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Assisted Dying Debate




The States Assembly have voted in favour of setting up an assisted dying service in Jersey for islanders with terminal illnesses and neurodegenerative diseases, following a landmark vote on the 22nd May 2024. Here is the full text of my speech where I articulate my views :


'The right to an assisted death is not just a legal or medical debate but a deeply human one that touches the core of our values, our compassion, and our understanding of autonomy and dignity.

This was always going to be a difficult debate and one where every member of the assembly, indeed every member of the public will have a personal experience which influences their response to this proposition.


In early 2020, the Minister for Health and Social Services made a commitment to commission a citizen’s jury, following community interest on assisted dying at local level.  I was selected as a member of the Independent Advisory Panel to provide an objective voice to advise, check and challenge throughout the process.  Having overseen the design of the jury process and having observed the delivery of the sessions, it is my view that the Jury process was appropriate, balanced and robust. This view was endorsed by the Public Accounts Committee in 2022 who commended the process as a model of best practice.


At the conclusion of the process, 78% of the jury members agreed that Assisted Dying should be permitted in Jersey and agreed that it should be possible for both routes.

As a result of my involvement in the jury process, I have had the opportunity to access a great deal of information and I have carefully considered competing perspectives on Assisted Dying from recent approaches made by different groups.


Before the recent change in government, I was a member of the Assisted Dying Ministerial Group, and on behalf of the Council of Ministers, finalised outstanding matters before the lodging of the Proposition. We took the decision, notwithstanding the findings of the Ethical Review, that Route 2 should be retained in the proposals presented to the Assembly on the basis that Route 2 was a central feature of not only the Citizen’s Jury but also the Assembly’s decision making in 2021.

For this debate, I have carefully considered the detail of the Proposition, Appendix A and the accompanying Report. I have paid close attention to the recently published Scrutiny Report of the Assisted Dying Review Panel, and particularly the subsequent Ministerial response, which endorses the findings, clarifies some information and accepts all of the recommendations.

I am grateful to everybody who has emailed me about this topic, those against, and those in favour, for taking the time to share their views which I have carefully considered.


At the heart of the argument for assisted dying is the principle of autonomy - the right of individuals to make informed decisions about their own lives. In the context of terminal illness, this includes the right to choose a dignified end rather than prolonged suffering. Respecting autonomy means acknowledging that competent individuals have the capacity to make decisions about their own well-being, including the manner and timing of their death.


As a humanist, I believe that every adult, with capacity, who is intolerably suffering from an incurable physical condition and has a clear and settled wish to die should have the option of an assisted death.

Being able to die with dignity, in a manner of one’s own choosing should be understood as a fundamental human right – this position is supported by the European Court of Human Rights – outlined by the cases of Debbie Purdy and Diane Pretty.


I do not believe that it is right that only those who can afford to travel to Switzerland are able to die at a time of their choosing. Often, patients will make the journey alone, fearing criminal repercussions for family members who accompany them. We heard from the Solicitor General yesterday that in Jersey, the legal position about this can best be described as ‘murky’. Often, they will have to go sooner than they would like in order to be fit enough for travel. For people who cannot afford to make the journey, and effectively outsource their passing to Switzerland, the only legal option is to take more brutal action. I believe that this is cruel and inhumane.

The principles of justice demand that we treat individuals fairly and equally. Denying assisted dying to those who are terminally ill and suffering, while others can legally refuse life-sustaining treatment creates a disparity. Palliative care has limits, it cannot give everyone the good death that they might wish for.  It is unjust to force individuals to endure unbearable pain when the means exist to end their suffering peacefully and on their own terms.


Compassion is a cornerstone of medical ethics.  For many terminally ill patients, pain and suffering cannot be adequately managed by palliative care alone. In such cases, allowing these individuals to choose assisted dying is a compassionate response that respects their wish to avoid unnecessary suffering. It acknowledges the limits of medicine and the profound distress that can accompany the end of life. While palliative care has advanced significantly, it is not always sufficient to alleviate the suffering of all terminally ill patients.


Concerns about potential abuses of assisted dying are valid and must be addressed through stringent safeguards and protocols. In jurisdictions where assisted dying is legal, robust procedures are in place to ensure that only eligible patients—those who are terminally ill, suffering unbearably, and capable of making informed decisions—can access this option. These protocols typically include multiple assessments by independent doctors, mental health evaluation, and waiting periods to ensure that the decision is voluntary, settled and well-considered. This Proposition mirrors these principles and exceeds those in place in other jurisdictions.


The Report is well written, thorough and measured. The safeguards in this proposition, at Appendix A appear comprehensive and considered. 


They are clearly set out for both routes and are made stronger by the Assisted Dying Scrutiny Panel amendment around participation, which has been accepted by the Minister. I am reassured that the Assisted Dying Review Panel will continue in its important role until the draft Assisted Dying Law is debated in 2025.


I consider the proposals to be well thought out and the safeguards presented satisfy my concerns about safeguarding support for the vulnerable at this point in the process.  

Other jurisdictions have shown that assisted dying can be implemented safely and ethically, with strong safeguards in place to protect vulnerable individuals. Data from these countries indicate that fears of widespread abuse or a slippery slope have not materialized. Instead, assisted dying laws have provided relief and dignity to many who face unbearable suffering.


The slippery slope argument suggests that legalizing assisted dying could lead to broader and unethical practices, such as the euthanasia of non-consenting individuals.  However, evidence from countries with legalised assisted dying shows that with proper safeguards, these concerns have not been realised.  Academic research has noted :

‘[the authors] found no evidence to justify the grave and important concern often expressed about the potential for abuse—namely, the fear that legalised physician-assisted dying will target the vulnerable or pose the greatest risk to people in vulnerable groups … [and] ‘ there is no current factual support for so-called slippery-slope concerns about the risks of legalisation of assisted dying – concerns that death in this way would be practised more frequently on persons in vulnerable groups’ 

Strict eligibility criteria, rigorous oversight, and transparency are shown to be effective in preventing misuse.  


 One of the most common objections to assisted dying is the belief in the sanctity of life—that life is inherently valuable and should be preserved at all costs. Whilst I agree that life is indeed so very precious, this argument must be balanced with respect for individual autonomy and the reality of unbearable suffering. Forcing individuals to endure a painful and undignified end can be seen as a violation of the sanctity of their lived experience and their right to make deeply personal decisions about their own lives. Like other members, I was moved by the testimony of a Jerseyman whose deeply moving account was published on Saturday in the Jersey Evening Post.

This view was also communicated powerfully in the Jersey context by Alain Duchemin, a terminally ill Jerseyman who presented to the Citizen’s Jury in April 2021 –

Alain said – ‘what makes anybody think that they have the right to force me to die in a particular way , that I don’t want. I cannot imagine for one second why anyone would think they have that right’. 


For me, this debate is the second step of a three step process. What we decide today will inform the drafting instructions that will produce a Law that will be debated in this assembly at the end of 2025.

It is not the final step, there is ample time to ensure that the procedural and safeguarding concerns raised by members are addressed in greater depth and I have no doubt that the Assisted Dying Scrutiny Panel will pay careful attention to members concerns.  For myself,

I would like to understand more about the training regime for those doctors who will assess whether an assisted death will be permitted, particularly around the issue of coercion;

·         I do have concerns about the residency criteria, which I feel is too short;

·         I have concerns about clinical governance which will need to be addressed carefully;

·      And, I will support a proposition to enshrine the provision of a ‘gold standard’ palliative care in the forthcoming Adult Safeguarding Law.  


We have arrived at another crossroads where we can take the path of prolonging suffering or enhancing the dignity and autonomy of terminally ill people (or those who endure unbearable suffering ).    I believe that we have to respect the right of individuals to end suffering on their own terms.

I too, have personal stories about loved ones who have died in distressing circumstances. I have sat at bedsides for days or weeks, holding the hands of the dying, hoping for a quick release from pain and suffering, willing the end to come swiftly and peacefully.  Sometimes it was a ‘good death’, others it was not at all what that person would have wanted for themselves nor what the family wanted for them.

I hold very specific views on how I would like my own death to be managed.  Those views are very well known to my family, and not all of my family agree with them.

I do not share the same attitude to death and dying held by some religious believers, particularly that the manner and time of death are for a deity to decide, and that interference in the course of nature is unacceptable.


My support for this proposition stems from my belief that assisted dying is about embracing compassion, respecting autonomy, and recognizing the limits of medicine. It is about providing a humane option for those who face terminal illness or unbearable suffering with no hope of recovery.

I believe that individuals should have the right to make the same deeply personal decisions about their own deaths as they do about their own lives, supported by rigorous safeguards and ethical medical practice.


Finally, I would like to add my thanks to the Minister, past and present, together with Officers for a comprehensive proposition, appendix and report. 

This does not mean that I will support the draft law, unless all of the safeguards are in place but I do want to be able to decide upon a draft Law in it’s entirety; one that includes Route One and Route Two.

And it is for that reason, that today, I shall be voting to support the proposition in its entirety'.


The draft Law will come to the States towards the end of 2025 for final debate.


 

 

 

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