Legalization of voluntary euthanasia and/or physician assisted suuicide – why it is worth considering.

As Gary Hayden has noted, in his article, captioned: What makes life meaningful? [Mind Your Body, page 17, 1 May 2014], the question: What is the meaning of life? – is a deep and difficult one. Thus, not surprisingly, Bertrand Russell, one of the greatest thinkers of the 20th century, found it difficult to answer. It was said, probably with tongue in cheek, that someone had tried to provide an answer at a philosophical level, and ended up in a psychiatric ward.

I concur fully with Gary’s comments that: We are all unique. We face different problems and encounter different opportunities. We possess different talents and are motivated by different desires. We have different hopes and different fears. We have different histories and operate under different sets of circumstances. Our challenge, then, is not to find some abstract meaning of life, but rather to find specific goals and tasks which will bring a sense of meaning to our individual lives…

 Hence, “What makes my life meaningful?” is a more meaningful question to ask than “What is the meaning of life?” And the answer of course may differ from person to person.

But what is life? Can there be life without death? Pragmatically speaking, the answer is a resounding NO. Everyone has to die, sooner or later. However, to be able to die peacefully, with dignity and without pain or fuss, can be considered a life achievement. Just as “What makes my life meaningful” is likely to have a diversity of answers, the question “Can I decide on the manner of my exit from this world?” is likely to evoke a variety of answers, and several articles published in the Forum Page of The Straits Times, 29 Apr 2014 and 1 May 2014 are proof that different people may think differently; where people are concerned, subjectivism cannot be ruled out.

However, a matter of personal perspective is not necessarily about a matter of fact or truth. An argument, on the other hand, must be decided on the basis of its being factual or non-factual, persuasive or unpersuasive, logical or illogical. Furthermore, any stalemate needs to be resolved, if necessary, through further arguments, but still on the basis of logic and/or facts. But where an argument can be resolved through logic and/or facts, we can expect logic and/or facts to prevail. In certain matters there is no right or wrong while in others questions of right or wrong may have to be decided, using our common sense plus the knowledge and experience we have acquired. We can’t be wrong in saying that morality is culturally rooted, thus what is right or wrong is what individuals or cultures agree on collectively at a particular time or place.

For the Forum Page articles referred to above, two writers were evidently prompted by Dr Andy Ho’s article: Better to die good death at home [ST 25 Apr 2014]. If I am not wrong, four writers were apparently supportive that patients should be free to decide how they wish to end their days. One writer thinks that assisted suicide is a slippery slope; a downside of permitting assisted suicide is that, according to research, “many elderly people seeking assistance to end their lives in Switzerland suffered not from terminal illnesses but chronic and other non-life-threatening conditions.” Another writer thinks “while the right to life is a human right, the ‘right to die’ is not.

According to a website and assuming the information given is up to date, there are only four places in the world where assisted suicide has been formally codified as legal:

 Oregon (since l997, physician-assisted suicide only);

Switzerland (1941, physician and non-physician assisted suicide only);

Belgium (2002, permits ‘euthanasia’ but does not define the method;

Netherlands (voluntary euthanasia and physician-assisted suicide lawful since April 2002 but permitted by the courts since l984).

Countries where euthanasia [voluntary euthanasia, active euthanasia or passive euthanasia] has been allegedly made legal or being allowed; this list may not be representative of the actual situation today:














US [States of Oregon, Washington, Montana and Vermont].

Whether Dr Andy Ho has since changed his mind concerning the right to die, he once wrote: “My self-autonomy does not imply an absolute authority to decide my own life,” in an article concerning euthanasia and/or suicide. As a counter to Dr Ho’s position, in the context of the aforesaid comment, and to the writer who thinks that the right to die is not a human right, I would say: This is of course subjective. Others may think differently. Others may hold that the right to life comes with a tacit understanding that one has to die sooner or later, and with the right to die in a manner and at a time of one’s choosing, and with assistance of medical technology, if necessary, to make the exit as peaceful and hassle-free as possible. Some people [and I am one of them] dread living to a stage where their mentality becomes impaired [dementia or Alzheimer’s, for instance]. When a person is at this stage they would not be aware of the problems they may be causing to others. Some of us now alive today may find ourselves going through a state of anxiety and anguish before making our final exit. If continuing to live means enduring or suffering pain or anguish, physically and/or mentally, must life continue on its natural course and, if so, on what grounds? I can’t think of any.

Sometimes it can be hard to die, even if you want to. “Let death come like a thief at night” seems an innocuous enough advice but let’s not forget that death may be a long time away or that waiting for the thief can be a very distressing or harrowing experience. And having the financial means may not help in ending the pain or anguish. People who talk of palliative care often forget or omit to mention the financial cost involved. If money is not an issue—for example, employing domestic maids or nurses to provide full-time nursing care—then it may be a non-issue. The situation can, however, be problematic if money and manpower resources are areas of contention. It is easy of course to talk from the sidelines about caring and so forth, but one really needs to evaluate who else suffer[s] along with patients who are, say, in a vegetative state, and the financial aspect that may add damage to the state of being of their family members. When we talk about suffering we cannot exclude mental anguish. What if the patient is without the financial means to employ, say, a full-time nurse or domestic maid but has two young children and a spouse who is now the sole bread winner and the spouse’s income is at a level that any talk of engaging a full-time nurse or domestic maid is out of the question? Would the government arrange all the essential care for such a patient at its own cost? If the answer is No, should the patient be left to rot to death?

To live is to risk having downsides, although one can always hope for the best. Looking at our surroundings, with all kinds of suffering and setbacks affecting the human condition, we can say that life is risky, and thus to be born is to risk experiencing its downsides. Undoubtedly, one can even start life with a severe downside, for example, being born blind or with some other serious, physical or mental handicap. And one can also end this life with another severe downside, by being counted among the goats rather than the sheep on so-called Judgment Day – in terms of Jesus’ preaching as expounded in the New Testament. If you are unlucky you may encounter more downsides than upsides. If we take poverty as a downside and wealth as an upside, and we can’t be wrong in assuming such a hypothesis, then it is true to say that in this world there are far more downsides than upsides. Well, we all have to live by our choices or decisions. Sometimes, and for some people, there are no other options, and living the kind of life they were born with and have been experiencing since early childhood is the only option available.

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 [say 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[s] 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 yrs] and his daughter [50 yrs], both of whom were found dead in their home after the stench from their corpses caught the attention of neighbors. When police arrived at the home, a woman [80 yrs] 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 no less I am in favor of legalizing 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], but 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/states mentioned above be considered to be unethical for having legalized euthanasia or PAS? Of course not! 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. Legalizing euthanasia/PAS, within prescribed conditions, is merely a process of making euthanasia/PAS “legal” within those conditions. Many countries in the world have made abortion legal; can these countries be considered as unethical in legalizing abortion? Of course not!

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” – were comments made by a woman [a Christian] in a letter she allegedly wrote to The Straits Times that was published on Nov 15, 2008, p A25. Needless to say, we can’t rule out that probably there are people who may harbor the kind of thinking this Christian 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 must never, ever 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 risks of going down the slippery slope, we 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, 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 judgment 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, and a quick gateway to Heaven for those who believe in Heaven. Opponents of euthanasia/PAS may offer their views about the “sanctity of life” or “preservation of life” and so on 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 [came into effect in July 1997] in Singapore can be lauded as a step in the right direction.





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