By Ravi Philemon
In April 2009, Health Minister Khaw Boon Wan categorically stated that, “euthanasia, which means helping the patient to commit suicide, is not what Ministry of Health (MOH) is promoting” and that MOH is actually “promoting palliative care for the terminally ill so that they, and their family members, will be able to cope with terminal illness with the least pain and being cared for in the most appropriate setting, which usually means the home they live in.”
When the Health Minister has categorically stated his position that he will not promote euthanasia, Ms Toh Puay San, a deputy public prosecutor (writing in her personal capacity), and National University of Singapore law don Stanley Yeo, seem to have taken the back door approach to push for the issue of dying with aid, with their controversial article in the latest issue of the Singapore Academy of Law Journal.
Although euthanasia is not the same as Physician Assisted Suicide (PAS) in that euthanasia generally means that the physician would act directly (for example, by giving a lethal injection to end a patient’s life), while PAS refers to the physician providing the means for death (most often with a prescription) and the patient (not the physician) ultimately using that means to end his life; they are similar in that it is intentional assistance given to a person by a physician to enable that person to terminate his own life upon that person’s request.
The arguments for euthanasia and PAS are often not cogent.
For example, pain and other symptoms causing discomfort and suffering, which is often cited by the proponents of assisted dying for euthanasia or PAS, are treatable.
Even where patients are considered to be terminally ill, there remains the frequent prognostic uncertainty.
A terminally ill person’s expression of a desire for death is very often a cry for help, to which a physician can respond in many non-lethal ways.
There are also no secure safeguards that euthanasia or PAS may lead to abuse through the singling out of the disenfranchised like the poor, people with disability, the elderly and the very young, who have no ‘voice’, to conclude their lives out of coercion, or even worse making such feel that they have a ‘duty to die’.
Focusing on euthanasia and PAS also diverts the much needed resources and energies away from patient-care and research on palliation.
As studies have shown that two-thirds of seniors over the age of 65, who receive long-term care, rely exclusively on family, friends and other informal caregivers, MOH’s emphasis on palliative care is the right one.
Mr Gerard Ee, the chairman of the Council for the Third Age, is indeed right in slamming such talk as going down a slippery slope, as there is too great a danger of abuse in legalising euthanasia or PAS.
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Picture courtesy of Jeffrey Leow
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Ccchia,
Sorry, scratch the last bit. It is a major failing of mine, a snarky tendency.
People have different upbringing and all that, as you say. Some may have been taught that when it is time to let go, go without fuss. Some may, due to circumstances, be unable to prolong life needlessly. All kinds of reasons. By all means die naturally if you so choose, but please do not advocate for others to suffer against their will so that your moral sensitivities are offended.
A&E,
I am all for debate, differences of opinion and freedom of choice. Not for one moment did I intend to force my opinion or morals on anyone; I was just stating my position.
If someone wanted to kill themselves by PAS or any other means, they can go ahead as far as I am concerned. There is no need to “make it legal”, as I feel that it would lead to abuse. It would be up to you or others to convince me otherwise.
I suddenly have a random thought triggered by A&E “by all means, die naturally…..”.
I am just wondering what does “dying naturally” really mean ? Does anyone ever “die naturally”? My experience tells me that more often than not, people grow old, fall terribly sick, cannot recover, then die…
Most of the time, no one ever grow old and then skip to being dead straightaway…
So really there is no such thing as “dying naturally”, is there? I am not trying to sound morbid but I have often thought how I will die eventually. Has anyone given much thought to this for their own lives ? Think about it… it may change you way you view euthanasia or PAS ….
Joe,
Beg to differ, but I have known or seen several people “die naturally”. Some were old, some were sick and others apparently healthy, but they were gone in a few days, hours or in the case of my father after one week from a stroke (bleeding in the brain, but he was 90 yrs old then).
Perhaps others in this forum who have more experience with death, such as doctors or those who work in hospitals can provide their viewpoint.
@A&E Inasmuch as there are people who have moral/religious sensitivities, the main opponents of PAS are more concerned about the propensity of the practice to be abused. However, as i mentioned in an earlier article, the slippery slope is an abstract concept. Perceived consequences are imaginary and unpredictable and therefore possible abuse should NOT be used as a reason against PAS.
Opening a casino also opens up possibilities of bankruptcy, suicide, depression and broken families. But the govt chose to go ahead with it anyway and instead impose safeguards against those possibilities. Why not do the same for PAS?
Make it an opt-in option for Singaporeans when they are still medically sane.
Attach trained social workers or psychologists to patients and their families to detect and (possibly) prevent/intervene possible abuses.
Allow considerations such as the amount and duration of pain, pain threshold and other psychological factors when approving the PAS procedure.
In short, disapprove procedure when abuses are likely or when the amount/duration of pain/suffering do not justify procedure. Yes, in all likelihood, only 10% of the cases may be approved based on such strict safeguards but that 10% is still a step forward.
It is ironic that ending a life that has potential to live out decades (abortion) is legal but yet people are so against ending a life several months earlier in order to eliminate pointless suffering and pain to patient and psychological stress and trauma to immediate family members.
LOL!
Joe,
To me, natural death is death by disease or extremely old age, since those are biological reasons for death. I would exclude non-bio causes of death, like making intimate acquaintance with a moving train, or running into a sharp knife. I think “we can safely disregard” being eaten by wild animals, to borrow a cute phrase form a cute lady.
Come to think of it, was the poor guy killed at Tanah Merah MRT station suicidal, or was it an accident? The sub-heading said he “leapt to his death”, but we learned that he had actually “fallen onto the tracks” by the time we got into the text.
Takumi,
You make a good point vis a vis abortion.
cchia
thanks for sharing. I was just struggling with the idea of dying naturally. Even though it sounds nice to say he die naturally, i am still trying to grapple with what that really means..
Are we really referring to the cause of death or the way we die ?
Or is it referring to the age – i.e once you hit a certain age, it is natural that you die, whatever cause it may be. If this is so, what is the age to “die naturally” ?
you mentioned your father passed away 1 week after suffering a stroke (bleeding in the brain). Do you deemed him as “dying naturally” because (a) he is 90 years old or “b” he bled in the head or (c) it was a quick 1 week situation ?
Seriously, i hope i am not sounding fippant about this and i certainly am not picking a argument with anyone. My dad pass away too some years back and it still saddens me the way he die…
My struggle is whether there is a natural way (presumably a less painful way) to die ? If there is, i really want to go that way.. Or is this just semantics ?
ccchia & Joe,
I see people die naturally everyday.
“dying naturally” – means you dont see doctor, dont take medicine … all those are unnatural, not present in nature.
A 86 year old patient suffering from 3rd stage cancer, brought to the hospital, doctor see patient but advise against operation as it would be life threatening to the patient because of his age. No recourse but for patient to wait for the ravages of cancer to slowly take patient life away….
Is this dying naturally ?
Is there no case for PAS for such cases ?
Would like to hear from forummers their views on abortion versus PAS. Isnt the basics the same, although one takes live away without consent and the other willingly wants to die. I happen to see a programme on TV last night about abortions, and was shocked to hear that one lady have had 3 !
Off topic but why are abortions legal when euthanasia or PAS is not ? I think abortion should be banned except under extenuating circumstances (like rape) and that PAS be allowed.
This is a very good topic and i regret that i have not had the time to read all the posts. But i feel that i just have to add my two cents. I am not with you on this Ravi. Fundamentally i see no reason why people should be under a legal obligation to live. I would go so far as to support euthanasia and PAS for any reason, meaning even for people who are not suffering from any terminal illness or indeed any illness at all.
The way this topic came up in Singapore is churlish – in the context of a talk by Khaw Boon Wan on healthcare costs. So the government’s motive in pushing this is not good liberal values but their overwhelming fear of having to actually look after the old sick and infirm. But the Government’s macabre priorities should not distract us from the fact that there are other, very good reasons, for PAS to be allowed.
It is true that there may be cases where PAS results in the sick being pressured to end their lives. Such cases will of course be horrible, but really i think the fear of this happening is overblown, and legislation should address this. Physicians should also be trained to identify cases where there has been pressure, which i think will be very rare. I suspect that such cases are rare in countries where euthanasia and PAS are allowed and there is no reason to think that things will be different in Singapore.
rovk,
(1) “For any reason” is dangerous. Frankly, it reminds me of Hitler’s “laboratories” and Stalin’s gulags. Surely, you don’t want that in Singapore, do you? Besides, it leads to a lack of respect for life, even you own. Imagine a group of Michael Jackson fans queuing up outside the hospital/PAS clinic for PAS/Euthansasia because they want to “join” Michael Jackson. Now that is a real nightmare scenario.
(2) Of course, it is very churlish indeed. But if you are for PAS/euthanasia “for any reason”, then why should churlishness matter at all? Not to mention, there are economic “benefits” from legalizing PAS/Euthanasia: we can be really the first country in Asia to have “suicide tourism”, the same way we have lots of other “tourisms” already.
(3) Ah, the overwhelming appeal to the authority of Law. But to paraphrase the old proverb, “Who will legislate the legislators?” The problem of pressure is not contingent; the pressure is a necessary feature of a Euthanasia/PAS culture. Think of Singapore’s famous 5Cs and the peer pressure associated with that. Then add a sixth C, “Creative Death”, and you can see where all this will lead, especially in our materialistic culture. (Other countries, even the liberal ones, have some form of cultural counterbalance, but we don’t. As the late British economist J.K. Galbraith once said, “Singapore has sold her soul to the MNCs”.)
We began with “death with dignity”. But “dignity” itself is a very fluid concept. And THAT is the real problem.
But for starters, how about an advertisement for Singapore Airlines?:-
“We offer two-way flights to several locations around the world, and a one-way flight to the Afterworld. So book Singapore Airlines today!”
small print: “There are no one-way flights back from the Afterworld.”
@Arix
(1) “For any reason” is dangerous. Frankly, it reminds me of Hitler’s “laboratories” and Stalin’s gulags. Surely, you don’t want that in Singapore, do you? Besides, it leads to a lack of respect for life, even you own. Imagine a group of Michael Jackson fans queuing up outside the hospital/PAS clinic for PAS/Euthansasia because they want to “join” Michael Jackson. Now that is a real nightmare scenario.
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Can you point to any one case (in a country which has legalized Euthanasia/PAS) where something like this has actually happened ? Otherwise all the scary ‘what if” scenarios are going to mere paranoia.
P.S There is a lot of prevarication and over-dramatization in your writing. Maybe it is time to step back into reality?
Takumi,
The point is that the countries that have legalized euthanasia/PAS have restricted the justifications people can use for pursuing such a drastic course of action. Whereas, if rovk is really suggesting euthanasia for “any reason”, then the nightmares can be a reality.
I was also wishing to point out that in other countries, they have a local culture which mitigates against the “Culture of Death” promoted by a pro-euthanasia policy. In Singapore, we do not have such a safety-net, because of the manner in which the government has constructed our society. So even though the worst cases do not happen in the Western countries that have legalised Euthanasia, they would be likely to happen here in Singapore because of our different cultural make-up, which is almost-totally economically-conditioned.
Incidentally, it was the Straits Times last year that labelled Switzerland as the World Capital for Suicide Tourism.
P.S.: Sometimes effects take time to percolate. The Western countries do not show signs yet, but in a few decades time, who knows? People take time to be desensitized, but once they are it is not easy to re-sensitize them.
Arix, I recognise that my view on this is an extreme one. But it must be understood correctly. Euthanasia/PAS is a matter of personal choice, it is nothing like Hitler’s labs or Stalin’s gulags. Why should people be under a legal obligation to extend their own lives if they don’t want to? I really don’t see anything churlish in the idea that a person may opt to end his own life, so long as the decision is not imposed on him. I do however see something churlish in the Government encouraging this because it is petrified that it might actually have to look after its sick citizens.
Sure, the idea of MJ fans wanting to kill themselves is not attractive. But is that a real fear? I don’t think so. People who are crazy enough to want to kill themselves after their idol dies will do it by jumping off a building if an injection is not made available to them. Anyway any euthanasia/PAS legislation will include processes for psychological assessments and cooling off periods that would address crazy and impulsive star struck teenagers.
Suicide tourism – i suppose that doesn’t sound great, but it is a label that in my view spells progressiveness and the day will come when it is meaningless because all countries will allow euthanasia/PAS and nobody will have to travel to out themselves out of chronic dissatisfaction.
rovk,
(1) In theory, it is a personal choice. In practice, there is no such thing as a fully personal choice because no (wo)man is an island. Even without the government encouraging it as a means to defray healthcare costs, hospitals and clinics could do so on their own accord.
And then there is social pressure. A patient depends on doctors and relations and friends for emotional support and advice. If all these three groups of people advise euthanasia, the patient is likely to go for it. But however, given the emotional state of the relations and friends, they are not really the appropriate people to be making decisions. The doctor/physician would be the right person if hospitals and clinics were only hospitals and clinics, and not businesses. A hospital or clinic that aims to maximize profits by maximizing patient turnovers will be likely to recommend euthanasia of patients for their own benefit.
And then there is the fear factor. Once the advertising industry starts churning out “Living wills” advertisements, they will be playing on fear and loneliness; is that not the reason for promoting euthanasia in the first place. Manipulating people’s insecurities in normal society (think: the 5Cs) is bad enough; manipulating people’s insecurities about health… is just unthinkable.
Remember the CNB’s advertisements that show how hopeless the life of an addict is: losing job, losing family, losing girlfriend. At least though, in this case, the addict deserves some of that (although not as serious as all that). Translate this onto a hospital patient’s relations and friends. The catch-line: If you don’t want your loved ones to go through all this, sign up for euthanasia at your nearest polyclinic. Delivered by the Ministry of Health, in conjunction with the Ministry of Community Development, Youth and Sport.
Because that is how Singapore Inc works, that is how it will turn out to be. There are similar ads in the countries that have legalized euthanasia.
(2) Luckily, MJ only dies once. The truth is, many people fear actually taking the plunge, except for some really depressed people. And this keeps depressed MJ fans from committing suicide. But if a way was created for them to be killed without having to take the plunge themselves, they would all swarm towards it.
MJ aside, I have been reading info on the debate. In 2008, there was a case of a French woman who wanted Euthanasia purely because the “pain” from having a face disfigured by a tumour was too great. And Belgium apparently welcomed her. I am not quite sure that this ought to be taken as a sufficient condition to qualify to be killed. And this is a real case.
The latest review of Oregon shows that 1 in 6 of the people committed to euthanasia were suffering from treatable depression, but the doctors were too trigger-happy to bother sending them for psychiatric treatment.
A review of Washington’s Death With Dignity Act (2008) showed that the majority of recipients of euthanasia were old people above the age of 65. More than one-fifth chose Euthanasia because they felt they were being “burdens”.
In 2009, the Washington State Bar Association published a pamphlet online criticising the Death With Dignity Act in Washington:-
http://wsba.org/media/publications/barnews/jul-09+deathwithdignity.htm
Of course, I suppose it depends whether you place more weight on the 23% who died because they felt to be a burden, or the 77% who died for other reasons. Of course, it is likely that a significant proportion of the 77% were, as in the case of Oregon, people with treatable depression whom doctors were to lazy to treat because euthanasia is just more cost-efficient.
Arix, I don’t deny that there are good arguments either way. yes there will be cases of social and familial pressure. but really i think these will be few and far between. How many Swiss patients does Dignitas see in a year? How many cases where the decision has been imposed on the person
And if a person wants to end his life because he or she has a disfigured face, or because he or she feels she is a burden, or because he or she is depressed for any other reason (treatable or not) well that is their choice. Thankfully i am not at this stage dependent on others but i suspect that if the time came when i needed help to go to the toilet i would want to end it, even if some psychiatrist thinks he can drug me out of being depressed about it. Of course i may change my mind on this if that became a reality but at this time that is how i think i would feel about it.
For every case where death is influenced by pressure (which should be guarded against but admittedly cannot be totally prevented) there will be very many more where it has been truly voluntary. There should be rules about attempting to coerce a person to die, and these will have some effect, though as you have pointed out there is no such thing as a law that completely solves the problem it is intended to address.
@ Arix,
what are you talking about?,most westernized society including Singapore are already been desensitized when abortion first introduced.Since then,the slippery road began.It is not difficult to forecast what would happen next.Look at the western world.Many who have allowed Euthanasia/DAS already justified additions such as alcohol abuse and narcotic addition as illnesses.Thus,those society allowed opening of safe shooting houses for all these addicts in order to prevent deaths or catching Aids thru dirty needles. If a society loses the moral compass,it out come will be very disastrous.
Here is a question for all Singaporeans to ponder.Who was that person that gave the advice to our MM LEE for a green light to legalize unrestricted abortion years ago?Here is a clue.He was a Singaporean and used to be a gynecologist and had passed on since.
Lol, where did those avatars come from? Is it possible to change your avatar?
Preston,
Your attitude is not constructive at all. The point is, nothing is irreversible. Policy is policy. It can be there one day, and repealed the next. What politicians and people need is courage.
Yes, I know about the West; in fact, as you would realize, I am there right now.
I know of rehab centres; I have no knowledge of “shooting houses”. Perhaps you are referring to cold-turkey treatment places?
And yes, you have alcohol abuse. But what makes alcohol and drugs different from euthanasia is that in the former it is the amount ingested that makes the difference; while there is no such thing as an acceptable amount of death: You are either dead or alive.
I have no idea which gynaecologist helped legalize abortion in Singapore.
rovk,
(1) How many people buy adidas or nike shoes a year? How many instances were those decisions imposed on those people? The same logic applies.
The thing is that the pressure does not come through a bottle-neck; it is several layers of subtle pressure that accumulate. So these “free” choices are not really free at all. Plus, Dignitas would not want to harm its business; so it really will just kill whoever comes to it to be killed.
(2) Is that situation inevitable? And even if that physical situation is inevitable, is your depression a necessary result from it? Your analysis begs the question of why be depressed in the first place?
(3) Coercive pressure can be coercively suppressed, but the real devil is non-coercive pressure from perceived social expectations. Euthanasia law works positively (“should allow”), as opposed to negatively (“should be allowed to allow”). So it sets a social expectation that doctors will indeed conduct euthanasia, which leads to a vicious circle.
Hi Erix@uk,
I am surprised that you never heard of safe houses for drug addicts and yet you claimed you are in the West.I really wish that these premises are for cold turkey treatments.Unfortunately,according to western mind set,cold turkey is a cruel form of treatment for drug addicts and so these so-called safe houses which are funded by taxpayers, allowing drug addicts to exchange their used syringes for new ones and at the same time given a safe dosage of heroin or narcotic of their choosing to ‘enjoy’.Can you enlighten us what social policy was reversed back to its original stance in this last 20 yrs.There was not one that i know of.Also,i guessed you too young to know about how abortion and sterilization was part of the Family Planning engineered in the Singapore;s society.
Think for yourself, dun let others decide for you cos you also have a brain.
It was not your choice to be borned, at least have your right to die when the time comes.
But please dun jump track.
There are places with free food, lodging as well as medical care.