This caught my eye today and affected me enough for me to break my longtime ban on myself for paying for mainstream news.
Reading Madam Lim’s story was honestly very heart wrenching. Here is a lady whose body is being slowly eaten up by cancer, and she wishes to stop it before it gets any worse. However there is one huge obstacle – the law.
While passive euthanasia is allowed here with the passing of the Advance Medical Directive Act (AMD Act) in May 1996, active euthanasia is still illegal.
Under the AMD Act, a person is allowed to instruct doctors not to take extraordinary measures not to prolong his/ her life is he/ she is terminally ill and unconscious by signing up for an Advance Medical Directive (AMD).
However that is not enough for Madam Lim. She wants to die in dignity and she wants it now with the help of an assisted death at a time and place of her choosing.
“I cannot even go to the toilet to pass motion. I cannot pass motion on my own. The nurse has to help me dig it out. What dignity do I have left as a human being?”
Gathering from the report, it seems that Madam Lim had written to President SR Nathan with the hope that he will kindly grant her that wish.
She had originally intended to speak about it at the Speakers’ Corner but was hospitalised and thus was unable to do so.
Madam Lim and her husband have reportedly considered going to Switzerland where assisted death is not a crime when performed by an individual who is not a medical doctor and who has no vested interested in the death. However that journey would be too ardous for her to attempt given her current state of health.
She was quoted saying,
“Every day I have now is not a gift to me. It is a mental and emotional torture because I know what awaits me. I will become more and more dependent on others. Every day I live now is one day too many.
“I want to die now, in peace, in my loved one’s arms. If I cannot have “an le shi” (happy death), I will simply stop eating and drinking.”
My personal stand.
Personally, I am for the legalisation of active euthanasia because I strongly believe that pain and suffering is a personal and private experience and one has every right to choose to either terminate it or go through it til the very end.
No one should deny a patient who is terminally ill the option of ending the pain and suffering. No one should expect the patient to accept hospice care and painkillers.
I do understand the concerns that many have with regards to what might happen should active euthanasia be legalised. I will explore the concerns along with my suggestions. It will be great if a discussion can be generated here.
1. Elderly patients might feel obligated to die.
First of all, not all terminally ill patients are old.
Anyway, yes there is a chance that terminally ill patients might feel that way because they do not want to burden their family members with the financial and physical exhaustion of the need to take care of them.
Now, before we blame euthanasia for allowing such a thought, why don’t we seek to improve the cost of health care and ensure that the patients and their families get as much moral support as they can with the moral support of the patients’ doctors, nurses and social workers who can be attached to the patients and their families.
Facing impending death does not come without stress, fear and other negative emotions so it is important that the mental well being of the patients and their families are taken care of by providing them with social workers to lessen the emotional pain that comes with the journey towards death.
2. Family members might coerce the patients to choose death out of greed.
Well, once again I would like to stress upon the importance of social workers here.
Once an application for euthanasia is made, social workers attached to the patient and his/ her family needs to come up with an analysis of whether coercion might have taken place, gathering from the daily observations and interactions with the patient and his/ her family.
The report should be analytical and neutral. It will then be submitted along with the medical doctor’s report on the condition of the patient’s health. Only when a patient has been certified to have no hope of recovery and it is satisfied that no coercion has taken place, then a letter of approval can be issued.
3. Active euthanasia contradicts the oath taken by medical doctors to save lives.
Indeed it does and that is why a medical doctor should not be the one to carry it out. Once a letter of approval has been issued, the patient can then check into a euthanasia clinic for it to be carried out by a person trained to carry out the process and who is not a medical doctor.
4. What if the patient wishes to reverse his/ her decision.
I personally think that the patient must be allowed to reverse his/ her decision at anytime he/ she wishes.
In fact, at least 5 hours before assisted death is to take place, a counsellor should be employed to talk to the patient about his/ her decision. He/ she must then be allowed some time to think through to see if he/ she wishes to reverse the decision.
Assisted should not take place without a final verbal or gestural confirmation from the patient at all. There should be chances for the patient to change his/ her mind even til the last second.
5. The legalisation of euthanasia is against religious beliefs and moral values of our Asian society.
Allowing active euthanasia does not violate religious beliefs and moral values of our society since it is voluntary and those who do not believe that choosing euthanasia is religiously and morally right, they do not need to opt for it. Legalising euthanasia only seeks to allow those who want to end their pain and suffering an option to do so legally.
When we talk about religious tolerance, we tend to forget about atheists who do not believe in the words of any gods, the teachings from any holy scriptures. Not all atheists believe that euthanasia is morally right anyway but the point here is that while the government promotes inter-religious tolerance, they should also promote the tolerance between theists and atheists.
What is moral to one might be immoral to another. Why not cater to all instead? No one should impose their religious or moral values onto another individual and expect them to accept it. In alot of ways, criminalising active euthanasia is in my opinion, a form of that.
6. “Those who want to go their way should do it peacefully and should not involve the majority of God-fearing people who believe in the sanctity of life.” (Quoting from a private discussion I was involved in)
My response?
Most of those who want to go their way do not dare to do so because it is illegal and as much as they are suffering and want to die, they want to do so medically without breaking the law because in many societies, breaking the law for whatever reasons is a very ‘lose face’ thing to do.
That is all for now!
The abovementioned suggestions were developed from constant thought about the issue. I might have missed out on some stuff here and there but they will be added on later when they come to mind.
I would love to hear from others what their suggestions and opinions may be. To me, talking about death is not a negative thing to do. It is simply part of life.
So let the discussion flow!
Rachel Zeng / rachelzeng.wordpress.com
Lobo76,
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I am going to leave you to your opinion because you are desperately arguing your point from out of range.
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How you can even equate my comments to that of terrorism is too far a bridge for me to climb with you.
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Know that you have adopted the PAP way of argument, which is, to come up with a tag, a label like guinea pig, and then stick it to their victim.
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Thanks but no thanks.
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I will continue to prefer hope over hopelessness.
Gemami,
How you can even equate my comments to that of terrorism is too far a bridge for me to climb with you.
I qualified in the very sentence, that I knew I was stretching it. It just crossed my mine and I put it down. That’s all. You are reading too much into it.
Know that you have adopted the PAP way of argument, which is, to come up with a tag, a label like guinea pig, and then stick it to their victim.
I didn’t I had it in me… *looks at my bank account* Why am I not earning millions? arh.. maybe because I am willing to debate. PAP shuns debates..
wait..isn’t that what you are doing?
p.s PAP way of argument is also a ‘tag’. So now you have fulfilled two criteria, and I only managed to do one.
Germami / Lobo
why so snipppy, both of you ?
relaggg
If there is a match between a patient wanting to leave his struggle with pain and a doc willing to end his struggle for him, then perhaps in allowing euthanasia, compassion is better demonstrated and served.
There is quite a bit of research into dutch/belgian or lowlands euthanasia laws.
It is pertinent to note that in those countries, euthanasia is still a criminal act.
What it does do is to prescribe circumstances in which doctors will not be prosecuted for assisting suicides.
An interesting article
http://www.ethical-perspectives.be/viewpic.php?LAN=E&TABLE=EP&ID=51
Its quite scary when dutch laws allow someone as young as 12 to be euthanised.
Lobo76,
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Fair enough, your explanation.
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About the value of pain. I suggest you go take a look at some of our hospitals to see how they measure pain.
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As an example, a hospital close to my home, NUH, you will see a graphic description of pain hanging on many of its consultation rooms.
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It tells of the different levels of pain, and how nurses and doctors can ascertain the level of pain felt by patients by seeing the expressions of their faces.
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There is a value to pain – a measurable value.
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Does this mean that the hospital is degrading its patients? Surely you would agree that it is not.
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Likewise, I place a value on pain so that we can understand that value and seek treatment, and holistic care to help the patient ease off his pain.
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You have subverted that thinking to one which you had so conveniently described as you did.
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It’s ok, I know you do not have a million dollar bank account. Neither do I, and so we can both disqualify ourselves as passengers on the PAP tugboat.
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Now, my argument is based on hope, while yours is based on ending that hope. You believed there is no hope because many have suffered ‘needlessly’ and died.
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I believe differently, that there is hope, if not for the patient, then for the future, and I will continue to encourage such a mindset. It is healthier and the right thing to do.
gemami, I think the point you’re missing is that no one here has the right to tell Mdm Lim how to live her life.
Yes we can go on about how noble it is for her to continue living so that future generations can benefit from her suffering.
But ultimately, we must never forget that she is the one paying the price for it and for that reason alone the decision is hers to make, not yours or mine.
To say that an individual must be forced to suffer, no matter how much good her suffering will bring to others, is simply unjustifiable. The decision to suffer or to end one’s suffering can never be a choice for others to make.
You said you prefer hope over hopelessness. I simply don’t see why your preference should have any effect whatsoever on her life.
Chipper 7 May 2010 gemami, I think the point you’re missing is that no one here has the right to tell Mdm Lim how to live her life.
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so many as shole aroun us onLEE know how to talk and lipsync…
they tell you that its a sin to die earlee..they tell you its against the law for you to take your owned life no matter how you sufferred to the extend of sittin in a wheelchair with a plastic urinal bag below you..
preachin you to pray and hopes for HOPES!!!..so easy to talk/preach…
when you tell them no money for treatments/followup as though you can hopped into an sbs bus with your wheelchair/urinal bags intact..as though that dr khaw will be waitin for you with open arms to welcom you to HIS hospital for treatment/aftercare…
THIS IS LIFE..IN SINGAPORE a sick citizen is a LIABILITY unless you are leekuanyew or dr khaw…
Chipper,
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I do understand your point and I can accept it.
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What I cannot accept is the defeatist sentiments expressed by some under the disguise that they are helping people like Madam Lim.
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I do realize that my comments may seem more medical than anything else but they do tie in with my main point of contention, which is hope. When you distinguish that hope, you distinguish all else.
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The other point is this, which has been waylaid, that if anyone chooses to die, there is no one to stop him. The question is why there is a need to rope in someone else to help him die.
MyviewsareHealthy,
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Yes, that is the suffering part which contribute largely to patients wanting to die. This is why it is so important to channel our energy to seeking ways to help these sort of patients live a life that is more dignified than it is now.
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It is why the focus should be on palliative care, which by the way, ought to encompass the whole care system of our terminally illed Singaporeans.
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Having said that, it cannot be used as reason to end all hopes.
Gemami,
About the value of pain. I suggest you go take a look at some of our hospitals to see how they measure pain.
You might wish to note that suffering != pain only. The article specifically quotes Mdm Lim on the indignity of needing help to pass motion. That, has nothing to do with pain.
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Does this mean that the hospital is degrading its patients? Surely you would agree that it is not.
Nope. It’s how you use the measurement tool as well. e.g To tell a patient he is worthless for not able to endure a certain level of pain, for whatever reason (even ‘greater good’), is an attempt to degrade that person.
I don’t mind degrading a brat who is making a huge fuss over a paper cut, but I will never do that to a terminal patient.
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Likewise, I place a value on pain so that we can understand that value and seek treatment, and holistic care to help the patient ease off his pain.
First, I reiterate that pain is but part of suffering.
Second, you consistently seemed to forget how long it would take to find that treatment, and thus how long the patient has to suffer.
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Now, my argument is based on hope, while yours is based on ending that hope
Hope is all good and positive. However, my stand is that it should be tempered with realism. You seem to throw realism out of the window altogether. I mentioned this before, how fast does a drug go from research to something usable?
It’s not so bad to be idealistic. It’s sometimes worth aiming for (world peace, anyone?). But when suffering is a result of trying to achieve that aim (which is unachievable), I will step back and think about it. e.g if I tell you world peace can be attained by killing 99% of world population (people will be shocked to peace), would you do it?
gemami 7 May 2010 MyviewsareHealthy,
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Yes, that is the suffering part which contribute largely to patients wanting to die. This is why it is so important to channel our energy to seeking ways to help these sort of patients live a life -
Having said that, it cannot be used as reason to end all hopes.
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lets talk bout hopes..shall we..
from dr khaw point of view…
you all heard of h1n1 virus? @ 1st it seem that there is no vaccine to the extend of leekuanyew visitin the middle east for such a lon lon in search of the lone lost camel that was lost in tang village..right?
and when the vaccines was availiable..there for HOPEs for every peasants of singapoor PROVIDED you are willin to pay upfront $214 for that jab..
while in thailand and usa you get it jabbed FOR FREE!!! now i did not go for the $214 jab simply because i couldn’t afford it and beside do i looked liked the courageous leekuanyew himself? in the end what happenned? when the h1n1 was not ^SELLABLE^ and hav near expiry dates..dr khaw decide to DONATE to a neighbourin country instead of jabbin on our POORER peasants…
so what HOPEs are you MUBBLIN here?
Mdm Lim’s case is a classic example of a patient who is still conscious of her suffering and wants to end it, “with dignity” because it appears there is no hope of attaining alleviation, even at a miniscule level, of her cancerous affliction.
Let’s recall her words:
“I cannot even go to the toilet to pass motion. I cannot pass motion on my own. The nurse has to help me dig it out. What dignity do I have left as a human being?”
To me, it is an evil not to accede to the request of a patient to end their suffering – the kind that is exemplified here.
Was Mdm Lim not conscious or aware of the meaning of those words?
Is there any doctor or medical specialist around who thinks there is hope for recovery or amelioration for Mdm Lim?
What about the financial cost for the nursing care for Mdm Lim?
Who is footing the bill? The government?
As lobo76 commented: It’s not so bad to be idealistic.
But where idealism is just a dream, [see lobo76's comments] pragmatism is far superior.
I disagree that its idealism. We’re talking about alleviation of Mdm Lim’s indignities rather than alleviation of her cancerous affliction (which is unlikely).
Are we saying that technology can’t assist a person to pass motion on her own or with dignity?
People (who aren’t dying) even go to private establishments for enemas (and I understand that doesn’t involve digging) nowadays…
If the indignities (and pain) are removed, would there still be a need for euthanasia?
If yes, then we should focus investing on palliative care rather than take the easy way out with euthanasia.
lim,
If the indignities (and pain) are removed, would there still be a need for euthanasia?
My answer is ‘yes’.
the other side question is then,
If the indignities (and pain) can’t be removed, would there be a need for euthanasia?
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If yes, then we should focus investing on palliative care …
While you invest and do research, is the patient supposed to wait? How long is a suitable waiting period?
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…rather than take the easy way out with euthanasia
Easy for who?
True, euthanasia may be ‘easy’ for the patient.
But the reverse (no euthanasia) is true for doctors, and/or people who hold sanctity of life in too high a regard. The cost of their having an ‘easy’ time? suffering by the patient.
lim,
“I disagree that its idealism. We’re talking about alleviation of Mdm Lim’s indignities rather than alleviation of her cancerous affliction (which is unlikely).”
Good. You are at least agreeable that from the details provided there is no hope of amelioration for Mdm Lim’s cancer.
Next, the question of her difficulty of passing motion.
You remarked:
“Are we saying that technology can’t assist a person to pass motion on her own or with dignity?
People (who aren’t dying) even go to private establishments for enemas (and I understand that doesn’t involve digging) nowadays…”
Maybe the technology you refer to is available, and maybe it has, prima facie, no value in Mdm Lim’s case. She is suffering from cancer, remember?
Why or what prompted her to say: “I cannot even go to the toilet to pass motion. I cannot pass motion on my own. The nurse has to help me dig it out. What dignity do I have left as a human being?” – if she wasn’t handicapped to such an extent? Can you think of any valid reason?
The indignity we are observing here is the result of being handicapped in ways we deem abhorrent; and clearly Mdm Lim thinks there is a better route to take: end her suffering by helping her to die quickly and peacefully [a lethal injection, for instance].
Yes, about pallative care: but has anyone considered about the financial costs? If the government is footing the bill, yes, by all means postpone euthanasia and let nature take its course.
Imagine a married man suffering from permanent paralysis, from say neck to toes, with no hope of recovery but he still has the capacity to talk audibly. Everyday, someone [maybe more than one person] needs to feed him, clean for him, etc. Now imagine he happens to have a wife and two young children and the wife is earning an income that is only sufficient to feed herself and their two children. The family can’t afford to employ a housemaid or nurse to take care of her husband. A situation like this or similar to this is not implausible, you agree?
So what is going to happen when the wife goes to work? Who is going to care for her bed-ridden husband? Assume they have no ralatives, but even if they do, no relatives are able to give the care or attention that is essential to keep the husband going.
What about the government? Would they provide full assistance, monetary and/or the manpower? My answer: Fat hope!
The husband, being a caring and loving man, understands the position; he thinks the best way for him is to make an exit, quickly and permanently. Solution: euthanasia or assisted suicide. And that is something I would happily count as a blessing if I were in such a situation.
This talk about hope, pallative care [without any consideration as to cost] and life being preciousness etc is what I would call idealism.
Idealism is only for dreamers. In real life pragmatism is a safer bet.
can go Mexico City get barbiturates off the shelf from pharmacies there to self-terminate.
you go to sleep and not gonna wake up – what a way to go !
you choose when, how and where to make your exit, what can be better than that ?!