Terminally Ill Adults (End of Life) Bill

Baroness Falkner of Margravine Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, I declare an interest as chair of the Equality and Human Rights Commission, but I am speaking in a personal capacity. This is particularly pertinent today because the EHRC has briefed on the Bill and I must therefore stress that my remarks are entirely personal and to my own circumstances and knowledge.

Some colleagues will know that I was found to have advanced stage 3 ovarian cancer last summer, after seven months of an unsuccessful diagnosis at a major NHS teaching hospital. My experience in that distressing period was of a disregarding and, at best, incompetent NHS. Finally, I turned to the private sector last August. Since then, I have had two rounds of chemotherapy and three operations, and I am now on relatively debilitating medication until 2027. So in this period, I too feel as though I glimpsed the Grim Reaper through my hospital window, in a morphine-induced haze. We know that 460 people die of cancer every day in this country, so I know I am not alone.

Before going further, I acknowledge the great suffering that is caused by several other illnesses that may result in applications for assisted dying but, today, in our limited time, I will concentrate on cancer. This is because the data tells us that, for every four-week delay in treatment, a patient is 10% more likely to die. The EIA on the Bill tells us that, in New Zealand and California, two-thirds of those who seek to end their lives this way are cancer sufferers.

I recognise the need for dispassion and objectivity when one is trying to pass legislation, so I turn to the flaws that I see in the Bill. The Constitution Committee of this House has stated that a Private Member’s Bill on this subject is wholly inadequate. Recognising the repeated attempts in my 21 years here to put this kind of legislation on the statute book, I would have expected the Government to have taken over the Bill and paused it for pre-legislative scrutiny through a Joint Committee. The amendment from the noble Baroness, Lady Berger, may give us that opportunity and I intend to vote for it.

The second flaw lies in the definitions of the Bill. How do we define “terminal illness”, measure the six months to live or calculate monetary equations that measure our lifespans more poorly than they do bats in HS2 railway tunnels, as in this impact assessment? What do we make of the impact of these measures, the lack of compassion for those genuinely concerned about the impact on disabled people or the questions of mental capacity—or for religious individuals and, of course, the elderly, who feel unwanted enough as it is?

Importantly, the most critical agents in this story, other than the patients themselves—GPs and specialist doctors—are given an impossible task. Doctors dread that inevitable question from the patient, “How long do I have?” It puts them in an invidious position, particularly in the case of cancer care, where management of the illness is the challenge. “How well?” and “How long?” are the critical questions asked on a daily basis. In England, a third question arises: “How much?” This is because NHS drugs for some cancer treatments in Scotland and Wales are simply not available here. That is the cruellest aspect of that postcode lottery.

There is much to discuss in the scrutiny of this flawed Bill—and I say that as someone who previously supported assisted dying. I wish we did not have to deal with this flawed Bill, but we will do so in good faith.

Terminally Ill Adults (End of Life) Bill

Baroness Falkner of Margravine Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Gerada (CB)]

My Lords, if a patient is at the end of their life in any practice in the NHS, that patient will be discussed at a multidisciplinary team meeting. The patient will be put on an end-of-life pathway and will have a named clinician within the practice to do their care. This would include assisted dying. There is absolutely no way that a patient, unless in an extraordinary situation—and I take the point about Wales, which has a desperate problem with GPs—would not be cared for in that way. That is how our contract is; that is how we want to care for our patients. We would code it on the notes so that every single person consulting with that patient would know that this patient was an assisted dying choice, and they would get the care that I have just described.

With respect to the arbitrary 12 months or 24 months, many patients choose to move at the end of their life. They choose to move to the place where their loved ones are. Many choose to do something such as go abroad to the countries that they may have come from and come back right towards the end of their life. To put in an arbitrary barrier of 12 or 24 months is not putting the patient first; it is putting an arbitrary time limit first.

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

[Lord Blencathra (Con)]

Before we move to the rest of the debate, could we please give way to those noble Lords who have tabled amendments? I would like to hear what they have to say.