Supporting palliative care is the most ethical and humane way to care for those at the end of their life, Hospice Malta said in reaction to the government's draft document on assisted voluntary euthanasia.

Following the Government's launch of the public consultation on assisted voluntary euthanasia, Hospice Malta has issued its position on the subject.

It acknowledged that this topic is a sensitive one and evokes significant emotive reactions on many levels, be it at a society, community or an individual level. "Hospice Malta's mission, firmly rooted in the principles of palliative care, is the preservation of life in a dignified manner until its natural end. This principle that continues to guide our mission also reflects the values upheld internationally by professional palliative care providers and social health care organisations alike," it said.

Comprehensive palliative care to patients and their families includes the provision of a number of professional services and support in various settings - within the community, through day therapy and through inpatient services, it said. It strongly believes that "all energy and resources" should focus on developing and strengthening these types of services so that patients and their families "can benefit from the care that addresses not only the physical pain, but also the emotional, social, and spiritual distress that normally accompany this phase of life," the organisation said.

"At this critical juncture, Hospice Malta robustly affirms the importance of investing in and expanding access to 24/7 comprehensive palliative care nationwide. This sentiment is reflected in the National Strategy for Palliative Care launched earlier on this year that calls for further development of existing services and new development of support services."

Regarding palliative care, Hospice Malta said that it addresses physical pain, emotional, social, and spiritual distress of patients and their families.

It also preserves dignity, it said. "It supports patients in maintaining quality of life until natural death, in comfort and with deep respect and compassion. This occurs in the context of advanced care planning where decisions are discussed with the patient and their relatives to enable the adoption of an agreed management plan. This may also involve, discussion on non-treatment decisions in order to fully address the dignity and quality of life of the individual."

Palliative care also supports families and caregivers, preparing them for bereavement and offering them continued support, Hospice Malta said. The organisation also said that palliative care principles are in alignment with most religious and ethical traditions that affirm the sanctity of life.

In its statement, Hospice highlighted the challenges faced by persons who are seriously.

These include actual or anticipated physical suffering, a deep sense of being a burden on their loved ones, psychological and/or spiritual pain and distress social isolation.

"These issues can be addressed around the clock through the immediate support of trained professionals and through access to the appropriate medication and equipment."

In addition to clinical support, families also require practical assistance, including medical equipment; Carer support, and respite care outside the domestic home as necessary; Psychological, social, and spiritual support for both patients and their loved ones, made available at the time of need; Help lines and immediate access to services in moments of crisis; and Companionship both at home and outside the home, Hospice Malta said.

It said that it "has been providing these services for over thirty years, expanding and introducing services gradually according to the availability of its resources whilst ensuring continuity and sustainability. The ever increasing demand for these services necessitates that all adequate human and financial resources are in place in a timely and consistent manner."

Gaps in palliative care.

Hospice Malta said that although progress has been made over the years, "there is ample room for improvement in Malta's palliative care landscape."

It identified a number of gaps, which include the need to implement the recently launched Palliative Care Strategy, the need for greater financial investment to support service growth and accessibility, the expansion beyond oncology to all limiting illnesses, improved community-based medication access, with patients fully supported in their own homes, among other things.

"Hospice Malta's current reach is approximately 60% of patients with a diagnosis of cancer who pass away annually, which indicates that many patients may possibly not be requesting and/or receiving the level of care they deserve at the end of life. The need for further education and awareness of Hospice services is evident."

It said that Malta's small geographical size offers a unique advantage. "Unlike larger countries, patients in Malta can be more easily reached in their homes, allowing for truly patient-centred care that enables people to remain in their home environment with adequate support."

Ethical implications

Hospice Malta also identified ethical implications of the proposed voluntary assisted euthanasia.

"The experience of other countries suggests that following the introduction of euthanasia legislation, the quality and investment in palliative care services often declines. This is deeply concerning. The right response to human suffering is not to shorten life, but to ensure quality of life even during its final stages until its natural end. With appropriate resources, no person should feel that euthanasia is their only option."

"In addition, Hospice Malta supports the concept of advanced care planning (as opposed to a living will/advance directive] where the emphasis is on discussions with the patient, the aim being to respect the dignity and quality of life of the patient and avoid extraordinary measures at the end of life. Hence, it is imperative to ensure the availability of comprehensive palliative care before considering irreversible policy changes. Informed decisions must be grounded in real and informed access to care, not in the absence of it."

Strengthening palliative care as a national priority

Hospice Malta acknowledged the support already received through funding agreements with the Ministry for Health and the Ministry for Social Policy and Children's Rights, as well as donations from the public and corporate sponsors.

"However, further investment and strategic collaboration are required to: Expand the palliative care workforce (HR); Ensure 24/7 availability of services across all care settings; Provide necessary medications in the community without delays; Develop educational programmes for healthcare professionals and the general public; Work towards a more compassionate and inclusive society, where amongst other things, advance care planning is promoted as part of the holistic care of patients."

Hospice Malta said it believes that supporting palliative care is the most ethical and humane way to care for those at the end of life. "Rather than the introduction of processes to end life, the emphasis should be on the advocacy for greater investment in crucial services that protect life and uphold the dignity of each person."