Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Friday 27th February 2026 Lords Chamber

[Lord Deben (Con)]

I think it perfectly right for the noble Baroness to have intervened because I referred to her, and I apologise.

I want the noble and learned Lord proposing the Bill to face three issues that are centred around these amendments—which I am dealing with, I say to the Whip. These amendments are trying to meet the genuine concerns of people who are not necessarily opposed to the Bill. They want to make sure that this key person knows what his or her job is, is appointed in a way the public can have confidence in, and is not the harbinger of what has been called mission creep. Those are three very simple things to ask for.

This is the thing that really worries me. I say this directly to the noble and learned Lord, Lord Falconer. I cannot understand why, at the beginning of the Bill’s passage, he did not say, “First, we know that there is a problem that it used to be thought this Bill had a judicial element to it and it does not now, and I am prepared to look at how to change that. Secondly, we know that the professional bodies have real concerns, and I am going to present my answers to those. Thirdly, I know that there is much in this Bill that is not specific enough, which is why the Select Committees have said it is inappropriate and unacceptable in its present form, and I will put those things right”. Had he said those three things, we would have been a long way forward with the Bill.

Therefore, the Bill is being held up not by filibustering but by the fact that the people who have put it forward are so determined that it will pass that they are not willing, it seems to me, to listen to reasonable comments—even from people who have restrained themselves from entering into the bear garden they have managed to stir up in the media.

[Lord Sandhurst (Con)]

My Lords, Amendments 430 and 434 in my name go to the practice in operation. I will introduce them by making this point. I was one of the seven people fortunate enough to be identified in the Observer a couple of weeks ago as having tabled a lot of amendments. Contrary to what the Observer—and the quite numerous hostile messages I have received by letter or email—suggested, these amendments, together with all the others I have tabled, except for two relating to the victims of industrial disease, were put forward by the Law Society of England and Wales and by the CLADD group at King’s College London. The latter, for those who were not here the other week, is a group of a distinguished psychiatrist, psychologist, social scientist and lawyer with a particular interest in this and related issues. They and the Law Society are neutral on the principle of the Bill but want to see a safe and effective Bill. Amendments 430 and 434, together with others I have tabled, are aimed at that.

Amendment 430, some will be pleased to see—others will not—is for a streamlined, non-panel basis. It would insert a new clause saying:

“This section applies where the Commissioner receives … a first declaration … a report about the first assessment … which contains a statement indicating that the coordinating professional is satisfied as to all of the matters … a report about the second assessment of the person which contains a statement indicating that the independent professional is satisfied as to all of the matters … The Commissioner must, as soon as reasonably practicable, consider the person’s eligibility to be provided with assistance”.


He or she may then

“consider the person’s eligibility personally … refer the person’s case to a person qualified to sit on the Assisted Dying Review Panel”,

or

“refer the person’s case to a multidisciplinary panel”.

In practice, this means that it would be a modified procedure where there is agreement between the co-ordinating and independent professionals. The commissioner could then consider the application alone or refer it to the panel, so it would not necessarily have to go to the panel. A full panel would be mandated only if the independent professional is not in agreement with the co-ordinating professional that the criteria are met, or if it becomes clear during the modified procedure that further evidence is needed.

Some of those who are not in favour of the Bill may be concerned that this amendment could potentially weaken the process. I remind the Committee that Dame Caroline Swift, latterly a High Court judge but formerly lead counsel in the Shipman Inquiry, has said she is afraid that safeguards on assisted dying are likely to be eroded. We have to be very careful, because Dame Caroline Swift was right at the sharp end of looking at this. That is important, as she has seen what happens with a rogue doctor. She said:

“Those safeguards may seem adequate now but they are likely to be eroded over time. As Leading Counsel to the Shipman Inquiry, I saw how this had happened with the safeguards for the issuing of cremation certificates … Over the years, the second doctor’s role became diluted, they were seldom independent of the first, rarely examined the body and the signing of the second form became little more than a ‘tick box exercise’”.


My Amendment 430 might later be at risk of leading to dilution, but I hope it is an indication that there might—in clear cases, where everyone is agreed early on—be a way of moving it on swiftly, to the advantage of someone who is really anxious to go down this course and has capacity and all the other requirements. I hope that will be seen as a positive move and not a wrecker’s move. I am surprised that no one has come to me since this was tabled and said, “That’s a good idea; we’ll stick it in the Bill”.

Amendment 434 would amend Clause 16 and is simply intended to make it clear beyond doubt that referral to the panel is mandatory wherever the independent professional is not satisfied that all the requirements are met. The Law Society believes, and I agree, that as it stands it is not necessarily mandatory, and it should be. So, I ask rhetorically, why not? Are these not both jolly good amendments?

[Baroness O'Loan (CB)]

I will speak to Amendment 146, tabled in my name and the name of the noble Baroness, Lady Eaton, but before I do so, in the interests of brevity, I say that I support all that has been said in the context of the appointment of the commissioner. This cannot be a personal prime ministerial appointment; it cannot be a matter of patronage. The role must be insulated from day-to-day politics, especially given the risk of damage to trust in nurses, doctors, the judiciary and in this new process by which the state enables the taking of life. I agree, too, with the amendments which seek to introduce some process to the actual appointment of the commissioner, and I agree with the amendments in relation to conflicts of interest and registers of interests.

Through Amendment 132, the noble Baroness, Lady Cass, seeks to establish conclusively that the commissioner’s principal functions are monitoring and reporting on the assisted dying process. Her Amendment 122 would introduce a new role, that of director, who will put the assisted dying regime into action, selecting and overseeing panels, receiving applications, and deciding on appeals and the other duties in Clause 44. Both the British Association of Social Workers and the Law Society gave evidence that an independent regulator for VAD was essential. In Amendment 128, the noble Baroness, Lady Foster, who is not able to be with us today, identifies necessary duties which would provide additional safeguards, ensuring compliance, identifying risk and identifying the circumstances in which things may go wrong with possible tragic consequences.

I want to speak to Amendment 146—the noble Baroness, Lady Eaton, is unable to be with us today—which is about the very specific risk to people in care and nursing homes, the majority of whom are vulnerable for one reason or another. The situation of care homes is a matter which the noble Baroness and I have raised repeatedly during the course of the Bill. This amendment develops an obligation which would be imposed by the noble Baroness’s Amendment 128, requiring identification and mitigation of risk. It imposes a duty on the commissioner to monitor and identify emerging risk in the operation of assisted dying in registered care or nursing homes, and to take reasonable and proportionate steps to prevent or mitigate that risk. Where such risk appears systemic, the commissioner must notify the Secretary of State for Health and Social Care, so that appropriate remedial action can be taken.

The issues of vulnerability and capacity, the risk of coercion and the risk of abuse are all particularly relevant to care and nursing homes. Can the noble and learned Lord, Lord Falconer, assure the Committee that these matters really have been properly considered and provided for? I have some difficulty, because the scope of the issue is massive. In 2023, the year for which there are the latest official figures, nearly 400,000 people lived in some 15,000 care and nursing homes in England and Wales. Some 85.7% of the total number of beds in care homes were occupied at the time of the survey. Some 70% of all care home residents have dementia or severe memory problems. The average period of residence in a care home is about two and a half years, and most of them die in the homes. Those figures will have increased in the three years since they became available. Some 120,000 people a year over 75 are diagnosed with cancer. There will therefore be a significant number, possibly the largest cohort in England and Wales, with a terminal illness—however you define it—who will have a prognosis of six months or less to live, and who live in our care homes. On the basis of these figures, it is possible to extrapolate that tens of thousands of people living in care homes will be eligible for assisted dying.

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[Lord Falconer of Thoroton (Lab)]

I could not agree more with the noble Baroness, Lady O’Loan. That is why, in addressing these issues, we have been very specific about what the voluntary assisted dying commissioner can do in both Clause 4 and the schedule. What is more, that is why we have such a limited panel that can be made for the voluntary assisted dying commissioner. It has to work, and that is why it has been drafted in this way. The noble Baroness is absolutely right that judicial review is an expensive process, and it provides a guardrail, but ultimately there must be sufficient detail in the Bill to give the public confidence that the system will work. That is why we have, for example, restricted it to a Supreme Court judge, a Court of Appeal judge or a High Court judge. We are absolutely on the same page on that.

I turn to the noble Lord, Lord Sandhurst. My understanding of his Amendment 430—although I may not be correct—is that, where the two doctors agree, the assisted dying commissioner, if he or she agrees, can then short-circuit the need to go to the panel. That is my understanding of the amendment, which is interesting. However, my anxiety is that we would then, in every single case, almost, be getting rid of the panel. The position would be that you only ever get to the panel if both doctors have agreed. The sponsors presented the Bill to this House on the basis that, in every case, the safeguard is—to shorten it—two doctors and a panel. So I respect the thinking, because it is trying to streamline the process, but I do not think that it is appropriate, and it would undermine the safeguards.

[Lord Sandhurst (Con)]

The noble and learned Lord is right. When I introduced the amendment, I did say that there might be problems with it, but I thought it was something that should be looked at.

[Lord Falconer of Thoroton (Lab)]

Yes, I understand that.

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Family members, carers and friends must not be forgotten. They need support while their loved one is going through the procedure and after death. A demedicalised model could include the offer of bereavement counselling. Such services could be extended to those who were not party to the person’s decision that they wanted to die but who then find out afterwards and feel excluded. It is highly unlikely that these wraparound services would be available within the NHS, or that taxpayers would be willing to fund them. Why then leave such services and care to charities and private organisations, while setting up a fully funded dying service within a health service? In my advertising days, I would have said that this goes against the NHS’s brand guidelines and values. My amendments offer another alternative, and I hope the noble and learned Lord will take the opportunity to clarify this in his response.

[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.

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[Lord McColl of Dulwich (Con)]

My Lords, I wish to speak to my Amendment 941. As a medical professional, I know only too well that medical interventions can be driven by financial motives; organ harvesting for a profit is one such example. When medical interventions are financially motivated, the best interests of the patient may be compromised. This amendment would help to prevent such compromise. It would deter the sort of financial abuse that could happen during the course of the assisted suicide process and would protect, in particular, the most vulnerable. I commend it to the Committee.

[Lord Sandhurst (Con)]

My Lords, I wish to speak to 21 amendments in this group. It is my misfortune that they have all been shoved together, giving me around 30 seconds on each one.

It is really important that the powers of the panel are clearly defined and that what we end up with is in accordance with what Parliament wants and intends. Each of the amendments that I have put down comes from either the Law Society or the CLADD group; to this extent, I endorse entirely what my noble friends Lord Murray and Lord McColl just said. The management of evidence gathering in the process is vital. My amendments aim to try to put that into some sort of proper regime that is set out on paper before the Bill becomes statute.

Amendment 929A is aimed simply at panels being able to consider cases with expertise appropriate to the particular nature of the case. It says that

“the Commissioner must have regard to the nature of the expertise required to determine the particular circumstances of the person”

in question. We know that there is a lack of psychiatrists in this country—it is in the public press all the time—so it is important that, when this process kicks off, there are sufficient psychiatrists who are willing and able to sit on these panels and to devote the necessary time, because they will have to make assessments. There is a risk that the commissioner may struggle to find enough of them.

Amendments 922 and 923A ask that there be sufficient people and say that they must be specified in regulations. In particular, they must have expertise in relevant matters as set out in regulations, so the Secretary of State would have to identify what expertise will be required and who is to address it.

Amendment 927A asks that one of the panel’s members

“must be a legal member”.

We cannot possibly have panels that do not have a lawyer on them. There must be a legal member with the expertise to deal with the particular case. Indeed, I note that, in giving evidence to the Select Committee, Sarah Hughes of Mind said that

“it is really clear that the safeguards described in the current Bill are not adequate”.

The British Association of Social Workers has also said that the current safeguards are not enough. Those are disinterested, important bodies with expertise in this area.

Amendment 928 aims at the target of medical expertise. There must be someone on the panel who can take a properly informed view of the diagnosis being given to the applicant.

The point of Amendment 473 is to insert the word “evidence”, which is very important, because it is not clear what the status of these panels and of the material given to them will be. The word “evidence” means that, or will have the effect that, the panel will clearly operate as a formal body. It would not make it a tribunal, but it would make the process formal and the panel act properly.

Amendment 479 would enable the panel to

“require a local authority or an NHS body to arrange for a report to be made dealing with such matters relating to the person as the panel may direct … or … such other person as the authority, or the NHS body, considers appropriate”.

There is more to it. This is the equivalent of Section 49 of the Mental Capacity Act 2005, which gives the power to the Court of Protection to get reports from the NHS or local authorities in order to allow it to discharge its inquisitorial powers. We need something similar here. It would reinforce the seriousness of the panel.

There are other provisions in this amendment to make it plain that the panel can appoint an expert to test evidence if it does not have its own expertise. It needs to have that power. In an appropriate case, the panel may hear evidence on oath, but it will be under no obligation to. That is in my proposed new paragraph (h). There may be cases where it is very anxious about some of the things it has heard, and it may think that putting someone on oath makes them think very seriously about telling the truth, the whole truth and nothing but the truth.

I will move on. I am trying to take this at a gallop.

Amendment 465 is another Law Society amendment. It would show that, although the panel is not a court, it is a formal body by using the word “evidence” in the provisions. That word will make the panel take it seriously. I am not suggesting that the people on it will be lightweight people, but the process is important. Those of us who are lawyers in particular will know that process is important, and it affects how panels and tribunals conduct themselves. If it is not to be called evidence, it will not have that same effect. The Law Society suggests that it is currently unclear precisely what status the information being received will have. It will not be a court, but it will be a formal body, and that provision occurs in some other amendments—Amendments 470 and 476, and possibly elsewhere.

How does the noble and learned Lord, Lord Falconer, understand the panel’s evidence-gathering powers? Will it be exempt from the normal rules of medical confidentiality and data protection? Will it be able to gather evidence from witnesses even if the patient does not want details to be shared? Will it be an executive public authority, subject to the limits that apply to the Government, or will it be a judicial body with unique powers? To say it is quasi-judicial does not answer the question; it is either one or the other. We need to know what powers it will have. Will it be those of an independent tribunal or not? This picks up the observation made by my noble friend Lord Murray.

Amendment 494 would mean that the panel would have to notify relevant bodies if it considers that the person meets the criteria but the request was made because the service provisions had failed in the past. This would be important in monitoring the Bill’s impact on health and social services. It would show whether someone has come for this because provision has not been made. That would be important in looking forward and seeing how we can improve the delivery of health services to the public. It is not a barrier, but it will provide valuable information.

Amendment 934, another Law Society amendment, would require the Secretary of State by regulations to make provision for how the chair of a panel is to decide whether to grant a person’s request that the panel sit in private, including the factors to be taken into account and the processes to be followed. Will it be sitting in private? Will it be sitting in public? How is this to be addressed? These are important practical questions that are bound to arise on the ground.

Amendment 934A, another Law Society amendment, states:

“For purposes of the law of contempt, where a panel determines a referral in public, then unless the panel provides to the contrary, publication of information about the person to whom the referral relates shall be treated as contempt of court, as if (in any relevant legislation) for the word ‘court’ were substituted ‘panel’”.


The panel will not be a court, but it will be hearing very sensitive information in public hearings by default. These amendments seek to ensure that such information about a person is not made public. The late and, I would suggest, great Sir James Munby remarked that

“judges are kept up to the mark by two things—having to comply with proper procedure and being exposed to the public gaze”.

He said that the same thing should apply to panels.

The Law Society told the Select Committee:

“What is unclear at the moment is where the panels will be held and how people would know about them”.


Obviously, consideration about whether the panels are private or public, and then where the powers would come from potentially to restrict the information and then being able to be made—

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

Will the noble Lord please wind up? He is over his time.

[Lord Sandhurst (Con)]

I hope the Committee will indulge me a little. All I will say is that I ask noble Lords to read carefully my amendments, which all come from the Law Society or CLADD. I will say one thing. I hope noble Lords will forgive me, but it is clear that this group will go beyond today, I would have thought, looking at the number of amendments there and the fact that we only have two hours left. If I need to leave—

[Lord Rooker (Lab)]

The noble Lord should sit down now and come back, still on this debate.

[Lord Sandhurst (Con)]

That is what I am hoping. Thank you very much.

[Lord Weir of Ballyholme (DUP)]

I rise to speak to two amendments in my name in this group, Amendments 496A and 496F. At the outset, I want to give an apology to the sponsor and to the Committee as a whole, in line with the Chief Whip’s procedural recommendations. Given that I suspect that this will carry on at least until 6 pm, I will unfortunately have to leave almost certainly before the end of this debate to catch the last flight home to Northern Ireland.

Both these amendments, like a number of the amendments that I have submitted, deal with concerns that have been raised with me by disability groups. We are aware, again without reiterating the detail of this, that a wide range of concerns has been raised by a large number of groups representing the disabled, which vary between having some concerns and total opposition to the Bill. As we know, no disabled group has expressed support for the Bill. Where concerns are being raised, it is important and incumbent that, where we can try to improve the Bill by trying to take on those concerns, we listen to them.

I will deal with the two amendments briefly, Amendment 496A would add an additional ground to the grounds for reconsideration: failure to adequately consider or to be inconsistent with evidence of disability-related vulnerabilities. I suppose the aim of this is to provoke an examination of the extent to which reconsideration focuses on the particular needs of the disabled. It may not necessarily be the route that I would pursue on Report, but the purpose of this is to ensure that the commissioner, when looking at this, focuses explicitly on the impact on disability and vulnerability.