Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I believe in choice and personal autonomy, but, if this Bill is passed, it will change how we treat each other as humans, and not for the better. Hard cases make bad law and the Bill is defective in too many respects. I say that despite the imperfect state of the current law.

The reports of the Delegated Powers Committee and the Constitution Committee cannot be brushed aside. The Bill is at once long but incomplete. There is insufficient detail or principle evident for proper scrutiny of the important powers to be delegated. We should, for example, have had draft regulations regarding the co-ordinating doctors, who are to have a central role and will make the most important assessments—namely, whether the person seeking assistance has sufficient mental capacity, a clear, settled and informed wish to end their own life and seeks assistance voluntarily, without coercion or pressure from another.

How will this be done and from what knowledge base? My noble friend Lord Murray has explained that. How will the panel then test the process? How long will the panel devote? How will it be resourced, so that it is not, as it must not be, a tick-box exercise? We all know that subtle family pressures are real.

Until now, doctors have been obliged to protect against suicide. The Bill goes against that. Death by poison is not treatment. It brings huge ethical challenges and changes for doctors.

What sort of people will be the independent advocates? What skills will they have? How will the vulnerable be identified? Qualifying vulnerable persons are those with a learning disability, mental disorder, or autism, which is often not diagnosed—people who may experience substantial difficulty in understanding the processes or information relevant to those processes, or in communicating their views, wishes or feelings. But there is no requirement to involve the independent advocate before a doctor decides to initiate a conversation on assisted dying with people in that precious cohort. The independent advocate will only be appointed once someone is on the path.

Who will consider family coercion—subtle family coercion or just the old person who thinks, “I’m probably a bit of a burden”—and with what resources? I am aware of the head of safeguarding in a London hospital who has recently said that there are already issues with families who want to clear the decks. The noble Lord, Lord Grabiner, explained all that.

The overloaded NHS is not always safe. Remember the Bristol Children’s Hospital and Stafford Hospital scandals. My chambers were involved in dealing with the aftermath of those and many other medical disasters. Mistakes happen and practitioners are, I am afraid, known to change the notes after the event. I have personal experience of that in matters in which I have been involved. How will we know whether the system is working properly? Cover-ups will happen. Yet, we are not to have coronial inquest. Why on earth not?

Giving responsibility to the NHS will create a stark financial conflict. It will likely damage the delivery of palliative care: the noble Lord, Lord Stevens, addressed that in detail. Palliative care should be our focus. This Bill cannot be put into acceptable shape. We shall be left with a national death service—and a poor one at that. We should have had a royal commission and proper legislation.

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Pannick (CB)]

My Lords, we have had an hour and three-quarters on this amendment and perhaps we should move on.

[Lord Sandhurst (Con)]

My Lords, I shall be very brief. The definition at the beginning is a most important matter. I am quite clear, having heard noble Lords make a number of very sound observations, that “capacity” is an essential term. That is the first thing. However, it is not sufficient, and it has to be added to. I say that because the Mental Capacity Act states explicitly that a person is not treated as lacking capacity merely because they make an unwise decision. That is a very different situation from what we will be dealing with in many cases going forward. I urge the House, when this comes back on Report and preferably beforehand, and the promoters, to consider adding simply “and ability” so that it reads “capacity and ability” because they are different concepts, and they are necessary if this is to work properly in future.

[Baroness Berger (Lab)]

I wish to respond briefly to two points. I have every admiration for the noble Baroness, Lady Hayman, and I definitely concur that we have a responsibility in this House. I also gently remind this House that there were a number of Members of the other place who said, both in writing to their constituents and in their spoken contributions in the House, that they were essentially outsourcing the job to this place for us to ensure legislation that is fit for purpose. I regret that that is the case. I think there are many of us on all sides of the debate, on both sides of this House, who would wish to see a government Bill, which has been the case with previous Private Members’ Bills that have been adopted by the Government. We would have more time and opportunity to ensure that we have robust legislation.

In the absence of that, in the process that we find before us, I want to share with the Committee—I was going to bring it up in the next group but in light of the comments and the contributions that we have heard so far I think it is important to share on record—the comments that we heard in the Select Committee from the Royal College of Psychiatrists. It is a professional body that was called to give evidence on behalf of its members as one of the pillars of the process, as one of the pillars of the panel.

We heard from Dr Annabel Price, who is the lead for the Royal College of Psychiatrists on the Bill. She is an eminent expert in this space. She shared with us that the college had very carefully thought through its position and its views and that it had asked for a review of the Mental Capacity Act’s suitability because it believes that the Bill currently states that a person is eligible if they have the capacity to make a decision to end their own life, but this framework has not been tested for this particular decision. There are principles within the Mental Capacity Act that the college is not certain are compatible with this decision and need to be thought through more carefully.

I think we should heed that warning and listen very carefully to that college whose members will be responsible should this legislation go through. Therefore, in the context of the amendment moved by the noble Baroness, Lady Finlay, I think it is important for us to consider this in terms of how we inform our debate going forward, which is relevant to this group and to the group that follows.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

That is very well put and is exactly the question. Is it appropriate to bring the Mental Capacity Act into this Bill? I understand that whether you have an assisted death is an incredibly important decision. You cannot remove the word “capacity”, so you have to reject the amendment from the noble Baroness, Lady Finlay.

Her Amendment 115 effectively draws on how the Mental Capacity Act 2005 is currently drafted, except it adds two things. It removes the presumption of capacity and, separately, it requires the person making the decision to be aware of a variety of things that are connected with their illness. To summarise, the way the Mental Capacity Act operates at the moment is that if you are unable to understand information relevant to the decision, to retain that information, to use and weigh that information or to communicate your decision, you do not have capacity under the current Mental Capacity Act. The extent to which the things that the noble Baroness, Lady Finlay, has referred to in her amendment would be relevant would have to be weighed in the context of the decision that has to be made.

I am more than happy to debate whether we need to make the changes to the Mental Capacity Act that she is suggesting. For my part, I do not think we do. One thing that is absolutely clear is that the amendment proposed, as the noble Lord, Lord Sandhurst, identified, is completely ridiculous. You cannot remove the question of capacity from this choice. Putting aside some detail hurdles, there are two hurdles that need to be overcome in how this Bill is constructed. You have to be capable of making the decision, as the noble Lord, Lord Wolfson, said, and—completely separately—you have to make that decision completely voluntarily. It has to be your own decision, not the product of pressure.

We have had—and I say this with warmth and respect—a rambling debate going over a whole range of issues, miles away from the question of whether one should remove the word “capacity” and put in the word “ability”. If this House wants to make the law completely confused in this area, either put in the word “ability” or put in “capacity and ability”. I echo the speech of the noble Baroness, Lady Hayman, when she says we have to approach this in a grown-up manner, and to remove the word “capacity” is not a sensible way to deal with this.

I also echo those who have said that the idea of running two systems at the same time—the Mental Capacity Act system and the separate system proposed by the noble Baroness, Lady Finlay—is wrong and confusing. I congratulate the noble Baroness, Lady Fox, for spotting what the right decision is. Of course, under the Mental Capacity Act some unimportant decisions are taken, but a decision such as whether to have the ventilation removed from you if you have motor neurone disease, that will almost certainly lead to your death, is without a shimmer of a shadow of doubt a life and death decision.

The Chief Medical Officer of England and Wales, in evidence to the Lords Select Committee, said:

“it is far better to use systems that people are used to and that are tested both in practice and, where necessary, in law”.

He went on to say:

“I have a concern that you could have a conversation in one bed in a hospital where someone is talking about, for example, an operation where they might well lose their life, because they are frail and there is the operative risk, done under the Mental Capacity Act, and, in the next-door bed, someone is trying to do the same process of having a difficult conversation about someone who might die, or could definitely die, as a result of that decision, but using a different legal framework. The risks that that could lead to confusion are not trivial”.


I also echo what the noble Baroness, Lady Browning, who sadly is not in her place, said. There are problems about practically every aspect of how various parts of the health service work, but she was part of a process that considered how the Mental Capacity Act worked. The broad conclusion was that it was a good, workable Act, and we should not stray from it in this particular case. I invite the noble Baroness to withdraw her amendment.

[Lord Sandhurst (Con)]

Before the noble and learned Lord sits down, may I just make it absolutely plain that I said that capacity was necessary but not sufficient. I am not stuck with whether it should be “and ability”, but I was absolutely plain in my very short speech that capacity was necessary but not sufficient.

[Lord Falconer of Thoroton (Lab)]

I was picking up on the word necessary. What the noble Baroness, Lady Finlay, is suggesting is that we remove the word “capacity”. I do not know if I misunderstood the noble Lord, but that is what I thought he was saying.

[Lord Sandhurst (Con)]

I wanted to make it plain because some people listening to the noble and learned Lord might have thought I had not said that.

[Baroness Lawlor (Con)]

Before the noble and learned Lord finishes, can he clarify for the Committee that a person who can grasp only a diluted amount of information, or who cannot retain the information in any real sense that would be intelligible to us, can be deemed to have capacity for the purposes of the Mental Capacity Act, but for this Bill, which is designed to give people agency and allow an individual as much choice as possible to choose treatment or have agency over medical and palliative care decisions and so on, an entirely different threshold should, quite rightly, be expected for such a serious measure as this?

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

I hope that the right reverend Prelate is not going to push for a vote at Third Reading. The task for this House is scrutiny of the Bill both at this stage and on Report, and I hope that that is what we will do.

[Lord Sandhurst (Con)]

My Lords, I will not be long. I speak to Amendment 726, which, as those of you who get that far in the list of amendments will see from the explanatory statement, is one of a number of amendments that I have been prompted to put down by the Law Society. They are intended to make the Bill safer in operation.

I would also like the House to know that I speak free from religious belief, but I do speak as a world-weary lawyer with many years’ practice at the sharp end in both medical negligence matters and legal professional negligence matters. I am all too conscious of my own experience of having seen things go wrong even where the people concerned were decent, honest professionals. Some of them, of course, although professionals, were neither decent nor honest. I have also sat as a legal assessor for five years at the General Medical Council, and I appeared as counsel for a north-eastern NHS trust in a very messy inquiry about 20 years ago about the misdoings of a Doctor Neale, who had featured in a “Panorama” programme—some of you may know about that. I have seen things go wrong on the ground for the past 30 or 40 years of my life.

It is with that in mind that I put down, among others, Amendment 726 with the support of the Law Society. I stress that the Law Society is neutral in principle but has looked at this Bill with what can be described as lawyers’ eyes. Its amendment is designed to make the Bill safer and better in practice. This amendment would “require” and not just permit—that is the difference—the Secretary of State to issue a code of practice in connection with what we are concerned with today; that is, capacity and so on, and the absence of coercion. A code is necessary. In Clause 39 of the Bill, there is provision for other codes of practice to be made; this is simply to add an additional code.

I suggest that this is a perfectly safe, non-destructive amendment that would improve the Bill in respect of a very important practice. As we have heard, coercion—I use the word loosely to cover a wide range of subtle pressures—must be addressed, and it should come from the Secretary of State. The panels that will oversee all this will not be enough. This must come from the Government, looking at things carefully and putting down a code of practice which says: “This is how the panels must address this”. We cannot have a postcode lottery with a panel in one part of England adopting one approach and another adopting a much tougher approach. We need uniformity.

[Lord Hay of Ballyore (DUP)]

My Lords, I support Amendment 48 in the name of the noble Baroness, Lady Ritchie, which seeks to protect individuals from being pressurised into assisted death. As the Bill stands, references to coercion and pressure in Clause 1 are strictly related to coercion and pressure coming from “any other person”. Amendment 48 would remove these three words and broaden out the whole understanding of coercion to include more than just that which comes directly from other people.

Various forms of pressure and influence can arise very easily from various sources: institutions, the media and, of course, even oneself. Every week there are new headlines about hospices struggling for funding and the increasing costs of caring for an ageing society. The Pathfinders Neuromuscular Alliance shared a heartbreaking story in its written evidence to the Commons Bill Committee of a patient who was told by their GP:

“Have you got any idea how much you cost the NHS?”


What kind of influence will these stories have on someone who has the option of assisted death? There is currently no safeguard to protect patients from pressure to choose an assisted death because they feel like a burden on the NHS or their family, or are experiencing loneliness, depression and many other related issues.

This is not just my concern. Caroline Abrahams of Age UK said to the Select Committee:

“We worry about the lack of choice about whether you are going to get good social care or good end-of-life and palliative care … We worry about a sense that, over time, it can exacerbate a feeling that an older person’s life is not worth as much as a younger person’s”.


She spoke about

“how we could ensure that older people in particular do not feel under pressure to make a decision that is for reasons other than their own real choice”.

I remind the House that Dignity in Dying put pro-assisted suicide campaigning material in our Tube stations last year. While advertising for assisted dying will not be legal under this Bill, the promotion of this service by its supporters and its presence in our society, alongside all the problems that our NHS and hospices are facing, seriously risks sending a message to people at the end of their lives that our society is better off without them. If a patient was motivated towards assisted death for this reason, Amendment 48 would ensure that they were not eligible as a result.

I ask those supporting the Bill how they intend to safeguard those who feel like a burden, cannot access the palliative care they need and feel that they have no choice but to pursue an assisted death. What would we say to Professor Smith, who said in her evidence to the Select Committee that the key question was:

“Is the person trying to escape the abuse and feelings that they have been made to feel a burden or are they trying to escape the suffering of their illness? If we cannot answer that question, then we should be very concerned”?


If we start permitting assisted suicide because people feel that institutions and the media do not want them, leading them down a dark path in their heads towards that decision, we will have completely failed the most vulnerable in our community. I urge noble Lords to support Amendment 48, because we are dealing with a life and death situation.

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I rise with some caution, because these are deep waters. I think we should err on the side of caution. I support the noble Baroness, Lady Berger, because this is an entirely new process. Assuming the Bill comes into force in some form, the age can always be lowered in the light of experience; by experience, I mean that of the human brain and how people are considering these things.

What has prompted me to say this in particular is the report in the Times on 25 November of the study by Cambridge’s MRC Cognition and Brain Sciences Unit, which compared the brains of 3,802 people aged between zero and 90 years, using datasets of MRI diffusion scans, which map neural connections by tracking how water molecules move through the brain tissues. Very simply, this study found that the topology of the childhood brain runs from birth until the turning point at the age of nine, and then it transitions into the adolescent phase, an era that it found—this is completely dispassionate—lasts right up to the age of 32 on average. Our early 30s see the brain’s neural wiring shift into the adult mode, and I emphasise that phrase: adult mode. This is the longest era and lasts over three decades. A third turning point, around the age of 66, marks the start of an early ageing phase and, for those of us who are a bit older, the late ageing brain takes shape at around 83 years old.

I conclude by reading from the report:

“While puberty offers a clear start, the end of adolescence is much harder to pin down scientifically. Based purely on neural architecture, we found that adolescent-like changes in brain structure end around the early thirties”.


If that is the architecture, at this stage in the Bill we should be looking at 25 and not a younger age.

[The Lord Bishop of Leicester]

My Lords, I too rise to support this amendment with some caution, noting that these are deep waters. I hope that noble Lords will forgive me for pointing out the blindingly obvious: as I look around your Lordships’ Committee, I do not see any 18 to 25 year-olds on these Benches, and the voices of children and young people are vital in such a debate.

The role of Children’s Commissioner was created to ensure that the voices of children and young people were heard within your Lordships’ House and the other place. Therefore, when the Children’s Commissioner, whom I know personally, who has visited my diocese and whom I have seen at work listening to children and young people—she and her staff are superbly skilled at that work—urges us to be cautious, I believe we should listen. I therefore urge consideration of that note of caution.

--- Later in debate ---

[Lord Sandhurst (Con)]

My Lords, I will be very brief. Having listened to this, I am more and more persuaded that we must have reasons, because there will be no coroner’s inquest. We know that some doctors have misbehaved in the past, but that does not always come out. One needs to have a paper trail so that, if concerns start to arise about Dr X, we can see what Dr Y has been saying, as well as Dr X.

[Lord Wolfson of Tredegar (Con)]

My Lords, I can be extremely brief, because of the confirmation given by the noble and learned Lord and also knowing that the substantive issues of domestic abuse, interpreters and various other matters will be dealt with in their appropriate place.

At the risk of underlining my reputation as a legal geek, I invite the noble and learned Lord’s attention to his Amendment 350, and in particular the Member’s Explanatory Statement. I understand the amendment, but I do not understand the statement. The amendment leaves out from “to” to end of the line and inserts “section 12(4) and (7)”, which are about “sharing of specialists’ opinions”. The Explanatory Statement says:

“This is a drafting change (consequential on subsection (4) being added to clause 12)”.


Now, Clause 12 already has a subsection (4), and the noble and learned Lord’s amendments to Clause 12 are to subsections (5) and (8). I do not know whether the Explanatory Statement has confused me and in fact the change is not consequential on a new subsection (4) being added but just stands in and of itself. It may be that I am confused unnecessarily, but if the noble and learned Lord could just clear up that minor point, I would be grateful.