WATCH | Rebecca Buttigieg: ‘You can invest in palliative care but... there is only so much you can do’

Palliative care will always be the first course of action for terminally ill patients, but sometimes there is only so much it can do, Rebecca Buttigieg says. 

Her statement captures much of what the debate surrounding euthanasia has coalesced around over the past weeks. 

As reforms parliamentary secretary, she has piloted the consultation process on voluntary assisted euthanasia, which came to a close last week. 

The consultation document does not state palliative care will be replaced by voluntary suicide but opponents have claimed the introduction of euthanasia in other countries has led to a decrease in hospice care quality. 

As we sit down for this interview, Buttigieg tells me that a positive outcome from the consultation process was the increased awareness on palliative care.  

“I am sure if you had asked people two or three months ago what palliative care is, a lot would not have known,” she says. 

Buttigieg adds that studies quoted by opponents of euthanasia that palliative care quality decreases following its introduction do not always make sense.  

“The UK, which is seen as the standard in palliative care, has just introduced euthanasia. Therefore, we are seeing that palliative care does not always remove all the pain,” she says. “While palliative care and euthanasia need to work hand in hand in the sense that palliative care needs to be the first choice, there is the reality that you can invest in palliative care, but at some point, there is only so much you can do.” 

She also slams misinformation which has emerged throughout the process, saying claims that people with disabilities, the elderly or with mental health problems would be pushed towards euthanasia, are not true. 

The proposal is to give adult patients, who are terminally ill and have been given six months to live, the option to choose euthanasia. I ask Buttigieg whether the six-month window should be extended. 

She says the “overwhelming feedback” throughout the public consultation process was that it was too short a period. 

Buttigieg insists government will not be rushing to put forward a bill, stating the consultation process would have been futile had it immediately tabled legislation. 

“I must insist that I believe a lot in the principle behind it, but I am not prepared to table a bill without carrying out the needed analysis in a tick-the-box exercise,” she says. 

The following is an excerpt of the interview  

Follow the full interview on maltatoday.com.mt and our socials 

While euthanasia does not come at the cost of palliative care, the issue has been raised a number of times during debates on the topic. Some have even claimed that when it was introduced in other countries, palliative care quality decreased. How do you react to these concerns? 

I think the public consultation started respectfully, and ended respectfully. I think we have managed to hold a civil and mature debate on what is a very sensitive subject.  

It also reflects how people feel about this consultation document. We used to discuss euthanasia in a sporadic manner; in an interview or a TV programme. But today as we had promised in our electoral manifesto, we have put forward a national discussion which encompasses principles and safeguards which we drew up together with a technical committee.  

I was also happy with how people have reacted. We had thousands of submissions, and it is testament to the emotions which this subject triggers.  

[…] 

You mentioned palliative care, and one of the pluses of this discussion is the increased awareness on this type of care and what it means. I am sure if you had asked people two or three months ago what palliative care is, a lot would not have known.  

But I must return back to the consultation document, and it clearly states palliative care must always be the first course of action. The choice of voluntary assisted euthanasia cannot come instead of it. 

You were the face of the public consultation, has your personal opinion on the subject shifted in any way since the start of it? 

I always believed in the principle of choice. The people who do not agree—and they have every right to disagree—will not be affected if the law is eventually enacted. It will never be imposed on them. 

If I was convinced [about the need for euthanasia] before, I am even more convinced now. The experiences I heard during the consultation meetings, with teary eyed people speaking about what they went through, really affects you.  

They told us they would never want to go through what their parents or family members went through. These people deserve solace. 

There were others who spoke about the need to include degenerative diseases as part of this law. Do you see a point where these diseases are included? 

This consultation was an eye opener, and I am remembering Martina’s story, who had come to Mosta to speak of her personal experience. She had said that her family has a history of Huntington’s and had pleaded for it to be included. 

As a legislator we have the responsibility of presenting a serious law which offers peace of mind.  

What is sure is the needs of people will be central in any decision taken by government. 

A survey carried out by MaltaToday showed the majority of people want a free vote to be given to MPs. Do you agree? And is everyone onboard inside Labour’s parliamentary group? 

This is an electoral pledge which was part of the electoral manifesto, and automatically if you are a Labour candidate and now a Labour MP, you understand you have to agree with manifesto you campaigned under.  

Despite all this, at Cabinet level we have discussed the topic, and while we all agree in principle, we discussed what parameters we have to put forward. 

But I think we are jumping the gun a bit, as we are speaking of a scenario where government has already tabled a bill. We are not at that stage yet, and I had declared from the start this is not a race against time. 

If we table a bill shortly after the consultation process, what is the use of that exercise in the first place, and we have thousands of submissions to review. 

I personally believe that in such situations, MPs should have a clear conscience and be granted the liberty to vote in line with their conscience. 

But do you want the law to be enacted in this legislature? 

I must insist that I believe a lot in the principle behind it, but I am not prepared to table a bill without carrying out the needed analysis in a tick-the-box exercise.