Assisted Voluntary Euthanasia or as it is known in some jurisdictions, Medical Aid in Dying, is a medical practice that allows a terminally ill, mentally capable adult with a prognosis of six months or less to live to request from their doctor a prescription for medication they can choose to self-administer in order to die peacefully and on their own terms. Given the patient's condition and the fact that the medication is self-administered, this is not considered assisted suicide, suicide, or death at the hands of another person. The law is intended to be a supportive end-of-life option that provides dying people with peace of mind and comfort during a difficult time when all other options have been exhausted.

At present, several countries authorise assisted death, including Holland, Luxembourg, New Zealand and Canada. Medical aid in dying has been in use in the U.S. since 1997, when it was first signed into law in the State of Oregon following approval by voters. A similar law went into effect in New Jersey in 2019, and today, it is legal in eleven states and Washington DC. As the New Jersey Chief State Medical Examiner responsible for the oversight of the program, one of my main concerns with assisted voluntary euthanasia was always the potential for abuse.

The laws in the US established core safeguards that include informing the terminally ill adult requesting medical aid in dying about all other end-of-life care options and that they can change their mind at any time while offering the individual the opportunity to rescind their request. These core safeguards ensure that individual patient preferences, needs and values are honoured, and guide all clinical decisions, including the decision to use medical aid in dying.

When discussing the recommendations regarding the introduction of Assisted Voluntary Euthanasia in Malta, the Committee kept the proposal of enhanced safeguards at the forefront of the discussions. Having the advantage of learning from the experiences in other jurisdictions, several enhancements were made to ensure that patients would be able to make the decision of their own free will, without any coercion from healthcare providers, relatives, or any other interested individuals. These enhanced recommendations include:

• Adding a third doctor, namely a psychiatrist to the initial certifying doctors. This would ensure that the patient is mentally competent to make their own informed decision. Furthermore, the psychiatrist would be in a better position to diagnose and treat any underlying depression as this could result in suicidal ideation, thereby impairing their decision-making ability.
• Having a Regulatory Board meet, review and approve an application for Assisted Voluntary Euthanasia before a prescription is issued, to ensure the patient meets all the necessary criteria to qualify for the program.
• Making it a crime for a healthcare providers to suggest or recommend Assisted Voluntary Euthanasia to any terminally ill patient.
• The medication be handled only by healthcare providers up to the point where the patient self-administers it, and any remaining medication and all medical equipment be returned to the government pharmacy within 24 hours. Given the nature of the medication, this eliminates the possibility of any accidental ingestion or abuse of the medication.
• A healthcare provider must be in attendance when the patient self-administers the medication to ensure that the procedure proceeds safely and without any undue distress for patients and their loved ones.
• Furthermore, the assessment of the patient and the necessary medication are provided free of charge. The process is prohibitively expensive in most countries, limiting the availability to only those who can afford it.

In many cases, one's personal feelings about the subject are informed by their own experiences with death and illness, and arguments in favour and against will always be made. The committee's proposals include layers of safeguards to ensure that no one individual is coerced into proceeding with the procedure, while respecting the opinion of patients and healthcare workers who disagree with the concept.

No one should consider Assisted Voluntary Euthanasia lightly, and not all people who receive approval will go through the process. For a terminally ill patient, having that option granted to them often provides a sense of control that makes it easier for them to cope with their illness or with natural death. At the end of the day, when one's quality of life has become unbearable, whether due to physical pain or loss of dignity, the terminally ill patient should be provided the necessary support and so that every Maltese resident gets the right to face their final chapter with peace, dignity and control.

Dr Andrew Falzon is a member of the committee that drafted the proposals on Assisted Voluntary Euthanasia