Euthanasia: Another taboo broken

It had long been coming, and it is now out. A growing majority of Maltese are in favour of euthanasia.

This latest controversial subject follows right on the heels of other broken taboo subjects such as divorce, IVF, abortion, same-sex marriages and the decriminalisation of cannabis use.

There seems to be a gradual shift in the attitude of a minority in the medical community as well as the lay public towards greater acceptance of euthanasia as an option for the care of the terminally ill and dying. A few within the medical community see certain similarities in terms of goals and aims between euthanasia and palliative care and, thus, propose that euthanasia be an option or choice for difficult palliative care cases. Some even go as far as to suggest that euthanasia and palliative care be part of the continuum of care for terminally ill patients. When palliative medicine fails to fully control pain and suffering for the patient, euthanasia can be the logical next step in the continuum of care.

Can it be that the rationale for legalising euthanasia is flawed, that it goes against the fundamental principles of medicine in general and is incompatible with the practice of palliative medicine?

Euthanasia merits a national, mature discussion with all stakeholders taken on board before proceeding to put the matter to the vote. Any discussion must consider the issue from all possible perspectives, not least moral, religious and legal.

I believe that we are still far from considering having a robust and strict legislative framework to regulate assisted suicide, even though something similar somehow found its way into the Labour Party’s electoral manifesto.

In the meantime, we are sure to hear and read contrasting views from all sides. There will be those superficial and hollow arguments in favour, based on the stereotypical ‘my body, my choice’ formula. Expect the Maltese Church to put forth its vehemently contrary views. The PN has, more than once, publicly asserted its stand against euthanasia.

Genuine and convinced pro-euthanasia exponents rest their case on their determination to resort to mercy killing. They have no control over how they arrive in the world, but at the end of life, they should have control over how they leave it, without in any way debasing the value of life. They are not afraid of being dead. They only ask for dignity in dying. Such determination requires great courage and an unwavering, strong will.

Euthanasia advocates will be advancing at least three allegedly legitimate and justifiable reasons for its legality. First, possibly, it is needed. This is ‘the compassion argument’. Supporters of assisted suicide believe that allowing people to ‘die with dignity’ is kinder than forcing them to continue their lives with suffering.

Secondly, there will be those who want it. This is known as ‘the autonomy argument’. Some believe that every patient has a right to choose when to die.

If autonomy is the issue, why do we not respect every disabled or suicidal person’s wish for death? Regardless of their health condition or life expectancy, there are always people who wish to die for reasons that seem compelling to them. Many of these people undergo great suffering that is comparable to the pain of a terminal illness and may afflict them for a much longer time while being less amenable to treatment by drugs like morphine. Most of them are clinically depressed, but so are most suicidal people with terminal illnesses. Why continue to insist on suicide prevention and enhancing the rights of the disabled for all these other people while offering suicide assistance to the terminally ill?

Thirdly, some believe that it can be controlled. I would describe this as ‘the public policy argument’, assuming that assisted suicide can be safely regulated by government legislation.

Taking the argument further, if we are to assert that patients should have a right to die, would that impose on doctors a duty to kill, thus restricting their autonomy? Even putting aside the Christian morality upon which the Constitution and our nation’s culture are based, the notion of forced euthanasia would contradict the long-held body of medical ethics to which all Maltese doctors must adhere.

Who should decide if euthanasia is to be carried out, especially if the persons in question are not in a fit state to make their own decision for reasons of illness or injury?

Shouldn’t certain fundamental conditions be met, such as that the patient be of a sound mind, suffering from an incurable or terminal illness, experiencing unbearable suffering and uncontrollable pain?

Yes, dear readers, there is much more to debating this delicate subject than meets the eye.

Admittedly, euthanasia will emphasise the personal decision in a way that was blissfully alien to the whole problem of dying in former times.

Changing the law to allow euthanasia or assisted suicide will inevitably put pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden to others. Any change in our law would have profound effects on the social fabric of our society, on our attitudes towards each other’s deaths and illnesses, and on our attitudes towards those who are ill and have disabilities.

As a lawyer who has witnessed situations where terminally ill individuals were involved, I envisage that there will be those who would face the added risk of coercion by others who might stand to gain from their deaths.

The more I think and ponder euthanasia, the more I find myself not being able to decide one way or the other.