Assisted dying in Jersey

About assisted dying

Assisted dying is where a person with a terminal illness, who is experiencing or is expected to experience unbearable physical suffering, chooses to end their life with the help of a medical professional.

It is not the same as suicide. Assisted dying is a service provided to people in certain limited circumstances that will be set out in law.

Assisted dying does not replace palliative care and end of life care services. A person approaching the end of their life or living with serious illness should be provided the care and treatment they need to maximise their quality of life and minimise any suffering or distress. Assisted dying is an additional choice that some people may make because they want more control over the manner and timing of their death.

Key dates

The following table outlines the key dates in the process so far.

Date	Action
March to June 2021	Jersey Assisted Dying Citizens' Jury takes place and initial report on Jury recommendations published
November 2021	The States Assembly approved assisted dying 'in principle'
March and April 2022	Phase 1 of public engagement on assisted dying in Jersey
17 October 2022 to 14 January 2023	Phase 2: Public consultation on detailed proposals
28 April 2023	Publication of consultation feedback report
7 November 2023	Publication of Ethical Review report
22 March 2024	Detailed assisted dying proposals presented to the States Assembly
21 May 2024	Debate on assisted dying proposals by the States Assembly - decision to proceed to law drafting for assisted dying for those with a terminal illness

Next steps

At their sitting on 21 May 2024 the States Assembly approved detailed proposals for assisted dying in Jersey, and requested the Minister for Health and Social Services to bring forward primary legislation that permits assisted dying in Jersey for those with a terminal illness.

Preparation and debate on draft law

Work is now being undertaken on the preparation of a draft assisted dying law. The preparation of draft law is complex, and it is anticipated that this process will take a minimum of 12 to 18 months, with a debate on the draft law by the States Assembly by the end of 2025.

Implementation period

If the draft law is approved by the States Assembly, an 18-month implementation period will begin before the law comes into effect. During this period all the required systems and safeguards will be put in place. This will include, for example, the training of health professionals and the development of accessible public information on assisted dying.

Assisted dying legislation comes into effect

The States Assembly will approve an appointed day act which will determine when the assisted dying law comes into force. It is anticipated that the earliest date the law would come into effect would be Summer 2027.

Policy proposals

Detailed proposals setting out who would be eligible for and assisted death and how the assisted dying service would work are described in the following document.

Assisted dying proposals (p.18-2024) on States Assembly

Summary of the policy proposals

Eligibility criteria

The law will set out the eligibility criteria for accessing assisted dying.

A person must meet all the eligibility criteria. They must:

have been diagnosed with a terminal illness
have decision-making capacity
have a voluntary, settled and informed wish to end their own life
be at least 18 years of age
have been ordinarily resident in Jersey for at least 12 months

Terminal illness

To be eligible under Route 1, the person must have been diagnosed with a terminal physical medical condition that:

is expected to cause death within 6 months, or within 12 months if diagnosed with a neurodegenerative condition such as Parkinson’s disease or Motor Neurone Disease
is causing, or is expected to cause unbearable suffering that cannot be alleviated in a manner the person deems tolerable

Decision-making capacity

The person must be able to demonstrate they have decision-making capacity throughout the process of assessment, approval and provision of assisted dying.

The law will set out a legal test that assessing doctors must use to determine whether a person has the capacity to make an assisted dying decision.

To demonstrate capacity to make an assisted dying decision, the person must be able to:

understand information or advice about their assisted dying decision
understand the matters involved in an assisted dying decision
understand the effect of an assisted dying decision
weigh up the factors referred to above for the purposes of making an assisted dying decision
communicate an assisted dying decision in some way (including verbally, using gestures or by other means)

Voluntary, settled and informed wish for an assisted death

The person must want an assisted death. They must be acting without coercion, or persuasion by another person (which may include coercion from a family member).

The assisted dying process has built in controls to help ensure the person’s wish is settled. The person must articulate their wishes throughout the whole assessment process. Each step in the assessment process can only be initiated by the person expressing a wish to proceed to the next step.

The law will require that the person requesting the assisted death must be fully informed about:

their diagnosis, prognosis and all available care and treatment options
all aspects of the assisted dying process

At least 18 years of age

Assisted dying will only be available to adults aged 18 years or older.

Ordinarily Jersey resident

To be able to access the assisted dying service, a person must have been ordinarily resident in Jersey for at least 12 months prior to making their first formal request for an assisted death.

Ordinarily resident means a person who lives in Jersey and spends all their time here except for short visits abroad on business or holiday. It does not include people who temporarily live in Jersey for work or for study, or people who are on holiday in Jersey.

Jersey Assisted Dying Service

The Jersey Assisted Dying Service will be delivered by the Government of Jersey’s Health and Community Services Department.

The Jersey Assisted Dying Service will be available free of charge to any person who meets the eligibility criteria.

The Jersey Assisted Dying Service will:

provide a point of contact for anyone who wants information about assisted dying or is considering requesting an assisted death
support people to navigate the assisted dying process
support the loved ones of people who have requested an assisted death
coordinate and deploy the professionals engaged in the assisted dying process

An Assisted Dying Assurance and Delivery Committee will oversee the clinical and corporate governance of the Jersey Assisted Dying Service, which means making sure that:

the assisted dying service is safe
standards of care are high
the service is well run and person centred

Health professionals can choose to work in the assisted dying service. To be an assisted dying practitioner, they must:

be registered with the Jersey Care Commission to work in Jersey
have completed assisted dying training
be able to demonstrate they meet the required competencies. The competencies refer to the knowledge, skills, and attributes required for each assisted dying role
make a decision to opt-in to work as assisted dying practitioner with the Jersey Assisted Dying Service

The specific roles in the assisted dying process are:

Care Navigator. Non-clinical staff who will support the person requesting an assisted death, as well as providing support and information to the general public and health and care staff
Coordinating Doctor. A doctor who undertakes the first assessment of the person who has requested an assisted death and coordinates the assessment process. They make the decision to either approve the request or decline the request
Independent Assessment Doctor. A doctor who undertakes the second assessment of the person who has requested an assisted death
Pharmacy professionals. Pharmacists and pharmacy technicians who will prepare and dispense the substance used in assisted dying
Administering Practitioner. A doctor or registered nurse who will directly administer the substance used in assisted dying or support the person to self-administer the substance

Right to refuse to participate in assisted dying

The law will state that no one can be compelled to participate in the assessment, approval or delivery of an assisted death either on any grounds. For example, the health care professional objects to assisted dying or practical considerations such as not having sufficient time to participate.

Participation means the professional could refuse to:

undertake any of the specified roles described above
be present at the time of administration of the AD substance
undertake a supporting assessment to inform Assessing Doctor’s determination of eligibility for AD

Premises owners, such as care home owners, may object to an assisted death taking place on their premises.

The professional could not refuse to undertake:

usual nursing care for a person who has requested an assisted death
related administrative or governance tasks such as providing records or booking appointments

Assisted dying process

There are 8 steps in the assisted dying process.

The person requesting an assisted death is in control of the process and must express a wish to proceed to each step at their own pace. They can stop or withdraw from the process at any time.

Step 1: first formal request

The Jersey Assisted Dying Service will provide accessible information to people considering an assisted death, their friends, family members and health professionals.

The process begins when a person makes a first formal request for an assisted death to a Coordinating Doctor. This is a written request.

Step 2: first assessment

The Coordinating Doctor will assess if the person is eligible for assisted dying.

The first assessment is an opportunity to discuss the reasons for the person's assisted dying request, and all alternative care and treatment options.

The Coordinating Doctor may arrange for additional assessments to help them determine whether the person meets the criteria, for example, a capacity assessment.

If the person is assessed as not meeting the criteria by the Coordinating Doctor, the process will stop.

Step 3: independent assessment

An Independent Assessment Doctor will undertake a second assessment to decide if the person is eligible. They must independently assess the person and form their own opinion.

The Coordinating and Independent Assessment Doctor must both determine that the person meets all the eligibility criteria.

Step 4: second formal request

If the person still wishes to have an assisted death, they must make a second formal request.

This will be a written declaration which is signed in the presence of a witness.

Step 5: approval process

The approval process is an administrative review by the Coordinating Doctor.

If both assessments indicate the person is eligible for assisted dying, the Coordinating Doctor will undertake a full and final review to check all the documentation for assessing eligibility for assisted dying has been properly completed and to ensure that all the appropriate formal requests are in place.

There will be no expiry date for an approval.

Appeals

An appeal can be made to the Royal Court by:

the person who has requested an assisted death, or someone they have asked to act on their behalf
any other person who the Court is satisfied has a special interest in the care and treatment of the person, such as a family member.

The grounds of appeal will only relate to:

whether or not a person has been ordinarily resident in Jersey for 12 months prior to making their first request
a determination by the Coordinating Doctor or the Independent Assessment Doctor that the person has, or does not have, decision making capacity to request an assisted death or that their wish for an assisted death is:

voluntary
clear
settled
informed

a failure, or perceived failure, to make determinations or act in accordance with the process set out in law

Step 6: assisted death care planning

If a person request for an assisted death is approved, the Administering Practitioner will support the person to plan for their assisted death, including supporting them to make decisions such as:

the preferred method for the assisted death. The person can choose to self-administer the substance that will end their life or can choose for the Administering Practitioner to give them the substance
who will be present. For example, family members
the most suitable location, this could include either:

their own home
their care home. If the owner of the care home agrees
a hospital facility

The assisted death care plan will set out if the person has provided any waivers or consents related to their assisted death, including:

Confirmation of Consent to Proceed. The person may choose to give the Administering Practitioner consent to make any necessary or appropriate interventions in the event of complications during the process of administrating the assisted dying substance. For example, consent to give the substance intravenously if the person had chosen to take the substance orally but fallen unconscious before taking it all
Waiver of Final Confirmation of Consent. The person may choose to sign this waiver form which allows for their assisted death to proceed if the person loses decision-making capacity after their request for an assisted death has been approved but before they are due to confirm their consent prior to administration of the assisted dying substance. This is only for people who are eligible under Route 1

Prescribing the substance

Only the Administering Practitioner or another assisted dying practitioner may prescribe the assisted dying substance such as the medications used to bring about the person's death.

Only pharmacy professionals who have opted-in to participate in the assisted dying process may dispense the assisted dying substance. It will only be dispensed from the Jersey General Hospital pharmacy.

Step 7: assisted death

Immediately before the person takes or is given the substance, the Administering Practitioner will carry out a final review to confirm that the person:

has decision making capacity
continues to have a voluntary, clear, settled and informed wish to proceed
is giving their final consent

If the Administering Practitioner is not satisfied that all these criteria are met, they will stop the process.

The substance will be taken by the person or administered by the Administering Practitioner. This may be orally or may be injected intravenously. If the person has chosen to self-administer, they may be supported to do so by a family member or loved one, under the direction of the Administering Practitioner.

Step 8: after an assisted death

Once the Administering Practitioner has confirmed the death of the person, they must complete a Post-Assisted Death Administration form providing details of the administration of the assisted dying substance.

All assisted deaths will be certified by dedicated assisted dying registered medical practitioners who have had specific training on death certification for assisted death

The process for the registration of the death and the burial or cremation of the person would be the same as with all deaths in Jersey.

Regulation and oversight

The Jersey Care Commission will:

provide independent regulation and oversight of the Jersey Assisted Dying Service
undertake annual inspections of the Service, including unannounced inspections
have powers to sanction or suspend the Service if any failings are identified

Assisted Dying Review Panel

The law will set out that a post-death review must be carried out after each assisted death by an Assisted Dying Review Panel.

The purpose of the post-death review is to:

determine whether, in each case, there was proper adherence to the legislation and guidance
identify any process matters that may require improvement or change

Upon completion of the review, the Panel will set out their findings in a report to the Assisted Dying Assurance and Delivery Committee, who will determine what, if any, action to take.

How the proposals were developed

Decision from Jersey's States Assembly

In November 2021, Jersey's States Assembly became the first parliament in the British Isles to decide 'in principle' that assisted dying should be allowed and to decide to make arrangements for the provision of an assisted dying service.

The debate on assisted dying was informed by recommendations of the Jersey Assisted Dying Citizens' Jury.

An 'in principle' decision means the States Assembly wants to receive more information before confirming how an assisted dying service in Jersey should operate.

Development of policy proposals

In addition to ‘in principle’ decision made by the States Assembly, the proposals for assisted dying in Jersey have also been informed by:

Phase 1: public engagement

During March and April 2022 Islanders were invited to take part in the first phase of public engagement on assisted dying proposals. Islanders were asked to share their hopes, thoughts, and concerns on assisted dying in Jersey.

Public engagement summary report on assisted dying in Jersey

A public engagement summary report was published in May 2022. The report identified the key themes from this first phase of engagement, which informed the development of detailed proposals which were the focus of Phase 2 public consultation.

Phase 2: public consultation

The second phase of consultation took place for a period of 12 weeks between 17 October 2022 and 14 January 2023.

Assisted dying in Jersey consultation

Islanders were asked to share their views on the proposals for an assisted dying service in Jersey. A consultation feedback report was published in April 2023.

Assisted Dying in Jersey Phase 2 Consultation Feedback Report

Professional leads working group

A professional leads advisory group was established in early 2022 to advise on matters relating to assisted dying service development and delivery. The group consists of:

the Medical Director
Chief Nurse
Chief Pharmacist
Director of Mental Health and Adult Social Care
Associate Medical Director for Prevention, Primary and Intermediate Care
Accident and Emergency Consultant
General Medical Council (GMC) lead contact
HCS Director of Culture Engagement and Wellbeing
Principal Social Worker
Palliative Care Consultant
Chief Inspector of the Jersey Care Commission as an observer

It is supported by policy representatives from the Strategic Policy, Planning and Performance Department.

Terms of reference for assisted dying, professional leads working group: service development and delivery

Dialogue with professional bodies

Engagement with the UK professional registration bodies began in August 2021. Several individual and collective discussions have taken place with General Medical Council (GMC); Nursing and Midwifery Council (NMC); Health and Care Professions Council (HCPC) and General Pharmaceutical Council (GPhC).

Expertise in other jurisdictions

The proposals set out in the consultation are based on extensive research of assisted dying legislation and practice in other jurisdictions where assisted dying is permitted.

Ethical review

In April 2023, the Council of Ministers agreed that the assisted dying proposals should be further informed by specialists with a background in medical ethics and law. This external review seeks to identify the ethical and moral considerations around assisted dying, including those raised in the responses to the consultation.

The authors of the ethical review were selected for their subject expertise and their range of personal positions on assisted dying, all were previously involved in the Jersey Assisted Dying Citizens’ Jury:

Professor Richard Huxtable
Dr Alexandra Mullock
Professor Trudo Lemmens

The Assisted Dying in Jersey Ethical Review Report was published on 7 November 2023. This report identifies and summarises ethical arguments on key aspects of assisted dying and maps these ethical considerations across the Jersey-specific proposals.

The Assisted Dying in Jersey Ethical Review Report

Lodging period for detailed proposals (P.18 – 2024) and States Assembly debate

Detailed assisted dying proposals were presented to the States Assembly on 22 March 2024, and debated on 21 May 2024.

During the 9-week lodging period a series of information sessions were held for the public and for healthcare professionals, these sessions were an opportunity to hear about and ask questions on proposals that States Members were voting on.

Between 17 and 30 April 2024 Government of Jersey policy officers, with support from third sector organisations, met with disabled islanders and islanders with long-term conditions to gather their views on assisted dying with a particular focus on the ‘Route 2 – unbearable suffering’ proposals. Detail of this work and a summary of the feedback received was published as an addendum to Assisted dying proposals (p.18 - 2024) on States Assembly

During the debate on 21 and 22 May 2024, the States Assembly considered the detailed proposals and made the decision to proceed to law drafting for assisted dying for those with terminal illness only. The Assembly rejected the proposal to permit assisted dying where a person has an incurable medical condition causing unbearable suffering (and does not have a life expectancy of 6 months or less).

Reports and consultations

We have published several key documents during the development of the policy proposals.

Assisted dying proposals (p.18 - 2024) on States Assembly

Assisted Dying in Jersey Ethical Review Report