Terminally Ill Adults (End of Life) Bill

Lord Markham Excerpts

Friday 16th January 2026 Lords Chamber

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I support the point about lasting power of attorney that the noble Baroness, Lady Coffey, has made and the noble Lord, Lord Harper, has reinforced, but I also want to look at it another way round. The fear—which is a very justified fear—is that the power could be abused in the case of assisted suicide, but I also think it is important to look at it from the point of view of the person who has given the lasting power of attorney.

Many noble Lords will have lasting power of attorney—I declare that I do myself—and it carries certain responsibilities. One thing that surprised me when I first got lasting power of attorney was that I might be asked to take a view about whether a “do not resuscitate” order should be given. Of course, that was an intimidating responsibility and something that I needed to establish with the person concerned. I understand why it had to happen, but it was pretty difficult and anxiety-inducing. Imagine if we who possess lasting power of attorney had some responsibility to take a view about whether the person over whom we have those powers should have an assisted suicide. It would seem a very unpleasant responsibility, and therefore it is important that both sides—the person who transfers the powers and the person who receives those transferred powers—should be quite excluded from this.

[Lord Markham (Con)]

Every point that has been raised is valid, and I am sure that, when the noble and learned Lord, Lord Falconer, gets up to respond, he will acknowledge those points as well. However, I think the question in each case is whether we want it to be a black or white assessment of whether that should apply.

Financial support is a very good example of where in some cases that may be very relevant and in others it may not. I remember that my mother, unfortunately, was given a matter of weeks to live and was helped on her way when there was a matter of days left. The financial circumstances just did not even come into it at that point, so having a black and white assessment saying, “Oh, she didn’t seek financial support or didn’t have it”, was not even a relevant criterion. On the question about mental health and whether someone has had any disorders, that is very relevant if it was a recent episode but I think we would probably say it was not very relevant at all if it was 50 or 60 years ago.

Therefore, in all these circumstances, are we not seeing cases where it depends on the circumstances? To me, it is a question of whether we trust the panel, and whether we trust the doctors assessing the case, who are looking into all the criteria and will have the opportunity to call for any evidence they need on it, to be able to do that.

[Lord Deben (Con)]

Does my noble friend accept that one of the problems is that the organisations of these very people whom we are trusting have said that they want clarification on these things. The issue, therefore, is that we should be giving them that clarification that they want, and then we can trust them. They say they do not want to be trusted unless they have that clarification. That is the only point we are trying to make.

[Lord Markham (Con)]

Again, it is about whether you put that financial support clarification in black and white and say, “This must be something that someone’s done”, where it might not even be relevant to the circumstances, or where the—

[Lord Scriven (LD)]

The fact that somebody has a terminal diagnosis of six months automatically triggers SR1, so that part of the amendment is superfluous. There are things in amendments that automatically happen but which they would put in the Bill, but they do not need to be put in the Bill by the amendments because they already happen.

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[Lord Markham (Con)]

This whole debate shows that these are not black and white matters. Although they are all relevant criteria, which absolutely should be in the assessment—my understanding from the Bill is that they are in the assessment—it should not be put down as some sort of tick-box exercise that says you are either eligible or not, according to them.

[Lord Harper (Con)]

May I just check: is the noble Lord, Lord Markham, really saying that he wants it to be open so that a lasting power of attorney could be used by somebody else to seek the death of the person on behalf of whom they have that power? Does he want that to be available? I do not think he does, and it appeared that the noble and learned Lord, Lord Falconer, did not either. If we do not think it should be, we should rule it out.

[Lord Markham (Con)]

What I am trying to come back to—a point that my noble friend Lord Deben was making—is that there are some valid criteria here. I am trying to build some flexibility into this system. Lots of eligibility criteria are being set out here, in all these different amendments.

[Baroness Berridge (Con)]

I believe that the noble Lord answered that intervention, so this is separate.

The noble Lord served on the Select Committee with other noble Lords. We heard clear evidence from Alex Ruck Keene and others that this is not about flexibility: you need to know which piece of legislation you, as a clinician, are applying. Are you acting under your general duty on suicide prevention or, as in the example I gave, are you acting under either the Mental Health Act or TIA? There is no flexibility. Clinicians are asking for clarity on this; with all due respect, that needs to be in the Bill.

[Lord Markham (Con)]

It is about whether we are trying to build everything in; I will try to make my point now that I have taken a few interventions.

The point I am trying to make in all this is that these groups of amendments set out lots of different eligibility criteria. Some are about nursing homes and whether you are a resident. Some are about whether you have ever had a mental health assessment. Some are about financial support. Everyone in every circumstance says that, in some people’s circumstances, these criteria are very relevant and should be the criteria set down for doctors. It should be very clear that, under those criteria, the doctors and the panel should be taking these things into account. The criteria might be totally irrelevant for other cases, too.

We are trying to give the doctors and panels the opportunity to make these decisions without being tied up in knots over black and white exercises around whether the law is applicable to someone according to this or that, so that we can have a workable set of rules that takes into account all noble Lords’ concerns to make it as safe as possible—quite rightly—and creates a process whereby, ultimately, it is the experts, doctors and social workers on panels who are best placed to make a decision.

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[Baroness Royall of Blaisdon (Lab)]

My Lords, I too warmly welcome the return of my noble friend Lady Campbell—the most extraordinary person and advocate for disabled people and so many more in our societies. I just remind the Committee that, in all these discussions about burdens and people who have had a stroke— I am terribly sorry that the husband of the noble Baroness, Lady Grey-Thompson, had a stroke—we are talking about six months for somebody who has been diagnosed with a terminal illness. We should reflect on and remember that in all our deliberations on the Bill.

[Lord Markham (Con)]

I may just build on that, because the noble Baroness is quite right that it is six months. This is absolutely about choice, and behind that choice is the person’s motivation. Of course pain is a very valid reason, but it is not the only reason as, again, research has shown. For lots of people it is about the loss of dignity. For others, it is about the loss of control of bodily functions or about losing autonomy. It is about being less able to engage in enjoyable activities.

Yes, sometimes it is about feeling a burden, inadequate pain controls or financial concerns as well, but that shows that it is a complex area. On average, people gave three or four different reasons or motivations. It is not for us to assess what a valid or invalid motivation is. We should be considering whether there is any coercion in those decisions but, beyond that, it is absolutely about choice. Recognising choice is about people having their own motivations behind this. It is not for us to decide whether they are valid or not.

[The Lord Bishop of Chester]

My Lords, this is an important and moving debate. It is an honour to speak in it and to follow some of the previous contributions. These amendments highlight the fact that eligibility is not the same as motivation. I agree with almost everything that has been said before me; I will not delay the Committee by repeating those points.

There are two things that I want to bring to your Lordships’ attention. First, I remind noble Lords of points made by my right reverend friend the Bishop of Gloucester. The Bill, if passed, will apply to those in our prison system, for whom there will be very particular motivations, which we need to make sure can be fairly applied to them.

Secondly, if the Bill is passed, we have a duty of care to those who survive the deceased. Some of us have had the privilege of sitting with many bereaved families. In my experience, there is almost not a death which does not leave a huge wake of pain behind it. Indeed, the one or two in which that has not been the case have been some of the most distressing pastoral situations I have ever dealt with. Where there has been an element of choice to that dying, the “what ifs”, the “if onlys” and the longings are deeply profound scars, which live with people for a long time. In passing the Bill—if we do pass it—we have a responsibility of care, not just to those considering their own death but to those left behind, those who are caring and those who long to do everything they can to be with those they love deeply, and to support and enable them to carry on living and to do so well.