EN
MT
This presentation addresses the proposed legislation on Assisted Voluntary Euthanasia (AVE), with specific reference to its implications on the medical profession. The response draws upon feedback from various medical associations and individual professionals.
1. AVE: Ethical and Systemic Concerns
The Medical Association of Malta (MAM) strongly asserts that Malta lacks the ethical, legal, and institutional infrastructure to safely implement AVE. The absence of an active Medical Council, inadequate mental capacity legislation, and under-resourced palliative care systems present serious risks to patients and professionals alike.
2. Conscientious Objection Must Be Absolute
The proposed law requires clinicians to refer patients to AVE services even if they object.
This undermines moral autonomy.
MAM is against forcing any doctor into participation at any level and would go a step further by removing assisted suicide from healthcare completely.
This is not about being unwilling to do difficult things—medical professionals do that every day. It is about being forced to participate in what they may perceive to be a morally wrongful act: ending a human life.
3. AVE Must Remain Voluntary for Professionals
A national registry of professionals willing to participate in assisted suicide must be created.
Patients can elect to ask for physician participation.
This ensures a clear, contractual arrangement between patient and professional, without coercion or pressure on others.
This separation preserves the dignity and moral boundaries of those who do not wish to engage.
4. Legal Clarity and Protection for Participating Professionals
Doctors who choose to assist must, however, be protected from medico-legal liability—especially if family members disagree after the patient has made an informed and lawful decision.
The final responsibility lies with the patient. Without such protections, clinicians may be exposed to reputational and legal risk even when following the law.
5. Discriminatory Criteria: Who Gets to Choose?
Eligibility is restricted to patients expected to die within six months.
This excludes many with prolonged, severe suffering such as ALS, end-stage heart or lung disease, and degenerative neurological disorders.
This selectivity is ethically problematic, discriminatory, and undermines the claim of autonomy. The system implicitly values one kind of suffering over another.
MAM is against this form of discrimination, as well as the arbitrary time-limit placed on suffering.
6. Invest in Palliative Care First
MAM affirms that palliative care must be strengthened before AVE is even considered. Malta has only two palliative care specialists—far below international recommendations.
According to MAM, many of the cases presented in favour of AVE reflect failures in current palliative provision, not a lack of alternatives.
We cannot offer death as an option when the alternative—life with dignity—is not fully resourced.
7. Final Message
This is not a rejection of dialogue or autonomy.
It is a call for ethical clarity, systemic readiness, and respect for the conscience and rights of all healthcare professionals.
Clarifying the Terminology
It is worth noting the longstanding distinction between assisted suicide and euthanasia. In the Swiss model, which allows assisted suicide, the patient must take the final act themselves—typically by self-administering a lethal dose of barbiturates.
Assisted suicide is thus not medicalised.
Self-administration is being proposed in the local scenario too, with the distinction that physician presence during the act is mandatory.
MAM is against this requirement of physician attendance and reiterates that the proposed legislation should follow established standards—such as those already present in countries like Switzerland—where assisted suicide is removed from the healthcare system entirely.
This model focuses on autonomy without direct clinician involvement in the act of ending life.
In conclusion, Malta must first ensure a robust palliative care system, remove assisted suicide from healthcare, eliminate mandatory participation of doctors, and ensure legal protection for both patients and clinicians should they choose to take part.