Euthanasia and physician assisted suicide – Part 2: Possibilities for Singapore

Note to readers: This commentary deals with a topic that not everyone will agree with, or even want to talk about. The subject of suicide is a sensitive one to most religions, and even the topic of death is taboo for most cultures. As such, we encourage readers to read this with an open mind - rather than simply accept or oppose these views, do discuss how you agree or disagree with them.

By Richard Woo

If we agree that, notwithstanding exceptions, the answer to what makes my life meaningful is certainly not the same for everyone else, but is most likely to vary from person to person, and it seems irrational to argue otherwise, then the assertion that the value of life has nothing to do with one’s quality of life has to be considered as lacking in circumspection - without regard to the wide variety or diversity inherent in nature including of course human existence, people’s mindsets, their idiosyncrasies, etc - and must therefore be rejected or refuted as baseless, unpersuasive or unsound.

We cannot discount the possibility of a person assigning a value - for instance, low, moderate or high - to his or her life based on the kind of life he or she is living; and the value assigned by this person may contrast sharply with the value assigned by another person in a similar position. In short, what you consider as palatable may taste horrible to me. Or we can agree that life has a value but we cannot agree that this value can be quantified as being the same for everyone. Or we may say that what you consider as value of life means nothing to me.

On questions of life and death, it is worth noting that Singapore has already become or is fast becoming a city with a high proportion of aged people. We have seen press reports of old people dying alone without anybody knowing anything about it until the stench from the corpse caught someone’s attention. Arguably, it is not a healthy sign to see old people living alone and dying without anyone knowing anything about their death. About four years ago, someone living in a flat in Jalan Bukit Merah died but his dead body was not discovered until six months later, despite the stench that was detected for months by some people living in the area.

Thus, being alive is not a big deal if you happen to be old and living by yourself; and being old and alive can become a social problem for others.

Another earlier case of death going undetected occurred in Jan 2008 and concerned a father, 82 and his daughter, 50, both of whom were found dead in their home after the stench from their corpses caught the attention of neighbours. When police arrived at the home, an elderly woman, aged 80, told them that her husband and daughter were sleeping.

This is an example, a very sad one, of a severe downside of growing old. And that may precisely be the kind of situation some people dread to be in. Dying sooner rather than later seems a pro-choice in such a scenario.

From my perspective, I am no less in favour of legalising voluntary euthanasia or physician assisted suicide, within clear boundaries that need to be discussed thoroughly by the members of the community concerned.

Arguably, everything in life has a cost; there is a cost to being alive, just as there is a cost to being dead - funeral expenses, effects the death has on others, etc. There is no need for us to expand into minutiae in this area. We can, however, only evaluate on such matters when we are alive, not when we are dead or in a coma or being in an advanced stage of Alzheimer’s disease or suffering from another form of dementia.

Hopefully, voluntary euthanasia can be a choice that settles as to which side of the equation one wants to be. If being dead can be evaluated as having a far lesser cost, then opting for an early death and dying as a consequence can be counted as an achievement or even a victory. Opting for an early exit through euthanasia or PAS, just to end one’s suffering, may be the preferred choice, even where the government is footing the bill for the palliative or nursing care for the patient.

Can euthanasia or PAS be considered as a solution, then? My answer is Yes, despite all the pro-life arguments about preserving life. If I were in such a condition with nothing to look forward to but misery and death I would opt for an early death. Through euthanasia or PAS my misery can be removed and I would consider it as an efficient way to go. And if someone else has to make a decision on my behalf, I would be thankful for the decision, for giving me a quick and efficient escape route. A lethal injection seems to be a far cleaner, more efficient way to go than starving oneself to death, or jumping, say, from a building if the illness is such that it does not affect the patient’s mobility but nevertheless is incurable and painful to him/her, physically and mentally.

Can the governments of the countries or states that legalise euthanasia or PAS be considered to be unethical for doing so? To note, the law is not strictly about ethics or morality. Furthermore, it would be a mistake to think that anything legal must be moral, or to conflate legality with morality. To say that something is legal is merely to say that there is no law in the statutes that prohibits it. If an action or inaction has not been codified as an act punishable in law it does not mean that it is not abhorrent, immoral or wrong. Legalising euthanasia or PAS, within prescribed conditions, is merely a process of making euthanasia or PAS “legal” within those conditions. The argument can also be applied similarly to countries that have made abortion legal.

Life can be meaningless, even to people who are not suffering from any form of disability or ill health. “There comes a time when life to the elderly is meaningless… and he or she does not want it anymore… dumping old folk in hospitals is a worse sin than death... the law of the land should not be based on religious doctrine” - these were comments made by a woman, a Christian, in a letter she allegedly wrote to The Straits Times on 15 November 2008.

We can’t rule out that probably there are people who may harbour the kind of thinking this woman espoused, that there may come a time when life seems meaningless, for reasons privy to themselves and which may not relate to issues of health, such as a debilitating illness. In a multi-cultural or multi-religious society, public policies should be formulated strictly on socio-economic considerations. Religious dogma of any stripe should not be allowed to be taken into consideration vis-a-vis the introduction of such policies.

What is being discussed here is a voluntary scheme. Refrain from participating if it is something forbidden by your religiosity, but do not deprive other people of the things they desire for themselves. If we are worried about going down the slippery slope, we also have to be fully conscious of the catastrophe that can arise from the creeping incursion of religion into politics which, to people who are savvy, has already happened - if not in this country, then in many parts of the world.

If people are denied the right to self-determination when they are mentally capable of doing so, with the proviso that it is not harmful to others, there may come a time when self- determination is no longer feasible, in terms of their mental state, and thus they may become wholly dependent on the judgement of others, which may or may not be beneficial and may lead to complications that they would not have dreamt of in the first place.

No doubt, euthanasia or PAS is appalling to some people. But euthanasia or PAS may just be the solution to pain and suffering. Opponents of euthanasia or PAS may offer their views about the “sanctity of life” or “preservation of life” in their defense, but they would do well to pause and then reflect on the evil of pain and suffering a person may be forced to endure when there is no hope of recovery or amelioration or when continuing simply means imposing suffering on others as well.

The Advanced Medical Directive in Singapore, which came into effect in July 1997, can then be lauded as a step in the right direction.