I would first like to say to Members that this amendment is not, contrary to some beliefs circulating, that we are reopening the debate on assisted dying. It is about whether an Assisted Dying Service should be prioritised and funded with public money, when the Minister for Health and Social Services has confirmed that currently core health services are under-resourced and in need of multi-million pound investment. When it comes to managing scarce public resources, our social care system often gets overlooked, particularly the provision of respite care and the support available to carers. They are our unsung heroes and between them they provide invaluable support to hundreds of vulnerable people every day. The purpose of this amendment is to ask Ministers to consider this in a bit more depth and commit to redirecting the £2.7 million earmarked for a new Assisted Dying Service into delivering much-needed respite care and a service for carers. On a matter of principle, it seems we may have galloped ahead of ourselves by assuming that the only way to deliver and fund an Assisted Dying Service is by the state. In some countries, that is not the way assisted dying is done, and by deciding it will be state-provided as well as state-funded, we are immediately opening up a can of worms that we have not given sufficient thought to. The scenario poses a number of questions.
Should our health service not be better prioritising health? Do people want the decision about ending their life to be in their own hands or in the hands of the state? And what priority do we give to carers and those in need of support? There is an argument that because of the narrow criteria we have set for the eligibility for an Assisted Dying Service, we can expect that the numbers for a population of our size will be small and at the lower end of the range somewhere. So the cost per patient on the basis of this proposal is to be questioned. If Jersey allocates nearly £2.7 million a year to assisted dying, the cost per patient, depending on the uptake, ranges from £64,000 to nearly £400,000 per patient. We must be honest about it, if Ministers tell us that there is no new money, then as an Assembly we have some strategic choices to make. Do we spend £2.7 million on the many who want to live well, a core purpose of our health and social care system, or on a small number who are making a very personal choice to have assistance with their death? Right now because of funding, carers cannot get regular breaks, respite beds are rationed, specialist respite for children is stretched beyond capacity and many families are simply exhausted. If departments are constrained and must take proportionate cuts, as Ministers have warned, then unprotected services will fall even further behind, unless this Assembly acts responsibly. I would say to the Minister for Social Security, maybe she does not need to commission a review into the needs of carers, because if she and her colleagues support the amendment, the money will be right there in the Budget to spend now, to improve the lives of carers and those in need of respite care. I am surprised by the decision taken by the Council to propose funding a service development which will place us even higher up in the O.E.C.D.
(Organisation for Economic Co-operation and Development) index for health expenditure, and this suddenly does not correlate with better health outcomes. If £2.7 million is approved by the Assembly to spend on assisted dying, it will also place us in the highest expenditure bracket for publicly-funded Assisted Dying Services, on the basis that we are likely to see between 2 and 38 deaths per year. The proposal put forward by the Government to spend money in this way is a statement of political choice.
It says this is what we value, this is what we will pay for, before we will pay for anything else.
Yesterday, Ministers themselves set the context for why this amendment is important. The Minister for Treasury and Resources told us yesterday there is no new money. The focus must be on driving efficiency and making savings. The Minister for the Environment stated we must take all proportionate costs. We have looked hard at the choices. Most starkly, the Minister for External Relations told us western economies can no longer afford to finance healthcare in the way that they are; it is going to be impossible to fund what health needs. These are not my words, these are the Government’s own words and they go directly to the heart of this amendment. If Ministers tell us these things then the Assembly must seriously consider how best to use £2.7 million of public money, and there is a basic strategic logic to be considered here. We cannot, on the one hand, be told that the public purse is exhausted, that efficiencies must be found everywhere, and that even health needs may soon be unaffordable. Then, on the other hand, spend over £2.7 million on developing an Assisted Dying Service for a very small number of people. I would like to move to reference the connection with C.S.P. (Common Strategic Policy) priorities, which are very often quoted back to Members, and there are key risks associated with using money in this way. Any system that requires fixed annual staffing, clinical oversight, advocacy and I.T. (information technology) systems, regulatory frameworks and communications, regardless of uptake, will always be proportionately more expensive in Jersey. No other small jurisdiction has made an Assisted Dying Service cost- efficient. Palliative care, respite and home care services remain underfunded in the Island. If assisted dying is fully funded, these will remain incomplete. The C.S.P. ambition is to support carers, strengthen community care, reduce hospital pressures, improve end-of-life dignity. It is undermined, not advanced, if we choose not to support carers in the way I am proposing. The risk is clear and they are not theoretical risks. It is exactly what disability rights, hospices and palliative care organisations have warned against and we need to listen to this. We are not immune from the consequences of introducing a state-funded Assisted Dying Service but we can do more for our carers and provide more respite. Countries that fund assisted dying through the public purse rely on 3 main arguments: it is part of end-of-life care; it is a small cost in the wider health budget; it ensures equitable access. But the international evidence shows that there are serious problems with these justifications. The counter-argument to it as part of end-of-life care is that assisted dying is not a treatment. It has no therapeutic aim and it is not comparable to palliative care.
[9:45] So the equal treatment does not logically stand. It is a small cost. This is where the major warnings emerge. In Canada, costs have risen sharply. Oversight, bodies have struggled. Palliative care investment has not kept pace and several provinces now warn that medical-assisted dying is easier to access than many other health services. It promotes equity is the third argument. New Zealand, Belgium and Canada argue that public funding prevents assisted dying become a service only for the wealthy. Disability rights groups and palliative care organisations now argue that equity in ending life is meaningless if equity in living with dignity is not met first. Equal access to ending life is not morally equivalent to equal access to support people to keep living. This is a critical point for Jersey.
We do not have the palliative care capacity we committed to. We do not have a respite system that meets the demand. We do not have full carers’ support in place. Yet, we are proposing to fully fund from the public purse the option to end life. This Assembly itself required palliative and support services to be strengthened first. We have not yet met that condition. It remains incomplete. Carer support reform has stalled and, as I have said before, respite care remains chronically underfunded.
This amendment ensures, or aims to ensure, that those commitments are honoured before a new service is built. If the Minister for Treasury and Resources says there is no new money, and the Minister for the Environment says departments must tighten their belts, and that even health needs may soon be unaffordable, then how can it be justified to protect millions of pounds for brand new assisted dying services while carers, families and palliative services go without? If this Assembly accepts those warnings, then the logical step is to prioritise the services that sustain life, support carers and reduce pressure on the health system today. The European Court of Human Rights has been absolutely clear that there is no right to die under the European Convention, so assisted dying is therefore not a mandated public service. It is a choice created by this Assembly and if it is a choice, then funding it ahead of essential care is a political decision, it is not a human rights obligation, and I urge Members to think carefully about the political choices we are making here today. I come back to disability rights groups because they warn that assisted dying services could provide a perverse financial incentive if ending life becomes cheaper than supporting it. State-funded assisted dying creates a moral hazard where limited care options can push people towards a legal alternative they would not otherwise choose. States-funded dying has the potential to cause systemic neglect where scarce resources fall further behind as funding and workforce are directed and diverted to new service developments. We already know that the hospice and other palliative care providers operate on tight budgets. Introducing a new resource-intensive legal framework without simultaneously boosting respite care, palliative care, is not a neutral act. It is a risk multiplier. This amendment is trying to address that. We have already heard the Ministerial warnings, but it does not seem the case that these concerns are shared by all. Where is the evidence of objectivity? Where is the focus on sustainable healthcare? Any sign of humble recognition or reflection that maybe this may not be the right time to fund the service in this way? We should ask why have we been presented with only one option as to how this development should be funded? Why have the Council of Ministers not called for other options to be considered? What financial assessment was done on affordability? How is the decision justified on a service that supports a few but provides little benefit to the many? I want to be clear, when Ministers warned that it is impossible to fund the health needs faced by Islanders at this time, I could not agree more. But at a time when other health priorities are competing for resources and carers cannot even get a weekend of respite care, it seems the Council have done nothing to challenge the fact that the amount of money identified to establish a state-funded Assisted Dying Service for a few people is unaffordable and engage the Assembly in discussions about alternative options. It seems that we are presented with a fait accompli. It is a problem in itself that we do not have reliable, up-to-date figures for how many Islanders need respite care, and I hope the Minister for Social Security is intending to address that issue as part of her review work. Government material consistently cites around 10,000 unpaid carers on the Island, but formal commissioned respite capacity is tiny by comparison. Recorded in Scrutiny reviews as only a few dozen beds and a limited community hours, even on conservative assumptions, if just 5 per cent of carers require regular scheduled respite that implies we need guaranteed respite for up to 500 Islanders. Yet the formal supply is measured in dozens. Until we can close the data gap and scale respite provision, it is reckless to commit millions of public funds to a new service while hundreds remain unsupported.
This is not about choice at the end of life. That right has been debated and decided. It is about responsible budgeting and it is an uncomfortable discussion to have. Members can support the right to assisted dying without supporting this particular funding model or its timing. This amendment does not block future implementation, it does not reopen the assisted dying debate, it does not change the law, but it does redirect money now where it produces the greatest benefit. It simply asks for what the Ministers themselves asked for today; careful choices, proportionate prioritisation and a responsible use of public funds. This is about responsible public finance and essential care. Do we spend £2.7 million on a service used by the few or on respite and palliative care used by hundreds?
Do we expand an optional service or strengthen essential ones? Do we follow the logic of previous days’ Ministerial statements or do we ignore them entirely? I urge Members to support the amendment. For me it puts carers first, it puts dignity in living before the funding of dying and it ensures that we meet our obligations to support life before we fund the option to end it. I move the amendment and open the debate.




































