Legalising euthanasia in Malta at this stage is premature, as end-of-life care in Malta is not good enough, the Medical Association of Malta said.
“No patient should be placed in a position where assisted voluntary euthanasia feels like the only option due to inadequate symptom control or lack of support,” the doctors’ union said.
“MAM remains committed to policies that honour compassion, autonomy, and dignity. But reforms must be built on a foundation of readiness, not rushed to meet political timelines,” they said.
MAM said “deficiencies” in Malta’s palliative care include poor infrastructure, insufficient training, and a lack of personnel.
There is also “a systemic lack of access to essential end-of-life medications,” they said.
Dignity and quality of life - core ethical priorities - cannot be upheld without comprehensive, equitable, and timely access to high-quality palliative care, MAM added.
“We urge the government to prioritise palliative care as a national health emergency before opening the door to assisted dying. The system, as it stands, is not ethically, clinically, or operationally equipped for such a step. Let us first ensure that no one chooses to die because we failed to help them live with dignity,” they said.
Quoting international trends, MAM added that the introduction of euthanasia could lead to a decline in the quality of palliative care.
Evidence from other jurisdictions is concerning. Countries that legalised assisted voluntary euthanasia have experienced subsequent declines in palliative care rankings: Canada dropped from 11th place in 2015 to 22nd in 2022; Belgium from 5th to 26th; and New Zealand from 3rd to 12th.
The government unveiled its plans to introduce voluntary euthanasia on Wednesday.
Under the plans, which are currently up for public consultation, only terminally ill patients with months to live will be able to apply for euthanasia.
The equality junior minister, who is leading the effort, said that if a euthanasia law is to be introduced, it must be on an entirely voluntary basis. The request can only come from the patient themselves, and only if they are in a good mental state to decide.
No one would be authorised to make the decision on a patient's behalf. Similarly, patients can in no way be coerced, pushed, or encouraged to opt for it, Buttigieg said.
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The patient must be aged over 18 and suffering from an incurable, terminal illness that is predicted to result in death within six months.
In its position paper on the issue, MAM said predicting when a patient will die is unreliable and should be abandoned as a criterion.
“Studies show prediction accuracy to be as low as 23%, regardless of speciality,” it said.
The doctors recommended a full audit on the current state of palliative care and an investment plan for expanding community-based end-of-life care.
“Robust legal frameworks for clinicians to navigate complex end-of-life decisions” should also be established, and an independent ethical review panel needs to be set up.
More also needs to be done to prevent coercion into euthanasia, they said.
In Washington State (a US state which allows euthanasia), 59 per cent of assisted voluntary euthanasia candidates cited feeling like a burden; 10 per cent cited financial distress.
“These are not valid clinical indications - they reflect gaps in psychosocial care,” MAM said.