The current public discussion on euthanasia is long overdue, just like the debate on divorce and abortion was in the recent past. This is the result of the ethical pluralism unleashed on Malta's EU adhesion.

Up till 2004 this was another issue in hibernation.

Since 2004, civil society has been empowered to speak its mind: nothing is anymore beyond consideration. Though physically detached from mainland Europe we are an integral part of the continent. Europe, however, is not an a la carte menu. We cannot pick and choose. We have to face the same realities currently faced by each and every European citizen. Divorce, abortion and euthanasia are part of the reality we must face, day-in, day out.

We too have to face fundamentalist extremes trying to convince us as to what we ought to do or not to do. At the end of the day, however, we have to decide on the direction to take ourselves: directly, through Parliament or else through a referendum.

Unfortunately, so far, we only have the possibility of an abrogative referendum. It would have been much more appropriate if we also have the right to initiate a referendum, as a result taking policy initiatives as other European countries do, notably neighbouring Italy and Switzerland. Euthanasia would definitely be a prime candidate for a referendum which initiates policy. Notwithstanding the religious fundamentalism which exists around and among us, such an initiative would, if properly framed, stand a reasonable chance of success, just as the divorce referendum did, 14 years ago.

The current debate would be much more fruitful if we have qualitative palliative care available in our hospitals and in our communities. Unfortunately, palliative care in Malta is still in its infancy as is also indicated by the ten-year Palliative Care Strategy, which, ironically is also subject to public consultation simultaneously with the euthanasia proposal.

As a nation we have to thank Hospice Malta, the local NGO, for that achieved to date in palliative care in Malta. The initiative taken by the Church in Malta to hand over the Santa Venera Adelaide Cini Institute to Hospice Malta to be developed as a Palliative Care Centre (St Michael Hospice) was commendable, as was the finance made available by the State for the same purpose.

The point to be made, however, is, that even if we have a state-of-the-art palliative care, ultimately there is a limit as to what this can achieve. The limits as to what is possible are continuously being extended through landmark medical advances. Notwithstanding, practical limits remain.

At the end of the day, some of us may have to face the inevitable choice. Each and every one of us will make that choice on the basis of his or her ethical compass. This is a right we have and no one can obstruct us in the exercise of such a right.

In these columns, last week (TMIS 18 May 2025: Think positive: dignified life before dignified death), I argued, that, before thinking about the right to a dignified death it is appropriate if we do our best to ensure dignified living. Ensuring that the necessary investments are made to set up a state-of-the-art palliative care is not an option. It is a duty. Only then would it be reasonable to discuss the parameters in which euthanasia could be considered.

Without qualitative palliative care in place, we face the risk to having euthanasia as the only choice available. This is why it is imperative that we keep insisting on the investments necessary to ensure that palliative care in well embedded in our health services. We do not want to be faced with a Hobson's choice.

Having said all this, it is essential to underline, that each and every one of us has the right to demand that our lives are not prolonged unnecessarily through futile medical treatment. Through a living will we have a right to demand this, as has been repeatedly emphasised by my party in a number of its electoral manifestoes. A point also rightly made by the euthanasia consultation document.

At the end of the day some of us may, notwithstanding, stoically opt to suffer pain. They have this right which ought to be respected unconditionally. It is reasonable however to expect that the right of those who consider that there is a limit as to what they can endure is to be respected too. Different views, resulting from different ethical perspectives.

This is at the end of the day ethical pluralism at work. In a democracy, we should go beyond tolerance: different views, as of right, ought not just be tolerated, they should co-exist.

An architect and civil engineer, the author is a former Chairperson of ADPD-The Green Party in Malta.  [email protected] ,   http://carmelcacopardo.wordpress.com