Compassion and autonomy

Peter Dingli of San Diego, California, writes:

Miguel Vassallo’s recent opinion piece (‘Doctors must save lives’, May 18) presents a heartfelt and principled objection to the legalisation of euthanasia in Malta.

His concerns, particularly as a medical student and future healthcare professional, are deeply rooted in a desire to protect life and uphold medical ethics. I respect his commitment to these values. However, I would like to offer a counterpoint, one that also values life but recognises that compassion sometimes means allowing patients to choose how and when their suffering ends.

A doctor seeing to a patient. Photo: Shutterstock.com

Vassallo argues that doctors are meant to save lives, not end them. But this view, while honourable, does not account for the full reality of modern medical practice. Doctors are also entrusted with alleviating suffering, respecting patient autonomy and recognising when interventions become more harmful than helpful.

Medicine is not simply about extending life, it is about supporting the quality of that life, even in its final moments.

Citing the Hippocratic Oath and the World Medical Association’s position, he reminds us of the historical foundations of medical ethics. Yet, these foundations have evolved.

The original Hippocratic Oath has undergone significant revision and many modern versions reflect current ethical standards that include respect for a patient’s informed choices, even when those choices involve refusing treatment or requesting assistance in dying under exceptional circumstances.

Vassallo rightly raises concerns about the potential for coercion, emotional vulnerability and the slippery slope that might follow legalisation. These concerns are not unfounded and must be addressed through clear, well-enforced legal safeguards.

However, the experiences of countries like the Netherlands, Belgium and Canada show that, with strict regulation, euthanasia can be practised ethically and responsibly. The fact that laws in these countries have evolved does not automatically imply abuse or neglect of vulnerable people; it reflects a society responding thoughtfully to complex cases and changing understandings of suffering.

The suggestion that euthanasia devalues the lives of the elderly, the disabled or the mentally ill is one that deserves careful scrutiny. However, the existence of the option does not mean that anyone is pressured to choose it. On the contrary, in jurisdictions where euthanasia is legal, it is only granted after thorough evaluation, often involving multiple professionals, ensuring that the decision is voluntary, well-considered and free from external pressure.

Vassallo advocates for palliative care as the ethical and humane alternative to euthanasia and, on this point, we can agree. Malta must expand and invest in high-quality, accessible palliative care. But it must also be acknowledged that even the best palliative care cannot eliminate all suffering. For a small number of patients enduring unrelievable pain or distress, the option of euthanasia may offer a sense of peace, control and dignity in their final days.

Euthanasia should never be seen as a substitute for care, nor as a solution for social neglect or economic hardship. But neither should it be denied to those who, after careful reflection and with full support, make a personal decision that their suffering has become unbearable. To respect that choice is not to abandon them; it is to honour their courage and autonomy.

Vassallo closes with the belief that Malta should continue to stand for life. I share that hope but I believe standing for life also means standing for the right to a dignified death, free from prolonged agony and chosen freely by those who must live, and die, with the consequences.

Let us, as a nation, explore this issue with both caution and compassion, ensuring that our laws protect the vulnerable while recognising the rights of those facing intolerable suffering.

Malta is indeed better than fear. We are a people of care, responsibility and respect. Let us reflect those values in how we treat our fellow citizens at the end of life.