I would publicly like to thank Pierre Portelli and Joe Mifsud for inviting me on their morning programme to discuss the proposal I made on working to help vulnerable people – with special reference to elderly who can be abused

They took up the issues immediately and of course one is ever so grateful that these important issues are put to light and perhaps taken up by legislators. I would therefore like to say more, especially with regard to the questions they raised on the programme; i.e. more on who, what, where, when...

Vulnerable Persons’ Acts, where they exist, have been introduced as an extension of people who live with a mental disability; the difference is that we now recognise that not only people with a mental disability can be vulnerable but also those who legally have the mental capacity to make decisions affecting themselves. We have seen how vultures can make elderly people dependent on them in several ways, only to make them sign a new will when they need them most. The elderly person comes to trust these so-called carers; but in reality the latter care only about themselves.

There are five guiding principles to such an act:

• Vulnerable people are presumed to have the capacity to make decisions affecting themselves, unless demonstrated otherwise.

• Vulnerable people should be encouraged to make their own decisions.

• The vulnerable person’s support network should be encouraged to assist the vulnerable person in making decisions so as to enhance his or her independence and self-determination.

• Assistance with decision making should be provided in a manner which respects the privacy and dignity of the person and should be the least restrictive and lease intrusive form of assistance that is appropriate in the circumstances.

• Substitute decision making should be invoked only as a last resort when a vulnerable person needs decisions to be made and is unable to make these decisions by himself or herself or with the involvement of members of his or her support network.

Moreover, there are three key areas of provision of such an Act – support services, protection from abuse and neglect, and substitute decision making.

Support services

Besides the support services which are offered by social services, one contemplates a ‘support network’. This depends on the needs and wishes of the person. A support network is one or more people who, over the short or long term, provide advice, support or assistance in response to various needs. It may be made up of family members, service providers and friends. The important thing is that areas of concern – such as changing of wills and management of finances – are managed with the collective knowledge of the network. Therefore there may be no danger, for example, that the friend (even if he or she is part of the support network) can act alone to bring in a notary and doctor to change legal documents.

Protection from abuse and neglect

An Act can make a provision that whoever even suspects that there may be abuse or a situation which can give rise to abuse, can make a report to a department; such as a department for family services. The department then has the right to look into the situation and perhaps request and help in the setting up of the aforementioned support network.

Substitute decision making

Of course having power of attorney (prokura) of any form can raise tensions and can even give rise to abuse. Yet they are necessary for many people who cannot make it to the bank or carry out decisions on their own – such as medical and end-of-life decisions, and legal ones. The support network will be there to ensure that all goes according to strict moral and ethical rules and not only legal statements; that is, the group can reassure itself that all is done in the best interests of the elderly person.

Of course it goes without saying that safeguards have to be in place so that people maintain the right to leave their property to whoever they want. This is why, if they are competent, they are involved in the choice of people in the support network; the idea is to protect rights and prevent abuse, and not to go to the other extreme and incapacitate them – which incidentally is the only recourse one now has if he or she does not wish anyone to change their will should someone pressure them in the future.

Apologies

No one is free from error, and certainly not I. On last week’s programme Affari Tagħna, I came across a little too harsh against a lecturer. Although what I said was true and I did not mention any names; and although I have a right to my opinion, I was somewhat ungenerous in my comments when the discussion fell on gender issues. For this I duly apologise. The irony is that I was advocating dialogue. Our own errors keep us humbly at bay.

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