Hospice Malta fights against nation’s slow march towards euthanasia

Malta Prime Minister Robert Abela has said he is open to discussing the legalization of euthanasia in the country, which is one of the most pro-life nations in the world. He’s not alone. Malta Health Minister Jo Etienne Abela also believes the country should consider legalizing euthanasia. The organization Hospice Malta is calling for improvements to palliative care.

KEY TAKEAWAYS: 

• Malta is one of the most pro-life countries in the world despite pressure to legalize abortion and assisted death.

• Earlier this year, the prime minister said he is open to discussing the legalization of assisted death, and he’s not alone.

• Hospice Malta said the country should focus instead on improving palliative care for patients.

THE DETAILS: 

Malta has steadfastly remained one of the most pro-life countries in the world, despite international pressure to abandon those principles. Groups within Malta are pushing to legalize abortion, as well as assisted suicide and euthanasia — but with the latter, at least one group is pushing back.

Earlier this year, Malta’s Prime Minister Robert Abela said he was open to discussing the legalization of euthanasia, thanks to his “brilliant” Youth Advisory Forum, a group of nine young adults who serve as his paid advisors. Euthanasia is a form of assisted death in which the doctor administers the deadly drugs.

PM Abela isn’t the only Maltese politician suggesting euthanasia become legal, though; Health Minister Jo Etienne Abela likewise said the country should consider it. “We will offer palliative care to patients, of course, but sometimes even the best palliative care leaves the patient in a lot of pain with no hope of surviving. In those circumstances, I believe doctor-assisted suicide is suitable and justified,” he said.

Reforms Parliamentary Secretary Rebecca Buttigieg also announced she would be releasing a White Paper on euthanasia sometime this year. And the government has already launched a public consultation, which is intended to lead to legislation on Assisted Voluntary Euthanasia (AVE).

But for Hospice Malta, there are other issues that need to be addressed before Malta considers legalizing euthanasia. In an interview with the Malta Independent, Anna Frendo, the Chief Clinical Officer at Hospice Malta, and Dr. Jurgen Abela, who has worked with Hospice Malta since 2006, said the country needs to focus on improving palliative care services first. Palliative care, as described by the Mayo Clinic, is specialized health care meant to provide pain relief and improve quality of life. While it is most often associated with terminal illness, it can be used for any serious medical condition, regardless of what the life expectancy may be, and palliative care can be provided in conjunction with whatever treatments the person may be undergoing.

While Frendo said it is understandable that some may be afraid of what they will experience as they go through an illness, it does not justify legalizing assisted death, especially without addressing palliative care needs first. “However we feel there is a lot more to be done for palliative care. There are so many gaps which exist,” she said. “We need to try and fill those gaps.”

Dr. Abela went even further, saying that legalizing euthanasia is at odds with Hospice Malta’s vision. “What happened in other countries was that, at times, when assisted suicide or euthanasia was introduced, there was an impact on palliative care services,” he said. He further added that a major part of the problem is that people with serious illnesses feel as if they are a burden — and that is the feeling that leads them to seek out assisted suicide. “So even if there are safeguards, how can we be reassured, as professionals, that a patient is not feeling a sense of pressure to go down that route because they no longer feel like they are an asset to society, possibly because their ‘identity’ in society changed since their illness emerged because they might be unable to work?” he asked.

As it stands now, Dr. Abela said Maltese citizens are often scared to request palliative care or to stop treatment.

“Even more fundamentally, there is a fear to discuss non-treatment decisions, and when to call stop to treatment. It is the elephant in the room and nobody talks about it. There is pressure by family, patients and doctors to continue treating when it is failing and might be causing undue side effects. I am not only referring to chemotherapy and cancer, it could also be the case when someone was admitted to hospital 13 times in a year — there might be something fundamentally wrong in their condition, and a plan might need to be drafted on the realistic expectations of the patient’s treatment,” Dr. Abela said. “This is called joint management planning, for the best possible outcome for the dignity and quality of life of the patient.”

Dr. Abela also pushed back against the idea that dying means suffering. “We cannot give the impression that because someone has an incurable disease they will de facto suffer until the end of their life,” he said. And in the meantime, he said throughout his career, he has only had two or three patients ever request to be euthanized, and that addressing their needs often helps.

“From my personal experience when you talk to these patients there is many a time something which can be addressed…be it on a physical or non physical level,” he said. “In these instances we worked on trying to address the issues we found.”

THE BOTTOM LINE:

There is legitimate concern that legalizing euthanasia and assisted suicide will lead to coercion and pressure to die. The act of legalizing assisted suicide alone is pressure, as it sends the message that the ill and disabled should at least consider dying. It implies that they should want to die, assuming that their lives are too difficult to continue living.

Stories of individuals being directly pressured into assisted suicide are common. Nearly half (47%) of individuals who requested assisted suicide in Oregon in 2022 cited fear of being a “burden on their family, friends/caregivers” as their reasoning. In addition, many have reported that they have been pressured to apply for assisted suicide by healthcare workers and insurers. There is also increased pressure in nations with taxpayer-funded universal healthcare (which Malta has), where it is reportedly cheaper for the government to pay for a person’s physician-assisted death than to provide them with adequate health care.