Assisted dying: but is it really what they want?

As Malta grapples with the assisted dying debate, I find myself compelled to share a deeply personal perspective shaped by witnessing the raw reality of end-of-life decisions up close.

While the discussion often centres on autonomy and dignity, there’s a darker undercurrent we rarely acknowledge, one that transforms theoretical debates into painful family realities.

Assisted dying is already a reality in a number of countries and my experience with close family members’ struggles in dealing with this option and handling the emotional fallout has fundamentally changed my perspective on this topic.

Picture this: an elderly parent, already feeling vulnerable, catches undertones of somehow being a burden. A fleeting sigh from an exhausted caregiver, a casual remark about mounting medical costs, or the subtle shift in family dynamics when care becomes demanding.

These moments, seemingly insignificant to those that utter them, plant seeds of doubt that grow into crushing pressure on those who experience them.

The psychological impact on our elderly, who have spent their lives caring for others, becomes particularly acute when they feel they’ve become a source of strain.

Through my own family’s experience, I’ve seen how the mere availability of assisted dying can transform from an option into an obligation in vulnerable minds. What begins as a well-intentioned choice becomes a persistent thought that haunts both those facing the decision and their caregivers. Each challenging day, each medical setback, each moment of dependency reinforces the question: “Should I just end it all?”

This thought pattern, once established, creates its own form of suffering.

Beyond the elderly’s own vulnerabilities, there are other aspects that are even more insidious. In our case, the exhausted partner, who simply cannot keep up with the demands of eldercare, starts passing comments that “assisted dying is the best option” and that “you really are now at a stage where you should consider this – before it stops being an option!”

Not only does this become tantamount to psychological abuse, the pressure becomes both hurtful and intense.

The reality is that true autonomy requires more than just legal permission – it demands comprehensive support systems that most societies, including ours, haven’t yet developed. When we talk about choice, we must acknowledge that choices made under the weight of inadequate palliative care, financial strain, and caregiver burnout aren’t really choices at all. They’re decisions made under duress, often influenced by circumstances we’ve failed to address as a society.

Once assisted dying enters the conversation, it becomes an ever-present shadow over every difficult moment in the care journey- Pier Massa

Most disturbing is how this “option” can corrupt family dynamics. Even loving relatives, stretched thin by caregiving demands, might unconsciously telegraph their exhaustion.

The road to emotional coercion is paved with subtle suggestions and unspoken pressures, not necessarily outright demands. Once assisted dying enters the conversation, it becomes an ever-present shadow over every difficult moment in the care journey.

What’s often missing from this debate is a serious discussion about strengthening palliative care, supporting caregivers, and creating communities where the elderly and sick feel valued rather than burdensome. These are the real solutions that preserve dignity without opening doors that cannot easily be closed.

On the one hand, society needs to invest in comprehensive end-of-life care systems that support both patients and their families through these challenging times.

And, on the other, families need to be open to the care and ensure they are actually getting all the support they need to allow them, as caregivers, to have a decent quality of life.

My journey has taught me that while we debate abstract principles, real families struggle with these decisions in ways that no legislation can fully address. The psychological toll of having assisted dying as an option creates its own form of suffering – one that, once introduced, becomes impossible to contain. It’s a Pandora’s box that, once opened, releases consequences that extend far beyond the individual making the choice.

As Malta stands at this crossroads, we must ask ourselves: are we prepared to handle the unintended consequences of what seems, on the surface, like a compassionate choice?

Have we truly exhausted all other avenues of providing dignified, supportive care for our most vulnerable?

In a rare moment of peace, away from the weight of judgement and the daily pressures of caregiving, I finally found the courage to ask the question directly, but with genuine compassion: “Is this really what you want?”

The response came in a quiet, almost apologetic whisper that spoke volumes: “No... I want to live. I just want to be with my family.”

And there it was, the truth that lies beneath all our theoretical debates about dignity and choice. Sometimes, what people need most is not another option for ending life, but the reassurance that they are loved and that their life, however challenging, is still worth living.

Pier Massa is an international business consultant who has lived in Europe and North America, and is now based in Malta.