Wishes of patients should prevail over medical advances – junior minister

A terminally ill patient’s wish to refuse invasive and extraordinary medical treatment should prevail over medical advances to prolong life, Rebecca Buttigieg told parliament during the second reading of the ‘living will’ bill on Monday. 

The legally binding 'living will', or advanced medical directive, would allow patients who are 18 and older to refuse treatments such as CPR and artificial hydration and feeding, following consultation with a family or trusted doctor, as well as the authorisation of a notary. 

The Parliamentary Secretary for Reforms told parliament wishes of patients should prevail over continued medical advances that allow a person’s life to be prolonged.

“Treatment may extend their lives, but it won’t bring back their health and dignity,” she said, adding that some treatments could have aggressive side effects that lead to more suffering and pain. 

The law, Buttigieg said, would remove uncertainty – both for doctors and for a patient’s next of kin, who might want to prolong treatment, “not out of cruelty but out of hope of recovery even when this is not medically possible”. 

“No one wants their loved ones to die. We need to educate ourselves that death is inevitable,” she said. 

If passed, the law would include a list of treatments that a patient can refuse.

However, patients would not be able to direct doctors on what treatments to administer. Nor would they be able to request illegal treatments, such as euthanasia, or refuse palliative care. 

Nationalist MP Graziella Attard Previ said the Opposition supported the bill in principle, since a living will would be a guarantee that a terminally ill person could make their wishes clear while they still had the mental faculty to do so. 

“The Opposition is in favour of the law because it respects a person’s wishes without creating ethical and moral issues. It also removes the need for someone else to decide for that person."

Attard Previ made a number of suggestions to strengthen the bill. While the current version of the bill requires the approval of one doctor, she suggested the additional input of a psychiatrist, geriatrician, or psychologist – “someone who can assess a patient’s mental state, especially when there is a history of dementia".   

The MP also recommended standardising the definition of certain terms, such as ‘reasonable possibility of recovery’ and ‘significant improvement’, which could be considered subjective, and the creation of a mechanism that would quickly resolve disputes. 

The bill has also found support outside of parliament, having been welcomed by the Medical Association of Malta, the Palliative Care Association, and political parties Momentum and ADPD.