Terminally Ill Adults (End of Life) Bill

Lord Hamilton of Epsom Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Hamilton of Epsom (Con)]

The noble and learned Lord kindly agreed to address the issue of inadvertent misdiagnosis and he said that this group of amendments led by Amendment 71 was the time to bring that up. It was pointed out at the time by the noble Baroness, Lady Berger, that 23% of six-month diagnoses of death turned out to be wrong. How does that tie in with the Minister telling us that there had to be an assumption of an 80% chance of somebody dying within six months? Can the noble and learned Lord address that problem before we finish?

[Lord Falconer of Thoroton (Lab)]

First, I am saying that six months is safe for the reasons that Chris Whitty gave: six months is generally about right; it might not be right and it might be five months or seven months, but it is a proper basis on which to proceed. The statistical evidence that the noble Lord, Lord Hamilton, is relying on is about errors that are not of the massive scale that would undermine that proposition. Secondly, having just checked with my noble friend the Minister, she was not saying that it had to be 80% right. She was saying what the amendment said—I think it was in the name of the noble Baroness, Lady Lawlor—and why it was not an appropriate or workable amendment.

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Separately from those issues, the noble Lord, Lord Carlile, raised the effect on, for example, Christian-based care homes and their legitimate entitlement under Clause 31 to withdraw. Perhaps I may deal with that when we get to Clause 31 rather than now, because there are a series of amendments that deal with it.

[Lord Hamilton of Epsom (Con)]

This is the second Friday we have had where the target has been 10 groups of amendments and we have come well below half on both those days. If we go on scrutinising the Bill in the way we have been doing, it is inconceivable that it will ever reach the statute book, so is it not time that the noble and learned Lord really considered what he can salvage from the Bill, where there is agreement on both sides of the Committee, so at least something will get through that improves the lots of people in this country?

[Lord Blencathra (Con)]

My Lords, once again, this has been a good little debate, with more noble Lords participating than I expected. The whole Committee admires the noble Baroness, Lady Hayter, for the way she described her husband’s condition and the extreme care, and possibly good luck, she has had in finding an excellent home for her husband. When we were in the House of Commons, we could never tell these personal stories about our disabilities, because we would be regarded as showing a weakness and therefore not suitable to fight for our constituents. The wonderful thing about these debates over the past few weeks is that noble Lords from all sides have been able to relate stories about their own disabilities, afflictions and illnesses and those of their close relatives, which has added a tremendous amount of wisdom and compassion to our debates.

I say to the noble Baroness that my amendment does not seek to throw anyone out; it does not excuse anyone in a care home from getting treatment. We just want extra care for them. As my noble friend Lord Deben and the noble Lord, Lord Carlile, said, there are good care homes, bad care homes and downright ugly care homes. Our amendments are designed to deal with those that are not quite up to scratch.

The noble Baroness, Lady O’Loan, made the point that dementia sufferers are even more vulnerable. The amendments from me and from my noble friends Lady Eaton and Lady Lawlor are different, but the thrust is still the same: we are suggesting that a bit more care is necessary to determine capacity in care homes.

I must come to the important point made by the noble Lord, Lord Carlile, backed up by my noble friend Lord Deben, about the ECHR. I am a member of the Council of Europe. I have been elected to a specialist committee on observing elections in former Soviet Union countries. I was on the committee that elected judges. I am pleased to say that we elected—I was one of those who voted—a superb English KC, who is just retiring this year, to be a judge. I am also a substitute on the election committee. I totally support the ECHR. What I am critical of are some of the judgments we have had in the United Kingdom from some of our immigration judges, who I do not think have properly read the ECHR. I have no problems with the ECHR itself. I am totally in support of it and the principle—I am just worried about some of the judgments.

The other point that the noble and learned Lord made—he ended with this—is that responsibility for this must not rest with care homes alone, and I agree entirely. The noble Baroness, Lady Finlay, made the point that some care home staff are very worried about operating this. The noble Lord, Lord Carlile, made a point about Mission Care and Christians in care homes feeling that they could not work it either. My noble friend Lady Lawlor made the simple point that a higher bar is necessary for care homes. The noble Baroness, Lady Smith of Newnham—to whom we are grateful for revealing her father’s story—stressed that the vagaries of cognitive decline vary depending on the medication that one is on, and I have experience of that.

The noble Baroness, Lady Fox of Buckley, said that she did not want to talk about some of the horror stories in care homes. None of us wants to do that, although every other month we read about some of the appalling treatment that happens, particularly to those suffering from severe dementia. She said that there is a social care home crisis, and that is right. She was spot on about ticking the food boxes.

A few years ago I was in St Thomas’—early on in my MS days, when I had a relapse—and there was an old boy in a bed in the corner, aged 82. At that time we would tick the boxes for what we wanted the next day. Do Members recall that the Government appointed Mr Loyd Grossman to review menus at NHS hospitals? He did review them, but he just wrote them in fancy language. The choice for one morning was ground beef, suffused with basil and scented with carrot juice—or something—and chopped potatoes. This old boy did not have a clue what it meant. I managed to get to him and say, “It’s mince and tatties”, and he was able to understand it. The nurse said, “Oh, you don’t want anything to eat, Mr Smith”. He just said, “Porridge, porridge”. She said, “Oh, we can’t give you porridge. There is only the choice of mueslis”. I will not labour the point any further, but the same thing can happen in care homes, as the noble Baroness, Lady Fox of Buckley, said. She asked, in conclusion, how can one decide capacity between a patient who is on a good day and a patient who is on a bad day? People in care homes need extra special measures to determine capacity.

My noble friend Lord Wolfson of Tredegar made an excellent point about care homes: there are good ones and bad ones. He asked the Government to spell out what the consequences would be of my noble friend’s amendment and my amendment, and what the Government think about it.

I say to the Minister that I am tempted to put down an amendment to the Animal Welfare Act to protect the poor rabbit that has been pulled out of the Government’s hat to say that all our amendments are contrary to the ECHR.

Finally, I say to the noble and learned Lord, Lord Falconer, that our amendments may not be perfect, but the consensus from all noble Lords who have spoken, apart from the noble Baroness, Lady Hayter, was that something more needs to be done for care homes—a little bit of extra protection is necessary. When we were dealing 18, 21 and 25 year-olds, the noble and learned Lord said that we need to think about a bit of extra protection for them. He was right, and I look forward to seeing his amendment on Report on that matter. But the same goes here. We need a bit of extra protection for people in care homes, for the various reasons advanced by noble Lords. Having said that, I look forward to seeing his amendments on Report—and if not, we will table some ourselves. In the meantime, I beg leave to withdraw my amendment.

Terminally Ill Adults (End of Life) Bill

Lord Hamilton of Epsom Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Berger (Lab)]

My Lords, very briefly, I support the amendment that is calling for face-to-face consultations to take place, rather than only in exceptional cases. I want to reflect on why this matters. We know from other jurisdictions that many of these assessments are being done online. It is a really important question for us to consider whether we would want that in our country—and if not, it should be in the Bill. In addition, my comments are informed by the evidence that we were presented with in the Select Committee and drawn from my experience of meeting a number of elderly constituents over the course of nearly a decade as a Member of Parliament.

I reflect particularly on the women I met in their 70s, 80s and 90s who shared their experiences of domestic abuse. This conversation and these amendments matter because this legislation does not happen in a vacuum. The Labour Government today are rightly concerned with addressing the public health emergency of violence against women and girls in our country and has an important landmark mission and goal of halving violence against women and girls over the next decades. The NHS is playing its part and enhancing its efforts in tackling and violence against women and girls, focusing particularly on early identification. There is a lot of other very important work going on via training and investment, and I commend the work of many colleagues who are dealing with this on a daily basis. It was the experts that told us that to identify coercion, undue influence and pressure, doctors and other professionals need to look at someone’s body language. It is not just the words we say, how we say them, the volume or the tone—it is our non-verbal cues and what our body says. It is what we do not say that often shares an important message.

I listened very carefully to the counterchallenge of noble Lords so far. I do not think there is anything to stop the Bill from stipulating that, in exceptional circumstances, the doctors, or the independent advocates or panel members can visit an individual. But I would much rather that we had legislation that supports the Government’s important aim to reduce violence against women and girls, rather than something that will exacerbate the very serious problem that we know that too many women in our country face, particularly at their most vulnerable moments, which includes the end of life.

[Lord Hamilton of Epsom (Con)]

Can the noble Baroness recall that last week she told the House that 23% of six-months-to-live diagnoses turned out to be wrong and that people lived longer? Does that not make the whole position of face-to-face diagnosis much more important when doctors so often get it wrong?

[Baroness Grey-Thompson (CB)]

My Lords, technology has gone a long way to helping disabled people to lead inclusive and integrated lives in British society, and I generally support the use of it. But for many of us who worked on the coronavirus legislation, where we had to make very quick decisions, the speed with which we went online made it seem as if, as a society, we had moved decades forward from having to meet only in person. Even your Lordships’ Chamber managed to meet and vote online. But that comes with a set of challenges.

We have to look at what happened during Covid and the huge increase in domestic abuse. It was not just because we did not have to ask people to turn their cameras on. It was deemed that would be upsetting, so we could not see if somebody had been domestically abused. The impact of increasing domestic abuse was also because there was more recording. Even when you look at the technology that we have in your Lordships’ Chamber, it is not foolproof. I was on a call yesterday in my office. The system crashed twice, and the people I was speaking to on Teams did not even realise and carried on talking. We have to think very carefully about how we would use technology.

Age UK said that about 2.4 million older people do not have access to technology in this country and just under 2 million do not have a mobile phone, let alone a smartphone, so if we are going to do this, we need to think carefully about what other provisions will be in place. I agree with the noble Baroness, Lady Berger; why can the panel not go and visit the individual? I think there is something about being in their own home. The noble Baroness, Lady Pidgeon, raised rural areas. What if people do not have the technology? What will be put in place to ensure that there is a suitable online option?

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[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.

[Lord Hamilton of Epsom (Con)]

My Lords, I have supported AI for as long as I can remember, and I think it is the future for this country. If we are looking for improvements in productivity, there is no doubt that we should look to the National Health Service and the public sector, where we can see AI having its greatest effect and improving the health of the economy of this country.

However, we are in early days with AI, although it has been with us for some time. We must be very careful not to rely on it for too many things which should be done by human beings. The noble Lord, Lord Stevens, has already referred to the appalling rate of misdiagnosis. We can look at these statistics and say, “Well, it is only a small number who are misdiagnosed”. Yes, but my noble friend Lord Polack was misdiagnosed as only having six months to live and he is still with us 32 years later. You must think about this, because if you get the situation with misdiagnosis badly wrong, it undermines the basis of this Bill. Therefore, we must be very careful that AI does not contribute to that as well.

I pay tribute to the right reverend Prelate. AI is having a tremendous effect in the health service and helping a large number of people to get better, and it may well be that AI introduces cures for people who are being written off by their doctors—perhaps wrongly. We must not dismiss AI, but we must be very wary about where it leads us. There will be an awful lot of bumps in the road before AI is something in which we can all have complete confidence and believe will deliver better outcomes than human beings.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, there are just a few remarks I would like to make. We live in an age where it is hard to get a human to interact with any more. We lift the phone and speak to a voice that says that if you want one thing, press 1, and if you want something else, press 2. I fear that this is what we are heading for: if you want death, just press a button.

I have no doubt that if this legislation is passed as it is, in the near future we will be heading towards AI assessment procedures. My concern is not where we start in this process, but where it leads to and where it ends.

I am informed that, in the Netherlands, it has been proposed to use AI to kill patients in cases where doctors are unwilling to participate. Indeed, it is suggested that AI could be less prone to human error. Surely, in crucial assessments and decision-making processes for a person seeking assisted suicide, AI could not identify subtle coercion and assess nuanced capacity, bearing in mind the irreversible nature of the outcome. There are concerns about the risk of coercion or encouragement by AI. It should be noted that, with the newly developed AI functions and chatbots, there are already cases globally of individuals being coerced into all sorts of different behaviours, practices and decision-making.

Clause 5 allows doctors to direct the person

“to where they can obtain information and have the preliminary discussion”.

That source of information could be AI or a chatbot. Is there anything in the Bill that will prevent this?

AI undermines accountability. If the technology fails, who bears responsibility? Traditionally in the health service, the doctor bears responsibility. If AI is used, who bears responsibility?

Terminally Ill Adults (End of Life) Bill

Lord Hamilton of Epsom Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Hamilton of Epsom (Con)]

Does the noble Baroness not share my concerns about the misdiagnosis of six months, when you think of all the people who live for much longer afterwards?

[Baroness Hayter of Kentish Town (Lab)]

While that is absolutely a legitimate thing to discuss, and I would always defer to doctors on that, it makes no difference to this part of the argument of whether we call it dying. The noble Lord may well want to raise the question of whether we can ever be sure that someone is dying, although I have to say that I cannot be the only one who has been with someone where it is jolly clear that they are not going to live till the end of the week. There are times when you absolutely know that someone is going to die. While he may well be right that there are other cases, that is not the issue of this word. This word in the Bill is to give to the public the understanding that we are talking about whether there is a way of helping either the final timing or the way of those final days. We are not talking about someone who just decides to commit suicide for some other reason; we are talking about people who are dying from some sort of terminal illness.