Terminally Ill Adults (End of Life) Bill

Lord Markham Excerpts

Friday 12th December 2025 Lords Chamber

[Baroness O’Loan (CB)]

My Lords, I thank the noble Baroness for her intervention. It is of course the case that the Select Committee was very truncated in its ability to hear evidence. That was a decision of the House and, although we would have preferred to hear evidence from others, it was not possible.

[Lord Markham (Con)]

I just say, if I may, as a member of the Select Committee, that it was decision by the Select Committee not to hear from terminally ill people. It was not to do with the time available; it was to do with the majority of the committee being opposed to hearing from terminally ill people.

[Baroness O’Loan (CB)]

I cannot comment on the deliberations of the committee. I think there are others here who possibly can.

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[Baroness Grey-Thompson (CB)]

My Lords, I will speak to Amendment 21, tabled in my name, from personal experience. The richness of the debate today shows that, even in your Lordships’ Chamber, we all have completely different experiences of how we access a GP practice.

I tabled this amendment partly from personal experience, trying to look at how we provide continuous care to a patient. As for my own experience, I am disabled, not sick, but I have had some very interesting experiences of interacting with doctors. Fairly recently, I was asked by a doctor how I caught spina bifida and had to explain to him that it was congenital. As for my husband’s experience of the healthcare system, he had a spinal cord injury in 1984 and, at a recent visit, was continually asked whether it was in 1884 that he had his accident—I know he looks good for his age, but not that good. This is not to be flippant, which I have been accused of before. It is actually to try to ensure that we have proper continuity of care for a person who wishes to end their life.

My amendment is also grounded in coercion detection and the limitations of any capacity assessment. When I tabled it, I was thinking that perhaps a GP could provide extra knowledge to contribute to the decision that was made. But then I heard of the experience of my noble friend Lady Falkner, which is absolutely appalling. It shows that there is far more work we need to do, not just on the National Health Service but on making sure we provide the right care. The noble Lord, Lord Deben, talked about the NHS we wish to have. Well, this might be a chance to think about the NHS we wish to have.

I take this opportunity to welcome my new noble friend Lady Gerada and the experience she brings to the Chamber. I have to say that it has left me slightly more confused. I have amendments on data recording, which we will be debating later. Her comments show that data recording and sharing is really important. The part I got a bit confused about was that, if there is a named clinician as part of that process, does that not ultimately feed in to the points that have been made today? I would welcome the chance to discuss that with her outside the Chamber.

Continuity of care is really important, and how it relates to improved patient outcomes. In 2012, 56.7% of patients had a preferred GP, but that is declining. There is a link between your preferred GP and being able to access that GP. The decline has happened regardless of baseline continuity, rural or urban location or level of deprivation. Providing a better experience to patients will make those final weeks and months better for them. The Royal College of General Practitioners published excellent work in 2021 on why the patient’s relationship with their general practitioner is so important. Research on coercion and undue influence demonstrates that standard capacity assessments, while necessary, are not currently sufficient to identify subtle forms of coercion. That is why I tabled an amendment.

In response to the comments of my noble friend Lord Pannick, about what happens if a GP dies, I am happy to be corrected, but I thought the provision in the Bill about your doctor dying would cover a general practitioner as well as any other doctor involved in the process.

What we are talking about here are really complex decisions. Consulting an established GP or GP practice might mean that they possess the nuanced knowledge which would help somebody make a choice. The requirement that GPs confirm that they have a good understanding of the individual’s personal circumstances represents, to me, a better form of safeguard, ensuring that this knowledge actually exists. We cannot assume anything during this process. The assessment should provide abuse detection capacity unavailable in other types of consultations. For individuals whose care is family dependent, the home visit element—which I had, not so long ago—can play an important part in identifying coercion. If the debate has raised nothing else today, it is that this is a really complicated issue which needs much further work.

[Lord Markham (Con)]

My Lords, perhaps I may just ask a question on that. Everyone believes a GP should be able to conscientiously object. But, in all of this, I have not heard an answer to what happens in that circumstance. Surely, we need a circumstance, as happens today, involving a team-based approach, as the noble Baroness, Lady Gerada, said. Otherwise, you could have formed a great relationship with a GP who then conscientiously objects—which we think is absolutely suitable—withdraws himself or herself from the situation and can no longer take part in it. Surely a team-based approach is the better approach.

[Baroness Grey-Thompson (CB)]

The comments made by my noble friend Lady Gerada explaining the team-based approach seem very sensible in terms of providing that continuity of care. I am very lucky that I see the same GP every time I go; it is interesting to understand that not everybody experiences that. I am not absolutely welded to it being a single GP. For me, it is about ensuring that we have continuity of care and the right support for an individual, and doing it in the right way that enables them to make the best choice, while not experiencing any coercion in making that decision. The more frequent contact means that a GP or a practice may be able to understand some of the really difficult family complications that we absolutely know go on.

Many noble colleagues who worked on the then Domestic Abuse Bill will see that coercion can be very subtle and understated and happens in numerous different ways. We have a duty to make this Bill the safest Bill in the world. The noble and learned Lord will say that it is. We slightly disagree on it being the safest Bill in the world, but we have a duty to make it safer.

--- Later in debate ---

[Lord Deben (Con)]

My Lords, the moments in the Bill that most concern me are when it gets nearest to saving money. There are several occasions on which that appears to be the case, particularly when talking about people for whom many have no sympathy at all, and when you are talking about a service in which we all know we are failing. It cannot be true that any Member of this House believes that our prisons are as they should be. Yet we imprison more and more people. We imprison twice as many people as the French or the Germans. I still do not understand why we cannot take this seriously, but we still go on doing it.

First, can one really think that someone in prison circumstances finds it possible to make the same kind of decision as people who are not? Just simply, those circumstances are the pressures, the crowding and the fact that you are not in any company that you would have chosen. I do not believe that those are the circumstances in which the Bill’s proponents meant for decisions of the sort we are talking about to be made.

The second issue is: what about the pressures there? We have been talking about the concerns of those who find themselves under pressure. Do we really believe that there will not be many prisoners for whom the whole issue will be presented as, “You will be better off and we will be better off if you make this decision”?

The third issue is surely this: we know that prisoners have much worse healthcare than people outside prison. Therefore, the fact that they are told that they have but six months to live is much more difficult than it would be if they were in normal circumstances. I put it no more sharply than that, but it does seem to be true.

Fourthly, earlier on, we were talking very strongly about the difficulty that the Government are willing to fund this when they are not funding palliative care for very large numbers of people in the country. I therefore come back to my deep concern that it will become so much easier for people to die than to continue.

The right reverend Prelate, whose experience is remarkable and whom I admire enormously for her work in the prisons, has reminded us of how old the prison population is and how much older it is becoming. I just do not think that those of us in this House who really believe that our major job in this Bill is to protect the vulnerable can possibly agree that people in prison should be included under the Bill. We should take them out.

[Lord Markham (Con)]

May I just offer a different perspective on this? It has been an interesting debate. One of the main reasons I am supportive of assisted dying is kindness—kindness to the people who are scared about the inevitable end of their life and kindness in that they face a lot of pain. They see assisted dying as a way of relieving themselves from that pain.

In this debate, are we saying that people in prison are not deserving of that kindness? People in prison have been deprived of their liberty because of the crimes they committed, and that is the punishment that they have been given in the face of the law. That is the debt being paid to society. But are we saying at the same time that they do not deserve the same kindness that we would give to others and that they should face pain because they are in prison, whereas others should not? That is my perspective on this.

[Baroness Finlay of Llandaff (CB)]

My Lords, I put a question to the noble Lord who has just spoken. I am really concerned—

[Lord Deben (Con)]

I did not realise that the noble Lord was intervening on me, but I will just say that, for me, it is very difficult to have that argument. Kindness is absolutely the central point of everything that I believe in, so I am very vulnerable to that question. But the truth is, the Bill does not talk about pain at all. There is nothing in the Bill about pain. This is about a totally different circumstance. One of the problems in the country as a whole is that many people who support the Bill do so because they think it is about pain.

We could have a Bill about pain, but then we would come back to the point made by the noble Baroness, Lady Berridge, that that is not what the Bill should have been. The Government should have said that they would give a free vote on a government Bill on this subject, rather than slipping it in in a wholly different way.

However, we are faced with what we have, and in that case it does not seem kind to say to people who are under all sorts of pressures and who are particularly vulnerable that this is a choice they should make. If we want kindness, we should be saying to the Government, “Get the Bill withdrawn and introduce a government Bill that is properly thought through where we can have the real debate that the public as a whole want us to have. You can still have a free vote”, but it should never have been put through in this way.

[Lord Markham (Con)]

If I may respond on the pain point, I have spoken to lots of people who are terminally ill and heard their evidence. Again, I recommend that as many people as possible hear them because they have heartwarming stories. For them—not all the time, but a lot of the time—it is because they want to have that choice at the end so they do not have to face that pain. That is a key reason for them. The Bill says that you have to be within six months of the end of your life, but then you have the choice within that. For some people, the thought of that pain, and the experience of that pain, is the real reason why they want an assisted death. My point is that I believe prisoners should have exactly that same right so that they have the possibility to avoid that pain.

[Baroness Gray of Tottenham (Lab)]

My Lords, I support Amendments 308 and 347 regarding the availability of assisted dying services to people who are homeless.

The intention and the fundamental principle behind the Bill are that terminally ill individuals are able to exercise their autonomy and end their lives on their terms and at a time of their choosing. But, as many noble Lords have articulated during the passage of the Bill, that is a vision of autonomy that simply does not exist for far too many people. We do not live in a society where everyone is equally able to make decisions without being constrained by external influences, whether that is in the form of other people or simply follows from one’s own life circumstances. Indeed, the noble Baroness, Lady Grey-Thompson, has highlighted the ways in which society does not always afford even her that degree of autonomy despite her extraordinary career and achievements, from physical obstacles that prevent her having equal access to the public transport that is supposed to serve everyone to people who are not disabled telling her that, were they in her position, they would not keep on going.

Not only are people who are homeless by definition cut off from and invisible to key public services, including healthcare, but they often have complex further needs, such as abusive relationships, poor mental health and addiction. How can we imagine that they will not be at risk of being offered an assisted death simply because those needs are judged too hard to meet, or because someone else has decided that their lives are not worth while? We have seen that happen in jurisdictions such as Canada, where the parameters for an assisted death were widened soon after the law was passed, and we duly saw examples of individuals dying by Medicaid explicitly because they were affected by isolation and homelessness. Yes, the Bill differs from the law in Canada in that it requires a terminal diagnosis, but as soon as that threshold is crossed there is nothing in the Bill that would stop a person accessing an assisted death for reasons that were nothing to do with their illness but simply because they had been too worn down for too long by problems that could have been solved with the right care, attention and funding.

This year, Crisis and Pathway reported that almost 80% of health professionals say that homeless people are discharged from hospital with unmet health needs, and 92% of homeless people find mental health care difficult to access. The average age of death is 46 for a homeless man and just 42 for a homeless woman. Their circumstances deprive them of autonomy because they remove meaningful choice. That applies just as much to the gravely ill person sleeping rough or isolated in temporary accommodation as it does to the one who cannot afford proper palliative care at the end of life.

While I have other reservations about the Bill and the pressuring effect it will have on disadvantaged groups, I am especially concerned that we are looking to introduce it at a time when the cost of living means that homelessness has reached critical levels throughout the UK. Only yesterday, the Government published a national plan to end homelessness, and I commend my colleagues in the Government on that, but there are some shocking statistics in that plan about the numbers who are homeless. It paints a picture of utter despair and isolation for some of the most vulnerable in our society. It is wholly impossible to justify leaving out safeguards that would prevent homeless people being coerced into an assisted death, whether through abuse, absence of choice or simply their despair. I urge noble Lords to support Amendments 308 and 347.