Following Government’s launch of the public consultation in relation to Assisted Voluntary Euthanasia,
Hospice Malta has viewed the published document and is hereby stating its position.
Hospice Malta acknowledges that this topic is a sensitive one and evokes significant emotive reactions on
many levels, be it a society, a community or an individual level. Hospice Malta’s mission, firmly rooted in the
principles of palliative care, is the preservation of life in a dignified manner until its natural end. This principle
that continues to guide our mission also reflects the values upheld internationally by professional palliative
care providers and social health care organisations alike.
Comprehensive palliative care to patients and their families includes the provision of a number of professional
services and support in various settings – within the community, through day therapy and through inpatient
services. Hospice Malta has pioneered community palliative services and Day services for the last 30 years
and is now on track to start operating Palliative inpatient services in the coming months.
Hospice Malta strongly believes that all energy and resources should focus on developing and strengthening
these types of services so that patients and their families can benefit from the care that addresses not only
the physical pain, but also the emotional, social, and spiritual distress that normally accompany this phase
of life. At this critical juncture, Hospice Malta robustly affirms the importance of investing in and expanding
access to 24/7 comprehensive palliative care nationwide. This sentiment is reflected in the National Strategy
for Palliative Care launched earlier on this year that calls for further development of existing services and
new development of support services.

The Value of Palliative Care:

1. Holistic Support: Palliative care addresses physical pain, emotional, social, and spiritual distress of
patients and their families.
2. Preserves Dignity: It supports patients in maintaining quality of life until natural death, in comfort
and with deep respect and compassion. This occurs in the context of advanced care planning where
decisions are discussed with the patient and their relatives to enable the adoption of an agreed
management plan. This may also involve, discussion on non-treatment decisions in order to fully
address the dignity and quality of life of the individual.
3. Family Involvement: It supports families and caregivers, preparing them for bereavement and offering
them continued support.
4. No Ethical Conflict: Palliative care principles are in alignment with most religious and ethical traditions
that affirm the sanctity of life.

Challenges Faced by Persons who are Seriously Ill:

Patients living with serious illnesses face a range of complex and distressing challenges, including:
• Actual or anticipated physical suffering
• A deep sense of being a burden on their loved ones
• Psychological and/or spiritual pain and distress
• Social isolation

These issues can be addressed around the clock through the immediate support of trained professionals and
through access to the appropriate medication and equipment.In addition to clinical support, families also require:

• Practical assistance, including medical equipment, carer support, and respite care outside the
domestic homeasnecessary
• Psychological, social, and spiritual support for both patients and their loved ones, made available at
the time of need
• Help lines and immediate access to services in moments of crisis.
• Companionship both at home and outside the home

Hospice Malta has been providing these services for over thirty years, expanding and introducing services
gradually according to the availability of its resources whilst ensuring continuity and sustainability. The ever
increasing demand for these services necessitates that all adequate human and financial resources are in
place in a timely and consistent manner.

Addressing the Gaps in Palliative Care:

Although progress has been made over the years, there is ample room for improvement in Malta’s palliative
care landscape. Identified gaps include:
• The implementation of the palliative care strategy recently launched by the Ministry for Health.
• Greater financial investment to support service growth and accessibility.
• Expansion beyond oncology to all limiting illnesses.
• Improved community-based medication access, with patients fully supported in their own homes.
• More educational efforts targeting both the healthcare sector and the general public, to foster full
understanding of palliative care principles.
• Providing more services and educating the public on a more compassionate society to avoid loneliness
and isolation.

Hospice Malta’s current reach is approximately 60% of patients with a diagnosis of cancer who pass away
annually, which indicates that many patients may possibly not be requesting and/or receiving the level of care
they deserve at the end of life. The need for further education and awareness of Hospice services is evident.
We also believe that Malta’s small geographical size offers a unique advantage. Unlike larger countries,
patients in Malta can be more easily reached in their homes, allowing for truly patient-centred care that
enables people to remain in their home environment with adequate support.

Ethical Implications:

The experience of other countries suggests that following the introduction of euthanasia legislation, the quality
and investment in palliative care services often declines. This is deeply concerning. The right response to
human suffering is not to shorten life, but to ensure quality of life even during its final stages until its natural
end. With appropriate resources, no person should feel that eutanasia is their only option. In addition,
Hospice Malta supports the concept of advanced care planning (as opposed to a living will/advance directive)
where the emphasis is on discussions with the patient, the aim being to respect the dignity and quality of life
of the patient and avoid extraordinary measures at the end of life.
Hence, it is imperative to ensure the availability of comprehensive palliative care before considering
irreversible policy changes. Informed decisions must be grounded in real and informed access to care, not in
the absence of it.

The Way Forward: Strengthening Palliative Care as a National Priority
Hospice Malta acknowledges the support already received through funding agreements with the Ministry
for Health and the Ministry for Social Policy and Children’s Rights, as well as donations from the public and
corporate sponsors. However, further investment and strategic collaboration are required to:

• Expand the palliative care workforce (HR).
• Ensure 24/7 availability of services across all care settings.
• Provide necessary medications in the community without delays.
• Develop educational programmes for healthcare professionals and the general public.
• Work towards a more compassionate and inclusive society, where amongst other things, Advance
Care Planning is promoted as part of the holistic care of patients.

Hospice Malta believes that supporting palliative care is the most ethical and humane way to care for those at
the end of life. Rather than the introduction of processes to end life, the emphasis should be on the advocacy
for greater investment in crucial services that protect life and uphold the dignity of each person.

To read Hospice Malta’s full position statement, please click here to view the PDF.