On 9 March 2013, Chief Justice Sundaresh Menon chose euthanasia as the topic of his lecture to the Singapore Medical Association. CJ Menon’s main argument in his wide-ranging lecture is that it is mainly for Parliament to decide on whether euthanasia or physician-assisted suicide (PAS) should be permitted. However, he recommended that this issue be subjected to robust public debate because its legislation would have serious ramifications. On 27 March 2013, The Straits Times published an article by senior writer Andy Ho who argues in favour of the legalisation of PAS on humanitarian and compassionate grounds. ‘No doing so in effect means we are saying that people should suffer severe pain before dying if their disease leads to this’, he writes.
This discussion recalls the public debate that followed the then Health Minister Khaw Boon Wan’s suggestion in 2008 that euthanasia is an ethical dilemma that Singapore will have to confront. The Straits Times published a slew of articles in the wake of this remark that explored the possibility and even benefits of legalising euthanasia. For example, an editorial ended with this bold statement: ‘Euthanasia is looking like a candidate whose time is nearer than most people would imagine’. Another article equated the acceptance of legal euthanasia with ‘social progress’. The medical correspondent Salma Khalik declared that she has always been a ‘proponent of euthanasia or assisted killing’ in her 22 October 2008 article published in The Straits Times, but quickly cautioned that ‘it is something not to be rushed into’. There were also sane voices in the debate. For example, Dr Chin Jing Jih, the Executive Director of the Singapore Medical Association’s Centre for Medical Ethics said in an interview that ‘We take the position that the solution to suffering in terminal illness is to continue to further develop and upgrade palliative care rather than legislate euthanasia’.
The Christian should never condone euthanasia or PAS. The commandment against murder that we find in the Old Testament (Exodus 20:13; Deuteronomy 5:17) includes self-murder or suicide. This commandment points to two important and interrelated theological truths concerning human life. The first is the sanctity of human life because it is a gift from God. This applies to all human life, however diminished. Secondly, because human life is divine gift, we are not in a position to dispose of it in any way we choose. This applies to the lives of others as well as our own. As Pope John Paul II puts it in The Gospel of Life (Evangelium Vitae), ‘Human life is sacred because from its beginning it involves “the creative action of God”, and it remains forever in a special relationship with the Creator, who is its sole end’.
In the public debate on PAS, however, religious objections are sometimes not taken seriously. As Ho points out in his article, the secular state may not give a religious argument ‘force of law’. It must be pointed out, however, that religious arguments against euthanasia and PAS are complex and wide-ranging, and are not made only on the basis of the divine command. They have to do with a certain vision of human life, suffering and illness, society’s responsibility towards the sick and the vulnerable, and the purpose of medicine. In addition, religious convictions about euthanasia and PAS are widely shared by non-religious bodies and organisations. For example, the World Medical Association declares in 2002 that ‘Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession’. In similar vein, the American Medical Association insists that ‘permitting physicians to engage in euthanasia would ultimately cause more harm than good’. And the Canadian Medical Association maintains that it ‘does not support euthanasia or physician-assisted suicide. It urges its members to uphold the principles of palliative care’. Thus, even though the Hippocratic Oath may be defunct, as Ho points out, these contemporary documents continue to speak unequivocally and eloquently against PAS and euthanasia.
In his article, Ho discusses the slippery slope argument against PAS – the view, held by many, that the legalisation of PAS would inexorably lead to the legalisation of active euthanasia. From the Christian standpoint, it must be pointed out that the Church’s objection to PAS is not based on the slippery slope argument. PAS is in itself wrong, and therefore should never be countenanced by society. However, for the sake of argument, the slippery slope argument should not be hastily and routinely dismissed as some philosophers and ethicists are wont to do. This is especially the case in discussions on the morality of euthanasia or PAS. If we were to look at the history of legalised PAS or euthanasia in countries like the Netherlands, we will notice a gradual but alarming liberalisation of the practice in the course of time. The slippery slope argument and the actual history of euthanasia in countries the Netherlands have led many to insist that absolute prohibitions against PAS and euthanasia should be maintained.
Ho argues that without the legalisation of PAS, ‘the terminally ill desperate to die may resort to anything from antifreeze to heroin’ and ‘doctors may covertly prescribe enough medication to hasten death to shorten the suffering when futility sets in’. In many ways, pragmatic arguments of this sort fly in the face of principled moral reasoning. The profound ethical issues surrounding the legalisation of euthanasia and PAS should never be brushed aside. Neither should the consequences of decriminalising PAS. This is because to do so is to introduce a distorted moral sensibility, an ethically astigmatic way of looking at human life. And this will in turn colour the way in which society sees its responsibility towards the sick, the disabled and the vulnerable. As the National Council of Churches in Singapore’s 2008 statement on euthanasia puts it, ‘The legalisation and acceptance of euthanasia would result in the “euthanasia mentality” that sees death as the only solution when faced with terminal illness …’ As the Council has also rightly pointed out, euthanasia or PAS is not one-to-one killing. When such practices are legalised and universally accepted, they become ‘societal killing’.
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity. This article was first published in The Bible Speaks Today (May 2013).