inherited a parlous situation in relation to the public finances and a failure to invest in essential infrastructure. One example was their dithering about nuclear power. Not one nuclear power station came close to being opened in 14 years under the last Administration.

[Baroness Finlay of Llandaff (CB)]

My Lords, following the discussions about tidal power, what discussions have been had with the Welsh Government about using the very high tides in the Severn estuary? Linked to that, what discussions have been had with the Scottish Government about the potential for hydro-electric power?

[Lord Hunt of Kings Heath (Lab)]

My Lords, right at the start of our new Government’s Administration, my right honourable friend the Prime Minister signalled that we wanted to reset relationships with the devolved Governments. That is happening. We are in regular discussion with the devolved Governments on energy policies. In the Great British Energy Bill, the consultation requirements are set out in relation to those countries.

Product Regulation and Metrology Bill [HL]

Debate between Lord Hunt of Kings Heath and Baroness Finlay of Llandaff

Committee stage
Wednesday 27th November 2024 Grand Committee

[Baroness Finlay of Llandaff (CB)]

I am most grateful to the Minister for having such an open door in discussing these issues. I may be wrong, but I understood from the London Fire Brigade that, although its collection of data is comprehensive, other fire brigades around the country do not feed in in the same way. We also have the issue of devolved responsibilities in the devolved nations. Therefore, there is a need to clarify data sharing. I wonder whether we might need to go over this in order to be clear in regulation that some incidents are notifiable.

In responding, the Minister referred to carbon monoxide, which is a colourless gas that does not smell but that can, at high levels, kill you in three minutes. Carbon monoxide deaths are still occurring in this country because of faulty boilers, gas cookers and so on; they are also caused by faulty vehicles when exhaust fumes leak. I understand that we cannot have regulation that includes notifying absolutely everything, but we need further debate on where to draw the line in terms of what becomes notifiable and what is not. It is about an assessment of risk of harm, perhaps.

[Lord Hunt of Kings Heath (Lab)]

On carbon monoxide, one of the issues concerns medical certificates and cause of death; there is a big problem because, often, carbon monoxide poisoning is not mentioned. The argument is that there is nothing in this legislation that precludes taking action in the way the noble Baroness wants us to take action. The question is whether the noble Baroness’s amendment is proportionate; we can have a further discussion about that.

[Baroness Finlay of Llandaff (CB)]

I completely accept that it is about what is and is not included. I recall having learned, on many occasions, the danger of having lists in legislation, because there is always something that has not been included, which becomes a tension. I look forward to further discussion. I am most grateful to others for supporting these amendments and recognising their importance. In the meantime, I beg leave to withdraw Amendment 23.