Terminally Ill Adults (End of Life) Bill

Lord Markham Excerpts

Friday 13th March 2026 Lords Chamber

These amendments would create a clear, streamlined service with greater transparency and clear, defined oversight that is more easily monitored. They have been written to respond to requests from the Royal College of GPs, the Royal College of Physicians, the Royal College of Psychiatrists and the Association for Palliative Medicine that an assisted death service must be a separate service. They respond to the call for a recognition that multidisciplinary input into assessment and good governance are essential and that an assisted death is not a medical treatment. They are based on more than 20 years’ work by clinicians and academics who have not been opposed to assisted dying but recognise the dangers of a system that can easily expand to have all the complications and escalation that we have seen, for example, in Canada. These amendments are designed to provide coherence. I beg to move.

[Lord Markham (Con)]

As requested, I was waiting until the noble Baroness had moved her amendment—

[The Deputy Chairman of Committees (Viscount Stansgate) (Lab)]

The noble Baroness has moved her amendment.

[Lord Markham (Con)]

I was trying to respond to the noble Baroness’s request not to be intervened on during her speech, but I have some questions on what she was talking about. I am now concerned that she will not have the opportunity to answer them.

[Noble Lords]

She will.

[Lord Markham (Con)]

I thank noble Lords. I totally appreciate that the noble Baroness’s intention in all this is to try to make the process as robust as possible and she gave a very moving example of why she believes in it. But surely the people best placed to give evidence and understand the situation or the capacity of the person involved—their circumstances and whether there is any coercion—are the very people who she is suggesting should not be part of that panel, namely the health professionals and doctors involved. I am trying to understand why the noble Baroness would not want to involve those professionals who are closest to the case.

[Baroness Finlay of Llandaff (CB)]

Unfortunately, I am not sure that the noble Lord heard me right. The panels that we discussed previously did not include the treating clinicians—they were to look at the evidence brought to them. In the panel structure that I am proposing, the panel would have access to all the patient’s notes—with their permission—all their investigations, the full assessment of capacity and all other aspects that would be happening in routine practice during the patient’s care.

Concerns over the patient’s family and behaviours during the course of their illness would be documented in the clinical record, along with the criteria on which the diagnosis was made, and that clinical record would be available to the panel. That is why I have suggested that there needs to be an expert with knowledge of the specific disease afflicting the person who is seeking an assisted death. There are many rare conditions in medicine; common things occur commonly, but rare things are not that uncommon, and it is quite common for there to be a misdiagnosis that may lead to the patient making a decision based on the fallacy that they have an illness they may even have been treated for. We heard evidence in a previous Select Committee that, at post-mortem, around 5% of people are found to have died of something different from what had been recorded on the death certificate, suggesting that misdiagnosis is, sadly, not a very rare occurrence.

[Lord Markham (Con)]

I was specifically referring to:

“The person’s health or social care professional cannot participate in any part of the assessment for a person’s request of an assisted death”.


That is the point I am trying to understand. Yes, unfortunately there are cases of misdiagnosis—the 5% that noble Baroness mentioned—but 95% of the time these people are the best qualified to make an assessment, so I am trying to understand why we would not want them involved.

[Baroness Finlay of Llandaff (CB)]

They will not be involved in the judgment as to whether the person is eligible for lethal drugs; they are providing their clinical expertise and knowledge. It is the panel who, separately, independently and through a process that can be completely scrutinised and documented, would make that assessment. That would mean that the patient’s care could not be contaminated by pressures causing the doctor to be burnt out, financial pressures on the system in which that patient is being treated, or even administrative pressures, such as the patient’s discharge becoming difficult and the hospital needing beds because patients are being treated in corridors—which we know is happening all the time. It provides separation and a degree of clarity over the assessment and judgment.

--- Later in debate ---

[Lord Deben (Con)]

The proposal here is not isolating them in all the things that matter; it is doing something quite different. It is saying that those who are looking after them continue to look after them and give the information that is necessary for those who will make judgments to make those judgments. It is making a distinction between care—that is, the people we are talking about—and a decision about life and death. That decision should not be made by the people who are looking after them, but the people who are looking after them should provide information to those who are making an objective decision. That is why putting carefulness at the heart of what we do, and putting the rest to one side, is a proper way of dealing with it.

[Lord Markham (Con)]

The noble Lord was at pains to say that he felt that assisted dying was somehow not a compassionate part of care, but will he accept that, for some people, it is the true definition of compassion? Noble Lords have heard me say on many occasions that, when my mother was terminally ill and it was suggested that we might help her take an earlier train home, that was absolutely the compassionate thing, which she and others wanted. For all the supporters of assisted dying in this House and in this country, which is about 70% of people of every religion and including those with a disability—every group we talk about—it is because they believe that that is the most compassionate thing they can do: to give the person the autonomy of their own choice of how they want to end their suffering.

[Lord Deben (Con)]

One problem with using the word “compassionate” is that it is a mechanism for suggesting that one’s own answers to these issues are compassionate and other people’s are not. I happen to think that the most compassionate way of dealing with this is, first, to have a society in which we have palliative care of the highest standard for everybody. Then, if you have that, it may be that some would believe that it would be better for them to make a choice to kill themselves. This is what we are debating: not the principle but how you do this. I have given a clear statement of what my principled views are, but I am talking now about the facts of this issue. First, you have to show that you have proper palliative care. Secondly, you have to accept that there will be, in accordance with the Bill, the opportunity for people to decide. Who should make that decision? The problem is that, if you have proper palliative care, that will continue—or it ought to continue. All the information that those people have should be given to the people who are making that decision.

My noble friend is absolutely right: there are those who feel that this is a compassionate answer. I suggest that, if they feel that, the opportunity to make that choice should not be in the hands of people who are actually looking after them. I have tried to explain that, first, it makes many people more frightened of hospitals; secondly, it confuses their relationship with doctors; and, thirdly, it is very difficult to see that all those people who are looking after people will want to be involved in this. Fourthly, this begins to get closer to what the people who support the Bill demand should be carried through. We are trying to find an answer and, if the sponsors of the Bill do not like this particular answer, perhaps they can come forward with a proper programme for how to do this, instead of leaving it to the vagueness which our own Select Committee said was unacceptable.