Terminally Ill Adults (End of Life) Bill

Baroness Finlay of Llandaff Excerpts

Friday 27th February 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, my Amendment 144 relates to those tabled by my noble friend Lord Frost, who has made many of the points I was about to make. To add to what my noble friend has said, he used the word “paperwork” all the way through his remarks, and he outlined its importance. The point I would make, over and above what my noble friend has just said, is that the NHS has a notorious reputation with regard to paperwork. How many times have we heard about the loss of patients’ medical records and—as my noble friend just said—that the medical records are inaccurate?

Many hours have been spent in this House talking about the digitisation of NHS paperwork. The Bill is an excellent opportunity to say to the NHS—or whoever takes responsibility for this process—that when people go for consultations, they should be done digitally, by which I mean that we do not use a pen and paper. Doctors’ handwriting is notoriously difficult to read; it must be transcribed and digitised by second parties, so mistakes and errors will happen—that is one of the reasons why there are so many errors in medical records.

I say briefly to the noble and learned Lord, Lord Falconer, that this House should insist that the Bill requires this to be done digitally. When clinicians interview vulnerable people, that should be instantly recorded there and then on a tablet, iPad or computer, which will therefore reduce the number of errors. The paperwork is so important, and this is an opportunity for the NHS to step up to the plate and, of all things, digitise the records for people making the decision to end their life.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have two amendments in this group. Amendment 139 simply requires the commissioner to report to Parliament, and in Amendment 913 I have tried to ensure the independence and freedom from bias of the commissioner and staff. The voluntary assisted dying commissioner, as the public figurehead of an assisted death regime, must be free from any whiff of conflict of interest or perceived bias.

Conflicts of interest can be direct, such as the commissioner having shares in a provider of assisted deaths, when increased deaths are profitable. However, as NHS England’s standards of business conduct point out, perceived conflicts of interest can also present problems, and all interests must be declared. NHS England’s policy states:

“Officers should be mindful of any situation where relationships may give rise to a perception that a loyalty, credit, or responsibility is owed to another person or body”.


It goes on to say that

“previous employment with an employer which directly or indirectly provides services or products”

could be seen to be an influential factor.

The noble Lord, Lord Weir, has addressed the functions of the commissioner; I will not repeat what he said, but I will add a few points. Appointments to panels must not be biased to those sympathetic to assisted death, and they must also avoid those who have publicly expressed some scepticism. The commissioner is to review appeals, and bias can creep in here. Failure to follow statutory safeguards could be viewed leniently, and we have already heard examples of that from the noble Lord, Lord Frost. Highlighting failures in panels would reflect badly on the commissioner who had appointed them. In reviewing and reporting on the operation, the whole regime could skew reporting, because it is not clear which stakeholder groups will be consulted, or which data will be collected and what will be omitted—again, that could leave room for bias.

The amendment simply embodies the principle set out in the Cabinet Office’s Governance Code on Public Appointments that there should be

“no conflicts of interest that would call into question their ability to perform the role”.

Can the Minister confirm that these standards would be adhered to in any appointment? The governance code states that many conflicts of interest could be satisfactorily resolved and mitigated, giving the Prime Minister much discretion. Could a mitigation allow an assisted suicide organisation’s patron to serve as the commissioner? This is not purely hypothetical. In Belgium, the joint head of the Federal Commission for the Control and Evaluation of Euthanasia was one of the leading proponents of the 2002 law there. Since then, it has euthanised more than 100 patients and become something of a celebrity. That reputation has caused controversy. We have already heard about underreporting—

[Lord Markham (Con)]

Is there not a critical difference, when we talk about conflicts of interest, in that, in this case, this will be law—something that has been passed by Parliament? I do not believe that, in any public appointment, being supportive of a law of the land is deemed to be a conflict of interest.

[Baroness Finlay of Llandaff (CB)]

The point that I was trying to make, and I am sorry if I have not expressed it properly, is that there is a huge amount of discretion here and the commissioner will be the person who appoints the panels. In a way, by assessing the work of the panels, the commissioner will be marking his or her own homework. That does not provide the independence that one would require.

If I may go on, we heard too in our Select Committee hearing, which the noble Lord was present at, about problems that have occurred in New Zealand. These need to be taken as a warning: we must ensure that there is independent transparency and lack of bias in the commission, through statutory safeguards, to avoid the failures that occurred in other countries. In the case of Mortier v Belgium, the European court—

[Baroness Whitaker (Lab)]

I apologise for interrupting, but I am a little confused. It seems that there is a considerable principled difference between expertise and conflict of interest. People who have been involved in assisted dying have expertise; they do not necessarily have a conflict of interest. You can be a professional, as I am sure the noble Baroness well understands, and be independent, so why is expertise ruled out?

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Baroness for that intervention, because expertise is not ruled out. It is the way that the commission functions that is important—that that does not allow skewing and silencing. What I was going on to point out is that one of the commissioners on the Belgian commission resigned because they felt that they were being silenced whenever they raised issues about problems in reporting, that they were unable to continue to provide ethically high standards and that their own expertise was not being respected.

I would be grateful if I could just continue for a moment, because I am not trying to filibuster. I would like to make that absolutely clear, following the extremely unpleasant, vicious comments that have been made about me, both in the media and in very aggressive emails that have been sent to me. If I may continue, I would be most grateful.

I am simply asking whether a commissioner with a financial interest in an assisted death business, whatever that is and however it is commissioned, is actually truly independent. There seems to be no requirement for the appointment to be scrutinised by a committee of Parliament or for a register of interest to be published. I am sure that that would happen, because that is a normal course of action in this country, but the equality impact assessment seems silent on this. The noble and learned Lord, Lord Garnier, referred to the Constitutional Reform Act 2005 in relation to appointments, so I will not repeat that, but this commissioner’s post appears, as written, to be in the gift of the Prime Minister, and there does not appear to be verified impartiality in terms of the exercise of the functions, given the great importance of this role and the problem that if it does not work well then public confidence in the system will be lost.

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[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.

[Lord Markham (Con)]

I am a bit confused. I think I heard from the noble Baroness a concern that savings of £13,000 a week would be generated if assisted dying happened. I then heard her say afterwards that there would be costs on other people. Obviously, she cannot have it each way. A few times I have heard people asking, “Where’s the money coming from?”, and other people saying, “There’s an incentive because there’s a saving in it”. Can the noble Baroness clarify that, please?

[Baroness Finlay of Llandaff (CB)]

I thank the noble Lord for asking for the clarification. I did not say a week; I said four months. Actually, with the severe deficit that we—

[Lord Markham (Con)]

I believe the noble Baroness’s general point was that there is a danger because savings would be made from an assisted death. On the other hand, she asks where the costs are going to come from. I am just wondering which she believes: that there will be savings or that there will be additional costs.

[Baroness Finlay of Llandaff (CB)]

My concern is that if you take money out of a healthcare budget that is already in deficit, you will end up with an incentive for people to go down the road of saving money by working towards promoting assisted deaths for patients for whom additional care would mean them no longer feeling in despair in any way and having their quality of life returned to them. The NHS budget appears to be in such a difficult and parlous state that we have to be very careful that we do not spend NHS money on what is not a healthcare treatment.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the amendments in the names of the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser of Craigmaddie, are very useful in making us think about what an assisted dying service would or should look like if the Bill is enacted and what the implications are for funding it—public funding or who is going to pay.

We will come to a more detailed discussion on this in later groups, but I will just raise a few things. As I understand it, and I probably need some clarification from the noble and learned Lord, Lord Falconer, the idea is that integrated care boards will be mandated to provide a fully funded assisted dying service. I would just like to get a sense of what is envisaged. If that is what is envisaged, we have to ask the question: is that reasonable?

As others have said, contrast that with hospices, which receive only a portion of their funding from ICBs and are heavily reliant on donations. I am sure we have all been to those coffee mornings and bought cakes, sold cakes and all the rest of it, trying to raise money for hospices. Meanwhile, palliative care services rely heavily on charity funding, recovering only 30% of their funds from the Government. I understand and note the important caveat from the noble Baroness, Lady Fraser. I am not trying to say that the state should run everything at all times and that anyone who is doing anything in the charitable sector is a problem, but underfunding end-of-life care at the same time as fully funding ending-your-life non-care is a bit peculiar.

The danger is that if the sponsor’s aspirations come to fruition—if I have got them right—funding for assisted dying will start competing with and risks diverting resources away from palliative and end-of-life care, and both will compete for a share of a limited health budget. I note that professional bodies, such as the Royal College of GPs and the Association for Palliative Medicine, argue that the assisted dying service must have distinct funding to avoid such competition.

It was very important that the Health Secretary, Wes Streeting, was frank with us when he noted that

“setting up this service will also take time and money that is in short supply … Politics is about prioritising. It is a daily series of choices and trade-offs”.

I would like to address a couple of questions to the Minister, who I know is confined to discussing workability, to ask how this prioritisation will work. Have the Government considered this? If funding will come from reprioritisation of existing budgets, are we not at this point being asked to legislate a direct conflict of interest, where integrated care boards will have to choose between, for example, funding palliative care and funding assisted dying? If it is not palliative care—I have overused that—which other services will be deprioritised in these choices in order to fund this? It is a limited budget. We keep being told that there is a scarcity of funds, so I want to understand that.

Finally, another reason to raise this—it is not directly to do with funding, but it counts—is that if assisted dying is to be paid for by the public purse and/or associated with the NHS, it could mean that assisted dying is treated as a standard healthcare solution. That surely could have a corrosive impact on trust between patients and clinicians, breaking their “first do no harm” contract with the public and flouting the Hippocratic oath.

Should doctors be expected to incorporate ending life into their routine roles if it is publicly paid for, when the major professional bodies explicitly warn against this? The BMA says that

“our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways—it is not something that a doctor can just add to their usual role.”

That more existential kind of question, or about medical ethics, will obviously be compromised when, if public funding and the taxpayer are paying for assisted death, those taxpayer-funded NHS doctors are surely going to be asked to do something that goes against their ethical code.

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[Lord Falconer of Thoroton (Lab)]

The impact assessment suggests that in year 10, assuming the highest possible cost, it would cost £37 million in total to do assisted dying. This is not by reference to any savings and it includes not just the health elements but also the panel and the assisted dying commissioner. It is plain that palliative care should get as much funding as possible. It is patchy throughout the country and it needs more funding. For me, it is not right to delay the option of assisted dying, particularly when the amount of money that we are talking about to fund assisted dying is so much less than that amount of money, which I would fully support being provided as much as possible. I understand what the noble Lord, Lord Harper, is saying. I am fully behind him if he is saying, “Let’s all put our backs into getting as much money as possible for palliative care”. But I do not accept the argument that the inadequacy in some parts of the country of palliative care is a reason for delaying the assisted dying Bill.

[Baroness Finlay of Llandaff (CB)]

Just as a point of information, does the noble and learned Lord accept that there is evidence that if specialist palliative care was available across the country on an equal basis, that in itself would result in a saving of around £800 million a year, because patients would be getting better care and unnecessary investigations and so on would be avoided? So there is a cost transfer. The problem at the moment is that we have areas without services and therefore patients do not have choice. If we are talking about patient choice, there must be equipoise in that choice argument.

[Lord Falconer of Thoroton (Lab)]

I am absolutely sure that if there were proper specialist palliative care of the highest quality—we would hope that there would be—it would lead to savings. I honestly do not think that the £37 million cost is a reason for delaying this because it would in some way hold back the provision of better specialist palliative care, which is something that we are all in favour of.

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[Baroness Hayter of Kentish Town (Lab)]

It is Committee; the noble Baroness can come in later.

As I say, the noble Baroness, Lady Finlay, will be able to speak to Amendment 459 afterwards. One consideration has to be that the person has informed their children of their decision for an assisted death. I cannot be the only person who knows people for whom there is completely no relationship between parent and child. The child could be aged 60 and have been living abroad for years. They might not know their parent is ill and may not have been in touch with them for 40 years. But somehow we are going to have to try to track down children. Also, the ill person may not want their child to know that they are ill. We are all old enough now; we have had lots of friends go through this. I had a friend who did not want his daughter to know he was terminally ill because she was facing her own health issues at that time. But this would somehow lay down that despite the desire of a father, in that case, nevertheless that child has to be found and told that their parent not only wants an assisted death but that their parent is dying and wants an assisted death.

I really wonder about this denial of agency. If that person does not want to tell their child, according to Amendment 459, they have to make

“adequate arrangements for another person to inform the children”—

who might live abroad, or whatever—

“of the assisted death and provide bereavement support”.

I just wonder what world we are living in where, when someone is reaching the end of their life, some agency of the state demands that they tell them whether they have any children, whether they know that those children are still alive and where they are, and has to tell that child that their parent is ill and that—in a way, a smaller matter—they want to bring forward that death a little bit so that it is not too bad at the end.

Some of these ideas seem to me to exclude from our consideration the patient concerned. They seem to put everyone else in a position of taking decisions. The noble Baroness, Lady Cass, spoke earlier about the amendment that wants more and more specialist advisers brought in. Can we just sometimes revert to remembering that we are talking about seriously, terminally ill people who surely have some agency over their life? If they are refused this, they can still commit suicide but they will probably do it, as a friend’s father did, by going into the garage, blocking the bottom of the door so that no air can get through, turning the engine on and killing themselves that way. I wonder sometimes whether we are remembering that people are facing a terrible end and we just ought to have a little respect for them.

[Baroness Finlay of Llandaff (CB)]

May I intervene on that, given that my amendment is being questioned? Let me explain. When looking after people who are parents, a conversation is often about what the children know. Telling the children about someone’s impending death is extremely difficult for most parents. Usually, it is because the person who is ill wishes to protect those children; they think that, by not telling them and preparing them, they are somehow protecting them. The way children are informed needs to be age appropriate and appropriate to where that child is.

I do not suggest in this amendment that it should be an agent of the state. The amendment refers to making

“adequate arrangements for another person”.

That could be anybody. It is about asking whether they have somebody who will inform those children—or not—about the death. As for bereavement support, it might simply be about telling them in person and letting them talk about it for an hour over a cup of tea, or it might be much longer, depending on the needs of the individual—because bereavement is a very individual thing as well.

I am concerned that we could legislate and somehow believe that, by someone having an assisted death, rather than a death for which there has been preparation, the impact on any children in a family will be less, because the evidence is that it will not.

[Lord Falconer of Thoroton (Lab)]

I do not know whether I am allowed to intervene, because I do not know whether the noble Baroness is intervening or speaking to her amendment.

[Baroness Finlay of Llandaff (CB)]

I am coming to my amendments later.

[Lord Farmer (Con)]

I speak in support of amendments on behalf of my noble friend Lady Maclean of Redditch, who unfortunately cannot be in her place at this hour on a Friday afternoon. I refer to Amendments 445, 483A, 495B and 941A. First, Amendment 445 would require the panel to consider signs of fluctuating capacity. That issue has been addressed in previous groups but needs raising again briefly here. As Professor Martin Vernon told the Lords Select Committee,

“fluctuating capacity is an extraordinarily common issue, but none the less somebody may retain capacity at some point during their dementia diagnosis sufficient to make a determination as to whether they wish to end their life”.

As has been stated, about two-thirds of people with dementia have never received a formal diagnosis, so it is incumbent on the panel to consider that possibility and take evidence on whether it could be the case. Given that the co-ordinating doctor is not required to be in the room at the actual moment of administration, fluctuating capacity could raise vital issues of consent.

Amendment 483A probes whether the panels have sufficient powers to gather all necessary evidence to decide on eligibility. It ensures that a panel can refer the patient for any further assessments that it considers necessary. Can the noble and learned Lord who is the sponsor explain why the panel does not sit within the usual tribunal structures, as doing so would give it more expansive powers to request further evidence where necessary? For example, the tribunal procedure rules for the First-tier Tribunal, in the Health, Education and Social Care Chamber, empowers the tribunal without restriction to give direction to matters such as,

“issues on which it requires evidence or submissions … the nature of the evidence or submissions it requires … whether the parties are permitted or required to provide expert evidence, and if so whether the parties must jointly appoint a single expert to provide such evidence … and the time at which any evidence or submissions are to be provided”.

It would be helpful if the Minister could confirm whether the powers given to the panel in Clause 17(4)(d) and (e) are as extensive.

Finally, my noble friend’s connected Amendments 495B and 941A would require the panel to provide a report to the person containing recommendations to address any unmet social and palliative care needs, in addition to determining whether an eligibility certificate should be granted. More fundamentally, these amendments probe what the panel is intended to be. The Bill’s sponsors previously have tried to argue that the panel is akin to a multidisciplinary team. My understanding is that on this point they have been rebuffed. After the noble and learned Lord cited the Association for Palliative Medicine’s Dr Sarah Cox in his defence on 9 January, the APM responded in a letter that the Bill’s sponsor had misrepresented Dr Cox’s position, saying:

“This panel fails to replicate a true multidisciplinary model and essential protection”.


Further, it says that the Bill’s current provisions render

“the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision-making at the end of life”.

My noble friend’s amendments are intended to help the noble and learned Lord by providing ways for his panel process to be strengthened so that it operates more like a multidisciplinary team. An important first step would be to expand the panel’s scope so that it includes explicitly the ability to provide assessments of or treatments for unmet health and social care needs. This would enable each panel member to assess, individually and then together, the holistic needs of the patient and contextualise their decision around assisted suicide. My noble friend’s Amendments 495B and 941A build on this and a recommendation of the Royal College of Psychiatrists that the panel should be able to recommend interventions addressing potential drivers of a desire to hasten death, such as depression, social isolation or difficult physical symptoms.

It should be remembered that the Bill does not guarantee that the person will ever have met a psychiatrist or social worker before this stage in the process. We cannot deny the patient the benefit of their holistic experience and expertise in favour of a rubber stamp. My noble friend would also tie her amendments to the sponsor’s commitment to consider a requirement for the co-ordinating and independent doctors, although not the panel, to ask why a person has requested assisted suicide. Ultimately, what is the point of exploring motivation unless the intent is to establish whether drivers can be addressed in another way?

To conclude, the heart of the problem is that, due to the way it was added to the Bill in the other place, the panel process suffers from a fundamental identity crisis. Are the members trying to be a kind of tribunal, or are they designed to be a kind of multidisciplinary team? It would be helpful if the sponsor could enlighten us, because currently they fall short of both.

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When my father died, a psychiatrist working at the hospital that I then chaired said to me, “However old they were, and however old you are, the loss of a parent is a deeply emotional and important event in your life”. I am sure there are many different circumstances in which children are bereaved of their parents, but there are other relationships as well. The obligation in this amendment is to talk about children, but what about talking about your husband, wife or partner, or the person who has meant most to you in your life? People say, “Yes, it should be the person who meant most to you in your life”, so the panel has to find out who means most to you in your life. We seem to be going into a granularity on this that is not needed and is actually not very kind.

[Baroness Finlay of Llandaff (CB)]

My Lords, perhaps I might come in at this point. First, factually, I point out that the amendment that I have tabled does not state “bereavement services”; it states “support”. That is completely different.

[Baroness Hayman (CB)]

Will the noble Baroness accept that we would have to define “support” and how it is different from “bereavement services”? Then we will have more of these complications.

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[Baroness Finlay of Llandaff (CB)]

Perhaps the noble Baroness might be relieved to note that I do not intend to move my amendment. I would like to speak to it now, but I will not be moving it.

Routinely, when you go into hospital, you are asked who your next of kin is. That is a routine question and it is entered in your medical record. That person has no legal status in terms of making medical decisions, although they may be consulted if a best-interest decision has to be taken. However, if you die, that will be the person the ward will phone to say that you are dead and your body is going to be moved to the mortuary, and that is the contact number that will go to the medical examiner to phone you later, which I think is the point the noble Baroness, Lady Berridge, was trying to extract.

It was helpful that the noble and learned Lord, Lord Falconer, described the shock of discovery of a death that you did not know about. That shock has been described by relatives who suddenly discovered that their parent had died by some form of assisted suicide or euthanasia when they had not known about it beforehand. That is documented.

It is also worth remembering that there is no evidence that suicide rates fall when these types of assisted death services come into play, but there is evidence that when people get the care they need, suicidality—that is, thinking about ending your life early—falls. So people need to have care.

I shall speak to my amendments now.

[Lord Falconer of Thoroton (Lab)]

Is the noble Baroness speaking to Amendment 459?

[Baroness Finlay of Llandaff (CB)]

I have already spoken to Amendment 459 and am finishing off speaking to it.

I will move on to Amendments 475 and 939 in Schedule 2. There is concern over the operation of the panels and safeguarding responsibilities, just in terms of the information that comes forward. Someone with relevant information would be allowed to come forward to the panel with appropriate evidence and be afforded whistleblower protection, in the type of situation described by the noble Baroness, Lady Berger, where there is a new person on the scene who others may feel has malintent, for one reason or another.

In the Bill’s current model, medical assessments that have previously gone to the panel will not be monitored contemporaneously. They could be poorly reported, they will not be reviewed and this could hide errors, unconscious bias and discrimination. The role of the panel will be to issue a certificate. In Amendment 493, I have suggested that the certificate should have validity for six months and, in the event that the person has a longer prognosis—we have many examples of that—it is renewable rather than having to start the process again because they have outlived their prognosis.

However, the appeal mechanism to a panel seems to be one-sided. The person can appeal against a refusal to give them a certificate, but there does not seem to be a mechanism for appeal. My Amendment 499 seeks to allow information to be brought to the panel that it may not have known about when it gave a certificate. This may relate to domestic abuse that had been hidden, to coercion or pressure, to any information that the diagnosis may have been wrong, to recent emotional or psychological trauma, or to depression or metabolic disturbance which might have impaired capacity.

Amendment 932 is a very practical one concerning the provision and distribution of panels around England and Wales. It has not been made clear how many panels there would be or that there needs to be fair distribution. I have suggested a minimum of three per region in England and a minimum of three in Wales. For the geography, topography and population, I think three would work for Wales. However, areas of England with high population density, or very large rural areas, would probably need more to enable the panel to visit the patient face to face for an assessment. It is completely inappropriate to expect a patient to go to see a panel when they are already ill or to rely on remote consultation rather than having the ability for face-to-face discussion. Those face-to-face discussions must be subject to the confidentiality that you would expect in any medical consultation. I hope that we will not be suggesting that this would be publicly available.

I suggest that, as has been said, these panels came in two-thirds of the way through and a panel can take testimony from others. However, in terms of getting information about the person, as the Minister of State for Courts and Legal Services said in Committee on this Bill:

“It is not a court or a tribunal … They can make the request, but they cannot compel someone to attend”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 12/3/25; col. 1102.]

[Baroness Grey-Thompson (CB)]

My Lords, I want to pick up on a couple of points that have been debated this afternoon, and those raised by the noble Lord, Weir, on the impact on disabled people. I seem to have completely failed in all the debates to get across the fear that disabled people feel with this Bill being debated.

Jennyfer Hatch in Canada had Ehlers-Danlos syndrome, experienced organ failure and was approved for MAID. It made me think of the letter that the Minister, the noble Baroness, Lady Merron, wrote to the noble Lord, Lord Moylan, this week, about the combination of illnesses that would qualify a person for this service. That is why disabled people are so worried. The combination of their disability and other conditions would make them eligible, even though we have been told that there is nothing to worry about. Can the Minister confirm what I understand the noble Baroness, Lady Merron, said when she wrote to us: that a combination of impairments would enable somebody to enter?

I strongly support the amendment from the noble Baroness, Lady Keeley. That is really important because in another case from Oregon, Joan Lucas, who had ALS, was approved for this service; her children filled out the form. There was no question about it; they just took it and she was approved, which is quite worrying.

I thought the debate on somebody dying by suicide was really interesting, and I am going to use “assisted dying” in this context. One of the reasons we are told we cannot use “dying by suicide” is because dying by suicide and this process are completely different. I am not really sure that we can have it both ways. We need to give a little more thought to that.

I get quite upset when we are constantly told that people are dying anyway. I apologise to the noble Baroness, Lady Hayter, but we have to find a better form of words. People may be dying, but the process and the experience they have as they go through that might vary considerably. Sometimes the language that we use in the Chamber can be quite dismissive of the amendments that we are trying to bring to make the Bill safer. We still never seem to hear the word “safe”, we just hear “workable” all the time.

My amendment in this group, Amendment 924, is about protecting older people and being able to make sure that any abuse or risk of coercion can be assessed. It is really about how the panels gather this information. It has already been mentioned that the British Association of Social Workers has said that the safeguarding is not enough. Hourglass has said that one in five of over-65s has experienced abuse, and on 15 June last year, which was World Elder Abuse Awareness Day, there were calls from numerous organisations to do more. The British Psychological Society has said that elder abuse is a “hidden epidemic”, and the scope is huge: it can be physical, emotional, financial or sexual; there is also neglect and self-neglect.

While the Domestic Abuse Act 2021 gives a framework, challenges persist of social isolation, caregiver abuse, power dynamics and, again, financial abuse. The role of professionals and how they report back on this is really important. I absolutely understand what my noble friend Lady Hayman is saying about not making the system overly complicated, but we have to find a holistic way of supporting people.

SafeLives has said that older people experience abuse before seeking help for twice as long as those who are under 61. Last year Age UK reported the fact that older people are overlooked by policymakers, service providers and programmes that are designed to support victims and survivors. Until 2021, people over 75 were not even asked about their experience of domestic abuse, so the lack of data means that there is an assumption about who is being abused. The ONS introduced new survey questions, which render comparison nearly impossible. Of course, the perpetrator of the abuse could be an adult child. What we found out is that women are at higher risk from their partners and men are at higher risk from adult children. Many organisations have talked about the need for professional support, which is really important.

When I am sitting in the Chamber and we talk about people becoming older at the age of 61, I wonder what the average age of the House of Lords is. I believe it is still 71, and everyone is incredibly active, but this is not the real world—on so many levels, it is not.