The MaltaToday stand on euthanasia | A question of dignity

The way a society cares for its people, the way its healthcare succours its afflicted, is the most basic indicator of a community’s wellbeing and sign of civility towards each other

Cartoon by Mark Scicluna
Cartoon by Mark Scicluna

The ongoing debate about euthanasia – regardless of the eventual conclusion it reaches, if any – attests to the profound changes that have taken place in Malta in recent years.

In some cases, the debate has been entirely consistent with traditional expectations. As is only natural, the Catholic Church urged MPs to resist euthanasia in favour of palliative end-of-life care. This is entirely consistent with the global Church’s views of the sanctity of life, life being – according to Catholic doctrine – a ‘gift from God’.

Various other entities, which broadly share the same view, have likewise weighed in against the introduction of euthanasia. But where, in years gone by, this would have been the extent of the entire discussion… today, the spectrum of opinions on the subject is clearly wider than ever before.

Since an impassioned plea by a terminally-ill man to be allowed to ‘end his life in dignity’, reactions to the prospect of euthanasia have often been surprising.

Perhaps the biggest surprise took the form of a recent survey which suggests that 53% agree with euthanasia under certain circumstances. This represents a radical change in national approach to issues that were previously met with unanimous resistance.

Likewise, the political reaction has to date been far from muted. Former Prime Minister Alfred Sant took the view that “anyone who wishes to continue to live in this state right up to the end should be given every means to do so. But, in the same way, those who decide otherwise should be given every opportunity to achieve their wish.”

It has been reported that members of the Labour Party are contemplating the inclusion of euthanasia in their next electoral manifesto (though this naturally remains to be seen).

Equally surprising was the announcement by the Green Party, which pronounced itself against euthanasia but in favour of ‘living wills’. AD’s stance puts it at odds with the rest of the international Green movement, which has been instrumental in the introduction of euthanasia in several countries.

Nonetheless, AD’s proposal for ‘living wills’ is equally valid and worthy of consideration. Many of the ethical dilemmas arise precisely out of an inability to determine the patients’ own wishes, especially in cases of catatonia, coma or other ‘vegetative’ conditions. A living will would address this lacuna, and also restore to its natural owner, the patient, the right to decide.

Whatever one makes of the actual opinions expressed, it is clear that this debate will not be the foregone conclusion one would normally expect. Malta has clearly shown that it is ready for a mature debate; and a debate is needed, too. Doctors – while in the main sceptical about euthanasia – have variously drawn attention to legal uncertainties affecting their professional decisions in such cases.

Maltese law is by no means clear on the culpability of doctors, in cases where lives may have been prematurely terminated through (for instance) an excessive dose of painkillers. There are borderline cases which challenge our precepts of ‘assisted suicide’. More clarity is clearly needed, and this can only come about by a revision of existing legislation in Parliament.

Even without this consideration, one must question whether current medical practice takes into consideration the wishes – or even beliefs – of the patient.

A study published in the Malta Medical Journal in 2015 revealed that 14.4% of general practitioners said they had received requests for euthanasia. An overwhelming majority, 89.1%, said they would never consider euthanasia. The study further reveals that most doctors are guided by religious values when dealing with end-of-life issues.

As with the Church’s position, doctors are naturally entitled to their private religious beliefs. We must however acknowledge that their patients may not share those beliefs; they, too, have rights which must be respected.

The question then becomes what sort of law would give equal recognition to both rights, in cases where there is conflict or uncertainty. 

MaltaToday is in favour of legislation that would accord people the right to make their own end-of-life decisions, and also with the introduction of a ‘living will’, as proposed by AD. 

In simple terms, the way a society cares for its people, the way its healthcare succours its afflicted, is the most basic indicator of a community’s wellbeing and sign of civility towards each other. People with chronic pain illnesses, terminal illness that results in drastic neurological degenerative conditions, should be accorded dignity in deciding their fate, together with doctors.

In cases where doctors conscientiously object, the law must also respect their beliefs. As per standard medical practice, patients should by the same token be entitled to a second opinion.

There are many grounds on which euthanasia should be permissible: such as when the patient’s suffering is unbearable with no prospect of improvement. But there are also important restrictions and precautions to be taken into account: the patient’s request for euthanasia must be voluntary and persist over time; the patient must be fully aware of his/her condition, prospects, and available options; the death must be carried out in a medically appropriate fashion by the doctor or patient, and the doctor must be present.

Ultimately, it is a question of human dignity. That must be the guiding principle of this debate.