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Two actions by the States Assembly and Government of Jersey would constitute better alternatives to euthanasia and assisted suicide, by properly addressing the underlying problems which those practices are meant to solve.
In 1961, the UK Parliament removed historic penalties for attempting suicide from English Common Law. At the same time, it introduced legal protections for those who might be pressured into suicide by criminalising any act which “aids, abets, counsels or procures the suicide of another, or attempt by another to commit suicide”, creating the new crime of ‘complicity in suicide’. These same provisions were introduced into (Northern) Irish Law by the Criminal Justice Act (Northern Ireland) 1966.
The Isle of Man followed suit by removing penalties for attempted suicide from their Criminal Code in 1981 and introducing a new crime of ‘abetment of suicide’ using the language in UK legislation. Guernsey similarly removed criminal penalties for suicide in their customary law, through the Homicide and Suicide (Bailiwick of Guernsey) Law 2006, with section 5 of that same Law also introducing penalties for assisting someone in their own suicide, so as to protect vulnerable people from being coerced through external or internal pressures to end their own life.
Jersey remains the only jurisdiction in the British Isles which has never formally removed its customary law penalties for suicide. This remains an important symbolic act to accomplish, as even though this law has fallen into desuetude, its existence still stigmatises those whose poor mental health leads them to suicidal ideation. Meanwhile, aiding, abetting, counseling or procuring the suicide (or attempt to commit suicide) of another is only hypothetically subject to prosecution under the related offence of ‘attempted murder and aiding, abetting, counselling and procuring murder’.
Adoption of a law like that of our neighbours would bring clarity to Jersey Law, and both removal of legal stigma towards, and better legal protection of, those suffering from suicidal ideation.
The answer to suffering at the end of life or through chronic illness is not euthanising or assisting the suicide of patients, but giving them the care they need to overcome suffering caused by their condition. Not ‘assisted dying’, but assisting living.
If Jersey is to be a truly compassionate and progressive society, it needs to ask the same questions that the U.K. is asking about the supply of palliative care on our island, and whether palliative care is a specialism integrated sufficiently enough into our medical centres, community-based medicine, and social care system. This must be planned, well-coordinated, and available out of normal hours. All of which is especially important for the “oldest old” (aged 85 and over), people living alone, and people who are most deprived in our community.
One of Britain’s leading experts in palliative care medicine, Lady Finlay of Llandaff, recently tabled an Access to Palliative Care and Treatment of Children Bill in the UK House of Lords that would ensure that all health and social care providers receive necessary education and training in palliative care and are thereby enabled to provide a quality service for patients who need it. This would mean that the individual analgesic requirements of patients would become a priority and a duty for all medical professionals. It would also involve training all staff in how to handle the sensitive communications between themselves, dying patients, and their loved ones, so that needed psychological and emotional support is provided at all times.
In addition to this, Lady Finlay’s Bill aimed to resolve problems such as access to the essential palliative medication for patients at all times needed by healthcare workers, and to the specialist advice needed to properly care for those with complex conditions.
In Jersey, something approximating this effort is taking place. an island-wide cross-sector partnership has been established to develop a palliative and end of life care strategy which will include an integrated care pathway. It is envisaged that this strategy will be published by spring 2022. The aim is for high-quality palliative care to be accessible to all and that care be co-ordinated and delivered by the right person, at the right time in, the right place. Until these reforms are implemented, it is wrong to talk about introducing EAS, as to do so in the absence of specialist palliative care being available to every member of our society who needs it would be to put people in a position where they would feel a need for EAS due to their lack of proper specialist palliation.
Worse, recent evidence from Canada shows that EAS actually undermines palliative care and its development. A very recent qualitative study conducted by a group of physicians in Canada interviewed palliative care physicians and nurses who practiced in healthcare settings where patients could access EAS in Southern Ontario. They found that clinicians experienced a a conflict between maintaining euthanasia eligibility and effective symptom control, as they felt they had to withhold symptom control medications that could cause sedation or confusion and therefore jeopardise a patient’s eligibility and thus access to euthanasia, even if the medication had the capacity to significantly alleviate their patient’s pain. This increased distress for both patients and the palliative practitioners themselves. Clinicians also reported resources that would otherwise have been allocated to palliative care were being dedicated to EAS deaths instead. This and a host of ethical and moral dilemmas led to a profound emotional cost and damage to the patient-doctor relationship.
Rather than consider euthanasia and assisted suicide, the Government and States Assembly should consider how they can better support the palliative care being delivered through the medical services in Jersey, so that few, if any, individuals ever feel that their care is so lacking that they desire to end their own lives.
