May 2015 Feature Article
Many reasons are being offered to support making euthanasia (meaning “good death”) and assisted suicide legal. Some arise from sensitivity to the suffering of terminally ill patients, who desire to end their sufferings by speeding up their death through medical intervention. On the surface, it seems the most compassionate action that society can take to allow this. However, there are serious problems that require careful consideration.
Firstly, there is the question of suicide. In assisted suicide, the patient voluntarily takes his life. Hence the term “suicide” is used, as it was by Singapore’s Minister of Health in 2008. In many societies, including Singapore, suicide is an offence. While social values may be changing, 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.
Proponents of euthanasia argue that patients have the absolute right to exercise autonomy. Even so, can a patient make a free and voluntary decision? In the first place, he depends on information regarding diagnosis and prognosis given to him by doctors whose knowledge is not perfect. Chief Justice Sundaresh Menon, in his lecture to the Singapore Medical Association in 2013, rightly cited the case of Singapore lawyer Suzanne Chin who was diagnosed with brain stem death. Her husband was advised by doctors to “pull the plug” but against all odds she recovered completely and is well.
When doctors are involved in the decision making, there is potential conflict of interest. Patients may also depend on information from the internet which may be misleading. In addition, patients may make their decisions in a state of depression, and if treated, studies show that they may think differently. There is also potential pressure on the patient from family and care-givers, and society at large.
Secondly, there is the problem of murder. Physicians are asked to be involved in euthanasia and assisted suicide, an involvement that would contravene the nature, identity and ethics of the medical profession. For more than 2000 years, physicians have held to the principles of the Hippocratic Oath: the goal of medicine is to heal, care, and bring relief. Harming patients or killing them is strongly prohibited. The World Medical Association has, over the years, repeatedly stated that euthanasia and physician-assisted suicide are unethical and contrary to the practice of medicine. In its most recent statement in 2013, it reiterates the call for “physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions.” The doctor-patient relationship which is based on trust would be adversely affected if physician-assisted suicide is allowed.
The medical profession will be under pressure to attend to patients who want assisted suicide. Though the involvement of doctors is voluntary, there is no guarantee that it will be strictly so, especially if there is pressure from superiors or from one’s institution. Dr Christoph Hufeland, Goethe’s doctor, articulated it well in 1806: “The physician should and may do nothing else but preserve life. Whether it is valuable or not, that is none of his business. If he once permits such considerations to influence his actions, the doctor will become the most dangerous man in the state.”
Some argue that the practice of euthanasia can be well-regulated to prevent abuse. But actual experience proves otherwise. Sundaresh Menon notes: “These concerns are not to be dismissed as patently fanciful. One study shows that whereas legal restrictions and safeguards have been enacted wherever euthanasia or assisted suicide has been legalised, these have been ‘regularly ignored and transgressed’ often without prosecution…”
Thirdly, allowing euthanasia and assisted suicide would have negative social consequences. There would be a widening of its application.
In Belgium, legislation was passed in early 2014 to extend euthanasia to children who can request for it if they are “in great pain” and no treatment is available. Not only is this open to abuse (for studies show that many doctors have been practising euthanasia without following the rules), but it will be a door to many more applications. In the Netherlands, one need not be terminally ill to be euthanized. That one cannot have a “livable life” is ground enough, as the Groningen Protocol (which allows infant euthanasia) shows.
Recently, a court in Belgium granted the request by a prisoner for assisted suicide. He is imprisoned for murder and rape and has pleaded to be put to death because of mental anguish caused by his violent impulses. It is significant that he is not suffering from terminal illness or physical pain but from mental anguish. Will this open the flood gates to those who are in a similar situation?
Terminally ill patients would not be able to escape pressure, either imposed by others or by themselves, to seek death and not trouble their loved ones and care givers or incur significant medical costs. In the longer term, legalising euthanasia would shape our society and affect the way we look at ourselves, and how we care for the vulnerable. It has been noted, for example, that hospices are not as well developed in the Netherlands (where euthanasia is legal) as in other European nations. A social mindset that has a “cure or kill” solution would have inadequate space to explore the responsibility to care for the dying and to help them die with dignity. It would affect private and public conscience and alter our society where utilitarianism will dominate and social responsibilities will diminish.
Some use pragmatic economic reasons to argue for euthanasia. However, economic concerns should not be used to support euthanasia. Patients’ lives should not be shortened simply because they occupy hospital beds or it costs money to care for them. We cannot reduce the value of human life to dollars and cents. If we do, we reduce human dignity and value and will think likewise about those who are considered a “burden” to society.
How, then, can we care for the dying? How can we help people dying painfully and feeling that their continuing suffering is pointless and meaningless? The solution of offering euthanasia or physician-assisted suicide has many serious moral and practical problems, a situation where the medicine offered is worse than the malady. A study in Holland showed that in 10% of euthanasia and 30% of assisted suicide, untoward complications arose. They included patients who recovered from an induced coma, vomiting and fits, and technical problems with administering the lethal substance.
Our response to such patients should be one of compassion. There are two points that will help us enable people in such situations to receive compassion and care and die with dignity, without resorting to solutions that will end up with patients taking their own lives or physicians being asked to terminate their lives. It is humane to want to do something to help someone who is suffering. However, euthanasia and assisted suicide are not as humane as they may seem. Pope John Paul II observed that in reality, “what might seem logical and humane, when looked at more closely seem to be senseless and inhumane”.
We should not seek to eliminate the sufferings of a person by eliminating him. There are better and more humane and ethical ways.
Firstly, we have the Advanced Medical Directive. This allows people to express their wish that should they be terminally ill, that “heroic” but futile medicine be excluded in their treatment so that their lives are not artificially and needlessly prolonged. This is different from speeding up death through suicide or homicide. It is a decision that can be rationally and carefully taken before the storm of pain and suffering that may mark terminal illness and cloud judgement.
Secondly, palliative medicine is being significantly improved and offers dying patients relief of pain and compassionate care that enables them to travel the last stage of their lives with dignity and in the company of caregivers. As a society, we should promote palliative medicine and find ways to care for the dying, thus emphasising the dignity of persons and a society that takes responsibility to care not only for the living but also the dying.
Palliative medicine must be mainlined to become part of the normal course of health care. As a medical science and art it must be further developed and offered to all who are dying, so that they can die comfortably and in dignity as recipients of compassionate care.
As a society, we should promote palliative medicine and find ways to care for the dying, thus emphasising the dignity of persons and a society that takes responsibility to care not only for the living but also the dying.
Bishop Emeritus Dr Robert Solomon served as Bishop of The Methodist Church in Singapore from 2000-2012. He had served previously as a medical doctor, church pastor, principal of Trinity Theological College and president of the National Council of Churches of Singapore. Dr Solomon has degrees in medicine, theology, intercultural studies, and a PhD in pastoral theology from the University of Edinburgh. He has contributed many articles to books, theological dictionaries and journals and authored 20 books, including ‘The Race’, ‘The Conscience’, ‘The Enduring Word’, ‘The Virtuous Life’, ‘The Sermon of Jesus’ and ‘Apprenticed to Jesus’. He now has an active itinerant ministry of preaching and teaching in Singapore and abroad.