The right to die | Joanna Onions, Christian Colombo

The way we die is not something Malta, as a democratic state, can continue to ignore

Unlike many religious people, as Humanists we start from the belief that our lives are our own, not a gift from, nor belonging to, any higher power. So we should be free to decide our own destiny and life-experience, living by our own personal values as long as that does not result in harm to others.

We must make our own decision, provided it is free from coercion, and covered by the strongest safeguards to protect the vulnerable, to end our lives in circumstances we choose, whether because we are terminally ill or permanently and incurably suffering, mentally or physically. We know from personal experience that there can, for some, come a time when quality of life, and the prospect of only further physical and/or mental discomfort, means they would rather die with dignity when they choose than continue a valueless, pointlessly suffering, distressing, life.

We would never support imposition of any of these ideas on those who disagree with them. We only ask for a choice for those who, in all conscience, believe they should have a say in how, when and where they die; what is right for them is their decision.

There is a debate growing in Malta which falls under the general title of ‘euthanasia’. We see three levels in that debate:

- legally enforceable living wills (also known as advance directives), which enable people to state their wishes in advance, which must be respected if, for example, they are no longer able to communicate or make decisions. This would include the denial of treatment (which a conscious patient has a right to do) to extend, or save, their lives if they would not wish to be in pain or discomfort, or dependent on others;

- assisted suicide, in which a doctor intentionally provides a patient with the knowledge, means, or both, required to commit suicide when the patient no longer wishes to extend an intolerable life;

- and finally euthanasia itself, the administration of a lethal drug to a terminally ill patient by a doctor, to enable the patient to end pointless suffering.

In Malta, euthanasia is not legal, and assisted suicide is a crime punishable by up to 12 years in prison. Palliative care (an alternative, and valid, choice for many), and withdrawal of treatment, are legal. Maltese patients have the right to refuse treatment (but must be able to express their wishes). There is no law regulating living wills.

Legally enforceable living wills, assisted suicide, and euthanasia are not considered as human rights under international treaties, nor by the European Court of Human Rights, though they are debated. As early as 2005, UNESCO’s Universal Declaration on Bioethics and Human Rights included (Article 5) “The autonomy of persons to make decisions, while taking responsibility for those decisions and respecting the autonomy of others, is to be respected. For persons who are not capable of exercising autonomy, special measures are to be taken to protect their rights and interests”.

In our view, the recognised human right to life is clearly not a duty to live under any circumstances. Assisted dying is legal for the terminally ill and incurably suffering in Switzerland, the Netherlands, Belgium, Luxembourg and Canada. It is legal for the terminally ill in Colombia, ten US jurisdictions, and the Australian states of Victoria and Western Australia. Recently, New Zealand voted in a referendum to make assisted dying legal, and Ireland’s Parliament voted to move forward on proposals to legalise assisted dying for the terminally ill and incurably suffering. According to the UK Assisted Dying Coalition, more than one person a week now travels from the UK to Switzerland for an assisted death, at considerable financial cost.

Euthanasia is slowly becoming more acceptable in Malta. A 2016 poll by Malta Today showed that 53% of Maltese people agree with euthanasia under certain circumstances. Amongst Maltese youth, including law and medicine students, euthanasia is becoming significantly more acceptable than among older generations; an Għaqda Studenti tal-Liġi survey 2016 showed that approval of euthanasia among law students was 69%, while the poll by Malta Today the same year showed that 65% of those between the ages of 18 and 34 agreed that the state should allow terminally ill people the right to end their life.

More recently, we hear from many – religious or otherwise – who believe that justice requires the ending of suffering if that is what the patient wants.

The way we die is not something Malta, as a democratic state, can continue to ignore. We need a legal, safe, and compassionate law on assisted dying and compliance with individuals’ wishes about the end of their life. We need this so that anyone who believes in autonomy over their own life and body may avoid the cruelty we have seen to some kept alive for no reason when all quality of life is gone. Faced with one of the most difficult moral, legal - and religious - dilemmas, our doctors need guidelines on how to respect their patients’ known wishes, which only a national, and parliamentary, debate can deliver.