Health Minister Jo Etienne Abela said Malta should start discussing the introduction of doctor-assisted dying “in the new year”, with the UK bill serving as a blueprint for the national debate.

British MPs have started to debate the Terminally Ill Adults (End of Life) Bill, which would legalise assisted dying in England and Wales. It may or may not be approved, and such a law may or may not be suitable for our own country, but it has highlighted the need for Malta to discuss this in a meaningful way.

The Labour Party manifesto for the 2022 general election included a promise to discuss the issue. It is an issue also raised in the past, perhaps most eloquently back in 2015 by Martin Scicluna, who went through the proposal from the point of view of the medical profession, the patient, religion, and the law.

With regard to doctors, Scicluna pointed out that the Hippocratic Oath states: “Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”

There is a solution: doctors can be given the right to opt out of administering the procedure, just as patients would have the right to opt in.

However, it is also important to consider the many types of assisted dying, from administering drugs that result in death to palliative sedation where the doctor heavily sedates the patient, who can prior to this request that he or she be given no water and food, resulting in death. We need to understand all the options available and the implications of each one, not just from the medical point of view, but also from the legal one with regard to both the doctors’ intention and the patients.

The discussion needs to consider the circumstances under which it would be admissible, the age of consent and whether it would be limited to only physical conditions, as opposed to mental ones. An important aspect of the debate in the British parliament was how to ensure that there are sufficient safeguards to avoid abuse.

Unscrupulous relatives might want a terminally-ill person out of the way as soon as possible to get their hands on their inheritance. A patient may want to die sooner to avoid causing psychological pain for their families.

But the main reason for a growing call for assisted dying is because the patient cannot bear the pain or indignity associated with terminal care. For some people, medical interventions cannot adequately alleviate physical or psychological suffering associated with terminal illnesses.

The religious aspect is much harder to resolve as beliefs are deeply entrenched in our society.

Medicine has allowed parents to choose when their baby is born by Caesarian section, for example. But extrapolating the argument from manipulating when we are born to when we die is far from self-evident.

The British bill is based on a doctor preparing medication but the patient taking it themselves. We still do not know whether this is what the Labour Party manifesto has in mind when it referred to ‘voluntary euthanasia’.

Medicine has come a long way over the years, affecting mortality rates and longevity. But for each victory there is an unintended consequence.

For example, we have eradicated some illnesses through vaccinations, but lifestyle, stress, obesity, pollution are resulting in more cancers. The World Health Organisation reported last February that in 2050, there would be over 35 million new cancer cases, a 77 per cent increase from the estimated 20 million cases in 2022. 

Why should we live longer only for life to end in unbearable pain and indignity? We hope the country can discuss such a sensitive and important issue properly in a mature and open-minded manner.