Position paper on the public consultation on “assisted voluntary euthanasia”

Abstract

1. This position paper, which has been written by a multidisciplinary group of academics at the University of Malta, brings together insights from different areas of expertise as a contribution to the recent public consultation launched by the Government on “Assisted Voluntary Euthanasia”, offering evidence-based reflections and recommendations.

2. Although the title of the consultation document is “Assisted Voluntary Euthanasia”, the academic group notes that what is actually being proposed is both physician-assisted suicide and euthanasia, terms with distinct meanings and implications as recognised in academic literature. The document also speaks of “medical wills” which are more accurately referred to in scholarly literature as “living wills”. This is a complex subject which merits a debate in its own right, certainly prior to considering the introduction of euthanasia.

3. A central concern pertains to the dissonance between the consultation document and two pivotal national health initiatives, namely, the National Palliative Care Strategy for Malta 2025-2035 and the National Suicide Prevention Strategy for Malta 2025-2030. Empirical evidence demonstrates that jurisdictions which have implemented physician-assisted suicide or euthanasia have experienced a significant decline in the quality and scope of palliative care services. Palliative care services in Malta, which are already under considerable strain, will suffer similar setbacks. Studies also show a correlation between the introduction of physician-assisted suicide and increased suicide rates, a development which directly undermines national suicide prevention efforts. The academic group therefore strongly urges responsible authorities to prioritise the development of comprehensive, robust and excellent palliative care for all to ensure the availability of essential medications and to invest in proactive suicide prevention strategies. These objectives should take precedence over legislative moves towards the institutionalisation of physician-assisted suicide and euthanasia which encourage and normalise practices that are fundamentally at odds with the ethics of care and the protection of vulnerable individuals.

4. The paper also highlights several ethical concerns arising from the consultation document. Foremost among these is the recognition of the inherent, inalienable and inviolable dignity of every human being which underpins the fundamental right to life. This right is not contingent on circumstances of individual preference and must be upheld unconditionally. The state has the duty to safeguard this right through appropriate legal frameworks.

5. The legalisation of physician-assisted suicide and euthanasia significantly threatens the dignity and well-being of the most vulnerable persons in society, particularly those with limited socio-economic means. Evidence shows that the implementation of such measures correlates with decreased investment in palliative care services, disproportionately affecting those who lack access to alternative end-of-life care. Socio-economically disadvantaged individuals are also more susceptible to internalising the perception of being a burden, and this may unduly influence them towards “choosing” physician-assisted suicide or euthanasia not out of genuine volition, but due to structural constraints. Indeed, the so-called “choice to die” risks transforming into a perceived “duty to die.” [extract].