If one had to ask me whether the current proposal for euthanasia when put forward as a bill will pass through parliament, or even, if put forward for a referendum, whether it will pass or not, I would say that as things stand, yes, it will. The reasons are simple.

First public consultation is not public information. There is a difference in having a space (be it physical or online) where to express one's opinions. It is merely a sounding device for the government to take a poll. Giving proper information however also means educating and giving enough information for one to effect an informed decision without any controlling influences.

The second is that we are not giving optimal palliative care to all, and even where we do, with the exception of Hospice, it is not ideal. I have personally witnessed dying relatives experiencing the agony of death and not receiving enough morphine. Not only, both the nurse and the doctor told us that they were receive, I quote, 'the maximum' dose. Well, there is no maximum dosage in palliative care. Perhaps they were waiting for the consultant to give the go-ahead to increase? Perhaps they did not have a protocol to call the senior on call? The fact is that people still die, if not in pain, in some form of agony or suffering.

To be sure I have no statistic on this and there are many people who die well and without pain and with what we refer to 'with dignity'. But it goes to show that even health care professionals need more than a superficial training in palliative care, and the truth of the matter is that many of them have not received any training in this area other than a few lectures during their degree. Palliative care is a speciality, yes, but there are certificates which give health professionals, especially doctors and nurses the training and theory to handle hospital patients. All should be versant.

Moreover, when a doctor is called it is usually the foundation doctor, who is the most junior of the firm. Certainly it is difficult, if not impossible, for a foundation doctor to increase morphine according to standards without training, authority and experience (I say experience because it takes a toll, a risk, knowing that the patient may die after the dose increase - which is morally accepted but which has seen complaints, grumbling and even threats of litigation).

So...when people are going through or hearing about this experience, it is no wonder that people say yes to euthanasia, giving reasons like, 'why should people die in pain?", or, "why should someone suffer". But the main question is ought we to give a right to euthanasia without yet having given the universal right to palliative care yet. Had we done this things would have been different because morality does allow you to give higher doses even if they indirectly cause death. In fact doses of morphine are usually double and it takes a strong character to double when you have already done so a number of times. Given that there are leeways, the fact it we can increase doses, and whilst many, perhaps rightly so, see this as equivalent to euthanasia anyway, it is not because the intention is to kill but to relieve suffering (in fact morphine is used, and not substances which stop the heart from beating further). Secondly it is a foreseen but unintended har, and moreover it is proportionate to the situation. These condition are often referred to as the principle, or doctrine, of double effect whereby a foreseen harm can be caused if the action is itself good, the harm is foreseen and indirect, and there is proportionality (death is still the eventual outcome).

Unfortunately people are not seeing this difference and one can hardly reach out at this stage. What do they mean by 'informa ruhek'? Where? Physical public consultations lead only to polarized emotions and indeed without information they will vote based on this feeling. Mind you, feelings do count; but ethics and morality are not only a feeling. Certainly we do not want to suffer, let alone see our relatives or friends suffer. Conversely giving them false hope which induces them to withstand some suffering is not ethical in and of itself, although this depends on the situation. One should say that they will increase the dosages if they are suffering or uncomfortable. Therefore one is not going against the concept of a natural death.

Now the proposal as it stands is for people deemed to have less than six months to live. There may be a place for euthanasia when we keep people alive following accidents or disease and they remain paralysed or severely handicapped to the extent that they cannot even leave their beds. This is unethical and abandonment. If we are not ready to take good care of these people, and even to discuss with them before putting them in that situation, whether they would rather be left alone with the possibility of dying, then the battle for euthanasia will reasonably win because no one wants to suffer.

Incidentally when we speak about palliative sedation, it is through the same medication and given for the last few hours until the patient dies. It is not as someone pointed out, to be a 'vegetative state'.

But this proposal is about where palliative care ought to be working - a replacement, as it were. It is the area of palliative care. And should the proposal go through to law it will show that we have failed in our training of palliative care. It is ironic that the final Palliative Care Strategy of the Ministry of Health came out at the same time as the proposal for euthanasia at the end of life. It is contradictory and one works against the other. I hope and trust that reason will prefer the right to the former.

Pierre Mallia is Professor of Family Medicine and Patients' Rights, and teaches Biomedical Ethics 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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