MHSA considerably backs the introduction of Euthanasia in the legislature of Malta, as is induced by an ALS sufferer, Mr. Magro, whose interview in The Times of Malta sparked discussion about the subject (1).
Currently, Euthanasia is illegal in Malta however a recent survey showed that 12% of doctors said they had received pleas for assisted suicide from their patients. Euthanasia is generally defined as the act, undertaken only by a physician, that intentionally ends the life of a person at his or her request (2,3). The physician therefore administers the lethal substance. In physician-assisted suicide (PAS) on the other hand, a person self- administers a lethal substance prescribed by a physician. To date, the Netherlands, Belgium, and Luxembourg have legalized euthanasia (2,3).
In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians (with the exception of Switzerland), and consultation by a second physician (4).
MHSA believes that autonomy and choice are important values in any society, but they are not without limits. Our democratic societies have many laws that limit individual autonomy and choice so as to protect the larger community. Thereby, a cautious approach is needed when wanting to legislate Euthanasia, nevertheless not violating the individual’s right to die in a dignified manner. MHSA feels that euthanasia should only be enabled to the patient if his quality of life is severely compromised. Patients with neurological disorders such as ALS, Parkinson’s disease and multiple sclerosis exemplify the typical patient whose quality of life may be severely hindered.
Voluntary euthanasia should be conducted with consent of the patient given that he is properly informed and is mentally competent to make a decision. Patients must be at least 18 years old and make specific, voluntary and repeated requests that their lives be ended. The exact number of “repeated requests” is not specified and should be open to interpretation, in which the appropriate health care professional deciphers the situation (5). In all jurisdictions, the request for euthanasia or PAS has to be voluntary, well-considered, informed, and persistent over time. The requesting person must provide explicit written consent and must be competent at the time the request is made.
A recent study found that in the Flemish part of Belgium, 66 of 208 cases of “euthanasia” (32%) occurred in the absence of request or consent (6). The reasons for not discussing the decision to end the person’s life and not obtaining consent were that patients were comatose (70% of cases) or had dementia (21% of cases). In 17% of cases, the physicians proceeded without consent because they felt that euthanasia was “clearly in the patient’s best interest” and, in 8% of cases, that discussing it with the patient would have been harmful to that patient.
Reporting is mandatory in all the jurisdictions, but this requirement is often ignored (6). In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee (7). Legal requirements were more frequently not met in unreported cases than in reported cases: a written request for euthanasia was more often absent, physicians specialized in palliative care were consulted less often, and the drugs were more often administered by a nurse.
Euthanasia is one of the most neglected issues that modern health care faces. MHSA believes that the health care system in Malta and Gozo should start to seriously consider the legalisation of Euthanasia as it is undoubtedly an answer to some of our critically-ill patients.
References:
1. http://www.timesofmalta.com/articles/view/20160713/local/let-me- end-my-life-in-dignity-mps-to-hear-request-for-euthanasia.618648
2. Deliens L, van der Wal G. The euthanasia law in Belgium and the Netherlands. Lancet. 2003;362:1239–40. doi: 10.1016/S0140- 6736(03)14520-5.
3. Watson R. Luxembourg is to allow euthanasia. BMJ. 2009;338:b1248. doi: 10.1136/bmj.b1248.
4. Perreria J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Multimed inc. 2011: Volume 18, Number 2.
5. Cohen-Almagor R. Euthanasia Policy and Practice in Belgium: Critical Observations and Suggestions for Improvement. Issues in Law & Medicine, Volume 24, Number 3, 2009.
6. Chambaere K, Bilsen J, Cohen J, Onwuteaka–Philipsen BD, Mortier F, Deliens L. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. CMAJ. 2010;182:895–901. doi: 10.1503/cmaj.091876.
7. Prager LO. Details emerge on Oregon’s first assisted suicides. American Medical News September 7, 1998
8. Smets T, Bilsen J, Cohen J, Rurup ML, Mortier F, Deliens L. Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases. BMJ 2010;341:c5174.