Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Friday 27th February 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, raised some interesting points in this group of amendments. I do not have the noble Lord’s experience of local councils—I declare that I am president of the LGA, but that is largely an honorary role—but I have a lot of experience of wheelchair services. I also declare that I am president of the Wheelchair Alliance.

A service that should be incredibly easy to provide has become one of the most complex parts of NHS funding. In the good old days, when I was a child, there were two choices of chair: a small one and a large one. These days, because we want to provide better wheelchairs for people, which is a good thing, the commissioning and provision of those services has become complicated, and in different areas different prices are paid for exactly the same chair. My concern is that, if we cannot do that for something as simple as wheelchair services, how are we going to do it for this process? Many wheelchairs should be provided within 18 weeks, but I know cases where it has taken years to provide a chair for a child. We should learn from previous experience.

Some noble Lords have mentioned the potential competition that could come from funding for this service and the challenges for palliative care. However, the consensus among several professional bodies, including the Royal College of General Practitioners and the Association for Palliative Medicine, is that assisted dying should have distinct funding. Others have mentioned the way that palliative care is currently funded in the UK, but Nancy Preston, who gave oral evidence as well as written evidence co-written with a professor at Lancaster, Suzanne Ost, expressed concern that it would communicate the wrong symbolic message.

I am one of the seven Peers who were in the Observer for my number of amendments. I am receiving lots of emails telling me I need to uphold the will of the people, but I am not sure the people have been asked how they would like to reprioritise the funding of the NHS. I accept that lot of people think the service is needed, but are they being given the choice of what else they might lose? The comments by Stephen Kinnock, who said there needs to be reprioritisation, were interesting. We need to be really clear what we are going to lose out on. The noble Lord, Lord Markham, made some interesting points about savings and cost, but for me that is more about how you schedule the payments and work through it.

I am more concerned about the comments made by the noble Baroness, Lady Finlay, about the incentive to encourage people to go down this route. In Belgium, the service is paid for through the national health and the doctors receive a fee of €180. The cost of the procedure in Canada is $2,327, and it is estimated that they spend about $22.3 million a year to put this service in place. They save $149 million, but for provincial healthcare that is a negligible saving—it is 0.08% of their budget.

Stephen Kinnock talked about doctors receiving a reasonable expense. I have raised the issue of “reasonable” in terms of the Equality Act before. What actually is it reasonable for a doctor to be paid? In Australia, 27% of the doctors were unpaid while 32% got direct state government reimbursement, but a conversation is going on there at the moment about whether clinicians should have to be altruistic to provide this service. Doctors are already talking about having a standardised price for a voluntary assisted dying assessment of $860 as an out-of-pocket expense. That is important because a lot of assumptions are being made about where this service is going to be provided. The reality is that if we are going to give people a choice, we need to give them a real choice.

This is probably going to come up in later groups as well, but I have also noticed a shift in the language, which originally talked about doctors and now we are talking about medical practitioners. Does this mean it could be physician assistants? Could it be nurses? Could someone else be trained to do this? Could there be a career path in this service? Might people think this a good step in their career? The reality is that somebody always pays: the question is just who and when.

[Lord Empey (UUP)]

My Lords, to some extent this group of amendments goes to the core of a lot of the potential downsides of this Bill because, whether we like it or not, it is going to be a source of coercion.

If we go back a few weeks to the issue that was drawn to our attention by the noble Lord, Lord Stevens, concerning the role and the purpose of the National Health Service, clearly, that would need to be changed because we are talking here about a mechanism for ending life rather than a service that does its best to preserve life. To anybody who has had to spend a lot of time around hospitals—be it as a consumer of, or a relative of a consumer of, NHS services; or if you have had any role in government, even at regional level, dealing with health services—it is inconceivable that looking at the balance sheet is not going to be an issue for a clinician and a trust. That is the nature of the beast if you are the finance director of a trust and it is over budget, as they nearly all are. In Canada, we see that some people are boasting about the money they have saved by providing assisted deaths. I do not believe for one moment that that factor can be airbrushed out of this equation as far as this legislation is concerned. While I do not necessarily accept or agree with every amendment in this group, it draws our attention to the principles at stake.

It is in those circumstances that we have got into the habit in this debate of euphemisms. We call one thing by a certain name, but we know it actually means something else. In that regard, I draw the attention of the Committee to a debate on assisted dying that took place during the last iteration of this Bill, proposed by Lady Meacher, on 22 October 2021. This is the point I want to try to get across. Incidentally, that Bill had 13 clauses and 10 pages, compared to the 59 clauses and 51 pages we are looking at today. After Lady Meacher proposed her Bill at Second Reading, the noble Lord, Lord Winston, who I think is not in his place, spoke. He said that the Bill should refer to “euthanasia” rather than “assisted dying” as the Bill’s title did not represent what was intended. He went on to provide the Greek definition of what the word “euthanasia” means.

These amendments go to the core of a couple of issues. The first is the rationale behind the National Health Service in the first place, and how it would be changed and turned if it is carrying out a service which is anything but—

[Baroness Royall of Blaisdon (Lab)]

My Lords, the point that the noble Lord is making is very interesting, but he may have heard my noble friend Lord Winston say previously in the debate on the current Bill that he has changed his mind. He may well have changed his mind about the words that we use in relation to assisted dying.

[Lord Empey (UUP)]

I accept that that may well be the case. I am simply referring to what was in Hansard in 2021. The noble Lord may have changed his mind, as we all do over our lifetime, and rightly so—if you have a completely solid view of everything throughout your life, it is not a good thing. I am not in any sense trying to demean his position in any way; he is a very highly respected member of your Lordships’ House. My point is that his reference to the euphemism is still valid in my view.

Coming to the nuts and bolts of how things would work in practice, at Second Reading of this Bill, and indeed in previous iterations in which I have had any role, I drew attention to one of the key issues: changing the nature of the service that we are funding. If we decide as a Parliament to make assisted dying, or whatever phrase one wishes to use, a legal activity, that does not necessarily mean that the National Health Service has to pay for it. Can you imagine the finance committee of a trust discussing its budget and getting into an argument? The sums may be modest, but to even put something such as that in this context, when we are talking about life and death, is fundamentally flawed, morally and in every other way. The noble and learned Lord needs to reflect on some of these matters.

[Lord Harper (Con)]

I am grateful to my noble friends Lord Moylan and Lady Fraser for tabling these amendments. They have put forward some important questions which are worth raising explicitly with the sponsors of the Bill, so that we can hear what their intentions are and how they have reached those conclusions.

I have a number of concerns in this area, which I will set out. On a previous day, the Minister currently on the Front Bench confirmed, when we were debating resources, that if Parliament were to pass this Bill then the Government would ensure that all the requirements in the Bill were funded. That is perfectly right and proper. It was clear from that debate that there was no guarantee of any extra resources and that therefore money would be reprioritised—not just in the National Health Service but in the courts’ budget, given the impact that this Bill would have on the courts. That has clearly been reflected by what Stephen Kinnock said in evidence and by the Health Secretary, who commented on the need for prioritisation.

I do not make as much of the cost of this as some people, because I accept what the noble and learned Lord, Lord Falconer, said on a previous occasion. Compared with the NHS’s overall budget, the cost of providing this service is relatively modest. I have a different concern, which is twofold. First, as has been raised already in the debate, it would be perverse if Parliament were to pass this Bill and the taxpayer were to fully fund an assisted suicide service when it only partially funds palliative care. That would set out a very weird set of priorities and choices to the country—that the taxpayer should fully fund helping to kill people and not fully fund helping them to live well.

My question to the Minister—which does not trespass on the Government expressing a view on the Bill—is, in the event that Parliament passes the Bill, and the Government rightly ensure that it is funded, will the Government ensure that palliative care is fully funded by the taxpayer? This is not a question about taking a view on the Bill; rather, it is about making sure that when the Government publish in the autumn—this is why doing it in this order is not helpful, because we are not going to hear about palliative care services until the autumn—they will fully fund those services so that the taxpayer will ensure that any individual facing a choice has a proper choice and, if they choose palliative care, they will have care fully funded by the taxpayer in the same way that they would have a fully funded assisted suicide. If you do not fund it on that basis, you are not providing people with a proper choice. That is a question for the Government to answer.