Debate: IS IT TIME FOR SINGAPORE TO CONSIDER A RIGHT-TO-DIE BILL? (15 SEP – 9 OCT 2014)

http://www.ipscommons.sg/debate-is-it-time-for-singapore-to-consider-a-right-to-die-bill/

My comments, in support of the moton.

I am on the side of Prof Tommy Koh which of course includes those in support of the motion.

That said, how exactly should this so-called right-to-die bill be introduced, and what exactly does it encompass should it be enacted needs to be thoroughly understood, leaving no room for any misunderstanding or ambiguity.

From the comments made so far, it appears a right-to-die bill refers to euthanasia and/or physician assisted suicide [PAS]. But the term “euthanasia” is broad in scope and what I am in favor of is “voluntary euthanasia” and, arguably, signing the Advanced Medical Directive can be viewed as opting voluntarily for euthanasia, to be effectively implemented at a certain time in certain circumstances, in the future. Besides “voluntary euthanasia,” we have “active euthanasia,” indirect euthanasia,” “involuntary euthanasia,” “non-voluntary euthanasia” and “passive euthanasia.”

With such a diversity of views expressed, as evidenced in the commentary section, my own comments may sound superfluous or repetitive. But, still, I hope they will add weight to the arguments that have been offered in favor of the motion. Why is there so much diversity or divergent views in the environment? A short answer is that we are all unique. Like it or not, the problems some of us are experiencing may be different from those of others and we may encounter opportunities totally different from those encountered by others. Different people have different talents, different desires, different hopes and different fears.

Needlessly to say, everyone has to die, sooner or later but to have the ability to die peacefully, with dignity and without pain or fuss, can be considered a life achievement. And it is precisely for delivering what is deemed a human good that some countries have legalized euthanasia and/or PAS. The same consideration can be cited in the case for legalizing abortion. Why has abortion been made legal in so many countries, despite the opposing views/arguments from the pro-life camp?

According to a website on assisted suicide 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).

There are also countries where euthanasia (voluntary euthanasia, active euthanasia or passive euthanasia) has been allegedly made legal or being allowed, although this list may not be representative of the actual situation today:

Albania

Andalusia

Belgium

Colombia

Finland

India

Ireland

Luxembourg

Mexico

Netherlands

Norway

Sweden

Thailand

US (States of Oregon, Washington, Montana, New Mexico and Vermont)

Can the governments of the countries or states that have legalized euthanasia or PAS be considered unethical for doing so?

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. But what is moral or immoral is not necessarily legal or illegal; it would be a mistake to think that anything legal must be moral, or to conflate legality with morality. Enactment of laws is not always based on the moral position but on considerations that affect the community or the nation as a whole. New laws where necessary can be introduced, just as old or outdated laws can be repealed or made obsolete. And like an old law that may be reviewed and repealed, a new law can also be repealed after being enacted, if circumstances favor revocation. 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 voluntary euthanasia or PAS, within prescribed conditions, is merely a process of making voluntary euthanasia or PAS “legal” within those conditions.

Bishop Emeritus Robert Solomon [RS] argues: “… suicide is still prohibited by the law, and for good reasons. The underlying logic, whether legally, socially or religiously expressed, is that the right to life cannot be extrapolated to the right to die. Life is sacred and one does not have the freedom to take one’s own life, no matter what the extenuating circumstances might be. This was echoed in 2002 by the European Court of Human Rights in its interpretation of Article 2 of the European Convention of Human Rights.” I disagree; I am of the view 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. In case RS has forgotten, I would urge him to review the list of countries mentioned above. Life may be sacred to RS, on the basis of his religious beliefs, but people who have made euthanasia and/or PAS legal have their own prerogatives or perspectives concerning life.

If we agree that, notwithstanding exceptions, 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 any 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.

One writer has raised the slippery slope argument; and I would offer this passage [http://www.logicalfallacies.info/presumption/slippery-slope/] as a counter: “Slippery slope arguments falsely assume that one thing must lead to another. They begin by suggesting that if we do one thing then that will lead to another and before we know it we’ll be doing something that we don’t want to do. They conclude that we therefore shouldn’t do the first thing. The problem with these arguments is that it is possible to do the first thing that they mention without going on to do the other things; restraint is possible.”

Some people (and I am one of them) dread living to a stage where their mentality becomes impaired – through dementia or Alzheimer’s disease, for instance. When a person is at this stage they would not be aware of the problems they may be causing to others. Sometimes it can be hard to die, even if you want to. 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 to talk from the sidelines about caring and so forth, but one really needs to evaluate who else suffers 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?

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.

Someone has made the comment that euthanasia is just a form of escape from pain and suffering. Precisely. That’s the whole idea of euthanasia. 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.

What I am advocating 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 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.

Issues like the Hippocratic Oath would become secondary if the consensus is in favor of voluntary euthanasia and/or PAS. And terms such as “life is sacred” or the “sanctity of life” appear as having a religious overtone. To an atheist like me, such terms have no impact.

Richard Woo

Posted on: Sep 27, 2014

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