The Maltese Government’s consultation on “assisted voluntary euthanasia” risks crossing an irreversible line. Behind the rhetoric of choice lies a deeply flawed proposal—one that threatens the dignity of life, the ethics of medicine, and the future of care for the vulnerable.
We’ve outlined seven objections that speak to the heart of what’s at stake.
The Seven Objections
- Undermining of Value of Life and starting on a slippery slope
- Negative impact on Palliative Care
- The Risk of Coercion
- Loss of trust in the Medical Profession
- The Government’s Definition of Terminal Illness is Flawed
- Mental Health Assessment for Patients
- Mental Illness, Disability, or an Age-Related Condition
1. Undermining of Value of Life and starting on a slippery slope
Legalising assisted suicide risks sending a societal message that some lives are no longer worth living. All human life holds intrinsic value, regardless of age, ability, or health status. In countries where euthanasia was initially restricted to extreme cases—such as Austria, Belgium, Luxembourg, the Netherlands, Spain, and Switzerland—legal boundaries have steadily expanded. In the Netherlands, euthanasia is now permitted not only for individuals with terminal illness but also for newborns with severe conditions and adults who are “tired of living.” In 2024, nearly 10,000 people were euthanised in the Netherlands alone.
2. Negative impact on Palliative Care
Advances in the field of palliative care and pain relief have been made precisely because of a commitment to care rather than to ending lives. Instead of offering death as a solution to suffering, health systems should prioritise comprehensive, holistic palliative care to patients, and support to their family.
Legalising assisted suicide risks diverting funding and resources away from palliative care.
In proposal 512 and 513 of the 2022 Electoral Manifesto, the Labour Party, now in Government, committed to investing in quality pain relief and palliative care. Moreover in proposal 654 they guaranteed the best possible end of life care.
3. The Risk of Coercion
No system can guarantee that decisions to access euthanasia are made entirely free of pressure or coercion. Vulnerable individuals, especially the elderly, disabled, or those experiencing chronic illness, may feel a sense of obligation to relieve their families or the healthcare system of the burden of care. Even with safeguards, subtle coercion or internalised pressure can undermine genuine consent. A so-called “right to die” can become “the duty to die”.
4. Loss of trust in the Medical Profession
The legalisation of euthanasia poses a fundamental challenge to the medical profession’s core ethical principle: “do no harm.” Authorising doctors to participate or to refer, in the intentional end of a life may blur the boundaries of their role as healers and undermine public trust. If patients begin to view physicians as instrumental in assisted suicide, the trust essential to effective healthcare will be significantly compromised.
The proposal also mandates that objecting medical practitioners must refer patients to other medics, which infringes on their rights to conscientious objection, forcing healthcare professionals to participate indirectly in a practice they may find morally objectionable.
5. The Government’s definition of terminal illness is flawed
The Government’s Definition of Terminal Illness
By “terminal illness” we mean:
i. the terminal stage of a progressive illness or medical condition that will lead to the end of the person’s life and which, in no way, can be cured or overcome; and
ii. because of that illness or progressive medical condition, a medical professional can reasonably conclude that the life expectancy of that person does not exceed a period of six months.
The Government’s Definition of Terminal Illness is vague, medically unreliable, and open to broad interpretation, making it an unsafe basis for a law that permits life-ending decisions.
a. Prognosis Is Not Always A Precise Science
Predicting that someone has “no more than six months to live” is inherently uncertain. Countless cases exist where patients diagnosed as terminal have outlived their prognosis by months or even years. Life expectancy varies greatly depending on individual health, treatment response, and co-existing conditions. Basing euthanasia eligibility on an estimated timeline invites fatal errors.
b. The Term “Cannot Be Cured or Overcome” Is Ambiguous
What does it mean to say a condition “cannot be cured or overcome”? Many progressive illnesses are not curable but can be managed effectively with palliative or supportive care, often resulting in years of quality life. This language could include people with chronic conditions that are stable but technically “incurable.”
c. The Term “Terminal Stage” Lacks Clinical Precision
The term “terminal stage” is not clearly defined in medical practice and can differ between conditions. For some diseases, like certain cancers, there may be more clinical clarity. But for others, like advanced heart failure, or neurodegenerative diseases, the boundaries between “progressive” and “terminal” are much less clear.
d. Vulnerable to Interpretation and Expansion
Because this definition relies heavily on subjective clinical judgment, it creates space for gradual reinterpretation. As seen in other jurisdictions, what begins as a narrow eligibility standard can quickly widen to include cases that were never originally intended.
e. Ignores Mental and Emotional Factors
It assumes that a six-month prognosis is sufficient a justification for ending life, without adequately considering mental health, existential distress, or potential for adaptation and support. Sometimes a difficult terminal diagnosis may have a better outcome if the patient is given the appropriate care.
Therefore, this definition is medically fragile and ethically dangerous.
6. Mental Health Assessment for patients
Assessing mental capacity in the context of euthanasia is complex and inherently uncertain. Psychological conditions such as depression, anxiety, or existential despair can distort a person’s judgment, sometimes making death seem like the only option. Even trained professionals may fail to detect underlying mental health disorders. As a result, euthanasia may be granted in cases where the root causes of suffering are treatable.
7. Mental illness, disability, or an age-related condition
The consultation paper says a patient does not qualify if their condition is a mental illness, disability, or an age-related condition like dementia. This may sound reassuring, but is the Government really trying to propose a law that specifically discriminates against people with disabilities? This safeguard will likely be deemed in contravention of Article 14 of the European Convention on Human Rights, and removed. In countries where euthanasia was first limited to terminal illness, these very categories: disability, dementia and mental illness,were later introduced.
You can read the Government’s document in full here.
