Some Reflections on the Debate on PAS and Euthanasia, and

on the Pedagogical Implications It Ought to Have on the

Teaching of Ethics and Religion

Bernard Cauchi bernard.cauchi@gmail.com Michael Grech michael.grech@um.edu.mt This article is a meta-article; not taking a side in a debate – the debate concerning the law on euthanasia or actually Physician Assisted Suicide PAS, (which is what the law fundamentally legalizes), kick-started by the government in May 2025i^ – but reflecting on the debate itself. It claims that in various respects the debate was undertheorised. In this regard, it points out how two concepts, which figured highly in the debate, autonomy and dignity, were generally used by participants to the debate. It also notes two prominent lines of argument that evidence undertheorising. The second part of the paper takes into account some educational implications of the debate. In light of the reflections presented in the first part, it considers what interested groups in subjects like Ethics and Religious Studies should learn from the public discussion. Conceptual shortcomings The paper claims that the debate concerning PAS/euthanasia was undertheorised. Some of the undertheorizing concerned some of the concepts employed. There was confusion already with the claim that the debate is about euthanasia. Euthanasia is: ‘the act of deliberately ending a person’s life to relieve suffering’. ii^ It can be voluntary (if sanctioned by the

patient) or involuntary if not. It may be performed by a person other than the patient, for instance, a medical professional who administers a lethal injection to a suffering patient. Assisted Suicide, on the other hand, involves: ‘the act of deliberately assisting another person to kill themselves.’

iii (^) Since the Maltese bill primarily envisages that it is: ‘the patient themselves who carries out the final procedure that leads to the end of their life’,iv^ and since the bill also stipulates that a: ‘medical professional must assist the patient in following the procedure’,v^ one should speak of a type of Assisted Suicide, Physician Assisted Suicide (PAS), rather than euthanasia.vi^ Yet, for some reason or other, the term suicide did not feature in the governmentpublished consultation document.vii^ (The only proviso the bill makes for individuals other than the patient to carry out the procedure involves cases where the patient him/herself is physically unable to do so: ‘In cases of physical health limitations, the patient may delegate this task in writing through a health proxy to a trusted person.’).viii^ This raises the question of why this confusion. The paper, however, focuses on other shortcomings, related to two concepts which featured considerably in the debate: autonomy and dignity. Autonomy ‘Autonomy’ is a rich, but also contested, term. Broadly speaking, it can be defined as having one being the author of one’s: ‘own life, free from the arbitrary authority of others….[and] from ‘external’ forces’.ix^ Off the cuff, the notion seems to imply living one’s life according to one’s own: ‘explicit wishes’.x^ This seems to be at least how most participants in the debate understood the term. Indeed, not merely do most of them assume that this is how ‘autonomy’ is to be understood but that, as a matter of fact, ‘autonomy’ so understood is a value worth upholding. Thus, on the pro-legislation side (henceforth the pro-side) the philosopher Kenneth Wain, defines the: ‘principle of personal autonomy…[as] the individual[‘s] right to choose for oneself how one wants to live and die’.xi Similarly, the Malta Humanist Association states that people have the: ‘right to choose the manner and timing of their own death [and] if circumstances warrant it….[they] should be free to decide their own destiny and life-experience’.xii^ The only limit to one’s choices shall be that these choices do: ‘not result in harm to others.’xiii^ Even the University of Malta

academics who signed a declaration supporting the bill (henceforth the ‘pro-law academics’) state that: ‘the principle of autonomy and selfdetermination holds that every mentally competent adult has the right to make decisions about their own body and life.’xiv By and large, even those opposing the bill (henceforth the anti-side) do not question this understanding of autonomy or the assumption that autonomy is an obviously positive value. Thus, the University of Malta academics who oppose the law (henceforth, the anti-law academics) claim that autonomy is a: ‘value…[that is] today widely recognised and deeply cherished. People rightfully seek to shape their lives…making choices in accordance with their values and aspirations … an important advancement in modern civilisation’.xv^ They note, however, that autonomy is not an absolute value, something which even government and many supporters of the bill concede.xvi^ The anti-law academics claim that the right to make choices for oneself is not: ‘an unrestricted right’,xvii^ especially in: ‘medical settings, where personal agency is often constrained…by circumstance, vulnerability or the complexity of decision making’xviii^ and by: ‘emotional, and contextual vulnerabilities.’.xix^ The exercise of autonomy should be: ‘linked to ethical, legal and social responsibilities.’xx^ It should be considered: ‘within the context of the common good of society as a whole’xxi^ (without defining what they understand by ‘common good’, a notion frequently equivocated for the aggregate sum of the goods of individuals).xxii^ According to the Antilaw academics, these considerations make it the case that valuing autonomy does not imply that one has the right to bring one’s existence to an end through PAS or voluntary euthanasia. Hence, though generally disagreeing regarding whether or not autonomy implies the right to terminate one’s existence, both sides to the debate tend to agree that: i) Autonomy implies acting according to one’s wishes. ii) Autonomy is a positive value. Both i) and ii) are however problematic. Consider i). While ‘autonomy’ may be defined as: ‘being the author of one’s own life, free from arbitrary compulsion’, it is not obvious that this implies that one should act according to one’s wishes simpliciter (referring only to some limiting parameter

relating to the autonomy and/or well-being of others). Within Immanuel Kant’s philosophy for instance, being the author of one’s own life, free from the arbitrary authority of others and from ‘external’ forces: ‘does not ..reduce autonomy to [mere] self-governance.’xxiii^ Autonomy is characterised in terms of acting according to: ‘a moral law’xxiv^ which, as rational beings, humans can give themselves. (Indeed, Kant’s definition of autonomy is: ‘the property of the will to be a law to itself’).xxv^ This would not be a moral law derived from external sources, be these religious, naturalistic or conventional sources. Nor would it be a law modelled on our impulses and desires. It would be a law we would: ‘recognise as necessary’xxvi^ and, since ‘we impose [it]… on ourselves’,xxvii^ we would be subject to it.xxviii This understanding of autonomy implies that one would be acting autonomously if one obeys the moral law even on those occasions where this conflicts with one’s wishes or desires. (The: ‘cultivation of reason….[can] interfere…with the attainment of …happiness’).xxix^ Indeed, on such occasions, acting according to one’s wishes or desires would imply that one is not acting autonomously but heteronomously; i.e. one’s will would be subject to causes which are other than the moral law, which as a rational and autonomous being one can give oneself.xxx^ With regards to suicide or any sanction to terminate one’s life, Kant thinks that the moral law we give ourselves as autonomous beings cannot sanction this type of action. Hence, intentionally terminating one’s life for whatever other reason will always be immoral. Given that Kant thinks moral laws are based on our rationality, such an act would be deemed irrational,xxxi^ and cannot be justified in terms of this understanding of autonomy. It may be noted that this Kantian understanding of ‘autonomy’ does not imply that one should be forced to live/act according to the dictates of the moral law. It does not imply that if the moral law commands that one ought or ought not to do X, one should be forced to act according to laws one can give oneself ‘autonomously’. (This would be a contradiction in terms). Forcing someone to act according to the moral law would still fall within the realm of heteronomy. The person would not be: ‘moved by reason…but …by sanctions’.xxxii^ This would imply: ‘disrespecting their capacity for reasoning…[and] deny their capacity for autonomy.’xxxiii^ One should instead offer others what one: ‘take[s] to be good reasons for acting one way

rather than another, but… leave it to them to evaluate these reasons’.xxxiv Still, from a Kantian perspective, someone who acts contrary to the dictates of the moral law – who acts heteronomously, even if for grave reasons concerning pain, sickness or any misfortune–cannot be said to be exercising his/her autonomy. If such person were to exercise her/his autonomy, s/he would obey the moral law, which enjoins one not to: ‘destroy …[one’s] own person…or kill [oneself]’xxxv, no matter how unhappy one’s situation would be.xxxvi Now one may criticise this characterisation of autonomy and reject it in toto (Howard Caygill notes that various critics have attacked Kant’s notion in toto of autonomy on different counts, with some claiming that it is: ‘empty, formalistic,…irrelevant…[and] at worst tyrannical’xxxvii). Yet, in a thoughtful debate in which the notion of autonomy played a key role, the Kantian understanding of autonomy ought at least to have been taken into consideration (In light of the role Kant’s characterisation of autonomy has within his moral philosophy and the importance of Kant’s philosophy to Western thought).xxxviii As stated, participants in the debate also seemed to assume that autonomy is an obviously positive value. Yet, autonomy is a problematic and contested notion. Tom O’Shea claims that there are critics who claim that autonomy: ‘is impossible or impracticable to achieve; it displaces other fundamental goods, such as solidarity or dignity; it is itself worthless or loathsome; it leads to or entrenches atomization and other social ills; it is inappropriate for vulnerable, fallible and communal creatures like ourselves; it is an ideological fiction reinforcing a moribund rights-based liberalism…’xxxix^ These critics include some feminists who dismiss autonomy as: ‘a thoroughly noxious concept which shares in a “myth of masculinity” that requires disavowal of relationships that sustain us’.xl Critics of autonomy within the Marxist tradition also tend to question autonomy (or widespread interpretations of autonomy) on various grounds (promoting social atomism, diluting solidarity, serving as a smokescreen whereby one is made liable for one’s oppression in the name of free choices, etc).xli^ Karl Marx himself notes that modern capitalist society, which formally abolished serfdom and slavery, promoted the autonomy of individuals, frequently expressed through freedom of

exchange. Here, labourer and capitalist supposedly: ‘confront each other as person[s]’xlii^ and as ‘independent individuals’.xliii^ Yet, this is a: ‘deceptive semblance’xliv^ and does not represent how the worker is actually: ‘[related] to the existence of capital as capital.’xlv There are also communitarian critics like Alasdair MacIntyre, who may not reject autonomy in toto,xlvi^ but who criticise the individualist manner in which this concept has generally been understood. This is how most participants to the local debate on PAS/euthanasia seem to understand the concept. Widespread characterisations of autonomy fail to understand that: ‘the capacity for making independent choices…the virtues of independent rational agency need…to be accompanied by…the virtues of acknowledged dependence’.xlvii^ For MacIntyre, the dominant individualist modern moral culture conceives of the moral agent as autonomous and free: ‘from hierarchy and teleology [and thus]… sovereign in his moral authority’.xlviii^ These autonomous agents have nonetheless to adopt some: ‘rules of morality ….deprived…of their older teleological character’.xlixThis understanding of autonomy does not take into consideration the social practices, traditions and institutions in relation to which our moral agency occurs and makes sense. The: ‘price paid for [this failure] was the loss of any authoritative content from the would-be moral utterances of the newly autonomous agent’.l^ The: ‘autonomous moral agent …[ fails to draw] secular, rational justification for his moral allegiances.’li^ MacIntyre also thinks that the way in which autonomy is frequently characterised does not take into consideration: ‘the facts of vulnerability…affliction and …dependence [which are] central to the human condition’;lii^ that we need to: ‘confront and respond to vulnerability and disability both in ourselves and in others’.liii Given these and other possible considerations, autonomy cannot be elevated to an ultimate benchmark in relation to moral and/or legal decision-making without sound arguments as to why it ought to enjoy such status.liv

Dignity Another shortcoming concerned the other term that featured prominently in the debate, the term dignity. In contrast to what was the case with ‘autonomy’, however, different parties to the debate tended to understand ‘dignity’ differently, and ended up talking past each other. Thus, many on the anti-side seem to hold that human life has intrinsic dignity, and that this is not related to the state of one’s health.lv^ The antilaw academics claim that there is an: ‘inherent, inalienable and inviolable dignity of every human being …not contingent on circumstances of individual preference.’lvi^ Human dignity would not depend on one’s ‘physical condition or degree of independence’lvii^ and must be upheld unconditionally’.lviii^ From these considerations, the implication was drawn that the right to life is inalienable and: ‘must be respected…from conception to natural death’.lix^ The belief that human life has an intrinsic dignity regardless of the condition one is in, and that this implies that one may not dispose of one’s life for any reason whatsoever, is very old in the Western (but not only) tradition. It has roots in the Abrahamic religions, though philosophers like Kant give the belief a secular backing. For Kant, human life has dignity which: ‘admits of no equivalent ..[and is of] unconditional and incomparable worth’.lx^ This stems from the fact that as rational beings, we can give laws to ourselves.lxi^ It implies that humanity, in others and in ourselves, cannot be used as mere means. Kant believes that one who: ‘destroys himself in order to escape from pain … uses a person [namely oneself] merely as a means to maintain a tolerable condition up to the end of life. But man is not a thing, something that may be used as a mere means’.lxii This understanding of human dignity does not imply valuing the quantity of life over its quality. Peter’s life does not have more dignity because he lived up to 90 compared to Paul, who died at 89. Dignity is not something that can be somehow measured or appraised, as would be the case if this is understood in terms of quantity or even quality (if this is understood in terms of the state of one’s body or psyche). Indeed, neither Kantianism nor the Abrahamic perspective suggest that life should be prolonged no matter what. What this understanding of human life’s dignity would imply is that this cannot be intentionally terminated. Now, one may reject this way of

thinking or this characterisation of the dignity of human life. Nevertheless, it is not a perspective that values life in terms of a cumulative concept like the number of years one lives. Quality and quantity of life should not be taken into consideration. Many on the pro-side, on the other hand, including the authors of the bill itself, seem to assume that dignity is not a feature of human life per se. Human dignity is rather conditional on the situations individual human beings find themselves in; to the quality of life one has. Thus, Kenneth Wain states that life is not: ‘an unconditional good. Life ceases to be so when it is endless, unendurable agony.lxiii^ The belief that human life possesses dignity depending on the situation one is in is not uncommon in philosophic circles. To give one example amongst many possible ones, proponents of philosophical Hedonism like Jeremy Bentham hold that only pleasure, or ‘what comes to the same thing, immunity from pain,’lxiv^ is intrinsically good. Anything else is valuable on account: ‘of the pleasure [it occasions or] …the pain…it …avert[s].’lxv^ In this line of thought, life itself is valuable only in relation to pleasure or freedom from pain one may (even prospectively) enjoy.lxvi By and large, then, the two sides assumed different characterisations of dignity and used them to buttress their conclusions. They generally talked past each other, because most parties on either side did not consider in detail the other way of conceiving the dignity attached to human life and then provided arguments why this opposite characterisation of dignity should not be upheld. The nearest one gets to an argument as to why a particular view about the value of life should be upheld is a passage in the position paper by the anti-law academics. They refer to the possible consequences of abandoning the belief that life has intrinsic dignity, claiming that this belief: ‘stands as the foundation of every civilisation committed to safeguarding and protecting the rights of every human being’.lxvii^ The implicit suggestion is that this belief indicates a line that should not be trespassed. As stated, the fact that participants in the debate on both sides assume their different ways of understanding the dignity of life without seeking to provide much argument for this represents philosophical undertheorising. Yet, sociologically, culturally and politically, the fact that there are these

two groups talking past each other in the way described above may be worth investigating. Up to a few decades ago, discourses that assumed the intrinsic value of human life (usually couched in terms of Catholic teaching rather than some secular philosophy like Kantianism) were dominant. This reflected the cultural hegemony of the Catholic Church in Maltese society. The fact that now there are different, inconsistent discourses as to how the dignity of human life should be understood and what respecting it implies, indicates the existence of incommensurable world views upheld by different sectors of society. It would be interesting to observe how these incommensurable world-views will evolve, which social classes and/or groups uphold one world-view or the other, which world-view attracts/will attract new members to Maltese society, and how these world-views are/will concretely collide against each other. Red herrings and a failure to discriminate The previous section showed how both sides to the debate tended to assume that autonomy implies acting according to one’s wishes, and that autonomy is a positive value, even if consistent literature in philosophy contests both. With regards to dignity, then, both sides tended to talk past each other. Another conceptual shortcoming evident throughout the debate was the assumption made by many in the anti-camp that palliative care and PAS and/or euthanasia are obviously incompatible; that one can only be offered to the detriment of the other. This was an assumption that was rightly called a: ‘red herring’.lxviii^ So was the argument that the government should not introduce PAS and/or euthanasia because the palliative care service in Malta was not yet up to standard.lxix^ Assuming the veracity of the claim,lxx if anything, the latter is an argument for improving palliative care, not one against PAS/euthanasia. Moreover, suppose palliative care becomes stateof-the-art. Would at that point government be justified in introducing PAS/euthanasia? One problem with those who make a correlation between palliative care on the one hand, and PAS/voluntary euthanasia on the other is that,

conceptually, the two are not mutually exclusive. This was pointed out by many of the pro-side.lxxi^ To back up the claim regarding the real or fallacious correlation between PAS/euthanasia and palliative care, both sides ended up in a war of statistics. The anti-side claimed that: ‘Empirical evidence demonstrates that jurisdictions which have implemented physician-assisted suicide or euthanasia have experienced a significant decline in the quality and scope of palliative care services’.lxxii^ The pro-side refuted this evidence and cited other evidence that holds that this is not the case.lxxiii^ Since this part of the dispute is empirical, it is beyond the remit of our paper. Hence we will not seek empirical confirmation or refutation of one claim or the other. A further conceptual shortcoming, this time on the pro-side, was the general failure to distinguish between allowing nature to take its course in relation to dying patients and causing death. Thus, the pro-law academics claim that: ‘The right to life….is not a mandate to force the prolongation of life regardless of suffering. A competent person already possesses the legal and ethical right to refuse or discontinue medical treatment, even if that decision hastens death. Permitting AVE at an individual’s considered and voluntary request is a logical extension of this respect for their right to avoid needless suffering.’lxxiv^ Now conceptually it is one thing not to go out of one’s way to prolong a life, it is something else to act intentionally to bring about death (as would be the case with PAS or euthanasia, even if the intention to bring about death is coupled to other intentions like the intention to alleviate suffering). This distinction, on the other hand, a distinction in terms of intentions, is recognised by the anti-law academics. These note that: ‘Choosing to withhold or withdraw medical treatment [which is not beneficial and comes at huge costs in terms of pain] … is very different from requesting medical assistance to accelerate the process of death. While the intention in the former case is to allow the natural process of death to unfold without any unnecessary medical interference, in a way which respects the dignity of the patient and the limits of medicine, the second case involves a deliberate intervention with the explicit intention of killing the patient. Th[is] crucial distinction … marks a clear ethical boundary between accepting the limits of treatment and actively intervening to terminate life.’lxxv

To downplay the distinction between letting nature take its course and intentionally terminating one’s life, one would need to refer to some principle or standpoint that allows this. One such principle would be that of utility. Here, intentions are estimated primarily in relation to the tendency they have to produce pain or pleasure.lxxvi^ The presence of the intention to bring about death in one scenario and its absence in the other does not morally carry much weight, since it is the consequences of the action and only these that count when evaluating its morality.lxxvii^ One would, obviously, have to argue why this principle and not any other should be upheld. One would also have to consider any objections to such a principle and to the consequences it implies. No one who dismissed the distinction between allowing nature to take its course and intentionally terminating a patient’s life took this or a similar course. No one invoked some principle in terms of which the distinction above in terms of the presence/absence of the intention to bring about death, would also be immaterial. Educational considerations The rest of the paper considers how schools and educational institutions can benefit from considering these and other characteristics of the debate. We believe that this debate – as with all political, economic and social phenomena taking place around us offers various educational opportunities. In particular, we shall refer to two subjects in whose remit a discussion on PAS/euthanasia fits directly: Ethics and Religious Studies. Before delving into this matter, however, some general considerations are in place. The PAS/euthanasia debate showed the inadequacy of the common tendency to avoid politics and ongoing controversies in classrooms, isolating the latter from the real world.lxxviii^ The real world will still knock at today’s students and tomorrow’s citizens’ world, requiring them to take a stand. If a debate like the one about PAS/euthanasia is to have educational significance, however, it should not be reduced to a binary and lifeless classroom debate of pros and cons, or worse, a dichotomy between a Catholic view on the one hand, and a secular one on the other. The debate around PAS/euthanasia was too often portrayed in “us vs them” terms – rational reformers vs religious traditionalists, progressives vs moralists.lxxix

This framing undercuts the promise of a ‘mature debate’ claimed by the state, and reduces this to a caricature (an exercise that could be carried out at schools would involve students examine how media narratives shape and often oversimplify public ethical discourse). A serious debate should consider the complexity, ambiguity, and thoughtful disagreement regarding such issues between and within different camps. Consideration should also be given to how inclusive the debate was in mainstream media and government circles. One article in the local media noted the almost total lack of inclusion of non-Catholic religious minorities in the debate.lxxx Another aspect which evidenced lack of inclusion was the impression given throughout the debate that this was a dispute by and for people who are Maltese born and bred..lxxxi^ The views of people not born in Malta, who have been residing in Malta for years, were by and large ignored.lxxxii^ A school exercise in this regard could be dissecting and analysing the various adverts – including those sponsored by the government – and media reports, in order to determine who was assumed to be part of the debate and who was excluded, and what does this say about inclusion. Apart from considering the features of the arguments themselves (as we ourselves did in the first part of the paper), schools should also situate such issues within the socio-political, cultural, and ideological contexts where they arise. Questions like the following should be raised and considered: Why were certain values (e.g., autonomy, dignity, etc.) assumed rather than interrogated? Why were certain voices amplified while others were ignored?lxxxiii^ What does this reveal about our broader ethical assumptions? Following these general considerations, some reflections on the issues mentioned in the first sections of the paper and the subjects of Ethics and Religious Studies are laid down. The focus shall primarily be on the syllabi of the subjects in question. Ethics Browsing through the Ethics syllabi, one can notice many positive features that could make it the case that, in the years to come, debates on such issues

will not evidence the shortcomings elicited in the first part of the paper. For instance, the SEC Ethics syllabus distinguishes between: ‘the view that life has intrinsic value; that it is valuable in and of itself which finds expression in the sanctity of life doctrine, and the view that life is valuable only if it is worthwhile, if through it we …are happy, not otherwise.’ lxxxiv^ As noted in the first part of the debate, most participants to the debate did not acknowledge this distinction. Each party assumed one or the other of these two mutually exclusive ways of looking at life, and built their arguments accordingly. The syllabus also has the merit of introducing students to different philosophical approaches like Utilitarianism, Aristotelianism and Kantianism, which could serve as benchmarks in relation to which one can consider issues like PAS and euthanasia.lxxxv The SEC Ethics Syllabus also discusses explicitly: ‘the case …for …the moral right to die as well as to live, whether through direct (self-inflicted) or assisted suicide, …. [and relates this issue to issues like] Who owns my life? Do I have the right to do with it what I please, to decide whether or not it is worthwhile?’lxxxvi^ When it comes to answers however, it seems to give more consideration to the: ‘affirmative answer…from a liberal viewpoint’,lxxxvii^ with the negative answer barely hinted at. Had the syllabus not misrepresented Kant’s Second Formulation of the Categorical Imperative slightly as the view: ‘that we should never treat others merely as means, one needs always to treat them as ends’;lxxxviii^ when in fact Kant refers also to oneself as being an end in itself; a more substantial negative answer could easily have been presented. The syllabus also mentions ‘individual autonomy’’, lxxxix^ incidentally, when discussing life and death. Though claiming that ‘autonomy’ is: ‘a concept which needs to be carefully explained’,xc^ it implicitly refers to an understanding of autonomy which defines this merely in terms of the choices one makes. Thus, the syllabus adopts one particular definition of autonomy, and this is understandable. Yet, it should also indicate to students that this is a contested notion with regard to its meanings, the implications it has, and whether or not it is a value that a society should uphold.

We suggest that Ethics Syllabi, particularly those concerning higher streams, should include linguistic analysis explicitly amongst the learning outcomes. This should be done not to solve ethical issues through linguistic analysis, but because conceptual clarity is fundamental to any mature discussion and engagement. We use the word ‘explicitly’ because various parts of the syllabi indicate implicit awareness of this need. We believe that it should be made more unequivocal. With regards to concepts, a failure of the Ethics syllabi is the fact that these barely consider notions like ‘Natural Law’ and ‘Common Good’; notions that tend to feature when some moral debate crops up in Malta. To be fair, during the PAS/euthanasia debate, the former did not feature as much as it did in other debates in the past, even in Catholic-inspired documents. Obviously, the notions should be presented as contested notions, with different parties providing different definitions, as well as different evaluations as to their sensibility or cogency. Given that the Ethics syllabi are meant for students who will grow up and live in Malta, and where such notions inform much of the discussions about ethical issues, their omission is regrettable Religious studies Something the Religious Studies syllabus should do when discussing moral and social issues is locate these discussions in the local context rather than considering them solely in abstract terms; a context that has changed considerably in the past few years. It has to acknowledge that we are no longer in a situation where, if the Catholic Church pronounces itself in relation to a particular moral issue, society and the state will bow their heads as it might have in the past.xci^ The divorce referendum was a watershed in this regard. This also holds for the terminology the Church uses in discussing such issues. Many people will no longer bother to understand what a term like Natural Law or Common Good means if it is just thrown into a particular document discussing some issue or other (Not that most bothered in the past; many just accepted). Regarding these terms, one shortcoming of the Religious Education Syllabus at secondary and Ordinary level standards is the failure to refer to a notion that recurs frequently whenever the Church discusses various

moral and socio-political issues – the notion of Natural Law (Though, as stated, unlike what was the case with other moral and social issues in the recent past, it did not feature so prominently in the discussion about PAS/euthanasia). The earliest stage at which the notion is discussed is at the Intermediate levelxcii^ (though the Year 5 syllabus refers to ‘Catholic marriage being based on nature’).xciii^ This is a notion that is frequently misunderstood – even by some members of the clergy – as akin to the physical and biological laws that govern the natural world. (Hence, speaking about some action or behaviour that contradicts the Natural Law would be akin to something like a metal which is not an alloy not expanding when heated or a dog reproducing asexually). The Religious Studies syllabus does contain a reference to the notion of ‘Common Good’. It states that students should know how to: ‘10.1j Define common good. 10.2j Explain the way how the common good is exercised in society. 10.3j Discuss the necessity of implementing the notion of the common good in politics.’xciv This is very laudable. It would also make sense, however, if the Syllabus were to analyse why the notion is frequently misunderstood, and the extent to which it is concretely applied in relation to various issues. Something that we think is missing from the Religious Studies syllabus in relation to moral and social issues is a reference to views other than those of the Magisterium. Obviously, given the raison d’être of the subject, the primary purpose of the syllabus is to teach the views of the Magisterium on such issues. There is nothing wrong with this, provided that this is done intelligently and the reasons for these positions are clearly presented. (Various literature could be used in this regard).xcv^ However, students should not be presented with a monolithic picture. They should not be guarded from the existence of Catholics who adopt contrasting positions on such issues, the reasons for these, and the Church’s rejoinder regarding such dissenting views. Presenting a monolithic Catholic façade is neither credible nor realistic. Students in today’s world will easily realise that this is not the case.

It also makes sense if the Religious Studies syllabus were to contain references to how different religious traditions view various moral and political issues. As stated, this was another lack, evident in the PAS/euthanasia debate; the fact that views apart from the Catholic ones were by and large ignored, despite the presence of non-Catholic religious communities – be these Christian or non-Christian – in Malta.xcvi^ Reference to these views should not be considered as detrimental to the teaching of the Catholic religion. If anything, it might confirm that Catholic views on issues like euthanasia and PAS are not the domain of diehard Catholics, as some secular pro-law writers in mainstream media wanted to frame the debate.xcvii Conclusion The paper claims that the debate concerning euthanasia and PAS, inaugurated by the government in May 2025, was undertheorised. To buttress this claim, it refers to the use of two terms that featured prominently in the debate; the terms ‘autonomy’ and ‘dignity’; and to two common but fallacious lines of argument. The paper noted that different participants in the debate, on both sides, assumed that autonomy implies acting according to one’s wishes, and that autonomy is an obviously positive value, when substantial literature contests both assumptions. With regards to ‘dignity’, it noted that the different parties on either side assumed different characterisations of what respecting human dignity implied, failed to confute opposite characterisations of the term, and ended up talking past each other. The paper also noticed the illicit tendency on the anti-side to take for granted that allowing for PAS/euthanasia will inevitably be to the detriment of palliative care, and the failure on the proside to distinguish between acts that involve the intention of terminating a life and those which (even though resulting in the patient’s death) do not contain such intention. In the final sections of the paper, suggestions are made regarding how educational institutions in general, and the subjects of Ethics and Religious Studies, in particular, can help students engage in thoughtful debates on such issues.

References Bentham. J, An Introduction to the Principles of Morals and Legislation , Oxford University Press, Oxford, 1996. Caygill. H, A Kant Dictionary , Blackwell Publishing, Oxford, 1995. Grech. M, ‘Rights and the Common Good – like chalk and cheese?’, Knisja 2000 , Pubblikazzjonijiet Dumnikani, Malta. 2024. Kant. I, Critique of Practical Reason , Prentice Hall, New Jersey, 1993. Kant. I, Fundamental Principles of the Metaphysics of Morals , Prometheus Books, New York, 1988. MacIntyre. A, After Virtue. Duckworth, London, 1997. MacIntyre. A, Dependent Rational Animals – Why Human Beings Need the Virtues , Open Court, Chicago, 2014. Marx. K, Grundrisse , Pelican. Middlesex. 1973. Christian Rostbøll ‘Kantian Autonomy and Political Liberalism’. Social Theory and Practice , Volume 37, Number 3, 2011. Electronic Sources Agius et al ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’ file:///C:/Users/Michael%20Grech/Downloads/POSITION-PAPERASSISTED-VOLUNTARY-EUTHANASIA%20(4).pdf ‘A Broader Academic Perspective on Assisted Voluntary Euthanasia in Malta. ’ https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_ on_assisted_voluntary_euthanasia_in_malta.pdf Neville Borg ‘Fact-check: Are WHO-advised palliative care medicines unavailable in Malta?’ https://timesofmalta.com/article/factcheck-are-palliative-caremedicines-really-unavailablemalta.1112472#:~:text=Several%20of%20the%20remaining%20seven,evidence%2 0clearly%20refutes%20the%20claim. Christian Colombo and Joanna Williams: ‘Let’s balance our values; not make them absolute’https://timesofmalta.com/article/let-balance-values-makeabsolute.1111941?fbclid=IwY2xjawMXbchleHRuA2FlbQIxMQABHqnEH2uI6pk F0Wkrg-3heGWHJVoTdWzK7Z7gdAdHi4S3BMLwjdBJtbXsOD8_aem_IaCCjgqV3aG-NcXAd2-VnQ James Debono, ‘There is no need to choose; palliative care and euthanasia can coexist’. https://www.maltatoday.com.mt/comment/opinions/135771/theres_no_need_ to_choose_palliative_care_and_euthanasia_can_coexist Mariana Debono ‘When death becomes easier than care’ https://timesofmalta.com/article/when-death-becomes-easier-care.1112103 Muhammad El Sadi and Samir Abou Houssein ‘Euthanasia in Islam: An act of killing’. https://www.maltatoday.com.mt/comment/opinions/135541/euthanasia_in_is lam_an_act_of_killing__imam_mohammad_elsadi_samir_abouhussein Michael Grech ‘On not serving Kant in the Euthanasia (or rather PAS) debate. https://www.maltatoday.com.mt/comment/opinions/136364/on_not_serving_ kant_in_the_euthanasia_or_rather_pas_debate__michael_grech

Hospice Malta ‘Hospice Malta Position on the Draft Document on Assisted Voluntary Euthanasia’ https://hospicemalta.org/wp-content/uploads/2025/05/HospiceMalta-Position-on-the-Draft-Document-on-Assisted-Voluntary-Euthanasia.pdf Malta Humanist Association: https://humanistsmalta.org/assisted-dying ICCS, ‘National Report Malta – 20222’ https://www.iea.nl/sites/default/files/202403/ICCS%202022%20National%20Report.pdf ‘Is-Sillabu tar-Reliġjon tas-CCP għall-Ħames Klassi’ https://curriculum.gov.mt/wpcontent/uploads/2024/04/curric_ccp_religion_f5.pdf Medical Association of Malta https://mam.org.mt/feedback-on-the-proposed-assistedvoluntary-euthanasia-bill-by-the-medical-association-ofmalta/#:~:text=The%20proposed%20law%20requires%20clinicians,assisted%20s uicide%20from%20healthcare%20completely. Moviment Graffitti ‘Moviment Graffitti submits input supporting the introduction of assisted voluntary euthanasia’ https://movimentgraffitti.org/2025/07/02/moviment-graffitti-submits-inputsupporting-the-introduction-of-assisted-voluntary-euthanasia/ Moviment ta’ Kana https://movimenttakana.mt/persuna-li-tkun-qed-tbaghti-jixirqilha-lahjar-kura-palljativa-sabiex-hija-tkun-tista-taffronta-t-tbatija-bserenta-udinijta/?fbclid=IwY2xjawLjUltleHRuA2FlbQIxMQABHoE4wvUXx4EtBY0TrFtn Ee0qwnCZrwqqt3PbHAhKwn0rrrlDR8-gwWZB3rrI_aem_2zfoFJWmX-3IEVlutp6Vg National Health Service. ‘Euthanasia and Assisted Suicide’: https://www.nhs.uk/testsand-treatments/euthanasia-and-assistedsuicide/#:~:text=Euthanasia%20is%20the%20act%20of,considered%20to%20be% 20assisting%20suicide. Office of the Prime Minister, ‘Public Consultation on Assisted Voluntary Euthanasia’, https://www.gov.mt/en/publicconsultation/Pages/2025/NL0019 2025.aspx Kenneth Wain ‘The case for assisted voluntary euthanasia’ https://timesofmalta.com/article/the-case-assisted-voluntaryeuthanasia.1111722 Kenneth Wain ‘Why the ‘easier’ option matters’ https://timesofmalta.com/article/whyeasier-option-matters.1113269 Religious Knowledge Intermediate Syllabus: ‘https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2026/ im/IM_28e.pdf’ Sec Syllabus, ‘Ethics’, 2024: https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/ sec/Syllabus20-20SEC204020Ethics202024.pdf Sec Syllabus ‘Religious Knowledge’ 2026: https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2026/ sec/Syllabus20-20SEC202520Religious20Knowledge202026.pdf Untitled: ‘Death becomes us: Euthanasia, for and against’ https://www.maltatoday.com.mt/announcements/social/122664/death_becom es_us_euthanasia_for_and_against

Endnotes

i (^) https://www.gov.mt/en/publicconsultation/Pages/2025/NL0019 2025.aspx iihttps://www.nhs.uk/tests-and-treatments/euthanasia-and-assistedsuicide/#:~~:text=Euthanasia%20is%20the%20act%20of,considered%20to%20be%20assisting %20suicide iiihttps://www.nhs.uk/tests-and-treatments/euthanasia-and-assistedsuicide/#:~~:text=Euthanasia%20is%20the%20act%20of,considered%20to%20be%20assisting %20suicide iv (^) https://cdn.newsbook.com.mt/wp-content/uploads/2025/05/07155815/EVA-DOCUMENTENG.pdf v (^) https://cdn.newsbook.com.mt/wp-content/uploads/2025/05/07155815/EVA-DOCUMENTENG.pdf vi. Credit to it, the Malta Humanist Association does mention suicide in its reaction to the law, claiming that what is being addressed by the bill includes: ‘Assisted suicide: intentional provision to a person, at their request, of the knowledge, means, or both, required to commit suicide.’ https://humanistsmalta.org/assisted-dying / So do the academics that oppose the proposed legislation (file:///C:/Users/Michael%20Grech/Downloads/POSITION-PAPERASSISTED-VOLUNTARY-EUTHANASIA%20(3).pdf ), the Medical Association of Malta https://mam.org.mt/feedback-on-the-proposed-assisted-voluntary-euthanasia-bill-by-themedical-association-ofmalta/#:~:text=The%20proposed%20law%20requires%20clinicians,assisted%20suicide%20fr om%20healthcare%20completely and the Catholic Moviment ta’ Kana (https://movimenttakana.mt/persuna-li-tkun-qed-tbaghti-jixirqilha-l-ahjar-kura-palljativasabiex-hija-tkun-tista-taffronta-t-tbatija-bserenta-udinijta/?fbclid=IwY2xjawLjUltleHRuA2FlbQIxMQABHoE4wvUXx4EtBY0TrFtnEe0qwnCZ rwqqt3PbHAhKwn0rrrlDR8-gwWZB3rrI_aem_2zfoFJWmX-3IEV-lutp6Vg. Others, for instance Moviment Graffiti , do not refer to suicide in their document. (https://movimentgraffitti.org/2025/07/02/moviment-graffitti-submits-input-supporting-theintroduction-of-assisted-voluntary-euthanasia) The academics who support the proposed legislation do use the term ‘suicide’ in their document, but only in relation to the whether the proposed legislation will lead to increased suicide rates or not; not whether the legislation proposed is tantamount to the legalization of an acceptable (from their perspective) form of suicide, PAS (https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volu ntary_euthanasia_in_malta.pdf). vii (^) See https://cdn.newsbook.com.mt/wp-content/uploads/2025/05/07155815/EVA-DOCUMENTENG.pdf; https://facts.mt/proposti/ viii (^) https://facts.mt/proposti/ ix (^) O’Shea, ‘Critics of Autonomy’, 1-5. x (^) O’Shea, ‘Critics of Autonomy’, 1-5. xi (^) https://timesofmalta.com/article/why-easier-option-matters.1113269 xii (^) https://humanistsmalta.org/assisted-dying xiii (^) https://humanistsmalta.org/assisted-dying xivhttps://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volunt ary_euthanasia_in_malta.pdf xv (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 10. Amongst the exceptions that fail to refer to autonomy altogether is the document by the Kana movement (https://movimenttakana.mt/persuna-li-tkun-qed-tbaghti-jixirqilha-l-ahjar-kura-palljativa

sabiex-hija-tkun-tista-taffronta-t-tbatija-bserenta-udinijta/?fbclid=IwY2xjawLpcilleHRuA2FlbQIxMQABHhWV_XqtHLdRN2ahvYizy4ogKkfEiZJ_biW4fIbdoFcfIc3GCk6DR2lcbq8_aem_m6J3V8etoTciZ29IVP3H5w) and the one published by Hospice Malta (https://hospicemalta.org/wpcontent/uploads/2025/05/Hospice-Malta-Position-on-the-Draft-Document-on-AssistedVoluntary-Euthanasia.pdf.)

xvi (^) Some of the limits set in various documents are not always consistent with and end up contradicting each other. Thus, the pro-law academics recognize that the right to selfdetermination is: ‘not an absolute right but one exercised within a robust framework of confirmed mental capacity and informed consent’ https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volu ntary_euthanasia_in_malta.pdf and that in relation to the termination of life: ‘autonomy [and] honouring …freedom to choose’ implies that one may request euthanasia/PVS when patients judge: ‘their quality of life has fallen below a personally acceptable threshold due to irreversible decline’ https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volu ntary_euthanasia_in_malta.pdf Hence, in this part of the document it is the very subjective ‘personally acceptable threshold’ in relation to the quality of life rather than one: ‘being a dying patient and in pain’ (as in government’s bill), that determines the right to terminate one’s existence. Elsewhere in the document however, these academics set the: ‘alleviat[ion of] suffering. …[having] a dying patient endur[ing] extreme distress that cannot be remedied by even the best palliative care’https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_ voluntary_euthanasia_in_malta.pdfas the parameter. xvii (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 10. xviii (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 11 xix (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 2 xx (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 10. xxi (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 11. xxii (^) See Grech, ‘Rights and the Common Good – like chalk and cheese?’, 31-33. xxiii (^) Rostbøll, ‘Kantian Autonomy and Political Liberalism’, 379. xxiv (^) Kant, Fundamental Principles of the Metaphysics of Morals , 70. xxv (^) Kant, Fundamental Principles of the Metaphysics of Morals, 78. xxvi (^) Kant, Fundamental Principles of the Metaphysics of Morals , 26 note. It would hold in all instances and circumstances, since for Kant to believe that a law can allow exceptions is irrational. The: ‘moral law commands the most un-waivering obedience’ Kant, Critique of Practical Reason , 38 xxvii (^) Kant, Fundamental Principles of the Metaphysics of Morals , 26 note. xxviii (^) Being this law: ‘of his own giving’ (Kant, Fundamental Principles of the Metaphysics of Morals , 61), one would be both sovereign and subject (‘giving universal laws he is also himself subject to these…’. Kant, Fundamental Principles of the Metaphysics of Morals , 63). One would both be: ‘self-legislat[ing] … yet also be subject to this law’ (Kant, Fundamental Principles of the Metaphysics of Morals , 82). xxix (^) Kant, Fundamental Principles of the Metaphysics of Morals , 21. xxx (^) Kant, Critique of Practical Reason , 34. xxxi (^) If from: ‘self-love I adopt it as a principle to shorten my life when its longer duration is likely to bring more evil than satisfaction’ (Kant, Fundamental Principles of the Metaphysics of Morals , 50), I would be: ‘destroy[ing] life by means of the very feeling whose special nature it is to impel to the improvement of life … [and] contradict [my]self … [the action] would be wholly inconsistent with itself’ (Kant, Fundamental Principles of the Metaphysics of Morals , 50).

xxxii (^) Rostbøll, ‘Kantian Autonomy and Political Liberalism’, 353. xxxiii (^) Rostbøll, ‘Kantian Autonomy and Political Liberalism’, 353 xxxiv (^) MacIntyre, After Virtue , 23. xxxv (^) Kant, Fundamental Principles of the Metaphysics of Morals , 58. xxxvi (^) Hence, from a Kantian perspective, one would not be acting autonomously both if one acts contrary to what the moral law commands (because of one’s wishes or desires), and if one is forced to act according to what the moral law commands. It is only if one acts according to the moral law one can give oneself as a rational being that one is exercising one’s autonomy. xxxvii (^) Caygill, A Kant Dictionary , 89. xxxviii (^) To be fair Wain refers to a Kantian understanding of autonomy (‘a political term for selfdetermination which Kant adapted to a moral context’ https://timesofmalta.com/article/whyeasier-option-matters.1113269), but then does not discuss in detail this definition of autonomy. He switches to the definition of autonomy as: ‘the right to make one’s own life choices, ‘even ‘wrong’ ones like smoking, excessive drinking, taking dangerous risks providing these do not harm others, provided one is informed about these choices and their risks, [and hence] one’s choice is free …responsible and informed’ (https://timesofmalta.com/article/why-easier-optionmatters.1113269). xxxix (^) O’Shea, Critics of Autonomy , 3. xl (^) O’Shea, ‘Critics of Autonomy’, 1-5. In a milder tone, it is the Anti-law academics who cite feminists who note that autonomy should not be considered as absolute (‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 11). xli (^) O’Shea, ‘Critics of Autonomy’, 1-5. xlii (^) Marx, Grundrisse , 464. xliii (^) Marx, Grundrisse , 464. xliv (^) Marx, Grundrisse , 464. xlv (^) Marx, Grundrisse , 464. xlvi (^) MacIntyre, After Virtue , 65. xlvii (^) MacIntyre, Dependent Rational Animals , 8. xlviii (^) MacIntrye, After Virtue , 62 xlix (^) MacIntrye, After Virtue , 62 l (^) MacIntyre, After Virtue , 68. li (^) MacIntyre, After Virtue , 68. lii (^) MacIntyre, Dependent Rational Animals, 4. liii (^) MacIntyre, Dependent Rational Animals , 5. The nearest one gets to this line of reasoning are some passages in the position paper by the Anti-Law academics, who claim that autonomy should be understood as a relational concept, one that: ‘recognises the inherently social nature of human decision-making’ (‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 2). liv (^) It is interesting to note that even the left-wing organization Moviment Graffiti takes ‘autonomy’ as a given and a positive one, without any critical engagement with the notion. https://movimentgraffitti.org/2025/07/02/moviment-graffitti-submits-input-supporting-theintroduction-of-assisted-voluntary-euthanasia/ The only proviso the group makes is that PAS should be exclusively provided the state; that the private sector ought to be excluded in light of possible abuse. (The assumption apparently being that the state is immune from such possible temptations). This obvious acceptance of autonomy (understood in the way characterized above) is very much in line with a type of militancy which relies on slogans like ‘My X, my choice’ as obvious and foundational. (Few realize that in the place holder one may easily put other terms like ‘my country’ and use it for aims that are anything but progressive). In relation to the civil rights the Maltese state is promoting, it would be interesting if organisations like Moviment Graffiti were to engage in some deep analyses as to why society

seems to become more progressive with regards to civil rights (and hence they are ‘winning’ their battles on that plane), while Neo-liberalism is becoming more ingrained in government, political parties and other major institutions (e.g. Trade Unions who accept the free-market rhetoric); whether this is accidental or whether there might be a link between the two.

lv (^) See for instance: https://hospicemalta.org/wp-content/uploads/2025/05/Hospice-Malta-Positionon-the-Draft-Document-on-Assisted-Voluntary-Euthanasia.pdf lvi (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’,1. lvii (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’,1. lviii (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’,1. lix (^) Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’,12. lx (^) Kant, Fundamental Principles of the Metaphysics of Morals , 65. lxi (^) Kant, Fundamental Principles of the Metaphysics of Morals , 69. lxii (^) Kant, Fundamental Principles of the Metaphysics of Morals , 58 lxiii (^) https://timesofmalta.com/article/why-easier-option-matters.1113269 lxiv (^) Bentham, Introduction to the Principles of Morals and Legislation , 34. lxv (^) Bentham, Introduction to the Principles of Morals and Legislation , 90. lxvi (^) Bentham’s Hedonism is used simply for illustrative purposes. We are not suggesting that anyone who upholds the belief that life has an instrumental value may buttress this claim only by reference to Hedonism in general or Bentham’s version in particular. lxvii (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia” 7. lxviii (^) https://timesofmalta.com/article/the-case-assisted-voluntary-euthanasia.1111722 lxix (^) See for instance https://timesofmalta.com/article/when-death-becomes-easier-care.1112103. lxx (^) For an article that throws doubt on the claim see: https://timesofmalta.com/article/factcheckare-palliative-care-medicines-really-unavailablemalta.1112472#:~:text=Several%20of%20the%20remaining%20seven,evidence%20clearly%2 0refutes%20the%20claim. lxxi‘https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volun tary_euthanasia_in_malta.pdf. lxxii (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”. 1 lxxiiihttps://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volu ntary_euthanasia_in_malta.pdf lxxiv‘https://content.maltatoday.com.mt/ui/files/a_broader_academic_perspective_on_assisted_volu ntary_euthanasia_in_malta.pdf. Consider also the following: ‘ Dignity means recognising that a life burdened by intolerable pain and loss of control is not worth preserving at all costs.’ (https://www.maltatoday.com.mt/comment/opinions/135771/theres_no_need_to_choose_pallia tive_care_and_euthanasia_can_coexist) lxxv (^) ‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 9. Indeed, these academics specify that: ‘patients have the right to refuse or withdraw from treatment when they consider such interventions to be disproportionate either in terms of burdens or lack of therapeutic benefit’ (‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 2). They further suggest that: ‘clinical guidelines be established to prevent overtreatment and the practice of defensive medicine, whereby medical professionals may administer aggressive or disproportionate treatment not because of a reasonable hope of benefit but rather out of fear of litigation’ (‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 2). Legal frameworks should be: ‘strengthened to give full and practical effect to the right of patients to refuse medical care that they deem burdensome, futile, or misaligned with their values’ (‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 9). These academics also lament that: ‘palliative sedation, an ethically permissible and medically recognised option for end-of-life care…remains underutilised due to lingering misconceptions and resistance among healthcare providers and the general public alike’

(‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’, 2). This sedation is: ‘morally acceptable… as the primary aim is to control pain, and not to hasten death, even though the patient’s life might be unintentionally shortened as a result’ (‘Position Paper on the Public Consultation on “Assisted Voluntary Euthanasia”’,10).

lxxvi (^) Bentham, Introduction to the Principles of Morals and Legislation , 89. An intention is: ‘a good one…if the consequence of the act, had they proved what to the agent they seemed likely to be, would have been of a beneficial nature.’ Bentham, Introduction to the Principles of Morals and Legislation , 95. lxxvii (^) Bentham, Introduction to the Principles of Morals and Legislation , 74. lxxviii (^) Now wonder that ICCS report notes that: “Malta’s mean scale score for ‘students’ opportunities to learn about civic topics and skills’ (46.5) is significantly lower than the ICCS international average (50).” ICCS Report 2022, xi. lxxix (^) In this regard see https://www.maltatoday.com.mt/comment/opinions/136364/on_not_serving_kant_in_the_euth anasia_or_rather_pas_debate__michael_grech lxxx (^) In this regard see https://www.maltatoday.com.mt/comment/opinions/136364/on_not_serving_kant_in_the_euth anasia_or_rather_pas_debate__michael_grech lxxxi (^) See for instance https://www.maltatoday.com.mt/announcements/social/122664/death_becomes_us_euthanasia _for_and_against lxxxiilxxxii (^) Exceptions were https://www.maltatoday.com.mt/comment/opinions/135541/euthanasia_in_islam_an_act_o f_killing__imam_mohammad_elsadi_samir_abouhussein; https://timesofmalta.com/article/let-balance-values-makeabsolute.1111941?fbclid=IwY2xjawMXbchleHRuA2FlbQIxMQABHqnEH2uI6pkF0Wkrg3heGWHJVoTdWzK7Z7gdAdHi4S3BMLwjdBJt-bXsOD8_aem_IaCCjgqV3aG-NcXAd2-VnQ. lxxxiii (^) See https://www.maltatoday.com.mt/comment/opinions/136364/on_not_serving_kant_in_the_euth anasia_or_rather_pas_debate__michael_grech lxxxivhttps://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf lxxxv (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf lxxxvi (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf lxxxvii (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf lxxxviii (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf lxxxix (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf xc (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2024/sec/Syllabus2020SEC204020Ethics202024.pdf xci (^) See Cauchi. B and Grech. M, ‘The other Kappillan of Malta: Characterising the New Conservative Cleric’, forthcoming. xcii (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2026/im/IM_28e.pdf xciii (^) https://curriculum.gov.mt/wp-content/uploads/2024/04/curric_ccp_religion_f5.pdf

xciv (^) https://www.um.edu.mt/media/um/docs/directorates/matsec/syllabi/2026/sec/Syllabus2020SEC202520Religious20Knowledge202026.pdf xcv (^) For instance, McCabe, The Teaching of the Catholic Church: A New Catechism of Christian Doctrine , 2000; xcvi (^) See https://www.maltatoday.com.mt/comment/opinions/136364/on_not_serving_kant_in_the_euth anasia_or_rather_pas_debate__michael_grech xcvii (^) Thus, according to MHA what stops patients and medical professionals from: ‘act[ing] on their own conscience’(https://humanistsmalta.org/assisted-dying) in cases which the new law is supposed to cover is ‘adher[ence] to Roman Catholic doctrine’ (https://humanistsmalta.org/assisted-dying) by the Maltese state; a situation which the new law will somehow rectify.