“Without universal access to effective symptom management, psychological support, and well-staffed, empowered hospice care, patients may be left with no meaningful alternative—rendering assisted voluntary euthanasia (AVE) a decision driven by lack rather than autonomy,” the association said.

Palliative Care “Nowhere Near Ready”

MAM argued that legalising AVE before fixing the country’s palliative care system is putting the cart before the horse.

Such care currently lacks adequate infrastructure, personnel, and training, access to essential end-of-life medications and support services like psychological care and home assistance, MAM explained.

They warned that this could lead to people feeling pressured to choose death simply because they aren’t being given enough help to live with dignity.

Citing international examples, MAM pointed out that countries which legalised euthanasia — like Canada, Belgium, and New Zealand — later saw a drop in their global palliative care rankings. The association warned Malta not to repeat the same mistake.

Ethical and Legal Concerns for Doctors

Doctors are also left exposed by the current draft, MAM said. While the proposal mentions conscientious objection, it fails to clearly define whether doctors can opt out of referral pathways or what legal protections they would have.

The association is calling for:

• Stronger protections for healthcare professionals who object.
• Clearer definitions of terms like “assisted dying” and “undue pressure”.
• A national ethics panel to guide complex decisions.
• A rethink of the six-month prognosis clause, which MAM says is unreliable.

‘This Is Premature’

MAM’s overall position is that while discussions around AVE are important, the country’s healthcare ecosystem is not ethically, clinically, or operationally ready for such a major shift.

They are urging the government to prioritise investment in Malta’s struggling palliative care system before opening the door to assisted dying.

To that end, MAM laid out a series of urgent recommendations it says must be implemented before Malta can safely and ethically consider legalising assisted voluntary euthanasia. These include:

• A full national audit of Malta’s palliative care system and access gaps.
• Strategic investment in 24/7 community-based palliative care.
• Fast-tracked access to essential palliative medications, social services, home aids, and psychological care.
• Creation of an independent ethical review panel involving palliative physicians, pharmacists, bioethicists, social workers, and international experts.
• Clear legal protections for conscientious objectors, including those unwilling to refer.
• National guidelines for ethical and clinical end-of-life decisions, including DNAR, treatment withdrawal, and palliative sedation.
• Mandatory education for healthcare professionals, patients, and caregivers on palliative care options.
• The removal of the six-month prognosis requirement, which MAM says is clinically unreliable.
• Clear, enforceable definitions for key terms such as “assisted dying” and “undue pressure”.
• Strong safeguards to prevent coercion — noting that in other jurisdictions, patients often cite feeling like a burden or facing financial distress as reasons for choosing AVE.

“Let us first ensure that no one chooses to die because we failed to help them live with dignity,” the association concluded.

What’s your take on the euthanasia debate?