Terminally Ill Adults (End of Life) Bill

Baroness Berridge Excerpts

Friday 27th February 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

Yes, I understand that.

[Baroness Berridge (Con)]

I am grateful to the noble and learned Lord for his realistic acceptance of the difficulty of judicial review as a remedy for many people. I would be grateful if he could also reflect on the situation with family members: if the panel approves assisted dying, their remedy to challenge that is judicial review. We heard evidence in the Select Committee, particularly from Sir Nick Mostyn, that that is just fine. Many of us, particularly myself, do not feel that it is satisfactory for family members to have to resort to judicial review if they have evidence, for instance, that there has been coercion. Will the noble and learned Lord reflect on that, which may avoid further amendments later down the line?

[Lord Falconer of Thoroton (Lab)]

I will certainly reflect on that, and may I express my gratitude to the noble Baroness, Lady Berridge, for facilitating the meeting with Professor Ruck Keene? It was incredibly helpful, and I genuinely appreciate it. Yes, I will reflect on what the noble Baroness said. I suspect there will be a similar answer to the one I gave to the noble Baroness, Lady O’Loan: we have to be as specific as we possibly can in the Bill, because judicial review is difficult for normal people, particularly in those circumstances. That is why, whether it is a court system or any other system, we must try to make this as clear as possible in the Bill.

Amendment 146, in the name of the noble Baroness, Lady O’Loan, says that the assisted dying commissioner should be able to investigate patterns. In particular, she cites what may happen in relation to care homes. I agree that the assisted dying commissioner should have that ability. He does have that ability under Clause 49(1)(a), (b) and (c); so, for example, if he is concerned about a pattern developing in care homes, he already has the power to monitor that.

The noble Lord, Lord Morrow, asked whether there should be a further Equality Act assessment. I dealt with that last time and said I had looked carefully at what the former commissioner had said and I did not think that a further impact assessment was appropriate, because, if you constantly make particular points that are covered in general, you are never going to get to an end of it. I do not think that the points the commissioner raised were ones that had not already been considered in the impact assessment.

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[Baroness Berridge (Con)]

For the accuracy of the record, I am grateful that my noble friend referred to a story that I presented to him at lunchtime because it was relevant to Suffolk. Marie Curie’s overnight nursing service—the part of the service that offers palliative care in Ipswich and Suffolk—will end after the NHS withdrew funding. The service supported 470 patients and delivered 15,385 hours of vital care in the last financial year. It relates to my noble friend’s particular area of the country. I know I was not here at the start of the group but, for the accuracy of the record, I have intervened.

[Baroness O'Loan (CB)]

My Lords, I thank the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, for these amendments. There is a very serious issue here, evidenced by the nature of the conversation we are having, because it is a conversation about realities. The noble Lord, Lord Empey, said that it was time we started using the language that described exactly what we are doing. I think that is what we are doing now. We are talking about how this is going to be paid for and who should pay for it. How should it be managed?

We have seen the Canadian experience. The noble Baroness, Lady Grey-Thompson, spoke about wheelchair access. In Canada, it is regularly reported that people who cannot get wheelchairs are offered assisted dying instead. I grant you that that would not necessarily apply in this particular Bill, but you can see how, with mission creep and with changes, this could happen. We could end up in a situation in which we are making the kind of decisions that the noble Lord just referred to in this matter.

I must declare that I have an interest, because I am a trustee of a hospice—an unpaid trustee, I would add, and it is not in my register of interests for that reason, but it is relevant to this debate.

The noble Baroness, Lady Finlay, defined the variety of costs attached to the proposals quite clearly. I have to ask, following the noble Lord, Lord Deben, if the estimate of £2,000 is in any way realistic for providing a service which requires for each individual the cost of clinicians, the commissioner, panels, admin staff, communications, monitoring and audit, et cetera. That is to say nothing of maybe a national help service, independent advocates and all sorts of other things. We know that to die at Dignitas and places like that costs an average of £10,000, not £2,000. I would like the noble and learned Lord to ask the Minister if we can have a proper assessment of what is currently planned might cost and where it is to come from.

I have another question for the noble and learned Lord, because it is not the Government who pay; it is us. It is taxpayers who pay. If the noble and learned Lord, Lord Falconer, rejects these proposals or something which approximates to taking the cost away from the National Health Service—as the noble Lord, Lord Deben, says, it is in such a parlous state that palliative care services are being extinguished or diminished very significantly—does he think that the public and the voters will think well of a Government who fund suicide while not funding hospices properly? Does he think it will enhance trust and confidence in the Government?

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[Lord Moylan (Con)]

My Lords, I have two amendments in this group, Amendments 926 and 929, which are related to each other. They are probing amendments related to Schedule 2 and the operation of the panel. It is something that has been niggling away at me and worrying me. I am perfectly prepared, of course, to be told by the noble and learned Lord that there is nothing for me to worry my little head about but let me raise the question none the less.

Schedule 2 makes provision for appointments to the assisted dying review panel. As I understand it— I am sure I will be corrected if I am wrong—the commissioner can create a list of people who are eligible to serve on panels. That is, if one likes, the mega panel at the top. These people can be appointed for a term of five years and reappointed for a term of a further five years. From that large group of people, the commissioner then, in each individual case, will draw and appoint the members of a panel—the three members with the specific skills that we have been discussing—and the decision of those panels needs to be unanimous. Even an abstention would count as a negative vote, so to speak. That is how I understand paragraph 5 of Schedule 2.

That is the background. To work properly, the panel members need to be independent of each other and reach their own view. It seems quite possible that they will have different personal thresholds as to what they regard as the appropriate level of evidence required to persuade them to say yes. In that light, it is more than possible that some of them might turn out to be slightly awkward, in the sense that they tend to say no rather more often than they say yes—which is fatal to the process because one no and the whole thing is over. You have been through the preliminary discussion and the two doctors, and at the panel you are being knocked back because of one rather awkward person. There will be pressure on the system as a whole, essentially, to eliminate those people from it—those who are difficult and who generally are more likely to say no than otherwise.

Amendment 926 says that, when deciding whether or not to reappoint somebody for a further five-year term, no account should be taken of what might be called for this purpose their voting record in panels. Similarly, Amendment 929 would mean the decision of whom to appoint to a panel cannot be taken on the basis of their past voting record. Voting record may be an inappropriate phrase, but I think noble Lords understand exactly what I mean.

As has been mentioned earlier in the course of the day, the background to this is of course the Abortion Act. The principal safeguard in the Abortion Act is that two doctors separately must agree there is a threat to the woman’s health. When the Act was introduced, that was quite possibly a genuine safeguard, and there may have been occasions when doctors said they did not consider there was a threat to the woman’s health that justified an abortion, but it has become entirely routine. There would probably be a flag run up a pole at DHSC headquarters if a doctor were to say no on an abortion application nowadays.

Therefore, I have put these amendments down to prevent something like that from happening—to prevent the panels from becoming routine—and to ensure those people who have the higher threshold of evidence, the more cautious approach, the slightly more sceptical attitude, are not eliminated from the panels, either through having their term not extended or through simply not being appointed when each opportunity comes up. There may be better ways of dealing with the concern I have expressed than the ways contained in my specific amendments. They are, as I say, probing, and I am open to those improvements. But we have to ensure that this does not go the way of the Abortion Act, and that the panels are robust and say no when it is appropriate to say no, which might be quite often. That is what I would like to hear the noble and learned Lord comment on when the time comes.

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 462A in my name, which outlines that, before approving any application, the panel must be satisfied that the person requesting assistance has had the requisite assistance from the local authority in relation to the delivery of statutory services.

The amendment deals with the problem caused by the basic principles of the Bill, which is based on a very narrow concept of procedural autonomy. If it is only this that matters, then for the panel, as long as they can tick the boxes saying there is no coercion or pressure, and that the person has capacity et cetera, then the application is approved. It is approved under the current drafting of the Bill even if the panel believes and has evidence that the person is applying because, for instance, their housing is inadequate, the care package fell apart, they are actually grieving for other relatives or they are poor.

This amendment would mean that, before any such approval is made by the panel, it must be satisfied that the local authority has received a referral to look at the statutory provision of services for the person. In relation to this, I am grateful that the noble and learned Lord enjoyed his meeting with Professor Alex Ruck Keene, because he has put this a number of times in written and oral evidence about the concept of the panel and its powers, and it is worth quoting:

“You have to think … carefully about what purpose any … of this oversight is actually serving societally, if the oversight panel, whether that be a judge or a panel, cannot decline to approve an application if it considers that the reason the individual is seeking assistance in dying is because of service provision failures by the statutory bodies responsible for meeting their health and social care needs”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 96.]


I know the noble and learned Lord has answered many questions and commented about the access to this service for the poor. This is a different question. I am not saying that poor people should not be able to apply. I distinguish that from a situation where the panel has concluded on the evidence that, although the person satisfies all the tests under the Act, the evidence is that they are before the panel because they are poor. There are many instances of this from other jurisdictions, for instance, particularly in relation to homelessness. People have come forward for MAID in Canada because they are homeless, which is available because it is not just for terminal illness in Canada.

In relation to the amendment, it may be that the drafting needs to be different; it might be that this needs to be done not just before the provision but can be twin tracked, so that you approve the application but at the same time make sure the local authority deals with the provision of services. I hope the noble and learned Lord will take seriously this additional power for the panel to ensure that people are there for the reason that they are exercising their autonomy in relation to the Act and not pressured because of lack of statutory services.

[Lord Falconer of Thoroton (Lab)]

The noble Baroness refers to it as an additional power but, as I understand the amendment, it says that this is an additional requirement for a certificate of eligibility.

[Baroness Berridge (Con)]

I am grateful to the noble and learned Lord. I accept that drafting changes might be needed between now—

[Lord Falconer of Thoroton (Lab)]

The noble Baroness says, “drafting changes”, but there is a fundamental difference between saying that this is an additional condition that the panel has to be satisfied of and giving it a power. I understand the noble Baroness’s amendment to be saying that an additional requirement needs to be satisfied.

[Baroness Berridge (Con)]

When I mention drafting changes, I mean in relation to the timing of this. As drafted, it would need to be done before the application is granted, and it may be that the requirement to go to the local authority could be at the same time as having approved it, not before. But, yes, this would be an additional requirement on the panel.

I hope the noble and learned Lord the sponsor or the noble Baroness, Lady Finlay, can help with my second point on the principle of the Bill. The noble Baroness, Lady Hayter, referred to the situation based on autonomy: the individual wants to do this and does not want to tell relatives. If we are strict purists about that—we had evidence on this at the Select Committee—then with this Bill there could be a situation where the first time anyone hears about the death is when the medical examiner telephones a relative.

I have tabled amendments in a different group on a requirement to nominate next of kin who are over the age of 18. I think it would be useful for the Committee to know what the situation is if someone acts completely autonomously like this and the body is there. Does the noble and learned Lord the sponsor need to bolt on a provision so that there is a public health burial? That is the continuation of the logic of this that you can do this alone, with no one in your life knowing about it. Therefore, to exercise that autonomy fully, there would need to be a public health burial, with everything done before anyone in the family knows. That is a conceptual difference. The noble and learned Lord and I spoke about this in a meeting in relation to what the law is, and it would be good for him to clarify the situation. Can the medical examiner not call anybody and go forward with a public health burial?

[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness understand that, quite often, people die and their family does not know about it?

[Baroness Berridge (Con)]

Absolutely, and therefore the medical examiner’s evidence is that, when they have the body in that circumstance, they are under an obligation, we think, to locate and find a relative. Sadly, this happens more frequently than we would like to think, and the local authority powers to perform a public health burial then become apparent. So, yes, there are these situations.

It is important to clarify this in relation to this Bill, because we have this evidence from the medical examiner that the first the family might know is when they are called by the medical examiner. We need to be clear about that and about the position of families. Is this personal autonomy—that is the conceptual point—so fully and properly enacted that there would be a public health burial, without any obligation to inform anybody that this is happening?

[Baroness Lawlor (Con)]

My Lords, I support Amendment 472, tabled by the noble Baroness, Lady Gray of Tottenham, to which I added my name, along with the noble Lord, Lord Goodman of Wycombe. I also support Amendment 941 from the noble Lord, Lord McColl of Dulwich, and I will just say a few words about that.

Amendment 941, to Schedule 2, on the assisted dying panel, would require the social worker to take account of financial dependence, potential financial pressure and potential coercion from someone benefiting financially from a person’s death. My noble friend Lord Deben referred to this apophthegm earlier, but I first heard it from the noble Lord, Lord Grabiner: “Where there is a will, there is a relative”. This is a very important amendment, and I hope the noble and learned Lord the sponsor will consider it seriously.

Amendment 472 from the noble Baroness, Lady Gray of Tottenham, would require that the panel must ask the person seeking an assisted death whether they have discussed the matter with their next of kin. We have been discussing this in different ways today. At the very least, this requirement would prompt reflection about those most affected by this action. It might prompt such a chat simply by virtue of asking.