• Honourable Member of Parliament,
    In the coming days, the issue of medical assistance to the dying with the intention of terminating their life, that has emerged in our country, will be discussed in a number of Parliamentary Standing Committees.
    As the Bishops of many whom you represent in the Maltese Parliament, we are writing to you this letter to express our concern about this matter and at the same time share with you the following ethical and moral considerations:
    1. We strongly believe in the respect of the dignity of human life that every citizen has the right to enjoy throughout all the stages of life, from conception to natural death. This belief is the foundation of every civilization built on the protection of the rights of every human being, among which is the fundamental right to life. The objective of the law is to provide protection to every human life, in particular when this is disadvantaged and vulnerable, rather than to facilitate and promote its termination. Every society that weakens the legal prohibition of intentional killing of a human being would be eroding its moral and social fibre.
    2. When a citizen becomes dependent, weak or vulnerable due to sickness, disability, or severe suffering, a modern society is expected to respond with solid and sensitive structures that provide solace and encouragement so that no one is marginalised, falls behind or is considered a burden on others. A society shows its merciful countenance when vulnerable people are neither abandoned or better, when it does not introduce legal protection for medical assistance with the aim to accelerate the process of death. On the contrary, we should consolidate the medical service of palliative care and continue to broaden the net of social solidarity through valuable free of charge services that the Hospice Movement is already providing in the community to so many patients with terminal illness and their relatives. High quality and efficient services in this area of medical expertise offer not only comfort and great support to the patients and their relatives, but they also instil peace of mind in society.
    3. The right to life is a fundamental right of every person and therefore the obligation arises that life should be respected from the beginning to its natural end. Every person has the right to treatment and society has the moral obligation to provide medical services to safeguard this right to life. The patient reserves the legal and the moral right to refuse disproportionate medical treatment, that is, treatment that does not offer any hope of benefit, involves exorbitant costs or inconvenience, and incurs severe pain and suffering. The decision to withhold or withdraw a medical treatment because of these reasons, while at the same time maintaining palliative care, is ethically different from the request of a patient to medical assistance to accelerate the process of death. While in the first instance, the intention is to refrain from any medical intervention out of respect for the natural process of death, in the second instance, the intention behind the medical intervention is to kill the patient. “Thus an act or omission which, of itself or by intentions, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator” (Catechism of the Catholic Church, 2277).
    4. Nowadays everyone appreciates the strong sense of autonomy that a person enjoys. Everyone desires to take control of one’s life in order to fashion life responsibly according to one’s wishes and plans. This is a big step forward in today’s civilisation! However, this autonomy does not mean that one has the right to unilaterally decide to end one’s life because of severe suffering, disability, or for other inconvenient reasons. The protection of life exceeds the right to liberty. The request of the patient to be given medical assistance that directly causes death, even when death is imminent, is not a question of freedom of choice. The autonomy enjoyed by every human being is not absolute or unlimited. The protection of human life, in particular when this is helpless and vulnerable, is an ethical and legal principle that goes beyond the principle of autonomy. If in this context, the principle of autonomy is understood in the absolute sense, then this impoverishes the medical vocation by reducing it to a mere “technical” function whereby the doctor performs whatever the patient wishes. In such a case, the doctor would betray his or her mission by causing death rather than protecting human life. A change in the law regarding the protection of human life would be a change in the culture and mentality of our country in how we would start perceiving our elderly, people with chronic illness, people with disability or other conditions.
    5. There are those who argue that when the patient loses his or her quality of life because of conditions related to severe pain, physical or mental disability, or absolute dependence on others, life loses its value and therefore the wish of those who have become tired of life and have lost the will to fight its battles, should be respected. We do understand the psychological and physical suffering that the patient and relatives would be going through. We stand shoulder-to-shoulder with each person undergoing these bitter experiences of suffering. This said, however, we believe that the value of human life does not depend on sickness or health. We believe that the medical assistance given to the patients for the abrupt termination of life could never be in his or her best interest.
    6. We remind those members of the medical profession who might be coerced into terminating someone’s life, that a law that obliges anyone to go against one’s conscience, is an unjust law.
    7. We appeal to each Member of Parliament to continue safeguarding the dignity of human life at every stage, from its conception to natural death. Among the best achievements that our country has striven for and nurtured in our Maltese culture throughout these long years, is the respect for human life at every stage. This is our national heritage that we must continue to cherish and consolidate in order to pass it on intact to future generations.
    8. We must express our deep appreciation to many families who continue to treasure the terminally ill, the elderly and vulnerable persons, by choosing to provide care in their own home. The love and empathy that these families demonstrate when they accompany these persons during these difficult times, even when they are in hospitals, is a sign of a unique human civilization. We appeal to our Maltese and Gozitan brothers and sisters to foster these acts of mercy and to continue to strive for a better society whereby no citizen of our country would be abandoned in his or her illness or chronic condition.
     ✠ Charles J. Scicluna                                                              ✠ Mario Grech
          Archbishop of Malta                                                                Bishop of Gozo