Terminally Ill Adults (End of Life) Bill

Lord Falconer of Thoroton Excerpts

Friday 30th January 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

I realise that your Lordships wish to get on to the substance of the Bill, and the points I am about to raise are specifically on the Bill and will have an impact on the groupings we are about to debate. I notified the Chief Whip, the clerks and the noble and learned Lord, Lord Falconer, of my intention to raise them.

The noble and learned Lord, Lord Falconer, explained in his letter this week that he recognises the concerns raised about independent advocates and that following discussions with the sponsor in the other place and their amendments, he has tabled changes. I am raising this now because of the sense of frustration that we are not getting answers to the amendments we are tabling in good faith. I hope that the noble and learned Lord will be able to answer these questions, so that we can move with a bit more pace.

I would like to probe how the changes the noble and learned Lord has suggested relate to what was agreed in the other place. The amendments in the Commons were understood to introduce independent advocates as a mandatory safeguard. This is an area that many of us are concerned about, reflecting the fact that the individuals in scope may have substantial difficulty understanding the process or communicating their wishes. Under the noble and learned Lord’s amendments, a person is treated as having an independent advocate, even if the advocate is not present or involved in the decision-making process. The amendments do not require an advocate to be present when the co-ordinating or independent doctor meets with the patient, nor when the panel considers the case. Advocacy is therefore satisfied by instruction alone rather than active participation. In addition, advocacy is made conditional on request. The preliminary discussion may proceed without an advocate, and a qualifying person may refuse one.

Could the noble and learned Lord please explain whether he considers that this framework preserves the substance of the Commons concession, or whether he accepts that it represents a shift away from a mandatory safeguard towards a more discretionary model? In particular, how does he address the concern that people who qualify precisely because they struggle to understand are required, unaided, to decide whether to waive one of the Bill’s central protections at the very outset of the process?

[Lord Falconer of Thoroton (Lab)]

These questions relate to a detailed amendment to Clause 22 that I tabled yesterday, which provides for an independent advocate to help people who need assistance. I will read the questions the noble Baroness has given me—she did not give me notice of them, and I make no complaint about that at all—but the appropriate place to deal with them is when we get to the amendments relating to Clause 22.

Clause 1: Assisted dying

Amendment 60

Moved by

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[Baroness Merron (Lab)]

I understand the point, but it is about verifying that.

[Lord Falconer of Thoroton (Lab)]

My Lords, I express my gratitude to everyone who has taken part in the debate. I make special mention of the noble Baroness, Lady Smith of Newnham, and the noble Lord, Lord Polak, who spoke about the death of their father and mother. Like everyone else, I am grateful for what may have been something that was quite difficult to contribute to the debate. I hope I have not left out anyone else out who has done that.

These amendments fall effectively into two categories. The first is the England and Wales category—what do you have to be in England and Wales to do?—and, secondly, and separately, in what circumstances is a face-to-face meeting between either the patient and the doctors or the patient and the panel required?

I will deal first with the position of England and Wales, raised by Amendment 60, from the noble Baroness, Lady Coffey. Currently, under the provisions of the Bill, the first declaration made by the patient, the second declaration made by the patient, the first assessment of the patient, the second assessment of the patient and assistance being given to the patient all have to take place in England and Wales. There was a range of other things that the noble Baroness wished to take place while the patient was in England and Wales—for example, switching from one doctor to another, which is a process. For my part, I think the Bill has broadly got right when you have to be in England and Wales. Having listened carefully to what the noble Baroness has said, I am not minded to suggest an amendment in relation to that, and I note that it was not picked up as an issue by other people.

The face-to-face issues were much more what the Committee, if I may say so, was interested in through the course of this debate. The effect of the debate has been, in effect, to identify four possibilities. First, Amendment 65 wants each of the occasions, namely the two doctors and the panel, to always involve a face-to-face meeting. Secondly, there should be a face-to-face meeting unless there are—I use this phrase without intending to pick up all the amendments—exceptional circumstances or practicability issues. Thirdly, the third amendment from the noble Lord, Lord Blencathra, which he referred to, is that there should be, to use his language, a “statutory protocol” defining where there can be remote meetings, accepting that the norm is face to face. Fourthly, we could simply rely on the existing provisions of the Bill, which is that codes of practice can be issued by the Minister under the various provisions of the Bill saying when face to face is appropriate and when it is not.

The testimony—that is what it felt like—given of cases where remote has gone wrong have enormous power and I think we are all aware of circumstances where face to face will lead to much greater and better communication. The other side of the coin, which was referred to by the noble Baronesses, Lady Pidgeon and Lady Hayman, my noble friends Lady Jay and Lady Blackstone and the noble Earl, Lord Howe, is that there will be circumstances where, if you insist on face to face, you are, in effect, excluding some people from this right when they should have it. There are arguments on both sides.

I come away with the strongest possible feeling that the Committee thinks that face to face where possible is best but that there will be circumstances where it is not appropriate. That brings me to my third and fourth possibilities. It is wrong and dangerous to try to use a phrase such as “reasonably practicable” or “exceptional”; more is required and guidance should be given. This is not a criticism—it is a congratulation—but I do not think the words “statutory protocol” are right, but I get from what the noble Lord, Lord Blencathra, is saying that he wants something that has the force of regulations or something similar that says, “This is what we have in mind”. Whether that is a code of practice or a statutory protocol, I am not sure. I am sure it is not what is called a protocol, but it might be something quite like that. I think the right course for me is to go away and bring back something that satisfies the Committee that there will be something—a statutory protocol or a code of guidance—that indicates when face to face is appropriate or should be the norm, but gives the circumstances where it would not be, because I get the sense of anxiety about that. I hope, in the light of that approach, noble Lords will feel able to withdraw or not to press their amendments.

[Lord Harries of Pentregarth (CB)]

I cannot quite understand why the noble and learned Lord is so unwilling to have in the Bill that the presumption should be face to face, with exceptions written into a protocol? Why is he objecting to having it that way round?

[Lord Falconer of Thoroton (Lab)]

As a lawyer, going for a presumption is wrong. I think the right thing to do is say something such as the norm is face to face, but there could be circumstances in which you may not do that. You should give maximum flexibility.

[Lord Harper (Con)]

Can I just illustrate, perhaps, to the noble and learned Lord why people are so nervous? In the Commons, at Second Reading and for much of the Committee stage, MPs were told that the panel would have to speak to the patient. Amendments were tabled subsequently—the ones I talked about—which then allowed the panel to accept pre-recorded video and waive hearing from the applicant entirely in those undefined exceptional circumstances. I absolutely accept the argument against a blanket position, but if there was a rebuttable presumption that it should be face to face and some circumstances were set out, which could be developed with case law, from listening to the debate, it seems that that would command widespread support from the Committee and would deal both with people’s concerns and, rightly, the patient-centred approach that the three noble Baronesses set out for noble Lords.

[Lord Falconer of Thoroton (Lab)]

In relation to the noble Lord’s point about the imposition of subsection (6), the Bill currently says that the panel

“must (subject to subsection (6)) hear from, and may question, the person to whom the referral relates”,

so it has to question the person, though not necessarily in person. Subsection (6), which he referred to, says:

“The duty … to hear from the person … does not apply if the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person”.


That was added during Committee, because a Member of the Committee described the circumstances of his own mother, I think. That is why it happened. But I will note what the noble Lord says. I do not think I will go for a presumption, but I hear what he says.

[Lord Harper (Con)]

The noble and learned Lord talked about questioning; this is important, because I think he slightly misspoke. Subsection (5) says:

“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material”.


The problem with that is that you lose any ability to ask questions, which is critical. That was added afterwards—after people had heard these concerns—and it went backwards. Will the noble and learned Lord reflect on that? If he is going to table an amendment, I ask him to make sure that it reflects the debate that he has heard this morning in your Lordships’ Committee.

[Lord Falconer of Thoroton (Lab)]

Obviously, you cannot ask questions under subsection (6), so it is exactly the same point. The point being made in subsections (5) and (6) is that the panel recognises that there are circumstances in which questioning is not possible. I do not know what additional point the noble Lord was making.

[Lord Blencathra (Con)]

I am grateful to the noble and learned Lord. I acknowledge that he has accepted that something else needs to be added to the Bill, possibly along the lines that I was suggesting. That comes on top of the dozen new clauses that he is already planning to add to the Bill, so I ask him to help me understand something. If the noble and learned Lord is therefore admitting that the Bill is fundamentally flawed, to a greater or lesser extent, and that it needs to be amended, how on earth can he reconcile that with what he said a couple of days ago? He said that he would seek to drive the Bill through, unamended from the House of Commons—the Bill that is so fundamentally flawed that he is now trying to move amendments to correct it. That said, I am grateful for his concession this morning.

[Lord Falconer of Thoroton (Lab)]

I would not look a gift horse in the mouth if I were the noble Lord. First, I do not regard accepting amendments in Committee of the House of Lords as indicating that a Bill is fundamentally flawed; I regard it as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for this to happen through the Parliament Act. I want this House to do the job that it is supposed to do, which is do scrutiny and then send it back to the Commons.

In the debate on 8 January 2026, I gave in detail the reasons why I thought we were not going about it properly, and I thought that the House agreed with me when it said that we needed to move quicker. The problem is not that everybody does not have good ideas; the problem is that it is taking not just far too long but disproportionately long. My experience of the Lords is that we can do this, and we can do it much quicker than we are doing it and there still be quality. That was the point I made on 8 January and that I understood the House to have accepted.

[Baroness O'Loan (CB)]

My Lords, if I remember it correctly, the Motion that the noble and learned Lord put before the House on 8 January was a Motion that more time was required, not that the House needed to race through the Bill and proceed more quickly. The Motion did not say that we needed to move more quickly; it said that we needed more time. That is what the House agreed to.

[Lord Falconer of Thoroton (Lab)]

The Motion said that more time should be given so that we could complete the stages of the Bill so that it would have sufficient time to get back to the Commons. I was particularly impressed during that debate by what my friend, the noble and learned Baroness, Lady Butler-Sloss, said—that we have to “get through” this. We are not getting through it.

[Baroness O'Loan (CB)]

My Lords, the noble and learned Lord has made the point that I was making. We were saying—we agreed and did not vote against him—that more time was required. But the discussion earlier this morning was about the fact that the House must not rush this, because that we are talking about life and death, and in particular the life and death of very vulnerable and marginalised people who are living in poverty and all those things. These things require the kind of consideration which has occurred this morning, as reflected in the noble and learned Lord’s response.

[Baroness Grey-Thompson (CB)]

I understand the noble and learned Lord’s comments about “reasonably practicable” in relation to this group of amendments. But the Bill actually has “reasonably practicable” written many times—in Clauses 10, 11, 16, 18, 47 and 50—in relation to the length of time a doctor should take to write a written report. I have amendments to shorten that length of time. I am interested in why the noble and learned Lord does not think—I am sure he is going to say that we will discuss this when we get on to those groupings—that “reasonably practicable” is not suitable in this situation, but is suitable in situations such as the length of time it takes doctors to write a report?

[Lord Falconer of Thoroton (Lab)]

That is a very valid point in relation to this particular amendment. The reason I think some sort of regulatory process from the Secretary of State—a code of practice or something similar—is better is that you can give much more detail and many more examples. You should not be relying on just a particular two-word legal test.

[Baroness Coffey (Con)]

My Lords, this has been quite a revealing debate in many ways. In trying to go with the spirit of getting on with the Bill, I could have easily broken that group into just consideration about what should be physically in the country and what should be face to face. However, I thought bringing that debate together could have been, and has been, of benefit to your Lordships.

One thing that has come up, and the noble and learned Lord has recognised, is that the concept of face to face being largely default has been well received. There have been a few other issues, though. In her contribution, the noble Baroness, Lady Pidgeon, gave a series of examples where, I have been informed by barristers, it would be required for clinicians to conduct home visits.

I was particularly struck by several speeches: I am not going to repeat them all. The noble Baroness, Lady Keeley, spoke about something as straightforward as a will, and certainly the legal protections are there.

Going forward to Report, I am clear that I believe that a lot of the operation and activities of these panels should happen in this country, rather than the psychiatrist, the KC or whoever being abroad in Tenerife—never mind anybody else. I think it is not sufficient to rely simply on statutory guidance. I gave the example last week when we talked about Montgomery: the GMC only changed their guidance, as was referred to, five years after the legal ruling. It did not happen straight away. The other thing about statutory guidance is that it does not have to come to Parliament; it is simply what the Minister can put out. For me, there are deficiencies in that approach, although I understand the flexibility. The whole point is that—

[Lord Falconer of Thoroton (Lab)]

Whether it has to come to Parliament depends on the provisions, does it not?

[Baroness Coffey (Con)]

As it stands, there seems to be a variety around the Bill on whether or not there is that 40-day pre-laying. It just seems to vary. Standard legislation would not require it, unless Parliament or the Government inserted that specifically into the Bill.

Overall, there is still a lot to be discussed. I would like to seek a meeting with the Minister on the response that somehow Article 8 is engaged, linked to Article 14 and how Amendments 60 and 65 in particular are not operable in that regard. With that, I beg leave to withdraw Amendment 60.

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[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions on this debate on artificial intelligence. It follows the debate yesterday, as referred to by the noble Lord, Lord Deben. The purpose of Amendment 66, tabled by the noble Baroness, Lady Coffey, is to prohibit artificial intelligence from being used to carry out functions under any section of or schedule to the Bill. This amendment is likely to have major workability impacts that could render the Bill unworkable and/or undeliverable.

While this is a policy matter, I will pick up points and considerations that have been made on the use of AI in practice. Broadly, artificial intelligence is absolutely in use in a number of pathways. It was indeed referred to in the 10-year health plan, and the ways it is being used include imaging and diagnosis. As this amendment stands, it would preclude an improvement in speed and in quality of care for patients.

Following my comments on workability, the amendment would incur an administrative burden that is likely to increase over time. AI is increasingly used across the economy and public services, including in the NHS, as set out in the 10-year health plan. The effect of the amendment as drafted is very broad in prohibiting this use of AI from carrying out any functions under the Bill. In the future, when AI is integrated into NHS systems across the board, it may well be difficult or even impossible to quarantine systems that are used for functions under the Bill. Additionally, this may risk creating a parallel system where voluntary assisted dying services are left behind and are potentially less safe for patients.

[Lord Falconer of Thoroton (Lab)]

I am grateful to the noble Baroness, Lady Coffey, for raising artificial intelligence. There was, broadly, a consensus around the Committee, which the noble Baroness supported, that the amendment is much too blunt, but as she said, fairly, it gives us an opportunity to talk about AI. I will also pick up the right reverend Prelate the Bishop of Hereford’s contribution; he rightly said, as has been echoed around the Committee, that there have been huge benefits for patients from AI.

I think four concerns were raised during the debate. The first was: will AI affect decision-making? I think the underlying point there is that we do not want machines to make the decisions that are referred to in the Bill; we want human beings to make them. In particular, the decisions I have in mind are the decision of the first doctor, the decision of the second doctor, the decision of the panel, and the decision of the doctor, at the point that the assistance is being given, that the conditions are still satisfied. Everybody around the Chamber wants that to be decided by a doctor or a panel, depending on which it is, and I completely and unreservedly endorse and accept that.

Does that need to be made even clearer in the Bill? I will consider it, but I do not think that it does. The acid test for me is that if you fail to comply with your obligations as a doctor or as a panel, you can go to prison for up to five years. It is very difficult to imagine how you could put a machine in prison, so it is pretty clear that these decisions must be made by a human being. For my part and for everybody who supports the Bill, that must remain the position.

The second concern is advertising, which the noble Baroness, Lady Berridge, referred to. She is absolutely right. I have made it clear that I will bring forward amendments. Those amendments, which are almost finally drafted, make provision specifically in relation to digital advertising—they do not specifically refer to AI, but we need to address that in the advertising provision. I will lay those amendments so that the House can consider them.

The third concern is slightly generalised, which is that AI is very persuasive, particularly in persuading people to do things that they do not necessarily want to do. The first thing on that is that there is a wider societal requirement to address the pervasive impacts of AI in a whole range of things. We should all try to contribute to that. More focused on this is the question of the safeguards in the Bill, because they then become incredibly important. In particular, the safeguards require that there is doctor-to-patient discussion in relation to the decision for that patient, and they are specifically required in the preliminary conversation, the first conversation and the second conversation. It is those safeguards that one must see as the antidote to the persuasive aspect of AI, but I completely accept what people said on that.

The fourth issue, which was touched on very briefly, was the operation of devices. That, I think, referred to the fact that quite a number of medical devices can be operated by, for example, the blink of an eye or something quite minor. Again, that needs to be properly safeguarded. Those may not necessarily be AI problems but problems with other sorts of developments in technology.

I thank the noble Baroness, Lady Coffey, for raising this. We need to consider all the points she made. At the moment, apart from the advertising amendment, which I will bring forward, I am not sure that it requires amendment to the Bill.

[Baroness Berridge (Con)]

Is there a guarantee that we will see those amendments in Committee rather than on Report? That is important, because there is a very different procedure in Committee, in which we can go back and forth and query amendments.

[Lord Falconer of Thoroton (Lab)]

I am going to do my best.

[Baroness Coffey (Con)]

My Lords, it has been an interesting debate. I was struck by the question from the noble Baroness, Lady Finlay of Llandaff, about fake voices. That is an interesting thing for us to consider.

Yes, my amendment was quite blunt, but we once had a briefing—sorry, it sounds like I am going to name drop—at the Cabinet table; we had a whole session on it, telling us that artificial intelligence had learned to lie. A classic example is “I am not a robot”: artificial intelligence will, in effect, just press the element that says, “I’ve got accessibility issues”, and if you do that, you do not have to do any more verification. There is a whole series here. The noble Lord, Lord McCrea, referred to an article. It is worth reading AI and Ethics Volume 5 from last year.

I wondered if the Minister might raise—I hoped that she would—the commission by the MHRA, which was started last year, specifically considering artificial intelligence. If she has not already, I think it would be worth while sending an instruction to the MHRA to start considering this aspect.

Ultimately, although I appreciate that there are noble Lords who do not want us to talk about the detail of how this might work, I think it is critical that we as parliamentarians set out for the future of any potential guidance, SIs or whatever legal rulings what we expect or how we expect this Act to deploy.

There is no doubt that algorithmic bias is a concern. That is why, although I do not entirely agree with the noble and learned Lord that we might not revisit an amendment on Report referring to AI, I thank noble Lords for this debate and beg leave to withdraw the amendment.

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[Lord Polak (Con)]

My Lords, I apologise to the Committee for intervening, but I have waited—we are now in our eighth week, I think. I have three amendments coming up in the next group but one. I have to be in synagogue at 4.30 pm so I will not be able to speak to them, sadly; I had short speeches on them but I thought that, as a courtesy, I should let the Committee know that I will not be here to make them.

[Lord Falconer of Thoroton (Lab)]

The noble Lord notified me of that beforehand; I thank him greatly for his courtesy.

May I briefly refer to the contents of the debate? First, the noble Baroness mentioned devolution. I have nothing to add in relation to devolution, but it felt like she was aiming more at the Government than at me. I am very supportive of the Government in this respect, but I had to say something in relation to that.

I will focus primarily on what my noble friend Lord Rooker said. I do not say this without thinking about it. I have the greatest respect for my noble friend, having been in government—though not as long as him, because I was sacked three years before he was sacked, and he was sacked only because the electorate replaced the Labour Government with a Conservative Government. He survived throughout the whole thing.

My noble friend is, in broad outline, right when he says that Clause 1 contains the spine—the trunk—of the Bill. I believe that this moment very much represents an opportunity for us as a House to see whether there is a way to get through this in time to send the Bill back. I completely accept what my noble friend said about my responsibility for bringing forward, as quickly and as well as possible, the areas where he was kind enough to say that I had been clear about my amendments. So I welcome the door that my noble friend has opened. I am more than willing, in relation to each of the areas where I have identified that I am willing to move, to sit down and try to agree, as much as possible, what those movements should be. I am absolutely sure that we will not agree on everything, but we can determine the things on which we do not agree on Report. So I welcome enthusiastically what my noble friend said about the way forward.

May I deal briefly with what the noble Baroness, Lady Falkner, said? Obviously, I am not responsible for either the impact assessment or the equality impact assessment. I must say, having read the points made by the commissioner of the EHRC, I think that the Government are right: it does not justify either a new impact assessment or a new equality assessment. The Government have been absolutely clear on why they think that, in principle, the Bill does not offend against the convention or the Human Rights Act. They have also been incredibly helpful, through Ministers, in saying where they think amendments might give rise to problems. It is perfectly legitimate for the Government to say, “We’re worried about amendments” but not to introduce a whole new assessment in relation to them.

[Baroness Falkner of Margravine (CB)]

Does the noble and learned Lord agree that, when courts in the United Kingdom rule that the public sector equality duty cannot be an afterthought—that it has to be complied with throughout and that Parliament needs to be aware of changes in circumstances or new issues that come up—it needs to be abided by? I am sorry; I cannot remember the title of the court case I referenced, but I am sure the noble and learned Lord will be able to find it in Hansard.

[Lord Falconer of Thoroton (Lab)]

I am well aware of the court case. It does not justify a new equality assessment in this case.

[Baroness Falkner of Margravine (CB)]

I was talking about the applicability of the public sector equality duty.

[Lord Falconer of Thoroton (Lab)]

I do not think that it justifies a new equality assessment. The thing about equality assessments is that lawyers can constantly write to clients and say, “You haven’t considered this and you haven’t considered that”. Having read in detail the equality assessment, I say that it deals properly and adequately with the issues.

[Baroness Butler-Sloss (CB)]

My Lords, I wonder whether it would be possible to get to the next group of amendments.

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[Baroness Merron (Lab)]

I appreciate the point the noble Lord is making—and indeed the points that the noble Earl, Lord Howe, made. However, as your Lordships’ House knows, I correctly restrict myself to commentary on what is before us. Should the Bill include this amendment, we will then respond at the appropriate time.

[Lord Falconer of Thoroton (Lab)]

My Lords, there are effectively two entirely separate issues raised by this group of amendments. The first is whether we should extend the current eligibility to people who have an inevitably progressive illness or disease to somebody who is terminally ill because they have injuries—for example, from a car accident—that might make them die within a specified period.

I was not sure whether the noble Lord, Lord Harper, was pressing that as an amendment, because the thrust of his remarks was much more focused on the effect on the Fatal Accidents Act. Whatever his position, I am afraid that I am not in favour of that amendment because the whole Bill has been put together and the argument for it has been based on people who are terminally ill. That is very different, for a whole variety of reasons mentioned by people, from somebody who is the victim of an injury.

I can see that people might say there was considerable moral equivalence, and the noble Lord, Lord Hendy, was right to say how persuasive he was when I spoke to him in relation to it. However, my clear view is that we should not extend the Bill beyond its current eligibility. I should also make absolutely clear that the wording of the Bill is clear; there is no prospect whatever that a court could construe the words “illness” or “disease” as meaning “injury”. What we send from Parliament will be the way it is read.

[Lord Sandhurst (Con)]

I am surprised by that because mesothelioma is an illness or disease caused by the injury—and that injury has been inflicted by the wrongdoing.

[Lord Falconer of Thoroton (Lab)]

I completely agree with that analysis, but it does not mean that if you have mesothelioma you are not suffering from a progressive illness or disease. That is different from somebody who is injured and has an injury that cannot be cured and was plainly caused by, for example, a car accident. I am grateful to the noble Lord, Lord Sandhurst, for making that point, because I was going to say that, when we are talking about, for example, an illness caused by smoking or a disease caused by industrial waste, that does not make it any the less an illness or disease. The Bill is not interested in how you got lung cancer or bowel cancer; it is interested only in whether you have an illness or disease.

The second point is of considerable importance—the question of the Fatal Accidents Act. I do not think that anybody in the Committee wants somebody who has, for example, mesothelioma to be deprived of any claim that they may have against somebody who has committed a tort in giving them mesothelioma. They should not lose that right as a result of taking an assisted death. My noble friend Lord Hendy made the important point that somebody who might want an assisted death should not be deterred from it because they worry that that might affect it. For me and for the Bill’s sponsor in the other place, the only question is: what is the best way to deal with that? One of the possible answers is to have a considered review that will report before the Act comes into force. There is a little difference between what I am saying now and what the noble Lord said. I have absolutely no desire to test this by a few court decisions early on. We have to resolve this before that happens.

That is why my Amendment 786A requires the Secretary of State to produce a report about the effects of the Fatal Accidents Act within “the first reporting period”—that means within 12 months of the Bill being passed—which is more than two years before it would come into effect. Plainly, the intention is that the report be given and then whatever necessary steps there are that have to be taken to deal with the position in tort can then be taken, if necessary, by primary legislation.

I think what the noble Baroness, Lady Finlay, meant in her speech was, “That is not good enough. You need to deal with the Fatal Accidents Act now, in the Bill.” There was no real sense one way or the other. Obviously, I will consider what she and others have said. If an amendment were tabled on Report saying that this had to be dealt with then and there—by which I mean a provision that said words to the effect of, “You do not lose your rights under the Fatal Accidents Act because you have an assisted death if you otherwise had them immediately before the assisted death”—it would be for the House to decide in relation to it.

The reason why I am advancing a review approach rather than nailing it down in the way proposed by the noble Baroness, Lady Finlay, is that it gives every single angle the opportunity to be looked at. But it would be for the House to decide which was the better way of dealing with it. There is no doubt that, one way or another, the point needs to be dealt with.

Three other points were raised. First, what about the statutory mesothelioma scheme, which makes provision for the payment of compensation? It is dealt with by regulations. We would need to look—actually I cannot look at them, but the Government would need to—at the regulations. I anticipate that there would be no real issue for the Government in making sure that an assisted death was not prejudicial to someone under that.

Secondly, on statutory compensation—I may have misunderstood the question but the noble Lord, Lord Harper, will help me with this if I have—statutory compensation for the military might have been what he had in mind, under the various statutory compensation schemes. Again, they are in the hands of the Government and we need to see what those statutory compensation schemes say.

The final point, made by the noble Baroness, Lady Finlay, was about insurance policies. As she will know, they depend entirely on the terms of the insurance policy and it is difficult to deal with the terms of an insurance policy in an Act of Parliament. However, I am grateful to everyone who contributed to this debate.

[Baroness Finlay of Llandaff (CB)]

Before the noble and learned Lord sits down and we end this, I have a real concern. If we are going to have a review from when the law is implemented, and it reports and decides what needs to be done, what is going to happen during that period to the victims, who may find that the argument that the chain of causation has been broken is picked up by insurance companies in an industry that is desperate not to pay out? As we have heard, the Government themselves have an interest in not having to pay out because of the size of the compensation for which people are rightly due because their lives have been not only ruined but taken away.

To go back to the point about injury, one of the long-term dangers of a catastrophic injury is renal failure. What if someone in that position decides that they do not want to continue with dialysis? That would then put them in the category of being terminally ill. I am also concerned that the building site, or wherever it was where they were working, that caused the catastrophic injury could then claim that the chain of causation had been broken in this situation and therefore wriggle out of compensation that would otherwise be due.

[Lord Falconer of Thoroton (Lab)]

On the first point, as I said, the review has to report in the first reporting period required under Clause 50. That means that it reports probably three years before the Bill comes into force, so there will be no cases. It is not doing what the noble Lord, Lord Sandhurst, was saying. On the second point about wriggling out, what the noble Baroness was describing would also be a Fatal Accidents Act case, so it would be covered, one hopes, by what the review deals with.

[Lord Deben (Con)]

My Lords, I come back to the idea of having an inquiry and a report. I do not quite understand why the noble and learned Lord does not feel that it is much more sensible for us to have it in the Bill. After all, otherwise you are in a sense dictating what the inquiry shall come up with. The only inquiry that you would want to have is one that found an answer to the problem, but you do not know that if you set up an inquiry. I would rather like to have the answer to start with in the Act so that we know that those people are protected.

[Lord Falconer of Thoroton (Lab)]

The reason, from discussing and thinking about this issue, is that the Government see the most convenient way of doing it is to have a review that can make sure every single aspect is covered. That is the argument for the review.

[Baroness O’Loan (CB)]

It seems from what the noble and learned Lord just said that the Government have been discussing this issue. If they have, is it his intention to ensure that, in providing such information as the Government provide under the terms of the Bill, they warn people that if they opt for assisted suicide in certain circumstances, it is possible that they will lose compensation to which they would otherwise be entitled and that this is a matter on which advice needs to be sought? Are the Government aware of any other situations in which this may happen to people who may opt for assisted suicide?

[Lord Falconer of Thoroton (Lab)]

I am afraid that I am not the Government. On the issue of risk, my proposal—although I recognise that some people want to go further—sets out a sensible course to reach the aim that everyone wants to reach, which is that the problem does not arise. One will have to look at the extent to which one has to warn against that problem when one sees where the review goes, because the question of what warnings have to be given will have to be addressed only at the point when the review has already reported and any action has been taken on it.

[Lord Harper (Con)]

My Lords, this has been a good debate, and it has raised a very important issue. The noble Lord, Lord Hendy, being a distinguished KC, and my noble friend Lord Blencathra spotted that I had not in my remarks pushed the injuries point. I confess that I am torn on that, because some injuries are effectively caused by employment, like mesothelioma where asbestos ingestion through employment results in an illness, as defined in this Bill already. Of course, there are other injuries that can be received in an employment context, where they would not qualify as an illness but where the outcomes may be very similar. But I do recognise all the issues raised by my noble friend Lord Blencathra, so I am torn on that.

--- Later in debate ---

[Lord Farmer (Con)]

My Lords, the noble Lord, Lord Pannick, is quite right that autonomy is the basic principle under this Bill. In fact, the noble and learned Lord, Lord Falconer, told the Select Committee that the essence of the Bill before us is autonomy, which makes it an outlier. Terminal illness plus an autonomous decision should not be the model that allows this Bill to be engaged. That terminal illness must also be causing suffering, which is why I support my noble friend Lord Frost’s Amendment 84. Rather than this being a cruel and heartless precondition, there are many public policy reasons for this that others have mentioned.

First, it would prevent social and economic circumstances and fear of being a burden from driving applications for assisted suicide. Secondly, if suffering were included, doctors could properly discuss palliative care and pain management, and lack of care could never be the motivation. Finally, there is a democratic imperative. The publicly presented raison d’être for this Bill is always the relief of suffering. Yet, without a suffering requirement, assisted suicide can be for any reason if there is a terminal illness judged to lead to death within six months. Others, such as the noble Baroness, Lady Finlay of Llandaff, have said why this six-month rule is unsafe and unworkable. We are glad Esther Rantzen is still with us three years after she was diagnosed with stage four lung cancer. We all sympathise greatly and genuinely with the loss of control she is facing; none of us looks forward to that. Like Dame Esther, I am also in my ninth decade. It is not at all theoretical that I, or indeed anybody else in this Chamber, might be in a similar position fairly soon.

None of us can be casual or flippant about the loss of autonomy. However, neither can we be reckless about this further move into what is in fact extreme bodily autonomy. I am particularly taken by the treatment of autonomy by the late Rabbi Jonathan Sacks. The noble and learned Lord, Lord Falconer, assured the nation on the “Today” programme yesterday that he respects people of faith. Throughout Morality, the last book Sacks published while alive, he stressed that human dignity does not come from autonomy alone but from being in relationship with others and—dare I say it—with God. The thread running through it is that we are moral beings because we are not alone. Autonomy is, he said, a “significant moral principle”, but there are other values, equally significant, that limit autonomy. When it comes to life and death, society must decide whether life is something we own or something over which we are stewards. For Sacks, redefining life as private property is inherently dangerous. If life becomes seen as disposable at will, society risks weakening its shared responsibility to protect and care for the vulnerable. When autonomy is allowed to trump all other values, the moral fabric of care and duty begins to unravel.

Allowing assisted suicide to enable unfettered choice shifts dignity away from intrinsic worth towards functionality or self-sufficiency, which is a dangerous precedent. Once the boundary between caring for life and ending life is blurred, society risks losing reverence for the vulnerable. Sacks treats the enthroning of personal autonomy as symptomatic of our cultural shift away from shared moral responsibility—a “we” orientation—to hyper-individualism, the fixation on “me”, which you could also say is selfishness. Assisted suicide further skews this imbalance by treating life purely as an individual possession rather than a shared trust.

It is not surprising that Bill’s sponsors have gone down the same autonomy rather than suffering route as the US has done, because international metrics bracket us with the US in terms of how individualistic we are as a nation. Yet Australia has an even higher individualism score than the UK. States and territories within it, and other high-scoring countries such as Netherlands, Canada and New Zealand, have all resisted the siren song of extreme bodily autonomy in this area and so should we.

[Lord Falconer of Thoroton (Lab)]

This is a pretty high-quality speech; it has pretty little to do with the six months. It is about the whole principle of the Bill. I am just wondering whether it is going to connect back to the six months.

[Lord Farmer (Con)]

I am supporting the inclusion of suffering from the noble Lord, Lord Frost, which is increasing the choice from autonomy to increased suffering. That is how it joins here. As many noble Lords have said, it is a very important area for us to discuss, and it is the underlying principle that the noble and learned Lord has said is supporting this Bill.

I mentioned shrouded attributes at Second Reading: the long-term unintended consequences of a course of action that might be politically attractive in the short term. Others have warned of the inevitable widening of the Bill through judicial review and future legislation, but I want to point out where else extreme bodily autonomy might take us. It is currently illegal to sell body materials—no money can change hands, apart from fixed compensation for expenses incurred for donating, for example, eggs, sperm or live organs such as kidneys. All that people can get for donating blood and plasma is light refreshments. Asserting autonomy and ownership over body parts would mean that people could sell one of their kidneys, perhaps to get out of debt. Do we really want that?

People with the rare condition body integrity dysphoria—BID—feel that a specific, healthy part of their body does not belong to them and that their body might feel right if it were removed or disabled. Until this happens—and, sadly, sometimes after amputation—they experience intense persistent distress, which usually starts in childhood or early adolescence and is lifelong. Again, do we really want what is illegal for doctors to perform now in this area to become legal and socially acceptable?

It is our duty and role in the UK legislative system to bottom out these shrouded attributes and long-term culture-shifting consequences. Bodily autonomy can never be treated as an absolute right. It must always be balanced against our status as moral social beings. Its primacy in the Bill is not a virtue but a fatal flaw.