Patients with numerous incurable diseases in Malta are being denied access to essential palliative care medications, including morphine for pain relief, due to restrictive prescribing guidelines that medical professionals say need urgent updating.
The country’s most recent Outpatient Formulary List, published in May, permits doctors to prescribe morphine—either by injection or tablet—only to patients with Motor Neuron Disease (such as ALS), spinal cord pathologies including spina bifida, trigeminal neuralgia, and malignant diseases including various forms of cancer.
However, the formulary excludes many other terminal conditions, meaning patients with end-stage heart failure, respiratory failure, and kidney failure cannot receive morphine to alleviate pain and other distressing symptoms, according to medical professionals working in palliative care.
The restrictions appear at odds with international medical guidance. In 2021, the European Society of Cardiology published guidelines for heart failure diagnosis and treatment that specifically mentioned the administration of opiates, including morphine, as effective additional treatment for patients at the end of life.
“There is no valid reason for this deficiency in the medical system,” said a medical doctor working in palliative care, who stressed the importance of making palliative care more widely available to serve all patients with incurable diseases.
Despite the formulary being updated monthly, appeals have been made to expand the list to include patients with other terminal conditions who could benefit from morphine and similar medications.
Recent reports have suggested Malta faces significant shortages in palliative care medications compared to World Health Organisation recommendations, though medical professionals contacted disputed the scale of these shortages whilst acknowledging that gaps do exist.
Professor Ilora Finlay, a palliative care specialist and member of the UK House of Lords, told Newsbook Malta in an exclusive interview that whilst palliative care in Malta shows “great potential,” it remains “in its infancy.” She noted that palliative care professionals in Malta “can be counted on one hand,” though praised their efforts to improve care within existing constraints.
The concerns over palliative care provision have emerged during ongoing public consultation on voluntary assisted euthanasia. The consultation, which runs until 2 July, seeks public input on principles and safeguards through the facts.mt website.
Several medical experts have argued that strengthening palliative care services should take priority before considering assisted dying legislation.
The Life Network Foundation has launched a campaign called ‘Kill the pain, not me’ opposing euthanasia legalisation whilst calling for improved palliative care. “Malta does not need assisted suicide but it does need the best care for those who are nearing the end of their lives,” said the Foundation’s CEO, Miriam Sciberras.
The Catholic Church has voiced opposition to voluntary assisted euthanasia, stating it conflicts with Catholic teaching and expressing concerns about potential abuse.
Additionally, 134 academics from the University of Malta published concerns that such legislation could diminish public trust in medical institutions and fundamentally alter Malta’s values.
Source: Newsbook.com.mt