Humanists propose framework for living wills

Humanists Malta have drafted a discussion paper with proposals for legislation on living wills, known as “advance directives”.

The proposed legislation would allow any person resident in Malta to register a notice of their wishes about medical treatment, in the event that they are unable to communicate decisions at the time.

“We think it important for people to have control over their own lives, to discuss with loved ones what the future might hold, and to know that their rights as patients will be upheld even when they can no longer voice their decisions,” Humanists Malta told MaltaToday.

In general, a living will would contain instructions about the medical care a person consents to or rejects if they are unable to make or communicate their decisions at the relevant time.

Such a will would allow people to refuse medical intervention aimed at prolonging or sustaining life if their condition is terminal, or would stop them from returning to a meaningful and independent quality of life.

In other uses, the patient could specify that the responsible doctor can make all treatment decisions on their behalf, or simply that they wish their life to be prolonged to the greatest extent possible regardless of their condition or chances for recovery.

“At a difficult time for loved ones and medical professionals, a living will can provide certainty about the patient’s wishes, reducing both emotional and professional dilemmas.”

Humanists Malta recommends that the living will should include instructions about medical intervention to which the person consents to, requests about preferred forms of care, and instructions on organ, tissue or body donation.

In their living will, a person could also nominate a proxy or executor that could be consulted in case the person’s stated wishes are not applicable.

“Our proposals concern a patient’s right to consent to, or deny, medical treatment. They do not cover requests for specific treatments, such as assisted dying, which is anyway illegal in Malta,” Humanists Malta said.

“Some people might want every effort to be made to prolong their life regardless of resulting disability. Others might prefer to avoid outcomes which they would find burdensome, such as the loss of dignity or independence. They should be able to register such choices.”

The debate on living wills has been closely related to euthanasia, an intentional end to a person’s life to alleviate them from pain and suffering.

Euthanasia is not legal in Malta, while assisted suicide carries a 12-year criminal sentence at law. There is also no law regulating living wills.

The euthanasia debate is a mixed bag in Malta. Back in 2016, ALS patient Joe Magro called for the introduction of euthanasia in an interview with MaltaToday. He had insisted that he would take his own life once his condition denies him human dignity.

He took his plea to parliament and appeared in front of its Family Affairs Committee.

But Bjorn Formosa, who also suffers from ALS, had come out saying that Malta should discuss introducing living wills before getting into the euthanasia debate.

Green party Alternattiva Demokratika – now ADPD – had a similar position. The party came out in 2016 vehemently opposing legalising euthanasia, and instead called for a debate on living wills. The party included a proposal for the introduction of living wills in its electoral manifesto for the March 2022 general election.

In its electoral manifesto, the Labour Party called for a national discussion on voluntary euthanasia for people suffering from a terminal illness. The Nationalist Party made no reference to euthanasia in its manifesto. The idea of a living will was not brought up by either party.