Issue link: https://maltatoday.uberflip.com/i/1495665
4 Unity SUNDAY 26 MARCH 2023 Death becomes For & Against As humanists, we start from the principle that our lives are our own, not a gift from, nor owing an- ything to, any higher power. We decide our own destiny and values, provided that does not cause harm to others. Of course, all are free to adhere to religious beliefs - but not to impose them on those who think differently. Competent adults have the right to control their own lives, including how they should end. Euthanasia is a broad term, covering: Assisted Suicide (a medical prac- titioner providing a patient with the knowledge, means or both to com- mit suicide); Voluntary Euthanasia (a medical practitioner administering a lethal drug to a patient with the patient's consent); Passive Euthanasia (a medical practitioner allowing a patient to die by the withholding of futile treat- ment) - whether or not formally acknowledged, this is common in many countries including, as we un- derstand it, Malta. We focus on the first two, joint- ly "Assisted Dying", as a matter of choice for the patient rather than a pragmatic medical judgement. Jus- tice and compassion must require cessation of suffering, if that is what the patient wants, having made a clear, considered and voluntary de- cision that their life has come to its proper end and they want to choose how, when and where they die. International Human Rights legis- lation recognises the right to life, but no law imposes a duty to live under any circumstances. Assisted Dying is not considered a human right under international law, but is increasingly recognised in various jurisdictions. Both Voluntary Euthanasia and As- sisted Suicide are legal in Belgium, Luxembourg, The Netherlands, Spain, Canada, New Zealand and Colombia, and under discussion in Chile, Portugal and France. Assisted Suicide is legal in Austria, Switzer- land, Germany, Australia and 10 US States, and under discussion in Scot- land and Jersey. It seems Voluntary Euthanasia is becoming more acceptable in Mal- ta, particularly for the terminally ill (Assisted Suicide is rarely mentioned here; perhaps seen as one element of euthanasia). While many cases do involve the terminally ill, we see no moral case to limit Assisted Dying to people with, for example, six months left to live. We would include those who are incurably suffering; in many ways, worse than being terminal, fac- ing longer periods without prospect of relief. It is often argued that better pal- liative care would obviate the need for Assisted Dying. We agree - to an extent. Patients must, of course, be informed about their options for palliative care and pain manage- ment, and we support calls for better end-of-life and palliative care. Many would choose good palliative care towards the end of their days, and to die under that care rather than act, or expect others to act, to end their lives. But improvements in such care do not negate the need for a right to Assisted Dying for those who have a positive wish that their body should not be kept functioning when they are without independence, quality of life and hope. Of course, laws on Assisted Dying could be abused, with pressure on the sick and vulnerable to act against their wishes for the convenience of families or medical services. All laws can be and are broken, and there are a few euthanasia cases in which that has happened, including in re- lation to a patient's mental capacity to choose, and failure of monitor- ing or enforcement. This underlines the need for strict regulation. But the possibility of misuse by others does not justify withholding that right to those who need it; if it did, much more than euthanasia should be banned (for example, in the US, about 30 die every day in drink-driv- ing crashes). And covert abuse will surely remain possible with or with- out regulation. If formulated and enforced cor- rectly, with the strongest safeguards against coercion and abuse, legalisa- tion of Assisted Dying could protect the vulnerable as far as is possible within any legal structure. Safeguards vary between jurisdictions, including whether available only to the ter- minally ill; to those 'only' unbeara- bly suffering; and to those suffering from mental, rather than physical, disorders. They should, at the mini- mum, include tightly-policed proto- cols ensuring that: • a request is expressed, not implied, voluntary, informed, considered over time, and rev- ocable; • if there are any doubts about a patient's capacity to make a clear choice, a psychiatrist must confirm such capacity; • two independent witnesses confirm the request was made willingly and free of coercion; • two doctors, independent of each other, give written agree- ment the patient has an incur- able, grievous and irremediable condition; • at least two independent doc- tors, trained in medical ethics, agree that all legal criteria, in- cluding that the patient is in- formed of all options (includ- ing the benefits of palliative care), have been met; • cases of Assisted Dying must be reported to a central body following the procedure. Various academic studies have con- cluded that where Assisted Dying is legal, people acting under the law were generally free from coercion, and abuse of the vulnerable was not evident. Finally, there must be a debate about conscientious objection. We would prefer not to allow for con- scientious objection to the fulfilment of a patient's wishes, because we do not agree a doctor should make mor- al judgements on behalf of others, but recognise that medical profes- sionals have their own human rights. For background information on some of the points we have raised, please visit https://maltahumanist. org/assisted-dying/ Dr Christian Colombo, Chairperson , Humanists Malta Joanna Onions, Committee Member, Humanists Malta for