Maltese MP addresses COE on euthanasia

The Parliamentary Assembly of the Council of Europe, which met last week, discussed several political and social issues and was addressed by heads of state and government.

Malta's delegation, led by Nationalist MP Jeffrey Pullicino Orlando, leader, included Nationalist MPs Robert Arrigo and Joseph Falzon. Three other members, Parliamentary Secretary Helen D'Amato, and Labour MPs Joe Debono Grech and John Attard Montalto, were unavoidably absent.

Dr Pullicino Orlando was elected vice-president and chaired the assembly during the debate on economic affairs and development and on the budget for 2005.

Mr Falzon addressed the Parliamentary Assembly on a Council of Europe report on euthanasia. This is the text of his address:

A terminally ill patient may ask for death because he is in extreme pain and suffering. The two concepts are different. Pain can be relieved by drugs and treatment regimens; suffering sometimes cannot.

A patient suffers when he feels that his integrity or life is threatened, or if he has psychological or emotional distress. He suffers when he does not understand the cause or meaning of his distress, or when others who should understand do not, and when it is ignored by others, especially those who should be interested.

The developments in the medical field are there to relieve and not to increase suffering.

Can suffering be measured or assessed? When a patient demands death, can anyone assess whether his suffering is greater or smaller than that of another person who would utter the same cry in different circumstances?

These underlying feelings could indicate a psychological pain which can be tackled with adequate understanding and care from the family and with help from the community. If this is the basic reason why a person asks to die, better supporting services could make him not want to die. So it follows that, if we concentrate more on our support services, euthanasia may not be necessary and neither would its legalisation. Euthanasia is becoming increasingly unnecessary because of progress in palliative care.

First, we should attempt to prevent the occurrence of those situations for which euthanasia has been suggested by anticipating their onset and forestalling their development. Secondly, we should offer our patients all the methods of relief and control of distressing symptoms that are currently available. Thirdly, we should encourage and promote research to improve the means of relief of suffering, whether by discovering new methods or by increasing the effectiveness of existing ones.

We must recognise that the care of the suffering patient and the relief of his suffering are never purely medical concerns. We must also provide for the patient's physical, mental and spiritual welfare by involving all the caring professions in an effective and sensitive approach to the patient and his family in order to support them in their moment of need.

The legalisation of euthanasia would have grave medical consequences. It would fundamentally alter our concept of what constitutes medical practice at the end of life. Letting a person die is different from making a person die - one risks death, the other seeks it. The legalisation of euthanasia raises fundamental ethical questions and we should not shy away from asking them.

Would it provide an answer to the ongoing debate on the rising cost of health services, welfare services and care of the dying by helping the strong and killing the frail and sick, or would it hinder the development of those services each country requires to help its own people, whatever their age, colour, creed or health?

Can anyone really say that his country's medical services, including palliative care and community support services, are so advanced that the time has come to legalise euthanasia? Is everyone happy with the state of affairs in his own country as regards the help available to dying patients, including the existence of quick and efficient institutions providing immediate care, multidisciplinary trained teams and immediate response palliative care?

The basic discussion today should be on how we can help each other increase the community care we provide our patients, to formulate strategies and to exchange information and resources to help our patients.

Let us exchange views on how to tackle these issues. Once a patient is dead there is no turning back; but while a patient is alive, whatever his or her condition, there is always something that can be done whether by the family or by the community.

Victory is achieved when one has done everything for one's family or patient to relieve pain and suffering without resorting to killing. It is a psychological defeat, which one has to bear for one's whole life, when one has to perform euthanasia because services by trained individuals or by family and community are inadequate. This important fact has to be borne in mind by everybody, because studies show that where palliative care is efficient euthanasia is neither needed nor requested.

In view of this, I would like to propose that, since Mr Marty's report offers no conclusion except more ongoing discussion, we should vote against the report.

We members of the Parliamentary Assembly of the Council of Europe should look forward not backward. We have to face these 'end of life' difficult situations as our challenges for life improvement and not of 'giving up'.