Draft Assisted Dying (Jersey) Law 202- (P.65/2025): addendum

STATES OF JERSEY

DRAFT ASSISTED DYING (JERSEY) LAW 202- (P.65/2025): ADDENDUM

Presented to the States on 27th October 2025 by the Minister for Health and Social Services

STATES GREFFE

2025  P.65 Add.(2)

COMMENTS

Response to Scrutiny Assisted Dying Review Panel Recommendations Background and contents of report

1. The Scrutiny Assisted Dying Review Panel established to examine proposals for assisted dying, as set out in P.18/2024, made several recommendations in their review report published in May 2024.1 These recommendations included placing a requirement of the Minister to publish additional information about the planned implementation of an assisted dying service, and to do so no later than 2 months before the draft law is scheduled for debate.
2. This  addendum  provides  the  information  requested  in  the  Scrutiny recommendations, as well as an update to the list of risks presented in P.18/2024

1 States Assembly | Report - Review of Assisted Dying - 14 May 2024

* indicates a key recommendation of the Scrutiny Panel

Section 1: End of Life Care

3. This section of the report provides a response to key recommendation 1 and recommendation 2.

Report on the quality and availability of palliative and end of life care in Jersey Contents:

• Executive summary

• Part 1: Background

• Part 2: Strategy delivery / activity

• Part 3: Evidence of quality of services in Jersey

• Part 4: Evidence of availability of services in Jersey

• Part 5: Delivery against Strategy success criteria

• Part 6: Conclusion

• Part 7: Palliative and End of Life Care Strategy post 2026

• Appendix 1: Impact Report for the Palliative and End of life Care Strategy for Adults in Jersey 2023-2026, Jersey Hospice Care, April 2025.

• Appendix 2: Assessment of Jersey palliative and end of life care services against NHS service specification and NICE guidance

Executive summary

4. This  report  is  published  in  accordance  with  recommendations2 from  the Scrutiny Review Panel established to examine proposals for assisted dying in Jersey. The purpose of the report is to:

• evidence the quality and availability of palliative and end of life care in Jersey

• confirm timelines for the development of Jersey's Palliative and End of Life Care Strategy beyond 2026.

5. Palliative care aims to improve the quality of life for people who have a life- threatening illness, and their families. It focuses on treating pain and easing suffering (physical, emotional and spiritual). End of life care is palliative care that is provided to people who have a 12-month life expectancy.

Quality and availability of palliative and end of life care in Jersey

2 S-R-3-2024-Res.pdf

6. Jersey's End of Life Partnership ("EOL Partnership") was established in 2021 to develop and oversee delivery of the Palliative and End of Life Care Strategy 2023 – 2026 [3]published in 2023 ("the Strategy").

7. The EOL Partnership has undertaken significant work to improve the quality and availability of palliative and end of life care services, in accordance with the Strategy's aim and objectives.

8. In 2023/4 the EOL Partnership undertook an assessment of service availability / capacity based on population size and benchmarking data from the UK. The assessment identified that Jersey had sufficient specialist hospice beds but had gaps in community provision. These gaps have now been largely addressed via the Strategy delivery.

9. A service assessment was undertaken in July 2025. That assessment provides evidence:

a. of improvements to the quality and availability of services which have already been achieved since the launch of the strategy (with work ongoing to drive further improvements); and

b. that services provided in Jersey are in largely in line with UK best practice evidence.

10. Key improvements to date include:

• Bridging the gap between generalist and specialist palliative and end of life care and introducing a new nursing team (the Living Well Team') to focus on those in the last year of life

• Increasing access to specialist advice and support to 24/7

• Launch of an island-wide education programme

• Improving access to LTC funding for those at the end of life

11. Evidence that services align with UK best practice:

• Current services meet the criteria set out in the NHS service specification for palliative and end of life care

• Current services are compliant with NICE guidance

• Services which are registered with the Jersey Care Commission (JCC) are compliant with JCC standards

12. Delivery of these improvements has been enabled, in part, by the £3m additional annual investment into palliative and end of life care provided through the 2023 Government Plan:

Timelines for the development of Palliative and End of Life Care Strategy beyond 2026

13. An  updated  strategy,  for  the  period  2027  to  2031,  with  updated recommendations and an updated action plan will be published at the end of 2026.
14. The updated strategy will be informed by a review of palliative care provision, to be undertaken in Q2 2026. The Q2 2026 review will provide further insight into the progress made since 2023. This is in addition to the quarterly strategy implementation reviews.4 As with all change processes, it takes time for new services and ways of working to be fully established, so the impact of the changes can be fully assessed.

4 Palliative and End of Life Care Strategy for Adults in Jersey 2023-26 Action Plan update.pdf Palliative and End of Life Care Strategy for Adults in Jersey 2023-26 Action Plan progress report.pdf

Palliative and End of Life Care Strategy for Adults in Jersey 2023-26 Action Plan progress report Q1 2025.pdf

Palliative and End of Life Care Strategy for Adults in Jersey 2023-26 Action Plan progress report Q2 2025.pdf

FULL REPORT

Part 1: Background Background to this report

15. The Assisted Dying Review Panel was established to review proposals related to assisted dying in Jersey as set out in P18/2024. The Panel's review report included the following recommendations:[4]

1. "the Minister for Health and Social Services should publish a plan (report) to evidence the quality and availability of palliative and end of life care in Jersey, by no later than two months before the assisted dying legislation is scheduled for debate by the States Assembly." (Recommendation 1)
2. "the Minister for Health and Social Services should confirm the timeline for the development of a Palliative and End of Life Care Strategy beyond 2026, by no later than two months before the assisted dying legislation is scheduled for debate by the States Assembly." (Recommendation 2).

16. The purpose of this report, in line with Scrutiny recommendations, is to:

• evidence the quality and availability of palliative and end of life care in Jersey

• confirm timelines for the development of Jersey's Palliative and End of Life Care Strategy ("the Strategy") beyond 2026.

17. The report provides an update on work done to date to implement the Strategy and provides evidence related to the quality and availability of palliative care and end of life care services in Jersey. It also highlights some areas of work that are still in train (as anticipated given the Strategy end date of December 2026).

18. The Panel's recommendations mirror a commitment of the previous Minister for Health and Social Services [5] to  "support the development of end-of-life and palliative care services to ensure that no person chooses an assisted death on the basis that they cannot access – or believe they cannot access – high quality end-of-life or palliative care services."

19. Furthermore, the Panel's recommendations also mirror the previous assisted dying propositions which state that, at the point at which the draft assisted dying law is presented to the Assembly, Members will be asked to agree, that:

"legislation permitting assisted dying should not be brought into force until the Assembly is satisfied that decision taken in the 2023 Government Plan to provide for additional investment in end of life and palliative care is supporting improvements in quality and availability of those services".

20. Assuming the draft law is adopted in December 2025, Assembly Members will not take the decision to bring the adopted law into full force until after the anticipated 18-month implementation period (i.e. c. July 2027). As such, they are not required to be satisfied as to improvement in palliative care until that

point, however, the information set out in this report will provide the Assembly assurance as to the progress currently in train.

21. Note: Article 94 of the draft law provides a power for the Assembly, by Regulations, to place a statutory duty on the Minister for Health and Social Services to provide end of life care.

Background to the Palliative and End of Life Care Strategy

22. The Palliative and End of Life Care Strategy for Adults in Jersey was published on 14 November 2023. It was developed by the Jersey End of Life Care Partnership Group ("EOL Partnership"). The Strategy was informed by the voices of patients, families and carers7.
23. The overarching aim of the strategy is to enhance the quality of palliative and end of life care services in Jersey, regardless of the person's underlying illness or care setting.
24. A particular focus of the EOL Partnership was, over the 4-year course of the strategy, to deliver the changes necessary to enable more people to die in their preferred place. In 2021 a significant number of people who were receiving care from Jersey's Specialist Palliative Care Team were not able to die in their preferred place:

25. The Strategy identified six outcomes, and the key actions required to help achieve those outcomes.

7 EOL Partnership members include Health and Care Jersey, Jersey Hospice Care, Family Nursing and Home Care, Jersey Doctors on Call, Primary Care board, Jersey Care Federation, LV Care Group, Macmillan Jersey, Maillard's Funeral Directors, Picher and Le Quesne, patient representatives and Education, Social Security and Housing.

26. The Strategy also set out key metrics for success to support evidence of improvements (see Section 5 below).
27. Delivery of these improvements has been enabled, in part, by the £3m additional annual investment into palliative and end of life care provided through the 2023 Government Plan:

Part 2: Strategy delivery / activity  

28. As set out above, the Strategy identified the key actions required to ensure delivery of the six strategy outcomes. Those key actions were clustered into a series of delivery projects, the details of which are set out in the table below.
29. Overall good progress is being made in delivery of the Strategy outcomes, and in accordance with the timeframe set out in that Strategy, and as evidenced in:
    1. the Q2 2025 Strategy progress report [6]published in July 2025
    2. impact report on Jersey Hospice Care activities since the launch of the strategy presented in Appendix 1.
30. Note: a number of areas of activity are still in development as anticipated given the Strategy end date of December 2026.

Project

Establish an Island wide education programme recognising that education is a key enabler in improving care

Part 3: Evidence of quality of services in Jersey

31. The quality of services provided in Jersey can be evidenced in the following ways:

1. compliance with contractual requirements
2. compliance with independent regulatory standards
3. alignment with UK national standards (NICE [7] and NHS services specifications [8]and NHS Ambitions Framework)[9]
4. compliance with the Gold Standards Framework.[10]

Contractual arrangements

32. HCJ make a financial contribution to hospice inpatient, community generalist and specialist palliative care, targeted care, bereavement support and palliative care education services, delivered by a number of providers. This arrangement is covered by contracts which set out the outcomes to be achieved and key performance indicators. Performance against outcome and indicators are reviewed at quarterly meetings. Key quality related measures show:

1. waiting and response times are within target levels as set out in the contract
2. consistent 100% patient and carer satisfaction ratings for services provided by Jersey Hospice Care and Family Nursing & Home Care.

Independent regulatory standards

33. The Jersey Care Commission (JCC) inspects the following services on an annual basis. During the most recent inspections all services were found to comply with JCC standards:

a. inpatient service provided by Jersey Hospice Care – 2 areas for improvement identified; an action plan to address this was put in place

b. specialist palliative care nursing service provided by Jersey Hospice Care

– no areas for improvement identified

c. district nursing service provided by Family Nursing & Home Care – no areas for improvement identified.

UK national standards

34. NICE standards, NHS service specifications and the NHS Ambitions Framework for Palliative and End-of-Life Care provide an up-to-date evidence base for gold standard care and person-centred services.
35. A July 2025 review, undertaken by the EOL Partnership, demonstrates significant strengths in meeting outcomes and shaping workforce and care delivery around gold standard evidence-based care. Outcomes that were historically absent are being achieved with the introduction of the Living Well Team (LWT), Palliative and End of Life Care Education (PED) and the

Overnight Telephone Consultation Line (OTC). Further detail is provided in Appendix 2.

36. A core strength is the proactive positioning of the LWT as clinical coordinators who also provide relational, holistic and practical support to not only patients and their families but the system workforce. They bridge a historic gap between the generalist care – GPs, community nursing services and specialist services. Their training in the Gold Standards Framework (GSF), advance care plan facilitation, recognition of the palliative phase and case coordination ensures a consistent and person-centred approach across the whole last year of life and not just the critical last moments.
37. Educational services provide a whole population evidence-based programme with a curriculum developed from the Health Education England EoLC-Core- Skills-Training-Framework.pdf.
38. Out  of  hours  specialist  telephone  support  and  existing  overnight  services including Jersey Doctors on Call and Palliative Consultant on Call (off island) adds resilience to the care model.
39. The LWT, PED and OTC services are in their infancy but are well-positioned to support enhanced care delivery. Through the commissioning cycle, services will be continuously monitored, reviewed and adapted as necessary to meet the evidenced needs of the population.
40. Compliance with standards and delivery of high-quality, timely care would be further enhanced if all patients and professionals had access to an up-to-date centralised patient record. The lack of a centralised record is a recognised deficit across all health and care services which, it is anticipated will be addressed as a matter of priority via additional investment in Digital Health (as set out in the 2026 Government Plan).

Gold Standards Framework

41. In addition to the above, work continues to ensure compliance with the Gold Standards Framework, a nationally accredited practical and evidence-based end of  life  care  service  improvement  programme13.  This  framework  was implemented across Jersey in 2015, with JHC currently being re-accredited against the Framework. Re-accreditation will demonstrate that quality end of life care is embedded through JHC.

13 End of Life Care Training & Accreditation

Part 4: Evidence of availability of services in Jersey

42. In  2023/24,  the  EOL  Partnership  undertook  an  assessment  of  service availability / capacity based on population size and benchmarking data from the UK. It identified that Jersey had sufficient specialist hospice beds but had gaps in community provision. These gaps have now been largely addressed by the establishment of the Living Well Team.

1. Using a UK forecasting model adapted for Jersey, the assessed need is 11 inpatient hospice beds based on the population size. However, over the last 4 years average usage has not exceeded 8 beds, suggesting that 8 beds is a more appropriate level for Jersey. Waiting times and inability to access beds due to lack of capacity are monitored as part of the quarterly service review process and have not been an issue of concern to date.
2. The UK forecasting model indicated that specialist palliative care  community  nursing  capacity  is  sufficient  for  the population size. However, research into palliative and end of life  care  models  in  other  jurisdictions  and  broader commissioning  activity,  including  system  wide  workshops supported  by  an  independent  UK  subject  matter  expert, identified  a  gap  in  provision  between  the  generalist  and specialist palliative care available.

43. The table below compares pre-Strategy and current availability. Changes to hours of provision are highlighted in grey.

Enhanced education provision  

44. In addition to the above, enhanced education provision has been introduced. This provision, which is generally in core working hours, but with some flexibility includes opportunities:
    1. in community settings (for example, nursing homes for staff; classes for family carers and members)
    2. across the hospital / hospice (for example, classroom-based provision to external professional such as GPs, ward-based provision to all ward staff).
45. The Strategy identifies education as one of four essential key enablers to achieving the strategic outcomes. The need for palliative care education that is delivered in an integrated, collaborative and cost-effective way is recognised by the World Health Organization, amongst others.
46. In addition to this, recent serious incident reviews carried out by HCJ have highlighted the need for palliative and end of life care training for hospital staff to prevent future recurrence of serious incidents.
47. A system-wide working group consisting of EOL Partnership members was formed to assess the need and codesign a service that meets the palliative and end of life care education needs of the Island. The service proposals were ratified by the EOL Partnership and the HCJ Executive in July 2024.

Part 5: Delivery against Strategy success criteria

48. The Strategy set out clear metrics against which to measure success. The table below details progress against those metrics, as identified in the July 2025 service assessment.
49. As with all change processes, it takes time for new services and ways of working to be fully established, and the benefits to be fully realised. As stated in P18/2024, it was never anticipated that all the metrics set out below will have been fully realised by December 2025.

Part 6: Conclusion

50. The additional investment into palliative and end of life care is supporting improvements in the quality and availability of those services. There are now more services available and for extended hours. There are still improvements to be made and further work to be done to fully achieve the aims and outcomes of the  strategy.  There  are  active  work  streams  ongoing  which  are  nearing completion. The new Living Well and Education Services are expected to drive the changes that will enable people to be cared for and die in their preferred place by the time that assisted dying legislation is in force.
51. Progress  towards  achievement  of  the  Strategy  outcomes  is  measured  and reviewed on a quarterly basis and there are processes in place to ensure that if the new services do not deliver the expected improvements corrective action will be taken.

Part 7: Palliative and End of Life Care Strategy post 2026

52. It will take time for the new services and ways of working to be established and to be at a point where the impact on closing the gaps can be fully assessed. A review of palliative and end of life care provision will be undertaken in Q2 2026. This will result in updated strategy document, recommendations and an action plan covering 2027- 2031.

Appendix 1: Impact Report for the Palliative and End of life Care Strategy for Adults in Jersey 2023-2026, Jersey Hospice Care, April 2025.

Strategy Outcome 1: People in Jersey who need palliative and or end of life care will be seen and treated as individuals who are encouraged to make and share advance care plans and to be involved in decisions around their care

Jersey  Hospice  Care  –  Every  patient  in  the  last  12  months  in  contact  with  the Community Specialist Palliative care team had Advance Care Planning discussions.

Jersey Hospice Care has continued to use and promote the Gold Standards framework (GSF), the GSF is a practical and evidence-based end of life care service improvement programme, which supports staff to deliver a gold standard of care for people with a life limiting condition. The Inpatient Unit has completed and submitted an application to be GSF accredited during summer 2025.

Emotional support and the Community Bereavement Service is provided by trained and specialist counsellors and is available to adults and children of all ages in need of support. For those accessing the Bereavement Service the team can support islanders, irrespective of whether or not they have come into contact with Jersey Hospice Care. Emotional support can be offered to islanders facing a life limiting diagnosis, along with their family members, to give support to people at a very difficult time and can continue to support the family members after the death of their loved one.

Services are delivered at Jersey Hospice at Mont Cochon, however, during the last year, the team have delivered sessions in a variety of locations including nursing homes, schools, patients own homes and the prison.

The Emotional and Bereavement Service at Jersey Hospice is a very busy service that supported over 400 islanders in 2024, some of whom were children and young people.

Referral rates for adults have continued to increase year on year. During 2022 - 2023 there was an increase in referrals of over 4% and in the following year, this jumped to 12% increase. As a result, the average caseload has increased by 38% over two years.

Over the period of 2022 – 2024, the total number of appointments for adults has increased by 29% There has also been an extension of child bereavement support, particularly in the community where the team have facilitated Grief and Loss sessions for pupils in two of our schools as part of their timetable.

Strategy Outcome 2: People in Jersey who need palliative and or end of life care will have their needs and conditions recognised quickly and be given fair access to services regardless of their background and characteristics

Timely access to the specialist palliative care services remains a priority for Jersey Hospice Care as evidenced in the turnaround time from point of referral to being seen. For urgent and non-urgent referrals, this time remains consistently within the benchmarked target of 48 hours, urgent and 14 days, non-urgent. The longest wait for urgent being just over a day (shortest 6 hours) and longest wait for non- urgent has been 7 days (with shortest at 3 days).

The team have remained busy undertaking 24% more patient home visits in 2024 than in the previous twelve months, in addition to which they have also undertaken 25% more telephone consultations than in the previous year.

Jersey Hospice Care have been working with colleagues in Government to improve the process for Long Term Care Funding applications for islanders approaching the end of their life when they have care needs, the work will ensure those who are eligible are processed in a timely manner.

Jersey Hospice Care in partnership with the Government of Jersey have developed a Living Well Service that will extend the reach of palliative and end of life care services to more islanders by connecting with them much earlier at the point at which they receive life limiting diagnosis and before they need the input of specialist palliative and end of life services. This team will provide support to islanders and their families and will complement the work of other services. Their focus is primarily on supporting people to live well and to have a good quality of life, whilst providing support in co- ordinating and signposting to appropriate services, which could be of a financial, spiritual, social, psychological or physical nature.

During 2024 much of the groundwork for the Living Well Service was undertaken with other providers from across the health and care system, which meant that in early 2025 JHC was able to successfully recruit to the 5 nursing posts for the Living Well Service. JHC will be working towards starting the new service within the second quarter of 2025.

From mid-April, Jersey Hospice Care will be providing an out of hours specialist telephone on-call advice service to give 24-hour access to specialist advice and support to health and care providers. Jersey Hospice Care already provides telephone access to an off-island specialist consultant on call; this enables GPs working out of hours access to 24-hour specialist advice.

Strategy Outcome 3: People in Jersey who need palliative and or end of life care will be supported to live as well as long as possible taking account of their expressed wishes and maximising their comfort and wellbeing

Quote from a family member: "Thanks for all the loving care you gave to my lovely dad in his last days. The kindness and respect shown to Dad warmed my heart and made this time more bearable. Also, a big thank you for all the love and kindness you gave mum who was so in need of a rest from caring for dad. And of course, how you helped us all as a family to manage a peaceful farewell."

Admissions to Jersey Hospice in patient unit have increased year on year and, over the two-year period since the island's strategy was launched, Jersey Hospice Care has seen an increase of over 50% in total patient admissions, with a higher number of patients accessing the service for end of life care.

There are some patients who access the in-patient service for specific needs, such as symptom management, and they return home after their stay. These patients represent about 12% of the total number of admissions.

Strategy Outcome 4: People in Jersey who need palliative and end of life care will receive care that is well co-ordinated

Patient's daughter "Thank you for all the care you gave us during the final weeks of my father's life. Your advice was invaluable and the speed you could sort things out such as medication. But most of all we appreciated the kindness to us as a family. My father dealt with his illness in his own way, and you were so patient with him, allowing him to remain in control. This was so important to him. We will always be grateful to you".

100% of patients known to Jersey Hospice Care Community Specialist Palliative Care team had a documented initial assessment, this ensures all of their immediate needs are identified and that the patient and family can be supported in the best way possible.

During 2024 Jersey Hospice Care achieved the preferred place of death as Hospice inpatient unit in 100% of patients who expressed it.

All patients known to the community specialist palliative care team during 2024 had a documented record regarding their preferred place of care.

Strategy Outcome 5: People in Jersey who need palliative and or end of life care will have their care provided by people who are well trained to do so and are receiving ongoing training to maintain their skills and competencies.

The Education Team at Jersey Hospice Care have continued to strengthen partnerships, connect with key providers, and offer targeted training. As a result during 2024, Jersey Hospice Care delivered 84 education sessions with a total of 725 attendees in the community.

In the following care settings:

• Age Concern (Future Planning/Advance Care Planning)

• 10 sessions Les Amis support homes (Advance Care Planning)

• 86 people attended Dementia End of Life Care (3 sessions in care homes and 2 held in JHC)

• 11 sessions delivered to 6 care homes – each care home was offered two training sessions

• 25 sessions delivered to 12 Home Care Providers – each provider was offered two training sessions

• Adult Learning Disabilities Team

• Mental Health Nursing Team

• St Saviours Hospital

• Prison Nursing Team

• 1 session delivered for 8 people from the LGBTQ+ community.

Sessions covered Fundamentals of Palliative and End of Life Care, The Gold Standard Framework, and Syringe Pump training (7 sessions)

In addition, many educational sessions delivered in JHC have a mix of external and internal attendees.

Strategy Outcome 6: People in Jersey who need palliative and or end of life care will be part of communities that talk about death and dying and that are ready, willing and able to provide the support needed.

Jersey Hospice Care has a strong, large, volunteer workforce who provide significant support to Jersey Hospice Care and the wider community, through a broad range of roles, covering patient care areas, reception roles, retail, driving, supporting fundraising events and many more. During 2024, a total of 26,337 hours were donated by volunteers. This is a further 4.7% increase on the previous year's activity and equates to a fulltime workforce of 13.5 FTE. Our volunteers come from our local community, from a range of backgrounds, and bring to the roles many experiences, skills and knowledge which are invaluable to the work of Jersey Hospice in Palliative and End of Life Care.

Compassionate Neighbours scheme was launched by Jersey Hospice Care in April 2024.This scheme connects islanders with a life limiting diagnosis with a volunteer who meets with them on a regular basis. The scheme helps reduce loneliness and social isolation, Evidence has shown that Compassionate Neighbours can also lower rates of depression, improve social skills, improve self-management, build a sense of purpose and reduce the use of emergency services. During its first year, 22 patients were supported by volunteers in the community on the scheme. The scheme not only benefits islanders but also the volunteer, knowing you are making a difference in someone's life, improving your own social skills and feeling their own confidence grow.

"Being a compassionate neighbour volunteer is such an honour. The lady I have been visiting was so interesting and I really enjoyed her company, she was so easy to get along with. I used to look forward to our weekly chats over a coffee so much and I learnt so much from her, listening to her stories from her younger years, she really lived life to the full. I thoroughly enjoyed building a relationship with her and with her family. They told me that they felt she had made a new friend on the island, and they were so grateful. I think we both got as much out of our meetings as each other and it's a great feeling knowing you have provided company and support to someone when they needed it most" Sarah, Volunteer.

Appendix 2: Assessment of Jersey palliative and end of life care services against NHS service specification and NICE guidance

The following Jersey services were assessed against UK standards: the Living Well Team (LWT), Specialist Palliative Care Team (SPCT), Hospice Inpatient Service, Bereavement and Emotional Support Service, and Education Services.

Compliance with NHS service specification14

1. Referral

14 B1674-specialist-palliative-and-end-of-life-care-services-adult-service-specification.pdf

2. Assessment and Care

SPCT  and  Southampton  provide  out  of

7-day medical/nursing cover hours by telephone. LWT provides face to   Outcome 3 & 6 and 24/7 telephone advice

face 12 hours/day, 365 days/year

Timely access to medication

Work in progress  Outcome 3 and equipment

Personalised  care  planning  

with  patients,  carers  and LWT  supports  advance  care  planning,   Outcome 1 & 4

navigation, and options at any time

families

families/carers,  includintog LWT  integrates  into  family  life  and   Outcome 2 Holistic  support

prepares carers

pre-bereavement

Outcome 2 Outcome 4 & 5

3. Co-ordination and Partnership Working

Effective  partnership  with Macmillan, Cancer Jersey, YES, Education   Outcome 4 third sector & services  Services, JTT

Outcome 4 Outcome 5

4. Leadership and Governance

Outcome 5 Quframalityewo/grokverninancl.ce /IT audit, Imneapsurores gressd; eveloaudpit ingplanalos ngasnidd e oustcoervmice e  Outcome 6 outcomes, patient feedback,

rollout

clinical info sharing

Outcome 5 CPD and education for wider CPD delivery via HCJ Education Service &   Outcome 5

workforce  JHC

Innovation,  evidence-led Shared  learning  via  Education  Services,   Outcome 6 practice, shared learning  public awareness supported

Public/community

engagement,  compassionate JHC and Education Services involved in   Outcome 6

outreach

communities

Compliance against NICE Guidance15

Strengthen  early conversations with  carers  and key people where possible. Education programme being rolled out.

15 Overview | End of life care for adults: service delivery | Guidance | NICE

Monitor  uptake and  feedback from  carers  to ensure  continued relevance

Expand availability  in multiple languages  or accessible formats if needed

Consider  real- time  review protocols  for sudden deterioration

Reinforce consistent  ACP review  and documentation

Use  patient feedback  to

Embedded  in  LWT's  ongoing  case  ensure  regular

7. Reviewing needs

coordination role  reassessment

remains  person- centred

8. Regular audits to Advance  care  plans  uploaded  to

Communicating/sharing  ensure  accuracy

EMIS/Maxims;  information  sharing  in

information  between  and  timely

development

services  updates

Promote  stronger integration  with JDOC  and  OOH services

Consider creating a  designated EOLC coordinator role/system across all providers

Develop clear and

1.11 Transferring between Policy is in place, will require review when  consistent  policy care settings  services are embedded  for  care transitions  and

communicate widely.  Allow service  to  embed and learn activity and  demographic to finalise SOP.

Ensure  clear escalation  plans and  visibility  of OOH, monitor the service  and integrate  service data into strategic overnight  service review  plans  to aide arrangements and  involve  all parties

Section 2: Training and guidance

53. This section of the report provides a response to key recommendation 2, and recommendations 6 and 10:

* indicates a key recommendation of the Scrutiny Panel Key Recommendation 2: Training requirements

Key Recommendation 2 requested the Minister to set out the training requirements that comprehensively cover the identification of and prevention of coercion

54. Appendix 4 of P18/2024 set out a summary of key elements of the assisted dying training.
55. P18/2024 also set out that the Assisted Dying Assurance and Delivery Committee would be responsible for overseeing the establishment and operations of the Assisted Dying Service, including development of training programmes and that, in doing so, the Committee will be required to consult with relevant parties, such as the professional regulatory bodies.[11]
56. In accordance with P18/2024, the draft law provides the following:

1. Article 65 requires the Committee to arrange for mandatory training that must be completed by an assisted dying practitioner, certifying doctor or care navigator before they can act in that role.
2. Article 65 sets out that the training must cover:

• the aspects of the assisted dying process that are relevant for each role, including training about –

(a) the requirements of the Law;

(b) operational guidance;

(c) risk; and

(d) the safety and well-being of the professional performing the role

• the technical knowledge required to perform each role, such as –

(a) the administration of approved drugs by an administering practitioner, including how to deal with a medical complication; or

(b) the certification of an individual's assisted death by a certifying doctor

• domestic abuse and whether someone has been coerced or pressured to do something, including coercive control and financial abuse.

2. Articles 80 and 81 provide that an assisted dying practitioner or certifying doctor may only be registered (or have registration renewed) if they have completed the training required for their role.
3. Article 66 requires the Committee to develop general training to be available to all on-island health and care professionals.
4. Article 67 requires the Committee, in developing the training, to consult with persons and organisations with relevant expertise, including for example the professional regulatory bodies.

57. The training requirements will be confirmed  by the  Committee following consultation. They cannot be confirmed prior to adoption of the law, as any amendments to the draft law may impact the training requirements. However,

in line with the Minister's response to Key Recommendation 2, additional information is set out below. This includes information related to:

1. training requirements for all assisted dying practitioners
2. training requirements for specific roles
3. training available to all on-island health and care professionals

Training requirements for all assisted dying practitioners

Format

58. Largely in-person, group/cohort delivery, with supplementary online/digital elements. Training modules will include periods of reflection to pause, discuss and reflect on learning.
59. Will incorporate case studies, role play & simulation – including identifying and assessing risk at each step of the process.
60. A professional may withdraw from training at any point if they change their mind about participating in the Assisted Dying Service [which would mean the professional would not go on to register and act as an assisted dying practitioner].
61. To include input from experienced assisted dying practitioners, from jurisdictions where assisted dying is permitted, with similar legislative frameworks – e.g. Australia and New Zealand.
62. As set out in the draft law, the Committee will determine the required intervals for refresher training. As set out in P18/2024, this is anticipated to be required (as a minimum) every 3 years.
63. In addition, ad hoc training will be provided to Assisted Dying Service staff as and when the need arises (for example, if review undertaken by the Review Panel finds that there is a requirement to strengthen any part of the process) as well as ongoing peer support, clinical supervision and case management.
64. Expected outcomes of assisted dying practitioner training:

1. Understand the key provisions of the assisted dying law, including

1. eligibility criteria
2. steps in the assisted dying process

2. Understand the role of the Assisted Dying Service
3. Demonstrate knowledge of roles of the bodies involved in the regulation and oversight of assisted dying
4. Demonstrate understanding of the assisted dying roles, and the involvement of wider health and care professionals in the assisted dying process
5. Demonstrate in-depth understanding of the professional's individual duties and requirements under the law and in guidance, for their specific role
6. Exhibit the knowledge and competencies required to undertake their specific assisted dying role
7. Apply knowledge of professional and personal resilience, including how and when to access to wellbeing support

Content

65. Overview of assisted dying, eligibility criteria, assessment and approval

1. eligibility criteria:
   1. additional focus on capacity and decision criteria (including voluntary nature of decision and potential coercion)
   2. overview of assessing eligibility criteria
2. roles of professionals involved
3. assisted dying process & steps
4. working with the operational guidance
5. consent for information sharing and disclosure of information
6. communication support and independent advocacy for individuals
7. appeals process

66. Overview of post-approval process

1. care planning
2. waiver of future capacity and confirmation of consent to proceed
3. places for assisted deaths
4. the approved drugs, including:
   1. Pharmacodynamics and pharmacokinetics
   2. Prescribing
   3. Dispensing
   4. Preparation
   5. Facilitation of Administration
   6. Interactions/Reactions/Unsuccessful Outcomes
   7. Acting in the event of medical complications
5. the assisted death, involvement of the witness
6. post-death procedures

67. Oversight, regulation and protections

1. role of:
   1. Assisted Dying Service
   2. Assurance and Delivery Committee
   3. Assisted Dying Review Panel
   4. Jersey Care Commission
   5. Professional Regulatory Bodies and professional representative bodies
2. right to refuse and protections for professionals
3. safe access zones
4. investigation of professionals and offences under the law

68. Other matters

1. extended team meetings
2. record keeping & the assisted dying person record
3. service standards and procedures for complaints
4. disclosure of interests
5. reporting concerns
6. personal and professional resilience (professional & skills development, wellbeing, counselling, self-care)

7. bereavement training – support for self, colleagues, family and friends of individual
8. trauma-informed practice – impact of current or past trauma on individuals and on professionals

Training requirements for specific roles

69. The  training  outlined  above  will  be  undertaken  by  all  assisted  dying practitioners. In addition, there will be specific elements of training required for the individual roles. In most cases this will provide additional depth and detail or practical training in addition to matters already covered above:

9. Care Navigator

a. elements  specific  to  the  Care  Navigator  role,  including additional training on providing support to:

- assessing doctors and extended team during assessment phase

- administering practitioner during care planning and delivery phase

- individuals and their family members

b. handling referrals and enquiries into the Assisted Dying Service

c. record management

j.  Assessing Doctors

1. assessing eligibility criteria – to cover all criteria in depth, with specific modules on:
   1. assessing capacity
   2. voluntary nature of decision – including domestic abuse and whether  someone  has  been  coerced  or  pressured  into decision, including coercive control and financial abuse and additional steps to take where this is suspected, e.g. onward referrals
2. seeking relevant opinions
3. decisions on requests to proceed to next step
4. review and decision on request for assisted dying
5. supporting individuals whose request for assisted dying has been declined
6. independence of Independent Assessment Doctor
7. Second Opinion Assessments
8. role of family and friends in the assessment process
9. record management

k.  Administering Practitioners

1. care planning
2. approval of location for assisted deaths
3. role of friends/family in the assisted death & support
4. role of administration witness
5. additional  considerations  around  individual's  wishes  for  the assisted death – e.g. inclusion of consideration of beliefs or faith
6. prescribing the approved drugs, and detail of the approved drugs:

1. pharmacodynamics and pharmacokinetics
2. prescribing
3. dispensing

4. preparation
5. facilitation of Administration
6. interactions/Reactions/Unsuccessful Outcomes
7. acting in the event of medical complications
   7. administration of approved drugs – clinical skills e.g. cannulation, equipment, care after death
   8. establishing refusal or resistance to administration of drugs, where waiver of future capacity is in place [see paragraph 82]
   9. disposal of unused/partially used drugs
   10. medical complications
   11. process after assisted death

13. Pharmacy Professionals

1. discussion  with  Administering  Practitioner  and  individual  on method/mode of assisted death and prescription of approved drugs
2. process for preparation and dispensing of approved drugs
3. detail of the approved drugs:
   1. pharmacodynamics and pharmacokinetics
   2. prescribing
   3. dispensing
   4. preparation
   5. facilitation of Administration
   6. interactions/Reactions/Unsuccessful Outcomes
   7. acting in the event of medical complications
4. process for disposal of unused/partially used drugs

m.  Extended team members

1. providing relevant opinions
2. role of extended team meetings
3. professional check and challenge for assessing doctors
4. voluntary nature of decision and supporting assessing doctor with identification of possible coercion – including additional steps to take where this is suspected, e.g. onward referrals
5. signposting and support for individual and family members

n.  Certifying Doctors

1. attending the individual prior to the assisted death
2. certification  of  an  assisted  death  –  completion  of  the  Medical Certificate of the Fact and Cause of Death (MCFCD)

Training available to all on-island health and care professionals

70. It is envisaged that training made available to all on-island health and care professionals will be available in a digital format, and professionals will have the choice to complete the training either in a self-guided format online or at in- person group sessions delivered by a trainer.
71. In addition to health and care professionals, it is anticipated that the training module will also be made available to relevant voluntary and community organisations who support islanders who may consider assisted dying – for example, cancer charities.

72. Expected outcomes of training:

1. Understand the basics of assisted dying in Jersey
2. Awareness of the appropriate conversations guidance, and what is/is not appropriate when talking about assisted dying with patients
3. Awareness of where to find out further information about assisted dying, including professional guidance, and how to signpost patients to further information
4. Understand  considerations  related  to  providing  ongoing  care  and treatment for a patient seeking an assisted death.

73. The training for all on-island health and care professionals will consist of three key topics:

• Part A: Overview of the assisted dying law

• Part B: Appropriate conversations around assisted dying

• Part C: Continuing Care for Patients requesting / having an assisted death.

74. It is intended that Part A of the training will cover an overview of the assisted dying law:

1. What is assisted dying?
   1. definition and overview
   2. key terms
   3. eligibility criteria
2. Overview of assisted dying process
   1. outline of steps 1 to 8
   2. relevant opinions
3. Role of the Assisted Dying Service
   1. how to contact Service
   2. referring patients
   3. information & support the Service provides to professionals
4. Rights and protections for professionals
   1. right to refuse
   2. employment protections
   3. safe access zones
5. Offences under the law
6. Signpost to information produced by Professional regulatory bodies (GMC, NMC etc.)

i.  information how on assisted dying law relates to professional's requirements to act in accordance with guidance issued by their professional body.

75. It is intended that Part B of the training will cover appropriate conversations around assisted dying:

1. Training will support guidance produced by Committee
2. It will set out process for when a patient raises the issue of assisted dying and steps for professional to take
3. It will include the limited circumstances where it may be appropriate for professional (doctor) to raise the subject of assisted dying with a patient (e.g. when discussing all care and treatment options, including palliative care, with a patient with a terminal diagnosis)

4. Steps to take when a patient appears to talk about assisted dying without using the words of assisted dying'
5. Actions for professional to take if they have a conscientious objection to assisted dying and wish to exercise their right to refuse participation

76. It is intended that Part C of the training will cover Continuing Care for Patients requesting / having an assisted death:

1. Continuing care of a patient who has requested assisted dying:
   1. respecting the patients views and wishes
   2. discussion with family members
   3. interaction with the Assisted Dying Service
   4. supporting  a  patient  who  has had  their  assisted  dying request declined or chooses to withdraw from the process
2. Continuing care of a patient who has requested assisted dying where the professional chooses to exercise their right to refuse
3. What to do if the professional is concerned their patient is experiencing coercion and pressure in relation to their assisted dying request.

Development of training package during implementation period  

77. As set out in P65/2025, £459,619 has been allocated in the 2026 Government Budget for assisted dying training for the 2026-2029 period. This includes costs associated with the development of a training package, as well as the costs associated with delivering training.
78. Development of a bespoke training package for assisted dying practitioners will require external expertise, which is anticipated to involve UK professional bodies and specialists from jurisdictions where assisted dying training for professionals is currently provided.
79. Acquiring a training provider will be a commercially sensitive matter and subject to Government procurement processes. Work on securing a preferred training provider will begin early in the implementation period, should the draft law be approved by the Assembly.
80. It  is  anticipated  that  Jersey  will  be  seeking  to  secure  specialist  training development support at broadly the same time as the UK government/Isle of Man government. Officers will seek to liaise with UK counterparts.
81. As set out in paragraph 56, the Assurance and Delivery Committee will have responsibility for developing the training and will be required to consult with relevant on and off-island persons and organisations in doing so.

Recommendation 6: Process for establishing refusal or resistance to an assisted death, where person does not have capacity

Recommendation 6 requested the Minister to publish the full details and processes for establishing refusal or resistance to an assisted death for a person who has lost decision-making capacity.

82. The guidance on the process for establishing refusal or resistance to an assisted death  (where  the  person  no  longer  has  capacity  and  has  waived  their requirement for future capacity) will be confirmed by the Committee following consultation (in accordance with all other guidance and training).
83. As set out in paragraph 69 above, the assisted dying training programme would also include a module on refusal or resistance to an assisted death.
84. It is intended that the guidance will set out:

a. that whilst an individual may have lost the capacity to consent to assisted dying, they always retain the legal ability to refuse the administration of approved drugs

b. that the guidance applies at Step 7 (final review and carrying out of assisted death) in relation to Article 9 of the draft law – where the practitioner is satisfied that the individual does not have capacity but the individual has (at Step 6) made their final request for assisted dying and waived the required for future capacity, the practitioner may carry out an individual's assisted death if:

• the individual does not show any refusal of, or resistance to, the approved drugs' administration (Art 9 (1) (k))

c. that signs of refusal or resistance to the carrying out of the assisted death may include:

• refusal by words, sounds or gestures

• any physical or verbal resistance to administration of the approved drugs

d. that signs of refusal or resistance are not considered to include involuntary words, sounds or gestures made in response to contact. This means any reactions to touch, restraint, or discomfort during the establishment of IV access (e.g., twitching or physical recoiling from contact or insertion of a needle) do not constitute a demonstration of refusal or resistance

e. that if the administering practitioner decides it is not appropriate to carry out the assisted death as a result of a demonstration of resistance, they may choose to delay or end the process in accordance with Article 11 of the draft law. If the process is ended the assisted death must not go ahead (unless overridden by appeal).

f. the circumstances where it is appropriate for the administering practitioner to stop the assisted death (and the process ends), for example:

1. where the individual does not have capacity and is showing clear signs of refusal or resistance; and
2. is not anticipated to regain capacity at a later date

g.  the circumstances where it is appropriate for the administering practitioner to  delay the assisted death  (which  may  then be  rescheduled  for an alternative date), for example:

1. where the individual does not have capacity and is showing possible signs of refusal or resistance; and
2. the administering practitioner determines the individual has fluctuating  capacity,  for  example  as  a  result  of  the administration of pain medication

h.  if the administering practitioner decides to delay the assisted death, the guidance will set out the considerations for the circumstances where the assisted death may be rescheduled, for example, if decision to pause the process was made as a result of the individual's fluctuating capacity, then the administering practitioner may reschedule, and the process proceed if:

1. the individual has capacity at time of rescheduled assisted death and gives their consent to proceed;
2. the individual does not have capacity at the agreed time of the rescheduled assisted death but has regained capacity at times during the intervening period prior to the rescheduled date, and at  those  times  they  consistently  expressed  a  wish  for  the assisted death to be carried out.

Recommendation 10: Details and plans about assisted dying training and guidance

Recommendation  10  requested the  Minister  to  provide  details  and  plans  about assisted dying training and guidance that include:

• a detailed summary outlining all items of assisted dying guidance to be developed and produced

• the  items  of guidance to be  prioritised, shared  and presented to States Members

• details  and  plans  about  the  development  of  the  assisted  dying  training programme.

85. Appendix 3 of P18/2024 provided a summary of the guidance that would be brought forward during the implementation phase.
86. In P65/2025, the development of guidance has been provided for in the draft law:

1. Article 62 requires the Committee to arrange for the development of guidance by the Service (or another supplier)
2. Article 62 (2), in line with P18/2024, sets out that there must be operational guidance about:

1. the right to refuse to participate in assisted dying;
2. having  appropriate  conversations  with  patients  about  assisted dying;
3. the places of assisted deaths;
4. independent advocacy, communication support and support for interpretation of languages;
5. assessing individuals for assisted dying;
6. care planning for individuals;
7. prescribing and dispensing approved drugs;

viii.  administering approved drugs, including detailed protocols for how

to deal with a medical complication; and

ix.  donating organs.

3. In addition, Article 62 (2) also requires the Committee to develop guidance about:
   1. holding, indexing and giving access to individuals' records;
   2. the registration of assisted dying practitioners;
   3. disclosing interests and deciding whether they conflict; and
   4. disclosing information about health professionals to a body that regulates their profession or to an enforcement authority (in Jersey or elsewhere).
4. Article 63 requires the Committee to develop general guidance for families and carers of an individual.
5. Article 67 requires the Committee in developing the guidance, to consult with  persons  and  organisations  with  relevant  expertise  including,  for example, the professional registration bodies.

87. Guidance will also be brought forward on death certification for assisted deaths.
88. Operational guidance published by many other jurisdictions where assisted dying is permitted is not publicly available, however, examples of published guidance issued by Australian states are provided below:

• New South Wales, Australia: NSW Voluntary Assisted Dying Clinical Practice Handbook

• Queensland, Australia: Queensland Voluntary Assisted Dying Handbook | Queensland Health

• Western  Australia:  Western  Australian  Voluntary  Assisted  Dying Guidelines

89. Further detail on the intended contents of the operational and general guidance is described in the following paragraphs. These paragraphs set out many of the intended key elements of the guidance but do not present an exhaustive list. Full detail  of  the  guidance  will  be  confirmed  by  the  Committee  during  the implementation phase.
90. Guidance on right to refuse to participate will:

1. summarise key provisions in law relating to the right to refuse to participate
2. provide examples of activities that are participation in assisted dying (and so may be refused)
3. provide examples of activities that are not participation in assisted dying (and so are not covered by the right to refuse)
4. set out what steps a health professional must take if they exercise their right to refuse to providing information about assisted dying to a patient, i.e. they must inform patient:

- they are exercising their right to refuse

- the Assisted Dying Service may be able to help the person

- how the person may find the contact details of the Service

o  including information produced by the Service, such as leaflets the professional may give to patient

5. set  out  protections  for  professionals  (for  either  involvement  or  non- participation in assisted dying) and the steps a person may take if they believe they have suffered an employment (or partnership) detriment (for example, if they have lost their job or been denied a promotion as a result of their views towards assisted dying.)
6. provide information on how right to refuse in assisted dying law relates to the professional's requirements to act in accordance with guidance issued

by their professional body

Target audience for Guidance: Any person who may choose to exercise their right to refuse, or employs someone who chooses to exercise their right, including all on- island health and care professionals

91. Guidance on appropriate conversations will:

a. set out the process for when a patient raises the issue of assisted dying, including the steps for professionals to take

b. confirm  the  limited  circumstances  where  it  may  be  appropriate  for professional (doctor) to raise the subject of assisted dying with a patient (e.g. when discussing all care and treatment options, including palliative care, with a patient with a terminal diagnosis)

c. set out the circumstances in which it would not be appropriate to raise the issue of assisted dying with a patient

d. set out steps to take when a patient appears to talk about assisted dying without using the exact term assisted dying', such as I would like to die on my own terms'

e. confirm actions  for professional to take  if they  have  a  conscientious objection to assisted dying and wish to exercise their right to refuse participation

f. set out considerations for professionals when having conversations with a patient who is going through the assisted dying process, whilst providing ongoing care and treatment to that patient, including:

- respecting the patients views and wishes

- discussion with family members

- interaction with the Assisted Dying Service

- supporting a patient who has had their assisted dying request declined or chooses to withdraw from the process

g. detail actions to take, if the professional is concerned their patient is experiencing coercion and pressure in relation to their assisted dying request

Target audience for Guidance: All on-island health and care professionals and other professionals whose clients may request assisted dying (e.g. staff of cancer support charities)

92. Guidance on places of assisted deaths will:

1. set out where an assisted death may take place, and key provisions in the law relating to the approval of a place for an assisted death

- including that in many instances this may be the individual's own home.

b. confirm how the administering practitioner should assess the suitability of a  location,  including  identification  of  risks  that  may  make  the  place unsuitable

c. set  out  considerations  to  be  taken  into  account  by  the  administering practitioner when deciding to approve a place for an assisted death, to include:

- wishes of the individual

- views of others who live in the place

- suitability of location and any risks that may make the place unsuitable

- views of the manager or provider, if that place is a care home

d. set out the process for the administering practitioner to approve a place for an assisted death

e. detail the steps to take where an individual believes their landlord may seek to prevent them having an assisted death in their home (which is contrary to the law)

f. set out additional considerations in relation to assisted deaths in care homes, including where the provider exercises their right to refuse, and the approval of an alternative place

g. see also paragraph 132 – for further detail of what the guidance will cover in relation to for assisted deaths taking place in care homes

h. set out additional considerations in relation to assisted deaths in the Jersey General Hospital, including:

- managing staff rotas on the ward where the assisted death will take place [in an assigned private room]

- transportation of the individual to the hospital, where they are not already an inpatient.

Target audience for Guidance: Administering practitioners, care home providers, any person who owns or resides in a place which is being considered as a place for an assisted death.

93. Guidance on independent advocacy, communication support and support for interpretation of languages will:

1. set out how an assessing doctor / administering practitioner will:
   1. decide the communication support or advocacy requirements for the  individual,  and  when  additional  relevant  opinions  may  be required to reach a decision
   2. arrange for communication support/advocacy for the individual considering factors such as: where a person may require more than one type of communication support and/or advocacy; where remote communication may be appropriate compared to when in-person support is required
   3. record details of the support provided on all assisted dying forms
2. describe matters related to:

1. requirements  related  to  providers  of  communication  support, including:

- requirements for qualifications and experience

- circumstances in which it may be appropriate for a connected person (i.e. a family member) to provide communications support, plus associated benefits and risks

2. requirements on providers to disclose interests in relation to the individual
3. requirements  related  to  additional  time  required  during  the assessment process if communication support and / or advocacy is provided to the individual
4. the  circumstances  where  a  pre-brief  or  debrief  between  the assessing doctor / administering practitioner and person providing communication support may be required
5. the process for arranging wellbeing support for those providing communication support

3. full guidance relating to independent advocacy will be developed alongside the development of the Regulations which will provide for the appointment of independent advocates. See P65/2025 paragraph 313.[12]

Target  audience  for  Guidance:  All  assisted  dying  practitioners,  in  particular, assessing doctors and administering practitioners. Any person who may provide communication  support,  including  interpretation  or  advocacy  support  to  an individual.

94. Guidance  on  assessing  individuals  for  assisted  dying  will  confirm  legal requirements associated with the assessment process, and provide specific guidance related to the different criteria including health, capacity, decision, age and residency criteria (as per following paragraphs.)
95. The health criteria section of the assessment guidance will include:

1. process for determining whether the individual meets the life expectancy criteria,  including review of  individual's  medical records  and  seeking relevant opinion of the person's treating consultant or a professional who specializes  in  that  condition,  which  may  include  examination  of  the individual.
2. matters  for  consideration  when  establishing  whether  the  individual's suffering arises from the person's terminal illness, as opposed to other reasons – for example the person's living situation, if the individual's relationship with their partner has recently broken down. To include:
   1. onward referral to services that may be able to address / support individual with these other matter
   2. role of extended team
3. how to document the individual's determination of whether they can bear their suffering
4. how to appropriately challenge the individual's  determination of their expected suffering

96. The capacity criterion section of the assessment guidance will include:

1. set out details related to the specific capacity test in law, clarifying that capacity is time and decision specific i.e., the assessing doctor should assess an individual's ability to make an assisted dying decision at the time that decision needs to be made
2. matters related to requirement on assessing doctors to be satisfied as to the individual's capacity (i.e., cannot be presumed, must be determined)
3. the assessment approach, which may, in order to determine the individual's ability to receive information; understand the information and matters relevant to their decision (including the effect of their decision), include asking the individual to describe in their own words:
   1. the problem with their health now
   2. their care and treatment options (including palliative care) and risks/benefits of these
   3. what they expect to happen if they have an assisted death/ do not have an assisted death
   4. what will happen as a result of administering the approved drug – i.e. that they will die
   5. how they have made their decision
   6. what makes their decision for assisted dying preferable to the other options available
   7. their thoughts and feelings about their health, treatment options and an assisted death
4. red flag' responses to the questions above, requiring further investigation could include that the individual:
   1. fails to remember or understand their medical condition
   2. cannot describe the possible care and treatment options, and benefits/risks
   3. cannot accurately explain what will happened when they are administered the approved drugs – i.e. that they will die
   4. does not express their choices consistently or cannot remember previous decisions
   5. makes an unusually quick decision
   6. makes a decision that does not appear to be based on their expressed beliefs or values
   7. frequently changes their decision
5. the assessment approach, which may, in order to determine whether the individual can communicate their assisted dying decision, include:
   1. listening to the individual's request and seek clarification if necessary
   2. if the individual has not decided on a treatment option, ask what is making it hard for them to decide
   3. red flags' in the individual's response include inconsistent responses to questions
6. consideration of capacity where the individual is experiencing depression or cognitive impairment, which is either pre-existing or as a result of their condition/terminal prognosis – neither of which necessarily mean the individual does not have capacity, but do require additional exploration
7. requirement on the assessing doctor to seek the relevant opinion of a professional with specific expertise to undertake a capacity assessment

(e.g.: psychiatrist, geriatrician, psychologist or specialist social worker) if assessing  doctor  cannot  be  satisfied  of  capacity,  including  where complexity arises due to the individual's medical condition and / or any comorbid mental illness

8. confirmed  actions  to  be  taken  where  the  individual  has  fluctuating capacity, meaning they may lack capacity to make a specific decision at one point in time but may have capacity to make the same decision at a different point in time. The assessing doctor must be satisfied that there is no evidence that the individual lacks capacity at the point at which an assisted dying decision is made but, between those decision-making points, it is accepted the person may not have capacity. Where the individual who has known fluctuating capacity, and does not have capacity to make an assisted dying decision at the point in time at which it is envisaged that the decision will be taken, the assessing doctor may decide to delay decision- making until a point in time when they determine the person has capacity. This is because it must be recognised that the drugs used to manage pain may have a temporary / fluctuating impact on decision making capacity.

97. The decision criteria section of the assessment guidance to include matters related to:

1. a decision on the voluntary nature of the wish including:

i. matters related to discussions with:

- the individual's family / friends about how they feel about the individual's decision and what they  understand  to  be  the  individual's underlying motivations and wishes, along with observation and assessment of family dynamics

- other professionals providing care and treatment to the individual. These professionals may have specific  observations  or  may  have  had conversations with the individual or their carers, family  or  friends  which  may  provide  useful insights into the motivation behind the person's decision

ii. indicators of possible coercion that may be detected during a consultation with carers, family or friends present which could include:

- excessive  deferment  by  the  person  to  their carers,  family  or  friends  for  answers, reassurance or explanation

- carers, family or friends talking over the person and answering on their behalf

- inconsistencies  in  the  person's  answers  to questions  about  their  suffering,  illness experience or assisted dying in general

- inconsistencies between what the person says in private to the assessing doctor, and what the person says in the presence of others.

iii. potential requirement to talk with the person away from others to determine if there is potential coercion. Questions they could ask in their discussion with the person could include:

- are you feeling any pressure from others to request assisted dying?

- do you have or are there any significant financial concerns?

- do you have any concerns about your family after you die?

- is there anything we need to know that you don't want your family to know?

- what  about  your  family/friends  (may  include  partners,  spouse, children, parents, siblings)? / Are they aware of your request for assisted dying? / How do they feel about it? / Do they support your decision?

- is your GP aware of your request for assisted dying? / Does your GP support it?

4. Set out process where there are concerns around coercion and/or abuse. If there is a concern that the person may be experiencing coercion and/or family and domestic violence, financial abuse or elder abuse these issues should be discussed with the individual. These concerns should also be considered at an extended team meeting, and the assessing doctor must make a referral to the appropriate adult safeguarding team if there are any safeguarding concerns regarding abuse.

2. a decision on whether wish is clearly expressed and settled including:

i. setting out that, in order to determine that the individual's wish is clear and settled, the assessing doctor must:

- discuss their reasons for requesting an assisted death

- fully explore with the individual their request for an assisted death and the fears, anxieties and suffering that gives rise to that request as well as their understanding of the impact of requesting and having an assisted death

- explain the purpose of these discussions to understand the individual's wishes and why the individual thinks accessing assisted dying will address their fears / concerns

- ask the individual how they reached their decision, including what or who may have influenced them.

ii. if the individual is requesting access to assisted dying because they are concerned that they are a burden on their carers or family, their situation should be explored.

- This may include the assessing doctor requesting that another member of the extended team, for example the social worker, reviews with the person their current care package and explores additional options for supportive care or respite care.

- The assessing doctor should also seek to understand why the individual has raised this concern and what they mean by it. Some people may say they feel like they are a burden because they believe or know that their family members are struggling to support them at the end of their life, while others may use this to start a discussion about their struggles with their current situation such as their sense of burden or loss of dignity.

- Such comments should also raise a red flag' to the assessing doctor to explore whether there may be any element of explicit or implicit coercion underlying the person's request for assisted dying [see above]

3. confirm that the assessing doctor must also consider any previous assisted dying requests, withdrawal of requests or requests the pause the process, in terms of what this indicates about the settled nature of the individual's wish.

3. a decision on whether a wish is informed including:

1. setting out the information the assessing doctor is required to tell the individual under the law, including both the general information about assisted dying, and specific information relating to the individual
2. providing additional detail on how this information should be delivered, and what should be discussed with the individual
3. setting out that when informing the individual about the care and treatment options available to them (and the likely outcome of those care and treatment options), the assessing doctor must also offer to arrange consultations with the professionals providing such services or care that may be available to the individual.

98. The age criterion section of the assessment guidance will include:
    1. reminder that age will be determined at Step 1 (First request).
    2. that proof of age documentation may not be required if it is self-evident the person is aged over 18 (for example, they are elderly and their date of birth is on their medical record)
99. The residency criterion section of the assessment guidance will include:

1. reminder that residency will be initially determined at Step 1 (First request) and reconfirmed at all subsequent steps in the process to ensure continued residency in Jersey
2. set out that residency checks will generally be undertaken by the HCJ team that currently deals with eligibility matters for accessing other HCJ services. In order to undertake these checks, the team may need to request information from the person (via the Care Navigator) or from other Government Departments. If consent is not given for information about residency to be shared, the individual may be found not to meet the criteria.

100.  In addition, the assessment guidance will also set out:

1. additional considerations for the assessment of individuals with learning disabilities and/or autism spectrum disorders, including requirement to allow  additional  time  for  assessments  (to  accord  with  guidance  on independent advocacy and communications support)
2. additional considerations where the individual has chosen not to provide consent for the assessing doctors to share information with others, for example: when consent is not given to speak with the person's family or GP
3. processes related to establishing the extended team including determining the skills / knowledge of the members of the team (as relevant to the circumstances of the individual)
4. matters related to holding extended team meetings (frequency, attendance, etc.) and associated record keeping
5. process for review of requests for second opinions, and process for second opinion assessments including examples of thresholds for second opinion assessment
6. considerations in relation to seeking relevant opinions, including:

- when relevant opinions may or must be sought

- who may provide relevant opinions

- steps the assessing doctor must take when requesting a relevant opinion, e.g.:

• informing the person they are requesting the opinion in relation to a request for assisted dying

• explaining to the person they have a right to refuse under the law

• where the person is not based in Jersey, that they should consider the law that applies in the location they are based in

- when relevant opinions by mental health practitioners should be sought

g. process for change of practitioner, for example where a Coordinating Doctor is no longer able to carry out the role due to illness

h. process for identifying and arranging for wellbeing support, if it is required by the individual (or their family member or carer)

- Including considerations for the assisted dying process where the individual has children/dependents aged under 18.

i. process for supporting individuals who are assessed as not meeting the eligibility criteria, including signposting to additional support services.

Target audience for Guidance: Assessing doctors, all assisted dying practitioners and any person who may be asked to provide a relevant opinion for the purpose of an assisted dying assessment

101.  Guidance on care planning for an individual's assisted death will:

1. confirm requirements for care planning as required by the law including matters related to the information that the administering practitioner is required to tell the individual at Step 6, which include:

1. information about  the  approved  drugs,  including  who  will administer them and how they may be administered and risks associated with each option
2. options  for  place  of  assisted  death  [with  reference  to  the location guidance]
3. involvement  of  family  or  friends  in  the  assisted  death  / managing  family  and  friends'  refusal  to  be  involved  / understanding and managing the potential impact on family and friends of their involvement
4. individual's choice to –

- consent to continued carrying out of assisted death, and/or

- make their final request and waive requirement for future capacity as Step 6

5. that the individual is expected to die if the approved drugs are administered to them
6. that the individual may withdraw their request at any time before the drugs are administered

2. set out process for developing care plan with the individual and all matters to be considered in that care plan
3. set out process for amending the care plan (when and how it can be amended)
4. detail considerations regarding involvement of family or friends in the care planning  phase  (i.e.  may  be  appropriate  to  include  them  in  the  care planning, but all decisions must be made by the individual)
5. detail how the administering practitioner can support the individual to decide on method and mode of the assisted death (e.g. self-administer or practitioner administer and whether drugs will be administered orally, or intravenously,  plus  any  additional  considerations,  for  example administration via nasogastric tube)
6. detail as to how administering practitioner can support individual to decide on whether to:
   1. consent to continued carrying out of assisted death
   2. make their final request and waive requirement for future capacity
   3. make an advance decision to refuse treatment (if they have not already done so)
7. confirm steps administering practitioner must undertake to decide whether they are satisfied individual has capacity to make final request, and is doing so voluntarily
8. confirmation of involvement of family or friends during the assisted death, and confirmation of who will be in attendance
9. requirements for who may act as an administration witness, and steps for administering practitioner to confirm who will act as the witness
10. include  specific  guidance  for  professionals  who  may  act  as  an administration witness, to include:

1. scope of right to refuse
2. requirements for acting as a witness – including witnessing the administering practitioner preparing the approved drugs and:

- providing them to the individual to self-administer; or

- administering to the individual