A conversation that a teenage Daniel Micallef had with a friend on the football pitch is often played back in his mind.
“While we were playing football, I asked about my friend’s father who was very ill. He responded: ‘Insomma aħjar Alla jieħdu’ (he’s not so good; it would be better if the Lord takes him).”
“That really shocked me and I began to dislike my friend because I couldn’t believe that someone would wish for his father to die. At that age, I just couldn’t comprehend it.”
But the conversation returned to the Labour deputy leader when his own father was in the last hours of his life, dying from a terminal illness.
“When my father was nearing his death, I never actually spoke those words out loud. But witnessing such tremendous suffering made me reflect upon what my friend had said.
“Each family has experienced the suffering of loved ones and, when you experience it, it gets you thinking. If I had to pass through something similar I would like to have the choice over my body or over my life,” he said.
Micallef’s father’s death 10 years ago was cited on Sunday by Prime Minister Robert Abela, who said it was time for a national discussion on euthanasia.
Euthanasia is not legal in Malta and assisted suicide is a crime punishable by up to 12 years in prison.
Micallef, whose stance on the issue has evolved and strengthened since the passing of his father, advocates for voluntary euthanasia and told Times of Malta he was glad the issue was now on the table.
Different views must be respected
He stressed the different views on the subject should be respected and that it was very important the discussion was not politicised.
While there is a need to strengthen palliative care, he said the way a person spends his last hours “should not be at the mercy of the doctor’s morals”.
A 2016 survey concluded that, due to lack of guidance, Maltese doctors use religion and their philosophy on life to make decisions on end of life care.
Almost one in two doctors said they believed that religion is very important in the end of life choices they made.
“On the basis of these findings, it would be better for doctors and patients to have a legislative framework which safeguards both,” Micallef argued.
While euthanasia is illegal, it is not normally illegal for medical professionals to withdraw futile treatment of terminally ill patients or to give them pain relief such as increased doses of morphine, which could indirectly shorten life.
And the 2016 survey found that most medical professionals agreed with such courses of action.
Such medical decisions did not constitute euthanasia, the co-author of the study – Jurgen Abela – said at the time because they aimed at relieving suffering and did not actively hasten death.
Need for education on the subject
Bioethics specialist Pierre Mallia, who is against legalising euthanasia, said that, while discussion on the issue was needed, widespread misinformation on end of life rights had cheapened the debate.
There was a pressing need for more education on the subject, he told Times of Malta.
“The question about euthanasia has tended to revolve around ‘why should I die in pain?’ We already have a model answer to that, we have palliative care, but it’s not enough for everyone,” Mallia pointed out.
He suggested that requests for euthanasia would diminish if adequate palliative care was extended to everyone and people better understood their right to certain choices like withholding life-prolonging treatment.
In a country where religion sets cultural norms, the Church also had a fundamental role to play in straightening out certain misconceptions, he said.
“Certainly, a lot can be accomplished by religious institutions to teach patients that pain relief, even if it hastens death by a few days, is in accordance with the teaching of the Church and that one can refuse life-prolonging treatment,” he said.
'Not the time to start a debate'
The general secretary of the Medical Association Malta (MAM), J.P. Tabone hit out against the calls for a discussion on euthanasia, saying it wasn’t the time to start a debate, particularly on ethics involving the elderly and the vulnerable.
“It is not an appropriate time to discuss changes to medical ethics, which have been there for thousands of years,” he said.
“The medical profession is focused on controlling the COVID-19 pandemic that has hit the elderly and the vulnerable disproportionately hard.”
MAM advocates against euthanasia and said that once the pandemic is over the focus can shift to palliative care, dignified symptom control and measures to make the elderly, sick and vulnerable feel more welcome in the community.
Places where euthanasia is legal
Which countries have legalised euthanasia?
Euthanasia, which is usually defined as another person, such as a doctor, ending the life of an individual, is legal in Belgium, Canada, Colombia, Luxembourg and the Netherlands.
Assisted suicide, which is about helping someone take one’s own life, is permitted in Switzerland.
Spain is also set to join this list of countries as lawmakers last year voted in favour of a law decriminalising euthanasia and assisted suicide.
New Zealand, parts of the United States and Australia have also made assisted dying legal.
In contrast to euthanasia and assisted suicide, assisted dying usually only applies to people who are terminally ill.