The government has decided to start a discussion about the introduction of euthanasia. I am not so sure it is not a deviation of the public's attention from the government's current political woes, but as I have contributed to this discussion before, I am again going to do so. In my opinion this way of doing things in medicine is a wild exercise in pure folly. Family ties and care in Malta is still very strong. We need to make it stronger and we do not need to weaken it. What people are afraid of, effectively, is being left to die alone and unsupported.

Secular biomedical ethics, rests on four principles. The first is autonomy, the second is beneficence or doing good, the third is non-maleficence or not doing any harm, and the final principle is justice, to give everyone his due. It is expedient to write of autonomy, that every patient has the right to determine when and how he is treated and ultimately needs access to information about what his treatment plan is from medical and other health care professionals. Ultimately any patient may refuse any care or cure plan set before him.

However, to extend this principle of autonomy to the patient's right to commit harm to himself by allowing him to cancel out his own life and allowing doctors and nurses to aid in this project legally, is sheer madness. This is because it throws the second and third principles out the window altogether, and seriously compromises the fourth. What remains of medicine if one is allowed to kill a patient on the pretext that the patient wants to end his life and negating from what due care and cure is due to him to be able to maintain his dignity as a patient and human being?

Doctors need beds in hospitals and old peoples' homes, one of the worse things a patient or the state can do is give the doctor, nurse or health care worker the legal right to terminate patients' lives. We have great difficulty sometimes to prevent this happening as things stand now, let alone introducing euthanasia in the arsenal of patient care! In countries where euthanasia has been allowed to occur legally, the situation has always rapidly gone downhill and gotten out of hand. The regulating authorities often lose control of the situation, as ill-intended medical and health professionals may have various ways to hide or side-line the way things are done.

The road to hell maybe marked with good intentions but eventually a very slippery slope ensues, where children, adults and old people with illness, depression, psychological factors and generally a bad quality of life and a thousand other reasons become included for the consideration of euthanasia on the statute books. Subsequently, hell is where we end up. The examples and the list of this are endless. This move worldwide also disincentivises the scientific research for the cure of several diseases in general, especially the orphan rarer diseases. If patients with disease are allowed to be exterminated instead, what scope or incentive is there for medical research?

The government is ill-advisedly promoting this introduction of euthanasia as a patient's exercise in free choice, when one considers that one is suffering. Patients need care and proper support when they are suffering; they need to be supported and shown that they are not alone in their suffering; they do not need to be told that they have the option to be ticked off.

Let me be clear here that it makes much more sense to invest in more palliative care and social and psychological and psychiatric support, including a humane legal advance directive, then to save yourself the trouble as a state to do so and help patients exterminate themselves. One needs to keep in mind here that health care professionals already have the legal means, in many cases, to know when proportional treatment is no longer necessary and when to withdraw it. When a patient is already in an irreversible state of dying, one makes the patient as comfortable as possible without pursuing disproportional treatment.

There are also several cases where the already legal principle of double effect may be used as an indirect way of letting a patient die, but the proper conditions here need to be adhered to, as there should be no direct killing, but death only occurring as a side-effect of treatment. Many patients in pain and severe physical discomfort are offered this option, in discussion with their relatives.

The important thing is to maintain a patient's human dignity, the term often used is that of the human person properly or adequately considered. The person who did sterling work in this field is Professor Louis Janssens of the Catholic University of Leuven. The human moral act is divided into three parts. The relative material object chosen as a means to the ends of the act, the circumstances surrounding the act, and most important of all, the intention or formal act of the ends of the action which is the object of the inner act of the will, that being that good is intended and evil avoided, that the human dignity of human persons is maintained always.

In order to use the relative material means of action to the intended end without the means used becoming evil themselves, Janssens mentions four conditions to achieve this. I will deal with several here which concern euthanasia. The first condition of the human act being the right act, is that the means used in the material object or norm we carry out to reach the intended formal end, must be in debita proportio to the formal end, which means there must be proportionate reason (Thomas Aquinas) to allow it. If the material norm carried out is intended as an evil itself, then the norm is vitiated.

Hopefully the end does justify the means when there is premoral (ontic) or unintended evil occurring as a deficiency or lack of perfection in order to reach the right intended end. There is definitely no proportionate reason to the intended end of human dignity, if the means used, is to directly kill the innocent patient or intentionally allow him to take his life! Here the evil in the means is not premoral, but becomes essentially morally intended and this vitiates the action. It is not accepted that one does something morally evil, so that a good may come of it.

One has to be always careful here to distinguish the premoral from the moral means to the end. Some material objects or norms in themselves can never be proportionately compensated by the intended good end, which then renders it not a right end. Some material norms to the end are always morally evil in themselves such as the taking of the life of an innocent human being, as no proportion can ever exists here between the means and the end. This includes euthanasia and abortion.

The second condition is that one has to consider the principle of totality of the whole act from the point of view of the rationality of the means to the end (debitus finis secundum rationem), The exterior material action has to be in conformity with right reason to debita proportio to the right end as a totality of the human act (Thomas Aquinas).  There is no proportion of the means in euthanasia to attain the rational end of maintaining human dignity. Euthanasia amounts to an immoral theft of the life of the patient.

The final question Janssens posits that effects euthanasia in this case, is what place the intentional end has in the totality of human existence, the hierarchy of human values. The end which we aim for has to be taken in relation to the totality of our human existence (nature, other fellow human beings, communities and God) an interrelationship of ends. The moral end must be not be isolated and contradictory, but the good end must be relatively considered and integrated into the whole scope of human existence, the desirable level of humanity not the tyranny of a one-dimensional life. A hierarchical scale of values must be maintained and one must compare particular ends in relationality to the totality of a meaningful human existence.

Will the introduction of euthanasia help in this consideration? Is this what the government wants for Maltese society as a value amongst values?  Is this what Maltese society must look forward to in the future, that of the state helping us to kill ourselves? Do we want a society based on the outside of the useful and profitable rather than on the inside essentials of human spirituality and dignity? The government has much to answer for here, when considering the range and scope of human society and dignity! I must suggest that whoever came up with this bird-brained idea, should revert back to the drawing board.