Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

Friday 30th January 2026 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I will speak to Amendment 75, which I have added my name to. It addresses probably the most decisive yet hardest to confirm clinical issue, and is central to the Bill.

Prognosis is not determined by diagnosis alone. Throughout my career as a doctor, I have seen many patients whose disease sounded on paper as though death was imminent, yet their course was significantly altered by evidence-based treatment and high-quality palliative care. In evidence to the Select Committee, the Royal College of General Practitioners stated:

“It is possible to give reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months then the scope for error can extend into years”.


I agree with my noble friend that a 50% likelihood of a six-month prognosis is not reasonable.

Amendment 75 would ensure that, when we speak of an expected prognosis of six months, we do so in the context of treatment offered to them, in line with national NICE guidelines and tied to clinical reality. Without this safeguard, there is a risk that people who choose to participate in assisted suicide could start the process even where treatment is delayed, unavailable or not even offered, and where symptoms or fear of the future are instead driving a perception of hopelessness.

A three-month prognosis, as proposed in Amendment 444A, from my noble friend Lady Finlay, would be much more accurate, as there is an evidence-based assessment tool available through the continuing healthcare fast-track process. Noble Lords may be unaware that fast-track funding is available for those who have a rapidly deteriorating condition where they are approaching the terminal stage and the end of their life. This funding is used to provide much-needed nursing care, hospice involvement and support for families, and can be put in place usually within 48 hours.

NHS guidance notes that the fast-track funding tool is used when urgent care is required at the end of life. The most robust data currently available comes from a 2023 observational study published in the British Medical Journal Open Quality. It examined 439 patients referred for NHS continuing healthcare fast-track funding. The median survival for patients whose fast-track funding was approved was only 18 days, and a minority of patients were still alive at 90 days after referral, showing a much more accurate prognosis. The short survival time found in the study suggests that many referrals occur very late, sometimes limiting the ability to arrange preferred care settings. I think ignorance within primary care of this funding pathway and its usefulness in supporting people to stay at home during their last days and weeks contributes to its low take-up, and perhaps the rather unnecessarily large number of people who spend their last days in hospital.

Approval for fast-track funding helps clinicians by grounding prognosis—an already incredibly difficult task to predict—in nationally agreed standards rather than variable local practice. There must be absolute clarity that no one becomes eligible for assisted suicide because the system has failed them, especially regarding geographical variability in treatment options or lack of awareness of these treatment options.

[Baroness Lawlor (Con)]

My Lords, I will speak to Amendments 72 and 80 in my name. I will not say anything about autonomy other than to mention to the noble Lord, Lord Pannick, that although it is a philosophical concept which was drafted in recent centuries, academic philosophy is very divided on how worthwhile it is as a concept.

I begin with my Amendment 80, which would substitute some detail for the very vague requirement that death within six months can reasonably be expected. We have already heard in the Committee, from everybody—not only today but on other days—that certain diagnosis is a very inexact science, and that diagnosing someone as having six months is very inexact.

We have heard from the noble Baroness, Lady Finlay, in opening, that conditions can differ, patterns can differ and patients can differ—we also heard that from the noble Baroness, Lady Hollins. Therefore, each patient must be assessed on an individual basis.

Against that, my Amendment 80 proposes that the difficult job of assessment is done by two consultants specialising in the relevant area, and it pins down that the expectation should instead be an 80% probability. If the sponsors are in earnest that those eligible really should be those who are within six months of death, they should be pleased to accept an amendment that tries to overcome the inexactness of such judgments by requiring confirmation by two of the most qualified experts in the area, and they should accept that an 80% likelihood is what, in this context, can reasonably be expected.

I move on briefly to Amendment 72. The Bill already refuses eligibility for assisted suicide when a condition that in itself is diagnosed to lead to death within six months can be reversed. My amendment takes the next logical step by limiting eligibility to cases where the condition not only cannot be reversed but cannot be relieved, controlled or ameliorated; I am adding to what has already been proposed in that group. The amendment aims to substitute a constructive, optimistic approach to treating illness, rather than one that writes off the patient and points them on the path to suicide.

That requirement—that, when steps can be taken to relieve, control or ameliorate a disease, the patient can no longer be considered for assisted suicide—will remove many otherwise difficult cases from this murky area and allow the mechanisms to operate as best they can for those for whom the Bill, on its face, intends them: people whose deterioration is inevitable.

There is an even more pressing reason than those two to accept this amendment: unless we positively exclude from eligibility patients whose condition could be relieved, controlled or ameliorated, we set up the conditions in which the relief, control and amelioration of terminal illnesses will become increasingly rare. We have heard of some remarkable instances today, not least from the noble Baroness, Lady Campbell of Surbiton—whom I am delighted to see back. Why would an overburdened health service try to give some extra months of life, give a higher degree of relief of pain, or ameliorate or arrest the progression of the disease, when it is so much easier to direct the patient, either implicitly or by expectation, towards assisted suicide?

What about relatives—even no more than ordinarily unscrupulous or greedy ones, or merely selfish ones—for whom the speedy death of their loved one is likely to seem desirable? We may also reasonably fear an overzealous state service committed to the task of accelerating the pathways of such unfortunate cases to their ends. My amendment guards against those consequences—some of the worst of a Bill so rich and varied in its capacity for harm.