Review of Assisted Dying Legislation (S.R.4/2026): response of the Minister for Health and Social Services

Findings

Comments

1

High quality end-of-life care is essential to ensuring real choice and preventing individuals from seeking assisted dying due to unmet care needs.

Agreed.

2

The statutory duty to provide end-of- life care represents an important step, but  clarity  is  still  needed  regarding scope,  access,  and  practical implementation. Detailed guidance and clear  interface  arrangements  between the  End-of-Life  Care  Law  and  the Assisted Dying Law will be essential to avoid gaps, confusion, or inconsistent provision.

Agreed.

To be considered as part of the process of developing the End-of-Life Care Law.

3

The Minister for Health and Social Services lodged an amendment to P.65/2025 to clarify that a person may pause the assisted dying process in order to seek assessment from an appropriately qualified health professional on their care and treatment options, including end-of-life and palliative care. This amendment reflects the Minister's commitment that assisted dying should not replace

Agreed.

Findings

Comments

palliative or end-of-life services and aligns with the safeguarding, dignity, and informed-choice principles set out in P.18/2024.

4

Whilst the Minister's Second Amendment to the draft law strengthens safeguards to seek assessment for end-of-life care options, it does not require that this assessment be carried out by a clinician with palliative care expertise, leaving uncertainty about whether individuals will receive specialist palliative assessment as standard practice.

Not agreed

The adopted law, as amended, does not require an individual to receive a specialist palliative care assessment, but provides all individuals with the right to access an assessment by a suitably qualified health professional should they choose to, which may be an assessment by a clinician with palliative care expertise.

This is because, the Minister, having consulted with palliative care providers, has been advised that that it is not necessary, in all cases, for the assessment be carried out by a clinician with palliative care expertise.

In some cases, an individual may have already been assessed by a palliative care clinician, and in cases and/or other professionals may have more relevant expertise depending on the individual's needs (for example, a social worker specialising in end-of-life care may assess needs for psychosocial support and practical support for both the individual and their family).

5

Practitioner administration carries greater safeguarding risks than self-administration and international data indicates that, despite the availability of self-administration, many individuals prefer or default to practitioner involvement. This trend raises safeguarding concerns related to clinician involvement, reduced opportunities for patient withdrawal, and potential implications for professional roles.

Not agreed.

It is correct that when both modes of administration are available, data from other jurisdictions indicates that more individuals choose practitioner administration, however, it is not correct to state that that practitioner administration carries greater safeguarding risks than self-administration'.

The Jersey Assisted Dying law, as adopted includes stringent safeguards that apply both to self-administration and practitioner

Findings

Comments

administration, for example the opportunity to withdraw at any stage in the process is equally available to those who choose practitioner administration or self-administration.

The Assembly demonstrated their support for providing for both modes of administration by choosing not to adopt the Panel's third amendment.

6

A self-administration-first model offers stronger safeguards while still enabling equitable access. Expert advisers and stakeholder feedback show that physical incapacity can be reliably assessed in practice, and that Article 10(3) provides a safeguarded route for assisted self-administration with support. This suggests that reserving practitioner administration for those physically unable to self-administer would better balance autonomy, safety, and proportionality, particularly during the introduction of a new and sensitive service.

Not agreed

As set out in the Minister's comments to the third amendment to the draft law1, it is not agreed that reserving practitioner administration for those physically unable to self-administer would better balance autonomy, safety, and proportionality.

It is noted that the Assembly did not adopt the Panel's third amendment which sought to introduce a self-administration-first model.

7

Experience requirements for Administering Practitioners remain unclear, creating risks for competence and public confidence. Stakeholders highlighted concerns about newly qualified clinicians undertaking complex assisted dying roles. Despite widespread calls for more experienced practitioners, the draft law currently contains no minimum experience requirement. This gap risks undermining public trust and practitioner preparedness, especially where opt-out provisions may reduce the pool of available practitioners.

Not agreed.

The competency requirements to act as an Administering Practitioner are intentionally not set out on the face of the law. However, Article 64 does require that those competencies are clearly defined and approved by the Committee. Those competencies will include matters related to:

• capabilities, including – (i) professional skills (such as practical, communication and clinical skills); (ii) professional knowledge; and (iii) professional values and behaviours (such as those relating to professional and ethical responsibilities and safeguarding vulnerable patients), and

• training (other than training developed under this Law) and professional qualifications; and

Findings

Comments

 being professionally registered (such as

the duration of registration).

The decision to include competency requirements as opposed to only a requirement for years of experience' on the face of the law, was made during the development of the proposals agreed in P18/2024, following discussions with the UK professional regulatory bodies. The rationale being that the law should provide a degree of flexibility/ future-proofing, and that requiring the Committee to set competency requirements ensures that practitioners have the range of skills and capabilities required for the specific role they are registering for, which cannot be guaranteed by a requirement for a certain number of years of experience only.

For example, two doctors who are both 10 years post-registration may have acquired very different skillsets and experience over the course of those 10 years, for instance one may have chosen to work in a non-patient facing role during that period. So it may be that of those two doctors, only one would have acquired the skills and sufficient experience to undertake the role of Coordinating Doctor, for example. By requiring the professionals meet the required competencies (which will include duration of registration), this type of situation will be managed appropriately.

 Whilst the competency requirements will be confirmed by the Committee during the implementation phase, it is anticipated that only practitioners with considerable experience will have the required skills and capabilities to meet the requirements for registration.

8

Public consultation supported choice, but safeguarding imperatives require stronger parameters for implementation. While consultation responses favoured allowing both self-administration and practitioner administration, the evidence indicates that offering an unconstrained choice may dilute safeguards and shift

Not agreed

As stated during the debate on the third amendment to P65, whilst more individuals may choose practitioner-administration (as opposed to self-administration) there is no evidence to support the assertion that this is problematic.

Findings

Comments

practice toward practitioner-led deaths. Choice must be balanced against the need to minimise coercion risks, reduce practitioner burden and error, and seek to ensure that assisted dying proceeds only where voluntariness is maximally protected.

The Panel stated that their third amendment was based on legislation in Victoria, Australia; however, Victoria updated their legislation in November 2025 to a position of unconstrained choice' – that is to say a jurisdiction that had introduced a law with self-administration as default, following a 5-year review, amended their law to allow the individual a choice of mode and did so consciously without concern of a dilution of safeguards'.

9

Clear guidance and training are required to operationalise safe administration practices. The feasibility of a self-administration-first model, accurate assessment of physical incapacity, and safe practitioner involvement depend on robust, standardised guidance and ongoing training. Without these, variability in practice may compromise safeguards and increase the risk of error, misinterpretation, or inconsistent application of the law.

Agreed

MHSS agrees that clear guidance and training are required to operationalise safe administration practices, and this accords with the law which provides for operational standardised' guidance on administering approved drugs, including detailed protocols for how to deal with a medical complication.

Furthermore, the addendum to P65, as previously lodged, had clearly set out that the training and guidance for administering practitioners would all matters related to approved drugs including2:

• prescribing

• dispensing

• preparation

• facilitation of administration

• possible interactions/reactions

• acting in the event of medical complications

• administration of approved drugs – clinical skills e.g. cannulation, equipment, care after death

• establishing refusal or resistance to administration of drugs, where waiver of future capacity is in place

• disposal of unused/partially used drugs

Findings

Comments

In addition, the addendum clearly stated that ongoing training for assisted dying practitioners will include peer support, clinical supervision and case management. See addendum pages 30, 32-33 and 46-49

10

The  assessment  of  decision  making capacity  in  assisted  dying  requires enhanced, context specific safeguards. The Capacity and Self Determination (Jersey) Law 2016 may not be sufficient for  decisions  involving  intentionally ending  life.  Stakeholders  emphasised that  end-of-life  circumstances, fluctuating  cognition,  emotional distress, and medication all complicate capacity assessments. The draft law's requirement that capacity must always be  actively  assessed  (rather  than presumed) adds an important layer of protection but will require clear training and guidance to be applied consistently.

Agreed

It was recognised during the assisted dying law policy development process that existing

capacity legislation was not sufficient for decisions involving intentionally ending life', hence the assisted dying law has a specific, separate capacity test, and requires capacity for assisted dying decisions to be actively assessed'.

As set out in the addendum to P65, all assisted dying practitioners must undertake training on capacity, and the waiver of future capacity. As set out in the section on guidance for assessing capacity, this will include specific end of life circumstances including, fluctuating cognition, emotional distress, and impact of end-of-life medication on capacity.[3]

See addendum pages 32, 35-37, 41-43.

11

Serious concerns exist about the risks and ethical complexity of the waiver of future  capacity.  The  evidence  shows consistent  concerns  that  allowing assisted dying to proceed after a person has lost capacity may create risks of acting  contrary  to  the  person's  final wishes,  especially  where  capacity fluctuates  or  declines  unexpectedly. Stakeholders noted that coercion, undue influence, or changes of mind may go undetected  once  capacity  is  lost. Internationally,  most  assisted  dying regimes do not include such waivers, reflecting  caution  about  proceeding without contemporaneous consent.

Agreed

It is agreed that most jurisdictions do not provide for waivers. The addendum to P65 provides an overview of the guidance to be developed by the Committee for establishing refusal or resistance to an assisted death, where person does not have capacity.[4] See addendum page 35.

Findings

Comments

12

Practitioners'  willingness  and preparedness  to  act  under  a  waiver remain  unknown  and  may  affect feasibility.  The  survey  of  healthcare practitioners did not ask whether they would be willing to administer assisted dying under a waiver. Expert advisers highlighted that, unlike Canada where the  law  permits  a  waiver  of  final consent,  Jersey  has  a  small  clinical workforce,  making  it  essential  to understand  whether  a  sufficient proportion  of  practitioners  would undertake  this  role.  Without  this information, the operational viability of the waiver remains uncertain.

Agreed

MHSS will undertake additional work to better understand practitioners' willingness and preparedness to act under a waiver.

13

Distinguishing refusal from involuntary movement is a recognised safeguarding challenge.  The  Panel's  hearing highlighted practical and ethical risks where an individual loses the ability to communicate  clearly  or  makes ambiguous  movements  during  the procedure. While the draft law requires practitioners  to  stop  at  any  sign  of resistance,  stakeholders  noted  that uncertainty  may  still  arise,  with potential  consequences  for  autonomy and safety.

Agreed

See response to finding 10 above. The Committee will develop guidance for establishing refusal or resistance to an assisted death, where person does not have capacity.

14

The  waiver  supports  autonomy  for some  individuals  but  increases safeguarding  complexity.  Expert advisers noted ethical benefits for those who  fear  imminent  loss  of  capacity, allowing  them  to  avoid  premature access  to  assisted  dying.  They  also identified  that  the  waiver  functions similarly in some ways to an advance decision, bringing with it the same risks recognised  internationally:  difficulty verifying  contemporaneous  consent, potential for coercion, and challenges for clinicians administering life ending medication  to  a  now  incapacitated person.

Agreed

It is agreed that the waiver supports autonomy for some individuals and that it may increase safeguarding complexity, which is accounted for in the additional safeguards provided in the law.

Not agreed

It is not agreed that the waiver is akin to an advance decision, given that the waiver provides for very specific circumstances in a very narrow scope. See MHSS's comments to the first amendment to P65.5

Findings

Comments

15

Additional  training,  clearer  guidance, and  further  consultation  are  required before  the  waiver  can  be  safely implemented. The Panel's review found gaps in guidance on how practitioners should  apply  the  waiver,  manage fluctuating  capacity,  identify  dissent, and navigate substitute decisions. The Panel identified the need for:

- further practitioner surveys,

- renewed  public  consultation  on support for the waiver,

- specific  training  for  administering practitioners, and

- clear guidance for how to proceed if a person  still  has  capacity  on  the scheduled day or wishes to pause the process.

Agreed

Additional training and guidance will be provided as set out in the addendum to P65, as previously lodged. In developing the training and guidance, the Committee is required, by law, to undertake consultation with relevant bodies and professionals.

16

Coercion is multifaceted, often subtle, and  requires  safeguards  that  address both  external  and  internal  pressures. Evidence  consistently  demonstrates that coercion rarely presents as overt force.  Instead,  it  may  arise  through emotional  dependence,  family dynamics, perceived burden, financial pressures,  or  relational  influence. Safeguards must therefore be designed to  detect  a  wide  spectrum  of  both visible and hidden pressures.

Agreed.

17

Certain  groups  face  heightened vulnerability  to  coercion  and  abuse, requiring  enhanced  assessment  and specialist  expertise.  Submissions identified that individuals with mental health  conditions,  neurodivergence, sensory impairments, diverse personal characteristics  or  complex  social environments may be at particular risk of  internalised  pressure  or  undue influence. This reinforces the need for specialist  training,  careful  capacity assessment,  and  contributions  from practitioners with wisdom and expertise in  safeguarding,  mental  health  and social care.

Agreed.

Findings

Comments

18

Strong procedural safeguards exist in the  draft  law,  but  key  gaps  remain, particularly  around  professional expertise, assessment consistency and risk management. While the draft law includes multiple layers of checks (two assessments,  voluntariness  tests, offences for coercion, prohibitions on promotion  of  assisted  dying,  and independent  oversight)  stakeholders and  expert  advisers  highlighted  the need  for  clearer  guidance,  specialist training  and  multidisciplinary involvement to enable these safeguards to operate effectively in practice.

It is noted that advisors and stakeholders referred to a need for clearer guidance. For clarity, no guidance has yet been developed, as this will be done during the implementation phase.

Under the law, this will be a duty of the Delivery and Assurance Committee to develop the guidance and training, and in so doing the Committee must consult with relevant bodies or individuals under Articles 62 – 68 (note, this take account of the additional consultation requirements that arise from Panel's seventh amendment, as supported by MHSS and as adopted by the Assembly)

19

Effective safeguarding against coercion relies on multidisciplinary assessment, not medical evaluation alone. Across all evidence, a common theme emerged: clinicians cannot realistically be expected to identify all forms of coercion without input from safeguarding professionals, mental capacity specialists and social care practitioners. Multidisciplinary assessment was highlighted as essential for recognising subtle relational pressures, improving consistency, and strengthening public confidence.

Agreed.

Effective safeguarding against coercion does rely, in part, on multidisciplinary assessment. Hence the law provides for an extended (multidisciplinary) team to support the assessing doctors in their determination of eligibility, including the voluntary nature of their decision – i.e. including identification of coercion.

20

The  current  financial  model  for  an assisted dying service is indicative only and  lacks  the  detailed  assumptions needed  for  a  reliable  funding  plan. Evidence from expert submissions and the  public  hearing  indicates  that  the Budget 2026–29 allocations are based on  early,  high-level  estimates  rather than a fully developed financial impact assessment.  Key  cost  drivers: governance  structures,  workforce requirements, inflation, training costs, and digital infrastructure - are not yet clearly established, creating a risk of underestimation.

The costs set out, and agreed, as part of the 2026- 2029 Budget are indicative costs. This is clearly stated.

Furthermore, it is also stated in P65, that detailed and updated costs will be developed as implementation progresses, and further refinements will be undertaken once the Service commences and accurate figures and estimates can be made on the numbers of individuals requesting assisted dying. This will then be reflected in future Budgets.

21

There are substantial risks of early cost overruns  and  longer-term  financial pressure.  A  financial  expert  raised

Not agreed.

Findings

Comments

concerns  around  structural  gaps:  no sensitivity  testing,  no  contingency provision,  insufficient  inflation adjustment, unclear distinction between one-off  and  recurring  costs,  and underestimation of specialist training, PMO governance and communications budgets.  International  evidence  (e.g., Western  Australia)  suggests implementation costs often rise in years two and three, reinforcing the need for a more resilient financial model.

Whilst there is always some risk of cost overruns', these are not considered to be substantial risks.'

As noted in the Council of Ministers comments on the twenty eighth amendment to the Budget, the assisted dying budget errs on the higher end of estimates and will be recast once the Service has been begun operating and the actual costs are better understood.[5]

It should also be noted that the costs agreed in the 2026-2029 Budget already allow for an increase in uptake of assisted dying in years 2 and 3 post-implementation. The costs undertaken adopt a cautious' approach and include, for example, significantly more staffing hours requirements per assisted death than the impact assessment undertaken by the UK Government on their Terminally Ill Adults Bill – i.e. the Jersey costs allow for 85.5 hours total staffing time per assisted death, as opposed to the 32 hours total staffing time per assisted death in the UK modelling.

22

Stakeholders  raised  concerns  about proportionality  and  competing pressures on the health budget. Written submissions  noted  that  Health  and Community Services faces significant financial pressures across core services. Several  concerns  were  raised  about whether a funded assisted dying service (expected to serve a small number of individuals)  might  divert  resources from essential, underfunded areas such as  palliative  and  end-of-life  care, mental  health,  social  care,  and long-term strategies.

The additional costs for the implementation and delivery of assisted dying agreed in the 2026- 2029 Budget are held in Reserves until such time the funding is drawn down into the HCJ head of expenditure and thereafter treated as growth funding, with respective safeguards, oversight and financial governance, in accordance with the Public Finances Manual.

Please see above comments regarding anticipated low risk of budget overruns.

The planned approach ensures the establishment of the Assisted Dying Service is proportionate, financially sustainable and does not exacerbate existing pressures on the Health & Care budget; preserving continued focus on financial recovery and investment in priority areas, while providing assurance to stakeholders that the service is being

Findings

Comments

funded responsibly and without detriment to essential services.

23

Funding forecasts are uncertain due to unpredictable  demand  and  limited baseline  data.  Officers  advised  that demand,  staffing  time  and  case complexity  cannot  yet  be  reliably forecasted for a new service. The lack of  historical  Jersey  data  means assumptions  remain  speculative, increasing the need for ongoing review and adjustments.

Noted.

24

Stronger  financial  modelling, transparency  and  structured  review processes  are  required  to  establish  a sustainable  and  accountable  service. The evidence demonstrates the need for a  full  financial  impact  assessment, planned  financial  review  points,  and clear  breakdowns  of  governance  and core costs. Without these, the long-term affordability  and  resilience  of  the service cannot be guaranteed.

Agreed

Financial review and clear breakdowns of governance and core costs is required to understand and assess long-term affordability and resilience of the service.

Not agreed

A full financial impact assessment would, include assessment of any savings / cost avoidance that arises from the availability of the assisted dying service (i.e., relative costs of providing assisted dying to providing long term or palliative care). MHSS will not undertake a comparative assessment of this nature, as MHSS is very clear that Assisted Dying should never be considered from a cost avoidance perspective.

See response to recommendation 16 below.

25

Training is a core safeguard and must be  rigorous,  detailed  and multidisciplinary.  The  evidence demonstrates that training is not merely an  operational  requirement  but  a primary  safeguard  that  enables practitioners to detect coercion, assess capacity  reliably,  navigate  ethical complexities  and  support  vulnerable individuals.  Without  robust  training, the  protections  in  the  draft  law  risk being  significantly  weakened  beyond those just involved in the assisted dying service.

Agreed

This is clearly provided for in Articles 66-68 of the Law.

Findings

Comments

26

The Draft Assisted Dying (Jersey) Law largely  aligns  with  the  principles  of P.18/2024;  however,  important  gaps remain  in  relation  to  safeguarding, autonomy,  equality  and  operational robustness.  Further  measures  and clarity, including the development of detailed training and guidance are key to full alignment with P.18/2024.

Not agreed.

The law aligns with the principles of P18 and includes all the elements set out in P18 that require statutory provision.

Matters of operational robustness and additional safeguarding requirements set out in P18, will be provided by the regulatory and oversight structures set out under the law (including the Assurance and delivery Committee, the Review Panel and independent regulation by the Jersey Care Commission), which will – in accordance with the law- be developed during the implementation phase.

27

Coercion  detection  and  capacity assessment  require  specialist  skills beyond  standard  clinical  training. Submissions  and  expert  advice highlighted that coercion can be subtle, internalised  or  relational,  and  that certain  cohorts  face  heightened marginalisation  and  vulnerability. Effective  training  must  therefore include  mental  health  expertise, safeguarding knowledge, and practical tools for identifying complex or hidden forms of undue influence.

Agreed.

28

Guidance  and  training  remain  under development  and  must  be  published early  to  enable  preparedness. Stakeholders  consistently  raised concerns  that  guidance  is  not  yet detailed, and the Minister for Health and  Social  Services  confirmed  that much of it will be developed during implementation. Early, comprehensive publication is essential to support safe, consistent  practice  in  a  small jurisdiction  with  limited  clinical exposure.

See response to finding 18

The guidance has not yet been developed, and could not have been developed prior to the Assembly's adoption of the Law.

Training and guidance will be developed by the Committee during the implementation phase as quickly as it is practicable to do so.

29

Training must be inclusive, accessible and  aligned  with  wider  safeguarding structures. Evidence from disability and safeguarding  submissions  shows  that communication  needs  vary

Agreed.

Findings

Comments

significantly, and training must reflect the realities of assessing and supporting people  with  disabilities,  sensory impairments, fluctuating capacity and/ or  socioeconomic  vulnerability. International  best  practice  also emphasises  alignment  with  adult safeguarding frameworks and domestic abuse  expertise  and  economic vulnerability.  International  best practice  also  emphasises  alignment with  adult  safeguarding  frameworks and domestic abuse expertise.

30

Ongoing  training,  monitoring  and evaluation  are  essential  for  system integrity and public confidence. Expert advisers and stakeholders stressed the need  for  continuous  updating  of training based on international learning, national  monitoring  outcomes,  and emerging risks. Regular evaluation will help to ensure training remains robust, evidence-based and responsive to the evolving practice environment.

Agreed.

31

Public awareness is a core safeguard and must reach all Islanders, including those most marginalised and at risk of exclusion. Stakeholder evidence shows that  many  Islanders,  particularly disabled  people,  older  adults, care-home residents and those without digital  access,  may  otherwise remain unaware of the law's introduction.

Agreed.

32

Accessible,  inclusive,  multi-format, proactive communication is essential to informed  choice  and  equity. Stakeholders  and  expert  advisers emphasised  that  equitable  access requires  audio,  large  print, plain-language  materials,  Easy  Read formats, and alternative routes beyond digital  channels.  Without  these,  key groups will be unable to make informed decisions or understand safeguards.

Agreed.

33

The  draft  law's  boundary  between factual  information  and  prohibited promotion of assisted dying (Article 78) is  clear  but  operationally  sensitive.

Agreed.

Findings

Comments

Evidence  from  the  public  hearing demonstrated  that  providers  would need  support  to  comply  with restrictions  on  promotional  content, especially in clinical settings such as GP  practices.  This  underpinned  the Panel's  amendment  restricting unsupervised  written  material  in  GP practices.

34

The  Panel's  analysis  shows  that,  in terms of public awareness, the draft law substantially aligns with the principles set  out  in  P.18/2024  while  noting, however, that practical implementation, particularly  around  accessibility,  will be  key  to  fully  achieving  those principles.

Agreed.

35

Jersey's approach to public awareness aligns broadly with international best practice, but successful implementation depends  on  early  guidance,  strong accessibility  standards  and  targeted outreach.  Expert  advisers  noted  that Jersey's  model  is  consistent  with international  norms  on  neutrality, transparency  and  safeguarding,  but warned  that  real-world  delivery (particularly accessible formats, timely publication of guidance, and sensitive engagement  with  disabled  Islanders) will determine whether the framework fully meets best-practice standards.

Agreed.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

The Minister for Health and Social Services  should  ensure  that  the statutory  consultation  on  End-of- Life  Care  [P.73/2025]  includes  a

Minister for Health and

Accept

No comment

Incorporate in draft law to be lodged

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

clear,  accessible  appeals  and dispute-resolution  mechanism  for families, carers, and professionals. This should address concerns about disagreements relating to eligibility, care planning, or access to services.

Social Services (MHSS)

before the Assisted Dying Law comes into full force

2

The Minister for Health and Social Services should publish detailed guidance on the interface between assessing doctors under the Assisted Dying Law and the statutory duties under the End-of-Life Care Law. This guidance should set out: requirements for informing individuals of all treatment and care options; referral pathways to end-of-life and palliative specialists; and expectations regarding multidisciplinary involvement.

MHSS

Accept

No comment

To be published before the End-of-Life Care Law comes into force

3

The Minister for Health and Social Services should ensure that workforce planning for both end-of-life care and assisted dying is developed and published, recognising the interdependence of the two services and the primary importance of End-of-Life Care. This is necessary to mitigate risks

of capacity constraints and seek to ensure the sustainability of services.  

MHSS

Accept

MHSS commits to providing information to the Panel regarding workforce planning for the Assisted Dying Service and any interdependence/intera ction this may have with end-of-life- care services.

Before the Assisted Dying Law comes into full force

4

The Minister for Health and Social Services should provide clarity on how the States Assembly will be kept informed of progress on implementation of P.73/2025 prior to the commencement of any assisted dying service.

MHSS

Already provided for (accept)

P73/2025 requires the Minister to lodge a draft end-of-life care law before the assisted dying comes into full force. Hence the Assembly must be informed before commencement of assisted dying service

Before the Assisted Dying Law comes into full force

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

5

The Minister for Health and Social Services should ensure that statutory guidance will: (a) define "suitably qualified health professional" for the purposes  of  Articles  4  and  8  to include  palliative  care  specialists where clinically appropriate; and (b) set  out  time-bound  referral  and feedback standards so that pauses do not  create  unnecessary  delay  or distress.

MHSS

Accept

No comment

Before the Assisted Dying Law comes into full force

6

The Minister for Health and Social Services should ensure that the implementation guidance developed under the Assisted Dying (Jersey) Law includes explicit, crossreferenced referral pathways to palliative and endoflife care services. This should help to ensure that, when an individual pauses the assisted dying process under Articles 4(3)(b)(iv) and 8(3)(b) to seek further clinical assessment, the referral occurs swiftly, consistently and with clarity across all care settings.

MHSS

Accept

The Assessment guidance will include explicit reference to referral pathways for palliative and end-of- life care, to help ensure that an individual requesting assisted dying is assessed in a timely manner [NOTE: any such referral would not impact on the waiting time for end-of-life patients who do not request assisted dying]

Before the Assisted Dying Law comes into full force

7

The Minister for Health and Social Services  should  ensure  that  the Assisted  Dying  Service  publishes monitoring data demonstrating the use  of  the  pause  mechanism,  the timeliness of palliative assessments, and any impact on final decisions, in order  to  support  transparency, assurance, and learning during the initial years of implementation. This data should be disaggregated by the characteristics referenced within the coercion-awareness  training framework,  to  enable  meaningful analysis  of  potential  risks  and patterns associated with vulnerable groups.  In  addition,  consideration

MHSS

Accept

No comment

Before the Assisted Dying Law comes into full force

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

should be given to whether States Members, the Minister, and relevant medical  professionals  should receive this datain confidence where appropriate, to allow access to  identifying  or  quasi-identifying statistics that may be necessary for safeguarding  purposes.  A confidential  record  of  this information should be maintained so that  decision-makers  are  able  to identify  any  emerging  trends  that could indicate risk, undue influence, or coercion.

8

The Minister for Health and Social Services  should  ensure  that guidance sets  out clear, minimum experience  requirements  for Administering Practitioners, prior to implementation of the draft Law.

MHSS

Legal requirem ent

(accept)

This is an existing requirement of Article 65 of the law

Before the Assisted Dying Law comes into full force

9

The Minister for Health and Social Services  should  ensure  robust criteria  for  assessing  physical incapacity, supported by consistent guidance  and  regular,  ongoing practitioner training.

MHSS

N/A

This recommendation is no longer valid as the Assembly did not adopt the Panel's third amendment.

N/A

10

Due  to  the  proportion  of practitioners who would be willing to administer the approved drugs in cases where a waiver is exercised not  being  identified  through  the survey  conducted  in  early  2025, there should be a further survey to ascertain this. The aim of this would be  to  enable  feasibility  of  the implementation  of  the  waiver  of future  capacity.  The  Minister  for Health and Social Services should undertake this further survey during the implementation stage of the draft law.

MHSS

Accept

MHSS will undertake additional engagement with on-island health and care professionals to better understand practitioners' willingness and preparedness to act under a waiver.

Before the Assisted Dying Law comes into full force

11

The Minister for Health and Social Services  should,  during  the implementation  stage  of  the  draft law, ascertain through further public consultation whether there is clear

MHSS

Reject

Not agreed. This matter was considered during Phase 2 consultation where 83% of respondents

N/A

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

public support for a waiver of future capacity and final consent.

who were supportive of the principal of assisted dying also supported the inclusion of the waiver.

12

The Minister for Health and Social Services  should  ensure  that  the training  for  administering practitioners  covers  the  practical complexities of the waiver of future capacity and final consent.

MHSS

Legal requirem ent (Accept)

Article 66 of the law states: There must be training that covers the aspects of the assisted dying process that are relevant for each role, including training about the requirements of this Law.

Therefore, the law requires the provision of training to assisted dying practitioners on matters related to waiver and final consent, which will include the practical complexities.

Before the Assisted Dying Law comes into full force

13

The Minister for Health and Social Services  should  ensure  that guidance  should  include  that  if  a registered  assisted  dying practitioner is not willing to perform an assisted death where there is a waiver  of  future  capacity,  they should  make  this  clear  at  Step  6 when such a waiver is exercised, so that  appropriate  planning  is possible.

MHSS

Accept

This will form part of the guidance and training.

Before the Assisted Dying Law comes into full force

14

The Minister for Health and Social Services  should  ensure  that guidance  for  assessing  doctors should stipulate what the effect will be on the waiver of the requirement of future capacity if the individual still has capacity on the date set for the occurrence of the assisted death and  wishes  to  pause  the  assisted

MHSS

Accept

The waiver, as per the law, is not date- specific, therefore if an individual with capacity choses to pause the process at any point, the waiver still stands unless the individual determines

Before the Assisted Dying Law comes into full force

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

dying  process.  It  should  also  be specified whether, in this event, a new waiver would be required.

it should not stand. In addition, the individual with capacity can choose to amend their care plan, which includes the planned date and location for the assisted death and the mode of administration – as per article 8 (9).

This will form part of the guidance and training.

15

The Minister for Health and Social Services  should  ensure  that eligibility assessments for assisted dying  are  supported  by  a multidisciplinary  team,  including safeguarding  professionals,  mental capacity specialists, and social care practitioners,  so  that coercion-related risks are examined from  multiple  professional perspectives.  The  aim  of  which being to strengthen the robustness of assessments,  improve  consistency, and enhance public confidence by ensuring that decisions are informed by a comprehensive understanding of  the  person's  social  context, vulnerabilities, and potential sources of undue influence.

MHSS

Legal requirem ent (Accept)

The law provides for this, and this will form part of the training and guidance.

16

The Minister for Health and Social Services  should,  prior  to implementation  of  the  Assisted Dying  Service,  develop  a comprehensive  financial  impact assessment  for  the  assisted  dying service,  including  detailed assumptions,  staffing  models, governance  structures,  and  costed operational requirements.

MHSS

Reject

The Minister does not agree to developing a full financial impact assessment for the assisted dying service. A full assessment would require cost / benefit analysis (i.e., the costs of providing an assisted dying service to an individual compared to

N/A

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

the costs of providing ongoing care to that individual). Whilst the UK have undertaken an exercise of this nature, the Minister holds to the principles that assisted dying is not about cost / benefit, hence will not undertake any associated analysis.

Detailed assumptions have already been developed and, until these have been tested through implementation, it is not clear what additional financial modelling can be realistically undertaken.

17

The Minister for Health and Social Services  should  consider  the introduction of contingency funding and  scheduled  financial  reviews, recognising  that  implementation costs are likely to increase in the early years as the service becomes established.

MHSS

Partially accept

Not accept

HCJ does not require a mechanism to establish contingency funds for monies held in Strategic reserves. Any additional funding would have to be drawn from the HCJ core budget thus impacting essential services and exacerbating existing financial pressures.

Accept

A financial review of the Service will be undertaken as part of the review of the Law after 3 years post-

As part of 3-year post implementa tion review

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

implementation, as per the Panel's eighth amendment.

18

The Minister for Health and Social Services,  in  conjunction  with  the Minister  for  Treasury  and Resources,  should  ensure transparency in the  use of central budget allocations, including a clear breakdown of core governance costs once these are finalised.

MHSS

Accept

This will be developed with the HCJ Director of Finance.

Before the Assisted Dying Law comes into full force (with target to confirm six months in advance where possible)

19

The Minister for Health and Social Services should ensure a time-bound publication of the statutory general guidance no later than six months before commencement of the law.

MHSS

Partially accept

The Minister will seek to publish all operational and general guidance required under the law before six-months commencement but cannot ensure this will be delivered in that timeframe given some technical aspects of the guidance will require third party input.

Before the Assisted Dying Law comes into full force (with target to publish six months in advance where possible)

20

The Minister for Health and Social Services  should  ensure  that  an accredited  training  programme includes,  but  is  not  limited  to, modules on:

1. Mental capacity assessment

2. Ethical reasoning

3. Detection of coercion and undue influence  (including  subtle, hidden and internalised forms)

4. Domestic abuse indicators and financial coercion

5. Mental  health  conditions  and neurodiversity

MHSS

Accept

The Minister commits to including training on the matters a-h as set out in this recommendation.

To note, Article 78 is now Article 81 in the Law as adopted.

Before the Assisted Dying Law comes into full force

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

6. Communication  with  disabled and vulnerable individuals

7. Compliance with Article 78

8. Documentation  standards  and record-keeping

21

The Minister for Health and Social Services should ensure that training materials  are  co-produced  with experts in disability, mental health, neurodivergence, Diversity, Equity and Inclusion (DEI), domestic abuse and palliative care.

MHSS

Partially accept

Experts in disability, mental health, neurodivergence, Diversity, Equity and Inclusion (DEI), domestic abuse and palliative care will be consulted in-depth on the training, but the development of training materials will be the responsibility of the Committee, as set out in the Law as adopted.

Before the Assisted Dying Law comes into full force

22

The Minister for Health and Social Services should ensure that evidence from  ongoing  national  and international  monitoring  be incorporated into training updates; and a formal evaluation framework be  established  to  assess  the effectiveness  of  training  and guidance over time.

MHSS

Accept

The Minister commits to  ensuring  that  the Committee's TOR will require it to develop a formal  process  to assess the effectiveness of  training  and guidance.

Before the Assisted Dying Law comes into

full force

23

The Minister for Health and Social Services  should  ensure  that  an "Accessibility Annex" is attached to the  guidance,  specifying  audio, large-print,  Easy  Read/plain language,  and  non-digital distribution routes for inclusion and accessibility purposes.

MHSS

Legal requirem ent (Accept)

This is already a requirement under Article 69 of the Law as adopted.

Before the Assisted Dying Law comes into full force

24

The Minister for Health and Social Services should ensure that in public materials,  neutral  signposting  is included on what to do if someone feels  pressured,  and  a  plain explanation  of  the  law's voluntariness/capacity checks.

MHSS

Accept

No comment

Before the Assisted Dying Law comes into full force

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

25

If the Panel's sixth amendment is adopted, the Minister for Health and Social  Services  should  include  in guidance that written materials are provided in GP practices only in the presence of a health professional, as well as best  practice  guidance  on what this should look like from an operational perspective.

MHSS

Accept

Agreed. Article 63 requires the development of appropriate conversation guidance which will logically include matters related to the provision of information in GPs surgeries. Even if Amendment

Before the Assisted Dying Law comes into full force

26

The Minister for Health and Social Services  should,  alongside  the statutory  annual  report,  publish  a plain-English  summary  (reach, accessibility uptake, key learnings) to  support  transparency  and continuous improvement.

MHSS

Accept

Agreed.

On an annual

basis post implementa tion of the

law

27

The Minister for Health and Social Services should collect robust and appropriate  data  and  evidence during  the  initial  review  to demonstrate  a  clear  understanding of  the  public's  awareness  of  the service.  In  doing so,  the Minister should make every reasonable effort to engage and gather insights from marginalised  groups  across  the island to ensure that all community perspectives are represented.

MHSS

Partially accepted

MHSS notes the importance of public awareness of the assisted dying service but is of the view that awareness is no more important that awareness of other services (arguable less important than awareness of end-of- life services). Hence the Minister will give consideration to deployment of appropriate and proportionate methods of understanding awareness.

As part of the 3-year review

28

The Minister for Health and Social Services  should  incorporate  the Panel's  sixth  amendment concerning  written  information provided  to  general  practitioners about the assisted dying service as a guiding principle for all settings in

MHSS

Reject

Whilst the provision of information in the presence of a health professional will, in many cases, be a good guiding principle, the definition of health professional in the law

N/A

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

which information on assisted dying will be delivered.

This principle should be explicitly embedded  within  the  guidance developed  to  support  the implementation and operation of the service,  ensuring  consistency, clarity, and accessibility across all healthcare  and  community environments.

is restrictive and does not include, for example, an appropriately trained support worker in a healthcare charity.

MHSS would contest that recommendation 28 potentially contradicts recommendation 27 as, de facto, the requirement for a healthcare professional to be present when information is provided, is a limited factor in creating awareness and understanding.