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Eyes around the world are on Jersey this week ahead of a landmark debate on whether to establish an assisted dying service on the island, and how it might work. Here, Express distils everything you need to know about the debate..
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Assisted dying... What is it, how did we get here, and what exactly is being voted on this week?
If it got passed... What happens next? And where would an Assisted Dying Service go?
Assisted dying is defined as where a person with a terminal illness, or experiencing unbearable physical suffering, chooses to end their life with the help of a medical professional.
An historic vote in 2021 – just months after the death of campaigner and glioblastoma sufferer Alain du Chemin – saw States Members approve assisted dying in principle.
Pictured: Paul Gazzard, the husband of a campaigner for assisted dying who passed away in May, Alain du Chemin, said he was "delighted" with the decision to approve the concept of assisted dying in principle in 2021.
Now, States Members are this afternoon due debate the practicalities of a new law to legalise assisted dying, with five specific votes planned.
The service: Whether the Island should create an assisted dying service for adult residents who have made a voluntary and informed decision to die.
Eligibility criteria: Who exactly should have access to the service.
Opt-out for health professionals: Whether to offer an opt-out for health professionals and give them a right to refuse to participate in assisted dying.
Minimum timeframes: To agree on minimum timeframes between the first formal request for an assisted death and the act itself – 14 days for route one and 90 days under route two.
States Members will be able to vote separately on the two “routes” to assisted dying: one for those with a terminal illness expected to cause death within a specified timeframe, and another for those with incurable conditions causing unbearable suffering whether or not the condition is terminal.
These are described as:
Route one: This limits eligibility to those with a terminal illness with a life expectancy of six months, or 12 months if they have a neurodegenerative disease. The proposed condition is: “A person must have been diagnosed with a terminal physical medical condition which is giving rise to, or is expected to give rise to, unbearable suffering that cannot be alleviated in a manner the person deems to be tolerable and that terminal condition must be reasonably expected to cause the person’s death within the timeframe specified.”
Route two: Expanding eligibility to those with an incurable physical condition causing unbearable suffering even if it is not terminal. The proposed conditions for route two states that: “The person must have an incurable physical medical condition that is giving rise to unbearable suffering that cannot be alleviated in a manner the person deems to be tolerable (which may or may not be a terminal physical condition).”
Before joining the political fray in June 2022, Health Minister Tom Binet campaigned prominently in favour of assisted dying, chairing the lobby group End of Life Choices Jersey. However, the foundations for assisted dying were laid by his predecessor, Deputy Karen Wilson.
End of Life Choices has always maintained that islanders should ultimately have a 'choice' when it comes to how they die, and be supported to follow that choice. In a previous letter to Express penned prior to his time in politics, Deputy Binet shared the view that the "principle of self-determination should lie at the heart of the current debate", adding: "Following considerable progress in recent years for LGBTQ and other personal rights, let us hope that the current process sees Jersey establish itself as a compassionate, courageous, forward looking place that understands the need for this long overdue legislation."
Michael Talibard, a current leading member of End of Life Choices Jersey, said he was in favour of route two to address the suffering of those with non-terminal conditions.
Another key campaign group in favour is the Jersey Assisted Dying Action Group, which has been led by Jennifer Bridge MBE, a former States Member. She has called on States Members to vote to progress choice and compassion for terminally ill people by allowing them to have the option for assisted dying.
She said: "The vast majority of us in Jersey want to see our cruel, outdated laws on assisted dying changed – States Members can no longer be in any doubt about that and they must have this front and centre of their minds during the debate this week."
Jersey's moves have also been supported by groups in the UK.
Sarah Wootton, Chief Executive of Dignity in Dying, echoed the comments of Ms Bridge, commenting: "This historic debate is a critical opportunity for States Members to do the right thing and pave the way for a safer, kinder, more compassionate law for dying people. The Jersey public believe that assisted dying is a movement whose time has come for the island.”
And, on an international level, broadcaster Esther Rantzen has been a prominent campaigner for the rights of individuals to end their lives, urging Jersey's politicians to "set an example to the entire UK" as they embark on the debate.
Dame Esther, a regular visitor to Jersey, who has stage-four cancer and is a strong advocate for assisted dying, has spoken about her wish to end her life at some point in the future, which would require a trip to a facility such as the Dignitas clinic in Switzerland.
The concept of assisted dying has caused some division among medical professionals, and some do not think the concept has been throughs-through carefully enough.
One group of healthcare workers called Our Duty of Care Jersey have opposed what they describe as the "intentional killing of patients".
In an open letter to the Health Minister signed by 84 medical professionals, the group expressed "grave concerns" about the proposed law and what they described as "serious consequences".
The letter, composed by Dr Andreas Melchior and Dr Helen Thomas, said there hadn't been enough consultation with long-term care professionals. The letter also expressed concerns about a potential lack of safeguards and robust governance systems.
"No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end," the Our Duty of Care group added.
The group separately arranged a survey of 74 medical professionals, which revealed:
The group has also queried whether allowing assisted dying would make Jersey a more difficult place to recruit and attract healthcare workers to.
Another doctor, retired GP John Stewart-Jones, who chairs the Jersey Dying Well Group, also said he does not believe that the proposition being considered this week included sufficient safeguards.
However, family doctor and former chair of the island's Primary Care Body, Dr Nigel Minihane, who formed the Healthcare Professionals for Assisted Dying in Jersey, has spoken strongly in favour of allowing assisted dying.
In a column for Express, he criticised some individuals within the medical profession for perpetuating what he described as "misconceptions".
He said he was in favour of route one due to the difficulties around the assessment and definition of suffering.
Pictured: Dr Nigel Minihane was a local GP for more than 30 years and is the former head of Jersey's Primary Care Body.
The former head of the island's Primary Care Body said: "I will always defend the right of my colleagues to conscientiously object from participating in any aspect of an assisted dying law.
"Indeed, I am sure that dying people who wish to access this choice want to know that they will be supported by someone who shares their values.
"Equally it is important we respect the rights of those who do want to be involved."
Members of a Scrutiny panel reviewing the proposals to introduce assisted dying in Jersey expressed concerns about some elements of the plans in a report published last week.
Pictured: Members of a Scrutiny panel reviewing the proposals to introduce assisted dying in Jersey expressed last week concerns about some elements of the plans and called for further details from the Health Minister.
The Assisted Dying Review Panel, chaired by Deputy Louise Doublet, called for the Health Minister to provide more details in a report published last week.
Scrutineers also called for a palliative care plan and training to prevent instances of coercion in the report.
It also called on the Health Minister to "ensure that the Jersey Assisted Dying Service is not headquartered within the Jersey General Hospital".
Pictured: The Assisted Dying Review Panel is chaired by Deputy Louise Doublet.
The Assisted Dying Review Panel also requested that the Health Minister provide details about the timeline and stakeholders involved in discussions regarding appropriate places within the Jersey General Hospital for assisted dying by no later than two months before the assisted dying legislation is scheduled for debate by the States Assembly.
Concerns raised include challenges in predicting life expectancy for individuals with terminal illnesses, mixed opinions regarding the inclusion of 'unbearable suffering' in eligibility criteria, and worries about the potential erosion of eligibility criteria and safeguards over time - which is known as the 'slippery slope' argument.
Additionally, some have raised concerns about whether newly qualified doctors should be 'assisted dying practitioners' and suggested that they should have five or ten years of experience.
Last year, an "ethics review" said that making assisted dying available to those with incurable conditions causing unbearable suffering “raised significant concerns”, citing an “ableist” judgment about the negative value of the lives of people with disabilities and difficulties around the assessment and definition of suffering.
But their view was at odds with a 23-person citizen’s jury in 2021 – more than three-quarters of whom supported assisted dying for “a Jersey resident aged 18 or over, who has a terminal illness or is experiencing unbearable suffering and wishes to end their life”.
It was also at odds with the majority of States Members who voted 36-10 in November 2021 to back the jury’s recommendations and give the green light to the development of the proposals crystallised in proposition P18 lodged by the Council of Ministers in March.
Some individuals have raised concerns that attention focused on assisted dying may take away from focus on providing good quality end-of-life care options.
Jersey Hospice CEO Mike Palfreman said the charity's focus would remain firmly fixed on this no matter what.
While Hospice had followed and been involved in consultation on the Government's proposals, it has aligned itself with the position of the European Association of Palliative Care, which has for the past 50 years said that assisted dying “shall not be included in the practice of palliative care”.
Pictured: Mike Palfreman speaking at the launch of the Palliative Care and End-of-Life Care Strategy last year. (Dave Ferguson)
The charity said, however, that it does welcome “an open and honest debate on all aspects of care" for people who are ill or dying.
"We believe it is important to talk about access to good and well-resourced palliative care and are encouraged by the dialogue and commitment to providing islanders with the best palliative care and end of life services," the statement said.
It further noted: "We actively support dedicated professionals providing palliative care in care homes, the hospital and in the community. We support and encourage investment in education and care through the whole healthcare system that alleviates suffering, promotes listening and communication, through skilled, evidence-based interventions, meeting the personal, physical, emotional, and spiritual needs of the person."
People need to know “they have a real choice in the matter", Mr Palfreman reflected.
Views of the public have been gathered on several occasions.
Back in 2018, an Express poll showed very strong support for allowing doctors to help terminally ill patients 'die with dignity'. More than 1,000 islanders chose to take part in the poll, with 90.6% (954 islanders) stating that they would support assisted dying proposals in Jersey.
A Citizens Jury set up by Government to consider the issue independently decided in 2021 that it would be in favour of allowing the change for Jersey residents aged 18 or over, who have a terminal illness or are experiencing unbearable suffering and wish to end their lives, so long as stringent safeguards were in place.
More recently, consultation with the public and disability charities revealed a split in views on whether assisted dying should also be made available to individuals with incurable conditions.
One person in favour said: "This isn’t about disability, it’s about suffering, and choice for people who feel that they can’t go on”.
However, those opposed were concerned about the subjective nature of suffering in cases where a person was not nearing the end of their life, the perceived risk of coercion, the possible adverse impact on medical professionals and the fostering of negative attitudes to disability.
Pictured: Only adults who have lived on the island for 12 months and who are terminally ill or have an incurable condition with unbearable suffering would be eligible for assisted dying.
Overnight, local polling company Island Global Research revealed the results of a poll commissioned by Dignity in Dying.
51% of islanders taking part strongly support reform and 10% somewhat support reform, after Island Global Research asked them whether they support changing the law to allow mentally competent, terminally ill adult residents the option of assisted dying.
It comes after more than 3,100 Jersey residents signed an open letter calling for law change on assisted dying that urges States Members to press ahead with reform without further delay.
Jersey may or may not be the first place in the British Isles to bring in legislation to allow residents to end their lives, but there are few if any parts of the UK, Crown Dependencies or Ireland where the topic has not moved up the agenda.
States Members, who have already backed the principle of assisted dying by a convincing majority, will convene this week to debate the practicalities of a new law.
The debate comes a week after a similar discussion in Tynwald, the Isle of Man parliament, which will resume next month, and follows the introduction of a bill in Scotland, set to be debated in the autumn, and a debate in Westminster which may serve as the precursor for the same process in England and Wales.
Politicians in Guernsey voted against assisted dying in 2018, but the subject is now back on the Sarnian agenda, while there has been some support from politicians in Northern Ireland. In the Irish Republic, a parliamentary committee issued a report in March calling for the legalisation of assisted dying in certain restricted circumstances.
If the proposals are voted through, it is expected the process for drafting a law could take around 18 months, with a debate then taking place by the end of 2025.
If a law is approved, it is expected a further 18-month implementation period will then begin, meaning the earliest for it to come into effect would be summer 2027.
During this time, some of the specifics of how the service would operate would need to be worked out – and this includes where it would operate from.
Deputy Binet has agreed with Scrutiny politicians that the General Hospital should be a "last resort" for assisted dying, but declined to fully rule out the idea of it being an Assisted Dying Service headquarters. Jersey Hospice has also been clear that it would not provide such a service on-site.
UK select committee focuses on Jersey's assisted dying move (March 2024)
Assisted dying proposals vote scheduled for May (February 2024)
Assisted dying proposals delayed to avoid end-of-year rush (October 2023)
Health Minister pledges to put forward assisted dying plan by end of year (April 2023)
Gov needs more time to consider public feedback on assisted dying (February 2023)
EXPLAINED: How assisted dying is proposed to work in Jersey (January 2023)
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