It is well-known to many a Maltese family how someone can abuse of an elderly person at the end of life and have their testament (will) changed in the last few days without the knowledge of other people involved

Often these persons may have obtained the trust of the perpetrator, who has proved that his or her intentions were to get something out of the ‘voluntary’ work they had been putting in to help a relative or a neighbour.

In one case, I know of two women who spent a lot of time with their aunt, went with a doctor and a lawyer to their aunt’s bedside towards the end of a terminal illness and asked her to agree to a new will which excluded their brother with whom they had qualms but who was also entitled to a share as he too used to spend nights with her.

In another case, I was called by a notary to visit a patient to certify that she can sign a will. When I went, I found that the person had severe dementia – by severe one means there is no orientation of place and person and would not be able to remember simple things like the names of their children and their address. I of course refused, much to the anger of the son, who of course refused to pay for my services. Unfortunately, even the notary was rather disappointed and I later found out that another doctor was brought in.

Indeed, many of these instances are cases of abuse by doctors and notaries who are accomplices in taking advantage of these people. But to be sure, in many instances the elderly person, as in the first case, is mentally quite fit to change a will. Yet they are frail and vulnerable due to their old age and the pressure of being left alone will make them sign a will even against their wishes. It is also known that these people who look after vulnerable old people are none less than vultures who scavenge and wait for the opportune moment. Till that moment arrives, they subtly brainwash the people into thinking that if it were not for them, no one will look after them or take care of their affairs.

There is a lot which is being done abroad to safeguard the affairs and integrity of old people. You may be mentally competent but still be vulnerable. A Vulnerable Persons’ Act will take us a long way to avoid abuse. These acts make it clear that vulnerable people are mentally competent but that their situation can make them accept things which they otherwise would not accept. To be sure, vulnerable people are not only old people but also asylum seekers, prisoners, etc.

The person or the person’s family will ask an authority to safeguard the interests of the person. Usually a support network of friends and family will be set up so that even if one has a power of attorney, this cannot be abused. All decisions must be agreed upon. The support group will need of course the supervision of healthcare and legal professions.

Another thing which can take us a long way is to have people registered with their family doctors. We unfortunately missed this golden opportunity because we were unable to sit down to discuss it before a proposal was leaked to the public, raising alarms. If someone has a family doctor, no one will be able to bring in another doctor to make a statement of mental competence without the knowledge and acceptance of this doctor. Again, there is a section in the law guiding the ethical principles of doctors, but it seems it cannot really be invoked without some form of agreement between doctor and patient and especially therefore without patient registration.

The perpetrators are intelligent people. They are literally wolves in sheep’s clothing. They move around thinking they are saintly people helping an old person. They say this in the streets. They show everyone – are not afraid. They shop, clean and take care of affairs for the old person. Then when the latter passes away you hear they have inherited their house. Sometimes they say that the old person owed them money. Etc. etc. etc. – we have all heard these stories.

On the rare occasion when an old person really wants to leave some inheritance to an acquaintance because they honestly felt abandoned by the rest, then this would be suspect. How can one distinguish between a professional and the other? It is only a court of law which can make such claims. Yet circumstantial evidence is often clear. If a doctor was brought in the final stages, and especially if the usual doctor is kept ignorant of what is going on, then this should raise questions. At the end of the day, we really rely on notaries, who unfortunately have given themselves a bad name simply because they rely on a piece of paper – a so-called certificate of mental competency – without using their common sense.

Of course if you don’t do it for them, someone else will. But is this reason to do wrong? With the hope that someone heeds these concerns from general practitioners, let us look forward to a law which guides professionals and reduces, if not eliminates, these abuses. And let us be clear, abuses can occur even by good people. How many people have remained disillusioned even by their parents, who left whole properties to institutions, thinking they will have a better place in heaven.

Let us heed our archbishop’s recent appeal in a local magazine – Flimkien – and foster a society of true solidarity with old people; a solidarity which helps without seeking gratification. If this is naïve thinking, then all the more reason for passing the Act. These vultures love themselves and not the person they help.

Pierre Mallia is Associate Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta; he is also Ethics Advisor to the Medical Council of Malta. He is also former president of the Malta College of

Family Doctors