Terminally Ill Adults (End of Life) Bill

Debate between Lord Moylan and Baroness Royall of Blaisdon

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Moylan (Con)]

My Lords, I will speak to Amendments 175 and 384, in my name, and I am grateful to the noble Baroness, Lady Fox of Buckley, for her support.

These amendments concern prognosis. We have discussed prognosis briefly in previous debates, but I wanted to raise this in the context of my own experience of cancer and to bring some sort of mathematical thinking to bear on the question. In August 2023, I was diagnosed with stage 4 oesophageal cancer. It was a fatal diagnosis and I was told that I had 12 months to live—18 months, if the character of my tumour qualified for immunotherapy, which it did. I do not need to be congratulated on being particularly brave for sharing this story, since noble Lords will hear, if they stick around, that the story has a happy ending.

Within a week or so of that diagnosis, a friend of mine sent me an article which had been written in 1991 by Professor Stephen Jay Gould of Harvard University. Professor Gould was an evolutionary biologist, and he was quite well known because he wrote a number of popularising science books—the sort of thing that sixth-formers and undergraduates would have read widely. He was a well-known and liked figure. The article was about his story. In 1982, he had been diagnosed with abdominal mesothelioma, a fatal condition, and the hospital would not give him a prognosis. When he got back to Harvard, he went straight to the medical library, and he found on reviewing the literature that he had eight months to live.

After about 15 minutes of shock, he began to think about what that meant, and he realised that the prognosis was in fact, arithmetically speaking, a median. All that it actually meant was that half the people in his condition would be dead by eight months and the other half would live longer than eight months. In fact, this median told him nothing about himself; it was an abstraction. To understand his own prospects, he had to look at the underlying data. When he looked at it, he found that quite a lot of people lived quite a long time beyond eight months in his condition. He said that

“all evolutionary biologists know that variation itself … is the hard reality … Means and medians are the abstractions”.

He asked himself, “What do I have to do to be one of those people who live a long time?” Speaking to oncologists, he learned that the universal response from all of them was that the key to survival in cancer was a positive attitude. To quote again briefly from the article,

“those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, and with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say tend to live longer”.

That is how he approached it, and I think we can learn a few lessons from this. I would like to run through what I think they are.

[Baroness Royall of Blaisdon (Lab)]

My Lords, what the noble Lord says and the article that he cites are very interesting. I am jolly glad that, for some people who have positive attitudes, they live a long time with their cancer. I know from personal circumstances, as do many other people around this Chamber, that we have had loved ones who have had very positive attitudes towards their cancer and they have died.

[Lord Moylan (Con)]

My Lords, I am not saying—nor was anybody—that a positive attitude on its own is going to save somebody from cancer. Professor Gould also benefited from the fact that he had the best medical treatment, and he went on various experimental courses. That was not my point at all. But people with a positive attitude, as I quoted, tend to live longer. I think that is scientifically demonstrable. I am surprised at the noble Baroness’s intervention.

I think we can learn some lessons from this. First, prognoses are not generally individuated. They are medians drawn from large data sets based on clinical trials. As Professor Gould said, if you get a prognosis of six months, the average person will think that means that they are going to be dead in six months, which, from a scientific point of view, is precisely the wrong conclusion.

Secondly, even when a prognosis is not based on a median but is an attempt by a doctor to give an individual assessment, it is very likely to be wrong. There are well-established studies on this. I will cite just one, which is Orlovic et al in 2023. It shows that, beyond 14 days, a clinician’s prognosis is almost always wrong. It is extremely unreliable. Within that shorter period of a week or two, a doctor and indeed an experienced nurse can very often say, with great reliability, that somebody is not going to last very much longer. But beyond that, an individual prognosis is of very little value indeed.

I think we all accept that for anyone who gets a prognosis, there is a degree of unreliability about it. Nobody believes that a six-month prognosis means exactly six months, or that eight months means exactly eight months, but we have a tendency to think that it is because we do not have enough knowledge—that with a bit more science and research, we could refine that prognosis so that it was more accurate. But as Professor Gould pointed out, the prognosis is merely an abstraction arising from the variability in the data. It is not that we cannot make the prognosis more accurate; it is that—

Higher Education (Freedom of Speech) Bill

Debate between Lord Moylan and Baroness Royall of Blaisdon

Report stage
Wednesday 7th December 2022 Lords Chamber

[Lord Moylan (Con)]

My Lords, I do not think I have said this before in your Lordships’ House, but I stand in almost constant awe of the noble Lord, Lord Wallace of Saltaire, because many years ago when I left university and joined the Foreign and Commonwealth Office, his book, The Foreign Policy Process in Britain, was, if not quite mandatory for those of us joining, then certainly highly recommended. I read it with great attention and I hope I learned much from it, both theoretically and to practical effect. I have been here in your Lordships’ House for over two years and I have never actually had the chance to say that I am slightly in awe of the fact that the very William Wallace who wrote that book is here and makes such a huge contribution to your Lordships’ House and, indeed, to my life.

I have not risen to speak predominantly to the amendment standing in the noble Lord’s name, but rather to the earlier amendment. However, I shall just say that the rosy picture he paints of academics happily getting on together, disagreeing on theoretical matters of physics and generally not hindering each other’s promotion, advancement or job prospects in any way is, I am sure, in many ways an ideal and one we should fight for, but is difficult to recognise in an age when we have seen professors effectively forced out of their jobs because they have views that are not sufficiently pro-trans or whatever. It is hard to imagine, even in a science department, how somebody could question or advance research that challenged some of the bases of climate science. In saying that, I am not suggesting that I have any reason for bringing forward such science, or that there is such scientific evidence, but, theoretically, were it to come forward, how would that affect somebody’s job prospects or their chance of securing academic grants and so forth? It is those realities, and I do regard them as realities, that the amendment in the name of the noble Baroness, Lady Fox of Buckley, seeks to address.

The wording of the noble Baroness’s amendment is, as I am sure noble Lords recognise, taken directly from various findings of case law of the European Court of Human Rights, the Strasbourg court. Case law in the Strasbourg court undoubtedly defends strongly the principle that, in a university, those who are employed by it, especially those in an academic role, have an absolute right to criticise the university, the university authorities, its conduct and its policies. So, the only objection, in my view, that can be raised to the noble Baroness’s amendment is that it is otiose—we do not need it because the right is already there and can be appealed to, so why do we need it in the Bill? The argument for putting it in the Bill, in many ways, is really to demonstrate to university authorities that these rights must be taken seriously.

I have to say that the cases in which these rights have been enunciated and vindicated by the European Court have difficult, and in some cases almost barbarous names. They tend to come from parts of Europe and Turkey. They are cases such as Erdoğan, Sorguç, Aksu, Kula, Kharlamov, which the noble Baroness referred to, and Ayuso Torres. They are not names or cases that trip easily off the tongues of the lawyers engaged by the majority of British universities to advise them on how to conduct the issues of free speech. Whereas the Equality Act, the Prevent duty and the Public Order Act are pieces of legislation with which those lawyers are very familiar indeed, and much more accessible to them. So, in defending free speech, there is a natural bias—the tension, if you like, that was at the heart of the debate on the earlier group—among those giving legal advice to universities and those receiving that advice, to pay attention to the legislation that has a tendency to restrict freedom of speech, rather than the European convention case law that defends and vindicates it.

The argument for the amendment from the noble Baroness is that it is not otiose to include it; these rights exist already but they need to be referred to and universities need to be reminded of their importance. Therefore, the amendment should stand. It is hard to know what I want to hear from the Front Bench in response, but I very much hope that my noble friend can say that the rights expressed by the noble Baroness are crucial and will be defended, and that the Government intend to ensure that the Office for Students does so. However difficult of access they may be, they none the less form a proper basis for the conduct of universities, by contrast to and in tension with the legislation, which restricts free speech.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I remind noble Lords of my interests in the register. I celebrate the fact that the European convention and the Human Rights Act are being cited all over the Chamber today. That is wonderful.

I noted what the noble Baroness, Lady Fox, said about the music faculty at Oxford University. I do not recognise the aspersions that she was casting and will ensure that noble Lords are aware in due course of the situation as it stands. I certainly do not recognise that the university sought to stifle criticism of whatever the music faculty did. I will seek to clarify that with the Minister in due course.