[WATCH] There is no hope left for me – let me decide what is best for myself | Humanists Malta

Those who are terminally ill cannot ask for a choice between living and dying, but they could be allowed to choose between two different deaths: one, peaceful and with dignity, at the time they want it, and one they are needlessly forced to just endure. Those who are incurably suffering can face a life which, for some, has lost all quality.

Of course, many in similar situations would not consider deliberately ending their lives. We only ask for sympathy for those who feel otherwise; who live in pain, discomfort, or indignity, despite the best palliative care; those whose lives no longer have any joy or value for them, with the only prospect being a drawn-out and distressing death.

Any right to assisted dying cannot be taken lightly. Concern is sometimes expressed about the possibility of coercion on the part of family members or health services. But the possibility of abuse of a legal right does not justify withholding that right for all. Any system is open to abuse – and covert euthanasia is probably more likely without, rather than with, a rigorously-enforced legal regime. In some countries which allow assisted dying, rare cases have arisen, especially in relation to a patient’s mental capacity. Any regime must protect all, especially the elderly, poor and disabled.

In addition to the necessity for certainty we mentioned in our first article – such as for witnesses, agreement about the patient’s medical and psychological health, and a central monitoring body – we suggest some other safeguards: exclusion of patients who, even if they had previously told their family of their wishes, hadn’t formalised them; neither witnesses nor health professionals involved should have any legal, financial or other interest in the outcome; and nominated professionals should be trained to assess a patient’s mental capacity to make decisions, and their incurable or intolerable suffering, each of which terms could be defined in law.

On a related subject, we would also urge everyone, before being faced with their life’s end, to plan ahead, to make their wishes known. In Malta, patients have the right to refuse medical treatments, but must be able to communicate to do so. Legally-enforceable Living Wills would enable competent adults, if they wish, to give instructions about the medical care they consent to, or reject, if they are unable to make or communicate decisions at the time. Unlike in at least 15 other countries, Living Wills are not legally binding here, so, if incapacitated, patients have no legal mechanism to communicate their decisions about medical care, including at the end of life. This can lead to dilemmas for medical professionals, and uncertainty and distress for patients’ loved ones. A Living Will, if given legal standing here, could not include a request for assisted dying while it remains illegal, but could ensure that, at a difficult time for all, a patient’s wishes – to be kept alive at all costs, or to be allowed to die without fruitless medical intervention to prolong life - are respected.

This article is the second in a series on assisted dying. We use the term ‘assisted dying’ rather than ‘euthanasia’, to cover only voluntary active euthanasia and assisted suicide - actions at the request of the patient.

Our hope is to raise awareness that assisted dying is an option that you or your loved ones might one day need to consider. Although many are adamant they would not want the choice for themselves, others do want a free choice, leading to death with dignity, which is denied them by current Maltese law. There are many issues to discuss, which we will address in our articles. Our overall aim is to call for understanding and tolerance, and a carefully monitored regime which respects individual wishes, while protecting all involved.