Baroness Finlay of Llandaff
Main Page: Baroness Finlay of Llandaff (Crossbench - Life peer)Terminally Ill Adults (End of Life) Bill
Baroness Finlay of Llandaff Excerpts
Lord Weir of Ballyholme (DUP)
The noble Baroness raised the issue of speed. It comes back to a point raised by the noble Baroness, Lady Fox. Often in public policy issues, there is a trade-off between the speed of a decision and its quality. Sometimes when we short-circuit or fast-track decisions it can inevitably lead to a greater level of mistakes being made. But in a wide range of other public administration or public policy decisions, there is at least the advantage that if a mistake is made, there is the opportunity at a later stage to come back and correct it—to perhaps appeal, review or reverse it. Of course, the major problem with this is that if we fast-track things and it leads to a death that should not have occurred, we cannot bring the person back to life.
I agree with the noble Lord, Lord Markham, who said in response to an intervention from the noble Baroness, Lady Berger, that he perfectly acknowledged that we should have the safest possible system—I see that he is nodding now. I therefore find it very difficult to see how we get the safest possible system if these amendments go through and decisions are fast-tracked, inevitably leading to greater numbers of mistakes and shortcuts.
Baroness Finlay of Llandaff (CB)
My Lords, in introducing this group of amendments, the noble Lord, Lord Birt, said that one of the reasons he tabled them was that the proposals in the Bill are potentially chaotic and prolonged. This group is in some ways something and nothing. The proposals make the case for a profound imbalance, with assisted death actively facilitated, accelerated and led through the dedicated service with speed. As my noble friend Lord Stevens said, this is not in scope for the NHS and NHS services, and we have to look at the NHS constitution. I ask the Minister whether, in the light of some of the proposals, there is a plan to rewrite the NHS constitution as well as the fundamental principles of the NHS, as read out by my noble friend.
The amendment’s structural conflict is between efficiency and caution. In responding, can the noble Lord, Lord Birt, explain how the clock will be stopped and by whom, and whether a request to shorten the process will trigger enhanced scrutiny? If so, how that will be done? Will all the assessments be face to face to improve the chances of detecting coercion to death? Will all the contacts with the navigator be recorded and audited so that one can be sure that the auditor is not acting in a profoundly subtle and coercive way?
The navigator seems to bypass a search for many things and, without the amendments in the names of the noble Lord, Lord Mackinlay, and others, I cannot see how that imbalance would be corrected. At least the imbalance is there, but Amendment 771 gets to the heart of the problem: it tries to make all of this a profound NHS responsibility. As we have heard, the NHS cannot cope. We have patients on extra beds in the middle of wards, seriously ill patients being looked after in corridors and patients sitting on plastic chairs waiting for a bed, sometimes dying on those plastic chairs.
The NHS is not the place to have a dignified death in a hospital setting in the lovely planned way that seems to be described and desired by some people. People are working themselves into the ground trying to manage their current workloads. As has been said, the workforce itself is completely on its knees. GPs are already overstretched. Evidence suggests that assisted dying would require around 30 hours for an individual case, yet many palliative care doctors and psychiatrists would opt out, therefore decreasing the pool. That is relevant to the way these amendments are put together.
I will respond to some of the points raised about whether the public want this. When the public are asked in polls what they understand about assisted dying, 52% say that it is a right to stop treatment. They already have that right. Nobody should be treated against their will, and they should be supported in that decision. Some 17% of people think that assisted dying is hospice care.
Lord Markham (Con)
In the spirit of helpfulness on public opinion and whether people understand the question, there are numerous surveys on this. A very clear one has the wording “Do you think doctors should be allowed to end the life of a terminally ill patient at their request?”, which was supported by 75% of 18 to 34 year-olds, 80% of 35 to 64 year-olds and 78% of those aged 65-plus. I do not think you could get a question clearer than that, or a level of public support greater than that.
Baroness Finlay of Llandaff (CB)
I am grateful to the noble Lord for his intervention, but I think we need to stay focused on the amendments in this group and not get diverted. That is what I am trying to do.
In terms of palliative care provision, I am extremely worried that the amendments put down to the amendments tabled by the noble Lord, Lord Birt, had to be limited because palliative care is repeatedly being deemed out of scope of the Bill. That is a major problem. We hear about bad deaths, but we know that actually, if clinicians act with urgency and have a 24 or 48-hour limit before they call for specialist palliative care intervention—so there is rapid intervention, with highly specialised knowledge—all of the outcome measures show an improvement, using things such as the IPOS scale and so on. Family reported outcomes can also improve. To view bad deaths as something that we should just leave and tolerate, and to say the only solution is the proposal in these amendments, does not recognise the reality of the services that are available already.
In introducing his amendments, the noble Lord quoted extensively from Australia and painted it as everything being perfect. I would like to briefly counter that by quoting the honourable Robert Clark, who was Victoria’s Attorney-General from 2010 to 2014. He has written about the Australian experience of assisted suicide. He describes a change in “attitudes”, with the “ethos” of the medical profession moving away from the practitioner’s primary duty to solve the problems the patient has, and a grave risk that this will lead over time to doctors forming views that a patient ought to be opting for assisted suicide and becoming inclined to regard that patients should go down that road.
He also highlights that there are things going wrong. I will not detain the Committee because of time, but I think there are alternatives. He points out that there are some doctors who, when they have resisted going along with a request for an assisted death, have found their whole careers eventually becoming somewhat blighted. Although there is a clause in the Bill which tries to avoid that, there is concern that that clause is incomplete. So, when we quote international evidence, we also have to be quite balanced in it.
The proposal in the amendments from the noble Lord, Lord Mackinlay, do us a favour, because they demonstrate that this cannot be part of the NHS as it is at the moment. It begins to move us towards viewing some kind of proposal like this being completely outside NHS services but not planted in the NHS. Then, of course, the funding question arises. If funding erodes palliative care funding, which has happened in other places, we really have a problem, because recent evidence to the Public Accounts Committee showed that, if you have specialist palliative care in place and available, as it ought to be, the savings to the country would be about £800 million a year.
Baroness Fraser of Craigmaddie (Con)
My Lords, I was not intending to stand up today, so I apologise, but this group has not gone at all how I thought it would.
When I looked at Amendment 771 and the proposed assisted dying help service, I was confused. I had thought that navigators might take a similar role to that of independent advocates. We have a group about the importance of independent advocacy, which I am a huge supporter of, and about advising people on other care, health or treatments. That is coming up in 19 groups’ time. But it seems that Amendment 771 is illustrating the flaws of the entire Bill, whether that is geographical provision, training and qualifications, the right of practitioners to withdraw and the need to support vulnerable people.
We have also had a debate today about the funding of the proposed assisted dying help service. We have another group—group 30, which I hope we get to—on the provision of an assisted dying service by groups other than the NHS. I suggest that noble Lords opposite take the suggestion of the noble Baroness, Lady Royall, to press the Government to provide clarity, before we get to that group, on the funding of an assisted dying service and—following the point from the noble Baroness, Lady Finlay—the future funding and support for hospice care.
I have an amendment in that 30th group, which I tabled because I think that the proposers of this Bill have missed a bit of a trick. If you want to set up an assisted dying service, you should do so in parity with the current arrangements for the hospice service. If we understand what the funding for the hospice service will be, we can have our debate in group 30 on alternative provisions.
Lord Kamall (Con)
I thank the noble Lord for that intervention, as well. It reinforces the points I am going to come to—if that makes sense.
The Minister, the noble Baroness, Lady Merron, ends the letter by saying:
“Through these actions … we hope to ensure sustainable funding for palliative care and end-of-life care sector in the long term”.
This is the Government’s stated intention. The next bit says:
“I hope this letter has provided clarification on the queries you raised”.
I will let noble Lords be the judge of whether it provides clarification. To be fair, the Minister copied the letter to all Peers who tabled amendments, as my noble friend Lord Harper said, and put a copy in the Library. I urge all noble Lords to read that letter to see whether they believe that it provides the clarification that many are seeking. If we feel that it does not, we should come back to this point in future weeks and raise these issues with the Government again.
I hope the Minister, the noble Baroness, Lady Blake, will take that on board when she answers. If she does not have the answer to many of these questions, we should wait for other noble Lords to read that letter, then maybe raise the questions again and ask whichever noble Baroness is on duty as the Minister in future weeks to answer questions on areas where we still believe there are gaps.
Baroness Finlay of Llandaff (CB)
I am grateful to the noble Lord for referring to that letter and quoting the amounts of money in it. Does he recognise that that is one-off and not recurring funding, and there is no intention for funding to increase as cost of living and so on increase, and to meet the gaps in services that we have been talking about?
Lord Kamall (Con)
I have to be very careful because I am not answering for the Government; I am just trying to reflect that letter. However, the Minister did make it clear that the children’s hospice funding is over the next three years and that it will account for £80 million in total. We all know how Governments work, and I not sure that any Government could give a commitment beyond three or four years or beyond another election. To be fair to the Government, I believe that they have answered the question about how much resource they will be allocating. It is up to noble Lords to decide whether they believe that that is sufficient, but if, whichever side of the debate they are on, they feel that the Government have not answered those questions, it is up to them to come back in future weeks and press the Minister on duty.
Lord Empey (UUP)
As I said when I opened my remarks, I have amendments in group 50 for that purpose, but there is an inextricable link between having knowledge about these substances and having informed consent, so we cannot compartmentalise it as easily as that. The people who are overseeing the consent of the person must also have that knowledge. The risk factors have to be made available to the patient: that is my point. Because there has not been sufficient research done on these matters, I am not convinced at this stage that the information being provided to the patient is accurate. How can it be if the research has not been done?
Baroness Finlay of Llandaff (CB)
My Lords, this group of amendments is about the process of information giving. The lead amendment, Amendment 39A, is about the person having an understanding.
In any process of giving information, there is no point just giving the information: broadcasting it, if you like. You have to check that the person has understood it. Usually, in clinical practice, that is done by asking the patient, “Can you tell me what you have understood from what I have just told you?” That allows the patient to repeat back. Sometimes, you find that they have not understood it at all. Sometimes, you find that they have over-understood and brought in other sources of information, and you can then deal with misinformation that comes in and that might be relevant to them. That process is behind consent. The signing of a consent form is simply verification that the process of handing over and receiving information has happened. It is not the signature that matters, it is the process.
I will deal very briefly with something that came up before lunch—
Lord Scriven (LD)
The noble Baroness is absolutely correct that it is the process. In the Bill, there would be two doctors who, after sitting down and discussing with the patient their understanding, have to write an independent report that details the very things that the noble Baroness has noted, which are within the provisions of the Bill, and then goes to the independent commissioner. What is missing in the Bill that would describe the process that the noble Baroness has given that would require extra provision to determine that the two doctors have not just understood that the patient has signed the form but have detailed in the report why they think the patient both has capacity and has given consent?
Baroness Finlay of Llandaff (CB)
If I may, I would like to come on to the issue of the information around drugs, because that is key. But I did not want people to think that simply signing the form was adequate.
Withdrawing ventilation, which was raised earlier, is a fundamentally different situation from this. If a patient is on a ventilator, they would have died earlier without that intervention. When they withdraw consent for ventilation to continue, you still have a duty of care towards them. You need to go through all the processes as to what you will do when you withdraw the ventilation and how that will be managed, so the patient understands how long you expect it to take and that they will die without the ventilation. They must understand that they are dying of the disease that they would have died from previously. That is quite different from to the proposal in this Bill about lethal drugs. I will come on to those lethal drugs now.
This has been sold out there to the public as if this is a Hollywood death—as if you take one little tablet and that is the end of it. In evidence to the Select Committee on 22 October, the noble and learned Lord, Lord Falconer, stated that the substance used
“will be safe, efficacious and not cause suffering”.
I would like to know the basis on which he can say that with assurance.
Lord Goddard of Stockport (LD)
In the Select Committee, Chris Whitty, the head of the NHS, said that no drug will be given to any patient that was not approved by NICE. That is what he said: no drug will be given to anybody that was not approved by NICE.
Baroness Finlay of Llandaff (CB)
When you prescribe a drug for a patient, NICE may have given approval for it, but the side effects, the toxic effects and the interaction with other drugs is not determined by NICE. That is done by the clinician, who must inform the patient. I do not dispute that they must be NICE-approved drugs, but NICE has not done an appraisal process for these drugs to be used for the process of ending life. The fundamental problem is that no research has been done into how these drugs, at high toxic dose, actually end life. I will come on to that, if noble Lords will bear with me.
In 2022, I co-authored a review of the efficacy and safety of drugs used for assisted dying, which was published in the British Medical Bulletin. The Oregon mixtures used to bring about death, which have been referred to, have a 6% to 7% complication rate. We have heard about the complications; I will not go through those again. The drugs are not being given at a therapeutic dose. I am not going to go into the doses, because there will be people watching this broadcast who may feel suicidal and there is no way that I want to be complicit in giving them information that promotes their suicidality.
The one thing I will say is that this is not about morphine. Morphine is not used to bring about the deaths. In Oregon, DDMA—the one already referred to—consists of overdoses of diazepam, digoxin, a small amount of morphine and amitriptyline. But the doses are 100 to 200 times the therapeutic dose. That means you are talking about 100 to 200 tablets to be swallowed or crushed in a mixture to swallow. Digoxin has a delayed effect in creating an abnormal heart rhythm or cardiac failure. Amitriptyline is highly toxic to the heart. Nobody has done the research in these patients to look to see why and when their heart stops.
Some patients, however—nine in Oregon and seven in California—have been documented as reawakening. Although that was not counted as a complication in their reports, these are documented. The Bill says nothing about what happens when the patient starts to reawaken, when they will be extremely drowsy and unable to take a further dose of drugs, or if they are very drowsy and have a very prolonged time between ingestion and death. As we have heard, the highly toxic barbiturate that has been used in Switzerland and in some other countries is not licensed for humans and there is no data on it.
Just to illustrate that it is not always straightforward, in 2017, a man called Kurt in Colorado was told that his death would come about within about two hours when he was given lethal drugs, but his wife described him coughing and choking for eight hours until he died—certainly distressing. If you are going to take this lethal mixture, you need to know what is in it and how it is going to bring about the end of your life.
There is also the ability in this to have equipment—that is specified in the Bill. But again, without knowing what that equipment is, we do not know what the patient will be consenting to. We have heard about the Sarco pod, which was a disaster in Switzerland, but the person who developed it is trying to develop further modifications of it. Basically, the idea is that a lack of oxygen will cause cardiac arrest and death, but, again, no research has been done. When the drugs are given intravenously, there is a short-acting sedative and, in the case of about two-thirds of patients, it is followed up by a paralysing agent, which means that all movement stops, you cannot signal if you have reawakened, you will stop breathing because all your muscles are paralysed and you will die of asphyxia. The difficulty is that the research that needs to be done has not been done.
Baroness Hayter of Kentish Town (Lab)
Does the noble Baroness agree that, if we do not pass the Bill, people will continue to self-administer drugs that they obtain from who knows where or, as some of us know, hang themselves or take themselves into a car and use the exhaust pipe? Am I right that the noble Baroness seems to want to add something that is not there now for people who take their lives in the same position?
Baroness Finlay of Llandaff (CB)
That is a very helpful intervention because the evidence from the places that have gone down this road and changed their legislation is that the unassisted suicide rate does not fall. This does not seem to prevent suicides from happening and these amendments are about people having information. With these amendments, we are not debating whether the Bill passes; we are debating the contents of the Bill and whether it is safe for patients.
Given the problems, I ask the noble and learned Lord, Lord Falconer: is there a plan to relicense drugs that in this country are available only for veterinary use, for the purpose of ending the life of patients here?
Lord Harper (Con)
My Lords, I will make two brief points. First, I support the important point made by my noble friend Lady Berridge about how we deal with misinformation. In an enlightening exchange I had with Health Ministers on the subject of flu vaccination, I discovered that a significant number of people working in the health service are vaccine hesitant and at least some of them are because of the scare stories that we read about vaccination. I suspect that those people will be more informed than the general public, because they work in the health service, so how we deal with misinformation is very important.
My main question, for which I am pleased to be in this House surrounded by expert lawyers, is a legal question on Amendment 188A, tabled by my noble friend Lady Coffey, about putting current case law in statute. My question is aimed at the Minister, I suspect, but if he is not able to answer it today, I would be grateful if he could write to us. Would it be helpful to put the current case law position in statute? Would that be helpful in the sense of giving Parliament’s imprimatur, saying that we are comfortable and that we think the current position is helpful? Would it in any way inhibit or prevent the development of further case law?
Again, because of what my noble friend Lady Berridge said, I am conscious that a lot of the information that people get is from online sources. Because of the fast-changing nature of the world, artificial intelligence and so forth, I would want to make sure that, in this area, evolving ways of people getting accurate information that they can rely on were able to be taken into account by case law; equally, I would want to ensure that case law could take into account information sources that are not reliable and reputable and give guidance to clinicians about how they deal with informed consent. The danger of putting some of that detail into statute is that it does take some time to update. I am looking for factual guidance about whether that is helpful for us to put into statute or whether it is better to leave it for evolving case law. It is a factual question, and I hope that the Minister can either deal with it today or write to us.
Baroness Lawlor (Con)
Is it the noble Baroness’s understanding of Clause 12(2)(d) that, while there is an obligation to discuss the person’s wishes in the event of complications arising, there is no obligation to discuss exactly what those complications could be?
Baroness Finlay of Llandaff (CB)
It might be helpful to add that, in normal procedure, you would explain to a patient what the complications may be but also what you will do. This Bill does not say what you will do. That is why I pointed out that somebody who is very drowsy and beginning to wake from a huge dose of lethal drugs would not be able to self-administer a further dose. This Bill is very clear that the practitioner does not administer the fatal dose; it must be done by the person themselves. Therefore, we have a bit of a gap here, because the doctor can tell them what might happen, but it does not seem that the doctor can tell them what they will do in the event of it happening and how it would be managed.
Lord Winston (Lab)
Before the noble Baroness sits down, what about the patient who says, “I’m not interested in the complications; I just want the injection as soon as possible”? At what stage is that allowable under medical practice? I have refused information from a doctor myself in the past. People have that autonomy, do they not?
Baroness Finlay of Llandaff (CB)
Of course patients are welcome to refuse. I am slightly worried by the noble Lord’s phrase “I just want the injection”. The Bill is very clear: this is about self-administration. The doctor has to discuss with the patient how they are going to inject themselves with the lethal dose of drugs, whether they will do it with different syringes, if there is a mixture in the syringe and the complications of trying to do that. In asking the question, the noble Lord has just illustrated the nub of the problem.
Lord McCrea of Magherafelt and Cookstown (DUP)
My Lords, on Friday 16 January 2026, the noble and learned Lord, Lord Falconer, defended the Bill’s provision for informed consent by arguing that the existing drafting already mandates comprehensive disclosure of information. He rejected Amendment 42 in the name of the noble Baroness, Lady Finlay, which would require patients to be fully informed. He argued that was unnecessary because the specific obligations listed in the Bill already ensure that the patient receives all necessary information. However, these amendments identify further gaps and the weakness in the noble and learned Lord’s reliance on the Bill’s current drafting to guarantee informed consent. Evidence of complications, lack of data, prolonged death risks—all these show that there are downsides and pitfalls, rather than simply a peaceful exit.
Proponents, some of whom we have heard today, tell us about prolonged and painful deaths from illness, but they seem to close their minds to long and potentially painful deaths for those who walk the path suggested by noble Lords. There are two mentions of complications in the Bill, but nowhere is there an explicit requirement to explain and discuss the risks of complications, despite this forming a standard part of GMC and NICE guidance on informed consent. I wonder why that is.
Lord Falconer of Thoroton (Lab)
The format of the Bill asks: “Is it your wish to receive assistance?” It has to be an informed wish. It seems to me that there is no need to add in another concept—that of informed consent —when we have “informed wish”, which is perfectly adequate.
Baroness Finlay of Llandaff (CB)
The noble and learned Lord has not responded to the question of what the doctor does if the patient develops the complication of not dying. The patient may begin to reawaken, but it is not clear at all what should happen if they say, “I want you to suffocate me. I want you to inject me with lethal drugs. I want you to force me to reingest”, or whatever. What is the doctor to do? The Bill requires the doctor to be present until either death occurs, the patient changes their mind or the procedure fails. So it would be helpful to make it clear that, in the event of a complication, the doctor is just to stand back and let things happen, because any intervention, such as clearing the patient’s airway when they are vomiting, would in fact be a resuscitative intervention.
Lord Falconer of Thoroton (Lab)
First, the noble Baroness is absolutely right when she says that, at that stage, no step can be taken by the doctor to kill the patient, as it were, because this is about the patient doing it. They will have to discuss it, and a whole variety of measures could be taken by a doctor in the face of complications. It is impossible for me to indicate in relation to every complication but, pursuant to Clause 12(2)(d), that is what must be discussed with the patient—subject to the important point, on which we both agree, that the doctor cannot kill.
Baroness Finlay of Llandaff (CB)
I seek a little more clarification. The noble and learned Lord just said that the doctor should act in a way to save the patient’s life. In that case, if the patient takes their lethal drugs and does not die, the doctor then stands back, lets them wake up, lets them vomit and tries to stop them fitting or clears the airway. But that has to be explicit in the Bill, so that there is no misunderstanding at all that there is any circumstance in which the doctor can then proceed to top up or further inject lethal drugs. In other countries, that is what happens if the patient has not died. Here we are talking about it being self-administered by the patient.
Lord Falconer of Thoroton (Lab)
I think that this is absolutely clear in the Bill. Self-administration is what is required. We are discussing how to deal with complications, including whether or not the patient wants some sort of non-intervention, which is perfectly possible. If it is not specifically agreed, and the patient is suffering in some way, the role of the doctor is to save their life, because the doctor cannot kill. I do not think that there is any doubt about that position in the Bill. I do not think that this is properly covered by the terms of this amendment—I will look at it again—and so I do not think that any further change is required.
Lord Hamilton of Epsom (Con)
If I understand the noble Baroness correctly, that is 23% of people who die well beyond the six-month sentence they have been given. That is an extraordinarily large figure, and I am grateful to her for it. I think that makes us question the whole basis of this Bill which is talking about medical diagnosis that gives people a limited life but turns out to be wrong. This could be very disturbing, if we are going to go ahead on the basis of information that could be wrong in quite as many cases as that.
Baroness Finlay of Llandaff (CB)
My Lords, the noble Lord asked about data. During the Select Committee that was held on Lord Joffe’s Bill on this subject, the Royal College of Pathologists told us in evidence that, at post-mortem, one in 20 people were found to have died from something different to what was written on the death certificate. That underlines the point that he makes: errors in diagnosis are the fundamental problem, happen quite often and result in the wrong treatment being given—not through malpractice, but just because medicine is a very inexact science.
Lord Hamilton of Epsom (Con)
I am very grateful to the noble Baroness. That just illustrates my point that misdiagnosis can very easily be done, and we are putting an enormous weight on it in this Bill and it can so often be wrong. We should be very disturbed and concerned about that because it means that we may be passing legislation which is based on faulty information.
Baroness Royall of Blaisdon (Lab)
My Lords, I completely agree with the noble Lord, Lord Deben, on the society that we are seeking to have. We agree on so many things. We are on different Benches, but we agree on many things. However, the pre-eminent reason for this Bill is a terminal illness for six months. I understand what the noble Lord opposite is saying—that one cannot be sure—but we are talking about six months. As other noble Lords have said, one might aspire to have access to the drugs so that one could take one’s life if one had a terminal illness and it was thought that it was going to last for six months, but it does not mean to say that people are going to use them. It is important to remember that all the time. Six months and a terminal illness is the important thing to keep in the forefront of our minds at all times.
Baroness Finlay of Llandaff (CB)
My Lords, the noble Baroness has prompted me to return to the point made by my noble friend Lady Cass, because the chance of being right about six months has been estimated at around 48%. It is just plucked out of the air. It depends on the individual, how their body responds to whatever disease it is and lots of other factors. I was concerned when the noble Lord, Lord Markham, said that these are people who want to live. They should be having access to specialist palliative care to maintain their quality of life as high as possible, yet we have huge gaps in this country.
Lord Markham (Con)
I was making the point that those people—I am looking at some in that category in this very Room, I believe—want to live for the rest of their natural life for as long as possible. That is what they really want. They desperately do not want to be diagnosed with a terminal illness.
Baroness Finlay of Llandaff (CB)
I have looked after thousands and thousands of patients, and I have to say that I have never come across someone who said they wanted to be terminally ill and to have their metastases or whatever. No, people want to live well but accept that death is a natural part of life. That is quite different from talking about deciding that someone is going to be given lethal drugs to foreshorten their life.
The benefit of the amendments proposed by the noble Baroness, Lady Berger, is that they fit fair and square with the Title of the Bill, which is about terminally ill adults, and make it clear that this is about terminal illness and cannot be masqueraded as anything else. Yes, there will be multiple factors, because of course someone who is already seriously ill but is content with their life will not seek assisted suicide—that goes without saying. However, we also need to be clear about differentiating medication, which is where we give a substance with the intention of achieving an improvement to the person’s well-being, from the large cocktail of lethal drugs that we debated previously, and I am not going to revisit that.
I have a concern when we label all these patients as having pain and suffering. Evidence from other countries is that pain and suffering are not the prime reason why people are going for this. I see the noble Baroness, Lady Jay, nodding, and I remember well from the Select Committee that we were on that we heard repeatedly that there were multiple existential factors that made someone’s life have so little meaning and worth that they felt they wanted to go for assisted suicide. However, we have to put some boundaries around it, because literally thousands of people in this country feel exactly that—that their lives are of no worth—and they feel suicidal. As Professor Louis Appleby, the lead suicide prevention adviser to the Government, has said,
“I’m worried once you say some suicides are acceptable, some self-inflicted deaths are understandable and we actually provide the means to facilitate the self-inflicted death. That seems to me to be so far removed from what we currently do and from the principle that’s always guided us on despairing individuals, that it’s an enormous change with far-reaching implications”.
The amendments would provide a ring fence and some safety barriers. Sadly, there are literally thousands of people in society who are suicidal. We heard a lot about that in relation to young people and the algorithms on their phones that they get into with social media and so on. There are an awful lot of people who are profoundly depressed and a lot of people in poverty, and when they become ill that may take them down one further notch, and there are a lot of people who just feel unloved. We have to make sure that the Bill sticks to what it claims to do, which is to be about terminal illness.
Baroness Grey-Thompson (CB)
My Lords, in other groups last week, I covered issues of why I was concerned about people requesting assisted suicide because they feel like a burden, so I will not seek to rehearse those, but we should care about the other reasons why people’s decisions might be impacted, not least because in 2022 Marie Curie said that when someone is given a terminal diagnosis they are quite often financially impacted by that. So not only do you have the trauma of the diagnosis but other things happen and fall apart very quickly around you.
I know that Members of the Committee from all sides have worked on welfare reform and on the Legal Aid, Sentencing and Punishment of Offenders Act—all designed to provide better support for people who may need it. It is great to hear that there are GPs who will offer support on benefit claims and to put other things in place, but I cannot quite understand and work out where in the process people would be signposted back to the GP. We know that there is often a long waiting list for people to get a GP’s appointment; would one or both of the two doctors actually help somebody with a benefits claim or who would they signpost to? That is an important part of understanding the process.
Baroness Finlay of Llandaff (CB)
I have a short question, if I may. If I heard it right, the noble and learned Lord said that he would bring forward an amendment to put asking the question of why in the Bill. Whereabouts in the Bill does he intend to put it, and when will we see it?
Lord Falconer of Thoroton (Lab)
I do not want to commit myself to where it will be. It will come somewhere, but I assume the best place for it, subject to advice, would be either with the co-ordinating doctor or the independent doctor, or the panel or all three, having to ask why.