CLC in Malta AVE Response 2025

CLC in Malta's Response to the Public Consultation Document about Assisted Voluntary Euthanasia

This paper has been prepared by members of the Christian Life Community (CLC) in Malta as a response to the Government’s public consultation on the proposed legalisation of Assisted Voluntary Euthanasia (AVE).

It reflects months of dialogue, personal discernment, professional reflection and spiritual commitment.

The document draws on our members’ life experiences and perspectives as professionals in the fields of medicine, ethics, theology, law, education, sociology, healthcare, academia and public policy.

Their contributions are synthesised here into a unified response that seeks to contribute constructively to the national dialogue on life, death, care and justice.

CHRISTIAN LIFE COMMUNITY (CLC) in Malta

info@clcmalta.org

June 2025

Executive Summary

1. Introduction

1.1 Christian Life Community in Malta
1.2 Context of the Public Consultation

2. Key Considerations

2.1 Suffering, Dignity, and Care

2.2 Language and Legal Clarity

2.3 Safeguards and the Slippery Slope

2.4 The Role and Integrity of the Medical Profession

2.5 The Role of Palliative Care and Compassionate Communities

2.6 The Broader Social Impact

3. Conclusion and Recommendations

3.1 CLC in Malta: Our Distinctive Voice

3.2 Recommendations

Bibliography

AUTHORS

Ms Maria Blanco

Rev Dr Carlo Calleja

Dr Edward Debono

Dr Anne Farrugia

Prof David Mamo

Dr Adrian Padovani

Mr Sandro Rossi

Dr Mario R Sammut

Ms Alison Vella

Prof Edward Warrington

This document has been approved and adopted by the CLC in Malta Leadership Community as CLC in Malta's official response to the document issued by the Government of Malta for 'Public Consultation on Assisted Voluntary Euthanasia'.

CLC in Malta Leadership Community

President: Ms Alison Vella

Vice President: Ms Cristina Spiteri

Members: Ms Maria Blanco, Mr Bernard Bugeja, Mr John Caruana

Secretary: Dr Mario R Sammut

Ecclesiastical Assistant: Fr Christopher Vella SJ

CLC in Malta represents 261 registered members (Database: April 2025)

EXECUTIVE SUMMARY

This paper presents the consolidated, discerned response of the Christian Life Community (CLC) in Malta to the Government’s 2025 consultation on the proposed legalisation of Assisted Voluntary Euthanasia (AVE). It is our contribution to a national conversation about the care of those approaching the end of life.

Our response addresses all those who hold dear the dignity and integrity of the human person, but it is especially an appeal to Malta’s legislators, who will shortly be called upon to enact the proposals that emerge from the consultation.

Drawing on the lived experiences and professional expertise of CLC members in medicine, ethics, law, theology, pastoral care, education, and the social and policy sciences, this paper articulates a firm yet compassionate opposition to the immediate legalisation of AVE. It does so not from a perspective of judgement or detachment, but as an act of civic responsibility and fidelity to the most vulnerable in our society. The paper is the fruit of extensive reflection, dialogue, and professional review carried out in a spirit of love, truth, and responsibility.

Our position emphasises that the legalisation of AVE is not compatible with Malta’s ethical tradition, nor with the country’s current social and healthcare needs.

Key concerns include:

● The complex nature of human suffering, which often stems from loneliness, fear, or a perceived loss of dignity – all of which can be compassionately addressed through holistic palliative care, not the intentional ending of life.

● The ambiguities and euphemisms embedded in the consultation document, particularly regarding definitions of death, safeguards, and mental capacity.

● The erosion of ethical safeguards over time in countries where AVE has been legalised, including Canada, the Netherlands, and Belgium, where eligibility has progressively widened and protections have correspondingly weakened.

● The threat to the moral integrity and the independence of the medical profession, whose vocation has always been to heal and comfort, not to administer or assist death.

● The exclusion of families from the decision-making process and the emotional trauma they may endure as a result.

● The legal and financial grey areas, particularly regarding insurance and institutional liability, with the misleading labelling of assisted deaths as “natural”.

● The risk of normalising death as a solution to suffering, creating a desensitised society and an unspoken pressure on vulnerable people to see themselves as burdens.

Central to the position of CLC in Malta is a call to give legal form to, and fully implement, the National Palliative Care Strategy 2025–2035, and to ensure equitable access to quality end-of-life care before any debate on legalising AVE is pursued. The paper also highlights the importance of Malta’s National Suicide Prevention Strategy (2025), which embodies the State’s commitment to life-affirming care. AVE stands in contradiction to these commendable national efforts, and risks undermining public health messages and mental health support.

Finally, CLC in Malta expresses its willingness to remain part of this national dialogue. While firmly opposing the proposed legalisation of AVE, the community offers its resources, expertise, and spirit of collaboration to shape policies that honour life, uphold dignity, and serve the common good.

This is not a rejection of compassion, but a call for a deeper, authentically humane response to suffering – one that places love, accompaniment, and community participation at the heart of patient care.

INTRODUCTION

1.1 Christian Life Community in Malta

The Christian Life Community (CLC) is a worldwide community of lay men and women of all ages and from all walks of life, who strive to participate in Christ’s mission by upholding the dignity of the person, the integrity of creation, and the promotion of justice for all, with a preferential option for the poorest and most vulnerable.

CLC in Malta has been established since 1967, and in April 2025 it brought together a national community of 261 members, divided into 23 small communities. As a registered NGO in Malta, we exercise our civic responsibility with a clear sense of community and mission, inspired by the spirituality and way of St. Ignatius of Loyola, founder of the Jesuit order. Our priorities include the formation of young people, attention to families, integral ecology, globalisation and poverty and active participation in both Church and civil society.

As a community committed to the dignity of life and the care of the vulnerable, we are in accord with the Church’s belief in the “seamless garment of life”, which is the metaphor representing the reality that all of us share one life. We reflect on various ethical considerations that concern life-decisions from the womb to the tomb. In the weeks following the publication of the consultation document, we have held an informative meeting regarding Euthanasia and Physician-Assisted Suicide with experts in the field, as well as constructive dialogue, and discerned within our small communities. A group of professionals from the medical, legal, policy, educational, social, healthcare, ethical and academic fields, all of whom are current or former members of our national community, were invited to write this consolidated, official response of the Christian Life Community (CLC) in Malta.

1.2 The Context of the Public Consultation

The publication of the Government’s Consultation Document on AVE marks a significant moment in the life of our nation. It opens a debate not only on law and health policy, but on our shared values as a society. As a Christian community committed to our participation in civil society, we welcome open, transparent and respectful discussion on how best to support people in a consistent ethical framework encompassing all life, including the most vulnerable and those facing end-of-life decisions.

However, we note with concern that the consultation document, while inviting feedback, presupposes a shift in policy direction without clearly presenting evidence of public demand, professional consensus, or health-system readiness. Furthermore, the framing of the issue does not adequately address the complex social, emotional, spiritual, and communal dimensions of dying.

Several contributors to this paper express reservations about the perceived haste of the consultation process. We question whether the Government has fully engaged with alternative and life-affirming approaches, particularly the strengthening of palliative care and community-based support. And we strongly maintain that it is not ethically permissible to debate ‘voluntarily’ ending lives in a health system that still fails to ensure proper care when a person approaches their end of days.

We believe the Government has a duty to ask deeper questions:

● What are the root causes of suffering at the end of life?

● What role should families, communities and social services play in supporting those who are ill and vulnerable?

● What kind of society do we become when the solution to distress is framed in terms of ending life?

These questions must precede – and not follow – any discussion about the legalisation of any form of euthanasia.

KEY CONSIDERATIONS

2.1 Suffering, Dignity, and Care

Any consideration of end-of-life care must begin by recognising that suffering is a complex, multidimensional experience. Beyond physical pain, individuals may experience deep psychological, emotional, social, and spiritual anguish – what palliative care specialists call “total pain.” Addressing such suffering requires “total care”: not only clinical support but also companionship, counselling, and spiritual accompaniment.

Medical opinion holds that the experience of suffering, if addressed properly and holistically, can be greatly alleviated without resorting to measures that intentionally end life. The reality of suffering raises profound questions, which need to be addressed:

● What does it mean to suffer?

● What does it mean to ‘die with dignity’?

● How should a compassionate society respond to those nearing their end of life?

● What is the impact on family and loved ones when faced with the heavy decision of voluntarily ending one’s life?

Contrary to the way it is sometimes portrayed, dying with dignity is not achieved by choosing the moment of one’s death, but by ensuring that each person is supported, valued, given adequate pain management, and never made to feel like a burden. In jurisdictions where assisted dying has been legalised, such as the Netherlands and Belgium, research shows that requests for euthanasia often stem not from uncontrolled physical pain, but from psychosocial suffering - including loneliness, existential distress, and a desire not to burden loved ones.

A 2021 Dutch study [1] found that 47% of general practitioners involved in euthanasia cases observed emotional burden and subtle pressure from relatives, especially in cases involving cognitive decline. Similar findings have emerged from Belgium, where patients frequently cite fear of dependency and loss of dignity as primary motivations. These patterns are echoed in other countries where assisted dying is legal, suggesting a consistent global trend: that the desire to die is often linked to relational and emotional factors - not just physical suffering.

Dignity is not sustained by personal autonomy only. It is enhanced by the experience of being loved, accompanied, and affirmed in one’s inherent worth until life’s natural end. To be human is to be vulnerable. The measure of a society is not how it enables people to escape vulnerability, but how it protects and honours vulnerable persons. True compassion does not eliminate the sufferer but embraces the person and the suffering.

In light of this, Malta’s policy makers should therefore focus on this complexity of human nature and relational care, to safeguard and affirm the dignity of every person as well as the common good.

2.2 Language and Legal Clarity

Clarity in terminology is essential in any ethical and legal discussion – especially when it concerns life and death. Unfortunately, the Government’s consultation document frequently uses language that is ambiguous or euphemistic, which undermines the transparency and credibility such a proposal requires.

The term “Assisted Voluntary Euthanasia” (AVE), as used in the document, masks what is in fact physician-assisted suicide – the intentional provision of means (usually a lethal prescription) by a healthcare professional so that a patient may end their own life. Euthanasia is the intentional act of ending a person’s life to relieve suffering, carried out by a healthcare professional or other designated person.

Meanwhile, important terms such as withdrawal of treatment and palliative sedation are not presented in the consultation document. Withdrawal of treatment is when the patient chooses to withdraw treatment when it becomes burdensome or when it is deemed futile. Palliative sedation is when a patient is given continuous deep sedation to relieve the distress and pain at the end of life. It is important to note that the latter two options are ethically and morally [2] acceptable to the Church, in so far as the end is to control pain and not to shorten the life of the patient, even though the life of the patient might be shortened as a result.

Equally troubling is the suggestion that deaths resulting from AVE be recorded as “natural” on official death certificates. Such a practice would not only obscure the true cause of death but would also distort national health statistics. And although the official records of AVE may be auditable and published, the discrepancy with the death certificates would make it difficult to measure, monitor and evaluate the long-term effects.

● If we can no longer distinguish medically-assisted death from natural-death, how will the real impact of these laws on society be assessed?

● Will relatives always be left wondering about the true circumstances of the death of their loved ones?

The consultation document also uses emotionally charged language – phrases like “dying with dignity,” “unbearable suffering,” and “the right to choose” – without sufficiently defining their scope or limits.

● What constitutes “unbearable” is always subjective.

● Human dignity is complex, as is “dying with dignity”.

● How do decision-makers and patients distinguish the “right to choose” from manipulation, subtle coercion or internalised guilt?

In the absence of clear definitions, these terms may be used to justify ethically troubling practices.

In addition, the proposed eligibility criteria, assessment procedures, and legal mechanisms are often vague and internally inconsistent. For instance,

● How can a six-month prognosis be confirmed with complete certainty? [3]

● What would ensure that “mental capacity” assessments are conducted rigorously?

● What distinguishes a person who has suicidal ideation and therefore needs help to regain mental stability from one who is considering physician assisted suicide?

● What procedures would exist for challenging or reviewing decisions?

The consultation document is remarkably silent on the practical realities – yet these are precisely where abuse and error tend to occur.

Language matters. Law depends on it. A compassionate society cannot afford to legislate based on sentimentality or imprecision. If Maltese policy-makers, legislation and institutions are to uphold the dignity of all, especially the most vulnerable, then clarity, truth and intellectual honesty must characterise our conversations about existential questions.

2.3 Safeguards and the Slippery Slope

A central claim of the Government’s consultation document is that any future law permitting assisted dying would include “strict safeguards” to prevent abuse. However, the experience of countries that have already legalised such practices shows that safeguards often fail to hold over time, and in some cases are quietly abandoned or diluted altogether.

Even when introduced with strict safeguards, Assisted Voluntary Euthanasia (AVE) may easily pave the way toward broader legalisation of euthanasia. International experience shows that safeguards tend to weaken over time. In Belgium, for example, euthanasia was initially legalised only for competent adults suffering with terminal illness. Today, it includes individuals with chronic conditions, psychological suffering, and is even available to minors.

While the consultation document insists that Malta’s law would be narrowly framed, there is little in its structure to guarantee that these limits will endure. Similar changes could be introduced quietly through administrative mechanisms and legal notices with limited or no public debate. In this regard, the Maltese experience with divorce legislation is instructive.

Once the legal and cultural threshold is crossed – that some lives can be intentionally ended – the scope of eligibility tends to grow, making the original safeguards difficult to enforce.

Even within the proposed limits, the safeguards as outlined are inadequate and poorly defined. There is no clear protocol for assessing mental competence, especially in patients suffering from depression, anxiety, or cognitive decline. There is no mention of a credible mechanism to ensure that a patient’s request is free of subtle coercion, internalised pressure, or external suggestion. Safeguards only work in theory. In practice, they rely on assumptions about the capacity, honesty and motivation of real people, which are factors that cannot always be verified.

Legalising Assisted Voluntary Euthanasia (AVE) would introduce serious uncertainties in insurance law. Health insurance policies, generally exclude any coverage for intentional acts. Most life insurance policies include a suicide exclusion period – typically one to two years – during which no payout is made if death is self-inflicted, including euthanasia. While claims may be honoured after this period in countries where euthanasia is legal, Malta’s current legal framework does not provide such clarity.

The Government’s proposal to classify assisted death as a “natural death” raises further concerns, potentially creating legal grey areas and undermining transparency. These implications must be fully addressed before introducing any legislative changes, to avoid unintended consequences for families, insurers, and the public.

The exclusion of family members from the decision-making process is particularly disturbing. While patients may have the legal right to keep such decisions private, their relatives are often left to carry the emotional and moral burden for years.

● What safeguard protects grieving families from being blindsided by a state-sanctioned death?

● What could possibly heal the wound of discovering – too late – that a loved one had made such a final decision, without any opportunity for dialogue, support, or intervention?

● What would be the effects on relatives and loved ones of not knowing whether the death was natural or self-induced?

There is deep grace in the act of accompanying a person as they take their final breath - a moment that should never be rushed, denied or hidden.

Another key vulnerability is the role of medical professionals and healthcare workers. Doctors and nurses who object to assisted dying may be legally exempt from providing lethal drugs – but under the proposed model, they would still be required to refer patients to colleagues who will. This requirement compromises conscience, effectively forcing clinicians to cooperate with actions they morally oppose, and which can cause acute personal and professional distress. It also raises long-term concerns about career progression, as professionals who object may find themselves excluded from certain institutions or roles.

Ultimately, laws are only as strong as their implementation. And no safeguard can undo a death that has already occurred. The burden of proof must lie with those who propose such a dramatic shift – not with those who urge caution.

2.4 The Role and Integrity of the Medical Profession

The question of assisted dying is inseparable from the vocation, professional identity and ethical standing of the medical profession. Medicine is not merely a technical discipline; it is a moral practice rooted in the duty to heal, to comfort, and to preserve life. While death is a natural part of life, intentionally causing it is not – and has never been – a legitimate part of a doctor’s role.

For centuries, this principle has been enshrined in the Hippocratic Oath, which clearly states: “Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course” [4] and thus a medical professional is prohibited from assisting a patient in following the procedure of voluntary euthanasia. This ancient ethic is not outdated; it remains a moral injunction, reminding physicians that their power must always serve life, even when a cure is no longer possible. Legalising assisted dying would undermine this foundation, recasting doctors not as healers, but as gatekeepers of death.

Contributors to this paper with medical expertise speak with conviction about the profound impact such a shift would have. Physician-assisted suicide distorts the mission of medicine. It requires doctors to cross a line that many entered this profession to avoid. It risks turning medicine from a vocation of presence and fidelity into a practice of efficiency and finality.

Advocates of assisted dying often point to patient autonomy. Yet patient autonomy cannot be the sole guiding principle in medical ethics – especially when the patient is vulnerable, depressed, or ambivalent about their worth. The deeper vocation of medicine is not simply to grant every request, but to care wisely, to act justly, and to affirm the dignity of life, even in its most fragile forms.

The consultation document’s commitment to honour conscientious objection is insincere, because objecting doctors will still be required to refer patients to a willing physician: their indirect, though enforced participation conflicts with their ethical convictions.

Over time, such tensions could divide the profession into two camps: those who participate in assisted dying and are seen as “compassionate,” and those who abstain and risk marginalisation. This would fracture the moral unity of the profession.

Physician assisted suicide and euthanasia take a cultural and psychological toll on healthcare professionals. In countries where assisted dying has become routine, such as parts of Canada and the Netherlands, clinicians report growing levels of moral distress, burnout, and pressure to comply. Exposure to repeated death in such circumstances can desensitise caregivers and dull their instinct for preservation.

The quiet erosion of medical conscience over years or decades is a cost too often ignored. Ultimately, assisted dying risks reframing medicine around conditional worth. Instead of asking, “What more can we do to care for you?” the question becomes, “Should we continue to care at all?”

That shift may begin subtly, but its long-term consequences are clear and profound: the exception eventually becomes the new standard. When healing no longer defines the centre of medical care, everyone – not just the dying – has reason to fear.

True medical care requires time, presence, and patience. It is built not on efficiency, but on fidelity. When the easiest solution becomes death, the more difficult but more humane solution of accompaniment risks being abandoned.

If we care about the soul of medicine in Malta, we must resist this shift. Those in the medical profession are not technicians of choice. They are guardians of life.

2.5 The Role of Palliative Care and Compassionate Communities

An authentically humane response to end-of-life suffering does not require the introduction of assisted dying. It requires the full development and accessibility of palliative care – a field that is already grounded in compassion, clinical expertise, and respect for human dignity.

Palliative care is not simply about managing physical pain. It offers holistic support: psychological counselling, spiritual accompaniment, family guidance, and symptom relief tailored to the needs of each person. In this respect, it embodies the very goals that proponents of assisted dying claim to pursue – without crossing the moral boundary of intentionally ending life.

In Malta, however, palliative care remains underdeveloped. Although the National Palliative Care Strategy 2025–2035 represents a commendable step forward, its implementation is still in the early stages. Access remains unequal, particularly for those with non-oncological illnesses or in community settings. Many people still die without adequate support, not because they choose to, but because the system does not reach them.

We welcome the statement in the consultation document explaining that the patient needs to be informed about alternative options available through palliative care. However, we believe that there needs to be a strong informative campaign aimed at for the general public in this regard.

To introduce assisted dying in a country where many cannot access basic palliative services is not only unjust – it is dangerous. Instead, Malta should prioritise the urgent rollout of its national strategy, investing in home-based care, multi-disciplinary teams, and public education on end-of-life support.

Equally important is the role of compassionate communities – families, neighbours, parish groups and civil society networks that accompany those who are dying. Medical care alone cannot carry the full emotional and existential weight of dying. It is through relationships, presence, solidarity and accompaniment that people find meaning, even in suffering.

As the EU Ageing Report 2024 highlights, Malta – like all European nations – is facing a rapidly ageing population. Rather than framing this as a burden to be “managed” through end-of-life shortcuts, we are called to respond with creativity and justice.

Investing in palliative care is not only the ethical response; it is also the only sustainable one for the true well-being of a nation.

2.6 The Broader Social Impact

Legalising assisted dying would reshape Malta’s moral landscape. Laws are never just regulatory – they are also formative. They express and affirm what a society considers acceptable, valuable, and desirable. Over time, laws influence attitudes, expectations in relation to human dignity, and the kinds of choices people feel they are allowed, or even expected, to make.

One of the greatest risks of legalising assisted dying is the subtle normalisation of death as a solution - particularly for those who feel old, ill, isolated, or dependent. We are deeply concerned that such legislation, even with “safeguards,” would send a cultural message: that some lives are no longer worth living, and that profound distress, needing help or becoming a burden is shameful.

What begins as a “choice to die” can subtly evolve into a “duty to die”. In a society where independence is idealised and dependency is stigmatised, those who are elderly, disabled, or chronically ill may begin to feel that choosing death is the “responsible” or “considerate” option. Even without explicit pressure, the legal availability of assisted dying can introduce a quiet moral expectation – that one should not be a burden, should not prolong suffering, should not cost too much. This shift is especially dangerous for those who are already vulnerable on account of isolation or diminished self-worth. Legal frameworks may insist on free choice, but cultural norms have a way of shaping those choices – subtly, but powerfully. A compassionate society must ensure that no one ever feels obliged to die to relieve others.

A final but very important point to note is that it is no secret that high-quality palliative care is costly and time-consuming, especially when it is comprehensive and person-centred, requiring substantial investment in personnel, infrastructure, home support, medication and training. In contrast, AVE may be perceived – implicitly or explicitly – as a quicker and less costly alternative. This creates an ethical risk: that the most vulnerable may be steered, however gently, toward a choice that relieves institutional burden rather than personal suffering. No person should ever feel that their continued care is “too expensive” or that choosing death is the responsible option.

International data reinforces these concerns. In jurisdictions where assisted dying has been legalised, requests for assisted death have expanded well beyond the original criteria. There is evidence of people seeking euthanasia due to loneliness, housing insecurity, or fear of institutionalisation. In these cases, the problem is social: hence, the response should be social solidarity, not medically induced death. A truly compassionate society ensures that economic constraints never become a hidden factor in life-or-death decisions.

In March 2025, Malta launched its first-ever National Suicide Prevention Strategy, a comprehensive five-year plan to reduce self-harm and suicide through coordinated, evidence-based action. Rooted in the national Mental Health Strategy (2020–2030), it reflects a strong commitment to safeguarding life and supporting vulnerable individuals. The strategy emphasises prevention, mental health literacy, access to crisis services, early intervention, and the responsible portrayal of suicide in the media. It includes initiatives such as school-based programmes, 24/7 crisis outreach, and strengthened psychiatric support in hospital and community settings. This national framework – built on collaboration between government, civil society and people with lived experience – demonstrates that when society is mobilised, alternatives to despair and isolation can be found. In this context, the legalisation of assisted suicide would send a contradictory message, undermining public efforts to prevent suicide at a time when the suicide prevention strategy calls for the affirmation of hope, resilience, and life-affirming care. It would be far better if the Government were seen to affirm these life-affirming choices. The opposite would put unnecessary strain on institutions – schools, parishes, clinics and care homes – that are already struggling to promote inclusion, resilience, and respect for life at all stages.

This shift would also profoundly affect families, the heart of all society. The burden of decision, the trauma of unresolved grief, and the lack of community rituals surrounding a death by suicide can leave lasting emotional scars. Families may also feel coerced – whether by resource pressures, by a patient's internalised guilt, or by the gradual erosion of cultural taboos.

In a small country like Malta, where community, family, and faith remain central to the social fabric, the introduction of assisted dying could accelerate a moral fragmentation we are not prepared to absorb. We risk building a society where the final message to the suffering is not “you are not alone”, but “you may leave if you wish”!

We believe that our society can do better.

The measure of our compassion is not how swiftly we induce suffering to end, but how faithfully we remain present to those who are suffering.

CONCLUSION and RECOMMENDATIONS

3.1 CLC in Malta: Our Distinctive Voice

While we acknowledge the emotional weight of the reflection on physician-assisted suicide and euthanasia, and the sincerity of those who support the government’s proposal, we must speak clearly and with deep conviction:

● Given the current ethical, social and healthcare needs in Malta, we are firmly opposed to the proposed legalisation of assisted voluntary euthanasia (AVE) or physician-assisted suicide.

We oppose it not out of fear or dogma, but out of a commitment to the common good, the dignity of those who would feel compelled to choose it because no better options really exist, and the conviction that suffering must be met with care – not abandonment or elimination.

Our position is grounded in four core convictions:

1. Human dignity does not diminish with illness or dependency. It is not defined by autonomy or utility, but by the inherent value of each person as a relational being.

2. True compassion means presence, not elimination. A society that responds to suffering by offering death loses its moral bearings. We must choose care, accompaniment and solidarity.

3. Legal safeguards are not sufficient. They often erode over time, and even when well-designed, they cannot undo the consequences of even a single mistaken, state-sanctioned death.

4. There is a better way. With investment in palliative care, support for families, and the building of compassionate communities, Malta can become a leader in affirming life and dignity at every stage.

CLC in Malta brings a particular sensitivity to these issues. We understand life as a sacred gift, entrusted to us not for control, but for stewardship. We are committed to forming conscience, and shaping a society rooted in hope and mercy. Once the threshold is crossed – that the State decides that some lives can be taken with impunity – we put ourselves into a very dangerous situation from which there is no turning back.

We do not stand outside the suffering. Many of our members have walked with dying relatives, supported patients in clinical settings, or faced ethical dilemmas in their professions.

We know that suffering is real, that fear can be overwhelming, and that silence can feel like abandonment. But we also know that when people are loved, listened to, and accompanied, they almost always choose life.

3.2 Recommendations

We respectfully appeal to policymakers to consider the following:

1. The State’s primary mission is to protect the life of every person living within its jurisdiction. The legislator’s primary mission is to craft laws that empower and oblige the State’s institutions and officials to discharge its mission justly, consistently and efficiently.

2. Considering the foregoing principles, the Government should revise its approach by giving clear and urgent priority, backed up by appropriate legislation, to the full implementation of the National Palliative Care Strategy and the National Suicide Prevention Strategy. It should ensure nationwide, equitable access to holistic end-of-life care and support the vulnerable. The primacy of palliative care and suicide prevention should be given legal status, before the legalisation of any form of euthanasia or physician assisted suicide.

3. Strengthen support for families and carers. Introduce flexible policies, respite care and psycho-social assistance for those supporting the ill and elderly.

4. Promote and invest in compassionate community models. Mobilise civil society, parish networks and other social communities, and local volunteers to ensure no one faces death in isolation.

5. Protect health professionals and those implicated in the implementation of this proposal. In all legislation requiring the participation of professionals, the right to conscientious objection takes priority over ethically dubious professional obligations. No healthcare professional should be pressured to participate in or refer clients for procedures that violate their ethical commitments.

6. Use clear and transparent terminology. Do not mask physician-assisted suicide and euthanasia under misleading euphemisms. Respect citizens by using honest, accurate language in all legal and medical contexts.

7. Support the continued development of the concept of a ‘Living Will’ as a standalone initiative. This important tool deserves its own mature, national discussion – not as an appendix to AVE – but as a way of encouraging society to engage more openly and thoughtfully with the realities of life, death, and medical decision-making.

8. Promote better public awareness and professional education on end-of-life care. Include ethical, psychological, and spiritual dimensions in the training of healthcare workers and the formation of public policy.

In opposing assisted dying we are not indifferent to suffering but are strongly affirming love and presence to the neighbour in need. We want to nurture a society that does not walk away from the dying, but walks with them – faithfully, humbly and without haste till the natural end.

Malta can become a leader in affirming life and dignity at every stage.

Let us be a nation known not for how efficiently we manage death, but for how courageously we uphold life.

CHRISTIAN LIFE COMMUNITY (CLC) in Malta

info@clcmalta.org

June 2025

Footnotes:

[1] Schuurmans, J., Crol, C., Olde Rikkert, M., & Engels, Y. (2021). Dutch general practitioners’ experience of burden by euthanasia requests from people with dementia: a quantitative survey. BJGP Open, 5(1), bjgpopen20X101123

[2] Congregation for the Doctrine of the Faith, Samaritanus Bonus, 2020, para. 7.

[3] Mandelli, S., Riva, E., Tettamanti, M., Lucca, U., Lombardi, D., Miolo, G., Spazzapan, S. & Marson, R., on behalf of the Via di Natale Hospice investigators, 2021. ‘How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy’, Support Care Cancer 29, 2093–2103

[4] Hippocrates of Cos, 1923. The Oath. Loeb Classical Library. 147: 298–299

BIBLIOGRAPHY

Abela, J., & Mallia, P., ‘Maltese Doctors: Views and Experiences on End of Life Decisions and Care’, Malta Medical Journal, 28 no. 2 (2016): 16-26.

Blundell R., Cini M., & Blundell K. (2024). ‘Palliative care with adequate pain relief challenges the need for euthanasia legislation’, History and Philosophy of Medicine, 6(2), 1-8.

Cini, M., Blundell, R., & Vella, S. (2023). ‘Exploring euthanasia in Malta: an intersectional analysis of medical, legal, and ethical perspectives’. History and Philosophy of Medicine, 5(3), 1-6.

Congregation for the Doctrine of the Faith, Samaritanus Bonus, 2020: para 7

Dugdale, L.S., & Callahan, D., ‘Assisted Death and the Public Good’, Southern Medical Journal 110, no. 9 (2017):559-561.

Ellul, G.J. ‘The Right to Die: Perspectives of Mental Health Professionals in Malta.’ European psychiatry 64, no. S1 (2021): S373–S374.

European Commission, Directorate‑General for Economic and Financial Affairs & Economic Policy Committee. (2024). 2024 Ageing Report: Economic and Budgetary Projections for the EU Member States (2022–2070) (Institutional Paper 279). Published 18 April 2024. Available at: https://economy-finance.ec.europa.eu/document/download/971dd209-41c2-425d-94f8-e3c3c3459af9_en?filename=ip279_en.pdf

Francis, Pope. Evangelii Gaudium: Apostolic Exhortation on the Proclamation of the Gospel in Today’s World. Vatican.va. November 24, 2013. Available online at https://www.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20131124_evangelii-gaudium.html

Government of Malta, National Suicide Prevention Strategy for Malta 2025 - 2030. Available online at https://health.gov.mt/wp-content/uploads/2025/03/National_Suicide-Prevention_Strategy_for_Malta_2025-2030.pdf

Government of Malta, Public Consultation Document on Voluntary Assisted Euthanasia, 2025. Available online at https://facts.mt/proposti/#flipbook-df_824/1/

Hippocrates of Cos, 1923. The Oath. Loeb Classical Library. 147: 298–299.

John Paul II, Pope. Evangelium Vitae: Encyclical Letter on the Value and Inviolability of Human Life. Vatican.va. March 25, 1995. Available online at https://www.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html

Jones, D.A., & Paton, D., ‘How does legalization of physician assisted suicide affect rates of suicide?’, Southern Medical Journal 108, no. 10 (2015): 599-694.

Malta Hospice Movement, Position Paper on the Draft Document on Assisted Voluntary Euthanasia (n.d.). Available online at https://hospicemalta.org/wp-content/uploads/2025/05/Hospice-Malta-Position-on-the-Draft-Document-on-Assisted-Voluntary-Euthanasia.pdf

Mandelli, S., Riva, E., Tettamanti, M., Lucca, U., Lombardi, D., Miolo, G., Spazzapan, S. & Marson, R., on behalf of the Via di Natale Hospice investigators, 2021. ‘How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy’, Support Care Cancer 29, 2093–2103.

Medical Association of Malta, Position Paper on the Consultation Document, 2025. Available online at https://mam.org.mt/mam-position-on-governments-draft-on-assisted-voluntary-euthanasia/

Ministry of Health and Active Aging, National Palliative Care Strategy for Malta 2025 - 2035 (n.d.). Available online at https://health.gov.mt/wp-content/uploads/2025/04/Palliative-Care-Strategy-March-2025.pdf

Preston, C., ‘Assisted Dying: The evidence from abroad’, in The Reality of Assisted Dying: Understanding the Issues edited by Julian C. Hughes, Ilora G. Finlay, 29 - 36, Denmark: Blackwell, (2024), 33.

Schuurmans, J., Crol, C., Olde Rikkert, M., & Engels, Y. (2021). Dutch general practitioners’ experience of burden by euthanasia requests from people with dementia: a quantitative survey. BJGP Open, 5(1), bjgpopen20X101123. Available online at https://doi.org/10.3399/bjgpopen20X101123.

WONCA Europe, 2023. The European Definition of General Practice / Family Medicine. Ljubljana: WONCA Europe – the European Regional Branch of the World Organisation of Family Doctors.

Christian Life Community in Malta (CLC) on AVE 2025