Terminally Ill Adults (End of Life) Bill

Debate between Baroness Smith of Newnham and Baroness Hayter of Kentish Town

Committee stage
Friday 6th February 2026 Lords Chamber

[Baroness Smith of Newnham (LD)]

My Lords, like the noble Baroness, Lady Hayter, I have recent experience of visiting care homes. My late father was in a care home from November 2024 until December 2025. Unlike in the noble Baroness’s case, although he was well cared for, there were a range of issues that I was aware of while he was in the nursing home, and in the period before he entered the nursing home, that might be relevant for noble Lords to reflect upon, not least because they also provide a lesson for those the noble Baroness has talked about who are in nursing homes but still have capacity, are able to form a view and would be able to say, “I still want an assisted death”.

The reason why I say that is precisely because of issues of fluctuating capacity, infection, delirium and medication. Before my father went into a nursing home, there was a period when I assumed he had dementia. He was becoming more and more vague. He was on a new medication, and over time the doctors had said, “Double the medication”, then, “Quadruple the medication”, and he became more and more vague and did not seem to know who I was.

Then, for whatever reason, the medication was changed. This was nothing to do with dementia or mental capacity; it was to do with blood pressure. The medicine was taken away and something else was put in its place, and my father returned. It happened to be around Easter, and it was like some Easter resurrection. He was able to function normally, as he had before.

Then my father got pneumonia, went into hospital and was let out into a care home. In the home, they said, “We’re slightly worried about cognitive decline and impairment”. At a review meeting they went through his medications, and I said, “Can you tell me everything he’s on?” They listed the medicines again, including doxazosin. I said, “Why’s he on that? That caused problems before”, and they said, “We don’t know, really. The hospital put him on it”. There had been nothing in his medical notes to say, “Don’t use this medication”.

The new GP, to whom my father had been referred, spoke to me on the phone and was entirely happy to accept my wholly non-medical suggestion that this medication was not appropriate. He was taken off it again, and a mental health practitioner was asked to call me. The suggestion had been that my father should have a capacity test while in the nursing home, but this practitioner said, “To be honest, there is not much point, because if somebody’s been in a care home for more than a few weeks they’re not even going to know what day of the week it is”. So the view was they would not bother testing my father for capacity. He subsequently had on his death certificate that he had vascular dementia. If a full capacity test had been done, maybe that would have been diagnosed at a point before he died rather than after. It was never fully diagnosed while he was alive: there was merely a suggestion that there might be an issue.

The point is that if medication can affect somebody who would otherwise have capacity, it might affect the resident that the noble Baroness, Lady Hayter, referred to. In a nursing home, that person could equally get an infection or be prescribed something for which there were contraindications, but would there be sufficient recognition of that? Although some nursing homes will have brilliant care, not all of them will, and my father was—

[Baroness Hayter of Kentish Town (Lab)]

Would the noble Baroness accept that could have been even more so than if her father, or my husband, were at home all day without any medical or nursing staff around them? These people are more likely to pick up those infections than equivalent people who are living at home.

[Baroness Smith of Newnham (LD)]

I can see a point to that, but the message I was given by the mental health practitioner who rang me from the mental health team—I think he was a psychiatrist—was basically that once somebody is in a home, these tests become much more difficult because of the nature of the environment. That may differ from home to home—and yes, when my father had pneumonia and was clearly delirious, he was at home. If there are concerns, we should surely make sure, if people have a cognitive impairment, that we know that is the case, but if somebody does not—if there are the short-term issues that are being discussed in the amendments, in particular Amendments 111 and 112—then surely those people who want an assisted death would want it ruled out that they had some sort of cognitive impairment if it were temporary and reversible. That is the sort of thing we really need to get right, not only for those people who have an impairment but for those who actually do not have one but would not then be able to have the assisted death that the noble Baroness, Lady Hayter, and others might wish them to be able to avail themselves of.