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Suicide and euthanasia – treading the ethical and legal boundaries

By Ghui

Anything associated with death is generally considered taboo in most cultures and Singapore is no exception to this.

No matter how distasteful the subject of death, it is a certainty for everyone at some point. To that extent, it is therefore grudgingly accepted. However, the idea of suicide, assisted or otherwise, is polarising to say the least.

The sanctity of life is universally upheld. This is made clear in every facet of life. The efforts put into medical science to ease disease and the punishment of those who take the lives of others are but examples of this belief.  Many of our long held opinions are premised on the right to life and the alleviation of suffering. As society progresses and becomes more enlightened, it is time to consider this issue on a deeper level.

lee kuan yew 2The late Mr Lee Kuan Yew had once indicated that he wanted his own death to be swift. He did not want to linger in a comatose state, bed ridden and incapable. As his daughter recently revealed, he had inquired into the possibility of euthanasia.

As a strongman who was always in control and at the helm of power, I can well understand why he would feel this way. It is natural not to want to suffer unnecessarily. What more from a proud man who had always wielded such authority?

If human beings possess the right to life, do they not also correspondingly possess the right to reject their own lives? This subject matter is of course a minefield and continues to be the subject of much heated debate. Critics would argue that only God can take a life and that it is not for mere mortals to interfere in matters of life and death. God’s will be done.

Proponents of the same would counter argue that God’s will is subjective at best – dependent on the state of medical evolution. If you take God’s will to the fullest extent, medical science should not exist. If God deems that your time if up, there should be no medical intervention at all because that can be seen also as taking the issue of life and death into humanity’s less able hands.

I can safely assume however, that the majority of people (including the deeply religious) would reject this outmoded form of thinking. The level of “God’s will” is therefore not static and constantly evolves.

Why then do we baulk at suicide? Is it the collateral effects of loved ones knowing that their kin or friend would willingly end their own lives? This then begs the question of how we value life. Do we live for ourselves or do we live for others? Any superficial discussion on this would deny it of its significance and as such I will restrict this discourse to circumstances of extreme suffering and illness where recovery is considered very rare and where the individual concerned has the full mental capacity to make this decision.

Information on the Advance Medical Directive from the Ministry of Health website
Information on the Advance Medical Directive from the Ministry of Health website

Such an individual can always take the action of ending his or her own life through committing suicide, as we traditionally understand it. In most countries committing suicide and the failed attempt of it is not a crime so this avenue is always open. However, what of assisted suicide or, as it is commonly and loosely termed, Voluntary Euthanasia?

The complexity of this topic can be seen in the many layers of definitions that this term holds. There is active euthanasia, passive euthanasia, assisted suicide and active assisted suicide just to cite a few. The carve outs and deliberate choice of words provide clear evidence that this is not a black and white case at all.

A number of countries in the world do legalise some semblance of voluntary euthanasia with caveats. All of these countries require for the individual to be terminally ill, suffering unbearably with very slim chances of recovery and to be of sound mind when the decision to end their lives is made.

Currently, only Belgium, Luxembourg and the Netherlands have legalised active euthanasia, whereby a healthcare professional or a doctor can deliberately end the life of a person provided that the above criteria is met. In countries such as Germany, five states in the United States and Mexico, assisted suicide such as a doctor prescribing life-ending medication is permitted as long as no one has physically assisted the person in taking such medication. Switzerland is slightly more liberal and allows assisted suicide as long as the assistant does not have any “self seeking motives” in helping the person end his or her own life.

In Singapore, any person above the age of 21 is permitted to sign a legal document granted by the Advanced Medical Directive which allows that individual to inform their doctor that he or she does not wish to be given life-sustaining treatment in the event that he or she is unable to make his or her wishes known at that time. In such scenarios, the doctor is permitted to switch off life support and allow the person to die.

This is similar to the situation in France although the Léonetti law goes one step further. Under strict conditions it allowed doctors to decide to “limit or stop any treatment that is not useful, is disproportionate or has no other object than to artificially prolong life” and to use pain-killing drugs that might “as a side effect, shorten life”.

In Singapore, it seems that we have a slight conflict – while the Advanced Medical Directive permits an individual to make certain decisions with regards to death, any attempt of suicide still remains a crime. This would technically mean that all things being equal, someone who is chronically ill with no hope of recovery with the requisite mental capacity is guilty of a crime if at the point he is able to physically choose to die; while someone who made the decision earlier is not guilty of any crime. The only difference in these two circumstances is the individual’s physical capacity.

Image - Singapore General Hospital
Image – Singapore General Hospital

Perhaps it is high time to eradicate attempted suicide as a crime? Given that this law is seldom enforced, why should it remain on our statute books? Besides, am I the only one who finds this position at odds with the death penalty? On the one hand, we disallow those who wish to die the right to die but on the other hand, we mete out the death penalty rather liberally.

To take it one step further, are we as a nation ready to enter into a debate on the topic of voluntary euthanasia? Given that the late Mr Lee has seemingly endorsed it and also that medical science and thought has evolved, should voluntary euthanasia be gradually introduced?

If an individual is suffering unduly with a terminal illness and wants to die with dignity, who are we to tell him that his decision is wrong? We may deem his decision selfish but are we not conversely selfish by expecting him to live for us? Is life worth preserving if it means unbearable suffering with an incurable illness? Is that preserving the sanctity of life or perpetuating suffering unnecessarily?

Whether we are against or in favour of it, we should at least have a mature discussion on the topic.