'Living will' to allow terminal patients to decide what treatment to refuse

Updated March 3 with palliative doctors' statement

A new law will allow terminally ill patients to make decisions about the care they want to refuse if they are unconscious.

The legally binding “living will”, or advanced medical directive, will need to be authorised by a notary in order to be in force.

It will allow a patient to refuse treatments such as CPR and artificial hydration and feeding.

The person formulating the will must be at least 18 years old and have the mental capacity to make such a decision, the draft law says. 

If still conscious, a patient can revoke their earlier wishes by just telling a medical professional in the presence of a witness.

Patients, however, cannot refuse any standard medical treatment, including palliative care, via the living will.

“Palliative care is considered a standard medical practice, so one cannot refuse it... Palliative care is there to ensure that a patient is kept as comfortable as possible in his last moments – when they are enduring great suffering,” Reforms Junior Minister Rebecca Buttigieg said.

“Refusing it would mean forcing doctors to let you endure inexplicable pain. No doctor or medical professional can ever do this,” she said.

The proposed legislation is set to be tabled in parliament in the coming hours or days, Buttigieg told a news conference.

She said medical professionals are already obliged to respect patient autonomy, and patients are allowed to refuse the treatment they do not want.

This law will ensure that the patient's right to choose continues to be respected even if they are unable to communicate it at that moment, Buttigieg said.

“Today, we are announcing another step in favour of the dignity of the person. Human dignity is fundamental for every individual to live with respect, to develop fully, and to be valued. It is a right of which no one may be deprived, and which ensures that all human beings are treated with intrinsic worth, even when we are speaking about delicate health circumstances,” she said.

The law will also reduce doubts and worries of a patient’s family who are often asked to decide on behalf of their loved ones on what treatment should be administered when a patient is no longer able to decide for himself, Buttigieg added.

Public consultation

Buttigieg stressed that the law was not introducing euthanasia into Malta but said the need for the law came from discussions during the government’s public consultation on introducing voluntary assisted dying into Malta.

“From that public consultation, it was established that there is a broad consensus regarding the need to provide this opportunity, which strengthens personal autonomy in matters affecting the health of individuals who, of their own volition, decide to have advance medical directives included in their medical records,” she said.

Former PBS editor Reno Bugeja, who sits on the consultative committee that steered the consultation, said that any living will must obey the laws of Malta.

“For example, if someone says they want euthanasia, should they get to a certain point in their treatment, that cannot be respected, as euthanasia is illegal,” he said.

Palliative doctors react

The Palliative Care Association of Malta said it welcomed the plan to introduce Advance Directives for patients with incurable illnesses.

"Medical interventions at the end of life should focus on comfort and dignity. Timely planning for future care needs with your doctor is an integral part of palliative care and ensures patient dignity and autonomy," the association said.