The Malta Independent 26 September 2021, Sunday

When we think in herds

Pierre Mallia Sunday, 1 August 2021, 09:30 Last update: about 3 months ago

Re-iterating what Charles MacKay once said, with no particular disrespect to any individual but only referring to "crowds": "men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only seem to recover their senses slowly, one by one". We now call this Emotional Contagion. In bioethical issues there is the very big danger that we all go "mad" in herds when we look at things only from the emotive point of view. I would be the first to agree, against some thoughtful philosophers, that all of philosophy and ethics starts with emotion - either empathy or the emotion of a wish to know more. But ethics, then, is not only a feeling; it has to be backed by logical thinking, first of what is right, secondly of the consequences of an action. Because even if something is right, the consequences may make it wrong. I can sell an organ, as has been said in this column in the past, but the consequences of allowing this would be a market force which will put the more vulnerable in a situation where they will have to sell organs for stuff they should be getting through welfare or proper work.


Having said that, I am writing this following last Sunday's Malta Independent which had a two-pager on Labour's position on euthanasia, written by Stephen Calleja. I do not wish to be partisan, however, it is also true, from what I have seen and the discussions I have had when invited on shows on euthanasia, that many inside labour are in favour. Labour are on a mission of liberalisation. One admires the courage. But assessing the current pulse is short-sighted without proper public education and debate. I have a great respect for the people who are invited, but I do feel at a disadvantage as being a professor, I am obliged to give non-emotive advice and to be impartial as much as possible. However, I am often invited as someone who is against euthanasia. It is true that I am not in favour, but my work as a lay bioethicist (as I understand those who come from clergy or otherwise) call for me to be as neutral as possible. When one arrives to a conclusion from facts, then one can assert a position.

It has cost me of course, but there is nothing new in this. MacKay again: "You have no enemies, you say? Alas, my friend, the boast is poor. He, who has mingled in the fray of duty that the brave endure, must have made foes. If you have none, small is the work that you have done. You've hit no traitor on the hip. You've dashed no cup from perjured lip. You've never turned the wrong to right. You've been a coward in the fight." Cowards are those who defend a position simply because they form part of a group or institution, when deep down they think that the position is wrong. They may continue in faith. But we are also called to express our opinions. This is how Catholics changed the position of the Church that a woman cannot receive treatment that will endanger a baby if she is pregnant - even if she would have had to die. Innumerable women with cancer went into surgery knowing they may not come out because they had deteriorated and the baby could be delivered. We chose over her life. We ended their lives to save, albeit, a baby. But they had no choice. At least not until 1985 when the Belgian Episcopal conference gave her that right.

Killing is wrong, but we are not allowed to treat people without their consent. If they do not want to receive further treatment, such as a respirator, we can keep them comfortable and they die a natural death without any discomfort. This is not euthanasia; neither is giving pain relief, if it hastens death by a few days, if your intention is to relieve the pain and titrate doses accordingly. There is a fine line between what euthanasia is and what is not. And philosophers have often disagreed, some importing the principle of double effect into an argument, while others say it was wrong. In this way we can move forward.

The only people who would truly deserve to have an argument for euthanasia are those who have been kept alive through medical intervention and are left totally paralysed or suffering from severe dementia in a psychiatric ward: Not a nice end, especially if you have been a headmistress. These are the side-effects of medicine. It is deemed ethical to continue to treat people with dementia for other causes. But these people may indeed make an Advance Directive or make use of an Advanced Care Plan, to stop all treatment and simply keep them comfortable when carers see no other option but to send them to a home. Even feeding, if forced through a drip without one's consent, is immoral. If one refuses this, one ought to do all to keep the person comfortable and not suffer hunger and allow one to die. There is a difference between killing and allowing to die. This is what the argument is all about. Some simply want us to give a lethal shot to get it over with. This can be burdensome on the family as well. Others may feel pressured to follow this path.

Legalising euthanasia is throwing out the baby with the bath water. Why? Because we would have thrown out what we can do for people who would otherwise prefer euthanasia because they see others die in pain. We have introduced a palliative care ward. The Church has offered a place some years ago to develop into a 20-or-so bed hospice for dying people - I believe it is still in progress. But it is not enough. The progress is too slow. We need to treat end-of-life as we treat other conditions. Certainly, allowing someone to die in distress or in pain is immoral. It cannot be said that treating people without their consent is a good thing because you are trying to save their life. It may be more emotionally taxing to withdraw futile treatment rather than not starting it at all, but we have a moral agreement that withdrawing and withholding are equivalent. We simply need the comfort of the law.

No government should introduce euthanasia without appropriate public debate, which is informative, educational and non-emotive (see Council of Europe Guidelines). It should be a place to involve both the professionals and the marginalised. And it should be led by neutral people and by an independent body. "Crowds" are owed a logical sense and not one built on emotions.

More importantly, if we fail to introduce good palliative care and allow relatives of dying patients see their death was comfortable, then we would simply be demolishing a house before we know whether it is salvageable.

Pierre Mallia is Professor of Family Medicine and Patients' Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee.

This article is his personal opinion and does not represent the opinion of any committee or Board he serves on.


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