Terminally Ill Adults (End of Life) Bill

Lord Meston Excerpts

Friday 9th January 2026 Lords Chamber

[Lord Meston (CB)]

My Lords, as the noble and learned Lord, Lord Garnier, said, we really have to make a choice between court-based decisions and the panel, as the Bill provides for in its present form. There is merit in both. There is a strong case for the use of the expertise and skills of the Family Division of the High Court and designated family judges—I should declare that, until quite recently, I was one of them. However, as the noble and learned Lord said, the courts will be faced with an initial rush of applications. That tends to happen with any significant change in the law, and it is likely to happen in this situation. It will take some time for the procedures to settle down, whether they are in front of a panel or the court. As the noble Baroness, Lady Berridge, said, we require some realistic assessment of the likely additional workload on the judiciary and the court system. The judiciary is of course well used to hard work and working under pressure, finding time when it is required. It should also be borne in mind that not all these cases will be complex or contested. In fairness to what was said by the noble Lord, Lord Shinkwin, there is no question of cases being nodded through or rubber-stamped, whether by the court or the panel. Family judges are used to prioritising cases when urgency is required, and they do so by underpinning their decisions with focused and robust case management.

The noble Baroness, Lady Berridge, is right, and I endorse what she said: judges are real people. I therefore endorse her call for consultation with the current President of the Family Division. I also suggest that one way through this might be an enhanced role for the independent advocate provided for in Clause 22, who will assume the role that guardians have in more conventional family cases—representing the interests of the person, whether a child or an adult, at the heart of the litigation.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I want to draw the implications for Northern Ireland into the conversation on the amendments from the noble Lord, Lord Carlile. Clearly, Northern Ireland has its own family court system, which, incidentally, has its own issues and backlog. However, that does not mean that people in Northern Ireland are entirely unaffected by court decisions in England and Wales. Each year, the family court for England and Wales hears cases involving parties on both sides of the Irish Sea, perhaps most notably applications for a child arrangements order, where one parent is living in England and the other in Northern Ireland. In such cases, delays in the English court can result in parents and children in Northern Ireland being left in limbo, awaiting decisions, with all the connected anxiety and parental conflict that goes with it. I simply present that as an example of the sort of impacts that ought to be considered, if we want to make any claim to be engaging in serious policy work.

There is no doubt that there will be even more acute impacts in England and Wales, where the strain on the court will be more direct. Catherine Atkinson MP in the other place reminded Members that:

“More than two thirds of care proceedings involving the most vulnerable children in our society cannot be completed within six months”.—[Official Report, Commons, 29/11/24; col. 1030.]


If that is the case at the moment, what can we expect if family court judges are increasingly swamped with assisted suicide cases instead?

The estimates from the former head of the Family Division, Sir James Munby, suggested that at least 34,000 hours of judicial involvement will be required each year for a proposal such as this to work, whereas the 20 judges in the Family Division of the High Court currently sit for only a total of 19,000 hours between them across all cases. Clearly, that is not something that we can ignore, and it is quite apparent that the bulk of the work will fall on circuit judges.

In saying that, I stress that I am not without sympathy for many of the concerns raised by the noble Lord, Lord Carlile. In the words of the Medical Defence Union, the current approach leaves doctors “unduly exposed”, making assessments on coercion, capacity and—as we heard a few weeks ago— residency that they feel unqualified to make. In my opinion, the Bill, as drafted, is not fit for purpose.

I have to say that I am equally concerned about the prospect of attempting to legislate on the fly, which is what we seem to be doing. What level of resource would the family court proposal require? How many additional circuit judges will be designated family judges? What impact would this have on the principle that, ideally, judges should be specialists in the area in which they are engaged? Incidentally, I believe the noble and learned Lord, Lord Falconer, has previously supported that principle. What would be the cost for an already overstretched court system?

We have been left to do policy in the dark. As former Lord Chief Justice the noble and learned Lord, Lord Thomas, warned in November,

“no one has grappled with the detail”

of the legislation’s impact on family courts. The legislative hokey-cokey on the issue of judicial involvement, which goes back much further than this Bill, has certainly not helped. It gives the impression that no one has worked out how to resolve the dilemma at the heart of the Bill—that the necessary level of safeguarding that such a Bill needs ultimately renders it unworkable. I know that the noble Lord, Lord Pannick, has said that this applies only to those who have six months to live, but no one can state categorically that a person has only six months to live. As a minister in the Church for 50 years, I have known numerous people who have been told that they have only six months to live, but they lived for years after that. Therefore, while it has been suggested that this applies only to those who have six months to live, we do not know that, and we cannot give that assurance.

In 2012, the Commission on Assisted Dying, chaired by the noble and learned Lord, Lord Falconer, considered several models for approval of assisted suicide. Those included: a medical decision-making model where doctors are solely responsible for decision-making; an NGO or volunteer-based organisation model, as they have in Switzerland or—to a certain extent—in Oregon; a tribunal model; and a court model, with the question posed whether the court should be the family court, as in the amendment, or another, such as the Court Of Protection. In 2012, the noble and learned Lord, Lord Falconer, firmly backed the medical-only model, as his report reads:

“Our assessment of the body of evidence overall has convinced us that it is health and social care professionals who have the knowledge, skills and training structures that would be needed to implement a safeguarded system to permit assisted dying in the UK. Therefore, we do not consider that it would be necessary or desirable to involve a tribunal or other legal body in decision-making”.


However, just two years later, in Committee on the Assisted Dying Bill, the noble and learned Lord made an about-turn—the court model had become the silver bullet. He told the House that

“I do not think that one can leave it to doctors alone, in particular to form two views: first, on whether it is the voluntary, clear, settled and informed wish that somebody wishes to end their own life; and, secondly, whether they have the capacity”.

In fact, he was such a convert that he made it clear in that debate that it needed to be

“the highest-quality judges to decide these issues”,—[Official Report, 7/11/14; cols. 1880-81.]

and the role for the Family Division was added into the Bill.

That position briefly persisted when the noble and learned Lord’s co-sponsor introduced the Bill in the other place, announcing it as the safest in the world due to the High Court element. But then that idea fell apart too, and the tribunal-style model, combining medical and legal elements, was adopted instead, on the claim that it would be “more robust”. At first, I thought that this was the plan all along because Dignity in Dying—the real sponsor behind the Bill—indicated this as its preferred option to the Commission on Assisted Dying in 2012. But then I read a line in the commission’s report where Dignity in Dying said:

“If there was going to be a tribunal then you would expect it to be part of the tribunal service”,


which of course the panel process currently in the Bill does not do.

This flip-flopping does not inspire confidence, and I certainly think that we should bear this in mind if the noble and learned Lord, Lord Falconer, indicates shortly that he suddenly once again thinks that the High Court judge is the way to go. It is incumbent on us to consider the reason that the High Court judge was scrapped in the Commons—again, not because I think that it was better but because it raises those questions of workability.

When interviewed by the Select Committee, Ms Leadbeater in the other place claimed that the removal of the High Court was to ensure a more “patient-centred approach”. But I am not sure that this tells the full story. In February, the Guardian reported that senior officials in the Ministry of Justice were understood to have significant concerns about the sign-off from a High Court judge in the original Bill, given lengthy backlogs in the family court. Perhaps the Minister would like to confirm these reports when she replies.

To conclude, it is important to stress that decisions around Amendment 120 are not peripheral but a central policy consideration that touches the very heart of the Bill. Is the Bill about introducing a new so-called treatment option to be overseen principally by the healthcare professionals, like other end-of-life choices, or is it more about giving the courts extraordinary discretionary power to resolve concerns about the operation of the Suicide Act in extreme cases? It is astonishing that at this late stage in the process, with the Bill having passed through the Commons, we have still not resolved this important point of principle.