There’s no need to choose: Palliative care and euthanasia can coexist

It is bewildering how palliative care only emerged as a ‘problem’ in Maltese public discourse only after the government proposed legalising euthanasia in a very narrow form.

For starters, the proposal, so far, is that euthanasia will be limited to terminally ill adult patients, expected to die within six months, and who have the mental faculty to make such a decision.

But it is amazing how all of a sudden, palliative care is being held up as a panacea that supposedly makes euthanasia unnecessary.

The main slogan of the campaign against euthanasia—Kill The Pain, Not Me—not only denies agency to those choosing to die, depicting them as victims of state violence, but also suggests that by ‘killing the pain’ euthanasia becomes superfluous.

Ironically, one could argue that the increased focus on palliative care is itself an added benefit of the proposed bill. By lifting the veil on a topic many choose to ignore or avoid, Malta now has not only a debate on euthanasia but a parallel and equally important discussion on ensuring universal access to the best possible palliative care.

This is not just a Maltese phenomenon. The introduction of euthanasia can itself act as a driver for greater investment in palliative care. A Dutch study shows that the percentage of hospitals providing palliative care consultations increased from 65% in 2014 to  98% in 2020, even as euthanasia requests became more openly discussed and accepted. In Canada, the federal government announced in 2017 a $6 billion investment over 10 years to support home care services, including palliative care.

While it is vital to ensure that everyone has access to good palliative care regardless of financial means, this should not be mistaken for a magic bullet that eliminates all pain and suffering. Such a view ignores the lived reality of countless patients worldwide who endure conditions and symptoms that no amount of symptom management can fully alleviate.

Symptoms such as breathlessness, severe pain, and agitation can be difficult to control despite the best palliative efforts. Conditions like advanced motor neurone disease, certain neurological illnesses, and refractory chronic pain syndromes notoriously defy palliative measures. Ironically, some of these conditions are not even covered by the government’s cautious approach to euthanasia.

Moreover, there is a question of dignity for those who wish to depart from their loved ones while still able to communicate and bid them farwell.

The false choice between palliative care and euthanasia obscures the urgent need to provide both and thus ensuring a humane, just, and dignified approach to dying.

Sure, it is positive that some of those opposed to euthanasia are bringing arguments based on social justice and equal access to care. But it is a pity that these arguments are only raised with the aim of restricting choice and body autonomy. 

Ultimately, the conversation should focus on social justice, freedom and dignity. Social justice demands that everyone should have equal access to palliative care and, when needed, euthanasia. Freedom means respecting bodily autonomy and allowing individuals the right to make profound personal choices about their own deaths. Dignity means recognising that a life burdened by intolerable pain and loss of control is not worth preserving at all costs. Otherwise we would be treating life as an ideological fetish, something which is imposed on others.