Public engagement summary report on assisted dying in Jersey

​​Assisted dying in Jersey, public engagement summary report

Introduction

About this report

This report provides detail on the first phase of public engagement on assisted dying in Jersey.

It sets out an overview of engagement activity carried out during March and April 2022, summarises the hopes, thoughts and concerns that people shared and provides responses to the key questions they posed.

The report has 5 sections:

• Introduction
• Summary of engagement activity
• Approach to key themes
  
• Key themes
• Key questions

Background to public engagement

In November 2021 the States Assembly decided in principle to permit assisted dying and to arrange for the provision of an assisted dying service. They were the first parliament in the British Isles to do so.

The Assembly debate was informed by recommendations of the Jersey Assisted Dying Citizens' Jury. The Jury consisted of a group of 23 Islanders, selected at random, who were demographically representative of the Island's population.

During that debate, Assembly Members highlighted need for continued public engagement to help inform the development of the detailed proposals.

This report describes the first phase of public engagement process that took place in March and April 2022. It will be followed by a second phase of public engagement which will take place in summer 2022. This second phase of engagement will focus on the details proposal to be debated by the States Assembly in autumn 2022. Should those proposals be approved, the Assembly will debate draft legislation in, or around, Spring 2023 after which an implementation period would be required before the legislation permitting assisted dying comes into effect.

Summary of engagement activity

This first phase of public engagement on assisted dying ran for 4 weeks between 9 March and 14 April 2022. During this period, the Government of Jersey asked Islanders to share their thoughts, hopes and concerns around assisted dying through a number of channels, both online and in-person.

In-person engagement opportunities

Islanders were invited to drop-in sessions to share their views with Government of Jersey policy officers. People were requested to book online via Eventbrite, but those who did not pre-book were also welcomed at the sessions.

The sessions were advertised:

• on www.gov.je
  
• via social media
• in advertisements in the Jersey Evening Post and Bailiwick Express
• in radio adverts on Channel 103
• digital screen advertising in public locations including Liberation Station
• through key stakeholder organisations

A total of 65 people attended across the 4 in-person sessions.

Online engagement opportunities

In addition to in-person events Islanders could also share their views online. They could do so anonymously or provide their name, as they wished. This included:

• emails to assisteddying@gov.je
• responses to Government of Jersey social media posts
• anonymous posts on sli.do

In total 63 responses were sent to assisteddying@gov.je, 50 social media comments were made and 171 people participated via sli.do. A total of 55 questions were posed and there was an engagement score of 170 (total number of questions and likes).

Wellbeing and support

Assisted dying is a sensitive topic which can give rise to distressing feelings for some people. On www.gov.je and social media posts links were provided to mental health and wellbeing support services. This information was also available at the drop-in session plus a number of the session facilitators are Mind Jersey trained Mental Health First Aiders.

Target audience for engagement

The public engagement sought to hear the views of people aged 18 and over. The Children's Commissioner has advised that children aged under 18 years old should not be engaged unless by specialist experts due to the sensitive and potentially distressing nature of assisted dying.

The views of campaign groups were not explicitly sought, although contributions were received from:

• Channel Islands Humanists
• Living and Dying Well
• End of Life Choices Jersey

Activity to promote participation in the public engagement

Making Islanders aware of the public engagement was extremely important. The following were used to draw attention to the engagement and to encourage people to have their say:

• information on the Government of Jersey website with highlighted link on the homepage
• full page advertisements in the Jersey Evening Post
• Bailiwick Express advertisements
• Google advertisements
• advertisements on Radio 103
• social media posts
• screen advertisements at Liberation Station and the Clock Tower, King Street
• leaflets distribution

To make sure that information on assisted dying proposals was accessible, information leaflets were produced in:

• English
• Portuguese
• Polish
• Romanian

These leaflets are available on gov.je/assisteddying and digital and paper copies were distributed via Caritas and the Association of Jersey Charities.

Summary of online and in-person responses received:

Approach to key themes

Approach to summarising responses

The purpose of public engagement was not to gauge whether Islanders support assisted dying as the States Assembly has already decided, in principle, to permit it in Jersey. But the engagement was to provide an opportunity for people to ask questions or share their:

• hopes
• thoughts
• concerns
  

This report summarises the range of views shared in the key themes and questions asked in the key questions. It does not set out to give weight to the responses received, except by indicating the strength of response where relevant.

Personal responses to the engagement process

Many Islanders who contributed to the engagement process shared their personal experiences of death and assisted dying. Including accounts of personal illness and bereavement. These contributions are not described in detail in this report but the themes they touch on are reflected below.

Key themes

Responses to the engagement have been clustered into 6 key themes. Some reflect arguments presented in the wider ethical and moral debate on the issue. Others focus on the practicalities and implications of establishing an assisted dying service in jersey.

Personal and societal experiences of death and dying

Desire for more open dialogue around death and dying

Many responses expressed a wish for a cultural shift in the way death is considered in society. They want the subject to feel less taboo and to be spoken about honestly and openly, and not just amongst those who are close to the end of life.

This included a desire for people to discuss their end-of-life choices at an early stage, including matters related to their:

• will
• financial affairs
• funeral arrangements

And matters such as lasting power of attorney and decisions related to end-of-life care, including advanced decisions to refuse treatment. Or, in future, the wish whether or not to have an assisted death.

Acknowledging 'bad deaths'

Personal experiences of deaths of loved ones were raised frequently during the engagement process. For some, these were stories about a 'good death' which was peaceful. This included symptoms and pain being well managed, and an experience that was not unduly distressing for both the individual and their family.

However, for others, there was a need to share and publicly acknowledge that there are 'bad deaths', even with excellent support and palliative or end of life care. For these people, watching loved ones come to the end of their life, sometimes slowly, and in intolerable pain was a traumatic experience. One that they think may be alleviated in future, with the introduction of assisted dying.

Autonomy of choice

Some of those who expressed support for assisted dying talked about it as a something they would want for themselves, depending on their future health. Others did not necessarily see it as an option for themselves, but rather they held a view that everyone should have a right to choose what happens at the end of their life.

For some this was seen in the context of choice and control over one's health and medical decisions, in the same way an individual has a choice about other health and medical treatments. For example the option to make a personal decision to not undergo chemotherapy, even if it's the recommended course of treatment.

Experience of assisted dying in other jurisdictions

Some shared experiences of friends and loved ones having assisted death in countries including:

• Switzerland
• the Netherlands
• Canada

Those who shared their experience considered it to be a largely positive, particularly for those who were resident in that country. For those who travelled to Switzerland, the stresses of funding, travel and legal uncertainty (fear of prosecution of family members) weighed against the benefits of seeking an assisted death to end their suffering.

The role and impact on medical professionals

The option to conscientiously object

The importance of medical professionals being able to choose whether or not to participate in an assisted dying service was seen as paramount. Some expressed a concern that even with a conscientious objection clause some doctors may feel pressured to take part.

Availability of doctors willing to participate

Some responses queried whether any doctors on island would actually be willing to participate in an assisted dying service. Others suggested health care professionals should be surveyed to gauge whether there would be sufficient numbers on island to support an assisted dying service.

As part of this engagement process, a small number of doctors did proactively make contact to express that they would be willing to participate in an assisted dying service.

Tensions in the role of doctors to prevent suffering or preserve life

The tensions of the duty of doctors to both prevent suffering and sustain life were noted in submissions from those both in favour and opposed to assisted dying. Those against it, felt this tension made assisted dying an impossible choice for doctors. Others noted a legal mandate to assist a patient to die would support doctors who felt that alleviating suffering was their principal duty.

Clarity over role in overseeing end of life care

Some raised the issue of the unspoken practice of doctors providing high doses of pain relief to hasten a death. They felt that a legal framework for assisted dying could provide clarity over medical intervention at the end of life in such instances.

Others cited the case of Harold Shipman, noting that assisted dying legislation would not have prevented this situation. Others were clear that this example of a convicted killer is not valid and assisted dying laws would provide safeguards and guidance for health professionals participating in the process to prevent abuse.

Medical complications during the procedure of an assisted death

Many responding to the public engagement wanted to understand more about the actual procedure of an assisted death. Some expressed a concern for things going wrong, such as an assisted death taking longer than expected or being a distressing experience for the individual or family members. They wanted to understand more about medications taken and the role of the doctor.

Eligibility for an assisted death

The States Assembly, in debating assisted dying, were of the view that more consideration should be given as to whether:

• people should be able to make an advanced decision in relation to assisted death
• assisted dying should be permitted for people aged 17 or under

Both these subjects were discussed extensively in the drop-in sessions as well as other eligibility criteria.

Advance decisions

An advance decision is where a person determines what care or treatment they want or do not want in advance of requiring it. For example, some people make an advanced decision not be resuscitated if they have a heart attack.

Many who attended the in-person sessions were in favour of the introduction of assisted dying and in favour of advanced decisions. They felt the law should permit a person to make an advanced decision to have an assisted death if, for example, they lost the ability to make that decision at a later date. For example, if they were in a coma or they lost capacity due to dementia. In particular, people spoke of loved ones diagnosed with dementia who had expressed a wish early in their diagnosis for an assisted death.

Whilst there was a lot of support for advanced decisions people acknowledged they are very difficult to provide for. In particular they recognised the importance of an individual giving their consent, and having the opportunity to change their mind, at every stage of the process. For example, a person may decide in advance that they want an assisted death if they get a certain condition but change their mind at a later stage but lack the ability to communicate that.

Under 18 years old

There was no definitive view as to whether children under 18 years old should be permitted an assisted death. Some people thought that those aged under 18 may not have the maturity to make such decision. Others felt children and young people should not be denied an option afforded to adults. Overall, the majority view was to legislate for adults aged over 18 years only and potentially reconsider in future.

Residents only

The majority expressed the view that an assisted dying service should only be available to residents, and that Jersey should not become a destination for 'suicide tourism'. Views varied on how a resident should be defined, and what length of time an applicant may need to have lived in Jersey to be eligible. A minority felt it would be more equitable if Jersey provided for anyone who wanted an assisted death and others noted the potential financial benefits of providing assisted dying to non-residents.

Terminal illness

Some agreed that 6 months felt to them an appropriate timeframe for those diagnosed with a terminal illness to request an assisted death. Others, both those in favour and opposed to assisted dying, were not comfortable with a specific time-period for defining terminal illness. They noted comments from many medical practitioners on the difficulty in accurately predicting life expectancy. Others noted the Canadian terminology that deaths that were either 'reasonably foreseeable' or 'not reasonably foreseeable.'

Defining unbearable suffering

The decision made by the Assembly to allow those experiencing unbearable suffering to have an assisted death, even where they do not have a short life expectancy, was welcomed by most who attended the in-person sessions, although some felt it should be restricted to those who were already near to the end of their life.

Many acknowledged that suffering was ultimately a personal and subjective experience, and the individual concerned was the only person who could determine whether their experience was unbearable. For some, this raised questions over how this would feature in the application and assessment process. Others questioned the interaction between mental and physical health and how the cause of suffering was determined.

'Slippery slope' of eligibility and responding to societal views

Several online submissions articulated a concern that over time criteria for eligibility would inevitably widen. For example, allow for those aged under 18 or those whose only medical condition is a mental illness. Citing jurisdictions such as Canada where eligibility criteria have widened over time. Some also expressed a concern that numbers requesting an assisted dying would continually increase.

Others stated that if, in time, a decision was taken by the States Assembly to widen eligibility criteria, this would be in response to evolving societal views at the time the decision is taken.

Safeguards and approval process for an assisted dying service

Navigating the process

Participants clearly articulated the need for an assisted dying service to be designed around the patient. For example, the service should be straightforward and equitable to access and should support the individual (and their family) at every stage of the process. There was some concern that an overcomplicated process may deter those who are eligible, given they will be in a vulnerable position and experiencing suffering.

Court or Tribunal involvement in the pre-approval process

Concerns were raised at the in-person events about including the courts or a tribunal in the decision-making process. Some people thought it would be an unnecessary burden, increasing the time taken to determine requests for an assisted death.

Conversely, others noted that judicial involvement was an important safeguard which added integrity and accountability to the process. A benefit both for applicants and the medical professionals involved.

Detecting coercion

The concern most frequently expressed during the engagement process was the fear of an individual being coerced into requesting an assisted death. Some felt that no safeguard could mitigate against this risk. For example, where there was implicit pressure that it would be better for other family members if death was sooner rather than later. Particularly in instances of 'covert' coercion. People were also unsure as to whether doctors would be able to detect coercion. Others felt that a robust assessment process, which included family members, would be sufficient to identify coercion.

Role of the family

Many cited the importance of involving family members in the assessment process. Both in order to safeguard against incorrect assessments of eligibility, but also in order to support family members as well as the patient throughout the process in terms of both practical and emotional support. Some noted the need for this support to extend beyond the death of their loved one.

Fluctuating circumstances and decisions

Whilst the in principle decision made by the States Assembly notes that a request for an assisted death must be settled, some responses to the public engagement raised concern over those whose health conditions fluctuated in terms of peaks and trough' in their physical and mental health. There was a concern that they may choose an assisted death, even though in future, their condition and suffering may improve.

Impact on suicide rates

Comments received online via sli.do raised a concern about a possible rise in suicide rates with the introduction of assisted dying. Others raised concerns that without assisted dying, suicide rates amongst those with health conditions that result in unbearable suffering could rise. See the key questions for more information.

Pre and post death scrutiny

Online contributions noted the importance of oversight and clear record keeping both during the assessment process and once an assisted death has taken place.

Funding, personal financial implications, and provision of end-of-life services

Funding for all end-of-life provision

Most contributions signalled the need for continued improvements and funding for all end-of-life care services. Both those provided by government and by other organisations. It was very clear that people believe that assisted dying should be a real choice, one that is made by a person who wants some control over the end of their life. As opposed to a false choice, one that is made by a person who believes they will not receive the care they need.

Some expressed a fear that the introduction of assisted dying would lead to a decline in the funding or quality of other services. 'Fund and support living, before you fund and support dying'.

Issues with accessing other services

Some submissions expressed concern that inadequate provision, or limited access, to other related services were more important. For example, mental health services and domiciliary care. A sense of 'other things need fixing first', before assisted dying can be introduced to Jersey.

False choice of an assisted death

As set out above, people expressed concern about assisted dying being a false choice. Not just in relation to an individual's ability to accessing the health and care services they need but also with regard to other external factors, beyond their health, that may impact their suffering. For example, inadequate housing. Some people sought assurance that the assessment process would take into account factors behind a request for assisted dying. To ensure these related only to the suffering caused by the health of an individual.

Cultural and societal pressure for an assisted death

Similarly to false choice, some participants were concerned about individuals choosing an assisted death for the wrong reasons. For example, if someone diagnosed with a terminal illness chooses to shorten their life in order to save care costs so they may pass an inheritance to children or grandchildren. Others were worried about people choosing an assisted death to avoid being a burden on family members in their final months.

The process of legalising assisted dying in Jersey

Make it happen

Those in favour of assisted dying who contributed to the public engagement were keen that progress was made at pace. Some felt they had already waited too long or were concerned that the legislation would come too late for their personal circumstances. Others worried that politicians would block the progression of the legislation, 'don't ignore public opinion'.

Learning from elsewhere

At the in-person sessions, some people stated that Jersey must learn from the experience of jurisdictions that have already introduced assisted dying. Some were positive about Jersey leading, not following the rest of the UK.

Keep the public informed at every step

Many reiterated the need for continued public engagement as the legislation is developed, and for effective and wide-reaching information campaigns in the event an assisted dying service is established.

Participants considered it extremely important that people know their rights and the options available to them. This was felt to be of particular importance for certain groups, including those with English as an additional language and those with other barriers to accessing information. For example, those with sight impairment.

Key questions

The questions below were frequently asked during the public engagement process. They are grouped into the same themes used in key themes.

As the engagement process continues to roll-out gov.je/assisteddying will be updated with the additional questions and answers.

Personal and societal experiences of death and dying            

What does assisted dying mean?

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

Assisted dying 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.

Those who choose an assisted death may self-administer drugs to end their life or be supported by a medical professional who administers the medication.

How do I request an assisted death?

At present, the legislation is not in place to request an assisted death in Jersey. This is likely to be an option in the future if the States Assembly approve legislation to permit this. However, in the meantime you may wish to discuss your end of life wishes in advance with your family. This may include other decisions and legal decisions not directly related to assisted dying, but that can be made in advance, including lasting powers of attorney and an advance decision to refuse treatment.

Will I be able to decide in advance that I want an assisted death?

Current proposals for assisted dying in Jersey do not allow for someone to make an advance decision about requesting an assisted death. Those who are considering an assisted death will need to make a request to the assisted dying service at that time.

The role and impact on medical professionals

Can doctors and other professionals conscientiously object to assisted dying?

The States Assembly have decided that any nurse, medical practitioner, or other health professional would be able to conscientiously object. They would not be under any legal duty to participate in assisted dying.

Proposals currently being considered would allow for health and care professionals to make a decision to opt in to participating in an assisted dying service. However, other health professionals may be asked to provide an assessment or professional opinion for an assisted dying service assessment with the provision of the option to conscientiously object.

If professionals do choose to participate in assisted dying, how will they be supported?

Experience from other jurisdictions where assisted dying is permitted suggests that supporting an assisted death can have an emotional impact on health and care professionals involved. Even where those professionals firmly believe that they should participate in the process.

With this in mind, proposals being developed will include provision for wellbeing and peer support for health professionals who do opt in to work in an assisted dying service.

How many doctors on Island are willing to participate?

A small number of health professionals have either publicly or privately said that they would opt-in to supporting people with an assisted death in Jersey. Others have said they support assisted dying in principle but would not actively participate, and others are clear that they do not support assisted dying in any form.

Should assisted dying legislation be approved, as part of the implementation phase, detailed work will be carried out to develop the pool of health care professionals needed to deliver the service. This may need to include a combination of professionals who live and work in Jersey and others who are brought in on an ad hoc basis.

What if my doctor doesn't support assisted dying?

Proposals being developed will look to ensure that anyone who meets the criteria in law can access an assisted dying service. This may include allowing people to directly contact a centralised assisted dying service, without being referred by a doctor in the event a doctor does not support assisted dying.

How does the process of an assisted death work and what drugs are used?

There are 2 ways that an individual may have an assisted death. Either they may choose to self-administer medication or have a medical practitioner administer the medication that will end their life.

Before the event, an individual would be supported to plan the day, time, and location for their assisted death. As well as other decisions such as who will be present at the time of the procedure.

On the day of the procedure, a registered medical practitioner or registered nurse will be present. They will confirm that the individual has capacity and consents (fully agrees) to the procedure. After this final confirmation, the assisted death can take place.

For a self-administered assisted death, the individual will ingest oral liquid medications. For a practitioner administrated assisted death, several medications are injected intravenously. The first medication will cause the individual to fall into a deep sleep, after which they will become unaware and stay unaware until their death.

The length of time this process can take varies with each individual. Based on data from other jurisdictions, the average time for self-administered oral medication from ingestion to unconsciousness is 5 minutes. And an average of 32 minutes between ingestion and death. The median time from administration to death, where medication is injected intravenously is 9 minutes.

The exact medications, combinations and dosages differ across the countries where assisted dying is currently permitted. Typically, a combination of 3 types of medications are used to bring about death:

• the first drug deeply relaxes the person, and they begin to lose consciousness
• the second drug puts the person into a deep coma
• the third drug stops their breathing and heart, and results in death

For example, in Oregon, USA, the medications most frequently prescribed for oral self-administration is a combination of:

• diazepam
• digoxin
• morphine sulfate
• amitriptyline

In Canada, where medications are more commonly administered by practitioners intravenously, the combinations of medications most commonly used is:

• midazolam (an anxiolytic, sometimes called anti-anxiety medications or tranquilizers)
• propofol (an anaesthetic coma-inducing agent)
• rocuronium or cisatracurium (neuromuscular blockers to stop respiration)

What if an assisted death goes wrong?

As with all medical procedures, it's possible that complications may occur. If this were to happen, it would most probably result in an individual taking longer to die than anticipated.

For this reason, an important safeguard is that a registered medical practitioner is present at all assisted deaths. Even if the individual chooses to self-administer the medication, so that they can intervene if things do not go to plan. Protocols will be established to provide practitioners with clear guidelines on what to do if complications do occur.

Eligibility for an assisted death

Who will be eligible for an assisted death in Jersey?

The States Assembly have decided, in principle, that a person who could choose to have an assisted death would be a Jersey resident who:

• is aged 18 or over
• has the capacity to take a decision to end their life
• has been diagnosed with a terminal illness and has a life expectancy of 6 months or less. Or has an incurable physical condition that causes enduring and unbearable suffering
  

The person's decision to access assisted dying must also be:

• voluntary, the decision would be their own choice, freely made with no pressure or coercion from others
• continuing, meaning that their choice is settled and stays the same
• fully informed, the person must be well-informed about their disease and their care and treatment options

If someone expresses a wish for an assisted death in advance, will this be taken into account?

An advance decision can guide medical treatment decision-making for people if they lose the ability to make their own medical decisions. Current proposals state that a person could not request assisted dying in advance. It was decided that people requesting assisted dying need to have decision-making ability throughout the entire process to make sure their decision remains voluntary and consistent.

Can someone with dementia access assisted dying?

Having dementia on its own is unlikely to make a person eligible for assisted dying. By the time the disease is advanced the person will usually no longer have decision-making capacity.

However, a person diagnosed with dementia may be eligible if they meet the eligibility criteria in relation to a different either:

• disease
• illness
• medical condition

Like anyone else, people who have dementia must still have the ability to make and communicate a decision about their wish for assisted dying throughout the process.

What if an individual has both physical and mental health conditions that result in unbearable suffering?

The States Assembly have agreed that an individual may only be eligible for assisted dying due to a physical health condition. However, the suffering resulting from this physical condition may also result in psychological suffering or a diagnosis of a mental health condition.

If this were to be the case, it's likely that as part of the assessment process, the individual would be required to undergo a psychiatric assessment to determine if the mental illness had an effect on their decision-making capacity to request an assisted death.

How can you define unbearable suffering?

Unbearable suffering is ultimately a subjective and personal term.

In jurisdictions, such as Canada, the law sets out that that an eligible person must have an illness that 'causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.'. The Canadian assessment process requires the medical practitioners to determine this, and if the doctor assessing does not have expertise in the condition causing the patient's suffering, they must consult with a practitioner who does.

In addition, the Canadian law sets out that the person reviewing the request for assisted dying must agree that the person requesting must have given serious consideration to all other means of alleviating their suffering in the first instance. Including accessing:

• counselling services
• mental health and disability support services
• hospice and palliative care services

Doesn't the introduction of assisted dying place a value on the lives of disabled people?

The proposed eligibility criteria do not propose a list of eligible health conditions, impairments, or disabilities or place a value judgement on them. It places a focus eligibility due to the unbearable suffering of an individual. Such unbearable suffering may be felt both by those who do, and do not identify, as having a disability.

Safeguards and approval process for an assisted dying service

Who would be responsible for oversight and regulation of an assisted dying service?

The Jersey Care Commission is Jersey's independent care regulator. It's broadly equivalent the UK's Care Quality Commission. The law would be amended to place a legal duty on the Care Commission to regulate and inspect any assisted dying service in Jersey.

In addition to Commission inspecting the service, the health professionals involved in its delivery would be subject to oversight from their professional registration bodies. For example, the doctors must operate in accordance with the professional standards set by the General Medical Council with whom they must be registered. The Government of Jersey is in discussion with professional registration bodies about assisted dying.

Where will assisted dying take place?

The Assembly have decided that assisted dying can only take place in pre-approved locations. This is to help ensure the service can be controlled and supervised. It's likely that law will provide that pre-approved locations will include both health and care facilities as well as people's private homes. The approval process will be set out in the detailed proposals currently under development.

What if people request an assisted death but change their mind beforehand?

Proposals will include the ability for anyone who has made a request for an assisted death to change their mind and withdraw their request at any time.

In addition, to ensure the decision to have an assisted death is settled, there will be a mandatory period of reflection built into the process. Sometimes referred to as a 'cooling off period'. This is a minimum time period between the day an initial request for an assisted death is made and the day when the assisted death takes place.

In countries where assisted dying takes places already, this is typically around 15 days for those who are terminally ill. Or between 1 month and 90 days for those whose death is not reasonably foreseeable. However, where the individual is expected to die in a very short period of time, the 15-day period may be reduced.

How will it be decided whether people have capacity to make the decision?

A decision on whether someone has the capacity to request an assisted death will form part of the assessment and eligibility process.

Capacity already plays a key role in end-of-life decision-making. People with capacity can refuse treatment, even if that is likely to result in their death.

The Capacity and Self Determination (Jersey) Law 2016 is a legal framework that exists to support doctors and other health professionals to assess capacity.

If a doctor doubted a person's capacity to make the decision at any point in the process, they would have to refer them to another professional, such as a psychiatrist.

Can family members request an assisted death?

Only the person seeking the assisted dying can ask for an assisted death. This is an important part of making sure the person's decision is entirely voluntary.

What if family members don't agree with the decision?

The decision to have an assisted death rests with the person. The permission of family members is not required, and they cannot override a person's decision.

However, if the family were concerned that the person's eligibility, for example, they thought they were being coerced, this would be considered as part of the assessment process. It could result in the request for an assisted death not being approved.

Can family members be actively involved in an assisted death?

The States Assembly decided that only registered medical practitioners and registered nurses may be involved in the direct assistance of an assisted death. So whilst family members and loved ones would usually be at the person's bedside, only the medical professionals could provide or administer the medication to bring about an assisted death.

Will the introduction of assisted dying increase suicide rates?

A number of studies have been undertaken of jurisdictions where assisted dying is permitted to gauge whether it results in increased rate of suicide. These studies reach different conclusions.

Recent data shows that suicide rates increased in the US and the Netherlands after the introduction of assisted dying but declined in Belgium and Canada.

Will the introduction of assisted dying reduce suicide rates?

The UK's Office of National Statistics (ONS) recently published data which indicates elevated suicide rates in the UK amongst those with severe health conditions. It's suggested that access to assisted dying may reduce the number of suicides in this population. For example, that these people who were seriously ill and dying may not have chosen to end their life by suicide if a legal alternative was available.

Funding, personal financial implications and provision of end-of-life services             

Is there a danger someone will ask for assisted dying because they cannot get palliative or end of life care?

Assisted dying is not an alternative to palliative care or end of life care. It's a choice that some people who are receiving palliative care or end of life care may make.

Palliative care and end of life services are widely available in Jersey. Jersey Hospice is currently working in partnership with Government and other care agencies on the development of a new end of life care strategy which is anticipated to be published in the autumn. The aim of this partnership work is to ensure that all islanders with a life limiting illness have access and informed choice:

• to the right care
• by the right person
• at the right time
• in the right place

Will funding be diverted away from other health services, including palliative care?

The report and proposition considered by the States Assembly in November 2021 (P.95/2021- Assisted dying) was clear that resources currently allocated for palliative care or associated services would not be r​e-directed to assisted dying.

It's anticipated that the 2023 Government Plan, which will be debated at the end of 2022, will include additional monies to support the development of palliative and end of life care services.

Will palliative care provision also be written into law?

The Council of Ministers will be asked to consider whether the law should be amended to place a legal duty on the Health Minister to provide end of life and palliative care services. Details will be set out in the proposals to be considered by the Assembly in autumn 2022.

Is assisted dying being introduced as a cheaper option to end of life care?

No. Assisted dying is being introduced to allow people, who meet the criteria in law, to have more control over the manner and timing of their death. It is not proposed as alternative to end of life care.

It's anticipated that only a very small minority of those approaching the end of their life will consider as assisted death. Based on experience of other jurisdictions it's estimated that between 2 and 38 people per year may seek an assisted death in Jersey.

How much will assisted dying cost?

It's anticipated that access to assisted dying would be free to anyone who is already entitled to free health care in Jersey.

Would assisted dying be treated like suicide with regard to life insurance?

Many other countries explicitly state in their legislation that assisted dying should not be considered as suicide. As a result, it does not impact on life insurance policies in those places. Work is ongoing to understand the possible implications on personal insurance in Jersey with regard to assisted dying. Ultimately, however, any individual requesting an assisted death in Jersey may need to check any exclusions on their personal insurance policies.

The process of legalising assisted dying in Jersey

What are the next steps towards legalising assisted dying in Jersey?

Following their in principle decision, the States Assembly's next steps are to consider more detailed proposals on assisted dying in November 2022. See the timeline below:

When will assisted dying become available in Jersey?

Detailed assisted dying proposals will be considered by the States Assembly in autumn 2022. If they are approved, it's hoped that legislation will be debated in Spring 2023.

There will be a minimum 18-months implementation period before the law comes into effect in order to set up the assisted dying service and ensure the necessary training, safeguards, regulation and oversight is in place. This means that the earliest date that assisted dying could be available in Jersey is late 2024 or early 2025.