Terminally Ill Adults (End of Life) Bill

Baroness Finlay of Llandaff Excerpts

Friday 30th January 2026 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, I will speak on face-to-face consultation; my Amendment 483 on this is in a later group.

During the Covid-19 pandemic, it was briefly made possible for the making of a will to be witnessed by videolink rather than in person. This change could have been made permanent, but instead the Government decided that the videolink provision should cease from January 2024. The law is now again that the witness must have a clear line of sight of the person making the will. Are these precautions any less important when assessing whether someone truly wants an assisted death and is not being coerced than when establishing what should happen to their assets afterwards?

[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Baroness, Lady Keeley, has already alluded to the issue of wills, so I will not go to that, but there is another legal precedent, Devon Partnership NHS Trust v the Secretary of State for Health and Social Care in 2021, when the High Court ruled that under the Mental Health Act, the phrases “personally seen” and “personally examined” require the clinician and approved mental health professional to be physically present with the patient for detention assessments. Following that, NHS England reviewed its guidance. That underscores the legal and clinical importance of physical co-present evaluation when decisions carry high consequence.

Secondly, during Covid I chaired the National Mental Capacity Forum and ran fast-track online seminars for those who were doing remote assessments because of the problem of people in care homes. It was a very difficult time and that was a public health necessity. Since then, some remote consultations have certainly continued, as we have already heard. However, the qualitative studies of remote mental health care during the pandemic found that a lack of face-to-face contact compromised risk assessment and therapeutic insight.

Systemic reviews have noted significant difficulty establishing a therapeutic relationship, identifying risk, and with challenges in picking up non-verbal communication and building rapport coming through as recurrent themes. They caution how remote assessments can be less effective in capturing complex, subtle behaviours, non-verbal distress, agitation and contextual pressures, which are crucial in determining voluntariness and in detecting distress or coercion. Clinicians and carers have reported that non-verbal cues were often unavailable or obscured in remote interactions, particularly telephone consultations but also by video. Even when remote assessments were used only to triage risk, delaying face-to-face evaluation, the effects slowed down accurate identification of deteriorating conditions.

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The public are worried about the way in which they feel increasingly manipulated by AI. Therefore, showing that we have thought that through and that we have made sure that AI is used in the proper sense, and not in any improper sense, seems to me to be valuable for the supporters of this Bill, to ensure that people understand that they have faced up to the very natural reactions that so many have, and which I think I have. I feel that I live in a society in which I constantly have to watch out as to whether I am being manipulated, as some have said, by advertisements or whatever else it is. If we get this right, I think it would help a very large number of people.

[Baroness Finlay of Llandaff (CB)]

My Lords, in the previous debate we had an interesting discussion about the importance of face to face. I think the conclusion was that the noble and learned Lord, Lord Falconer, should bring forward amendments that would make face to face the default mechanism, while accepting that there would be exceptions. At that point, I raised the question of recorded statements made by someone who then could not speak. It is important to remember that speech can now be faked and can sound exactly like the person. I hope that, in drawing up those amendments, the noble and learned Lord will be able to encompass some protection to ensure that, when a presentation is made of a recording that seems to be in somebody’s voice and in their words, we are still protecting against abuse and coercion and against those with malintent who may have faked that. Unfortunately, we are already hearing stories of criminal activity where such fake voice recordings are used, and we find that people believe them as being from the person, when actually they have been part of a criminal activity. This amendment has been important—although I accept, of course, that it is only a probing amendment—because it has actually made us think on a much wider scale.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the Government’s 10-year health plan for England seeks to

“make the NHS the most AI-enabled health system in the world”.

Like others, I think that is an incredibly exciting prospect. I do not want it to be dystopian. I think that the right reverend Prelate the Bishop of Hereford makes an important point in warning us against going completely over the top. I think it is important that this amendment has been tabled, because it makes us think about what the possible problems are, which have been well expressed by others. Despite my excitement about what AI might do, even in terms of treatments—there are wonderful possibilities in terms of helping people to walk, what is happening with the brain, and so on—we do not want to be naive.

The question for the noble and learned Lord, Lord Falconer, is: as the NHS digitises and doctors become increasingly reliant on AI for notes and diagnostics, given that the diagnosis is so important in a life-or-death situation in this instance, how can we ensure that a time-poor doctor does not use AI as an assessment tool or a shortcut? We would be naive to imagine that that does not happen elsewhere; we would only have to think of politics. People now use AI to avoid doing research, in a wide range of instances, and I do not want that to be translated over.

As for the patients, algorithms are supremely impressive and can take things that have happened on Facebook or TikTok, from when you have been on a Teams meeting or Zoom—all sorts of indications—and detect chronic illness conversations. The algorithms can then push pro-assisted dying content such as the Switzerland adverts or positive end-of-life options. Interestingly, when discussing banning social media for under-16s, which I completely disapprove of, or bringing in the Online Safety Act, which I argued against, everybody kept saying, “Algorithms, oh my goodness, they can do all these things”. We should consider not that chatbots are malevolent but that AI tends to agree with people via the algorithms; to quote the title of a piece in Psychology Today, “When Everyone Has a Yes-Man in Their Pocket”. If you say that you are interested in something, they will just say, “Yes, here are your options”. That is something to be concerned about, and it will come up when we discuss advertising.

I finish with that BBC story from August of a Californian couple suing OpenAI over the death of their teenage son. They allege that ChatGPT encouraged him to take his own life, and they have produced the chat logs between Adam, who died last April, and ChatGPT that show him explaining his suicidal thoughts. They argue that the programme validated his most harmful and self-destructive thoughts. I am just saying that AI is a wonderful, man-made solution to many problems, but if we pass a Bill such as this without considering the potential negative possible outcomes, we would be being irresponsible.

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[Lord Empey (UUP)]

My Lords, this has been a very interesting debate. Many Members perhaps do not appreciate the extent of the potential, and the length of time over which that potential could remain open.

When I was Minister for Enterprise in Belfast and represented Belfast East as an elected Member, that area had vast numbers of people suffering from asbestosis, mesothelioma, pleural plaques and so on, because it was an industrial area. We had shipbuilding, aircraft-building and electrical work, and asbestos was involved in wiring. The workforce used to play snowballs with it; that was the extent of it.

What emerged—and this is the important point, as I am sure the noble and learned Lord, Lord Falconer, will understand—is that first, a lot of companies, such as Turner & Newell, a very famous company, had gone out of business and, in some cases, their insurers had gone with them because of the extent of the claims. What people need to understand, and the reason why the Northern Ireland Government got involved, is that, in some cases, the state had owned those companies at one point, so the state was the employer. Therefore, there was a direct line of liability between the client, the company and, ultimately, the state. Now, the state has owned a number of businesses on and off over the years, all over the UK. This is not confined to asbestosis or related diseases; as the noble Lord, Lord Harper, mentioned, there is the whole question of the Armed Forces, for example.

To give a sense of the spread of all this, it can take up to 30 years before a disease such as asbestosis becomes obvious, and for mesothelioma and many of these diseases, there is no cure; it is very brutal, and it can be very quick. It emerged that, when workers came home, their clothing passed the asbestos on to their spouses and children. I remember many years ago setting money aside, up to 2050, to cover potential claims arising from the state having owned parts of some companies over the years. So in the absence of any insurer or employer, the state ended up in that position.

These amendments have opened up a whole new frontier that we have to get sorted out. The risk, obviously, is that those dependants will therefore have absolutely no recompense: not only will their relative have died a pretty brutal death—as the noble Lord, Lord Hendy, knows from his experience—but they will be left destitute. This needs sorting out.

[Baroness Finlay of Llandaff (CB)]

I am most grateful to the noble Lord, Lord Hendy, with whom I have had conversations going back to last September. I have looked after many patients dying of mesothelioma, and it seemed to be a loophole if the chain of causation was not completely intact.

We had advice in several calls from extremely wise sources—I will not list them all—and I learned a great deal about the legal side and the Fatal Accidents Act. I have some questions for the noble and learned Lord, whom I met with yesterday. He assured me that he would be bringing forward amendments, but unfortunately, I did not see them at the time; it was only much later that they appeared in my inbox. I have not been able to go through them in detail to examine the precise wording.

The concern is that unless this is watertight, these companies will wriggle out of any type of compensation. Therefore, what is the position of coronial oversight in these cases, where perhaps even the diagnosis might be questioned by a company, and it could be difficult for a family to provide the evidence it might be demanding? One does not know. Also, what is the position regarding the life insurance policy of the individual when they have an industrial disease and there is a chain of causation? They might be eligible, one hopes, for compensation. That needs to be followed through. However, somebody could claim that in some way, the chain of causation had been broken.

[Baroness O'Loan (CB)]

My Lords, I express my appreciation to the noble Lords, Lord Hendy and Lord Harper, for bringing these matters to our attention. I had prepared a speech describing the awful situation of mesothelioma, et cetera. I will not talk about that but will just say a couple of other things.

This has clearly identified a huge gap in provision in this legislation: a Bill is being passed that may have consequences it does not provide for in any way. I am thinking in particular of the Fatal Accidents Act: people are dying of these industrial diseases, including military victims. I had no idea that military victims would lose compensation in that situation. I am very grateful to them for identifying such a significant gap. This is very important for members of the Armed Forces, because many of them suffer from mental illnesses as a consequence of their service, in addition to any other condition from which they may suffer. That always makes life harder for them in trying to negotiate their way through and make decisions of such a profound kind. The noble Baroness, Lady Finlay, mentioned the problem with insurance policies and suicides. Most insurance companies will pay out after a suicide, provided that the minimum time has elapsed since taking out the policy. If someone has an assisted suicide, we do not quite know how that will affect their insurance policy; but it now appears that if the underlying cause of death—the terminal illness which led to the granting of assisted suicide—is something such as cancer, that may send the insurer straight back to find out what underlying habits were disclosed, such as the person being a smoker. It all becomes enormously complicated for the person suffering from a terminal illness who is trying to decide whether to seek an assisted death. There is no provision in this legislation for consequences for their families in situations such as this.

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[Lord Falconer of Thoroton (Lab)]

I completely agree with that analysis, but it does not mean that if you have mesothelioma you are not suffering from a progressive illness or disease. That is different from somebody who is injured and has an injury that cannot be cured and was plainly caused by, for example, a car accident. I am grateful to the noble Lord, Lord Sandhurst, for making that point, because I was going to say that, when we are talking about, for example, an illness caused by smoking or a disease caused by industrial waste, that does not make it any the less an illness or disease. The Bill is not interested in how you got lung cancer or bowel cancer; it is interested only in whether you have an illness or disease.

The second point is of considerable importance—the question of the Fatal Accidents Act. I do not think that anybody in the Committee wants somebody who has, for example, mesothelioma to be deprived of any claim that they may have against somebody who has committed a tort in giving them mesothelioma. They should not lose that right as a result of taking an assisted death. My noble friend Lord Hendy made the important point that somebody who might want an assisted death should not be deterred from it because they worry that that might affect it. For me and for the Bill’s sponsor in the other place, the only question is: what is the best way to deal with that? One of the possible answers is to have a considered review that will report before the Act comes into force. There is a little difference between what I am saying now and what the noble Lord said. I have absolutely no desire to test this by a few court decisions early on. We have to resolve this before that happens.

That is why my Amendment 786A requires the Secretary of State to produce a report about the effects of the Fatal Accidents Act within “the first reporting period”—that means within 12 months of the Bill being passed—which is more than two years before it would come into effect. Plainly, the intention is that the report be given and then whatever necessary steps there are that have to be taken to deal with the position in tort can then be taken, if necessary, by primary legislation.

I think what the noble Baroness, Lady Finlay, meant in her speech was, “That is not good enough. You need to deal with the Fatal Accidents Act now, in the Bill.” There was no real sense one way or the other. Obviously, I will consider what she and others have said. If an amendment were tabled on Report saying that this had to be dealt with then and there—by which I mean a provision that said words to the effect of, “You do not lose your rights under the Fatal Accidents Act because you have an assisted death if you otherwise had them immediately before the assisted death”—it would be for the House to decide in relation to it.

The reason why I am advancing a review approach rather than nailing it down in the way proposed by the noble Baroness, Lady Finlay, is that it gives every single angle the opportunity to be looked at. But it would be for the House to decide which was the better way of dealing with it. There is no doubt that, one way or another, the point needs to be dealt with.

Three other points were raised. First, what about the statutory mesothelioma scheme, which makes provision for the payment of compensation? It is dealt with by regulations. We would need to look—actually I cannot look at them, but the Government would need to—at the regulations. I anticipate that there would be no real issue for the Government in making sure that an assisted death was not prejudicial to someone under that.

Secondly, on statutory compensation—I may have misunderstood the question but the noble Lord, Lord Harper, will help me with this if I have—statutory compensation for the military might have been what he had in mind, under the various statutory compensation schemes. Again, they are in the hands of the Government and we need to see what those statutory compensation schemes say.

The final point, made by the noble Baroness, Lady Finlay, was about insurance policies. As she will know, they depend entirely on the terms of the insurance policy and it is difficult to deal with the terms of an insurance policy in an Act of Parliament. However, I am grateful to everyone who contributed to this debate.

[Baroness Finlay of Llandaff (CB)]

Before the noble and learned Lord sits down and we end this, I have a real concern. If we are going to have a review from when the law is implemented, and it reports and decides what needs to be done, what is going to happen during that period to the victims, who may find that the argument that the chain of causation has been broken is picked up by insurance companies in an industry that is desperate not to pay out? As we have heard, the Government themselves have an interest in not having to pay out because of the size of the compensation for which people are rightly due because their lives have been not only ruined but taken away.

To go back to the point about injury, one of the long-term dangers of a catastrophic injury is renal failure. What if someone in that position decides that they do not want to continue with dialysis? That would then put them in the category of being terminally ill. I am also concerned that the building site, or wherever it was where they were working, that caused the catastrophic injury could then claim that the chain of causation had been broken in this situation and therefore wriggle out of compensation that would otherwise be due.

[Lord Falconer of Thoroton (Lab)]

On the first point, as I said, the review has to report in the first reporting period required under Clause 50. That means that it reports probably three years before the Bill comes into force, so there will be no cases. It is not doing what the noble Lord, Lord Sandhurst, was saying. On the second point about wriggling out, what the noble Baroness was describing would also be a Fatal Accidents Act case, so it would be covered, one hopes, by what the review deals with.

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Moved by

[Baroness Finlay of Llandaff]

71: Clause 2, page 2, line 4, after “reversed” insert “or slowed”

[Baroness Finlay of Llandaff (CB)]

My Lords, this group concerns terminal illness. It is incredibly important. It is the title of the Bill, so it is extremely important that we have proper definitions of terminal illness in the Bill that are beyond doubt. The proposal to make eligibility dependent on a clinician’s judgment that a person is expected to die within six months might appear to be a safeguard, but evidence from palliative care, primary care and prognostic research shows that predictions are highly unreliable and largely guesswork. Some national celebrities who clamoured for eligibility live for years, while others campaigning for this Bill for themselves are clearly ineligible. Do doctors need to be 95% confident or 50% confident to rule that the patient will die within six months to be eligible? No validated clinical tools or tests exist to make such determinations with sufficient reliability for life-ending decisions. This lack of reliable knowledge leaves clinicians to face pressure to make prognoses they cannot substantiate with concurrent legal risks and ethical dilemmas.

Medical science recognises broad trajectories of decline. Those dying of cancer often experience a relatively long stable period followed by rapid deterioration over weeks or months. People with advanced organ failure, such as heart or lung disease, tend to decline in an unpredictable, fluctuating pattern marked by crises and partial recoveries. Others, particularly those with multiple conditions, neurological illness or frailty, experience a slow, progressive dwindling over years with an average of 20 or more months from identification of early palliative care needs to death and, during that time, quite marked fluctuations.

While these patterns help clinicians anticipate needs for care, they do not forecast how long an individual has left to live. A six-month prognosis is not a clinical truth. Medical prognostication for terminal illnesses is based on averages. However, in the individual, marked variables influence survival, including treatment response, infections and physiological resilience. A time-based legal threshold would turn population-level averages into high-stakes individual errors, approving some who are not within six months and denying others who are. An assisted death is irreversible, amplifying the consequences of prognostic errors and litigation. A systematic review of 42 studies on clinicians’ predictions for terminal cancer patients found very low accuracy rates ranging from 23% upwards. In a multicentre study of more than 2,000 palliative care patients with advanced cancer, physicians’ clinical predictions were accurate in only 35% of cases. Tools such as the surprise question—Would you be surprised if this patient is alive in a certain number of months or weeks?—have been tried as a way to predict those likely to die. It performs poorly at six to 12-month predictions, especially for people who have multiple conditions.

The six-month rule is unsafe and unworkable. Assisted dying legislation requires criteria that are objective, transparent and as evidence-based as possible. The definition must exclude conditions that can be meaningfully stabilised or controlled for years, as in Amendment 104 in the name of my noble friend Lady Grey-Thompson. Manageable conditions must not be treated as terminal if somebody during an episode of depression or other life trauma, such as bereavement or a relationship break-up, decides to stop whatever treatment they have when they are feeling suicidal, such as the diabetic who decides to stop their insulin knowing that if they do, they will die within weeks.

The arbitrary time of six months is unverifiable. You have a less than 50% chance of being right, and the index of suspicion, as written in the Bill, is far too low. A review paper by Scott Murray and Simon Etkind, published in the British Medical Journal in March 2025, described how inaccurate prognostic tools are—as well as the importance of illness trajectories, which can

“provide broad timeframes and patterns of likely decline”

to help doctors understand disease progress.

Patients with frailty have been described as being “on a tightrope”: some will stay on for years, but others may suddenly be blown off by an infection or a fall, and die rapidly. The Bill says nothing about pain, suffering or potential suffering. The only disease-related issue in it is prognosis, yet accuracy at six months below 50% is a pure guess that someone has six months to live. To tackle these problems, Amendments 71, 77 and 90 offer options to look at the progress of disease to increase the chance of being a little more accurate at six months, which is the point at which you could trigger the process of applying for an assisted death.

Amendment 79 would help clarify whether the disease is progressing because some potential disease-modifying treatments have been ignored—or, perhaps, the patient does not even know about such treatments. The progress of the illness will give a far better indication of whether you are rapidly deteriorating or are, in fact, remarkably stable.

My Amendment 444A would allow you to be monitored while you have other support, having triggered a request for an assisted death. This would allow specialist palliative care to be available to you if you wish to try out various suggestions. Then, as the disease is progressing more obviously towards death and there is a greater sense of predictability, the person would be eligible for sign-off by the panel and given the lethal drugs. The best evidence on predictability would be the point at which the palliative prognostic index score indicates that the person has a more than 50% chance of dying within six weeks.

However, Amendment 444A offers a compromise, because I am sure that many people will feel that six weeks is too short a timeframe. It suggests that the patient cannot have lethal drugs until they really are seen to be terminally ill and the clinicians are more confident in predicting that death is likely to occur within three months. The patient who is rapidly declining would not need to wait between first assessment and having an assisted death because they would be seen to be declining rapidly, but the patient who is completely stable would not risk having the lethal drugs until there was evidence that they were actually in the last phase of their terminal illness and a wrongful death could be avoided.

Some jurisdictions include frailty in their definition of “terminal illness”, but others do not. Evidence on this came up in Committee in the other place: a 2025 paper in Age and Ageing titled, “Why We Need to Consider Frailty in the Assisted Dying Debate”. With this extensive uncertainty around frailty and other multimorbid conditions, does the noble and learned Lord, Lord Falconer, include frailty in his definition of “terminal illness” or not? Also, does he accept that disease progress is critical to avoiding wrongful deaths? I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Campbell of Surbiton, is taking part remotely. I invite the noble Baroness to speak.