Issue link: https://maltatoday.uberflip.com/i/1536636
11 OPINION maltatoday | SUNDAY • 22 JUNE 2025 of killing Imam Mohammad Elsadi is director of the Islamic Centre and Samir AbouHussein is a medical consultant Daniel Schembri Daniel Schembri is a physiotherapist working in the public service Putting choice at the heart of our care MALTA is at another ethical crossroads. Fundamentally, the assisted voluntary eu- tha-nasia (AVE) debate boils down to wheth- er or not we should allow individuals, who are terminally ill and suffering, the right to face their pain and death on their own terms. As expected, the emotionally-charged de- bate has reignited the old fears of social col- lapse in the face of change. The main concern voiced by the anti-choice group is that giving autonomy to an indi-vid- ual by legalising AVE could somehow com- promise the common good. But legalising AVE is not just about empow- ering the individual to have a choice. It is also about providing a legal framework that pro- tects vulnerable people from coer-cion. Doctors are already allowed to stop inter- vention, declare a patient as not being a can- didate for CPR, or put a patient on a mor- phine pump. Can these powers conferred to medical pro- fessionals be used abusively against vul-nera- ble people? Of course. Yet such practices are well established and generally un-questioned. In light of all this, and the fact that com- petent adults are already allowed to refuse life-saving treatments, why can't requesting a medically assisted death be accepta-ble? Af- ter all, patient autonomy is a cornerstone in medical ethics. While the doctors' oath not to cause harm is often used as justification to discredit assisted voluntary euthanasia as a form of healthcare, such a statement, devoid of context, is an un- just oversimplification of the issue at hand. A good medical professional is not one who prolongs life at all costs, but one who takes a balanced approach that takes into account longevity, quality of life and above all, respect for the patient's wishes. The common good is served not by denying pa-tients their right to choose, but by respecting human dignity and upholding the pa-tient's choice, while still ensuring effective support systems, informed consent, and using all the legal tools to pre- vent coercion. Another concern of the anti-choice group is that legalising AVE will impact invest-ment in palliative care. A number of medical pro- fessionals who oppose choice have also raised the issue that current palliative care in Malta is inadequate and that it is too early to legalise AVE. I am sure that whoever is against AVE because of some moral conviction, will re- main against it even if the best palliative care is available. Still, just like any other health service, there is much room for improvement when it comes to palliative care, and just as the state is duty-bound to offer a sound legal frame- work with effective safeguards when it comes to AVE, it is also obliged to pro-vide the best palliative care possible. Palliative care and eu- thanasia are not exclusive of each other, but rather work in tandem for the patient to have a full spectrum of options to choose from. An article published in the Journal of Medi- cal Ethics in 2015 entitled Does Legal Phy-si- cian-assisted Dying Impede Development Of Palliative Care? states that the Neth-erlands and Belgium invested more in palliative care after legalising euthanasia. Sim-ilarly, the Third Annual Report on Medical Assistance in Dying in Canada, 2021, found that 81% of patients who chose euthanasia did so after going through palliative care, and 39% of pa- tients who were considering euthanasia, opt- ed out as palliative care was enough. These studies not only show that legalising euthanasia has had a positive impact on pal- liative care, but they are evidence that AVE and palliative care can coexist and support each other. There is no valid reason why Mal- ta cannot achieve this goal. The fear of introducing slippery slopes that might lead to social fallout has always charac- terised the debates preceding reforms. Yet, in spite of the fears expressed by those opposed to women's suffrage in 1947, social benefits in the 1950s, divorce in 2011 and same-sex marriage in 2017, we now have a progressive society with more respect towards people's autonomy and marginalised groups. We have an opportuni-ty to make history again. Legalising AVE is not about choosing death over life. It is about choosing autonomy and dignity over enforced suffering. It is about putting the patient at the centre of our care by offering all possible services, instead of forcing anyone to live in agony against their will. their children by emphasising perseverance and the refusal to surrender when confront- ed with hardship. We support and encourage them to persist, be patient and strive until the solutions are found. This con- crete determination to over- come any obstacle, no matter how formidable, is a pivotal driver of progress. As Muslims, we believe eu- thanasia within any societal fabric promotes a sense of de- spondency. It can deliver the message of embracing one's circumstances instead of ac- tively pursuing approaches for enhancement. As many know, our society already grapples with the issue of suicide, often driven by a perceived absence of hope or avenues for better- ment. We need to be very cau- tious as embracing such atti- tudes is likely to worsen these issues further. Some Muslim scholars stated that if specialised, credible doc- tors are certain that the medi- cation of certain patients is use- less, so the suspension of such treatment may be permissible. Under such conditions the ba- sic human rights of hydration, nutrition and pain relief (pallia- tive care) cannot be withheld. If a patient is medically presumed dead through what is known as brain death, the switching off of the life support machine is permissible. While turning off a life support machine is allowed, hastening of death by any means is not allowed as this will equate to euthanasia. Euthanasia can undermine the intrinsic belief that all lives are inherently valuable and deserving of protection. This erosion has the potential to drastically reduce the ability to advocate for the welfare of other humans, to extend com- passion, support and assistance to the needy, and to uphold the sanctity of life in all its forms. Patience according to the teaching of Islam is a way of purification and forgiveness. Also, it is a way for accumulat- ing more rewards from Allah. We need to highly endeavour as a society to find alternative avenues rather than intention- ally terminating lives as a means to alleviate suffering. While the well-intentioned motives of proponents advocating for compassionate euthanasia may be acknowledged, such a trajec- tory may steer our society to- wards a potentially dangerous and harmful course in the years and decades to come. euthanasia debate