I recently received an email from one of my readers who supports the issue of euthanasia and abortion. Although not wishing to enter into debates, I respect points of views, even if I do not entirely disagree. But he said that even if there are slippery slopes in euthanasia, it remains a person’s right to choose. Indeed, the right to make personal choices, including when to die, and therefore including the medical professions (as the right cannot exist without imposing, as it were, upon the profession to change its own professional ethics), has come down to this fundamental issue. It is not more about suffering and pain, but simply a right. It is akin to the divorce verdict in Malta, where this was introduced with a “no-fault” caveat. Therefore, one needs no reason to ask for a divorce, although often there are. No one is at fault – but of course there are always victims.

This leads us to ask two fundamental questions. The first is “what is a right?” and the second, “what is the source of professional values?” The first question has often been touched upon in this column. A right is fundamentally something which many peoples hold as important. These are what Kant had called “categorical imperative” – if they apply universally then they become this. Today we call them principles. It took time to define Universal Human Rights. Among these are the right to life, to work, to raise a family, and so on. There is no mention of the right to die other than to die in dignity. The word dignity has been given many interpretations however by law and professional people.

Dignity basically means worthy of a high value; a moral value if one wishes. It is something which is worthy of honour. Of course, humans consider themselves worthy of honour – some of these would not consider others worthy of the same. Therefore, for many, although an embryo is worthy of honour, the “right” of a mother to a, I dare use the word, “no fault” choice over her body, should trump over the dignity of that embryo. Dignity and rights are not the same. In the UK, for example, abortion remains illegal but the embryo has no legal rights. The fact it does not have rights therefore does not mean, in this context, that it has no dignity. Hence, the right for the Society for the Protection of the Unborn Child SPCU to challenge emergency contraception several years ago. It is legal only for health reasons and two doctors have to sign the document. Now of course this gives a wide angle for interpretation and perhaps even abuse. But nevertheless it is the intrinsic value of the law which concerns us here. A woman has a right to her own health and she has therefore a right to participate in any decision in this regard, even when it comes to developing an embryo inside her. This is fair; what may not be fair is how we define health and rights. Is, for example, the fact that I already have two or three children, and do not wish (for my mental well-being) to raise another one, a health issue? Of course it is! But does this right trump the dignity of the embryo or its rights? The point is that if we broaden the definition of “health”, then, as in the UK, the embryo would have to have no legal rights at law.

Bioethics tends to notoriously involve political, scientific, religious, social, philosophical and legal issues. But if we do not engage in reaching consensus our values will be reduced to a statistic. And I do not say this with any tongue in cheek. It is the reality. It is because we failed at upholding marriage financially and to the advantage of those who are ready to commit, and because we failed to acknowledge that some marriages simply do not work, that divorce became a big issue. The result was even worse. Today people do not even bother to get married. They question the point and we have given them ample reason to. We have not shown the stages of love, beyond attraction and living together, which is only a partial commitment.

The second fundamental question – the source of professional values. The Lancet had a profound article; the professional ethics often fail if they fail to engage with societal norms. In point of fact one cannot even count on codes of practice – from the Hippocratic Oath, the Declaration of Geneva and various others, which one cannot even assume that they mean the same thing – which they do not. The problem is further compounded by the fact that doctors themselves belong to various religious groups and that it is unfair to tell them to put aside their values, be they Muslim, Catholic or another Christian or tradition, at home. All they have is a right to an objection of conscience if the law imposes on the profession to change.

Change must come about and those who fail to acknowledge, either lose in the process of winning by a “might-is-right” attitude which, as we said is basically a statistic. Remove values from society and what are we left with? Unfortunately, both the liberal and the fundamental positions are not willing to budge. Pride is one of the cardinal sins. Sometimes, to value others, even in the name of freedom and liberty or in the name of our religion, we have to give way to dialogue and consensus – and dialogue is not something which will have the other convert or else. The time has come for professionals and lay people to think together what is in the best interests of society. Otherwise politicians will simply have to adhere to that group, which will guarantee them the position to continue with the other work that the country needs. Politicians need us to make the right choice. They inadvertently tell us – “Decide. Otherwise we will have to decide for you and that means we will have to do it democratically and to either abide by the principles of the Party or to choose the principles of the majority”.

The medical profession needs to listen, as a source of its professional values, to the patients it treats. Is it right to continue treating someone who does not want to live in the state we as a profession can offer in order to save his or her life? Of course, this will depend on the value of the person. But if religion has failed the person in giving him or her a higher moral understanding of life, or, if the person has failed the religion by not wanting to listen, the professional cannot come in between. Healing goes beyond curing; sometimes it may mean respecting that healing will never come if we continue down a path, which will leave someone a cripple. We have to seriously ask whether, after emergency care, for example, we ought to take into consideration that a person may not want to live in that state and allow them to die a natural death, accepting that any further treatment will be extraordinary for this patient, something which even major religions allow, and not continue down heroic paths just because they are possible or the latest state of the art.

 

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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