Euthanasia: A serious discussion is needed, but no politics please – Pierre Mallia

Political parties, the Church and the government should stay away from the serious discussion that is needed on euthanasia, said professor of medical ethics Pierre Mallia. The Malta Independent on Sunday.

When asked if he saw Malta introducing euthanasia as a right in the near future, he said the most important thing before that happens is that there is a serious public debate without the interference from political parties, the Church and the government.

One of the dangers in our political system is that if someone introduced euthanasia as a private member’s bill in Parliament, it would lead to a rushed referendum like what happened in 2011 with the divorce.

Conversely, serious public debate needs government funding and must listen to all voices, including the less popular and marginalized, not just the powerful voices – political parties, religious organizations and NGOs.

He added that unless values, morals and ethics simply become a matter of statistics, we cannot simply follow our leaders because a majority wants to, having only superficially understood what they are for. vote. Ethics is not just a feeling but requires rational thinking.

Ahead of the last general election, Prime Minister Robert Abela said Malta needed to start a discussion on euthanasia.

The Malta Independent Sunday met Professor Mallia who, during the last legislature, was president of the bioethics committee.

Professor Mallia said euthanasia is defined as the deliberate and intentional killing of an individual, which in most cases would be carried out for health reasons. He added other things like refusing to give unnecessary end-of-life treatment is not considered passive euthanasia, “unlike many people think”.

Professor Mallia said that when many people are asked about the subject, they say the law should be brought in because they don’t want to die in pain. “These are not valid reasons because we already give, or should give more, morphine and sedation at the end of life…increasing the dose until we can.”

He said giving morphine and a sedative at the end for pain relief is allowed even if it shortens life by a few days, as it is not clearly defined by law. Professor Mallia said even the Catholic Catechism, when referring to end-of-life pain relief, describes it in its teachings as an act of benevolence.

“At this stage, patients do not need extraordinary care and should be able to refuse treatment, such as a hydration drop, especially at the end of life in order to avoid unnecessary pain or discomfort with the repeated search for veins that are starting to clog,” he said.

Adding to the list of misconceptions people have on the sensitive subject, Mallia said some believe that if a patient dies just after 10 minutes of being given a dose of morphine, then that treatment is what killed them. .

He said that unless the dose of morphine administered did not violate the standard of care established by physicians universally and therefore recognized by law, physicians and nurses should not be afraid of relatives threatening to sue them for justice in such cases. “It’s a question of upstream communication.”

“The most important thing at the end of life is to keep the person comfortable, even if that means sedating them,” Mallia said.

The doctor explained that there are two different types of euthanasia: active and passive. He said active euthanasia is when a dose of a lethal substance is given to immediately stop the heart, while passive euthanasia is when, for example, a cancer patient who is not at the end of life has a lung infection and instead treats if the doctor decides to let nature take its course. Conversely, patients have the right to refuse treatment and the responsibility here does not lie with the doctor who cannot treat without consent.

Aside from those two, there’s also physician-assisted suicide, which Mallia says is a misnomer, “because if I give you a gun to kill yourself, I’m still an accomplice.” He is as active as possible.

Speaking of euthanasia in general, he said the medical profession was always against it, but that has started to change in recent years.

Referring to a European project on end-of-life care, which he coordinated, he said that end-of-life care in Malta is not optimal as it should be according to the surveys carried out. The workshops were attended by healthcare professionals, including consultants, and there was a demand to hold more.

Mallia said he and other medical professionals partnered and created an end-of-life protocol #. Apart from this, he edited a consensus document between the Faculties of Law, Medicine and Theology and also designed a course curriculum on the ethical, legal, social and spiritual aspect.

“Every doctor and nurse needs palliative care training because during their college years, end-of-life care is very little discussed,” he said. Not all patients actually die in the palliative care unit. That said, several specialties, such as respiratory medicine, oncology, gastroenterology and others, lend themselves well to end-of-life care.

One of the biggest problems concerning euthanasia as a right arises mainly when people who are still young learn through genetic testing that in the future they will suffer from autoimmune diseases such as Huntington’s disease. which, most often, triggers dementia. Professor Mallia said the first thing these people say is that they want euthanasia as a right because they don’t want to live with the disease.

He said medical professionals are not inherently there to help people commit suicide.

“Many of us will have dementia. We just don’t know what it’s like. Should it be a medical philosophy to end lives if people don’t want to live with a disease? said.

He added that some people don’t understand that while dementia makes people forget things, they are sometimes lucid. Despite this, Mallia said these patients demand more dignified care.

Citing another example, he said that even when a person becomes paralyzed and becomes dependent on other people and they might think euthanasia is their answer, Mallia still believes it’s totally preventable. In this situation, he added that it is not the first time that these people find the necessary support and attention from their families and are thus able to lead a fulfilling life. Moreover, we should rethink the argument of saving at all costs without acceding to the wishes of patients to live the kind of life offered to them. He said that if at any time patients refuse to continue treatment, we should, after assessment and consultation, accede to their wishes.

Speaking of countries that have introduced euthanasia as a right, Mallia said if Malta followed their lead it would be on a “slippery slope” because although the patients to be considered for the procedure first are most likely those who are in the terminal phase. sick, it would only be a matter of time before it would also be presented as an option to those who suffer, for example, from chronic depression. “You can’t have a universal law for the exceptional case,” he said.

Mallia predicts that such a right would be abused if it were not limited to certain circumstances and conditions. Explaining in more detail what he meant by abuse, he said people would be more willing to “stop it” rather than deal with any health issues they might have and find ways to improve. their life. Although the medical argument for euthanasia as a right embraces the autonomy of the individual and their right to decide for themselves, Mallia said that “rights are something given and accepted by a company… they are not something that falls from the sky. There has to be a social agreement because it is society that gives the rights, and surveys have clearly shown that 85% of society is asking for more information, including those who are in favor of such an approach” .

In conclusion, Professor Mallia noted that when a person dies by suicide, everyone wonders why they weren’t getting help, but when it comes to euthanasia, nobody does because euthanasia is more “socially acceptable” and that patients are assisted by doctors.

what they think

The Malta Independent on Sunday, has over the past few weeks interviewed several people who work closely with those affected by cancer and those who are terminally diagnosed.

In these interviews, they were also asked to share their views on euthanasia based on their experience.

Oncology Nurse Manager Ronnie Frendo said that in his personal opinion he feels that if euthanasia were ever to be introduced in Malta as a right, it should be limited to certain cases only, where a patient would have exhausted all treatment options.

Although a person with a strong Catholic faith, Ronnie said he felt deeply for those who were suffering and that personally if he was ever in this position he would not want to spend his last days in pain.

He added that some of these patients end up bedridden with severe skin abrasions, although nurses and doctors are doing all they can to avoid them.

He said that in his opinion he would choose euthanasia if he had exhausted all treatment options and failed and received an ultimatum from the doctors, especially if he would have a long way to go before dying, like six months at one year.

“I wouldn’t want my loved ones to see me in this state,” he said.

Another nurse who works in the palliative care section and decided to remain anonymous for various reasons said he would not consider euthanasia if they were ever to be given a terminal diagnosis by doctors and having already explored all options.

“I don’t agree with euthanasia because there are many ethical issues,” he said.

The palliative care nurse said he wouldn’t personally choose his date and time of death, but let nature take its course because “I don’t think it’s ethically right because it also goes to the against the scope of palliative care, which is to make the terminally ill patient comfortable”.

Mentioning some of the reasons why he disagrees with euthanasia, he said that in some cases, terminally ill patients might be more inclined to opt for euthanasia because they don’t want to cause unnecessary suffering to their loved ones “even if they would not suffer”. .

Bella Mifsud, whose husband died of cancer, said Jesmond was diagnosed as terminally ill but never considered euthanasia “because he was a man with a strong Catholic faith”.

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