Terminally Ill Adults (End of Life) Bill

Baroness Falkner of Margravine Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, I declare an interest as chair of the Equality and Human Rights Commission, but I am speaking in a personal capacity. This is particularly pertinent today because the EHRC has briefed on the Bill and I must therefore stress that my remarks are entirely personal and to my own circumstances and knowledge.

Some colleagues will know that I was found to have advanced stage 3 ovarian cancer last summer, after seven months of an unsuccessful diagnosis at a major NHS teaching hospital. My experience in that distressing period was of a disregarding and, at best, incompetent NHS. Finally, I turned to the private sector last August. Since then, I have had two rounds of chemotherapy and three operations, and I am now on relatively debilitating medication until 2027. So in this period, I too feel as though I glimpsed the Grim Reaper through my hospital window, in a morphine-induced haze. We know that 460 people die of cancer every day in this country, so I know I am not alone.

Before going further, I acknowledge the great suffering that is caused by several other illnesses that may result in applications for assisted dying but, today, in our limited time, I will concentrate on cancer. This is because the data tells us that, for every four-week delay in treatment, a patient is 10% more likely to die. The EIA on the Bill tells us that, in New Zealand and California, two-thirds of those who seek to end their lives this way are cancer sufferers.

I recognise the need for dispassion and objectivity when one is trying to pass legislation, so I turn to the flaws that I see in the Bill. The Constitution Committee of this House has stated that a Private Member’s Bill on this subject is wholly inadequate. Recognising the repeated attempts in my 21 years here to put this kind of legislation on the statute book, I would have expected the Government to have taken over the Bill and paused it for pre-legislative scrutiny through a Joint Committee. The amendment from the noble Baroness, Lady Berger, may give us that opportunity and I intend to vote for it.

The second flaw lies in the definitions of the Bill. How do we define “terminal illness”, measure the six months to live or calculate monetary equations that measure our lifespans more poorly than they do bats in HS2 railway tunnels, as in this impact assessment? What do we make of the impact of these measures, the lack of compassion for those genuinely concerned about the impact on disabled people or the questions of mental capacity—or for religious individuals and, of course, the elderly, who feel unwanted enough as it is?

Importantly, the most critical agents in this story, other than the patients themselves—GPs and specialist doctors—are given an impossible task. Doctors dread that inevitable question from the patient, “How long do I have?” It puts them in an invidious position, particularly in the case of cancer care, where management of the illness is the challenge. “How well?” and “How long?” are the critical questions asked on a daily basis. In England, a third question arises: “How much?” This is because NHS drugs for some cancer treatments in Scotland and Wales are simply not available here. That is the cruellest aspect of that postcode lottery.

There is much to discuss in the scrutiny of this flawed Bill—and I say that as someone who previously supported assisted dying. I wish we did not have to deal with this flawed Bill, but we will do so in good faith.

Terminally Ill Adults (End of Life) Bill

Baroness Falkner of Margravine Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Gerada (CB)]

My Lords, if a patient is at the end of their life in any practice in the NHS, that patient will be discussed at a multidisciplinary team meeting. The patient will be put on an end-of-life pathway and will have a named clinician within the practice to do their care. This would include assisted dying. There is absolutely no way that a patient, unless in an extraordinary situation—and I take the point about Wales, which has a desperate problem with GPs—would not be cared for in that way. That is how our contract is; that is how we want to care for our patients. We would code it on the notes so that every single person consulting with that patient would know that this patient was an assisted dying choice, and they would get the care that I have just described.

With respect to the arbitrary 12 months or 24 months, many patients choose to move at the end of their life. They choose to move to the place where their loved ones are. Many choose to do something such as go abroad to the countries that they may have come from and come back right towards the end of their life. To put in an arbitrary barrier of 12 or 24 months is not putting the patient first; it is putting an arbitrary time limit first.

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

[Lord Blencathra (Con)]

Before we move to the rest of the debate, could we please give way to those noble Lords who have tabled amendments? I would like to hear what they have to say.

Terminally Ill Adults (End of Life) Bill

Baroness Falkner of Margravine Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Markham (Con)]

Given that I did not write any of the manifestos, I am not sure I can say. If I was writing them, it is something that I would probably put in. It is something that everyone agrees is one of personal choice, like many other issues, and of course that is why everyone has a free vote in this matter. It is undeniable that there is overwhelming public support for this and, as it is “our NHS”, it is entirely fitting that if it is the decision that money is spent in this way, it should be directed towards this service.

The question becomes one of what I believe the noble Lords, Lord Birt and Lord Pannick, are trying to do in their amendments, which is to take what we know is a complex system and make it as easy to navigate as possible. We know that it is a time of great distress. In many cases you have just been diagnosed with a terminal illness, and sometimes you will be told straightaway that you have only a few months to live, so automatically you are within the six months and it is something you want to move on quickly. It is entirely right and proper that you want to ensure that it then happens as efficiently as possible. That does not mean you do not want other services to happen as efficiently as possible in the NHS. It is not a binary choice between one and the other.

[Baroness Falkner of Margravine (CB)]

The noble Lord has repeated on several occasions the fact of overwhelming public support for this. Does he agree that there are a lot of other areas in which opinion polling may show public support, but the job of this House is to ensure that the support is buttressed by legislation that is deliverable, is compassionate, respects the rights of all and is applicable across a range of different situations?

[Lord Markham (Con)]

Yes, absolutely. That is what these debates are all about: trying to find an approach that makes assisted dying tight and safe, safeguarding all sorts of vulnerable groups, but also navigable. I know that is what the sponsors of the Bill are trying to do and what the noble Lords are trying to do in this amendment. I commend the amendment for that reason. I do not think they are trying to be prescriptive. They are trying to start a conversation with the Bill’s sponsors that will go on between now and Report, which is an entirely constructive way to do it.

On how the service is best provided, I was on the Select Committee and it is one for the NHS to commission in the best way. Commissioning can use the NHS or voluntary services, and I think we would all agree that, in the hospice sector, voluntary services provide very well. It is wrong at this stage for us to try to be prescriptive in terms of a one-size-fits-all NHS provision. The main thing on these amendments is trying to get a constructive approach, which I am sure the Bill’s sponsors will pick up, to how we make this as simple as possible to use for those who are in the most distressing period of their lives, when they have less than six months to live and they want to die in a method of their choice and in the most comfortable way possible.

Terminally Ill Adults (End of Life) Bill

Baroness Falkner of Margravine Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[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.

[Lord Polak (Con)]

My Lords, I support the amendments in this group, especially the one from my noble friend Lord Evans. I was not going to speak but I was moved by what the noble Baroness, Lady Smith, said about her father.

I am not a Luddite. My mother passed away in July 2023 from brain cancer, and this debate has reminded me of the Zoom call we had to look at the next stage of her treatment. I was here in London; my sister was with my mother in Liverpool, where she was lying in bed unable to speak. The nurse who was looking at the next stage of treatment for her was in Margate, had never met my mother, and was asking questions for over an hour to which mother could not reply. I have listened to this whole debate, and if we cannot put face-to-face consultation in the Bill, we are doing a great injustice to many people.

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[Lord Harries of Pentregarth (CB)]

My Lords, like the noble Baroness, Lady Hayman, I will respond to the noble Baroness, Lady Blackstone. She seemed to express a kind of common-sense view that of course we all agree that it is much better to have face-to-face interviews, and we have heard all sorts of evidence today from the medical profession and the legal profession about how that is much better. The noble Baroness thinks there should be a code of practice. I agree, but surely that code of practice should be about where there are exceptions. It would be much safer to have a Bill in which it is specified that interviews should be face to face, except for certain exceptions laid out in a code of practice. Surely it should be that way around in order that we have as safe a Bill as possible.

[Baroness Falkner of Margravine (CB)]

My Lords, the noble and right reverend Lord makes a really valid point about codes of practice. Codes of practice sometimes are not statutory, so it would need to be a statutory code. Apart from all that, we also know that codes of practice become outdated. In another area of my expertise, a statutory code of practice was agreed in 2011. Although it is unlawful today, it has still not been withdrawn by the Government.

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[Baroness Andrews (Lab)]

My Lords, I think it is right, as my noble friend Lord Rooker said, that this clause stand part debate is an opportunity for a reset and a rethink about how we are approaching the Bill and the way we are prioritising the arguments. Where I slightly take issue with my noble friend is that I do not think it is helpful to apportion blame. We are where we are with this Bill now, and we are all under the clear impression and instruction that, if the Committee wants to change the Bill, whether those who oppose it or those who support it, we have to get it to Report so that we can do that and then send it back to the Commons improved and amended.

On the question of delegation, I worked with my noble friend Lord Blencathra—I will call him that—on the reports on delegated legislation, and they were extremely important. What we have discovered in this Bill, as the amendments have been put forward, is that there is a difficult balance to be achieved between what goes into the Bill on the principle and the design—our task in this House is to make every Bill workable—and what has been left to delegation. As a result of the nature of the Bill, the behavioural issues that are raised by it, and the extraordinary personal and exceptional circumstances when we are dealing with people in the last months of their life—which we should never lose sight of, no matter what we are debating and how technical and process-driven it is—we have to think about the balance between what is workable because it is in the Bill and will stand in law and what has to be left to delegation going forward and therefore can be amended as circumstances change. That is the situation the Australians find themselves in. We have a lot to learn, as we have already learned, from Australian medics who have told us how they are managing the Bill and what an extraordinary benefit it has been. That is on the public record.

All I would say, before my noble friend Lord Blencathra possibly opposes me, although I hope not, is that this is an opportunity to look at the amendments that are coming forward and the priorities we are attaching to them and whether we can triage them in some way. My noble friend Lord Rooker is right that a lot of these early amendments can fall away, because we have addressed the principle. Can we focus on what it will now take to agree to improve the Bill, so that we can have shared trust across the Committee that this is about improving the Bill and not delaying it to the point that it will never become law?

[Baroness Falkner of Margravine (CB)]

My Lords, I have a point related to the point made by the noble Lord, Lord Harper, about impact assessments. Noble Lords will be aware that I am a former chair of the Equality and Human Rights Commission. I gave evidence on this Bill when it was being examined in the other place. Once it was introduced in your Lordships’ House, I recused myself from the EHRC’s involvement on the Bill, as I anticipated participating on the basis of being a Member of this House. That is the background, should anyone detect any conflict of interest on my part. A senior EHRC commissioner, Alasdair Henderson, who is a barrister, has since represented the EHRC on this Bill.

On 22 January, nearly 60 Members, including me, wrote to the Minister calling on the Government to update their equality impact assessment. This was to pick up the argument from the EHRC—which was put nearly three months ago, so the Government have had a substantial amount of time to think about it—that the current EIA contains several gaps and focuses primarily on access to an assisted death rather than on safeguarding risks and the potential for coercion. That letter has been circulated to the whole House. Yesterday, I received a reply from the Minister declining the request. Parliament will receive an updated impact assessment and equality impact assessment only

“should the Bill receive Royal Assent”,

and

“once detailed implementation work has been completed”.

In other words, the Committee is being told that it must legislate blind.

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[Baroness Thornton (Lab)]

I am slightly puzzled. I have of course read the Minister’s letters, but I am not quite sure why the noble Baroness is speaking about these in the middle of a discussion about clause 1 standing part. Is she supporting the clause standing part or not? Surely that is the debate we are supposed to be having.

[Baroness Falkner of Margravine (CB)]

My Lords, perhaps reference to the Companion will help reduce the noble Baroness’s confusion about my speech. The Companion says that, once the Chair has put the Question,

“a general debate on the clause may take place”.

I am highlighting problems with the clause. Clause 1 is the substance of the Bill and an equality impact assessment is fundamental to our understanding of whether it should stand part.

To come back to the letter, it refers to the possibility of generating comparative evidence on the wider matters, but that would not have produced sufficiently robust conclusions. The matter raised was that the EIA did not deal with any detail of all those certain protected characteristics because it focused on access to assisted dying. Access to assisted dying is not relevant to the safeguarding risks that we have all spent some eight days in Committee debating. The letter says:

“We intend to update both the Impact Assessment and the Equality Impact Assessment should the Bill receive Royal Assent, once detailed implementation work has been completed”.


That will be too little too late. It is of no assistance to Parliament in considering the Bill and its potential consequences. Indeed, the whole point of an EIA is that it is done before or at the time a decision is taken. I refer again to the Cabinet Office guide to making legislation. A failure to undertake a comprehensive EIA means a failure to comply with a public sector equality duty, as post hoc analysis cannot generally cure a failure to have due regard to equality implications at the time a decision is being made.

That is what the courts consistently emphasise. R (Blundell) v Secretary of State for Work and Pensions 2021 noted that post-decision equality analysis is not sufficient to fulfil the duty, as it is supposed to be a real, open-minded consideration of the equality implications, conducted with substance and rigour, not a rearguard box-ticking exercise.

In concluding, I say to the Government that an accurate assessment of how the Bill impacts people who share each of the nine protected characteristics does not betray that position of neutrality. In fact, it is the converse: withholding information is not an act of neutrality but the opposite of that.

The Constitution Committee published a report on the Bill on 11 September, lamenting that supporting documents, including the EIA, “were issued late” or were not available. In the other place, Ministers gave the excuse that the Bill was “highly dynamic” and likely to undergo significant changes during scrutiny, so it was important to wait until the committee concluded its work so that

“we know what it is that we are assessing the impact of”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 282.]

Now we are told that there is insufficient evidence to produce conclusions that are sufficiently robust. I suggest that the Minister review what both the EHRC and the letter submitted by 59 Members of this House have asked her to do and come back with some more positive news at an earlier date.

[Lord Jackson of Peterborough (Con)]

My Lords, I beg the indulgence of the Committee to raise what I think is an important point; I hope the Committee does not think it pedantic. I had not intended to speak but was prompted to by the excellent speech of the noble Baroness, Lady Falkner, and by my noble friend Lady Coffey’s reference to the lack of insight provided by the Government—I will not criticise the sponsor, the noble and learned Lord, Lord Falconer of Thoroton. This—our deliberations, scrutiny and oversight of the Bill—is a moveable feast, so we need information in real time.

My specific point is not just about freedom of information but about Written Questions that the Government have received and not answered. On 1 December 2025 my noble friend Lord Kempsell asked His Majesty’s Government a very reasonable Question. He asked, with regard to the Bill and its impact assessment,

“what assessment they have made of the effectiveness of judicial approval as a safeguard in countries with assisted suicide regimes, including the proportion of applications refused in those countries and the reasons for refusal”.

Two months on, that Question has not been answered. That is unacceptable, because scrutiny and oversight require us to have all the information in our hands, including comparative legal, regulatory and medical regimes.

By comparison, the very sensible Question from the noble Viscount, Lord Stansgate—I do not want to embarrass him because he is in the Chair—about the use of the Parliament Act was asked on 26 January and answered promptly on 29 January. The point is that there should be equality and a level playing field on Questions asked, irrespective of the position on the Bill of the noble Lord asking it.

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[Lord Falconer of Thoroton (Lab)]

The noble Lord notified me of that beforehand; I thank him greatly for his courtesy.

May I briefly refer to the contents of the debate? First, the noble Baroness mentioned devolution. I have nothing to add in relation to devolution, but it felt like she was aiming more at the Government than at me. I am very supportive of the Government in this respect, but I had to say something in relation to that.

I will focus primarily on what my noble friend Lord Rooker said. I do not say this without thinking about it. I have the greatest respect for my noble friend, having been in government—though not as long as him, because I was sacked three years before he was sacked, and he was sacked only because the electorate replaced the Labour Government with a Conservative Government. He survived throughout the whole thing.

My noble friend is, in broad outline, right when he says that Clause 1 contains the spine—the trunk—of the Bill. I believe that this moment very much represents an opportunity for us as a House to see whether there is a way to get through this in time to send the Bill back. I completely accept what my noble friend said about my responsibility for bringing forward, as quickly and as well as possible, the areas where he was kind enough to say that I had been clear about my amendments. So I welcome the door that my noble friend has opened. I am more than willing, in relation to each of the areas where I have identified that I am willing to move, to sit down and try to agree, as much as possible, what those movements should be. I am absolutely sure that we will not agree on everything, but we can determine the things on which we do not agree on Report. So I welcome enthusiastically what my noble friend said about the way forward.

May I deal briefly with what the noble Baroness, Lady Falkner, said? Obviously, I am not responsible for either the impact assessment or the equality impact assessment. I must say, having read the points made by the commissioner of the EHRC, I think that the Government are right: it does not justify either a new impact assessment or a new equality assessment. The Government have been absolutely clear on why they think that, in principle, the Bill does not offend against the convention or the Human Rights Act. They have also been incredibly helpful, through Ministers, in saying where they think amendments might give rise to problems. It is perfectly legitimate for the Government to say, “We’re worried about amendments” but not to introduce a whole new assessment in relation to them.

[Baroness Falkner of Margravine (CB)]

Does the noble and learned Lord agree that, when courts in the United Kingdom rule that the public sector equality duty cannot be an afterthought—that it has to be complied with throughout and that Parliament needs to be aware of changes in circumstances or new issues that come up—it needs to be abided by? I am sorry; I cannot remember the title of the court case I referenced, but I am sure the noble and learned Lord will be able to find it in Hansard.

[Lord Falconer of Thoroton (Lab)]

I am well aware of the court case. It does not justify a new equality assessment in this case.

[Baroness Falkner of Margravine (CB)]

I was talking about the applicability of the public sector equality duty.

[Lord Falconer of Thoroton (Lab)]

I do not think that it justifies a new equality assessment. The thing about equality assessments is that lawyers can constantly write to clients and say, “You haven’t considered this and you haven’t considered that”. Having read in detail the equality assessment, I say that it deals properly and adequately with the issues.

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[Lord Pannick (CB)]

The noble Baroness makes an important point, because this Bill is concerned with providing choice. Of course there is no mandatory obligation, but, if you are given this information, you should have the right—it is your life—to decide whether you wish to take advantage of these provisions. In many cases, if it were me or my family, I would argue strongly that there are other options and other things should be done. But it is a choice, and people should have that choice. That is the philosophy and what has guided so many jurisdictions around the world. Many noble Lords do not agree with that, which is their right, but that is what this Bill is all about.

[Baroness Falkner of Margravine (CB)]

My Lords, the noble Lord rightly emphasises that choice is an essential element of this. But in so emphasising, he appears to cast “choice” in a very black and white manner as if it can suggest, not perhaps 100%, but 99% certainty, one way or another. I am sure the noble Lord is very grateful that he has never been in the situation of the patient sitting in that chair, having a conversation with a doctor, as I have, unfortunately. I can tell him that it is not a conversation with one doctor; it is a conversation across a multiple range of people, because doctors want you to have second opinions and speak to others to see if they might think of how you might ameliorate your illness, particularly in the case of cancer.