The Malta Association of Public Health Medicine (MAPHM) on Thursday voiced serious concerns over the government's proposed legal framework for Assisted Voluntary Euthanasia (AVE), calling the move "premature" and "ethically troubling." In a detailed submission to the ongoing public consultation, the MAPHM aligned itself with the Medical Association of Malta (MAM) and raised a host of scientific, ethical, and procedural objections to the proposed legislation.
The most significant critique centres on terminology. MAPHM contends that the proposal inaccurately uses the term "Assisted Voluntary Euthanasia," more closely resembles "Physician Assisted Suicide" - a key distinction recognised by both the World Medical Association (WMA) and the European Association (WMA) and the European Association for Palliative Care (EAPC). Notably, MAPHM points out a direct contradiction between the AVE proposal and Malta's National Suicide Prevention Strategy 2025-2030, which was launched for consultation just months ago.
In their submission, MAPHM criticised the lack of evidence based justification for the proposed legal change, noting the absence of both local and international data to support its necessity. Moreover, the Association expressed dismay at the apparent lack of transparent stakeholder consultation, arguing that such a profound ethical and societal issue demands broad and inclusive expert engagement.
A key concern raised involves the potential erosion of public trust in the medical profession. MAPHM warned that AVEm if legalised, risks undermining the foundational ethics of medicine, which prioritise care and the preservation of life. They emphasise that the ongoing implementation of Malta's National Palliative Care Strategy (2025- 2035) should be completed before considering AVE legislation. The group underlines that no one should feel compelled to end their life due to inadequate palliative support.
MAPHM also called attention to the glaring lack of legal recognition for Advance Care Directives in Malta- documents that allow individuals to express their end-of-life care preferences. The Association believes these directives should be legally enshrined and considered as a standalone policy issue rather than an afterthought in AVE discussions.
The submission warned against the risk of a "slippery slope" should AVE be introduced. Drawing on European and North American examples, MAPHM notes how initial safeguards in other jurisdictions have eroded over time, eventually allowing euthanasia for psychiatric conditions and non-terminal illnesses. In Malta's small, close-knit society, such developments could raise significant ethical and logistical challenges, particularly with potential involvement from private entities driven by commercial interests.
Additionally, the Association rejects the proposal that death certificates classify AVE-induced deaths as "natural," asserting that mortality statistics must reflect actual circumstances for public health accuracy and transparency.
On the issue of conscientious objection, MAPHM insists on full professional autonomy, including the right of all healthcare workers-and students-to opt out without obligation to refer patients elsewhere.
MAPHM also highlighted the general public's confusion between AVE and palliative care, as evidenced by recent UK surveys, and urges caution in interpreting Maltese public opinion polls.