Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Friday 30th January 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

My Lords, I want to make two points about whether these consultations should be face to face. First, I remind the Committee of the General Medical Council’s remote consultation diagram, which is in the GMC guidance. It is not absolutist about whether doctors should see patients remotely or face to face, but it sets out guidance. It starts:

“Remote consultations may be appropriate when… The patient’s clinical need or treatment request is straightforward”.


We are not talking about straightforward clinical needs or treatment requests here. The other side of the diagram says:

“Face to face consultations may be preferrable when… The patient has complex clinical needs or is requesting higher risk treatments”.


As I have said previously, and it is historic, I was a lay member of the General Medical Council for 10 years and I was involved in helping to draft GMC guidance as well as dealing with conduct and health cases. It is unimaginable to me that the General Medical Council would create guidance in which it accepted the proposal that, save from the most exceptional circumstances based on the clearest evidence, such consultations should be done remotely.

Secondly, the medical profession is not the only group of people who have to give important advice to their patients, clients or customers. Like a few other Members of your Lordships’ House here, I have often had to give advice to people in critical situations when they faced spending possibly the rest of their lives in custody. I recall one case when, in the middle of a longish murder trial, the client asked to see me to ask a very simple question, “How do you think it’s going, sir?” The answer had to be robust and realistic, and it was very difficult. It changed the whole course of the case, which came to a quick end shortly afterwards. The result was a minor advantage to the client: he did not spend the rest of his life in prison, just a substantial proportion of it, but that was very important to him.

I would say to your Lordships that it is quite difficult to see a doctor these days, unless you go to a private doctor. Even if you have seen a doctor, it is quite difficult to see the same one twice. There are remote hearings in the legal profession in certain circumstances, but for the sort of important decisions that I have been describing, it is unthinkable—to us, the professional lawyers who do these cases—that such consultations should not be face to face. That is a qualitative analysis based on two examples, but I hope your Lordships found it convincing.

[Lord Sandhurst (Con)]

My Lords, I can be truly short here and it is further to a point made by the noble Baroness, Lady Grey-Thompson. Many of us are concerned about subtle pressure and coercion. It will not appear in all cases, but it will in some and these are legitimate concerns. If this is online, doctors are unlikely to know whether there is someone else present in the room or whether the door is open for someone to listen, nod and encourage the applicant—if I can call the person that—to make their request. If at least one of the panel is present in the room, they would be able to see and counter that. It is really important that there is at least one of those people, preferably the panel, in order to prevent that. That is an important safeguard and, if it is done online, such things could be missed. My recollection is that, in Canada, there have been instances where people, including coroners, have raised legitimate questions afterwards.

[Baroness Falkner of Margravine (CB)]

My Lords, I want to pick up on two points made in this debate. First, if I heard the noble Baroness, Lady Gerada, correctly, when she advocated online meetings, she said that there is no distinction between whether the person requesting permission is in Torbay or Tenerife. That is a profoundly important legal point, which I hope the noble and learned Lord will cover in his summing up. If a person was in an online meeting in a foreign jurisdiction and it subsequently transpired that there was coercion—noble Lords have given several examples of how that could happen—from a foreign citizen, assuming the patient returned to the UK to carry out their wish to be assisted to die, what would be the legal position in the criminal law?

My second point relates to what the noble Baroness, Lady Berger, said about home assessments. I do not have the impact assessment to hand, but I recall that the number of people likely to seek assisted dying is not enormously large, running, say, to many thousands per year. Therefore, if only 10% of people were unable to have face-to-face consultations, surely the impact assessment should cover that small minority of people and the costs and practicalities of them requiring home assessments.

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[Lord Harper (Con)]

My Lords, in moving my Amendment 70, I will also speak to my Amendment 78 and to Amendment 829 from my noble friend Lord Sandhurst. The first two amendments were originally tabled in the name of the noble Lord, Lord Hendy, who was unable to be here last week—although we did not get to them then—so I have taken them over in my name.

I will explain to noble Lords why they have been tabled. They are responding to concerns raised by David Green, a barrister specialising in industrial disease cases, and Michael Rawlinson KC, who wrote to a number of Peers, alerting us to the fact that the current drafting of the Bill can negatively affect some victims of occupational diseases. I will set out that concern and then the noble and learned Lord, Lord Falconer, can, I hope, respond to it in a more detailed way than he did in the letter that he circulated to Peers in the past day or so. I will also raise a couple of related issues that we will come to later in our debates and that concern similar issues.

The reference in the amendments is to “injuries” or “disease” that people get during their working life. The reason for including those words is to raise the following issue. If victims of occupational diseases opt for assisted suicide, their dependants, under my reading of it, would probably lose their right to sue whoever caused their disease under the Fatal Accidents Act 1976, unless this Bill specifically provided otherwise, which it does not currently.

I will give noble Lords an idea of the size of the issue. In 2023, 2,218 people in Britain died of mesothelioma, which is the prime fatal occupational disease. It is a fatal cancer caused exclusively by asbestos. By way of comparison, that is considerably more than the 1,624 road deaths that year and we know how seriously the Government take that issue; they have just published an entire road safety strategy to reduce that number. Many more died of lung cancer with asbestos as a causative factor, or of respiratory failure secondary to asbestosis or pleural thickening, or of other occupational diseases.

Since virtually all instances of mesothelioma are caused by asbestos exposure, and most asbestos exposure was occupational, most victims can sue a former employer—in reality usually represented by an insurer. The damages recovered are an important way of paying for medical and nursing care and, importantly, of providing for surviving dependants. Claims arising from these occupational diseases can be pursued during the lifetime of the victim or by their families after their death under the Fatal Accidents Act 1976 and the Law Reform (Miscellaneous Provisions) Act 1934. A good deal of claims are pursued after death in this way for the benefit of families, partly because the prognosis following a diagnosis of mesothelioma is, sadly, relatively short. That is why so many families have to seek the damages rather than the victim being able to do so.

The key point is that the dependants of a deceased person can sue if, and only if,

“death is caused by any wrongful act, neglect or default which is such as would (if death had not ensued) have entitled the person injured to maintain an action and recover damages”.

That is in Section 1(1) of the Fatal Accidents Act. The requirement is that the breach of duties caused the death, but the law that has developed on that section requires an unbroken chain of causation between the defendant’s breach of duty and the death if the dependants of the deceased are to recover damages. In general, an individual’s decision to end their life by suicide breaks the chain of causation between a defendant’s earlier breach of duty and the death. In other words, the law considers that the death has been caused by the choice of the victim and not by the negligence of the defendant.

There are narrow exceptions to this rule—for example, where the defendant’s breach was of a duty to prevent suicide, as it was in the Reeves case, or where the defendant causes a psychiatric injury that itself causes the suicide. But where an individual has full capacity—we know that they must have if they have used this Bill, if it becomes an Act, because we have debated that at length—and the defendant’s duty was decades in the past, the common law would regard a freely made choice to end their life as a novus actus interveniens. Forgive me if I mispronounced that, not being a lawyer, as I have said on many occasions. It is a new and different cause, breaking the chain of causation.

That would mean that the person who died of fatal mesothelioma would have their cause of death recorded by the coroner as an industrial disease, but Clause 38 as drafted makes provision for the cause of death in these cases to be recorded for coronial and certification purposes as an assisted death and excludes this cause from the category of unnatural deaths, meaning that there is no inquest. That means that the assisted deaths will necessarily not be certificated as being caused by industrial disease, even if that were the cause of the terminal illness that led the deceased to be eligible for an assisted death.

That means that, under common law and the Fatal Accidents Act, it would break the chain of causation between the former employer’s negligence and the victim’s ultimate death. That means that a victim of an occupational cancer with a limited life expectancy who would meet the criteria in the Bill—and who would probably face a painful and unpleasant death, even though that is not a criterion in the Bill, as we have debated—has a dilemma. They have a choice between prolonging their suffering but preserving their family’s right to damages and ending their suffering but losing a right potentially worth hundreds of thousands of pounds to the people they leave behind. At the moment, that is not dealt with anywhere in the Bill.

I have a specific question about that, and I will refer in a minute to what the noble and learned Lord said in his letter. But I also want to ask whether there are other areas where similar issues have not been thought about. Two come to mind, the first of which is members of the Armed Forces. I tabled an amendment, which will come up later, because the compensation schemes in the Armed Forces again would not, in my understanding, pay out if somebody got an occupational disease because of their military service. If they were to seek an assisted suicide, that would preclude them and their dependants from receiving compensation under that scheme. That is even more particularly a failure given the duty of care that the state owes to those who put their lives at risk on its behalf.

I would also be interested in understanding the interaction between this and the Government’s statutory diffuse mesothelioma payment scheme. In cases where there is no employer or insurer still in existence, or they cannot be identified, there is a statutory scheme, which I know a bit about; I took the regulations through Parliament as a Minister in the Department for Work and Pensions. That pays out on diagnosis. It means, potentially, someone whose employer was still around and on the hook who sought an assisted suicide would do themselves or their dependants out of compensation, whereas somebody whose employer or insurer was not around or not traceable and who qualified under the statutory scheme, which is paid out on diagnosis, would actually not do themselves— I think—out of the compensation. That seems an invidious position based on complete chance.

I do not know whether that has been thought about by the sponsors of the Bill. I would be interested to know the specific answers to those questions and whether there are other areas like this which have not been considered. If this had been a government Bill, as part of the process, other government departments would have looked at it, thought about these issues and would have made sure they were dealt with.

My final point is that the noble and learned Lord referenced this and dealt with it a bit in the letter that he circulated. He thanked my noble friend Lord Sandhurst and the noble Lord, Lord Hendy—whose name, as I said, was originally on these amendments—for their conversations. He said that he had tabled amendments to Clause 47, the reporting section of this Bill, which would require an early report about the impact. I welcome that, but I do not think it goes far enough.

If this Bill goes on to the statute book, there will be people whose legal position will be put at risk and damaged by what is in it. That is not going to be remedied by a report. If the report comes out and says “Yes, there is a problem”, it will require further primary legislation to fix it. It would be better if we understood what the issue is now and, if there is an issue, we should make sure there is an amendment tabled for Report which would deal with it—both for the Fatal Accidents Act and members of the Armed Forces.

In this area, it would be helpful if—I do not think this breaches the Government’s neutral position on the Bill—any other similar areas were identified so that we could deal with them with amendments on Report. That would be welcome. That was my purpose in tabling these two amendments. It is a very important area, and I look forward in due course to the answers from the noble and learned Lord, Lord Falconer. I beg to move.

[Lord Sandhurst (Con)]

My Lords, I will follow my noble friend and, I hope, be reasonably concise.

I asked for my Amendment 829 to be grouped with these amendments as it covers the same substantive ground. It was helpful that, about a fortnight ago, with the noble Lord, Lord Hendy, I met the noble and learned Lord, and we discussed this situation. Broadly speaking, there was acceptance. As I understand it, the sponsor of this Bill will be bringing forward an amendment which will tidy up various loose ends. The word “review” will be changed to “assessment”, there will be reference to victims of occupational diseases and one or two other tidying-up matters.

As has been explained—I can do this briefly, but it is important—as the Bill is drafted, it is highly probable that a victim of an occupational disease, such as asbestosis caused by the negligence of some tortfeasor, will, if they go down the assisted dying route, lose the right to recover damages for the injury that has put them in the position where they wish to die. This will also mean that their heirs and successors—their family—will lose that right to the Fatal Accidents Act claim.

If someone is suffering from a horrible illness, they may decide that they cannot bear it any longer and that they wish to terminate their life just a few months before the end. It would be quite wrong if their family and dependants, who deserve the money to cover themselves for the whole of the life that that person would have enjoyed but for the injury that created the asbestosis, should lose that entitlement to compensation because the victim has gone down the route of assisted dying. As the law stands—it has been to the Supreme Court or the House of Lords not in this context exactly but in others—it is quite clear that this would be a break in the chain of causation. It seems such to me and to others who are interested in this field.

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[Lord Falconer of Thoroton (Lab)]

My Lords, there are effectively two entirely separate issues raised by this group of amendments. The first is whether we should extend the current eligibility to people who have an inevitably progressive illness or disease to somebody who is terminally ill because they have injuries—for example, from a car accident—that might make them die within a specified period.

I was not sure whether the noble Lord, Lord Harper, was pressing that as an amendment, because the thrust of his remarks was much more focused on the effect on the Fatal Accidents Act. Whatever his position, I am afraid that I am not in favour of that amendment because the whole Bill has been put together and the argument for it has been based on people who are terminally ill. That is very different, for a whole variety of reasons mentioned by people, from somebody who is the victim of an injury.

I can see that people might say there was considerable moral equivalence, and the noble Lord, Lord Hendy, was right to say how persuasive he was when I spoke to him in relation to it. However, my clear view is that we should not extend the Bill beyond its current eligibility. I should also make absolutely clear that the wording of the Bill is clear; there is no prospect whatever that a court could construe the words “illness” or “disease” as meaning “injury”. What we send from Parliament will be the way it is read.

[Lord Sandhurst (Con)]

I am surprised by that because mesothelioma is an illness or disease caused by the injury—and that injury has been inflicted by the wrongdoing.

[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.

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I encourage my noble and learned friend, Lord Falconer of Thoroton, to consider these amendments and, if not, to at least assure the Committee that we can make sure this legislation protects against ageism, ableism and a quiet drift from terminal illness to judging certain lives as less worth living. In that sense, these amendments are not hostile to the Bill’s supporters. They are an invitation to make the Bill honest about its scope, defensible in law and safer in practice. I therefore strongly support Amendments 99, 102 and 105. I urge the Committee to do likewise.

[Lord Sandhurst (Con)]

My Lords, I speak to Amendments 82 and 83A in particular, which were advanced by my noble friend Lord Polak, who could not be here after 4 pm today, and I said that I would speak in support of them. I endorse entirely what my noble friends Lord Taylor of Holbeach and Lord Frost have said—theirs were admirable speeches and every word was right.

Amendment 82—I can take this shortly, as I am conscious of the time—addresses the phrase “reasonably be expected” in defining who is terminally ill. It asks for those words to be removed and seeks to insert in their place,

“be highly probable and require dual specialist certification by independent consultants”.

In other words, it is to do with the vagueness which would otherwise occur, and which would be subjective and dangerously elastic as life goes forward five and 10 years down the road and this Bill is applied—I am assuming that the Bill will come into force.

The threshold is too low and the condition is too uncertain. Inserting these words would require two independent specialists—consultants with expertise in the relevant field. When looking at vagueness and uncertainty and the risk of people who are not really experts in the field giving this sort of advice to an individual, I was particularly moved by the powerful speech of the noble Baroness, Lady Campbell. We have heard others, as well, from those who have had similar experiences, not least my noble friend Lord Polak, who cannot be here and who would have been speaking to this amendment. I know it is that which has motivated him to bring this amendment. Amendment 82 would introduce a higher test. It would be a safeguard that is both practical and ethical. It is about introducing something which is much closer to certainty or confidence, not just vague possibilities.

Amendment 83A does not touch on the six-month timeframe. It would ensure that eligibility for assisted dying rests on rigorous and established clinical standards, not on a broad prognostic guess; it would be determined by clinical judgment, in accordance with peer-reviewed palliative care standards. It may be that someone can come up with a better way of putting it, but it is a shot at saying something that doctors in this position will understand.

I remind the Committee that my noble friend Lord Polak is living proof that such predictions can be very wrong. Amendment 83A would be a step towards a proper principle. It would retain the six-month timeframe but would insist that the judgment was grounded in peer-reviewed palliative care standards, not vague estimates. These small amendments would strengthen the Bill and safeguard our humanity, if we decide to go down the route of adopting it.