There are few events that evoke comparable emotional responses than those associated with the beginning and the ending of human life. They could not be more fundamental, deeply personal and existential.
Consequently, they are the focus of intense debate across society involving ethical, legal and medical as well social and religious dimensions. Few more so than the highly charged issue of euthanasia.
The topic is back in the news again in the context of palliative care provision and funding in Malta as well as the prime minister’s recent assertion (in line with his party’s election manifesto) that a decision on euthanasia might be on the cards and his call for a mature discussion that leads somewhere.
Despite it being illegal, a 2021 survey suggested that a slim majority of Maltese are in favour of the introduction of euthanasia in cases of terminal disease. The Nationalist Party has made it clear that it remains opposed to euthanasia.
It is clear that Maltese society is divided morally, socially and politically on the issue and this does not bode well for the initiation of such an informed and mature discussion.
Having a clear definition of euthanasia is a necessary starting point for any discussion. According to the UK House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is “a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering”.
Euthanasia can take two forms – voluntary and involuntary – and the distinction between the two is vital.
The first occurs if an informed and competent patient makes a request (over time) for a life-ending intervention. The latter occurs if a patient does not make such a request or does not consent to such intervention.
Most of the support for euthanasia arises from the first context while most of the opposition arises in the latter.
The debate becomes complex when we consider the difference between active and passive euthanasia. The former occurs if deliberate steps are taken to end a patient’s life whereas passive euthanasia is when treatments necessary for extending life are withheld. Many would argue that the latter already routinely happens in medical or care settings.
Advocates for euthanasia argue that the decision of when and how to die should be left to individual choice and rights (something we routinely exercise or respect throughout life). They insist that many are needlessly condemned to excruciating suffering by refusing to legalise voluntary euthanasia.
Many who oppose euthanasia often describe it as a ‘slippery slope’ towards involuntary euthanasia, especially if individuals have lost their ability to exercise choice or didn’t indicate such choice beforehand or become subject to undue pressure. Regulating euthanasia appropriately is, they argue, extremely difficult if not impossible.
Many also oppose euthanasia on moral or religious grounds arguing that it is against the will of God and that it denies the inherent value and sanctity of human life. For believers, the premature ending of life is wrong as it denies God’s plan.
Focused and quality palliative care is often viewed as the effective alternative to euthanasia. Yet, the availability of such care is often very expensive or non-existent, especially in poorer countries or communities or is dependent on voluntary or community resources.
Individuals and families as well as entire societies routinely discuss the issues of life and death and how they can be managed and mediated. They are intensely difficult topics often made all the more difficult by entrenched attitudes, customs and beliefs.
The debate on euthanasia seems set to be revived in Malta. It will require sensitivity, care and mutual respect, attributes too often absent in ongoing private and public discussions.