The island’s parliament could this week make it the first place in the British Isles to legalise euthanasia

Flags and bunting fluttered over Guernsey last week as the island celebrated the 73rd anniversary of its liberation from five years of Nazi occupation – a period of privation, curfews and summary executions.

In the capital, St Peter Port, crowds were cheerfully winning and losing money on crown and anchor, an 18th-century dice game still popular in the Channel Islands. Celebratory pints were being drunk.

At a service in the Town Church, the Dean of Guernsey, Tim Barker, gave thanks for “our continuing freedom and self-determination”. Guernsey, a crown dependency, has had its own government for more than 800 years, setting taxes and passing legislation. The island has its own bank notes and its own language, though this is spoken by a tiny and dwindling proportion of the 63,000 population.

With that autonomy comes political responsibility. This week, Guernsey’s parliament, the States of Deliberation, will debate and vote on a proposal that could see it become the first place in the British Isles to legalise euthanasia. If passed, the move is likely to reignite the debate in the UK, three years after Westminster MPs decisively rejected a bill that would have allowed doctors to help terminally ill people end their lives.

Sitting in his garden in the seaside hamlet of Cobo, Martin MacIntyre, 56, hopes that a majority of the 40 elected deputies – all independent: there are no political parties on the island – will back the proposal. But any legislation will be too late for him: he was diagnosed with terminal cancer 13 months ago.

“When I was first told, I thought about death every few minutes,” he says. “Now that I’ve accepted it, I’m not angry any more. The sun is shining, the birds are singing, and every day is a bonus. How lucky am I? But I would like to be able to decide how and when I die. I don’t want to die in severe pain or mental anguish; I don’t want my wife to go through that either. No one wants to die, but I’d like the option of having some control when the time comes, and to be at home with loved ones.”

The proposal – a requête, similar to a private member’s bill in Westminster – initially called for an agreement in principle on assisted dying, with details to be worked out over an 18-month consultation. But last week, Gavin St Pier, the island’s chief minister and the requête’s lead proposer, tabled an amendment clarifying the scope of the proposed law and removing any suggestion that the island could become a euthanasia destination.

St Pier’s amendment calls for a law along the lines of the “Oregon model”: the US state has since 1997 allowed assisted dying for people with a diagnosed terminal illness who have less than six months’ life expectancy and full mental capacity. Similar legislation has been passed in six other US states, as well as Canada and the Australian state of Victoria. New Zealand is also considering legislation.

Facebook Twitter Pinterest Martin MacIntyre: ‘I would like to be able to decide how and when I die.’ Photograph: Andrew Le Poidevin/Tallpictures/The Observer

The Netherlands, Belgium and Luxembourg have more permissive laws, based on applicants’ suffering but not requiring a terminal diagnosis. Switzerland allows assisted dying on compassionate grounds to residents and non-residents. In Guernsey, there have been no public opinion polls on the issue, but there has been lively debate on social media, phone-ins and newspapers and at a couple of public meetings.

“The island is quite conservative,” St Pier says. “An issue like this is outside the comfort zone of many. People are expressing strong views, but it hasn’t become ill-tempered. It has felt like a mature conversation.”

He adds: “I don’t believe the public mood here is significantly different from elsewhere,” pointing to UK polls which consistently show a majority in favour of assisted dying. But Guernsey’s deputies are more divided, he says. “This has the potential to be close, with perhaps one or two votes deciding it.”

If the law is passed, there would be a detailed policy report and further votes before assisted dying became legal, with the process probably taking at least three years, according to St Pier. Any law would need Privy Council approval and, possibly, legislative change in Westminster to avoid medical professionals practising in Guernsey being prosecuted under UK law.

Chief minister since 2016, St Pier has lived in Guernsey since 1995 and describes himself as “fiscally conservative, socially liberal”. He says he has advocated self-determination at the end of life for some time. Nine years ago, his father died of cardiovascular disease at the age of 77. “About two weeks before, he said he’d had enough. His leg had been amputated, he was riddled with infection and he knew he was terminally ill. His palliative care team were superb, but his wasn’t the death he wanted. And that is the reality for most people.”

Opposwition to the proposal has been led by churches, the British Medical Association (BMA) and the Guernsey Disabilities Alliance. A key government committee has refused to back the proposal, saying it is not a priority and investigations would be a drain on resources.

In March, the Catholic bishop of Portsmouth, Philip Egan, sent an emotive letter to be read out in the island’s RC churches. “Let there be no death clinics in Guernsey,” it said. “I appeal to Catholics to mobilise. Speak out against this proposal. It is never permissible to do good by an evil means.”

An open letter from 53 Christian ministers and officials in Guernsey also opposed the proposal, saying it was “seen as a threat by people living with various disabilities, vulnerable people and ultimately, perhaps, by all of us, as we approach the end of our lives. Every life is a gift that is precious and worthy of defence. Living life in all its fullness will include darker times, pain and sorrow. This is part of the rich diversity and tapestry of life that also provides opportunities for care, generosity, kindness and selfless love.”

Quick guide Q&A: Victoria's assisted dying scheme Show Hide Who is eligible? Only terminally ill Victorian residents over the age of 18 and are living with "intolerable suffering". They must have a life expectancy of less than six months, or 12 months if the patient is suffering a neurodegenerative illness such as motor neurone disease. Mental illness or disability will not be considered alone as a reason. How does a patient access the scheme? Anyone wanting access has to make three requests to a medical practitioner, including one in writing. The patient's eligibility would then be determined by two experienced doctors, of whom one must be a specialist. What safeguards exist? There are 68 separate safeguards in the legislation. These range from strict eligibility requirements to severe penalties for those abusing the scheme, including life in prison for any doctor found to have coerced or encouraged a patient to consider voluntary assisted dying. Doctors are prohibited from raising the subject with patients – a patient must ask. How many people are expected to use it? The Victorian scheme was modelled on laws in the US state of Oregon. Based on data from that scheme, it is expected about 150 people a year will end their lives – about 0.005% of all deaths in the state. However, the Victorian scheme is more conservative than the Oregon laws. In contrast, under a much more liberal model introduced in the Netherlands in 2002, demand has grown to 7,000 in the past year and now accounts for 4.5% of all deaths. How does it work in practice? Patients will be prescribed a lethal dose of drugs that can be self-administered at a time of their choosing. The drugs would need to be kept in a locked box. If a patient is unable to take the drug themselves, lethal injection can be administered by a doctor. Which drug is used? The drug to be used is not specified in the legislation. An implementation taskforce will work with a university pharmacy department to research available medications and appropriate formulations. Pentobarbital, better known under the brand name Nembutal, is used elsewhere as a euthanasia drug, but is prohibited in Australia under federal legislation.

When will the scheme begin? The law comes into operation in June 2019.

Barker, who as Dean is the island’s most senior Anglican cleric, with 38 years of service, says: “I have had the huge privilege of being with people in the last hours of their lives. I look at this issue with that pastoral experience. And I hear the voices of those who are concerned that however tightly a law is drawn, there is always pressure to push boundaries. The evidence of other jurisdictions is that even a tight law becomes broader once there is a presumption that [assisted death] is possible.

“The deliberate taking of life, or aiding someone to take their own life, is a significant change to the moral and ethical compass of society. This is one of the most profound moral issues we can face. This is an issue that touches deeply on what it is to be human.”

Brian Parkin, a Guernsey doctor and the local BMA representative, says he acknowledges that views vary within the profession. “I know of doctors who are sympathetic [to the proposal] and a lot who don’t want anything to do with it. People trust their doctors to do their best for them, not to kill them.”

The BMA position since 2006 has been “to oppose assisted dying in all its forms, and support the current legal framework, which allows for compassionate and ethical care for the dying to enable people to die with dignity,” says Parkin.

The “slippery slope” argument put forward by many opponents is firmly rejected by St Pier. “Before we legalised abortion [in 1997], people said it would lead to gender selection, or people choosing their babies’ eye colour. It simply hasn’t happened. The reality is that very few people would take up the option [of assisted dying]. Most people who do would be choosing to end their lives a matter of weeks before they would die anyway. It wouldn’t increase the number of deaths, but it would reduce the amount of suffering.”