Lord Markham
Main Page: Lord Markham (Conservative - Life peer)
Lord Harper (Con)
I am grateful for my noble friend’s comments, and he is right: we had an extensive exchange on this subject on a previous Friday, and I am sure the Minister will correct me if my interpretation of what one of her ministerial colleagues said was incorrect, but it was very clear when I asked whether the Government were going to fund anything in the Bill. The Minister confirmed that, if Parliament were to choose to pass the Bill, the Government would indeed fund it and make sure it could be delivered. But when I asked the Minister whether that funding would be extra funding from the Treasury or would be taken from other parts of the public services—I think this was in the context of the extensive debate we had on the proposals on the court system by the noble Lord, Lord Carlile—it was made very clear that that assurance was not given. I am afraid that the only conclusion I could come to, which was not challenged by the Minister—if she thinks I have got it wrong, she is welcome to intervene—was that the money would come from other parts of the public services.
I have to say for myself that, if this assisted dying navigator proposal were to be funded by taking money away from NHS services to pay for it, I think people would find that quite extraordinary. I personally would find it indefensible that we were, again, taking money away from services to help people live to pay for a service to help them die. That would show a very odd sense of priorities. When the Minister responds, because she is the only one who can answer this question, not the sponsor of the Bill, because he is not, as far as I am aware, responsible for His Majesty’s Treasury, I hope she can tell us—
Lord Markham (Con)
My Lords, I think I heard my noble friend say that NHS resources should be used just to help people live. Of course, we would all agree that is a very important thing, but surely palliative care is all about helping people to die comfortably, which I think we all believe in as well. Given that, maybe my noble friend would agree that helping people to die comfortably, such as through palliative care, is a very good way to spend NHS resources as well.
Lord Harper (Con)
I agree that palliative care is a very good way to spend NHS resources, to help people live the rest of their lives in as comfortable a way as possible; it is not about accelerating their demise. That is a fundamentally different thing. In the exchange towards the end of our debate last week between my noble friend Lord Markham and my noble friend Lady Finlay about what palliative care is and is not, we had that, and I think it came out very clearly.
I do not wish to overstep the time available to me. The purpose of the amendments is to challenge some of the premises of the proposal set out by the noble Lord, Lord Birt. I hope I have set out some of the concerns that we have, and I hope that the House will support the amendments I have supported on the Order Paper.
Lord Winston (Lab)
I will not give way. I will answer at the end. I have almost finished what I have to say.
The fact of the matter is that this is not a true argument. There are many examples. In my practice, probably about 60% of the time when people came to my clinic, and it was always true even when IVF was successful, I refused them treatment. I refused to treat them, not because there was no money or we could not afford to treat them, but because I thought the treatment would increase their distress because it was so unlikely to be helpful.
When that happens to people, it is a kind of death within them, but they have the great advantage that they can mourn that death and overcome it by doing other things. Unfortunately, in this situation, when people are dying in the way they are, often horribly, there is something that we need to try to do purely out of compassion.
Lord Markham (Con)
To build on that, I will put the financial numbers into context. The impact assessment has it down as £28 million; I believe that is 0.000175% of the NHS budget. It is right and proper that we decide how NHS resources are spent and in which direction, as the noble Lord, Lord Winston, said. We make those decisions all the time—for example, whether we put more funding into cancer or other services. It is entirely appropriate.
One of the key phrases was, “It is our NHS”, and what do we know about assisted dying? That 70% of the public support it. Given that, surely it is entirely right that resources are spent in that way.
Lord Moore of Etchingham (Non-Afl)
The point that is being missed was made by the noble Lord, Lord Stevens, and it is the problem with what the noble Lord, Lord Winston, was saying. Can the noble Lord respond to it? We are talking about what the aim of this is, but it is not a health aim. The noble Lord, Lord Winston, spoke of better treatment for cancer and in vitro fertilisation. Are the noble Lords arguing that death is a health aim?
Lord in Waiting/Government Whip (Lord Lemos) (Lab)
I apologise to my noble friend. The guidance of the House is that you cannot intervene on an intervention.
Lord Markham (Con)
Let me answer that, then I will be perfectly happy to be intervened on—
Lord Kamall (Con)
I am sorry to interrupt. If I am correct, the noble Lord can speak again, but he cannot intervene on an intervention.
Lord Markham (Con)
I believe I am answering the question. Once I have finished answering, the noble Lord can intervene on me and say what he would like to say. If he is willing to wait a few moments, that would be the appropriate point.
We spoke earlier about how palliative care is a way for people to choose to ease the way they die. I would say that assisted dying is also giving people the choice to die in a way they want to. In birth services, people have a birth plan. I remember going through this recently and there was a midwife who played a role very similar to that of a personal navigator, helping us talk about what sort of birth plan we wanted: whether we wanted a home birth and what we wanted to do about pain relief. It was very similar to many of the things that the noble Lord, Lord Birt, was talking about. The fundamental point here—the noble Lord, Lord Winston, is free to intervene at any point now I have answered that—is that it is giving people choice and autonomy. I believe that choice in the way you wish to die and when you want to die, if it is certain that your diagnosis is that you will die within six months, is a fundamental choice and a health choice.
Lord McCrea of Magherafelt and Cookstown (DUP)
Part of the noble Lord’s argument is based on assisted suicide being so popular with the general public that 70% of people want it. If that is so, perhaps he can help me to understand why none of the parties in this House put in their manifesto that they want assisted dying?
Lord Markham (Con)
Given that I did not write any of the manifestos, I am not sure I can say. If I was writing them, it is something that I would probably put in. It is something that everyone agrees is one of personal choice, like many other issues, and of course that is why everyone has a free vote in this matter. It is undeniable that there is overwhelming public support for this and, as it is “our NHS”, it is entirely fitting that if it is the decision that money is spent in this way, it should be directed towards this service.
The question becomes one of what I believe the noble Lords, Lord Birt and Lord Pannick, are trying to do in their amendments, which is to take what we know is a complex system and make it as easy to navigate as possible. We know that it is a time of great distress. In many cases you have just been diagnosed with a terminal illness, and sometimes you will be told straightaway that you have only a few months to live, so automatically you are within the six months and it is something you want to move on quickly. It is entirely right and proper that you want to ensure that it then happens as efficiently as possible. That does not mean you do not want other services to happen as efficiently as possible in the NHS. It is not a binary choice between one and the other.
Baroness Falkner of Margravine (CB)
The noble Lord has repeated on several occasions the fact of overwhelming public support for this. Does he agree that there are a lot of other areas in which opinion polling may show public support, but the job of this House is to ensure that the support is buttressed by legislation that is deliverable, is compassionate, respects the rights of all and is applicable across a range of different situations?
Lord Markham (Con)
Yes, absolutely. That is what these debates are all about: trying to find an approach that makes assisted dying tight and safe, safeguarding all sorts of vulnerable groups, but also navigable. I know that is what the sponsors of the Bill are trying to do and what the noble Lords are trying to do in this amendment. I commend the amendment for that reason. I do not think they are trying to be prescriptive. They are trying to start a conversation with the Bill’s sponsors that will go on between now and Report, which is an entirely constructive way to do it.
On how the service is best provided, I was on the Select Committee and it is one for the NHS to commission in the best way. Commissioning can use the NHS or voluntary services, and I think we would all agree that, in the hospice sector, voluntary services provide very well. It is wrong at this stage for us to try to be prescriptive in terms of a one-size-fits-all NHS provision. The main thing on these amendments is trying to get a constructive approach, which I am sure the Bill’s sponsors will pick up, to how we make this as simple as possible to use for those who are in the most distressing period of their lives, when they have less than six months to live and they want to die in a method of their choice and in the most comfortable way possible.
Baroness O'Loan (CB)
My Lords, of the 43 amendments in this group, 35 are in the names of the noble Lords, Lord Pannick and Lord Birt. They propose a framework for a completely new process outside that already created by this defective Bill, requiring a service of both advice and assistance. This includes the provision of assisted suicide every day of the year, including public holidays, Christmas, Easter et cetera, from 8 am to 6 pm, unless the doctor is in the house where the drug is being administered, in which case he has to stay. As has been said, there is no impact assessment on the cost of this new service and it is a relevant matter. Concerns must arise, given the advice of the Health Secretary that there is already a lack of access to high-quality end-of-life care and that there are tightened finances within the NHS, which could add to the pressure faced by dying patients.
These amendments require a new service that must be part of the NHS. We have heard arguments against that, and I support them. They impose deadlines and create processes for enforcing those deadlines, which will provide assisted death at a time when the person who is terminally ill will, in many cases, struggle to access palliative care; they may even never be able to do so.
The assisted suicide service would take priority. There is no process, as has been said, for a personal guide to get palliative care or the necessary social care. Would the noble and learned Lord, Lord Falconer, be willing to accept amendments that would require palliative care treatment options to be available and accessible within similar structures and timeframes?
Baroness Berridge (Con)
My Lords, I am grateful to the noble Lord, Lord Moore, for answering much of what would have been in my intervention to the noble Lord, Lord Winston. In my 15 years in your Lordships’ House, it has been the usual practice to give way, but I recognise that noble Lords have the prerogative not to accept an intervention. But I find it surprising—and I have never known it before—that the noble Lord is now no longer in his place. That is not in accordance with the advice that the Chief Whip gave this morning that we should treat each other in this House with respect.
The only additional point I make in response to the noble Lord, Lord Winston, who clearly did amazing work on the creation of life—it was on the television as I grew up—and the noble Lord, Lord Markham, who talked about the pathway that midwives give for the safe delivery of that created life, is that it is entirely different to talk about a situation where the state pays for and facilitates lethal drugs to enable a citizen to end their own life.
Looking at the amendment—
Lord Markham (Con)
If I may respond to the noble Baroness’s first point, I believe that the noble Lord, Lord Winston, as well as the noble Lord, Lord Mackinlay, who is not in his place either, mentioned that they had appointments that they needed to go to. I believe that that is why the noble Lord, Lord Winston, is not here now.
Baroness Berridge (Con)
Well, I hope that he will write to me personally about this.
In relation to the evidence on which the noble Lord, Lord Birt, is basing his argument, I was surprised that the right reverend Prelate mentioned the Australian non-comparable. Paragraph 8.4 of the impact assessment, on the delivery model, states that
“in most jurisdictions where assisted dying is legal it is provided through the healthcare system”,
so looking for international comparators is an unusual approach. The 30 jurisdictions that we keep hearing about include the Isle of Man, Tuscany in Italy, and only 13 of the 50 United States. This is not a wave that we must get with, as many progressive politicians like to say it is. Denmark considered this in 2024, and 16 out of 17 members of the Danish Council of Ethics voted against introducing assisted dying into their jurisdiction. Only yesterday, the French Senate decided not to go forward with legislation. This is in no way a progressive train that we need to get on.
My second point relates to the speed of these decisions for families. We know that the Bill is philosophically based on individual autonomy, which is anathema to many communities. For families to know that this was done within 18 days will only compound what we believe will be complicated grief. I am particularly concerned about how the speed of service will fit in with the increasing uncertainty of diagnoses for 18 to 25 year-olds because of the various positive effects of treatments for them. The noble and learned Lord, Lord Falconer, has admitted that there are, sadly, deficiencies in Clause 43 in relation to advertising. I do not think I am a cynic, but I am sorry to say that I can see a competition: “Can I get to 18 years and 18 days and be the first young person to meet that milestone?” We do not want a culture of speed in this process, limiting reflection.
Finally, maybe I am the only noble Lord sitting here without the benefits of the pre-legislative scrutiny of a consultation White Paper but, with many amendments, I am wondering how this service will fit together with a panel—or will it be a judge, or a judge with a couple of other members? That is the deficiency: in Committee, we are still trying to put right the lack of pre-legislative scrutiny, and I do not know whether that is possible.
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.
Lord Markham (Con)
In terms of, hopefully, being helpful, it is in the impact assessment. It is £28 million or, as I said, 0.000175% of the NHS budget.
Lord Deben (Con)
I am perfectly happy to accept the intervention, but I understand why the noble Lord, Lord Birt, did not accept any intervention, as he might have found it difficult to answer the questions that we are asking.
The point that I am making is very simple and it remains: we have to make a decision always among priorities. The problem with this decision—and it is why this should have been a government Bill and not a Private Member’s Bill—is that, as a Private Member’s Bill, it is a single-issue Bill. It is promoted by people who want this to be decided irrespective of its effect on everything else that happens. That it is not acceptable, it seems to me, for the Government. The purpose of my comment is that it is not about how much the proponents think it will cost; it is about the effect of this over the rest of the National Health Service. If the Bill is passed, where is it going to fit? The Government really cannot get up and say that we are entirely independent. They have to tell us, if this Bill is passed, where they see it sitting, because the proponents of the Bill have not expressed this. What is the real cost; that is, not the sum of money, but the effect of it on the rest of the service provided? They also have to tell us how it will impact the essential demands that the public have for so many other things.
We can argue about what the public think about this Bill—I am pretty sure that they think about this Bill rather differently from what it actually is—but we have to recognise that the public also have very strong views about what money should be spent in other areas. The Government have to tell us, from their point of view, how much it will cost, what the effect will be on the other services provided, where it will sit if it is passed, and how they will overcome the problem that many of those who may be asked to support it have said that they will not. Those are things for the Government to tell us and, so far, they have been unable to put answers to any of those questions, which is the second reason—the other is the point that the noble Lord has just made about amendments—why we have constantly to go on arguing, in detail, about this Bill.
Lord Blencathra (Con)
My Lords, this may be a convenient point to speak to two amendments in my name in this group. My Amendment 320ZA complements Amendments 39B and 39C, which I briefly touched on in the last debate, by making explicit that non-medical motivations cannot drive an assisted death. It draws a distinct line between medical suffering and social abandonment. International evidence shows that non-medical motivations dominate assisted dying requests. In Oregon, “being a burden” is cited by nearly half of all applicants. Parliament must decide whether it is comfortable legislating for that. This amendment ensures that England and Wales do not drift into a model in which existential distress, loneliness or, in the words of the noble and learned Lord, “sheer misery” or lack of care become accepted reasons for state-facilitated death. It also responds directly to the Equality and Human Rights Commission, which warned that subtle pressures from lack of services can drive people prematurely towards death. This amendment ensures those pressures are addressed, not endorsed.
My other Amendment 332AA operationalises the “ask why” concession. The noble and learned Lord, Lord Falconer, said he is “attracted” to requiring clinicians to ask why a person wants to die but unless the answer has consequences, the question is meaningless. This amendment ensures that when the answer is, “I am a burden” or “I cannot afford care,” or “I am alone”, “I am fed up” or “I am miserable”, the process pauses and support is provided. It reflects the evidence from the Royal College of Psychiatrists and British Geriatrics Society, both of which emphasise the need for holistic assessment. It ensures that treatable depression, unmet care needs or social pressures are addressed before an irreversible decision is made. This is safeguarding, not obstruction. It ensures that assisted death is not used as a substitute for care.
My amendments matter because, first, they protect genuine choice. A decision driven by lack of heating, housing or social care is not the same as one driven by intractable physical decline. These amendments stop the law becoming a backdoor response to social failure.
Secondly, I believe they are a practical safeguard, not a veto. This is not a blanket ban; it is a procedural pause to address fixable problems—social support, benefits, palliative referrals—before a final medical judgment is made. Thirdly, clinicians need clarity. Doctors must be able to ask why and act on the answer. These amendments would give them a clear statutory duty to do so, reducing moral and legal ambiguity. If the noble and learned Lord, Lord Falconer of Thoroton, truly believes this Bill is about free, informed choice, will he oppose leaving people to die because the state failed to provide basic support or will he back these modest, targeted safeguards?
Lord Markham (Con)
The main point here is that, by definition, you are eligible for assisted death only if you have been diagnosed to be within six months of the end of your life through a terminal illness. That is the reason that you are applying for an assisted death. That is motivation for doing it, because clearly it is not like those people want to die. We have talked to many people, and I am sure a lot of people have, and they desperately do not want to be in this situation.
Lord Moylan (Con)
I am very sorry to interrupt my noble friend, but even the sponsor of the Bill, the noble and learned Lord, has been very clear in saying that the six-month prognosis is a trigger that gives you admission to the process, if you like, but it does not have to be the reason, so it is not by definition the case that if you have the prognosis, that must be the reason. They are two quite different concepts.
Lord Markham (Con)
As I said, these are not people who want to die; they are people who absolutely want to live. The only reason they are entering into this process, and the only reason they would be eligible—
Baroness Fox of Buckley (Non-Afl)
I completely sympathise with the point made by the noble Lord, Lord Markham, that these people do not want to die; they want to live. Would he then agree with some of the amendments that I tabled last week and spoke on? If, for example, they want to die and are then diagnosed with a terminal illness, that would be relevant to not allowing them into the process; that is, they want to die, and then the trigger of terminal illness allows the state-sanctioned administration of lethal drugs so that they can commit suicide, which is why people have raised problems about suicide ideation and mental illness. I therefore hope that the noble Lord will back some of the amendments on safeguarding that I tabled.
Lord Markham (Con)
The noble Baroness is talking about a slightly different circumstance where there are prior reasons, which could be mental health or other reasons, and why that could be a cause. What we are talking about here is basically the criterion on which you can first be assessed for assisted dying, which is, of course, that you have been diagnosed in the first place. To the point that, of course, people might then live longer, my experience is that they are delighted by that. Just because they have been assessed as being able to have assisted dying does not mean that they will take the medication. Again, evidence shows strongly that they will take the medication only right near the end when the pain, the loss of dignity or whatever the reason is becomes unbearable. My experience is that those people would be delighted if it was a misdiagnosis, and if they are fortunate enough to be living 30 years later, as per some of these examples, that would be fantastic. Of course, they will not have taken the medication. The point is that they take it only right at the end where there is no other choice, so to speak.
Within that, accepting that these are the people we are talking about, of course there are all sorts of different motivations why, when they are unfortunately at the point where they are looking at such a death, they might want to go ahead with it. Research shows that there are multiple reasons; it is impossible to put it down to just one. Loss of autonomy, less ability to engage in enjoyable activities, loss of dignity, loss of control of bodily functions, burden, inadequate pain relief or finances are all part of the reasons. They are all part of the research, and, on average, you will find that there are three or four reasons to do it.
So it is quite wrong to say, “No, we’ll only allow you to go ahead with this if you only have that single motivation”. As I said before, they would rather not be there in the first place, but given that they are in that unfortunate circumstance, surely they should be allowed the choice of why they wish to die.
Lord Carlile of Berriew (CB)
My Lords, I put my name to the amendments of the noble Baroness, Lady Berger, and I will not repeat what she said. She opened the debate on these amendments with superb clarity, characteristic of her contributions to your Lordships’ House.
I have been shocked by what I have just heard from the noble Lord, Lord Markham. I ask him just to reflect on two contributions made earlier in this afternoon’s session by my noble friend Lord Mawson, who, from his own experience, described what happens in poorer neighbourhoods, which he has experienced very directly, in which people face different problems and are more likely to want to die for reasons to which their terminal illness is just an ancillary point.
I have been involved in these debates since I came into your Lordships’ House at least. I was on the Joffe Bill Committee with my noble friend Lady Finlay. In the Committee on that Bill, in all the other Bills I can remember since, and particularly in all the case law that I have followed over the years—mostly very celebrated cases—the purpose of asking for assisted suicide has been to alleviate terrible suffering. That has been the sole purpose for demanding a change in the law: to alleviate terrible suffering. I do not believe that the noble and learned Lord wishes to achieve anything different from that. It is just that it does not say in the Bill that the purpose of having assisted suicide should be to alleviate terrible suffering.
Of course, there may be other issues at work in that person’s mind when they ask for assisted suicide—we cannot read every synapse in their brain—but we are here to legislate to save people from terrible suffering, if the Bill is to pass. I am very concerned that the Bill should be amended so that the capability to have assisted suicide does not arise as an opportunity to commit suicide. The reason to commit suicide, the absolute cause, should be the intolerable suffering.
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.