Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
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.

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to my noble friend Lady Cass for having clarified that so well. I welcome my noble friend Lady Campbell back to the Chamber and thank her for her contribution, with all her in-depth experience, which complements and builds on that of my noble friend Lady Grey-Thompson.

This debate has gone right to the heart of an area that is not clear in the Bill, which is whether this is or is not a medical treatment in terms of providing an assisted death. There seems to be lack of a clarity on that. When the Bill was in the other place, the Bill Committee, in an exchange, highlighted the ongoing confusion around the point and the profound consequences of it. One member of the Committee asked the sponsor whether doctors would have to suggest assisted dying to every potentially eligible patient as they are required to do with all medical treatments—you must inform the patient of everything that is an option for them. The sponsor replied positively that doctors are required to set out all the available options. The sponsor was then asked again by a different member of the committee about doctors having a duty to raise it with every patient, to which she replied they did not and that it should be down to professional judgment. There is a fundamental conflict there for the routine doctor looking after a patient.

Earlier today, we heard about the concern over ableist attitudes. I have to say that one does see them. It is not uncommon to hear people say, “Oh, it must be awful to be like that” in relation to somebody who has a disability of some sort. Of course, nobody wants to be disabled. I have never come across a patient who has said, “I want to have spinal cord compression now”. Of course they do not. Nobody wants it, but in the event, you have to try to not get into a very negative view with the patient and make sure that you make options available that are likely to improve their quality of life, irrespective of whether they extend their life.

It would be important for the noble and learned Lord to confirm whether he considers assisted dying to be a form of medical treatment, and if it is, to say whether doctors have a duty to raise it with every potentially eligible patient. There has been concern that some patients might be hinting that they want to talk about having an assisted death, but they cannot quite verbalise it. As anyone who has taught communication skills knows, when you are in doubt, you answer a question with a question and you keep on exploring so that people will tell you what they really want to know and think about, and you use their own words, because people have different words for different things. That is quite common. The Bill needs to make it absolutely clear what it is because requiring an assessment will be quite different if it is being suggested by a doctor versus if it is, as we debated earlier on today, instigated by the person themselves.

The medical royal colleges and equivalent bodies are clear: they do not regard assisted dying as a medical treatment and would prefer it to be delivered outside medical settings. My professional group, the Association for Palliative Medicine, has expressed the view that assisted dying services should be implemented outside usual medical practice. The BMA does not believe that assisted dying should be integrated into existing care pathways. Fraser Rickatson from Care England pointed out that in its survey,

“some expressed very clearly that this goes against their ethos as a care service”.

Michael Mulholland from the Royal College of General Practitioners told our Select Committee:

“The whole question of making decisions for assisted dying is against everything that I have been trained in and I have practised for 30-plus years. The outcome at the end of life has been that we will support and care for you and provide palliative care, as best we can in the circumstances”.


He went on to say:

“As a college, we would hope that this goes on to the face of the Bill that we would have a separate service”.


We have had discussions about people’s internal feelings, possible external pressures and coercion that may be felt by a person, the difficulties of assessing those and all the grey areas that my noble friend Lady Cass has referred to in this spectrum that we deal with every day in clinical practice. There are fundamental issues that this debate has raised that need to be clarified as a way of going forward.

[Lord Sandhurst (Con)]

My Lords, I will be very brief. We have heard the most powerful support for these amendments from the distinguished most severely disabled Members of this House—people who really know what their conditions mean and who all support these amendments. We know also that all the major organisations representing disabled people have spoken against, or cannot support, the Bill.

How can we ignore that without being patronising and paternalistic? What possible good reason is there for us or the noble and learned Lord to know better? What possible good reason can there be, therefore, for us not to accept these amendments and say that, subject to any minor drafting details, they are accepted in principle now?

Puberty Suppressants Trial

Lord Sandhurst Excerpts

Thursday 18th December 2025 Lords Chamber

[Lord Paddick (Non-Afl)]

My Lords—

[Lord Sandhurst (Con)]

My Lords, I understand the concern about illicit provision on the dark web, which is a very serious matter and difficult to manage. None the less, I must ask what provision is being made to meet potential claims for damages from young people like Keira Bell in the future who sustain permanent damage to sexual function and emotional well-being after being on the trial?

[Baroness Merron (Lab)]

It is probably helpful to say that no one is required to be on the trial. Nobody will be accepted on to the trial unless there is an extremely rigorous and clinically led judgment about whether a young person is suitable. On the point about transparency, all that information is available online and I would urge noble Lords to look at it. The temporary ban was brought in by the previous Health Secretary, Victoria Atkins, and, in my view, it was absolutely right that we made it a permanent one. However, the issues remain, and we must work out how best to support children and young people who suffer gender incongruence.

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I rise with some caution, because these are deep waters. I think we should err on the side of caution. I support the noble Baroness, Lady Berger, because this is an entirely new process. Assuming the Bill comes into force in some form, the age can always be lowered in the light of experience; by experience, I mean that of the human brain and how people are considering these things.

What has prompted me to say this in particular is the report in the Times on 25 November of the study by Cambridge’s MRC Cognition and Brain Sciences Unit, which compared the brains of 3,802 people aged between zero and 90 years, using datasets of MRI diffusion scans, which map neural connections by tracking how water molecules move through the brain tissues. Very simply, this study found that the topology of the childhood brain runs from birth until the turning point at the age of nine, and then it transitions into the adolescent phase, an era that it found—this is completely dispassionate—lasts right up to the age of 32 on average. Our early 30s see the brain’s neural wiring shift into the adult mode, and I emphasise that phrase: adult mode. This is the longest era and lasts over three decades. A third turning point, around the age of 66, marks the start of an early ageing phase and, for those of us who are a bit older, the late ageing brain takes shape at around 83 years old.

I conclude by reading from the report:

“While puberty offers a clear start, the end of adolescence is much harder to pin down scientifically. Based purely on neural architecture, we found that adolescent-like changes in brain structure end around the early thirties”.


If that is the architecture, at this stage in the Bill we should be looking at 25 and not a younger age.

[The Lord Bishop of Leicester]

My Lords, I too rise to support this amendment with some caution, noting that these are deep waters. I hope that noble Lords will forgive me for pointing out the blindingly obvious: as I look around your Lordships’ Committee, I do not see any 18 to 25 year-olds on these Benches, and the voices of children and young people are vital in such a debate.

The role of Children’s Commissioner was created to ensure that the voices of children and young people were heard within your Lordships’ House and the other place. Therefore, when the Children’s Commissioner, whom I know personally, who has visited my diocese and whom I have seen at work listening to children and young people—she and her staff are superbly skilled at that work—urges us to be cautious, I believe we should listen. I therefore urge consideration of that note of caution.

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[Lord Sandhurst (Con)]

My Lords, I will be very brief. Having listened to this, I am more and more persuaded that we must have reasons, because there will be no coroner’s inquest. We know that some doctors have misbehaved in the past, but that does not always come out. One needs to have a paper trail so that, if concerns start to arise about Dr X, we can see what Dr Y has been saying, as well as Dr X.

[Lord Wolfson of Tredegar (Con)]

My Lords, I can be extremely brief, because of the confirmation given by the noble and learned Lord and also knowing that the substantive issues of domestic abuse, interpreters and various other matters will be dealt with in their appropriate place.

At the risk of underlining my reputation as a legal geek, I invite the noble and learned Lord’s attention to his Amendment 350, and in particular the Member’s Explanatory Statement. I understand the amendment, but I do not understand the statement. The amendment leaves out from “to” to end of the line and inserts “section 12(4) and (7)”, which are about “sharing of specialists’ opinions”. The Explanatory Statement says:

“This is a drafting change (consequential on subsection (4) being added to clause 12)”.


Now, Clause 12 already has a subsection (4), and the noble and learned Lord’s amendments to Clause 12 are to subsections (5) and (8). I do not know whether the Explanatory Statement has confused me and in fact the change is not consequential on a new subsection (4) being added but just stands in and of itself. It may be that I am confused unnecessarily, but if the noble and learned Lord could just clear up that minor point, I would be grateful.

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

I hope that the right reverend Prelate is not going to push for a vote at Third Reading. The task for this House is scrutiny of the Bill both at this stage and on Report, and I hope that that is what we will do.

[Lord Sandhurst (Con)]

My Lords, I will not be long. I speak to Amendment 726, which, as those of you who get that far in the list of amendments will see from the explanatory statement, is one of a number of amendments that I have been prompted to put down by the Law Society. They are intended to make the Bill safer in operation.

I would also like the House to know that I speak free from religious belief, but I do speak as a world-weary lawyer with many years’ practice at the sharp end in both medical negligence matters and legal professional negligence matters. I am all too conscious of my own experience of having seen things go wrong even where the people concerned were decent, honest professionals. Some of them, of course, although professionals, were neither decent nor honest. I have also sat as a legal assessor for five years at the General Medical Council, and I appeared as counsel for a north-eastern NHS trust in a very messy inquiry about 20 years ago about the misdoings of a Doctor Neale, who had featured in a “Panorama” programme—some of you may know about that. I have seen things go wrong on the ground for the past 30 or 40 years of my life.

It is with that in mind that I put down, among others, Amendment 726 with the support of the Law Society. I stress that the Law Society is neutral in principle but has looked at this Bill with what can be described as lawyers’ eyes. Its amendment is designed to make the Bill safer and better in practice. This amendment would “require” and not just permit—that is the difference—the Secretary of State to issue a code of practice in connection with what we are concerned with today; that is, capacity and so on, and the absence of coercion. A code is necessary. In Clause 39 of the Bill, there is provision for other codes of practice to be made; this is simply to add an additional code.

I suggest that this is a perfectly safe, non-destructive amendment that would improve the Bill in respect of a very important practice. As we have heard, coercion—I use the word loosely to cover a wide range of subtle pressures—must be addressed, and it should come from the Secretary of State. The panels that will oversee all this will not be enough. This must come from the Government, looking at things carefully and putting down a code of practice which says: “This is how the panels must address this”. We cannot have a postcode lottery with a panel in one part of England adopting one approach and another adopting a much tougher approach. We need uniformity.

[Lord Hay of Ballyore (DUP)]

My Lords, I support Amendment 48 in the name of the noble Baroness, Lady Ritchie, which seeks to protect individuals from being pressurised into assisted death. As the Bill stands, references to coercion and pressure in Clause 1 are strictly related to coercion and pressure coming from “any other person”. Amendment 48 would remove these three words and broaden out the whole understanding of coercion to include more than just that which comes directly from other people.

Various forms of pressure and influence can arise very easily from various sources: institutions, the media and, of course, even oneself. Every week there are new headlines about hospices struggling for funding and the increasing costs of caring for an ageing society. The Pathfinders Neuromuscular Alliance shared a heartbreaking story in its written evidence to the Commons Bill Committee of a patient who was told by their GP:

“Have you got any idea how much you cost the NHS?”


What kind of influence will these stories have on someone who has the option of assisted death? There is currently no safeguard to protect patients from pressure to choose an assisted death because they feel like a burden on the NHS or their family, or are experiencing loneliness, depression and many other related issues.

This is not just my concern. Caroline Abrahams of Age UK said to the Select Committee:

“We worry about the lack of choice about whether you are going to get good social care or good end-of-life and palliative care … We worry about a sense that, over time, it can exacerbate a feeling that an older person’s life is not worth as much as a younger person’s”.


She spoke about

“how we could ensure that older people in particular do not feel under pressure to make a decision that is for reasons other than their own real choice”.

I remind the House that Dignity in Dying put pro-assisted suicide campaigning material in our Tube stations last year. While advertising for assisted dying will not be legal under this Bill, the promotion of this service by its supporters and its presence in our society, alongside all the problems that our NHS and hospices are facing, seriously risks sending a message to people at the end of their lives that our society is better off without them. If a patient was motivated towards assisted death for this reason, Amendment 48 would ensure that they were not eligible as a result.

I ask those supporting the Bill how they intend to safeguard those who feel like a burden, cannot access the palliative care they need and feel that they have no choice but to pursue an assisted death. What would we say to Professor Smith, who said in her evidence to the Select Committee that the key question was:

“Is the person trying to escape the abuse and feelings that they have been made to feel a burden or are they trying to escape the suffering of their illness? If we cannot answer that question, then we should be very concerned”?


If we start permitting assisted suicide because people feel that institutions and the media do not want them, leading them down a dark path in their heads towards that decision, we will have completely failed the most vulnerable in our community. I urge noble Lords to support Amendment 48, because we are dealing with a life and death situation.

Terminally Ill Adults (End of Life) Bill

Lord Sandhurst Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Pannick (CB)]

My Lords, we have had an hour and three-quarters on this amendment and perhaps we should move on.

[Lord Sandhurst (Con)]

My Lords, I shall be very brief. The definition at the beginning is a most important matter. I am quite clear, having heard noble Lords make a number of very sound observations, that “capacity” is an essential term. That is the first thing. However, it is not sufficient, and it has to be added to. I say that because the Mental Capacity Act states explicitly that a person is not treated as lacking capacity merely because they make an unwise decision. That is a very different situation from what we will be dealing with in many cases going forward. I urge the House, when this comes back on Report and preferably beforehand, and the promoters, to consider adding simply “and ability” so that it reads “capacity and ability” because they are different concepts, and they are necessary if this is to work properly in future.

[Baroness Berger (Lab)]

I wish to respond briefly to two points. I have every admiration for the noble Baroness, Lady Hayman, and I definitely concur that we have a responsibility in this House. I also gently remind this House that there were a number of Members of the other place who said, both in writing to their constituents and in their spoken contributions in the House, that they were essentially outsourcing the job to this place for us to ensure legislation that is fit for purpose. I regret that that is the case. I think there are many of us on all sides of the debate, on both sides of this House, who would wish to see a government Bill, which has been the case with previous Private Members’ Bills that have been adopted by the Government. We would have more time and opportunity to ensure that we have robust legislation.

In the absence of that, in the process that we find before us, I want to share with the Committee—I was going to bring it up in the next group but in light of the comments and the contributions that we have heard so far I think it is important to share on record—the comments that we heard in the Select Committee from the Royal College of Psychiatrists. It is a professional body that was called to give evidence on behalf of its members as one of the pillars of the process, as one of the pillars of the panel.

We heard from Dr Annabel Price, who is the lead for the Royal College of Psychiatrists on the Bill. She is an eminent expert in this space. She shared with us that the college had very carefully thought through its position and its views and that it had asked for a review of the Mental Capacity Act’s suitability because it believes that the Bill currently states that a person is eligible if they have the capacity to make a decision to end their own life, but this framework has not been tested for this particular decision. There are principles within the Mental Capacity Act that the college is not certain are compatible with this decision and need to be thought through more carefully.

I think we should heed that warning and listen very carefully to that college whose members will be responsible should this legislation go through. Therefore, in the context of the amendment moved by the noble Baroness, Lady Finlay, I think it is important for us to consider this in terms of how we inform our debate going forward, which is relevant to this group and to the group that follows.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

That is very well put and is exactly the question. Is it appropriate to bring the Mental Capacity Act into this Bill? I understand that whether you have an assisted death is an incredibly important decision. You cannot remove the word “capacity”, so you have to reject the amendment from the noble Baroness, Lady Finlay.

Her Amendment 115 effectively draws on how the Mental Capacity Act 2005 is currently drafted, except it adds two things. It removes the presumption of capacity and, separately, it requires the person making the decision to be aware of a variety of things that are connected with their illness. To summarise, the way the Mental Capacity Act operates at the moment is that if you are unable to understand information relevant to the decision, to retain that information, to use and weigh that information or to communicate your decision, you do not have capacity under the current Mental Capacity Act. The extent to which the things that the noble Baroness, Lady Finlay, has referred to in her amendment would be relevant would have to be weighed in the context of the decision that has to be made.

I am more than happy to debate whether we need to make the changes to the Mental Capacity Act that she is suggesting. For my part, I do not think we do. One thing that is absolutely clear is that the amendment proposed, as the noble Lord, Lord Sandhurst, identified, is completely ridiculous. You cannot remove the question of capacity from this choice. Putting aside some detail hurdles, there are two hurdles that need to be overcome in how this Bill is constructed. You have to be capable of making the decision, as the noble Lord, Lord Wolfson, said, and—completely separately—you have to make that decision completely voluntarily. It has to be your own decision, not the product of pressure.

We have had—and I say this with warmth and respect—a rambling debate going over a whole range of issues, miles away from the question of whether one should remove the word “capacity” and put in the word “ability”. If this House wants to make the law completely confused in this area, either put in the word “ability” or put in “capacity and ability”. I echo the speech of the noble Baroness, Lady Hayman, when she says we have to approach this in a grown-up manner, and to remove the word “capacity” is not a sensible way to deal with this.

I also echo those who have said that the idea of running two systems at the same time—the Mental Capacity Act system and the separate system proposed by the noble Baroness, Lady Finlay—is wrong and confusing. I congratulate the noble Baroness, Lady Fox, for spotting what the right decision is. Of course, under the Mental Capacity Act some unimportant decisions are taken, but a decision such as whether to have the ventilation removed from you if you have motor neurone disease, that will almost certainly lead to your death, is without a shimmer of a shadow of doubt a life and death decision.

The Chief Medical Officer of England and Wales, in evidence to the Lords Select Committee, said:

“it is far better to use systems that people are used to and that are tested both in practice and, where necessary, in law”.

He went on to say:

“I have a concern that you could have a conversation in one bed in a hospital where someone is talking about, for example, an operation where they might well lose their life, because they are frail and there is the operative risk, done under the Mental Capacity Act, and, in the next-door bed, someone is trying to do the same process of having a difficult conversation about someone who might die, or could definitely die, as a result of that decision, but using a different legal framework. The risks that that could lead to confusion are not trivial”.


I also echo what the noble Baroness, Lady Browning, who sadly is not in her place, said. There are problems about practically every aspect of how various parts of the health service work, but she was part of a process that considered how the Mental Capacity Act worked. The broad conclusion was that it was a good, workable Act, and we should not stray from it in this particular case. I invite the noble Baroness to withdraw her amendment.

[Lord Sandhurst (Con)]

Before the noble and learned Lord sits down, may I just make it absolutely plain that I said that capacity was necessary but not sufficient. I am not stuck with whether it should be “and ability”, but I was absolutely plain in my very short speech that capacity was necessary but not sufficient.

[Lord Falconer of Thoroton (Lab)]

I was picking up on the word necessary. What the noble Baroness, Lady Finlay, is suggesting is that we remove the word “capacity”. I do not know if I misunderstood the noble Lord, but that is what I thought he was saying.

[Lord Sandhurst (Con)]

I wanted to make it plain because some people listening to the noble and learned Lord might have thought I had not said that.

[Baroness Lawlor (Con)]

Before the noble and learned Lord finishes, can he clarify for the Committee that a person who can grasp only a diluted amount of information, or who cannot retain the information in any real sense that would be intelligible to us, can be deemed to have capacity for the purposes of the Mental Capacity Act, but for this Bill, which is designed to give people agency and allow an individual as much choice as possible to choose treatment or have agency over medical and palliative care decisions and so on, an entirely different threshold should, quite rightly, be expected for such a serious measure as this?

Complications from Abortions (Annual Report) Bill [HL]

Lord Sandhurst Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

[Baroness Boycott (CB)]

My Lords, I join this debate to follow up the powerful speech by the noble Baroness, Lady Barker. I have been involved in women’s rights for a very long time; I started a magazine called Spare Rib in 1972 and within that we campaigned all our lives for things such as abortions. I can honestly say that I think the life facing a young woman today is more frightening than the life that faced me as a young woman.

I look at what is happening online, where you can download a very simple app. I had a lunch for Laura Bates the other day, which many noble Lords came to. She explained that I could download an app, take a photograph of the noble Baroness, Lady Freeman, right beside me, press a button and have a photograph of the noble Baroness naked—not with Kate Moss’s body, but with the noble Baroness’s body. You can do this at 11 or 12. It is really threatening being a young woman today. There are many things that are out of our control. We, as older women who have had successful lives, have to fight fantastically hard to protect this next generation from a lot of the stuff that is coming down the pipe.

I very much listen to and know about the conspiracies and the power happening in America to try to alter fundamental rights such as abortion. I find it extremely distressing that measures such as this should come to the House of Lords and even be debated seriously, and that there should be a politicisation of women who face abortion. Frankly, nobody wants an abortion; I cannot think why people ever thought that. Nobody wants one. There are several things you do not say when you ask yourself, “What do I want to do in my life?” No one says, “I want to be an alcoholic”, or, “I want to have an abortion”, or, “I want to be a druggie”. You do not put those on your wish list. They happen and we should protect women and support them all the way through, as the noble Lord, Lord Patel, spoke about in his fantastic debate earlier. These are people who need our protection and our love. I really support the noble Baroness, Lady Thornton, in bringing this forward. I will take part in any further debate because this is vital, and we are vital to this. Our voices really matter here.

[Lord Sandhurst (Con)]

My Lords, I thank my noble friend Lord Moylan again for bringing to our attention the issue of the reliability of statistics on the complications of abortion. It is absolutely right that, in all healthcare, we have correct and accurate data that health service providers can use to understand the safety of procedures.

It is the usual practice for Committee to include discussion of the amendments that have been tabled to the Bill, but here, of course, there is only the proposition that the only substantive clause should not stand part. This, therefore, has necessitated a general discussion of the underlying principles behind the Bill in a restatement on this side of the Chamber of our positions.

At Second Reading, I said that our view was that the Bill performs “an important service” by highlighting

“the absence of accurate, comprehensive statistics in respect of abortions”,—[Official Report, 13/12/24; col. 1990.]

but I explained in the same speech that improved data collection and reporting does not require legislation for it to be delivered. In short, I do not depart from that view, but this Bill has allowed an informed debate to emerge about data in this field. It presents an opportunity to urge the Government to do more to rationalise data recording and collection, so that proper evidence-based medicine can be implemented. In this respect, I endorse what my noble friend Lady Finn said about data collection and statistics more generally.

In answer to a Written Question asked by my noble friend, the director-general of the Office for Statistics Regulation stated that that office—the OSR—had not completed a compliance check on the abortion statistics collected by the Office for Health Improvement and Disparities since as long ago as 2012. That raises important issues of data quality. I am glad to note that it has now been agreed that the OSR will carry out a long-overdue compliance check on those statistics, but only after the Department of Health and Social Care has been able to update the design of the abortion notification system. This seems, to me and to others on this side, the wrong way round. Surely it would make more sense to complete these compliance checks before making alterations to the ANS. That way, the department will be able better to understand any deficiencies in the system—and we know there are some. I hope the Minister will be able to comment on this and address it.

Overall, my noble friend has raised an important concern. I suggest that the Government must now take steps to ensure that the data are gathered on a more reliable and consistent basis.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Member’s Bill and my noble friend Lady Thornton for tabling an amendment. I very much appreciate the contributions made by a number of noble Lords.

The stated main purpose of the Bill is to impose a legal duty on the Secretary of State to

“publish and lay before Parliament an annual report on complications from the termination of pregnancy in England under the Abortion Act 1967”.

The purpose of such an annual report, as I understand it, would be

“to inform policy and safe practice regarding the termination of pregnancy”.

I know that noble Lords appreciate that this Government are entirely committed to the priority of patient safety.