Terminally Ill Adults (End of Life) Bill

Lord Hendy Excerpts

Friday 30th January 2026 Lords Chamber

At the very least, therefore, there should either be an express amendment to the Bill, which would be a matter for the proposer, that addresses this directly; or a review, which I ask for in Amendment 829, which would look at what has been happening in the first year after the Bill becomes an Act and comes into effect and how it is operating. It is really important that the large numbers of people each year who stand to be in the class of people who might be affected are not disadvantaged by the Bill. It would be an unintended consequence and a most undesirable one. I put the amendment before the Committee on that basis.

[Lord Hendy (Lab)]

My Lords, it is a pleasure to follow the noble Lord, Lord Sandhurst, and I am particularly grateful to the noble Lord, Lord Harper, for advancing Amendments 70 and 78, which I drafted. Unfortunately, I was unable to be here last week when I thought they would be debated. I disagree with nothing that the noble Lords, Lord Harper and Lord Sandhurst, said.

The purpose of Amendments 70 and 78 was to broaden the definition of “disease” to include “injuries”. It is completely illogical that people who are facing death within six months because of some untoward event, such as contracting an illness, being hit by a car or suffering an injury at work, should not be in the same position. One thinks about injuries at work, in particular: if inhalation of asbestos fibre, silica or cotton results in asbestosis, silicosis, byssinosis or mesothelioma, they would be covered by the legislation currently proposed. But inhalation of a poisonous gas at work, causing an injury that is likely to result in death within six months, would not be covered. There does not seem to be a logical distinction there.

The law also does not regard there being a distinction. The common law of negligence requires one not to harm someone else, whether by an injury or causing that person to contract an illness. That is particularly evident in the field that the noble Lord, Lord Harper, developed; namely, injury at work. The Health and Safety at Work etc. Act 1974, the Workplace (Health, Safety and Welfare) Regulations 1992 and the common law of workplace negligence all require that the employer keeps the workplace safe and they make no distinction between whether the danger arises from a risk of injury, such as getting an arm mangled in a machine, or the risk of disease, by the inhalation of noxious particles causing lung disease. There is no logical distinction to me and it would be right for the Bill to extend the scope of “disease”—illness and disease are not defined in the Bill—to cover “illness” as well.

I turn to the main point that the noble Lords, Lord Harper and Lord Sandhurst, developed. The risk, as the noble Lords, Lord Sandhurst and Lord Carlile, put in their explanatory statement and which the noble Lord, Lord Sandhurst, developed, is that the dependants

“will probably lose their right under the Fatal Accidents Act 1976 to sue the alleged tortfeasor said to have caused the disease, unless the Bill specifically provides otherwise (which currently it does not)”.

I agree with his legal analysis. It is likely that insurers will say, “No, the cause of death here was not the underlying mesothelioma. It was the fact that this person opted for an assisted death”.

The noble Lord developed the consequences for the family. I just want to add: what about the consequences for the injured person? Are they going to think to themselves, “Well, if I opt for an assisted death, I’m going to deprive my family of extensive damages that they will not enjoy”? Of course there will be considerable pressure on that person to say, “I’m going to put up with the suffering as long as I can until I die to make sure that my family get the money”. I do not want to be rude to insurance companies, but they have to do what they can to safeguard their assets and avoid paying out what they do not need to pay out; they will fight these cases. Therefore, it seems important that the Bill, to quote those words, “specifically provides otherwise”, which it does not currently.

I am very grateful for the interview that I had with my noble and learned friend Lord Falconer and the noble Lord, Lord Sandhurst, to discuss these matters a week or so ago. I had mistakenly thought that the power of my oratory was such that my noble friend was convinced by my argument, but he was not. It is quite clear from his Amendment 718C, which he has tabled today, that he does not accept that the Bill should provide a measure that would protect the victim in the circumstances that we are discussing.

The noble Baroness, Lady Finlay of Llandaff, and I tabled Amendment 717, which is obviously not before the Committee today, which seeks to redress this by requiring that the coroner records that the cause of death was the underlying disease, while noting that the death was one by assisted dying. I do not know whether that would go far enough to protect these victims from the insurers who claim that the death was not caused by the underlying disease, but it goes a bit further than the amendment proposed by the noble Lords, Lord Sandhurst and Lord Carlile. In my view, it is essential that the Bill protects against the danger that I have outlined.

[Lord Blencathra (Con)]

My Lords, I am very concerned by my noble friend Lord Harper’s amendment to extend the Bill’s definition of terminal illness to include simply the one word, “injuries”. I agree entirely with my noble friend Lord Sandhurst and with what the noble and learned Lord, Lord Falconer, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. I support entirely what the noble Lord, Lord Hendy, said on that, but I disagreed with his general thesis that the Bill should be extended to include all other injuries, because that could take us in a rather dangerous direction.

We all know that some injuries are awfully catastrophic, relentlessly painful and leave no prospect of meaningful recovery. For those individuals, the desire for control over the timing and manner of their death is understandable and deeply felt. If the law permits assisted death for terminal illness, it is in some ways emotionally coherent to ask why a grievous and irreversible injury that will inevitably lead to death should be treated differently. I think the amendment from my noble friend and the suggestion of the noble Lord, Lord Hendy, is born of a humane impulse: to extend compassion to a group whose suffering can be as severe as that of the terminally ill. However, compassion must be married to clarity and caution when Parliament contemplates measures that permit an irreversible outcome. Extending the definition to “injuries” raises serious legal, clinical and ethical problems. I will set out the principal flaws and risks that I see flowing from the proposed change.

First, the term “injury” is legally and clinically vague. What counts as an “injury”? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long-term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort the amendment’s proponents intend. Vagueness at this threshold invites inconsistent application and litigation.

Secondly, I suggest that the proposed threshold—that the injury be “reasonably expected to result in death”—is problematic. Prognosis after severe injury is often uncertain, as it is with terminal illnesses, and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside. Using “reasonably expected to result in death” without a clear evidential standard hands clinicians wide discretion and risks premature decisions made on the basis of an evolving clinical picture.

Thirdly, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contexts where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes. Allowing assisted death on the basis of an early prognosis risks decisions taken before full treatment options have been explored and before the patient has had the opportunity to adapt to new circumstances or to benefit from specialist rehabilitation.

I will not talk about civil law and compensation, because that has already been expertly covered by my noble friends and the noble Lord, Lord Hendy. My noble friend also mentioned the coronial and investigatory consequences which arise, so I will not elaborate on those.

There is a “slippery slope” argument here. Once “injuries” are included—just that one, simple word—pressure may grow to widen eligibility further to chronic disability, psychiatric consequences or non-combat trauma. Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed.

The clinical complexity of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require trauma surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The Bill’s processes must ensure that such expertise is mandatory before any irreversible step is taken, otherwise we risk decisions being made without the full range of clinical knowledge that these cases demand.

In conclusion, if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, higher evidential standards, mandatory specialist review, and explicit protections for families and compensation rights; only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect carefully on the human impulse behind this amendment and on the legal and clinical realities that make adding it to the Bill as currently drafted—with just one word, “injuries”, as my noble friend proposes—deeply problematic.