Assisted dying in Jersey

About assisted dying

Assisted dying is where a person with a terminal illness, or experiencing 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.

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.

Assisted dying in Jersey proposals 

The proposals for who would be eligible, the assisted dying service and the assisted dying process, are summarised in the sections below.

Public consultation on these proposals took place between October 2022 and January 2023.

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 either:
  
• a terminal physical medical condition, known as Route 1 - terminal illness
  
• an incurable physical condition, causing unbearable suffering, known as Route 2 - unbearable suffering
  
• have decision making capacity
• have a voluntary, settled and informed wish for an assisted death
• be at least 18 years of age
  
• have been ordinarily resident in Jersey for at least 12 months
  

Jersey Assisted Dying Service

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

The 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
  

A Delivery and Assurance Board 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
• there is fair access to the service
  

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 navigators, 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 (first assessment) Doctor, the doctor who undertakes the first assessment of the person who has requested an assisted death and coordinates the assessment process
  
• Independent Assessment Doctor, the 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, the doctor or nurse who will directly administer the substance used in assisted dying or support the person to self administer
  

Conscientious objection

A right to conscientious objection makes sure people are free to act in accordance with their own personal beliefs about assisted dying.

The assisted dying law will state that no one can be compelled to directly participate in the assessment, approval or delivery of an assisted death.

Assisted dying process

There are nine 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 the process at any time.

Step 1. First 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 request to a Coordinating Doctor. This is a formal 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 request

If the person still wishes 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. Request approval

• for people who are eligible under Route 1 - terminal illness, the Coordinating Doctor will approve the assisted dying request but can only do so if both the Coordinating Doctor and the Independent Assessment Doctor determined that the person meets all the criteria
  
• for people who are eligible under Route 2 - unbearable suffering a special Tribunal must confirm the Coordinating Doctor's approval. The Tribunal may either confirm or reject the Coordinating Doctor's decision
  

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. Planning and preparation

• the Administering Practitioner will support the person to have an 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
• the location
• private homes
• care homes
• hospital facilities
  

Step 7. Prescribing the substance

• only the Administering Practitioner or another assisted dying practitioner may prescribe the assisted dying substance, for example, the medications used to bring about the person's death
  
• Jersey General Hospital pharmacy will dispense medications used for the assisted dying substance
  

Step 8. End of life

• 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
  

Step 9. After an assisted death

The process for the registration of the death and the burial or cremation of a person who has had an assisted death 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
• publish an annual report on assisted dying, setting out the number of assisted deaths and requests for an assisted death
  

The development of assisted dying proposals

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 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. These decisions are the first steps towards assisted dying being permitted in Jersey.

Phase 1 of 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. 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 are the focus of the second phase of consultation.

Development of policy proposals

In addition to phase 1 of the public engagement, the development of the proposals for assisted dying in Jersey have been informed by:

Professional leads working group

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

• the Medical Director
• Chief Nurse
  
• Chief Pharmacist
• Interim Chief Allied Health Professional
• 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
• Chief Inspector of the Jersey Care Commission as an observer

It is supported by policy representatives from SPPP (Strategic Policy, Planning and Performance) and HCS (Health and Community Services).

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.

Phase 2 of public consultation

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

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

Key dates

The following table summarises the next steps development of an assisted dying service and outlines the key dates in the process so far.

Next steps

Alongside the publication of the consultation feedback report, the Minister for Health and Social Services will publish a revised process for the development of assisted dying legislation in April 2023. Having reflected on the feedback received to date, the Minister wishes to ensure that more time is allowed to scrutinise and examine assisted dying proposals.

The next steps for the development of an assisted dying service are:

1. Develop final proposals and States Assembly debate on assisted dying proposals
2. Preparation of draft law and States Assembly debate on draft law
3. Implementation period for assisted dying service in Jersey, including:
   
• training of health professionals
• development of website and public information
  
• set up of service and regulatory regime
  
4. Assisted dying legislation comes into effect
   

Debate on proposals for assisted dying

Responses to the consultation will be used to inform final proposals for debate by the States Assembly. The States Assembly will confirm the proposals for an assisted dying service in Jersey.

Preparation and debate on draft law

Should the States Assembly approve the policy proposals, work will commence on the preparation of a draft assisted dying law. The preparation of a draft law is complex, and it is anticipated that this process will take a minimum of 12 months. 

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.

Wellbeing support

Assisted dying is a sensitive subject. If you need support, contact:

Mind Jersey on 0800 7359404 or visit Mind Jersey website

The Listening Lounge on +44 (0) 1534 866793 or visit Listening Lounge website