After a decade, the health service seems to have stagnated morally and legally, with little modernisation and development in its basic infrastructure and regulation.
The first few years of the current governmental administration benefitted from Mater Dei Hospital’s relatively easy internal expansion. In the interim, changes among ministers lost precious time. National health plans became stalled and then scrapped in the absence of direction. The only exception was the new health centre and peripheral clinics (bereġ) in the previous health minister’s electoral district.
Regarding regulation, the law that will replace the existing inquiry proceedings against dentists and doctors seems to have been shelved after they were declared constitutionally null in June last year.
A doctor’s certificate of conduct is now defunct, serving no purpose except to demonstrate how ineffective regulation has become.
Regulation needs to improve when it comes to health professional standards in other ways as well. Although the law states that councils regulating health professions have the remit to check language and practical proficiency at clinics via checks, there is no legal infrastructure to enforce it practically. In the end, such anachronisms will keep cascading further failures.
What is worrying from a bioregulatory point of view is that calls for euthanasia are being made without adequate palliative care coverage amid this unchecked environment.
Non-governmental hospice services only cater to the worst off with stretched resources and cannot be expected to cover a national deficit. Thankfully, the close proximity of hospitals makes inpatient care readily available.
Readers must know that, in Northern Europe, it is not uncommon for professionals to covertly change their practice to euthanising patients without asking consent, even though it is illegal to do so. It is a problem foreign politicians that encourage euthanasia have to deal with, and, as if to bury their hatchet, try to drag others into following their example.
The health service, reeling as it is, is not in a position to safely guarantee that abuses to euthanasia will be appropriately dealt with. Doctors will not have their licences struck off if mistakes are made, investigation of practical aspects of care to prevent harm cannot be carried out, hospitals do not have qualified, ethical committees to appropriately counsel on such decisions, courts appear to be overloaded, health budgets have taken a hit with financial scandals, and patients do not know where to begin to understand what it means for them.
It is also cringeworthy how arguments are made to offload decisions concerning euthanasia onto ‘patients’ when, in reality, readers should ask whether they would want to be euthanised in Malta.
The health service is not in a position to safely guarantee that abuses to euthanasia will be appropriately dealt with- Ian Baldacchino
Euthanasia came about when patients were abandoned to continue futile care because palliation was not invested in. This is the trend that led to euthanasia after patients were forsaken in their solitary, tortured lives in the absence of palliative care. As funding and interest in palliative care fell with the introduction of euthanasia, a culture of abandonment towards people living with terminal diseases was instituted. Palliative care centres dwindled and the only option left was obvious.
If the government neglects the terminally ill or areas of the country for lack of votes and to cut costs, it is also participating in their dehumanisation and furthering inequality.
The government must be wary of attempts to encourage ideologies through populist messaging and emotivism, trying to swing public morality and political bias.
Unfortunately, mainstream media is ideologically and sensationally driven, preferring to promote banners as moral signposts. It has yet to mature enough to discuss proper evidence-based and argumentative bioethics, preferring sensationalist, one-sided statements. Perhaps it fears that which it does not understand.
Haphazard calls for practices that seek to change medicine’s ethos from a healing profession are no joke, and one should ask whether doctors should carry out euthanasia in the first place.
Medicine does not come from ideology or economic motives but from a selfless moral tradition that recognises patients’ vulnerability and consistently strives for their healing and flourishing.
If politics replaces the scope of medicine with gaining votes or economic aims, it will fail to nurture the scope of medicine. It will become harder to fulfil its objective and, worse, it will harm professionals and patients.
Dr Ian Baldacchino is a specialist in family medicine and an elected member of the Medical Council Malta.