Draft Assisted Dying (Jersey) Law 202- (P.65/2025): third amendment (P.65/2025 Amd.(3)) – comments

STATES OF JERSEY

DRAFT ASSISTED DYING LAW 202- (P.65/2025): THIRD AMDENDMENT (P.65/2025 AMD.(3)) – COMMENTS

Presented to the States on 13th February 2026 by the Minister for Health and Social Services

STATES GREFFE

2025  P.65 Amd.(3) Com.

COMMENTS

1. The draft law provides that an individual, whose request for an assisted death is approved, may choose to self-administer the approved drugs (with or without support from a loved one or family member) or choose for the Administering Practitioner to administer the drugs. This amendment seeks to amend the law, requiring a person to self-administer unless they are physically unable to do so.
2. Self-administration and practitioner administration are referred to as the modes of administration. Allowing an individual to choose their preferred mode of administration accords with the principle of autonomy and control over the manner and timing of death and, as such it directly accords with the two previous States Assembly decisions.
3. Furthermore,  retention  of  both  modes  best  aligns  with  public  engagement findings, expert ethical analysis, and international legislative practice. Restricting the option to choose practitioner administration reduces patient autonomy and both significantly, and unnecessarily, limits compassionate, support and choice for dying individuals in their last moments of life.
4. The Minister for Health and Social Services rejects this amendment and, in doing so, notes it was not a recommendation of the Panel's expert advisors.

Development of Jersey proposals permitting both modes of administration

5. There  has  been  consistent  support  for  the  inclusion  of  both  modes  of administration during the assisted dying policy development process:

1. the 2021 Citizen's Jury supported proposals to permit both modes of administration (65% voted in favour)
2. P95/2021  –  the  Assembly  supported,  in-principle,  both  modes  of administration
3. the 2023 Ethical review stated that: "If the States Assembly considers the arguments about the two modes to be balanced, then it may judge it appropriate to provide for both modes in law, with patients offered the choice of mode. If the (or a) central goal of the proposed law governing AD is to respect patient autonomy, then allowing patients the choice of mode of AD would also be consistent with this goal."
4. P18/2024 – the Assembly explicitly agreed to a draft law should be brought forward which permitted both modes
5. whilst no direct survey questions were asked about the inclusion of both modes in the Phase 1 & 2 public and stakeholder consultation, they were a clear feature of the consultation proposals and were discussed at length in public  meeting.  Neither  those  meetings  nor  the  associated  written submissions  indicated  majority  opposition  to  providing  individuals  a choice of mode.

Respecting Autonomy and Choice

6. A key principle of the draft law is providing a terminally ill person with the choice to have some control over the manner and timing of their death.
7. It is a false argument to state that autonomy requires the person to perform the final act themselves (i.e., to self-administer); autonomy of choice is expressed when an individual determines the mode of administration which they prefer. Autonomy is having the option to choose.
8. Many  people  who  are  physically  able  to  self-administer  may  nevertheless experience fear, concern or psychological barriers. If the law limits practitioner administration, it restricts choice for those who are physically able but unwilling to self-administer, reducing fairness and equity, and potentially resulting in unnecessary suffering, particularly for individuals fearing complications or feel overwhelmed by prospect of self-administration
9. As the Panel's own expert advisors observe, many people prefer practitioner administration for legitimate reasons, such as:

• the drugs are more likely to work [and work more quickly if administered via IV, and with less risk of medical complications]

• the person or family prefers a medicalised death

• the person may not be well enough to self-administer, even with support

Evolution of the Australian model

10. Having regard to the importance of choice, is well illustrated when considering how different Australian states approach modes of administration in their assisted dying legislation.
11. The model presented in the Panel's amendment most closely resembles Victoria's 2017 legislation. This was the first assisted dying law enacted in Australia. The approach taken by subsequent States builds on the Victoria experience. For example:

1. in Western Australia and Queensland, whose laws came into effect in 2021 and  2023,  the  legislation  prioritises  self-administration  but  allows  for practitioner administration for reasons other than physical incapacity (e.g. if the person has fears or concerns about self-administering the substance.)
2. in  New  South  Wales  and  the  Australin  Capital  Territory  -  the  two jurisdictions where assisted dying legislation has most recently come into force - the model has further evolved and allows for a choice of self- administration  or  practitioner  administration  in  consultation  with  the practitioner [i.e. as per the Jersey draft law as lodged]

12. Australian States have increasingly moved towards permitting both modes, with most jurisdictions now allowing practitioner administration beyond cases of physical  incapacity,  as  each  State  learns  from  the  experiences  of  others  -

including assisted dying practitioners, the people having assisted deaths and their loved ones.

13. Furthermore,  Australian  assisted  dying  practitioners  have  directly  told Government of Jersey Officers of the difficulties that can exist for them when left to determine if an individual can or cannot self-administer (whether based on physical  or  psychological  capabilities);  they  spoke  of  difficulties  they  can experience when balancing a lack of legal certainty against compassionate for a fearful person.
14. Australia  has  moved  towards  compassionate,  personcentred  practice,  which provides legal certainty for all – in comparison this proposed amendment is a retrograde step.

Safeguards in draft law do not depend on selfadministration

15. The Scrutiny Panel argue against permitting both modes of administration stating that permitting practitioner- administration would enable further safeguarding risks in terms of coercion' on the basis that by requiring that the individual performs  the  final  step,  self-administration  provides  the  clearest  possible evidence that the decision is voluntary In contrast, practitioner administration introduces a degree of dependency on a third party and requires the individual to transfer responsibility for the final act to a clinician'.
16. The Minister rejects the argument that requiring selfadministration as default mode is necessary as it is a safeguard against coercion. The draft law embeds a whole framework of safeguards that protect against coercion at every step in the process (assessment, transition between steps, careplanning, and immediately before administration) regardless of mode.
17. The Administering Practitioner must halt the process if the individual's capacity or the voluntary nature of their decision is in doubt for either mode. Thus, coercion is addressed through process safeguards, not through limiting mode choice.
18. Reliance on self-administration as a backstop safeguard against coercion is an ineffective measure that runs the risk of creating a false impression of safety. Especially, if practitioner administration is still permitted in cases where the person is physically incapable.

Practitioner Administration is not a source of covert pressure

19. The Scrutiny Panel report notes that the 2023 Ethical Review expressed the following concerns in relation to practitioner-administration:

• "increased  use  of  this  administration  model  over  time  in  other jurisdictions..."

• "potential implications for healthcare professionals", and

• "evidence  [from  2023  and  before]  that  fewer  people  withdraw  from proceeding  when  practitioners  are  responsible  for  administering  the drugs."

20. Increased administration: It is correct that there have been increases in numbers of assisted deaths over time, but this is across all jurisdictions that permit assisted dying, including those that only permit self-administration. The reasons for this are complex and multifactorial and should be anticipated in jurisdictions for a period of time post- introduction.
21. With regard to the implications for healthcare professionals:

1. the Minister's clarifying amendment (Amendment 2) to the draft law will allow Administering Practitioners to opt out of administering approved drugs at any time i.e., an Administering Practitioner is not required by law to administer  the  approved  drugs,  they  may  opt  to  only  support  self- administration;
2. the 2025 survey of local health and care professionals (as per Appendix 2 of P65/2025) indicated 51 professionals would be willing to undertake the role of Administering Practitioner [though it should be noted the survey did not specifically ask if those professionals were willing to support both modes of administration. Anecdotally, however, on-island professionals have indicated they  would  be  willing to  administer the  approved  drugs].  Furthermore, international experience clearly demonstrates that many practitioners are willing  to  administer  the  approved  drugs  because  they  view  it  as  a compassionate act.
3. the  draft law  explicitly requires the  provision  of  wellbeing  support for assisted dying practitioners, which will include support to practitioners who have chosen to administer the approved drugs.

22. Non-administration of approved drugs / completion' of an assisted death: The 2023 Ethical report, as referenced in the expert advisors' report, refers to non- completion' data in Canada and Oregon. It notes that more people in Oregon (who, by law, must self-administer) end up not taking the approved drugs when compared to Canada (where people can choose practitioner administration) i.e., there is a higher completion rate' of assisted deaths in Canada than Oregon:

• in Oregon - 65% of people issued an approved drugs prescription proceed to have an assisted death (ie. 35% do not have an assisted death)

• in Canada - 81% of people whose assisted death is approved, have an assisted death (i.e., 9% do not have an assisted death).

23. However, these two jurisdictions have very different legislative frameworks, and it would be more meaningful to compare completion rates for self-administration and practitioner administration in a jurisdiction that permits both modes. For example, New South Wales (NSW) permits individuals a choice of either mode and,  whilst  the  non-completion  rates  are  higher  for  self-administration,  the difference is not as pronounced as that suggested in 2023 Ethical Review. In NSW there is a 13 percentage point difference between in the rate of non-completion' based on modes of administration, which is exactly half the 26 percentage points difference suggested if equivalence is drawn between Oregan and Canada.

24. It should also be noted that:

1. higher completion rates in practitioneradministered systems may reflect reduced fear and anxiety and improved medical support at the end of life. It  is  supposition  to  conclude  that  the  involvement  of  a  health  care professional makes it harder for people to choose not to take the final step (i.e.,  that  there  is  covert  pressure  to  proceed  if  a  practitioner  is administering the substance) as referenced Panel's advisors
2. Jersey's  model  requires  a  practitioner  to  be  present  both  modes  of administration. This differs from Oregon and most Australian states, where selfadministration typically occurs without clinician presence.

25. The Panel's amendment report states that the Panel is of the view that "the self- administration model enables individuals to choose the moment, the context, and the circumstances in which they act, reinforcing their agency" - but the Minister contests that this clearly applies to the draft law as lodged; indeed the draft law provides greater agency, because it allows for agency of choice.
26. Furthermore, the Panel state that: "Practitioner administration, by contrast, typically  requires  more  structured,  clinical  involvement,  which  may  limit flexibility or impose conditions that constrain personal choice" – whilst is it accepted that this may be the case in the Oregon model, this is not the case in Jersey  model  as  both  modes  of  administration  require  the  Administering practitioner to be present – i.e. the draft law provides for clinical involvement and oversight regardless of whether the person self-administers the approved drugs, or they are administered by the practitioner.

Conclusion

27. Retaining both selfadministration and practitioner administration ensures the Jersey assisted dying model remains compassionate, ethically grounded and upholds the principles of autonomy and choice. Furthermore, it ensures the draft law remains aligned with public expectations and previous Assembly decisions.
28. Restricting practitioner administration reduces choice and autonomy and create inequities without providing the benefit of significant additional safeguards.
29. Accordingly, Members are asked not to support the amendment.