Terminally Ill Adults (End of Life) Bill

Debate between Baroness Fox of Buckley and Baroness Finlay of Llandaff

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My concern is that if you take money out of a healthcare budget that is already in deficit, you will end up with an incentive for people to go down the road of saving money by working towards promoting assisted deaths for patients for whom additional care would mean them no longer feeling in despair in any way and having their quality of life returned to them. The NHS budget appears to be in such a difficult and parlous state that we have to be very careful that we do not spend NHS money on what is not a healthcare treatment.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the amendments in the names of the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser of Craigmaddie, are very useful in making us think about what an assisted dying service would or should look like if the Bill is enacted and what the implications are for funding it—public funding or who is going to pay.

We will come to a more detailed discussion on this in later groups, but I will just raise a few things. As I understand it, and I probably need some clarification from the noble and learned Lord, Lord Falconer, the idea is that integrated care boards will be mandated to provide a fully funded assisted dying service. I would just like to get a sense of what is envisaged. If that is what is envisaged, we have to ask the question: is that reasonable?

As others have said, contrast that with hospices, which receive only a portion of their funding from ICBs and are heavily reliant on donations. I am sure we have all been to those coffee mornings and bought cakes, sold cakes and all the rest of it, trying to raise money for hospices. Meanwhile, palliative care services rely heavily on charity funding, recovering only 30% of their funds from the Government. I understand and note the important caveat from the noble Baroness, Lady Fraser. I am not trying to say that the state should run everything at all times and that anyone who is doing anything in the charitable sector is a problem, but underfunding end-of-life care at the same time as fully funding ending-your-life non-care is a bit peculiar.

The danger is that if the sponsor’s aspirations come to fruition—if I have got them right—funding for assisted dying will start competing with and risks diverting resources away from palliative and end-of-life care, and both will compete for a share of a limited health budget. I note that professional bodies, such as the Royal College of GPs and the Association for Palliative Medicine, argue that the assisted dying service must have distinct funding to avoid such competition.

It was very important that the Health Secretary, Wes Streeting, was frank with us when he noted that

“setting up this service will also take time and money that is in short supply … Politics is about prioritising. It is a daily series of choices and trade-offs”.

I would like to address a couple of questions to the Minister, who I know is confined to discussing workability, to ask how this prioritisation will work. Have the Government considered this? If funding will come from reprioritisation of existing budgets, are we not at this point being asked to legislate a direct conflict of interest, where integrated care boards will have to choose between, for example, funding palliative care and funding assisted dying? If it is not palliative care—I have overused that—which other services will be deprioritised in these choices in order to fund this? It is a limited budget. We keep being told that there is a scarcity of funds, so I want to understand that.

Finally, another reason to raise this—it is not directly to do with funding, but it counts—is that if assisted dying is to be paid for by the public purse and/or associated with the NHS, it could mean that assisted dying is treated as a standard healthcare solution. That surely could have a corrosive impact on trust between patients and clinicians, breaking their “first do no harm” contract with the public and flouting the Hippocratic oath.

Should doctors be expected to incorporate ending life into their routine roles if it is publicly paid for, when the major professional bodies explicitly warn against this? The BMA says that

“our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways—it is not something that a doctor can just add to their usual role.”

That more existential kind of question, or about medical ethics, will obviously be compromised when, if public funding and the taxpayer are paying for assisted death, those taxpayer-funded NHS doctors are surely going to be asked to do something that goes against their ethical code.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Fox of Buckley and Baroness Finlay of Llandaff

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, in the previous debate we had an interesting discussion about the importance of face to face. I think the conclusion was that the noble and learned Lord, Lord Falconer, should bring forward amendments that would make face to face the default mechanism, while accepting that there would be exceptions. At that point, I raised the question of recorded statements made by someone who then could not speak. It is important to remember that speech can now be faked and can sound exactly like the person. I hope that, in drawing up those amendments, the noble and learned Lord will be able to encompass some protection to ensure that, when a presentation is made of a recording that seems to be in somebody’s voice and in their words, we are still protecting against abuse and coercion and against those with malintent who may have faked that. Unfortunately, we are already hearing stories of criminal activity where such fake voice recordings are used, and we find that people believe them as being from the person, when actually they have been part of a criminal activity. This amendment has been important—although I accept, of course, that it is only a probing amendment—because it has actually made us think on a much wider scale.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the Government’s 10-year health plan for England seeks to

“make the NHS the most AI-enabled health system in the world”.

Like others, I think that is an incredibly exciting prospect. I do not want it to be dystopian. I think that the right reverend Prelate the Bishop of Hereford makes an important point in warning us against going completely over the top. I think it is important that this amendment has been tabled, because it makes us think about what the possible problems are, which have been well expressed by others. Despite my excitement about what AI might do, even in terms of treatments—there are wonderful possibilities in terms of helping people to walk, what is happening with the brain, and so on—we do not want to be naive.

The question for the noble and learned Lord, Lord Falconer, is: as the NHS digitises and doctors become increasingly reliant on AI for notes and diagnostics, given that the diagnosis is so important in a life-or-death situation in this instance, how can we ensure that a time-poor doctor does not use AI as an assessment tool or a shortcut? We would be naive to imagine that that does not happen elsewhere; we would only have to think of politics. People now use AI to avoid doing research, in a wide range of instances, and I do not want that to be translated over.

As for the patients, algorithms are supremely impressive and can take things that have happened on Facebook or TikTok, from when you have been on a Teams meeting or Zoom—all sorts of indications—and detect chronic illness conversations. The algorithms can then push pro-assisted dying content such as the Switzerland adverts or positive end-of-life options. Interestingly, when discussing banning social media for under-16s, which I completely disapprove of, or bringing in the Online Safety Act, which I argued against, everybody kept saying, “Algorithms, oh my goodness, they can do all these things”. We should consider not that chatbots are malevolent but that AI tends to agree with people via the algorithms; to quote the title of a piece in Psychology Today, “When Everyone Has a Yes-Man in Their Pocket”. If you say that you are interested in something, they will just say, “Yes, here are your options”. That is something to be concerned about, and it will come up when we discuss advertising.

I finish with that BBC story from August of a Californian couple suing OpenAI over the death of their teenage son. They allege that ChatGPT encouraged him to take his own life, and they have produced the chat logs between Adam, who died last April, and ChatGPT that show him explaining his suicidal thoughts. They argue that the programme validated his most harmful and self-destructive thoughts. I am just saying that AI is a wonderful, man-made solution to many problems, but if we pass a Bill such as this without considering the potential negative possible outcomes, we would be being irresponsible.

Tobacco and Vapes Bill

Debate between Baroness Fox of Buckley and Baroness Finlay of Llandaff

Committee stage
Thursday 30th October 2025 Grand Committee

[Baroness Watkins of Tavistock (CB)]

My Lords, I broadly support these amendments but also agree with my noble friend Lord Patel that there is probably no reason to have oral pouches at all. It is something that we could carefully consider deleting from our society. If you are trying to withdraw from tobacco, nicotine patches are just as effective as pouches and do not cause the problems that have been so readily described today. While the debate has been going on, I looked back, and it was 1950 when Sir Richard Doll proved the relationship between tobacco and lung cancer. It has therefore taken us 75 years to get to this point, with the Bill. There is sufficient evidence in relation to pouches for us not to decide that we need a 75-year prospective trial to show their damage.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too support the amendment, and I have a question for those who have tabled it, which relates to proposed new subsection (2)(b), saying the product is

“not intended to be inhaled or chewed”.

I am afraid that as someone who has been looking at tobacco control measures for many years now, through legislation, I am slightly concerned that, as we get rid of one thing, the nicotine manufacturers will find another way of bringing in a substance that is, in effect, addictive, which is promoted to young people, and is a way to get them started on the inevitable chain of addiction that leads to promotion.

When we look at the evidence around nicotine, we see that, yes, it is highly addictive, but the other thing that happens with an addictive substance is that you become tolerant to the effect, to that boost. Therefore, the addict seeks higher and higher doses to get a greater and greater hit. In the long term, as my noble friend Lord Patel pointed out, it is not only blood pressure and so on; there is a problem with platelet stickiness. We do not know what this will do in the microvasculature in the brain in the long term, because these high-dose nicotine products have not been around long enough and we have not had enough brains that have come to post-mortems—I am sorry to put it so bluntly—of people who have been using them for a long time. The hit that they get is greater than they would get from smoking a cigarette.

[Baroness Fox of Buckley (Non-Afl)]

I want to clarify how we make policy based on evidence if that evidence is unknown unknowns about what might possibly be the problem with something. It is absolutely the case that, where there is proof of harm, evidence is given and medical papers are produced. They have not been produced on this issue—I have looked—so it would be useful to see lots of peer-reviewed evidence that showed harm. To suggest that something could be a harm because we have not had long enough to find out whether it is a harm does not seem to be the basis of sensible evidence-based policy.

[Baroness Finlay of Llandaff (CB)]

I completely take that criticism; it is a fair comment. However, we know the damage to the brain microvasculature from smoking over the long term and that these substances are highly addictive. We also know that when we previously took through tobacco control measures, we never anticipated vapes or pouches. The evidence therefore is that those producing nicotine products are very imaginative and creative, and there is concern about this being used as a gateway to further addictive products. That is why I question whether proposed new subsection (2)(b) is necessary or adds anything to Amendment 13, which otherwise should be strongly supported.