Terminally Ill Adults (End of Life) Bill

Lord Meston Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Meston (CB)]

My Lords, I am one of the two survivors of the Committee on Medical Ethics that reported in 1994, consequent on the case of Anthony Bland. Since then, my views have changed, assisted by the report from the Nuffield Council on Bioethics. While some arguments for and against the Bill are finely balanced, it now seems to me that the balance comes down in its favour, and I support it.

The status quo is unacceptable. At present, it is possible irrationally to refuse life-saving treatment, but not possible to pursue an independent, rational request for life-ending treatment. At present, the law allows suicide but can criminalise any compassionate loved ones from whom the person may want or need help. The law cannot be left as it is: discriminating in favour of those who still have the physical ability and finance to travel abroad unaided, while allowing other unregulated, covert and sometimes drastic practices to continue. Opponents of the Bill must consider how much of the existing status quo they wish to continue.

I do not accept the more extreme objections to the Bill. The legislation is indeed not rushed; the topic has been extensively considered in and out of Parliament for years. Ironically, the first Bill rejected by this House in 1936 is said to have failed because the safeguards were too cumbersome. I do not accept speculative, overstated, slippery slope arguments. Good legislation can and should provide firm footholds on any perceived slope through unambiguous drafting, clear and specific safeguards and guidelines—including active oversight—and proper exploration of realistic alternative medical options, including palliative care. Parliament can and should retain control of the focus and clear confines of the new law, and the courts and the Government can be expected to make clear that any further permitted extension of such law should be for Parliament and require primary legislation.

The risk and sources of possible improper pressure by unscrupulous partners or relatives can be discerned and addressed by appropriate regulation and procedures, and by informed assessment of the family’s structure and dynamics and the financial implications. The proposed multidisciplinary panel should have an inquisitorial approach to collect and test the necessary evidence and, where necessary, make factual decisions.

Further consideration should be given to requiring earlier notification to family and carers, and encouraging their participation, if wanted, and requiring disclosure of testamentary arrangements. I would like to see a wider role for the independent advocate, authoritative guidance for vital assessment of capacity and possible protection of anonymity. This Bill was improved in another place; it can be further improved here.

Finally, I would suggest that perhaps the worst possible outcome would be differing laws in different jurisdictional parts of the British Isles.

Terminally Ill Adults (End of Life) Bill

Lord Meston Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Stroud (Con)]

My Lords, I seek clarity on a point raised in precisely this exchange between the noble Lords, Lord Harper and Lord Lansley, particularly on the issue of “ordinarily resident”, following the enthusiasm expressed for aligning the language of the Bill with the usual terms of the NHS.

If we aligned “ordinarily resident” with NHS maternity care, for example, it would act as a definition for who pays but not for who receives the service. All pregnant women are entitled to the service of NHS maternity care; it is only whether it is free that depends on your residency, nationality and immigration status. Those ordinarily resident get free care, while overseas visitors and those not settled may have to pay charges, although care is never refused, and payment plans are available. Can the noble and learned Lord confirm that the enthusiasm for alignment with existing NHS terms would not extend to a widening of service eligibility, and thereby the UK becoming a destination venue?

[Lord Meston (CB)]

I seriously question whether Amendments 11 and 11A are necessary or useful. Following on from what has just been said, my experience in the courts is that the concept of ordinary residence stated in the Bill is well established in our law, workable in practice and well understood by practitioners and judiciary, particularly in family law, where it most often appears. It is a tried and tested expression.

To impose the more stringent precondition of permanent residence, requiring, in effect, unbroken physical presence, could unnecessarily—and, I suggest, unkindly—restrict the mobility of those who are seriously ill, or becoming seriously ill, who might be entitled to the benefits of the Bill if it is enacted. Such people, particularly those who have a clear, stable and lasting residential connection to England and Wales, should not be left to fear that they cannot make even a brief visit away from home, fully intending to return, in case that visit away is said to have changed or interrupted their permanent residence and thereby stopped the clock on their eligibility for assistance under the Bill’s provisions, requiring the qualifying period of 12 months to restart from the beginning. That, I suggest, would be a great disservice to such people and would not be any improvement to the Bill.

As for “domicile”, as others have already said, it is a notoriously difficult concept to define. You can have only one domicile at any one time. It can be a domicile of origin, a domicile of dependency or a domicile of choice. In the explanatory statement to the amendment seeking to introduce the concept of domicile, it is suggested that it would tighten the eligibility requirements. In reality, it would do little more than complicate them—indeed, in some situations, it could loosen them.

You can retain your domicile of origin in this country even if you have not lived here for years. You can also acquire a domicile of choice or revive a domicile of origin immediately on arrival in this country with no minimum period of residence. I therefore suggest that the substitution of “domiciled” for “ordinarily resident” would not be helpful to anyone. I suggest that we should adhere to the concept of ordinary residence.

[Lord Mackinlay of Richborough (Con)]

My Lords, too often we have vague legislation that comes out of our Houses of Parliament, with phrases such as “shall have regard to”. I remember that the Speaker’s Counsel examined this at some length and when I was on the Speaker’s Committee on the Electoral Commission he said, in rather easy speak, “It doesn’t really mean much”. The other term that we hear is “reasonable”.

Now, I am sorry, but in Clause 1 we have “ordinarily resident”, so what does that mean? I am rather disappointed that the Bill has seemingly had a lot of investigation and clarification in the other place, but it comes here with that rather vague phrase within it, which has been examined at some length here and is the reason for this multitude of amendments. Is it a common-law or case-law interpretation? The noble Baroness, Lady Finlay, eloquently opened the debate by saying that it was a vague term and offered some case law. In the Barnet case, it was far from clear.

I have come up with five different types of “ordinarily resident” where there are different rules. There is case law: the one that has been mentioned today, as it should be, is the residence tool that is advanced by the Department of Health. That gives us the closest attempt at explaining what “ordinarily resident” means in healthcare, but it is peculiar because its purpose is to keep people away from healthcare if they are not resident, and hence we charge them, rightly, for those services. One wonders whether that operates as effectively as it might but at least it tries to codify what it means, with guidance.

The noble Lord, Lord Carlile, said that that was easy; I have the guidance here, strangely enough. There are 14 pages, which is blissfully short compared with some guidance, but it has in it the golden phrase: “This list is not exhaustive”. I am afraid that that, in itself, is not that clear, but at least it attempts to be. The legislation before us would restrict the availability of assisted dying to England and Wales, so I support what my noble friend Lord Lansley said about the UK being mentioned in the residency tool, so why not keep that concurrency in considering whether people are validly able to access secondary care?

Then there is the availability of DWP benefits, which are restricted in a wholly different legislative way. If people who are fully domiciled but are away from the country fairly briefly return to it, they would face another mountain of rules to be able to claim universal credit, for instance. That is a whole new raft of interpretation about what “ordinarily resident” is.

Voting is a whole different ball game; that came to light most graphically in the 2014 Scottish referendum on independence. Your Lordships may have noticed that my name is Mackinlay, which one would think had some Scottish connotation, but that is long gone in the mists of time, and I had no part in that vote. However, there could be a family who have had generations of attachment to Scotland, which, merely by dint of living in England for a short period, would have disqualified them from having a say in that rather extensive constitutional referendum; whereas had anybody in England decided to go and live in Scotland for the briefest of periods, within a short time they would have gained the qualification to take part in that referendum.

In election law, we have a whole new raft of interpretation as to what “ordinarily resident” is. We see that in live action quite regularly, whenever there is a parliamentary by-election. Parties seem to aim the finger at other parties and say, “Your candidate has lived here for only five minutes; he is renting his auntie’s flat and is not properly resident”. So even in electoral law, there is complication, but if we are really looking for complication, that would be in tax law.

I support my noble friend Lady Coffey’s attempts to assist us by adding “domicile” into the interpretation, a position that the noble Lord, Lord Pannick, does not seem to agree with, saying that it is infinitely complex. If we look at tax, I am afraid that the whole issue of “ordinarily resident” is the stuff of true complication. There was an attempt to codify it in the Finance Act 2013, where we introduced the statutory residence basis, and even that is not without complication. I should know, because I have exactly such a case on my desk professionally, as a chartered accountant, at the moment: HMRC is trying to claim that somebody who has been out of the country for 10 years has suddenly reacquired UK ordinarily resident status and hence tax status.

We therefore have conflicts across those five different interpretations, and it all depends on whether the state is trying to deny money, such as DWP benefits; deny healthcare, such as by qualification for secondary care only; or trying to get someone into the UK as resident because the state will then be able to claim a lot more tax from them. I am afraid that I have to express to the noble and learned Lord, Lord Falconer, my gross disappointment that we have had an hour and a half of debate on this legislation about one concept of what “ordinarily resident” means. Having listened to a wide-ranging debate by people who have infinitely more experience in the law than I do, we are still all at sea as to what this actually means.

When we come back on Report, we must have a properly defined qualification for assisted dying under this Act, whether that is by a helpful amendment, as proposed by my noble friends Lord Goodman and Lord Frost, which adds a little more to at least determine the qualification, or whether it is properly and very clearly under a case law interpretation, which I think my noble friend Lord Moylan has tried to advance and examine. As it stands at the moment, I am none the wiser, after this expansive debate, as to what that phrase actually means. I would appreciate it if, in his summing up, the noble and learned Lord, Lord Falconer, could say which of those five interpretations is meant by the Bill. I have a sneaking suspicion that it is an attempt to copy the healthcare definition of what “ordinarily resident” means. If that is the case, let us have it explicitly stated in the Bill, so that we at least know what we are talking about.

Terminally Ill Adults (End of Life) Bill

Lord Meston Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Meston (CB)]

My Lords, as the noble and learned Lord, Lord Garnier, said, we really have to make a choice between court-based decisions and the panel, as the Bill provides for in its present form. There is merit in both. There is a strong case for the use of the expertise and skills of the Family Division of the High Court and designated family judges—I should declare that, until quite recently, I was one of them. However, as the noble and learned Lord said, the courts will be faced with an initial rush of applications. That tends to happen with any significant change in the law, and it is likely to happen in this situation. It will take some time for the procedures to settle down, whether they are in front of a panel or the court. As the noble Baroness, Lady Berridge, said, we require some realistic assessment of the likely additional workload on the judiciary and the court system. The judiciary is of course well used to hard work and working under pressure, finding time when it is required. It should also be borne in mind that not all these cases will be complex or contested. In fairness to what was said by the noble Lord, Lord Shinkwin, there is no question of cases being nodded through or rubber-stamped, whether by the court or the panel. Family judges are used to prioritising cases when urgency is required, and they do so by underpinning their decisions with focused and robust case management.

The noble Baroness, Lady Berridge, is right, and I endorse what she said: judges are real people. I therefore endorse her call for consultation with the current President of the Family Division. I also suggest that one way through this might be an enhanced role for the independent advocate provided for in Clause 22, who will assume the role that guardians have in more conventional family cases—representing the interests of the person, whether a child or an adult, at the heart of the litigation.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I want to draw the implications for Northern Ireland into the conversation on the amendments from the noble Lord, Lord Carlile. Clearly, Northern Ireland has its own family court system, which, incidentally, has its own issues and backlog. However, that does not mean that people in Northern Ireland are entirely unaffected by court decisions in England and Wales. Each year, the family court for England and Wales hears cases involving parties on both sides of the Irish Sea, perhaps most notably applications for a child arrangements order, where one parent is living in England and the other in Northern Ireland. In such cases, delays in the English court can result in parents and children in Northern Ireland being left in limbo, awaiting decisions, with all the connected anxiety and parental conflict that goes with it. I simply present that as an example of the sort of impacts that ought to be considered, if we want to make any claim to be engaging in serious policy work.

There is no doubt that there will be even more acute impacts in England and Wales, where the strain on the court will be more direct. Catherine Atkinson MP in the other place reminded Members that:

“More than two thirds of care proceedings involving the most vulnerable children in our society cannot be completed within six months”.—[Official Report, Commons, 29/11/24; col. 1030.]


If that is the case at the moment, what can we expect if family court judges are increasingly swamped with assisted suicide cases instead?

The estimates from the former head of the Family Division, Sir James Munby, suggested that at least 34,000 hours of judicial involvement will be required each year for a proposal such as this to work, whereas the 20 judges in the Family Division of the High Court currently sit for only a total of 19,000 hours between them across all cases. Clearly, that is not something that we can ignore, and it is quite apparent that the bulk of the work will fall on circuit judges.

In saying that, I stress that I am not without sympathy for many of the concerns raised by the noble Lord, Lord Carlile. In the words of the Medical Defence Union, the current approach leaves doctors “unduly exposed”, making assessments on coercion, capacity and—as we heard a few weeks ago— residency that they feel unqualified to make. In my opinion, the Bill, as drafted, is not fit for purpose.

I have to say that I am equally concerned about the prospect of attempting to legislate on the fly, which is what we seem to be doing. What level of resource would the family court proposal require? How many additional circuit judges will be designated family judges? What impact would this have on the principle that, ideally, judges should be specialists in the area in which they are engaged? Incidentally, I believe the noble and learned Lord, Lord Falconer, has previously supported that principle. What would be the cost for an already overstretched court system?

We have been left to do policy in the dark. As former Lord Chief Justice the noble and learned Lord, Lord Thomas, warned in November,

“no one has grappled with the detail”

of the legislation’s impact on family courts. The legislative hokey-cokey on the issue of judicial involvement, which goes back much further than this Bill, has certainly not helped. It gives the impression that no one has worked out how to resolve the dilemma at the heart of the Bill—that the necessary level of safeguarding that such a Bill needs ultimately renders it unworkable. I know that the noble Lord, Lord Pannick, has said that this applies only to those who have six months to live, but no one can state categorically that a person has only six months to live. As a minister in the Church for 50 years, I have known numerous people who have been told that they have only six months to live, but they lived for years after that. Therefore, while it has been suggested that this applies only to those who have six months to live, we do not know that, and we cannot give that assurance.

In 2012, the Commission on Assisted Dying, chaired by the noble and learned Lord, Lord Falconer, considered several models for approval of assisted suicide. Those included: a medical decision-making model where doctors are solely responsible for decision-making; an NGO or volunteer-based organisation model, as they have in Switzerland or—to a certain extent—in Oregon; a tribunal model; and a court model, with the question posed whether the court should be the family court, as in the amendment, or another, such as the Court Of Protection. In 2012, the noble and learned Lord, Lord Falconer, firmly backed the medical-only model, as his report reads:

“Our assessment of the body of evidence overall has convinced us that it is health and social care professionals who have the knowledge, skills and training structures that would be needed to implement a safeguarded system to permit assisted dying in the UK. Therefore, we do not consider that it would be necessary or desirable to involve a tribunal or other legal body in decision-making”.


However, just two years later, in Committee on the Assisted Dying Bill, the noble and learned Lord made an about-turn—the court model had become the silver bullet. He told the House that

“I do not think that one can leave it to doctors alone, in particular to form two views: first, on whether it is the voluntary, clear, settled and informed wish that somebody wishes to end their own life; and, secondly, whether they have the capacity”.

In fact, he was such a convert that he made it clear in that debate that it needed to be

“the highest-quality judges to decide these issues”,—[Official Report, 7/11/14; cols. 1880-81.]

and the role for the Family Division was added into the Bill.

That position briefly persisted when the noble and learned Lord’s co-sponsor introduced the Bill in the other place, announcing it as the safest in the world due to the High Court element. But then that idea fell apart too, and the tribunal-style model, combining medical and legal elements, was adopted instead, on the claim that it would be “more robust”. At first, I thought that this was the plan all along because Dignity in Dying—the real sponsor behind the Bill—indicated this as its preferred option to the Commission on Assisted Dying in 2012. But then I read a line in the commission’s report where Dignity in Dying said:

“If there was going to be a tribunal then you would expect it to be part of the tribunal service”,


which of course the panel process currently in the Bill does not do.

This flip-flopping does not inspire confidence, and I certainly think that we should bear this in mind if the noble and learned Lord, Lord Falconer, indicates shortly that he suddenly once again thinks that the High Court judge is the way to go. It is incumbent on us to consider the reason that the High Court judge was scrapped in the Commons—again, not because I think that it was better but because it raises those questions of workability.

When interviewed by the Select Committee, Ms Leadbeater in the other place claimed that the removal of the High Court was to ensure a more “patient-centred approach”. But I am not sure that this tells the full story. In February, the Guardian reported that senior officials in the Ministry of Justice were understood to have significant concerns about the sign-off from a High Court judge in the original Bill, given lengthy backlogs in the family court. Perhaps the Minister would like to confirm these reports when she replies.

To conclude, it is important to stress that decisions around Amendment 120 are not peripheral but a central policy consideration that touches the very heart of the Bill. Is the Bill about introducing a new so-called treatment option to be overseen principally by the healthcare professionals, like other end-of-life choices, or is it more about giving the courts extraordinary discretionary power to resolve concerns about the operation of the Suicide Act in extreme cases? It is astonishing that at this late stage in the process, with the Bill having passed through the Commons, we have still not resolved this important point of principle.