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Monday, December 15, 2008

ST Forum: Euthanasia 3 major considerations - 13 Dec 2008 - by David Siauw

Euthanasia: Three major considerations (As published in ST Forum 13 Dec 2008)

DISCUSSIONS on euthanasia have been carried by the media in recent weeks. I believe there is a strong need to help readers understand the factors involved in the procedure.
There are three major considerations in the act of euthanasia: namely, the presence of voluntary decisions, active agents and external assistance.

Voluntary decisions refer to whether the patient chooses euthanasia of his own free will. In the case of active agents, the question is whether the act occurs via active means like lethal injection, or passive means like the removal of life-support systems. External assistance refers to whether the patient ends his life on his own or is assisted by someone. Cases that occur involuntarily, without the patient's consent, involve obvious legal and ethical issues.

Consequently, there are five possible options, namely:
- Voluntary, passive
- Voluntary, active, non-assisted
- Voluntary, active, assisted
- Non-voluntary, passive
- Non-voluntary, active, assisted.

Non-voluntary euthanasia can occur when the patient does not have the capacity to make a conscious decision.

The second scenario - voluntary, active, non-assisted - is equivalent to suicide. Proponents of euthanasia often assume this will happen if euthanasia is not legalised. However, it is not necessarily a well-founded assumption.
Palliative care specialist Rosalie Shaw has expressed the contrary view - based on her abundant experience - that most people cling to life, rather than wanting to end it ('Helping with the dying', Nov 5).

More often than not, the wish to die occurs when the sufferer loses hope in life. If he continues to receive affirmation, acceptance and aid, it is very unlikely that he will choose the lonely path of death. It must also be noted that, with medical advances, management of pain has improved.
Hence, proponents of euthanasia basically propose to legalise the voluntary-active-assisted act of dying, which is allowed in the Netherlands, where a substance is introduced into the patient to hasten his death.

Many believe this procedure can be controlled by outlining all available options before the patient makes a decision. Again, this is debateable. Most psychologists agree that a person with constrained options cannot make an autonomous decision. Hence, it is questionable whether a patient who believes he is in a hopeless state can make a rational decision. More often, it is the perception of being a burden to others that triggers the desire to end one's life.

In fact, legalising euthanasia may lead to negative social implications. Society may consider the procedure as an immediate and achievable solution for the 'suffering' family member. In the name of 'ending the patient's pain', society may become more self-centric. This would be especially true of a society with a growing number of elderly members and where resources are considered scarce.

Euthanasia is much more than an issue of individual choice. Singapore, as a nation and a community that speaks highly of the sacredness of life, family values and selfless grace, should never legalise euthanasia.

David Siauw

Latest comments

Why do we assume that everyone "clings to life"? I feel that those who are opposed to legalising euthanasia do so purely out of blind compliance to their particular religious beliefs. Of course, they try to cover this up with all sorts of flimsy reasoning on why euthanasia should not be legalised. Hey, there are some people who believe in reincarnation, so shouldn't this be considered too? Euthanasia does not matter so much if you're going to be reincarnated :-)
Posted by: Fox_KiloGRAM at Sun Dec 14 22:33:55 SGT 2008

Thks Gigamole for your clarification. Yes, agree with you the worst that can happen is S'pore being a "euthanasia hub". There is always this small group of people who are faced with no other choice but euthanasia due to intense suffering and pain, but then as luciferixangel put it..."Life is precious and if possible why does the individual not have the will to fight this pain? Why succumb to it using such means?" I think that was very well said..I for one hope that the government would never legalise euthanasia. I fear that the patient's family members may not be able to live with the guilt that they may have given up hope too easily, even if the patient had given his consent. Maybe more effort should be spent on improving palliative care facillities, instead of arguing what consitutes the right time to die.I believe when the time is up, we will all naturally leave this world. The pain of knowing that your loved one is alive but suffering will be just as great as knowing that you had taken the easy way out to let him die prematurely, and not done your best to help relieve it. There are no short cuts in life.
Posted by: MichiganOne at Sun Dec 14 22:01:44 SGT 2008

Euthanasia and the rationale behind it is actually multi-faceted. Consider this. Euthanasia is only even considered due to the reason that it eases suffering by inducing a form of painless death to an individual. However, I always believe in the logic of the human life cycle and accept that everyone must die sooner or later, and based on this, is it even remotely acceptable that an individual chooses such an option? There is a fine line between Euthanasia and suicide. Life is precious and if possible why does the individual not have the will to fight this pain? Why succumb to it using such means?Using Euthanasia as a poor excuse to ease one's suffering. However, on the other hand, one might argue that every person has to be given a fair choice, and they obviously have the right to choose Euthanasia, but like whar Mr Gigimole has mentioned, only as a last resort. On a personal level, Euthanasia is definitely an option, but it should not be in anyway a starting point for it to be sold commercially as a full-proof method. There are many legality and moral issues that comes tied in with the bargain. Euthanasia can be made use of, especially so when the individual himself is unconscious or is involuntary. From a Singaporean context, we have to be wary of Euthanasia as it marks a shift from the conventional medical hub concept. We are moving from saving lives to ending lives in order to ease pain. Such a concept is fresh but dangerous, coming with a high moral price tag. It is cruel, even if the individual is voluntary. It might be personal, but I do not condone people "perpetuating" their own deaths and resorting to Euthanasia as a way to run away from troubles in life or because it is an easier option to tak in the circumstances. Without doubt, people will shirk away from such an option, but there might be a way out. There must be strict laws in place to allow Euthanasia to be carried out efficiently and in the correct way on a case to case basis. If at anytime morality is compromised, it should be banned straight away. However, in the end, the debate is: If the individuals and their loved ones condone Euthanasia, does morality still hold, especially since our model of society cannot possibly accept premature death as an option, due to the need to uphold the importance of human lives and the global medical hub concept. It is once again a battle between morality of the personal ring surrounding the individual, and the community value of the society. With better ways to combat pain and technology, should Euthanasia actually be commercialized?
Posted by: luciferixangel at Sun Dec 14 20:02:55 SGT 2008

Reading between the lines, I suspect that the government is testing the ground, to see whether , euthanasia is acceptable to the population of Singapore to solve problems associated with patients suffering from terminal cancer or other end of life diseases, which in time to come will include those patients not economically active and lingering away in nursing homes, demented and straining the economy. Tell me I am wrong.
Posted by: kiam123straitstimes at Sun Dec 14 19:43:28 SGT 2008

Euthanasibe an option of first choice in any society. It is always an option of last resort. I am not a champion of euthanasia, but grudgingly recognize that it may represent a final solution to a small group of patients for which palliation has failed.If euthanasia is to be legalized and offered as a solution, society will have to pay a high ethical/moral price. Euthanasia, thus should only be an option only for the members of that society. It should not be part of a commercialized set of activities. I could never condone euthanasia, if offered in the context of a globalized medical hub concept. I could never ever support Singapore becoming an euthanasia capital of the world, which it will da cannot efinitely be should we offer euthanasia services to non-citizens.
Posted by: gigamole3 at Sun Dec 14 09:14:57 SGT 2008