The regulation of palliative care for patients, as well as the provision of support to them and their families, must precede the law of euthanasia in Cyprus. That is, the patient should not seek the termination of his life out of despair and because he is not offered services for a dignified and without suffering, death.

This is what Aristotelis Constantinides, Associate Professor of International and Human Rights Law at the Law Department of the University of Cyprus, told "F" on the occasion of the proposal for a law on medically assisted termination of life. Similar were the positions of the honorary president of OSAC, Marios Kouloumas, arguing that the State still has a lot to do in terms of palliative care, social welfare and the support network.

It is very important, says Mr. Konstantinidis, to proceed with the legislative regulation for the provision of palliative care to all patients. "The euthanasia law should not be enacted before a palliative care law is passed. In the sense that the terminally ill person must have palliative care at his disposal, be informed of its availability and have rejected it. It is also mentioned in the draft law that "it is confirmed by the attending physician and/or the authorized doctor that the terminally ill person has been duly and competently informed about the support and care services provided for his case, such as psychological, social, palliative, home support and other related services", he said, adding that there must be options for patients and they must not be driven by despair for what they experience in the request to end their lives.

To date, the professor explains, there is no provision in Cyprus for medically assisted termination of life. "It was an unregulated issue." However, he explains, so-called passive euthanasia has always occurred as a medical practice. "This happens when the doctor does not continue those means, which prolong the patient's life. This form of euthanasia happens anyway. In fact, during the pandemic it was taking place around the world as a medical practice. Where it was judged that there was no point in technically prolonging the patient's life, they interrupted the artificial preservation of life. Many times during the pandemic we have heard discussions about what criteria doctors will use to decide who will be prioritized in intensive care or who will live."

Passive euthanasia, he stresses, is not regulated in the bill. What is regulated is medically assisted termination of life in two ways:

Active euthanasia. That is, the administration of medicine by a doctor, after the persistent and conscious appeals / requests of a patient who is in an incurable and irreversible stage, with a life expectancy of a few months and suffers from unbearable pain.

Medically assisted suicide. When the doctor leaves next to the patient the medicine, which the patient will take on his own to bring about death.

During 2022, the ECtHR in a case against Belgium ruled that medically assisted termination of life, if done under strict conditions, is compatible with the European Convention on Human Rights and does not violate the Right to Life. "There is, therefore, no question whether it conflicts with provisions of our Constitution, such as the Right to Life. On the contrary, it is fully consistent with the right to autonomy, which is an essential aspect of the human right to privacy," he said.

We are talking about rights, he underlined. "No patient will be forced into such a practice. At the same time, however, no doctor will be obliged to offer this service. No doctor will be compelled to do anything against his conscience or religious freedom if it conflicts with his religious beliefs. In essence, the state comes to regulate the very strict conditions, guarantees and safeguards under which a patient who persistently asks to hasten his certain, imminent death, which occurs in a painful way, physically and/or mentally, can undergo medically assisted termination of his life."

The draft law, based on the relevant decision of the ECtHR and other courts, "provides for the patient to decide whether he wants to proceed with a medically assisted termination of his life, with his free, informed, explicit, unambiguous consent". These services therefore exclude minors and people who do not have the capacity to make decisions for themselves. "The same patient should ask for it and wish it, based on the many and strict conditions provided and after checking."

Excluded from such services, he clarifies, are those who are mentally ill in the sense attributed to this term by the provisions of the Psychiatric Hospitalization Law. Also, those who are deemed incompetent under the provisions of the Management of Property of Incapacitated Persons Law are excluded. "I think this bill is something good and useful for many of our fellow human beings."

Support and care come first, patients say

"The State has a lot more to do on the issue of palliative care, on the issue of social welfare, on the support network for patients and their families. I believe that it is not paramount to move forward with medically assisted termination of life legislation. Rather, what we should do is move forward with the regulation of these loopholes, which are very serious," OSAC honorary president Marios Kouloumas told F, noting at the same time that the right to euthanasia must be examined, in compliance with very strict procedures and safeguards.

"Many of our patients arrive in desperate situations because there is a lack of proper palliative care and access. That is, a multidisciplinary care that a person will have at the end of his life, so that he will have a dignified and without suffering, death. There is an absence of the welfare state and social support. We should correct these and prioritize them and once they are implemented, then discuss euthanasia," he said.

"We have seen tragedies in Cyprus because of the absence of palliative care," he said, adding: "If you have a terminally ill patient who doesn't have palliative support, doesn't have a support network, doesn't have money, doesn't receive care, they'll tell you they want to die."

Mr. Kouloumas believes that if there is support and care, then there will be many fewer patients interested in ending their lives. Today, he said, there are patients fleeing abroad to be euthanized. "You can't legislate euthanasia when it has so many shortcomings and loopholes. Palliative care must be voted on first."