22 April 2024, marks the 300th anniversary of the birth of Immanuel Kant. Kant is a towering figure in ethics, deciding on what is good or bad, because at a time when skepticism and empirical subjectivism was rewriting the ethics textbooks in Europe, he managed to come up with an ethical system, based on the good will or intention of the acting person, and the duty of applying it autonomously, freely and rationally.

This system dealt with applied ethics in an objective manner and with a system that applied to all people universally. Kant believed that when we take in empirical a posteriori data, this is sythesised through a priori ideas and knowledge already present in the mind (imagine looking at object through spectacles or sunglasses), so that he managed to show that neither empiricism alone, nor rationality alone, were enough to construct a theory of epistemological knowledge.

Both were needed. Kant’s thesis also applied to ethics. In the age of enlightenment, this man from Koningsberg in Eastern Prussia built an innate moral system which equalled Aquinas’ theory of natural law but without the God factor included. Man had to act morally out of his intentional goodwill irrespective of the consequences or utility of the outcomes. He had to act out of a sense of duty for its own sake, avoiding any self-interest. The action had to be good in itself not consequential or utilitarian.

This duty comes to us in the form of an imperative or command which is categorical because it includes all rational people and applies to all situations as an end in itself. This imperative in the form of an ‘ought’ statement, suggests, that “one should act only on that personal principle of volition whereby one can at the same time choose that this becomes a universal law.”

Although there is only one categorical imperative, there are three formulations of this, whereby the social aspects of such a command are added together with the fact that man should be considered and end in himself not a means to any end. Basically, Kant is saying that before we act, we have to make sure that we use our reason so that our proposed line of action had to fit in as if this action was a universal law that applied equally to everyone and everywhere. That it was also a proposition for action that was able to be rationally intended for the good for and by all other human individuals. It was not to contradict the universal moral laws of others in restricting them in their duty to be moral (for example asking others to tell a lie for you) and that it was not to use people as means to an end.

Our Minister of Health seems to be eager to put euthanasia on the social and political agenda. Euthanasia clearly comes into a scenario where people become scared to face certain illnesses or their outcomes or are left to do so alone. I do not believe that in Malta, with our social and family fabric still intact, with the support of organisations of palliative care like Hospice, we need to have patients fearing that they will be left to face illnesses even terminal ones, alone or in pain.

Doctors today have the medical and legal means through the use of medicines and the double effect principle and the use of the principle of proportional treatment strategies, to help patients to not to be in pain or distressed and to help them cope comfortably even with terminal conditions. I really do not see any need for euthanasia to enter into our legal texts at present.

The government should focus on palliative care and community counselling and building networks for support, many of which are today either tenuously scarce or undermanned. Wherever in the world euthanasia came in, it ended up being abused and spiralled quickly out of control, with the overseeing bodies usually losing command of the situation as cases mounted exponentially.

I have a suggestion for the Minister of Health on how to deal with these complex bioethical issues as they become more frequent and complicated. From IVF issues, to organ donation, to end-of-life issues, to beginning-of-life issues, issues of proper treatment, adoptions, surrogacy, AI, so on and so forth.

Bioethics is a very complex subject comprising multidisciplinary academic subjects and issues. It is very simplistic to expect every minister or politician to have a commanding grasp of the issues involved in these subjects. It is simplistic to expect the man in the street or a simple vox pop or public opinion to have a commanding grasp of the subjects involved.

It is simplistic to expect a politician to put an idea forward and then one expects it to be passed through parliament in two or three weeks without many parliamentarians knowing what in heaven’s name they are supposed to be talking or voting about! These are matters for experts to elucidate upon before politicians or the public can decide effectively. There is an absolute need to set up a structured legal body that can examine all these issues and come out with evaluative synthetic reports before they are presented to the public and parliament for digestion.

By a structured body, I mean a law setting up a national multidisciplinary team, with representatives of academics in the field, the main political parties and other institutions in society, which can regularly partly change on a rotationary annual cycle, much based on the lines of Italy’s excellent law on the setting up of the National Bioethics Committee. The present way adopted in Malta of passing legislation on bioethics in a disjointed, amateurish type of manner is naïve, incomplete and childish and very often counterproductive. So, if the Minister for Health wishes to do something positive and substantial, he should start from there, rather than firing from the hip on this or that subject!

Kant would not have approved of a law on euthanasia, because if anyone would have suggested it as a propositional maxim to act upon, it could never have become a universal law otherwise the whole human race would eventually wipe itself out and disappear! Now if Kant had such an objective opinion to give on the subject, I would mark time, before making euthanasia a public football and ending up creating a travesty of human dignity and human rights. Of course, natural law theory and virtue ethics would very much tell you the same thing, not to say anything of God and his law, all of course amenable to human reason!