Terminally Ill Adults (End of Life) Bill

Debate between Lord Sandhurst and Baroness Finlay of Llandaff

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I shall try not to repeat what my noble friends Lord Moylan and Lady Fraser said. My amendment asks the Secretary of State to make regulations providing for

“the circumstances in which a fee is payable in relation to any of the steps set out at sections 15 to 18”.

I remind noble Lords that those are: replacing the co-ordinating or independent doctor, references to the panel, determination by the panel and reconsideration by the commissioner.

My reading is that it is not clear what is to happen. The Commons sponsor has said that the service should be free at the point of use as regards the NHS. That is laid down by Clause 41(5), but it is not clear whether that refers to the panel’s activities and ancillary services relating to that. It is possible that, given the strain on public services caused by the Bill, fees will be needed to off-set some of the costs. We need to be clear about this. The way forward is for the Secretary of State to make regulations explaining what is to be charged for, when and on what basis.

[Baroness Finlay of Llandaff (CB)]

My Lords, I added my name in support of Amendment 827, although I also support the amendments that make it clear that the delivery of the service must not be provided by the NHS, an NHS trust or any body or any agency holding itself out to be part of the NHS, as in Amendment 835 from the noble Baroness, Lady Fraser of Craigmaddie.

The amendment to which I added my name would allow a collaborative funding model for the service to be developed, based on a means-tested formula, for those who are able to pay adequately and would otherwise have paid the fees charged by Dignitas in Switzerland, whose accounts are not open for examination. The collaborative funding model could be based in part on the principles behind co-operatives. The accounts of a collaborative scheme would need to be completely open to public scrutiny. Co-operative funding models leverage shared ownership, democratic control and member investment to finance enterprises, prioritising community benefit over profit maximisation. The shared ownership would relate to those who use the service, with levels set depending on the aspects that they access, because some might access information only and others might access the whole process.

There are five interconnected component parts to a co-operative model. First, the policy and regulatory framework defined by government would give proportionate oversight and regulation. Secondly, it would ensure adequate training across the whole system. Thirdly, the clearly defined market environment would be restricted to the provision of an assisted death service. Fourthly, the culture of the co-operative collaborative would be shaped by those wishing to avail themselves of an assisted death without jeopardising their ability to access clinical care and without jeopardising the clinical care of others through the diversion of NHS funds. This could involve crowdfunding and allow specific donations in memoriam and so on.

The fifth component relates to networks of knowledge exchange to inform the criteria used in the financial assessment, based on needs. The Bill is based on the principle of choice, and that principle could run to the funding as well. People may choose to have a slightly less extravagant funeral and pay into a collaborative system, allowing others who would not be able to afford a fancy funeral to still access the service even if they could not pay for the components of the service. After all, we have people who pay high rates of tax, such as council tax, to fund our public services, equally benefiting those who are in a much lower financial bracket.

Overall, these amendments are important because they would ensure that NHS funding is not eroded. We hear consistently about NHS deficits in all parts of the system. The palliative care and hospice sector is withering under extreme financial pressures since it has no secure rolling contracts for the services it delivers. Pressures on commissioners are already resulting in difficult decisions. There is no spare money to pay for an assisted death service.

The noble and learned Lord, Lord Falconer, has tabled amendments that would require ICBs to commission this service, but the Minister has admitted that the funding will come from reprioritisation of existing budgets. How will the ICB balance its legal obligation to meet the palliative care needs of its population with the provision of an assisted death service? The noble and learned Lord’s Amendment 749B would mandate the provision of assisted deaths by ICBs, meaning that they will be fully funded by the NHS—in contrast to hospices, which are heavily reliant on donations for a major portion of their funding.

I hate to suggest it, but sometimes this looks like a way to save money. Each assisted death has been estimated to cost around £2,000 yet would save about £13,000, four months of healthcare costs, giving a net saving of £11,000 overall. The money has to be found from somewhere. At the moment, there is a serious risk of clinical services being eroded to fund the multiple payments that will need to be made to the different professionals involved; that will become particularly important when we looked at funding it in a devolved model.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Sandhurst and Baroness Finlay of Llandaff

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to my noble friend Lady Cass for having clarified that so well. I welcome my noble friend Lady Campbell back to the Chamber and thank her for her contribution, with all her in-depth experience, which complements and builds on that of my noble friend Lady Grey-Thompson.

This debate has gone right to the heart of an area that is not clear in the Bill, which is whether this is or is not a medical treatment in terms of providing an assisted death. There seems to be lack of a clarity on that. When the Bill was in the other place, the Bill Committee, in an exchange, highlighted the ongoing confusion around the point and the profound consequences of it. One member of the Committee asked the sponsor whether doctors would have to suggest assisted dying to every potentially eligible patient as they are required to do with all medical treatments—you must inform the patient of everything that is an option for them. The sponsor replied positively that doctors are required to set out all the available options. The sponsor was then asked again by a different member of the committee about doctors having a duty to raise it with every patient, to which she replied they did not and that it should be down to professional judgment. There is a fundamental conflict there for the routine doctor looking after a patient.

Earlier today, we heard about the concern over ableist attitudes. I have to say that one does see them. It is not uncommon to hear people say, “Oh, it must be awful to be like that” in relation to somebody who has a disability of some sort. Of course, nobody wants to be disabled. I have never come across a patient who has said, “I want to have spinal cord compression now”. Of course they do not. Nobody wants it, but in the event, you have to try to not get into a very negative view with the patient and make sure that you make options available that are likely to improve their quality of life, irrespective of whether they extend their life.

It would be important for the noble and learned Lord to confirm whether he considers assisted dying to be a form of medical treatment, and if it is, to say whether doctors have a duty to raise it with every potentially eligible patient. There has been concern that some patients might be hinting that they want to talk about having an assisted death, but they cannot quite verbalise it. As anyone who has taught communication skills knows, when you are in doubt, you answer a question with a question and you keep on exploring so that people will tell you what they really want to know and think about, and you use their own words, because people have different words for different things. That is quite common. The Bill needs to make it absolutely clear what it is because requiring an assessment will be quite different if it is being suggested by a doctor versus if it is, as we debated earlier on today, instigated by the person themselves.

The medical royal colleges and equivalent bodies are clear: they do not regard assisted dying as a medical treatment and would prefer it to be delivered outside medical settings. My professional group, the Association for Palliative Medicine, has expressed the view that assisted dying services should be implemented outside usual medical practice. The BMA does not believe that assisted dying should be integrated into existing care pathways. Fraser Rickatson from Care England pointed out that in its survey,

“some expressed very clearly that this goes against their ethos as a care service”.

Michael Mulholland from the Royal College of General Practitioners told our Select Committee:

“The whole question of making decisions for assisted dying is against everything that I have been trained in and I have practised for 30-plus years. The outcome at the end of life has been that we will support and care for you and provide palliative care, as best we can in the circumstances”.


He went on to say:

“As a college, we would hope that this goes on to the face of the Bill that we would have a separate service”.


We have had discussions about people’s internal feelings, possible external pressures and coercion that may be felt by a person, the difficulties of assessing those and all the grey areas that my noble friend Lady Cass has referred to in this spectrum that we deal with every day in clinical practice. There are fundamental issues that this debate has raised that need to be clarified as a way of going forward.

[Lord Sandhurst (Con)]

My Lords, I will be very brief. We have heard the most powerful support for these amendments from the distinguished most severely disabled Members of this House—people who really know what their conditions mean and who all support these amendments. We know also that all the major organisations representing disabled people have spoken against, or cannot support, the Bill.

How can we ignore that without being patronising and paternalistic? What possible good reason is there for us or the noble and learned Lord to know better? What possible good reason can there be, therefore, for us not to accept these amendments and say that, subject to any minor drafting details, they are accepted in principle now?