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[Debate closed] Is it time for Singapore to consider a right-to-die bill? (15 Sep – 9 Oct 2014)

Responses to this debate are moderated by the IPSCommons team in the interest of ensuring a civil exchange of views.
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  • Overview
  • Opening Statement
  • Response
  • Closing Statement

Representing the sides

  • Yes

    Professor Tommy Koh

    Professor Tommy Koh supports the motion. A former Dean of the Faculty of Law of the University of Singapore from 1971 to 1974, Prof Koh is a prolific diplomat, champion of the Arts and author. He is Special Adviser at the Institute of Policy Studies (IPS) and Chairman of the Centre for International Law, National University of Singapore. He is also the Rector of Tembusu College at the University Town of the National University of Singapore.

    Professor Koh is currently Ambassador-At-Large at the Ministry of Foreign Affairs. He was Singapore’s Permanent Representative to the United Nations, New York from 1968 to 1971 (concurrently accredited as High Commissioner to Canada) and again from 1974 to 1984 (concurrently accredited as High Commissioner to Canada and Ambassador to Mexico). He was Ambassador to the United States of America from 1984 to 1990.

  • No

    Bishop Emeritus Robert Solomon

    Bishop Emeritus Robert Solomon opposes the motion. He 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 19 books, including Living in Two Worlds, The Hurting Heart, The Conscience and The Virtuous Life. He currently has an active itinerant ministry of teaching in Singapore and abroad.

About this debate

When you see someone who is ill and in pain, with little hope of recovery, what is the first thing you may think about? Most of us would hope for the suffering to go away, or at least, for their agony to lessen. Others among us might want to do anything possible to give them relief from their pain.

Euthanasia, also known as mercy killing, is the deliberate ending of life of a terminally ill person. Assisted suicide is when a mentally competent, terminally ill person is allowed to choose when to end his or her life, with medication prescribed by a doctor.

In public discussions, the opposition to assisted dying (the collective term for euthanasia and assisted suicide) is often framed as a commitment to the sanctity of life versus a belief in the freedom of choice. In Europe, assisted dying is legal – but subject to varying restrictions – in countries such as the Netherlands, Switzerland and Belgium. In the United States, doctors are allowed to prescribe lethal doses of medicine to terminally ill patients in five states: Oregon, Washington, Vermont, Montana and New Mexico. Great Britain’s House of Lords recently debated a proposed assisted dying bill but were split over whether to back such legislation.

Though euthanasia and suicide are illegal in Singapore, there is the Advance Medical Directive (AMD), where an individual can expressly state that doctors should not prolong his life with extraordinary life-sustaining treatment if he has no hope of recovery. As Singapore’s population ages, and with chronic disease becoming a growing cause of disability and death, should the terminally ill be able to plan, and time their own deaths? Would such a move empower individuals, or be subject to abuse?

IPS Special Adviser and Ambassador-at-Large, Professor Tommy Koh will explain why it is time for Singapore to consider a “right-to-die” bill. Bishop Emeritus Robert Solomon from the Methodist Church of Singapore will provide the opposing voice in this debate.

Background Reading

Professor Tommy Koh

Yes

I am 76 years old. I have lived a long, happy and useful life. I hope I will continue to enjoy good health for a few more years. Statistically, I know that I will die within the next 10 years. I face the prospect of death with equanimity. My only wish is that I would be allowed to die with dignity.

I have made a living will or Advanced Medical Directive. It is a legal document specifying that should I become terminally ill and unconscious, I do not want any medical intervention or treatment to prolong my life. I urge other senior citizens to consider doing the same. The failure to do so often creates a moral dilemma for our doctors. Let me cite the following example.

My mother died at the ripe old age of 90. After a bad fall at her home, she was warded in a private hospital. Although she had not made a living will, she had instructed her cardiologist that she would like to die with dignity, in her own home, and did not want to be kept alive by machines in a hospital. Her cardiologist was away on vacation when she suffered a heart attack and lapsed into a coma. Instead of allowing her to die, the doctors in the hospital intervened and kept her alive by hooking her to machines. When the cardiologist returned, he had a meeting with the members of the family, who reminded her of our mother’s wish.

The cardiologist discharged my mother from the hospital. An ambulance took my mother back to her home. After resting her comfortably in her own bed, the cardiologist took her off the machines. She passed away peacefully after a few minutes. It was the right thing to do.

The Advance Medical Directive is a good thing but it is not enough. I recently read a moving essay by Dr Chong Siow Ann, entitled “The day I wanted my father to die” in The Straits Times (15 August 2014). He described his father as a life-long smoker who had developed chronic obstructive pulmonary disease. Towards the end, his father was in pain and unable to breath. As a filial and loving son, he wanted his father to die quickly and peacefully.

When I read the article, I told myself that if I were to find myself in a similar situation, I would want a willing doctor to help me to die with dignity. At the moment, both assisted suicide and euthanasia are illegal under our laws. I would suggest that we change our laws to make them lawful. That is the situation in several countries. In Europe, assisted dying is legal – but subject to varying restrictions – in countries such as the Netherlands, Switzerland and Belgium. In the United States, doctors are allowed to prescribe lethal doses of medicine to terminally ill patients in five states: Oregon, Washington, Vermont, Montana and New Mexico.

Singapore is a secular state. In the private sphere, we can live our lives according to our religious principles. However, in the public sphere, our policies should be governed by secular and not religious principles. The question is whether Singapore’s citizens, irrespective of their religious faith or lack thereof, should have a right to die with dignity. My answer is yes. I rest my case on two arguments, one moral and the other utilitarian.

My moral argument is that a Singaporean should have the right to determine his destiny. If he is suffering from a terminal illness and his doctors have determined that he has less than six months to live or if he is suffering from an incurable illness and is in constant and intolerable pain, I believe that he should be empowered to decide that he would like to end his life. I also believe that a doctor helping him to fulfil his wish should be commended and not condemned as a criminal.

My utilitarian argument is that one of the principal reasons for the escalating cost of healthcare in Singapore is due to the current practice in our hospitals and by our doctors. The practice is to prolong a patient’s life, by heroic and very expensive interventions and medication, even for a few days, weeks or months. In many cases, such interventions and treatment are futile and unnecessary. In those cases, it would be more merciful if the doctors were to allow the patients to die with dignity.

I shall conclude. I support the Advance Medical Directive and urge our senior citizens to consider making a living will. I would also like to see a change in our laws to make assisted suicide and euthanasia lawful. I believe that for both moral and utilitarian reasons, the state should empower our citizens to be able to die in dignity. I would remind our readers that Singapore is a secular state and, as such, our public policies should be decided on the basis of secular and not religious principles.

Bishop Emeritus Robert Solomon

No

Many reasons are being offered to support the legislation of euthanasia and assisted suicide. Some of these 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 to be the most compassionate action that society can take to allow such patients to end their lives — and suffering. However, there are serious problems that need to be considered before society goes ahead with this solution.

First, there is the question of suicide. In assisted suicide, the patient is voluntarily taking 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.

Second, there is the problem of contravening the nature, identity and ethics of the medical profession. For more than 2,000 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 in its general assemblies and council meetings 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 were allowed.

Third, allowing euthanasia and assisted suicide would have negative social consequences. There would be a widening of its application; for example, those suffering from other conditions such as mental distress and see their suffering as pointless might request to be put to death as well. This has already been noted by doctors in the few countries (such as the Netherlands) where euthanasia is legal. 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 caregivers 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 not have adequate space to explore the responsibility to care for the dying and to help them to die with dignity.

We return to the problem of 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. 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.

First, 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.

Second, 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.

comments

  • 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

  • The bishop’s response is fraught with logical fallacies.

    The debate at hand is about regulating suicide through a right-to-die bill, which implies setting up a framework to ensuring that proper conditions are put in place before a person may choose to end his life. The bishop has instead set up a straw man argument by empathetically stating that one cannot possibly have absolute autonomy to choose premature death. There is critical difference between freedom that is qualified and freedom that is absolute – the bishop’s failure to draw the distinction is an unnecessary detraction from the main issue at hand, because the motion does not ask the debaters to consider granting Singaporeans absolute freedom to end their lives.

    The next assertion that the bishop made is that a patient cannot make a free and voluntary decision to end his own life because (a) information regarding diagnosis and prognosis may not be perfect; and (b) there may be ‘potential pressure from family and caregivers and society at large’ that impinge on the patient’s decision to be euthanised.

    The bishop’s definition of making ‘free and voluntary’ decision is flawed. Almost all decisions we make in life are based on whatever information we have at hand, which may not be perfect; they will also undoubtedly be affected by opinion and pressure of the people around us. If we are unable to make ‘free and voluntary decisions’ because of the abovementioned considerations, which are inherent in life, then we would soon arrive at a conclusion that most of the decisions we make are made involuntarily. By extension, according to the bishop, our consent to marriage, contract, would all be invalid – surely that is impracticable.

    The bishop also made some ill-substantiated claims:

    For example, where he had said that euthanasia and assisted suicide are not as humane as they may seem, the only support he could conjure was that a Pope had said so – this could hardly seem convincing in light of medical advances today.

    The bishop also sought to conjure up a boogeyman by claiming that legalizing euthanasia and assisted suicide for the terminally ill may lead to an opening of floodgates for something no less than an absolute freedom to take one’s life. Insomuch as checks are in place to ensure that legislation is a reflection of societal views and goals, whether a bill legalizing a right-to-die will lead to an opening of floodgates would depend on how the bill is being drafted, and whether it is compatible with the views and goals of society in time to come – anything more than that would be pure speculation.

    Bin Hong Posted on: Sep 27, 2014

  • I can sincerely understand the pain suffered by both patients and their families, when there is no hope or only meaningless effort.
    We can give kind advice and best wishes to others, but we should not speak for them.
    We should respect those desperate patients’ will which way they want to go, without harming others and the society.
    However, the decision should not only be solely made by the patient himself/herself, but based on a consensus from his/her family as a whole.

    SUN Xi Posted on: Sep 26, 2014

  • Human rights should extend to the right of each person to decide when he or she should decide to die should it be physically unbearable for to continue living. I won’t bother quoting examples as I have too many to choose from, but I have seen the pain, the prolonging of life brings to both the patient, caregiver and family. I have heard such patients express their wish to discontinue their treatment and even to appeal to the Gods to take them away but modern medicine continued to keep them alive till they lost all dignity and self respect. Everyone should have the right to decide whether or not modern medicine should prolong their lives if it means that quality of life is degraded to the point where they lose both dignity and self respect.

    HH Tong Posted on: Sep 26, 2014

  • I think that a key feature of democratic societies is that we value rights, choice and freedom, and that as a society we should aim to facilitate pursuit of these freedoms insofar as they do not impinge on the choices, rights or freedoms of others, a view enunciated originally by J.S. Mill. Before proceeding with my explanation, the version of this law that I am in support of would need a few caveats and conditions to prevent abuse. I would only support a bill that ensures the following conditions are met:

    (A) Absence of duress;
    (B) Mental capacity;
    (C) Express consent;
    (D) Exhaustion of all reasonable options in seeking a cure, within means.

    Having said that, I see no further reason for us to deprive anyone of the right to die. To assume that the right to live is mutually exclusive to the right to die is a fallacy. In fact, I would say the opposite; the right to live necessitates the right to die because they share the same underlying principle i.e. self determination. I would personally not sign up for the AMD, but that does not mean I should prevent someone else from doing it. Choice is the key operator here, not whether it takes up resources, or whether you, me, or someone else thinks its ‘dignified’. If a suffering person wanted to live as long as possible, then lets do our best to make sure it happens. But lets also remember to do the same if they think death is preferable, and not deprive them of their rights just before they leave us.

    Ali Ahmad Yaakub Posted on: Sep 24, 2014

  • The inconvenient truth is that Singaporeans have been killing themselves because the pain of their illness can be unbearable. Hence, it is preferable to let those who want to die to do so with dignity through professionally-assisted suicide. And to help us come to terms with euthanasia, we need to understand it within the context of medicine. If we remove our rose-tinted lenses, we see medicine for what it is: A practice that has killed countless number of people via iatrogenics – where the healer causes more harm than good. This is where the infirm go to the doctor for a cure, only to wind up dead. But mercy killing has shown that we have actually made medical progress: We have developed the means to assist people in dying as painlessly as possible, rather than killing them on the pretext of curing them. If this isn’t a step forward for the practice of medicine, then I don’t know what is. Plus, allowing people to die has to be seen in the context of humanity’s evolution through the past millions of years. For the longest time, humans have lived short brutish lives. Our Savannah-dwelling ancestors barely made it past 30 years old. Now we live till 75. Even our closest ape cousins do not experience such artificially extended lifespans. Ipso facto, what medicine and technological advances giveth, what medicine and technological advances taketh away. Living to 75 is already considered living on borrowed time. What’s the benefit of a few extra weeks or months?

    Belmont Lay Posted on: Sep 23, 2014

  • “Life is sacred”. “Right to live”. These are noble ideals.

    Tell these ideals to the man lying in the hospital bed, suffering from pain and grief. Tubes all over his body. Defecating on himself uncontrollably. That he knows his end is near, and there is no more to look forward to.

    The only difference between the man who jumped down, and the man in the hospital is that the latter is imprisoned and thus able to do what he wishes to do.

    Rick Posted on: Sep 18, 2014

  • Just this morning, I read the sad news of a son who could not bear the suffering of his father who was terminally ill; he helped his father to jump down from his high floor HDB flat and he followed suit. Two deaths ! While we are still debating, people have already made their choice with or without the bill.
    Would this tragedy be prevented if we had the a “Right-TO-Die” bill ? probably. One life could have been saved. From what I read , it was the father who urgred his son to kill him, and probably the son suffered from guilt and depression when he conceded. No body will ever know the real reasons now.
    Life is never measured by its length but its quality. Only people who suffer long enough really understand what pain means. All men are made differently, while some might be able to endure and believe that suffering makes them strong and profound, many of us earth mortals would find such pain unbearable. I fully agreed with the article “The day I wanted my father to die”, I went through the same experience. Prolonged life has no meaning at all, it is no longer a life, merely a “living”.
    Eventually life is transient, I agree that all lives shall have their purpose in this world, but when the purpose is fulfilled, there is no point to linger further. We shall have the given freedom to decide for our living.
    Having said the above, I believe this is not an issue to be debated just in the cognitive realm, the poll will give us the conclusion.

    Ong Eng Kian Posted on: Sep 17, 2014

  • Bishop Emeritus Robert Solomon states that, “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 caregivers or incur significant medical costs.” However, in his last paragraph, he mentioned that Advanced Medical Directive can be made rationally and carefully by the person. Which can Mr Robert make it clear to me, if a terminally-ill person has the ability to make a rational and clear decision to sign AMD, without the pressure imposed by others or themselves to seek their own death?

    I read up on the guidelines for making an AMD,under “Terminal illness”, which I quote, “It is actually best to make an AMD when there is no pressure to do so – when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.”. This means that a terminally ill person can make make an AMD when they are terminally ill, even if there’s a possibility of pressure from others and themselves.

    Source: http://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/making_an_amd.html

    Alyssa Goh Posted on: Sep 16, 2014

  • With respect, I think the issue could be more precisely formulated to focus on the substance of the contention (whether Singapore should have a right-to-die bill), rather than focus on whether the present time is appropriate for such a debate, on which the answer would likely be yes, for the reason that such a moral issue is a timeless one, given its relevance and impact on people who suffer pain from physiological infirmities. For that reason, my view on the issue, as it is presently worded, must be ‘yes’.

    However, if the issue was focussed on whether a right-to-die bill is justifiable for Singapore, my answer is no, until we have considered the repercussions, and are satisfied that we are willing to bear them. On this, there are many implications, some of which presently unforeseeable. Assisted suicide has reversible effects on the person who elects to undergo the same.

    Philosophically and ethically, this is problematic because, even assuming that the person’s autonomy should be given the highest priority, it is uncertain whether such autonomy is freely exercised. Pressures, self-induced and external, bear on a patient in such situations as terminal illness, etc. Could assisted suicide result in e.g. middle-income patients who suffer significant but non-critical illnesses opting death over life, notwithstanding the prospect of cure, because of cost concerns or suasion (conscious or unwitting) from doctors managing resource constraints?

    Ronald Wong Posted on: Sep 14, 2014

  • Man may like to think that he can be master of his own destiny. The truth is that he is not in control. Man does not decide when he is born. Nor does he determine the length of his life. He can be well in one moment and gone the next when calamity unexpectedly strikes. What man does have is his unique capacity to make choices, notwithstanding he is no master of his own life. At the crux of this debate is the wisdom of the choice that man and, by extension, society chooses. Experience shows there is a sad human tendency to make poor, ill-advised choices. These choices have led to a state of decline in societies today. On the surface, we see ourselves as progressing, celebrating freedoms in various spheres of life. But the reality is that we as a human race are increasingly abandoning what is good for the licence to do as we see fit. It is a great platonic shift in values that we used to hold dear! The question we need to ask ourselves on this issue (and others) is this: Do our choices make us better people? Does it contribute to society’s moral well-being? Or will it lead to further decline? I share Bishop Solomon’s points and concerns.

    Gerald Ng Posted on: Oct 09, 2014

  • I disagree with the passing of the euthanasia law. Even if one might argue that Singapore is not a religious society (that argument by itself is flawed as 83% of our society profess to be attached to a faith community as Bishop), Singapore is still a moral society which is governed by law.
    As such, the law has stated that suicide is illegal, murder is illegal – having the right to die I feel must in the same light – also be illegal.
    Life is sacred. As Hipprocrates has put it – a doctor’s goal is to cure sometimes, to relief often, to comfort always. While we cannot make light of the suffering of terminally ill patients, as a society, we can stand together with them in their suffering: to comfort them. The practice of palliative medicine exists for this reason- so as to help the dying pass on in dignity and in comfort. The Singapore government has also recognized this – and the ministry is putting in more effort and money in growing the palliative care community.
    Should the law for euthanasia and assisted suicide be passed- we will find ourselves on that slippery slope, and soon you will see that vulnerable people (handicapped/mentally impaired children for example) would be at risk of being euthanised : so as to prevent further ”suffering” – as per what is happening in the Netherlands. This is happening in the Netherlands- even though safeguards are supposedly present to prevent abuse of the system.
    Should Singapore still believe in herself as a moral society – it should not pass this euthanasia bill.

    Shirlyn Posted on: Oct 08, 2014

  • With the right to die bill, patients and their family may be pressured to make the ‘right’ decision be it for self or their loved ones. No one can give a definite timeline on when a patient will die, miracles do happen. The Advance Medical Directive bill is already in place to ensure that patients (who opt in) will not need to prolong their suffering via futile medicines / technology. I advocate for palliative medicine which can help patients relieve their pains, spend their precious last moments with their loved ones and die with dignity when the time comes.

    Bernice Posted on: Oct 08, 2014

  • reading the comments from both sides i realise that they fall into generally 2 categories. Those that Agree talk about Self. Those that Disagree talk about Community (others). So what kind of society do we want? For Self, or for Others? I choose to give, not to take.

    Sheldon Posted on: Oct 08, 2014

  • I hope that this shall never come to pass … It promotes the “self” over family, friends and society at large. We belong to not only ourselves but our dear family and friends. As much as we give love, we also receive love. It would be morally selfish to deny others the right to care and love us, even when we are stricken with terminal illness. When we suffer, they lovingly suffer with us to the end. We need love in society to persist over personal desires !

    Goh Chu Teng Posted on: Oct 03, 2014

  • According to Professor Tommy Koh, “in the public sphere, our policies should be governed by secular and not religious principles.” And he goes on to argue his case based on two points ; moral and utilitarian.

    While Singapore is a secular state, we cannot run away from the fact, as Bishop Solomon pointed out in his reply to Prof. Koh’s response to his opening statement, that “Singapore being a multi-religious society with 83% of the population being connected to faith communities, their views based on their fundamental beliefs cannot be ignored.”

    Furthermore, in Chief Justice Menon’s speech at the Singapore Medical Association Annual Lecture, on “Euthanasia: A matter of life or death?” on March 9, 2013, http://www.straitstimes.com/breaking-news/singapore/story/euthanasia-matter-life-or-death-20130324#sthash, quoting the American experience amongst others, he said that “The important lesson which one draws from the American experience is that, at the level of abstraction, human rights may be universal. …At the level of application, however, the messy detail of concrete problems, the human rights which these abstractions have generated are national. Their application requires trade-offs and compromises, exercises of judgment which can be made only in the context of a given society and its legal system.”

    Taking together the above two points, I beg to differ with Prof. Koh’s contextual reference because national consensus on the issue reflecting our collective beliefs of our multi-faith society is crucial not only for its acceptance and implementation, but more importantly, the collective voice of Singaporeans on such important decisions concerning their lives, should be heard. Otherwise, we might unwittingly be risking ourselves to the tyranny of the vocal minority deciding for the silent majority in a contextual vacuum. As the good professor says that religious beliefs must be kept private in the public space, like wise private right-to-die beliefs should not impinge on our societal values.

    Not withstanding this, I would also have to disagree with his moral and utilitarian arguments to justify a right-to-die bill.

    On his moral argument, he basically says that a person who is terminally ill with six months left to live or suffering from an incurable illness which gives him constant and intolerable pain should be empowered with the legal right to end his life at the time of his own choosing and the doctor(s) assisting him to die should not be criminalize(s) for his(their) action(s) in doing so. This he argues is to allow the patient to die with dignity.

    While it is laudable to want to relieve a person from unbearable pain, to give him the right to end his own life is an entirely different matter and I hope it shall never be legalized to ending one’s suffering, whether mental or physical. It has been the collective and the time honored wisdom of many societies to promulgate laws against the taking of one’s life because of the value placed on the sanctity of life to the extent that the larger societal family has the right to prevent you from ending your own life.

    But should there be an exception for a person who is suffering intolerable pain whether mental or physical to be given the right to end his own life with the assistance of doctors so that he can die with dignity ?

    Before I state my views, let us first come to some common understanding of the meaning of the word dignity. According to Wikipedia, traditionally, moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment. However, In the modern context dignity can function as an extension of the Enlightenment-era concepts of inherent, inalienable rights.

    So, I suppose it would not be presumptuous for me to say that the proposed notion can be rephrased to say that to die with dignity, a Singaporean should have the inherent and inalienable right to end his or her life when he is suffering intolerable pain from an incurable illness or that he/she has less than six months to live because of a terminal illness. This basically says that the person involved has complete control over his destiny and nobody else, only conditions to effect his rights have to be met.

    As much as a person who claims that it is his right to choose premature death because of his intolerable suffering, I would argue as strongly that his suffering should not have any bearing on his right to die and even go to the extent to suggest that his suffering should instead be the very reason why he should live on, in the wider context of societal values and norms.

    Regardless of our private opinions or inclinations, once we claim to be part of the Singaporean society, we cease to be a person unto ourselves and will have to be inextricably linked to our societal values and norms whether we like it or not.
    The option of taking away a person’s life because he/she is suffering from intolerable pain, be it mental or physical is anathema to our collective psyche, as seen from the laws against suicide. Another situation which can amply demonstrate our societal values on the dignity (defined in the traditional way) of human life is the treatment of likely war casualties. God forbid that we be caught up in a war ! But a more realistic scenario would perhaps be that of one of our young man being fatally wounded in a peace keeping mission. It is a foregone conclusion that no efforts will be spared to save him and failing to do so, the doctors will do all they can to reduce his pain and suffering as much as they medically can, but taking away his life is definitely not an option. The sanctity of human life and to die with dignity in the traditional sense is aptly illustrated here. Do we want to change this value system to one that ends this soldier’s life at the operating table because he claims it is his right to end his life in this irrecoverable and painful situation ?

    Otherwise, where is the heroism, where is the dignity of dying, how can such human values of perseverance, pride, courage and sacrifice which we treasure so much be preserved ! Imagine if the right-to-die bill was in existence when our navy serviceman Mr. Jason Chee was badly injured in the accident that cost him three of his limbs and three fingers of his right arm. In his mental anguish and unbearable physical pain he might have opted for the soft option to end his life ! But thanks to his indomitable spirit, the exemplary care, support and encouragement given by his medical team and his organization, and most importantly the value placed on him as a human being and not just another digit by his organization, he has overcome all odds and has developed a healthy and robust attitude towards life inspite of all that has happened to him.

    With significant improvements in palliative medicine and good hospice care, the intolerable pain element in the right-to-die equation thus becomes invalid. Terminally ill patients under hospice care in Singapore on average die within 3 months of being admitted, where they receive compassionate and palliative care. From my personal experiences with dying relatives, intolerable pain comes only towards the last few days of the very end. But by then, most of them are already in a semi-conscious or comatose state. When the ultimate finality comes, they die with dignity and human decency, surrounded by loved ones.

    The very societal values we hold dear like resilience, courage, character even in the terminally ill, tampered by the utmost humanistic and compassionate care for them, together provide too compelling a reason why the terminal ill and those suffering intolerable pain should live on and eventually die naturally with dignity.

    In contrast, it would be ironic if the right-to-die bill is legalized, as it allows for a selfish, parochial, and cowardly way to commit suicide but passing the responsibility and accountability to someone else to legally pull the trigger, thus dying devoid of dignity.

    Beyond the conceptual level, there are also issues that many people have already brought up about the abuses and the negative experiences of such a right-to-die law in countries practicing it, and should be predicated only on the strength or otherwise of the conceptual arguments.

    On the utilitarian argument, there is not even the need to debate it as our Eastern culture on filial piety which is being encouraged in our society, runs counter to its very core. As it is, seniors in our society beyond a certain age, already feel marginalized when trying to find employment. It would be a sad day and the whole nation should go into mourning should the day come when the law is passed on account of the utilitarian argument ! For what it amounts to is the extension to the national level of children telling their parents that it is pointless and too costly to keeping them alive, even if they can afford to continue to do so. At best, the utilitarian argument might convince a person to perform his last economic service for the nation in taking his or her own life prematurely, devoid of all human decency and compassion, and dignity and at worst, it debases the very soul of our nation.

    Therefore, my answer as to whether it is time for Singapore to consider a right-to-die bill, is not only a big no, but that I don’t even see the need to initiate further discussions on it.

    Cyril Chiam

    Cyril Chiam Posted on: Oct 02, 2014

  • Having read all the comments thus far, I am still positively sure that I will disagree with the endorsement to exercise the right-to-die bill for “healthy” individuals. I understand that there are grey areas in which we define the process of prolonging life or death; as pointed out by George Yeo. However, I would like to add to his points for us to further deliberate on the subject topic of prolonging death.

    In the likeliest possibility, we may all die one day. The duration in which we remain in this World is definitely finite. Thus, the topic of prolonging life ought to be less emphasized. The main discussion should revolve around whether we should naturally or unnaturally prolong or hasten someone’s death.

    Should it be a choice that individuals make on their own? With a group of professionals like how Martino Tan mentioned? Or with family members? I would say that it should be none of the above. The choice ought to be natural; and unlike how Jerick Tan had mentioned in his post about how the right to die presents a false dilemma of little resource to assist terminally ill patients, I believe that natural death can be assisted too.

    For example, if someone is suffering from pain; physically or mentally, we may employ the use of medical equipment or consumables to reduce the pain that they are experiencing. While we reduce their pain and suffering, it is unlike assisting them to die faster, but a means for us to assist them through a natural transition. I wish to emphasise again, that I believe that such an option should only be applied to individuals who are suffering terribly. Thus, it should not be a subject of the lack of resources, but with adequate resources, we may still assist someone to die naturally and with dignity.

    I disagree with the process of hastening the process of death, because it raises the topic of a criminal act of murder. With or without consent from the patient, I believe that the process of death should not be prolonged or hasten. We may prolong the process of death unless there is an absolute possibility of ensuring that the patient will indeed have a more good years in our World.

    However, if the process of prolonging death results to a prolonged period of pain and suffering, we should allow nature to take its place by reducing their pain; not through death as an option, but to minimise their pain and suffering.

    Edmond Wong Posted on: Sep 26, 2014

  • I notice that humans when besotted by a problem or disease or illness would often seek an escape route rather than facing up to it. Euthanasia is just a form of escape from pain and suffering. Do we not agree that such is life? And have we not also suffered at a younger age, events and circumstances which shaped us to be who we are now?
    Truly Life is sacred and a gift. It is not created by our own selves or our parents. In fact we must agree that we don’t choose where and how we are born. Unfortunately, throughout life, when things are going well, we would often think that we are self-made in every sense of the word until an illness strikes, we realise we are not in control anymore. And grasping at whatever possible, we hope to control our own death by determining how and when we should die. Though it seems like control, it is in actual fact a surrender to fate and a finality that is totally out of our hands.
    The only time that one can TAKE is when one can GIVE. If I take your freedom or rights or money, I too must have the power to give you back what I have taken. Therefore if one chooses to take a life, he or she must be able to also give life back to whoever’s life he/she has taken. If a mistake has been made, make sure you can undo the mistake or rectify it.
    Can anyone then guarantee that in every act of Euthanasia there be no mistake made? No regrets? No repercussions on those left behind? If not, then I think we need not visit this question ever again.

    Simon Chong Posted on: Sep 26, 2014

  • Much research has been done in jurisdictions where euthanasia has been legal for decades. References to scholarly studies cannot be cited here for length constraints but are available on request. These studies provide insights into this important social experiment and reveal some consequences thereof.
    People seek euthanasia mainly because of depression, hopelessness, loss of independence, desire for control, fear of the future and low social support. Low spirituality (a diminished sense of life’s purpose and meaning; not religiosity) is a strong predictor of euthanasia-seeking behaviour. Physical symptoms are generally unimportant to those pursuing euthanasia. There is evidence that euthanasia engenders distrust of physicians.
    The utilitarian argument is troubling. Terminally ill people know that they cause financial, social and emotional strain to their families and society by draining resources. Thus, in the Oregon experience “relief of burden” has become a more common reason after euthanasia was legalised. Taken to its logical end, utilitarianism demands a “duty to die” of all unproductive and resource-consuming people.
    The autonomy argument overlooks the truism that autonomy cannot be absolute and inviolable. Unfettered autonomy has clearly negative consequences for society. Is the decision to live or die a consumerist choice? This debate must engage all levels of community to hear more than the views of the intelligentsia. Euthanasia of neonates is now legal in the Benelux region, and euthanasia for organ donation has been advocated. We need to go beyond emotive anecdotes to envisage how giving all physicians the potential to kill their patients will likely corrode and corrupt society – and whether this is what we really want.

    Kon Oi Lian Posted on: Sep 26, 2014

  • Disagree. I remember the Parliamentary consultations and debate when the Advance Medical Directive Bill was introduced around 1995. There is a difficult grey area between prolonging life and prolonging death which AMD seeks to address sensitively. Euthanasia as assisted suicide takes it too far.

    George Yeo Posted on: Sep 26, 2014

  • When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

    gp Posted on: Sep 25, 2014

  • The right to die imposes an obligation on the society (one’s family, relatives, friends and doctors etc). One’s right to die becomes a doctor’s obligation to kill.

    Should we grant the medical profession the license to kill? The ethical foundation of Western medicine (Hippocratic Oath) is the idea that the doctor should seek to preserve and enhance life, and cause no harm. Such a bill perverts that role and places responsibility on the shoulders of a profession that are asked to implement it.

    A “right” is a moral claim. Do we have such a claim on death? It is not up to us to decide when our life will end or when it will began.

    So where do we draw the line? The advance medical directive in S’pore is instructive. It states that one can inform his/her doctor that he/she does not want to use any life-sustaining treatment to prolong one’s life. This appears to be an ideal state situation now.

    I don’t think a society should have a situation where an individual or a group of people think they have the right to put someone else to death.

    Suppose we go down this slippery slope. Will a change in legislation mean that a right to die becomes a “duty to die”?

    Perhaps our compassion is too focused on a few cases and does not consider the most vulnerable people in society. Such a legislation would apply enormous pressure on the elderly, the sick and the disabled to “do the right thing” and not be a burden on others.

    Martino Tan Posted on: Sep 24, 2014

  • It is indisputable that everyone has the right to die with dignity. However, we must be careful not to equate this with dying painlessly or without suffering. Dignity is the state or quality of being worthy of honour or respect. There are countless stories of cancer patients & people who have put up a brave fight against their illness. And when they pass on, can we say they did not die with dignity? Prof Koh also mistakenly assumed that all who are against assisted dying are religious. I believe the non-religious would agree that life is precious and therefore, every effort must be made to save it. Prof Koh also argued that because resources are scarce, society should not waste efforts on treating some persons. Not every terminally ill wants to die. Many treasured whatever “extra time” they have with their families through life extension treatment. There are some things in life that we cannot and should never adopt a utilitarian approach towards it. Especially not in a society where we want to encourage Compassion. Lives are not disposables. We are not commodities, ready to be traded or crushed when there’s no use.

    Oneida Posted on: Sep 23, 2014

  • It is very hard to come to a solid conclusion on weather someone has to right to decide when they would like to die. I cannot and will not judge someone who feels the need to end pain through death becasue I have not sufferd that pain and do not know someone who has. However making this a law is not as easy as quoting a few examples of people in these situations and then making a law based on that. How will you draw the line? Who decides when it is ok? The day you come up with a full proof plan on how you can execute this law without any loopholes is the day you can decide if you really want to implement such a law. We are often asked not to make any important decisions when we are stressed or when we are not in a good frame of mind. How is this any different? How can we ever be sure that we have (with a clear mind) actually exhausted every other option and so we are allowed to decide that we should die?Anyone who is told they are terminally ill would be shattered and broken. But we human beings have it in us to fight. If we already know we can take the easy way and choose to end it how will we even know what we are capable of? There could be a cure just around the corner. But we will never know if we do not give it a chance. And finally let us look to places that have already made this a law and learn from them. Read the article posted by Denise. Many chooseing this path are the aged, the lonely and the bereaved. Is that why we want? How are we sure we can prevent that here?

    Jessica Posted on: Sep 22, 2014

  • Rather than focus on the ‘right’ to die, our nation should be focusing on the right to live. The right to die debate presents a false dilemma. It assumes that there is little resource left available for our terminally ill patients, and goes on to present them the choice between delaying death and accelerated death. However, the truth of the matter is that resources are available, and that their dispensation is controlled by the authorities. A nation that focuses more on economy and less on people will be left with ‘no choice’ but to choose between delaying and accelerating death. A nation that focuses on people, will instead be active in seeking out ways and means to give the patient the best welfare, and this could include firstly, giving family members and close friends paid leave from work and excusing the children from schools. Scientific research has shown that the presence of loved ones help in recovery. Secondly,making treatment more affordble. Thirdly, improving social and family policies and education, which means more investments should be made into this sector rather than trade, defense, transport, communications, etc. After all, Singapore exists for its people, not the other way around. Parents should be taught how to be role models for their children, and incentives at work should not motivate them to strive to the extent of neglecting their family. Similarly, children should not be challenged to strive in CCAs or for academic results but to spend more time with their family. Morals and values should be taught in society, to tackle the growing culture of individualism, narcissism and consumerism. This last approach will go a long way in the long term, because it will build healthy families, secure in love, with individuals confident of their identity, and eager to contribute to society.

    Jerick Tan Posted on: Sep 18, 2014

  • Can one leave one’s values and principles at the door of the public-square and marketplace, yet maintain one’s integrity and conscious? Would this individual be in any situation, be as the blowing of the wind?

    Can we indicate to be for diversity and inclusiveness, when an individual requires atypical number of supports for daily living activities, to face these challenges, be allowed to request for one’s life to be terminated? Pause, consider, it be a disproportionate number of the vulnerable young and elderly with daily living challenges to confronted with this issue.
    As the situation is, a positive for Downs Syndrome, is likely for the doctor to advice the couple to terminate the life. Would the elderly faced with multi-factorial issues in family and societal domains, throw in the towel too?

    It be the vulnerable who shall be at risk most. Pause, consider, the intangible cost upon society, if such a pathway be established and normalized.

    Koh Gay Posted on: Sep 18, 2014

  • Article 6(1) of the International Covenant on Civil and Political Rights provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

    This article makes two important points. Firstly, the right to life is inherent. This means that there is no “right to die”. Neither does the value of life or its protection depend on its quality. Secondly, this right shall be protected by law. Regardless of one’s personal views in favour or against euthanasia and assisted dying, States are required to protect life as an inherent right.

    The relaxation of laws protecting life does not only affect some, but also fundamentally alters the value of all human life, especially that of the vulnerable or those perceived as having a lower “quality of life”.

    There is also a real prospect of abuse. For example, a 2010 study reported that 32 per cent of the assisted deaths in the region of Flanders in Belgium between June and November 2007 were done without explicit request.

    Hence, I agree with Bishop Emeritus Robert Solomon that 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.

    In doing so, we respect the inherent value of all human life, and indeed the value of living with dignity.

    Darius Lee Posted on: Sep 18, 2014

  • Introducing assisted suicide in any society will inevitably lead to its moral decline. The Dutch euthanasia experience started with very strict criteria. Patients had to prove intolerable suffering and consistent desire and more than one doctor had to be consulted. 5 years later, large surveys showed that doctors were involved in causing 5,000 patient deaths without their consent. These doctors started out with altruistic intentions, but ended up killing their patients! Once assisted suicide is allowed, it introduces a logic to society that some lives are simply not worth living. Once such logic is in place, then Prof Tommy Koh’s utilitarian logic will take precedence due to limited healthcare resources, and no safeguards are left to prevent the subsequent killing of disabled children or frail elderly whose lives are deemed “not worth living”. Imagine a society where the most vulnerable are not only not protected, but are removed and discriminated against by law!

    Furthermore, contrary to what Prof Tommy Koh suggests, death with dignity does not necessarily entail dying without suffering at the time of one’s choosing. Rather, the true meaning of Compassion is “to suffer with” and not to eliminate suffering at all costs. Today, palliative care is a viable option which provides significant pain relief and comfort at the end of life. It promulgates a harmonious departure from one’s life at peace with one’s loved ones in a way which suicide can never achieve.

    colin ong Posted on: Sep 16, 2014

  • Hindsight is always perfect vision. Take it from the forerunners, they have already changed their minds about euthanasia.

    http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

    “Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.”

    Denise Posted on: Sep 15, 2014

comments

  • 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

  • The bishop’s response is fraught with logical fallacies.

    The debate at hand is about regulating suicide through a right-to-die bill, which implies setting up a framework to ensuring that proper conditions are put in place before a person may choose to end his life. The bishop has instead set up a straw man argument by empathetically stating that one cannot possibly have absolute autonomy to choose premature death. There is critical difference between freedom that is qualified and freedom that is absolute – the bishop’s failure to draw the distinction is an unnecessary detraction from the main issue at hand, because the motion does not ask the debaters to consider granting Singaporeans absolute freedom to end their lives.

    The next assertion that the bishop made is that a patient cannot make a free and voluntary decision to end his own life because (a) information regarding diagnosis and prognosis may not be perfect; and (b) there may be ‘potential pressure from family and caregivers and society at large’ that impinge on the patient’s decision to be euthanised.

    The bishop’s definition of making ‘free and voluntary’ decision is flawed. Almost all decisions we make in life are based on whatever information we have at hand, which may not be perfect; they will also undoubtedly be affected by opinion and pressure of the people around us. If we are unable to make ‘free and voluntary decisions’ because of the abovementioned considerations, which are inherent in life, then we would soon arrive at a conclusion that most of the decisions we make are made involuntarily. By extension, according to the bishop, our consent to marriage, contract, would all be invalid – surely that is impracticable.

    The bishop also made some ill-substantiated claims:

    For example, where he had said that euthanasia and assisted suicide are not as humane as they may seem, the only support he could conjure was that a Pope had said so – this could hardly seem convincing in light of medical advances today.

    The bishop also sought to conjure up a boogeyman by claiming that legalizing euthanasia and assisted suicide for the terminally ill may lead to an opening of floodgates for something no less than an absolute freedom to take one’s life. Insomuch as checks are in place to ensure that legislation is a reflection of societal views and goals, whether a bill legalizing a right-to-die will lead to an opening of floodgates would depend on how the bill is being drafted, and whether it is compatible with the views and goals of society in time to come – anything more than that would be pure speculation.

    Bin Hong Posted on: Sep 27, 2014

  • I can sincerely understand the pain suffered by both patients and their families, when there is no hope or only meaningless effort.
    We can give kind advice and best wishes to others, but we should not speak for them.
    We should respect those desperate patients’ will which way they want to go, without harming others and the society.
    However, the decision should not only be solely made by the patient himself/herself, but based on a consensus from his/her family as a whole.

    SUN Xi Posted on: Sep 26, 2014

  • Human rights should extend to the right of each person to decide when he or she should decide to die should it be physically unbearable for to continue living. I won’t bother quoting examples as I have too many to choose from, but I have seen the pain, the prolonging of life brings to both the patient, caregiver and family. I have heard such patients express their wish to discontinue their treatment and even to appeal to the Gods to take them away but modern medicine continued to keep them alive till they lost all dignity and self respect. Everyone should have the right to decide whether or not modern medicine should prolong their lives if it means that quality of life is degraded to the point where they lose both dignity and self respect.

    HH Tong Posted on: Sep 26, 2014

  • I think that a key feature of democratic societies is that we value rights, choice and freedom, and that as a society we should aim to facilitate pursuit of these freedoms insofar as they do not impinge on the choices, rights or freedoms of others, a view enunciated originally by J.S. Mill. Before proceeding with my explanation, the version of this law that I am in support of would need a few caveats and conditions to prevent abuse. I would only support a bill that ensures the following conditions are met:

    (A) Absence of duress;
    (B) Mental capacity;
    (C) Express consent;
    (D) Exhaustion of all reasonable options in seeking a cure, within means.

    Having said that, I see no further reason for us to deprive anyone of the right to die. To assume that the right to live is mutually exclusive to the right to die is a fallacy. In fact, I would say the opposite; the right to live necessitates the right to die because they share the same underlying principle i.e. self determination. I would personally not sign up for the AMD, but that does not mean I should prevent someone else from doing it. Choice is the key operator here, not whether it takes up resources, or whether you, me, or someone else thinks its ‘dignified’. If a suffering person wanted to live as long as possible, then lets do our best to make sure it happens. But lets also remember to do the same if they think death is preferable, and not deprive them of their rights just before they leave us.

    Ali Ahmad Yaakub Posted on: Sep 24, 2014

  • The inconvenient truth is that Singaporeans have been killing themselves because the pain of their illness can be unbearable. Hence, it is preferable to let those who want to die to do so with dignity through professionally-assisted suicide. And to help us come to terms with euthanasia, we need to understand it within the context of medicine. If we remove our rose-tinted lenses, we see medicine for what it is: A practice that has killed countless number of people via iatrogenics – where the healer causes more harm than good. This is where the infirm go to the doctor for a cure, only to wind up dead. But mercy killing has shown that we have actually made medical progress: We have developed the means to assist people in dying as painlessly as possible, rather than killing them on the pretext of curing them. If this isn’t a step forward for the practice of medicine, then I don’t know what is. Plus, allowing people to die has to be seen in the context of humanity’s evolution through the past millions of years. For the longest time, humans have lived short brutish lives. Our Savannah-dwelling ancestors barely made it past 30 years old. Now we live till 75. Even our closest ape cousins do not experience such artificially extended lifespans. Ipso facto, what medicine and technological advances giveth, what medicine and technological advances taketh away. Living to 75 is already considered living on borrowed time. What’s the benefit of a few extra weeks or months?

    Belmont Lay Posted on: Sep 23, 2014

  • “Life is sacred”. “Right to live”. These are noble ideals.

    Tell these ideals to the man lying in the hospital bed, suffering from pain and grief. Tubes all over his body. Defecating on himself uncontrollably. That he knows his end is near, and there is no more to look forward to.

    The only difference between the man who jumped down, and the man in the hospital is that the latter is imprisoned and thus able to do what he wishes to do.

    Rick Posted on: Sep 18, 2014

  • Just this morning, I read the sad news of a son who could not bear the suffering of his father who was terminally ill; he helped his father to jump down from his high floor HDB flat and he followed suit. Two deaths ! While we are still debating, people have already made their choice with or without the bill.
    Would this tragedy be prevented if we had the a “Right-TO-Die” bill ? probably. One life could have been saved. From what I read , it was the father who urgred his son to kill him, and probably the son suffered from guilt and depression when he conceded. No body will ever know the real reasons now.
    Life is never measured by its length but its quality. Only people who suffer long enough really understand what pain means. All men are made differently, while some might be able to endure and believe that suffering makes them strong and profound, many of us earth mortals would find such pain unbearable. I fully agreed with the article “The day I wanted my father to die”, I went through the same experience. Prolonged life has no meaning at all, it is no longer a life, merely a “living”.
    Eventually life is transient, I agree that all lives shall have their purpose in this world, but when the purpose is fulfilled, there is no point to linger further. We shall have the given freedom to decide for our living.
    Having said the above, I believe this is not an issue to be debated just in the cognitive realm, the poll will give us the conclusion.

    Ong Eng Kian Posted on: Sep 17, 2014

  • Bishop Emeritus Robert Solomon states that, “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 caregivers or incur significant medical costs.” However, in his last paragraph, he mentioned that Advanced Medical Directive can be made rationally and carefully by the person. Which can Mr Robert make it clear to me, if a terminally-ill person has the ability to make a rational and clear decision to sign AMD, without the pressure imposed by others or themselves to seek their own death?

    I read up on the guidelines for making an AMD,under “Terminal illness”, which I quote, “It is actually best to make an AMD when there is no pressure to do so – when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.”. This means that a terminally ill person can make make an AMD when they are terminally ill, even if there’s a possibility of pressure from others and themselves.

    Source: http://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/making_an_amd.html

    Alyssa Goh Posted on: Sep 16, 2014

  • With respect, I think the issue could be more precisely formulated to focus on the substance of the contention (whether Singapore should have a right-to-die bill), rather than focus on whether the present time is appropriate for such a debate, on which the answer would likely be yes, for the reason that such a moral issue is a timeless one, given its relevance and impact on people who suffer pain from physiological infirmities. For that reason, my view on the issue, as it is presently worded, must be ‘yes’.

    However, if the issue was focussed on whether a right-to-die bill is justifiable for Singapore, my answer is no, until we have considered the repercussions, and are satisfied that we are willing to bear them. On this, there are many implications, some of which presently unforeseeable. Assisted suicide has reversible effects on the person who elects to undergo the same.

    Philosophically and ethically, this is problematic because, even assuming that the person’s autonomy should be given the highest priority, it is uncertain whether such autonomy is freely exercised. Pressures, self-induced and external, bear on a patient in such situations as terminal illness, etc. Could assisted suicide result in e.g. middle-income patients who suffer significant but non-critical illnesses opting death over life, notwithstanding the prospect of cure, because of cost concerns or suasion (conscious or unwitting) from doctors managing resource constraints?

    Ronald Wong Posted on: Sep 14, 2014

  • Man may like to think that he can be master of his own destiny. The truth is that he is not in control. Man does not decide when he is born. Nor does he determine the length of his life. He can be well in one moment and gone the next when calamity unexpectedly strikes. What man does have is his unique capacity to make choices, notwithstanding he is no master of his own life. At the crux of this debate is the wisdom of the choice that man and, by extension, society chooses. Experience shows there is a sad human tendency to make poor, ill-advised choices. These choices have led to a state of decline in societies today. On the surface, we see ourselves as progressing, celebrating freedoms in various spheres of life. But the reality is that we as a human race are increasingly abandoning what is good for the licence to do as we see fit. It is a great platonic shift in values that we used to hold dear! The question we need to ask ourselves on this issue (and others) is this: Do our choices make us better people? Does it contribute to society’s moral well-being? Or will it lead to further decline? I share Bishop Solomon’s points and concerns.

    Gerald Ng Posted on: Oct 09, 2014

  • I disagree with the passing of the euthanasia law. Even if one might argue that Singapore is not a religious society (that argument by itself is flawed as 83% of our society profess to be attached to a faith community as Bishop), Singapore is still a moral society which is governed by law.
    As such, the law has stated that suicide is illegal, murder is illegal – having the right to die I feel must in the same light – also be illegal.
    Life is sacred. As Hipprocrates has put it – a doctor’s goal is to cure sometimes, to relief often, to comfort always. While we cannot make light of the suffering of terminally ill patients, as a society, we can stand together with them in their suffering: to comfort them. The practice of palliative medicine exists for this reason- so as to help the dying pass on in dignity and in comfort. The Singapore government has also recognized this – and the ministry is putting in more effort and money in growing the palliative care community.
    Should the law for euthanasia and assisted suicide be passed- we will find ourselves on that slippery slope, and soon you will see that vulnerable people (handicapped/mentally impaired children for example) would be at risk of being euthanised : so as to prevent further ”suffering” – as per what is happening in the Netherlands. This is happening in the Netherlands- even though safeguards are supposedly present to prevent abuse of the system.
    Should Singapore still believe in herself as a moral society – it should not pass this euthanasia bill.

    Shirlyn Posted on: Oct 08, 2014

  • With the right to die bill, patients and their family may be pressured to make the ‘right’ decision be it for self or their loved ones. No one can give a definite timeline on when a patient will die, miracles do happen. The Advance Medical Directive bill is already in place to ensure that patients (who opt in) will not need to prolong their suffering via futile medicines / technology. I advocate for palliative medicine which can help patients relieve their pains, spend their precious last moments with their loved ones and die with dignity when the time comes.

    Bernice Posted on: Oct 08, 2014

  • reading the comments from both sides i realise that they fall into generally 2 categories. Those that Agree talk about Self. Those that Disagree talk about Community (others). So what kind of society do we want? For Self, or for Others? I choose to give, not to take.

    Sheldon Posted on: Oct 08, 2014

  • I hope that this shall never come to pass … It promotes the “self” over family, friends and society at large. We belong to not only ourselves but our dear family and friends. As much as we give love, we also receive love. It would be morally selfish to deny others the right to care and love us, even when we are stricken with terminal illness. When we suffer, they lovingly suffer with us to the end. We need love in society to persist over personal desires !

    Goh Chu Teng Posted on: Oct 03, 2014

  • According to Professor Tommy Koh, “in the public sphere, our policies should be governed by secular and not religious principles.” And he goes on to argue his case based on two points ; moral and utilitarian.

    While Singapore is a secular state, we cannot run away from the fact, as Bishop Solomon pointed out in his reply to Prof. Koh’s response to his opening statement, that “Singapore being a multi-religious society with 83% of the population being connected to faith communities, their views based on their fundamental beliefs cannot be ignored.”

    Furthermore, in Chief Justice Menon’s speech at the Singapore Medical Association Annual Lecture, on “Euthanasia: A matter of life or death?” on March 9, 2013, http://www.straitstimes.com/breaking-news/singapore/story/euthanasia-matter-life-or-death-20130324#sthash, quoting the American experience amongst others, he said that “The important lesson which one draws from the American experience is that, at the level of abstraction, human rights may be universal. …At the level of application, however, the messy detail of concrete problems, the human rights which these abstractions have generated are national. Their application requires trade-offs and compromises, exercises of judgment which can be made only in the context of a given society and its legal system.”

    Taking together the above two points, I beg to differ with Prof. Koh’s contextual reference because national consensus on the issue reflecting our collective beliefs of our multi-faith society is crucial not only for its acceptance and implementation, but more importantly, the collective voice of Singaporeans on such important decisions concerning their lives, should be heard. Otherwise, we might unwittingly be risking ourselves to the tyranny of the vocal minority deciding for the silent majority in a contextual vacuum. As the good professor says that religious beliefs must be kept private in the public space, like wise private right-to-die beliefs should not impinge on our societal values.

    Not withstanding this, I would also have to disagree with his moral and utilitarian arguments to justify a right-to-die bill.

    On his moral argument, he basically says that a person who is terminally ill with six months left to live or suffering from an incurable illness which gives him constant and intolerable pain should be empowered with the legal right to end his life at the time of his own choosing and the doctor(s) assisting him to die should not be criminalize(s) for his(their) action(s) in doing so. This he argues is to allow the patient to die with dignity.

    While it is laudable to want to relieve a person from unbearable pain, to give him the right to end his own life is an entirely different matter and I hope it shall never be legalized to ending one’s suffering, whether mental or physical. It has been the collective and the time honored wisdom of many societies to promulgate laws against the taking of one’s life because of the value placed on the sanctity of life to the extent that the larger societal family has the right to prevent you from ending your own life.

    But should there be an exception for a person who is suffering intolerable pain whether mental or physical to be given the right to end his own life with the assistance of doctors so that he can die with dignity ?

    Before I state my views, let us first come to some common understanding of the meaning of the word dignity. According to Wikipedia, traditionally, moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment. However, In the modern context dignity can function as an extension of the Enlightenment-era concepts of inherent, inalienable rights.

    So, I suppose it would not be presumptuous for me to say that the proposed notion can be rephrased to say that to die with dignity, a Singaporean should have the inherent and inalienable right to end his or her life when he is suffering intolerable pain from an incurable illness or that he/she has less than six months to live because of a terminal illness. This basically says that the person involved has complete control over his destiny and nobody else, only conditions to effect his rights have to be met.

    As much as a person who claims that it is his right to choose premature death because of his intolerable suffering, I would argue as strongly that his suffering should not have any bearing on his right to die and even go to the extent to suggest that his suffering should instead be the very reason why he should live on, in the wider context of societal values and norms.

    Regardless of our private opinions or inclinations, once we claim to be part of the Singaporean society, we cease to be a person unto ourselves and will have to be inextricably linked to our societal values and norms whether we like it or not.
    The option of taking away a person’s life because he/she is suffering from intolerable pain, be it mental or physical is anathema to our collective psyche, as seen from the laws against suicide. Another situation which can amply demonstrate our societal values on the dignity (defined in the traditional way) of human life is the treatment of likely war casualties. God forbid that we be caught up in a war ! But a more realistic scenario would perhaps be that of one of our young man being fatally wounded in a peace keeping mission. It is a foregone conclusion that no efforts will be spared to save him and failing to do so, the doctors will do all they can to reduce his pain and suffering as much as they medically can, but taking away his life is definitely not an option. The sanctity of human life and to die with dignity in the traditional sense is aptly illustrated here. Do we want to change this value system to one that ends this soldier’s life at the operating table because he claims it is his right to end his life in this irrecoverable and painful situation ?

    Otherwise, where is the heroism, where is the dignity of dying, how can such human values of perseverance, pride, courage and sacrifice which we treasure so much be preserved ! Imagine if the right-to-die bill was in existence when our navy serviceman Mr. Jason Chee was badly injured in the accident that cost him three of his limbs and three fingers of his right arm. In his mental anguish and unbearable physical pain he might have opted for the soft option to end his life ! But thanks to his indomitable spirit, the exemplary care, support and encouragement given by his medical team and his organization, and most importantly the value placed on him as a human being and not just another digit by his organization, he has overcome all odds and has developed a healthy and robust attitude towards life inspite of all that has happened to him.

    With significant improvements in palliative medicine and good hospice care, the intolerable pain element in the right-to-die equation thus becomes invalid. Terminally ill patients under hospice care in Singapore on average die within 3 months of being admitted, where they receive compassionate and palliative care. From my personal experiences with dying relatives, intolerable pain comes only towards the last few days of the very end. But by then, most of them are already in a semi-conscious or comatose state. When the ultimate finality comes, they die with dignity and human decency, surrounded by loved ones.

    The very societal values we hold dear like resilience, courage, character even in the terminally ill, tampered by the utmost humanistic and compassionate care for them, together provide too compelling a reason why the terminal ill and those suffering intolerable pain should live on and eventually die naturally with dignity.

    In contrast, it would be ironic if the right-to-die bill is legalized, as it allows for a selfish, parochial, and cowardly way to commit suicide but passing the responsibility and accountability to someone else to legally pull the trigger, thus dying devoid of dignity.

    Beyond the conceptual level, there are also issues that many people have already brought up about the abuses and the negative experiences of such a right-to-die law in countries practicing it, and should be predicated only on the strength or otherwise of the conceptual arguments.

    On the utilitarian argument, there is not even the need to debate it as our Eastern culture on filial piety which is being encouraged in our society, runs counter to its very core. As it is, seniors in our society beyond a certain age, already feel marginalized when trying to find employment. It would be a sad day and the whole nation should go into mourning should the day come when the law is passed on account of the utilitarian argument ! For what it amounts to is the extension to the national level of children telling their parents that it is pointless and too costly to keeping them alive, even if they can afford to continue to do so. At best, the utilitarian argument might convince a person to perform his last economic service for the nation in taking his or her own life prematurely, devoid of all human decency and compassion, and dignity and at worst, it debases the very soul of our nation.

    Therefore, my answer as to whether it is time for Singapore to consider a right-to-die bill, is not only a big no, but that I don’t even see the need to initiate further discussions on it.

    Cyril Chiam

    Cyril Chiam Posted on: Oct 02, 2014

  • Having read all the comments thus far, I am still positively sure that I will disagree with the endorsement to exercise the right-to-die bill for “healthy” individuals. I understand that there are grey areas in which we define the process of prolonging life or death; as pointed out by George Yeo. However, I would like to add to his points for us to further deliberate on the subject topic of prolonging death.

    In the likeliest possibility, we may all die one day. The duration in which we remain in this World is definitely finite. Thus, the topic of prolonging life ought to be less emphasized. The main discussion should revolve around whether we should naturally or unnaturally prolong or hasten someone’s death.

    Should it be a choice that individuals make on their own? With a group of professionals like how Martino Tan mentioned? Or with family members? I would say that it should be none of the above. The choice ought to be natural; and unlike how Jerick Tan had mentioned in his post about how the right to die presents a false dilemma of little resource to assist terminally ill patients, I believe that natural death can be assisted too.

    For example, if someone is suffering from pain; physically or mentally, we may employ the use of medical equipment or consumables to reduce the pain that they are experiencing. While we reduce their pain and suffering, it is unlike assisting them to die faster, but a means for us to assist them through a natural transition. I wish to emphasise again, that I believe that such an option should only be applied to individuals who are suffering terribly. Thus, it should not be a subject of the lack of resources, but with adequate resources, we may still assist someone to die naturally and with dignity.

    I disagree with the process of hastening the process of death, because it raises the topic of a criminal act of murder. With or without consent from the patient, I believe that the process of death should not be prolonged or hasten. We may prolong the process of death unless there is an absolute possibility of ensuring that the patient will indeed have a more good years in our World.

    However, if the process of prolonging death results to a prolonged period of pain and suffering, we should allow nature to take its place by reducing their pain; not through death as an option, but to minimise their pain and suffering.

    Edmond Wong Posted on: Sep 26, 2014

  • I notice that humans when besotted by a problem or disease or illness would often seek an escape route rather than facing up to it. Euthanasia is just a form of escape from pain and suffering. Do we not agree that such is life? And have we not also suffered at a younger age, events and circumstances which shaped us to be who we are now?
    Truly Life is sacred and a gift. It is not created by our own selves or our parents. In fact we must agree that we don’t choose where and how we are born. Unfortunately, throughout life, when things are going well, we would often think that we are self-made in every sense of the word until an illness strikes, we realise we are not in control anymore. And grasping at whatever possible, we hope to control our own death by determining how and when we should die. Though it seems like control, it is in actual fact a surrender to fate and a finality that is totally out of our hands.
    The only time that one can TAKE is when one can GIVE. If I take your freedom or rights or money, I too must have the power to give you back what I have taken. Therefore if one chooses to take a life, he or she must be able to also give life back to whoever’s life he/she has taken. If a mistake has been made, make sure you can undo the mistake or rectify it.
    Can anyone then guarantee that in every act of Euthanasia there be no mistake made? No regrets? No repercussions on those left behind? If not, then I think we need not visit this question ever again.

    Simon Chong Posted on: Sep 26, 2014

  • Much research has been done in jurisdictions where euthanasia has been legal for decades. References to scholarly studies cannot be cited here for length constraints but are available on request. These studies provide insights into this important social experiment and reveal some consequences thereof.
    People seek euthanasia mainly because of depression, hopelessness, loss of independence, desire for control, fear of the future and low social support. Low spirituality (a diminished sense of life’s purpose and meaning; not religiosity) is a strong predictor of euthanasia-seeking behaviour. Physical symptoms are generally unimportant to those pursuing euthanasia. There is evidence that euthanasia engenders distrust of physicians.
    The utilitarian argument is troubling. Terminally ill people know that they cause financial, social and emotional strain to their families and society by draining resources. Thus, in the Oregon experience “relief of burden” has become a more common reason after euthanasia was legalised. Taken to its logical end, utilitarianism demands a “duty to die” of all unproductive and resource-consuming people.
    The autonomy argument overlooks the truism that autonomy cannot be absolute and inviolable. Unfettered autonomy has clearly negative consequences for society. Is the decision to live or die a consumerist choice? This debate must engage all levels of community to hear more than the views of the intelligentsia. Euthanasia of neonates is now legal in the Benelux region, and euthanasia for organ donation has been advocated. We need to go beyond emotive anecdotes to envisage how giving all physicians the potential to kill their patients will likely corrode and corrupt society – and whether this is what we really want.

    Kon Oi Lian Posted on: Sep 26, 2014

  • Disagree. I remember the Parliamentary consultations and debate when the Advance Medical Directive Bill was introduced around 1995. There is a difficult grey area between prolonging life and prolonging death which AMD seeks to address sensitively. Euthanasia as assisted suicide takes it too far.

    George Yeo Posted on: Sep 26, 2014

  • When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

    gp Posted on: Sep 25, 2014

  • The right to die imposes an obligation on the society (one’s family, relatives, friends and doctors etc). One’s right to die becomes a doctor’s obligation to kill.

    Should we grant the medical profession the license to kill? The ethical foundation of Western medicine (Hippocratic Oath) is the idea that the doctor should seek to preserve and enhance life, and cause no harm. Such a bill perverts that role and places responsibility on the shoulders of a profession that are asked to implement it.

    A “right” is a moral claim. Do we have such a claim on death? It is not up to us to decide when our life will end or when it will began.

    So where do we draw the line? The advance medical directive in S’pore is instructive. It states that one can inform his/her doctor that he/she does not want to use any life-sustaining treatment to prolong one’s life. This appears to be an ideal state situation now.

    I don’t think a society should have a situation where an individual or a group of people think they have the right to put someone else to death.

    Suppose we go down this slippery slope. Will a change in legislation mean that a right to die becomes a “duty to die”?

    Perhaps our compassion is too focused on a few cases and does not consider the most vulnerable people in society. Such a legislation would apply enormous pressure on the elderly, the sick and the disabled to “do the right thing” and not be a burden on others.

    Martino Tan Posted on: Sep 24, 2014

  • It is indisputable that everyone has the right to die with dignity. However, we must be careful not to equate this with dying painlessly or without suffering. Dignity is the state or quality of being worthy of honour or respect. There are countless stories of cancer patients & people who have put up a brave fight against their illness. And when they pass on, can we say they did not die with dignity? Prof Koh also mistakenly assumed that all who are against assisted dying are religious. I believe the non-religious would agree that life is precious and therefore, every effort must be made to save it. Prof Koh also argued that because resources are scarce, society should not waste efforts on treating some persons. Not every terminally ill wants to die. Many treasured whatever “extra time” they have with their families through life extension treatment. There are some things in life that we cannot and should never adopt a utilitarian approach towards it. Especially not in a society where we want to encourage Compassion. Lives are not disposables. We are not commodities, ready to be traded or crushed when there’s no use.

    Oneida Posted on: Sep 23, 2014

  • It is very hard to come to a solid conclusion on weather someone has to right to decide when they would like to die. I cannot and will not judge someone who feels the need to end pain through death becasue I have not sufferd that pain and do not know someone who has. However making this a law is not as easy as quoting a few examples of people in these situations and then making a law based on that. How will you draw the line? Who decides when it is ok? The day you come up with a full proof plan on how you can execute this law without any loopholes is the day you can decide if you really want to implement such a law. We are often asked not to make any important decisions when we are stressed or when we are not in a good frame of mind. How is this any different? How can we ever be sure that we have (with a clear mind) actually exhausted every other option and so we are allowed to decide that we should die?Anyone who is told they are terminally ill would be shattered and broken. But we human beings have it in us to fight. If we already know we can take the easy way and choose to end it how will we even know what we are capable of? There could be a cure just around the corner. But we will never know if we do not give it a chance. And finally let us look to places that have already made this a law and learn from them. Read the article posted by Denise. Many chooseing this path are the aged, the lonely and the bereaved. Is that why we want? How are we sure we can prevent that here?

    Jessica Posted on: Sep 22, 2014

  • Rather than focus on the ‘right’ to die, our nation should be focusing on the right to live. The right to die debate presents a false dilemma. It assumes that there is little resource left available for our terminally ill patients, and goes on to present them the choice between delaying death and accelerated death. However, the truth of the matter is that resources are available, and that their dispensation is controlled by the authorities. A nation that focuses more on economy and less on people will be left with ‘no choice’ but to choose between delaying and accelerating death. A nation that focuses on people, will instead be active in seeking out ways and means to give the patient the best welfare, and this could include firstly, giving family members and close friends paid leave from work and excusing the children from schools. Scientific research has shown that the presence of loved ones help in recovery. Secondly,making treatment more affordble. Thirdly, improving social and family policies and education, which means more investments should be made into this sector rather than trade, defense, transport, communications, etc. After all, Singapore exists for its people, not the other way around. Parents should be taught how to be role models for their children, and incentives at work should not motivate them to strive to the extent of neglecting their family. Similarly, children should not be challenged to strive in CCAs or for academic results but to spend more time with their family. Morals and values should be taught in society, to tackle the growing culture of individualism, narcissism and consumerism. This last approach will go a long way in the long term, because it will build healthy families, secure in love, with individuals confident of their identity, and eager to contribute to society.

    Jerick Tan Posted on: Sep 18, 2014

  • Can one leave one’s values and principles at the door of the public-square and marketplace, yet maintain one’s integrity and conscious? Would this individual be in any situation, be as the blowing of the wind?

    Can we indicate to be for diversity and inclusiveness, when an individual requires atypical number of supports for daily living activities, to face these challenges, be allowed to request for one’s life to be terminated? Pause, consider, it be a disproportionate number of the vulnerable young and elderly with daily living challenges to confronted with this issue.
    As the situation is, a positive for Downs Syndrome, is likely for the doctor to advice the couple to terminate the life. Would the elderly faced with multi-factorial issues in family and societal domains, throw in the towel too?

    It be the vulnerable who shall be at risk most. Pause, consider, the intangible cost upon society, if such a pathway be established and normalized.

    Koh Gay Posted on: Sep 18, 2014

  • Article 6(1) of the International Covenant on Civil and Political Rights provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

    This article makes two important points. Firstly, the right to life is inherent. This means that there is no “right to die”. Neither does the value of life or its protection depend on its quality. Secondly, this right shall be protected by law. Regardless of one’s personal views in favour or against euthanasia and assisted dying, States are required to protect life as an inherent right.

    The relaxation of laws protecting life does not only affect some, but also fundamentally alters the value of all human life, especially that of the vulnerable or those perceived as having a lower “quality of life”.

    There is also a real prospect of abuse. For example, a 2010 study reported that 32 per cent of the assisted deaths in the region of Flanders in Belgium between June and November 2007 were done without explicit request.

    Hence, I agree with Bishop Emeritus Robert Solomon that 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.

    In doing so, we respect the inherent value of all human life, and indeed the value of living with dignity.

    Darius Lee Posted on: Sep 18, 2014

  • Introducing assisted suicide in any society will inevitably lead to its moral decline. The Dutch euthanasia experience started with very strict criteria. Patients had to prove intolerable suffering and consistent desire and more than one doctor had to be consulted. 5 years later, large surveys showed that doctors were involved in causing 5,000 patient deaths without their consent. These doctors started out with altruistic intentions, but ended up killing their patients! Once assisted suicide is allowed, it introduces a logic to society that some lives are simply not worth living. Once such logic is in place, then Prof Tommy Koh’s utilitarian logic will take precedence due to limited healthcare resources, and no safeguards are left to prevent the subsequent killing of disabled children or frail elderly whose lives are deemed “not worth living”. Imagine a society where the most vulnerable are not only not protected, but are removed and discriminated against by law!

    Furthermore, contrary to what Prof Tommy Koh suggests, death with dignity does not necessarily entail dying without suffering at the time of one’s choosing. Rather, the true meaning of Compassion is “to suffer with” and not to eliminate suffering at all costs. Today, palliative care is a viable option which provides significant pain relief and comfort at the end of life. It promulgates a harmonious departure from one’s life at peace with one’s loved ones in a way which suicide can never achieve.

    colin ong Posted on: Sep 16, 2014

  • Hindsight is always perfect vision. Take it from the forerunners, they have already changed their minds about euthanasia.

    http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

    “Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.”

    Denise Posted on: Sep 15, 2014

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Professor Tommy Koh

Yes

My friend, Bishop Emeritus Robert Solomon, has raised three objections to my proposal.  I want to begin by saying that I have great respect for Dr Solomon, who is both a pastor and a doctor.  I will reply briefly to his three objections:

First, Dr Solomon argues that our law criminalises attempted suicide and it should stay that way.  His reason is that life is sacred and one does not have the freedom to take one’s life.  This is a religious view that our lives belong not to us but to God.  Therefore, only God can take our lives away.  I hold the secular view that we are the masters of our own destiny.  As empowered beings, we should have the right to live with dignity and to die with dignity.  Our law should reflect our values and not those of the British colonial authorities who drafted our Penal Code.  To the question, “Whose life is it anyway?”, my answer is that it is my life.

Second, I have great respect for doctors and for their noble profession.  I understand that the goal of medicine is to heal, care and bring relief.  Doctors, like other professions, can sometimes suffer from the defects of their virtues.  Their commitment to saving lives, when carried to extremes, can result in heroic and costly interventions to prolong the lives of their patients by a few hours or days when it would have been more merciful if the doctors had allowed them to die.  The AMD, which Dr Solomon supports, is a way to stop the doctors from such futile interventions.  Doctors in countries such as the Netherlands and Switzerland are not forced to participate in assisted suicides or euthanasia.  It is voluntary.  There is zero evidence to support Dr Solomon’s point that it would undermine the doctor-patient relationship.

Third, Dr Solomon’s third objection is what I would call the slippery slope argument.  It is a familiar argument and often invoked by those who oppose change.  I regard the Netherlands and Switzerland as two of the most admirable and civilized countries on earth.  I see no evidence to support Dr Solomon’s point that assisted suicide and euthanasia have been abused there or in any other state or country which has legalised them.

Bishop Emeritus Robert Solomon

No

Professor Tommy Koh has made a spirited case for euthanasia and assisted suicide. We both agree that something must be done to help patients with intractable pain. Where we differ significantly is in the means employed. Prof Koh advocates changing our laws to make euthanasia and assisted suicide lawful. He offers two arguments in his Opening Statement that I wish to address.

First, Prof Koh’s “moral argument”. There are two issues here: the right to die as personal autonomy, and allowing it as an act of mercy.

Does one have absolute autonomy to choose premature death? The answer is “no” because in real life there are limits imposed by society through laws and commonly-held values. We do have laws that prohibit people from attempting suicide, selling their organs, practising polygamy or keeping slaves. This is based on two principles: rights come with responsibilities and restrictions, and no person lives (or dies) in a social vacuum. A patient’s decision to be euthanised affects family, friends, health care workers and society at large. We are all connected in some way and our decisions to live or die as we like affect others.

Can a patient make a free and voluntary decision? He depends on information regarding diagnosis and prognosis provided by doctors whose knowledge is not perfect. Chief Justice Sundaresh Menon, in his Singapore Medical Association Lecture 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. 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 decisions in a state of depression; studies show that they may think differently if treated. There is also potential pressure from family and caregivers and society at large that impinge on the patient’s decision to be euthanised.

It is humane to want to do something to help a suffering patient. However, euthanasia and assisted suicide are not as humane as they may seem. 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. Palliative medicine , which requires compassion and care, can help the patient, allowing him to die with true dignity.

Prof Koh’s second argument is utilitarian, and essentially economic in nature. I agree that medicine should be practised with skill and discernment, and unnecessary “heroic” medicine should be avoided. However, economic concerns must not be used to support euthanasia and assisted suicide. One should not shorten patients’ lives simply because they occupy hospital beds or because caring for them costs money. When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

Two other points need to be made briefly. First, events in the Netherlands and Belgium show that legalising euthanasia will inevitably lead to wider application. In Belgium, legislation passed in March 2014 extends euthanasia to children who can request to be euthanised. This is open to abuse (for studies show that many doctors have been practising euthanasia without following the rules) and will lead to many more applications. In the Netherlands, one need not be terminally ill to be euthanised. That one cannot have a “livable life” is reason enough for euthanasia, as the Groningen Protocol (which allows infant euthanasia) shows. Recently, a Belgian court granted the request by a prisoner for assisted suicide. The prisoner pleaded to be put to death because of mental anguish caused by his violent impulses. What is significant here is that he is not suffering from terminal illness or physical pain but from mental anguish. Will this open the floodgates to those who are in a similar situation?

Secondly, Prof Koh states that religious principles should be kept out of state laws. I am sure he is not saying that religious opinions should be kept out of social discourse. All principles are based on fundamental beliefs, whether identified as religious or not. Singapore is a multi-religious society, with 83% of the population being connected to faith communities. Their views cannot be ignored. In any case, except for three European countries that allow euthanasia, and another European country and five states in the US that allow assisted suicide, the rest of the world has laws, whether for religious or secular reasons, that prohibit euthanasia and assisted suicide. We would do well to stand with the wisdom of the majority rather than embrace the folly of the few.

comments

  • 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

  • The bishop’s response is fraught with logical fallacies.

    The debate at hand is about regulating suicide through a right-to-die bill, which implies setting up a framework to ensuring that proper conditions are put in place before a person may choose to end his life. The bishop has instead set up a straw man argument by empathetically stating that one cannot possibly have absolute autonomy to choose premature death. There is critical difference between freedom that is qualified and freedom that is absolute – the bishop’s failure to draw the distinction is an unnecessary detraction from the main issue at hand, because the motion does not ask the debaters to consider granting Singaporeans absolute freedom to end their lives.

    The next assertion that the bishop made is that a patient cannot make a free and voluntary decision to end his own life because (a) information regarding diagnosis and prognosis may not be perfect; and (b) there may be ‘potential pressure from family and caregivers and society at large’ that impinge on the patient’s decision to be euthanised.

    The bishop’s definition of making ‘free and voluntary’ decision is flawed. Almost all decisions we make in life are based on whatever information we have at hand, which may not be perfect; they will also undoubtedly be affected by opinion and pressure of the people around us. If we are unable to make ‘free and voluntary decisions’ because of the abovementioned considerations, which are inherent in life, then we would soon arrive at a conclusion that most of the decisions we make are made involuntarily. By extension, according to the bishop, our consent to marriage, contract, would all be invalid – surely that is impracticable.

    The bishop also made some ill-substantiated claims:

    For example, where he had said that euthanasia and assisted suicide are not as humane as they may seem, the only support he could conjure was that a Pope had said so – this could hardly seem convincing in light of medical advances today.

    The bishop also sought to conjure up a boogeyman by claiming that legalizing euthanasia and assisted suicide for the terminally ill may lead to an opening of floodgates for something no less than an absolute freedom to take one’s life. Insomuch as checks are in place to ensure that legislation is a reflection of societal views and goals, whether a bill legalizing a right-to-die will lead to an opening of floodgates would depend on how the bill is being drafted, and whether it is compatible with the views and goals of society in time to come – anything more than that would be pure speculation.

    Bin Hong Posted on: Sep 27, 2014

  • I can sincerely understand the pain suffered by both patients and their families, when there is no hope or only meaningless effort.
    We can give kind advice and best wishes to others, but we should not speak for them.
    We should respect those desperate patients’ will which way they want to go, without harming others and the society.
    However, the decision should not only be solely made by the patient himself/herself, but based on a consensus from his/her family as a whole.

    SUN Xi Posted on: Sep 26, 2014

  • Human rights should extend to the right of each person to decide when he or she should decide to die should it be physically unbearable for to continue living. I won’t bother quoting examples as I have too many to choose from, but I have seen the pain, the prolonging of life brings to both the patient, caregiver and family. I have heard such patients express their wish to discontinue their treatment and even to appeal to the Gods to take them away but modern medicine continued to keep them alive till they lost all dignity and self respect. Everyone should have the right to decide whether or not modern medicine should prolong their lives if it means that quality of life is degraded to the point where they lose both dignity and self respect.

    HH Tong Posted on: Sep 26, 2014

  • I think that a key feature of democratic societies is that we value rights, choice and freedom, and that as a society we should aim to facilitate pursuit of these freedoms insofar as they do not impinge on the choices, rights or freedoms of others, a view enunciated originally by J.S. Mill. Before proceeding with my explanation, the version of this law that I am in support of would need a few caveats and conditions to prevent abuse. I would only support a bill that ensures the following conditions are met:

    (A) Absence of duress;
    (B) Mental capacity;
    (C) Express consent;
    (D) Exhaustion of all reasonable options in seeking a cure, within means.

    Having said that, I see no further reason for us to deprive anyone of the right to die. To assume that the right to live is mutually exclusive to the right to die is a fallacy. In fact, I would say the opposite; the right to live necessitates the right to die because they share the same underlying principle i.e. self determination. I would personally not sign up for the AMD, but that does not mean I should prevent someone else from doing it. Choice is the key operator here, not whether it takes up resources, or whether you, me, or someone else thinks its ‘dignified’. If a suffering person wanted to live as long as possible, then lets do our best to make sure it happens. But lets also remember to do the same if they think death is preferable, and not deprive them of their rights just before they leave us.

    Ali Ahmad Yaakub Posted on: Sep 24, 2014

  • The inconvenient truth is that Singaporeans have been killing themselves because the pain of their illness can be unbearable. Hence, it is preferable to let those who want to die to do so with dignity through professionally-assisted suicide. And to help us come to terms with euthanasia, we need to understand it within the context of medicine. If we remove our rose-tinted lenses, we see medicine for what it is: A practice that has killed countless number of people via iatrogenics – where the healer causes more harm than good. This is where the infirm go to the doctor for a cure, only to wind up dead. But mercy killing has shown that we have actually made medical progress: We have developed the means to assist people in dying as painlessly as possible, rather than killing them on the pretext of curing them. If this isn’t a step forward for the practice of medicine, then I don’t know what is. Plus, allowing people to die has to be seen in the context of humanity’s evolution through the past millions of years. For the longest time, humans have lived short brutish lives. Our Savannah-dwelling ancestors barely made it past 30 years old. Now we live till 75. Even our closest ape cousins do not experience such artificially extended lifespans. Ipso facto, what medicine and technological advances giveth, what medicine and technological advances taketh away. Living to 75 is already considered living on borrowed time. What’s the benefit of a few extra weeks or months?

    Belmont Lay Posted on: Sep 23, 2014

  • “Life is sacred”. “Right to live”. These are noble ideals.

    Tell these ideals to the man lying in the hospital bed, suffering from pain and grief. Tubes all over his body. Defecating on himself uncontrollably. That he knows his end is near, and there is no more to look forward to.

    The only difference between the man who jumped down, and the man in the hospital is that the latter is imprisoned and thus able to do what he wishes to do.

    Rick Posted on: Sep 18, 2014

  • Just this morning, I read the sad news of a son who could not bear the suffering of his father who was terminally ill; he helped his father to jump down from his high floor HDB flat and he followed suit. Two deaths ! While we are still debating, people have already made their choice with or without the bill.
    Would this tragedy be prevented if we had the a “Right-TO-Die” bill ? probably. One life could have been saved. From what I read , it was the father who urgred his son to kill him, and probably the son suffered from guilt and depression when he conceded. No body will ever know the real reasons now.
    Life is never measured by its length but its quality. Only people who suffer long enough really understand what pain means. All men are made differently, while some might be able to endure and believe that suffering makes them strong and profound, many of us earth mortals would find such pain unbearable. I fully agreed with the article “The day I wanted my father to die”, I went through the same experience. Prolonged life has no meaning at all, it is no longer a life, merely a “living”.
    Eventually life is transient, I agree that all lives shall have their purpose in this world, but when the purpose is fulfilled, there is no point to linger further. We shall have the given freedom to decide for our living.
    Having said the above, I believe this is not an issue to be debated just in the cognitive realm, the poll will give us the conclusion.

    Ong Eng Kian Posted on: Sep 17, 2014

  • Bishop Emeritus Robert Solomon states that, “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 caregivers or incur significant medical costs.” However, in his last paragraph, he mentioned that Advanced Medical Directive can be made rationally and carefully by the person. Which can Mr Robert make it clear to me, if a terminally-ill person has the ability to make a rational and clear decision to sign AMD, without the pressure imposed by others or themselves to seek their own death?

    I read up on the guidelines for making an AMD,under “Terminal illness”, which I quote, “It is actually best to make an AMD when there is no pressure to do so – when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.”. This means that a terminally ill person can make make an AMD when they are terminally ill, even if there’s a possibility of pressure from others and themselves.

    Source: http://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/making_an_amd.html

    Alyssa Goh Posted on: Sep 16, 2014

  • With respect, I think the issue could be more precisely formulated to focus on the substance of the contention (whether Singapore should have a right-to-die bill), rather than focus on whether the present time is appropriate for such a debate, on which the answer would likely be yes, for the reason that such a moral issue is a timeless one, given its relevance and impact on people who suffer pain from physiological infirmities. For that reason, my view on the issue, as it is presently worded, must be ‘yes’.

    However, if the issue was focussed on whether a right-to-die bill is justifiable for Singapore, my answer is no, until we have considered the repercussions, and are satisfied that we are willing to bear them. On this, there are many implications, some of which presently unforeseeable. Assisted suicide has reversible effects on the person who elects to undergo the same.

    Philosophically and ethically, this is problematic because, even assuming that the person’s autonomy should be given the highest priority, it is uncertain whether such autonomy is freely exercised. Pressures, self-induced and external, bear on a patient in such situations as terminal illness, etc. Could assisted suicide result in e.g. middle-income patients who suffer significant but non-critical illnesses opting death over life, notwithstanding the prospect of cure, because of cost concerns or suasion (conscious or unwitting) from doctors managing resource constraints?

    Ronald Wong Posted on: Sep 14, 2014

  • Man may like to think that he can be master of his own destiny. The truth is that he is not in control. Man does not decide when he is born. Nor does he determine the length of his life. He can be well in one moment and gone the next when calamity unexpectedly strikes. What man does have is his unique capacity to make choices, notwithstanding he is no master of his own life. At the crux of this debate is the wisdom of the choice that man and, by extension, society chooses. Experience shows there is a sad human tendency to make poor, ill-advised choices. These choices have led to a state of decline in societies today. On the surface, we see ourselves as progressing, celebrating freedoms in various spheres of life. But the reality is that we as a human race are increasingly abandoning what is good for the licence to do as we see fit. It is a great platonic shift in values that we used to hold dear! The question we need to ask ourselves on this issue (and others) is this: Do our choices make us better people? Does it contribute to society’s moral well-being? Or will it lead to further decline? I share Bishop Solomon’s points and concerns.

    Gerald Ng Posted on: Oct 09, 2014

  • I disagree with the passing of the euthanasia law. Even if one might argue that Singapore is not a religious society (that argument by itself is flawed as 83% of our society profess to be attached to a faith community as Bishop), Singapore is still a moral society which is governed by law.
    As such, the law has stated that suicide is illegal, murder is illegal – having the right to die I feel must in the same light – also be illegal.
    Life is sacred. As Hipprocrates has put it – a doctor’s goal is to cure sometimes, to relief often, to comfort always. While we cannot make light of the suffering of terminally ill patients, as a society, we can stand together with them in their suffering: to comfort them. The practice of palliative medicine exists for this reason- so as to help the dying pass on in dignity and in comfort. The Singapore government has also recognized this – and the ministry is putting in more effort and money in growing the palliative care community.
    Should the law for euthanasia and assisted suicide be passed- we will find ourselves on that slippery slope, and soon you will see that vulnerable people (handicapped/mentally impaired children for example) would be at risk of being euthanised : so as to prevent further ”suffering” – as per what is happening in the Netherlands. This is happening in the Netherlands- even though safeguards are supposedly present to prevent abuse of the system.
    Should Singapore still believe in herself as a moral society – it should not pass this euthanasia bill.

    Shirlyn Posted on: Oct 08, 2014

  • With the right to die bill, patients and their family may be pressured to make the ‘right’ decision be it for self or their loved ones. No one can give a definite timeline on when a patient will die, miracles do happen. The Advance Medical Directive bill is already in place to ensure that patients (who opt in) will not need to prolong their suffering via futile medicines / technology. I advocate for palliative medicine which can help patients relieve their pains, spend their precious last moments with their loved ones and die with dignity when the time comes.

    Bernice Posted on: Oct 08, 2014

  • reading the comments from both sides i realise that they fall into generally 2 categories. Those that Agree talk about Self. Those that Disagree talk about Community (others). So what kind of society do we want? For Self, or for Others? I choose to give, not to take.

    Sheldon Posted on: Oct 08, 2014

  • I hope that this shall never come to pass … It promotes the “self” over family, friends and society at large. We belong to not only ourselves but our dear family and friends. As much as we give love, we also receive love. It would be morally selfish to deny others the right to care and love us, even when we are stricken with terminal illness. When we suffer, they lovingly suffer with us to the end. We need love in society to persist over personal desires !

    Goh Chu Teng Posted on: Oct 03, 2014

  • According to Professor Tommy Koh, “in the public sphere, our policies should be governed by secular and not religious principles.” And he goes on to argue his case based on two points ; moral and utilitarian.

    While Singapore is a secular state, we cannot run away from the fact, as Bishop Solomon pointed out in his reply to Prof. Koh’s response to his opening statement, that “Singapore being a multi-religious society with 83% of the population being connected to faith communities, their views based on their fundamental beliefs cannot be ignored.”

    Furthermore, in Chief Justice Menon’s speech at the Singapore Medical Association Annual Lecture, on “Euthanasia: A matter of life or death?” on March 9, 2013, http://www.straitstimes.com/breaking-news/singapore/story/euthanasia-matter-life-or-death-20130324#sthash, quoting the American experience amongst others, he said that “The important lesson which one draws from the American experience is that, at the level of abstraction, human rights may be universal. …At the level of application, however, the messy detail of concrete problems, the human rights which these abstractions have generated are national. Their application requires trade-offs and compromises, exercises of judgment which can be made only in the context of a given society and its legal system.”

    Taking together the above two points, I beg to differ with Prof. Koh’s contextual reference because national consensus on the issue reflecting our collective beliefs of our multi-faith society is crucial not only for its acceptance and implementation, but more importantly, the collective voice of Singaporeans on such important decisions concerning their lives, should be heard. Otherwise, we might unwittingly be risking ourselves to the tyranny of the vocal minority deciding for the silent majority in a contextual vacuum. As the good professor says that religious beliefs must be kept private in the public space, like wise private right-to-die beliefs should not impinge on our societal values.

    Not withstanding this, I would also have to disagree with his moral and utilitarian arguments to justify a right-to-die bill.

    On his moral argument, he basically says that a person who is terminally ill with six months left to live or suffering from an incurable illness which gives him constant and intolerable pain should be empowered with the legal right to end his life at the time of his own choosing and the doctor(s) assisting him to die should not be criminalize(s) for his(their) action(s) in doing so. This he argues is to allow the patient to die with dignity.

    While it is laudable to want to relieve a person from unbearable pain, to give him the right to end his own life is an entirely different matter and I hope it shall never be legalized to ending one’s suffering, whether mental or physical. It has been the collective and the time honored wisdom of many societies to promulgate laws against the taking of one’s life because of the value placed on the sanctity of life to the extent that the larger societal family has the right to prevent you from ending your own life.

    But should there be an exception for a person who is suffering intolerable pain whether mental or physical to be given the right to end his own life with the assistance of doctors so that he can die with dignity ?

    Before I state my views, let us first come to some common understanding of the meaning of the word dignity. According to Wikipedia, traditionally, moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment. However, In the modern context dignity can function as an extension of the Enlightenment-era concepts of inherent, inalienable rights.

    So, I suppose it would not be presumptuous for me to say that the proposed notion can be rephrased to say that to die with dignity, a Singaporean should have the inherent and inalienable right to end his or her life when he is suffering intolerable pain from an incurable illness or that he/she has less than six months to live because of a terminal illness. This basically says that the person involved has complete control over his destiny and nobody else, only conditions to effect his rights have to be met.

    As much as a person who claims that it is his right to choose premature death because of his intolerable suffering, I would argue as strongly that his suffering should not have any bearing on his right to die and even go to the extent to suggest that his suffering should instead be the very reason why he should live on, in the wider context of societal values and norms.

    Regardless of our private opinions or inclinations, once we claim to be part of the Singaporean society, we cease to be a person unto ourselves and will have to be inextricably linked to our societal values and norms whether we like it or not.
    The option of taking away a person’s life because he/she is suffering from intolerable pain, be it mental or physical is anathema to our collective psyche, as seen from the laws against suicide. Another situation which can amply demonstrate our societal values on the dignity (defined in the traditional way) of human life is the treatment of likely war casualties. God forbid that we be caught up in a war ! But a more realistic scenario would perhaps be that of one of our young man being fatally wounded in a peace keeping mission. It is a foregone conclusion that no efforts will be spared to save him and failing to do so, the doctors will do all they can to reduce his pain and suffering as much as they medically can, but taking away his life is definitely not an option. The sanctity of human life and to die with dignity in the traditional sense is aptly illustrated here. Do we want to change this value system to one that ends this soldier’s life at the operating table because he claims it is his right to end his life in this irrecoverable and painful situation ?

    Otherwise, where is the heroism, where is the dignity of dying, how can such human values of perseverance, pride, courage and sacrifice which we treasure so much be preserved ! Imagine if the right-to-die bill was in existence when our navy serviceman Mr. Jason Chee was badly injured in the accident that cost him three of his limbs and three fingers of his right arm. In his mental anguish and unbearable physical pain he might have opted for the soft option to end his life ! But thanks to his indomitable spirit, the exemplary care, support and encouragement given by his medical team and his organization, and most importantly the value placed on him as a human being and not just another digit by his organization, he has overcome all odds and has developed a healthy and robust attitude towards life inspite of all that has happened to him.

    With significant improvements in palliative medicine and good hospice care, the intolerable pain element in the right-to-die equation thus becomes invalid. Terminally ill patients under hospice care in Singapore on average die within 3 months of being admitted, where they receive compassionate and palliative care. From my personal experiences with dying relatives, intolerable pain comes only towards the last few days of the very end. But by then, most of them are already in a semi-conscious or comatose state. When the ultimate finality comes, they die with dignity and human decency, surrounded by loved ones.

    The very societal values we hold dear like resilience, courage, character even in the terminally ill, tampered by the utmost humanistic and compassionate care for them, together provide too compelling a reason why the terminal ill and those suffering intolerable pain should live on and eventually die naturally with dignity.

    In contrast, it would be ironic if the right-to-die bill is legalized, as it allows for a selfish, parochial, and cowardly way to commit suicide but passing the responsibility and accountability to someone else to legally pull the trigger, thus dying devoid of dignity.

    Beyond the conceptual level, there are also issues that many people have already brought up about the abuses and the negative experiences of such a right-to-die law in countries practicing it, and should be predicated only on the strength or otherwise of the conceptual arguments.

    On the utilitarian argument, there is not even the need to debate it as our Eastern culture on filial piety which is being encouraged in our society, runs counter to its very core. As it is, seniors in our society beyond a certain age, already feel marginalized when trying to find employment. It would be a sad day and the whole nation should go into mourning should the day come when the law is passed on account of the utilitarian argument ! For what it amounts to is the extension to the national level of children telling their parents that it is pointless and too costly to keeping them alive, even if they can afford to continue to do so. At best, the utilitarian argument might convince a person to perform his last economic service for the nation in taking his or her own life prematurely, devoid of all human decency and compassion, and dignity and at worst, it debases the very soul of our nation.

    Therefore, my answer as to whether it is time for Singapore to consider a right-to-die bill, is not only a big no, but that I don’t even see the need to initiate further discussions on it.

    Cyril Chiam

    Cyril Chiam Posted on: Oct 02, 2014

  • Having read all the comments thus far, I am still positively sure that I will disagree with the endorsement to exercise the right-to-die bill for “healthy” individuals. I understand that there are grey areas in which we define the process of prolonging life or death; as pointed out by George Yeo. However, I would like to add to his points for us to further deliberate on the subject topic of prolonging death.

    In the likeliest possibility, we may all die one day. The duration in which we remain in this World is definitely finite. Thus, the topic of prolonging life ought to be less emphasized. The main discussion should revolve around whether we should naturally or unnaturally prolong or hasten someone’s death.

    Should it be a choice that individuals make on their own? With a group of professionals like how Martino Tan mentioned? Or with family members? I would say that it should be none of the above. The choice ought to be natural; and unlike how Jerick Tan had mentioned in his post about how the right to die presents a false dilemma of little resource to assist terminally ill patients, I believe that natural death can be assisted too.

    For example, if someone is suffering from pain; physically or mentally, we may employ the use of medical equipment or consumables to reduce the pain that they are experiencing. While we reduce their pain and suffering, it is unlike assisting them to die faster, but a means for us to assist them through a natural transition. I wish to emphasise again, that I believe that such an option should only be applied to individuals who are suffering terribly. Thus, it should not be a subject of the lack of resources, but with adequate resources, we may still assist someone to die naturally and with dignity.

    I disagree with the process of hastening the process of death, because it raises the topic of a criminal act of murder. With or without consent from the patient, I believe that the process of death should not be prolonged or hasten. We may prolong the process of death unless there is an absolute possibility of ensuring that the patient will indeed have a more good years in our World.

    However, if the process of prolonging death results to a prolonged period of pain and suffering, we should allow nature to take its place by reducing their pain; not through death as an option, but to minimise their pain and suffering.

    Edmond Wong Posted on: Sep 26, 2014

  • I notice that humans when besotted by a problem or disease or illness would often seek an escape route rather than facing up to it. Euthanasia is just a form of escape from pain and suffering. Do we not agree that such is life? And have we not also suffered at a younger age, events and circumstances which shaped us to be who we are now?
    Truly Life is sacred and a gift. It is not created by our own selves or our parents. In fact we must agree that we don’t choose where and how we are born. Unfortunately, throughout life, when things are going well, we would often think that we are self-made in every sense of the word until an illness strikes, we realise we are not in control anymore. And grasping at whatever possible, we hope to control our own death by determining how and when we should die. Though it seems like control, it is in actual fact a surrender to fate and a finality that is totally out of our hands.
    The only time that one can TAKE is when one can GIVE. If I take your freedom or rights or money, I too must have the power to give you back what I have taken. Therefore if one chooses to take a life, he or she must be able to also give life back to whoever’s life he/she has taken. If a mistake has been made, make sure you can undo the mistake or rectify it.
    Can anyone then guarantee that in every act of Euthanasia there be no mistake made? No regrets? No repercussions on those left behind? If not, then I think we need not visit this question ever again.

    Simon Chong Posted on: Sep 26, 2014

  • Much research has been done in jurisdictions where euthanasia has been legal for decades. References to scholarly studies cannot be cited here for length constraints but are available on request. These studies provide insights into this important social experiment and reveal some consequences thereof.
    People seek euthanasia mainly because of depression, hopelessness, loss of independence, desire for control, fear of the future and low social support. Low spirituality (a diminished sense of life’s purpose and meaning; not religiosity) is a strong predictor of euthanasia-seeking behaviour. Physical symptoms are generally unimportant to those pursuing euthanasia. There is evidence that euthanasia engenders distrust of physicians.
    The utilitarian argument is troubling. Terminally ill people know that they cause financial, social and emotional strain to their families and society by draining resources. Thus, in the Oregon experience “relief of burden” has become a more common reason after euthanasia was legalised. Taken to its logical end, utilitarianism demands a “duty to die” of all unproductive and resource-consuming people.
    The autonomy argument overlooks the truism that autonomy cannot be absolute and inviolable. Unfettered autonomy has clearly negative consequences for society. Is the decision to live or die a consumerist choice? This debate must engage all levels of community to hear more than the views of the intelligentsia. Euthanasia of neonates is now legal in the Benelux region, and euthanasia for organ donation has been advocated. We need to go beyond emotive anecdotes to envisage how giving all physicians the potential to kill their patients will likely corrode and corrupt society – and whether this is what we really want.

    Kon Oi Lian Posted on: Sep 26, 2014

  • Disagree. I remember the Parliamentary consultations and debate when the Advance Medical Directive Bill was introduced around 1995. There is a difficult grey area between prolonging life and prolonging death which AMD seeks to address sensitively. Euthanasia as assisted suicide takes it too far.

    George Yeo Posted on: Sep 26, 2014

  • When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

    gp Posted on: Sep 25, 2014

  • The right to die imposes an obligation on the society (one’s family, relatives, friends and doctors etc). One’s right to die becomes a doctor’s obligation to kill.

    Should we grant the medical profession the license to kill? The ethical foundation of Western medicine (Hippocratic Oath) is the idea that the doctor should seek to preserve and enhance life, and cause no harm. Such a bill perverts that role and places responsibility on the shoulders of a profession that are asked to implement it.

    A “right” is a moral claim. Do we have such a claim on death? It is not up to us to decide when our life will end or when it will began.

    So where do we draw the line? The advance medical directive in S’pore is instructive. It states that one can inform his/her doctor that he/she does not want to use any life-sustaining treatment to prolong one’s life. This appears to be an ideal state situation now.

    I don’t think a society should have a situation where an individual or a group of people think they have the right to put someone else to death.

    Suppose we go down this slippery slope. Will a change in legislation mean that a right to die becomes a “duty to die”?

    Perhaps our compassion is too focused on a few cases and does not consider the most vulnerable people in society. Such a legislation would apply enormous pressure on the elderly, the sick and the disabled to “do the right thing” and not be a burden on others.

    Martino Tan Posted on: Sep 24, 2014

  • It is indisputable that everyone has the right to die with dignity. However, we must be careful not to equate this with dying painlessly or without suffering. Dignity is the state or quality of being worthy of honour or respect. There are countless stories of cancer patients & people who have put up a brave fight against their illness. And when they pass on, can we say they did not die with dignity? Prof Koh also mistakenly assumed that all who are against assisted dying are religious. I believe the non-religious would agree that life is precious and therefore, every effort must be made to save it. Prof Koh also argued that because resources are scarce, society should not waste efforts on treating some persons. Not every terminally ill wants to die. Many treasured whatever “extra time” they have with their families through life extension treatment. There are some things in life that we cannot and should never adopt a utilitarian approach towards it. Especially not in a society where we want to encourage Compassion. Lives are not disposables. We are not commodities, ready to be traded or crushed when there’s no use.

    Oneida Posted on: Sep 23, 2014

  • It is very hard to come to a solid conclusion on weather someone has to right to decide when they would like to die. I cannot and will not judge someone who feels the need to end pain through death becasue I have not sufferd that pain and do not know someone who has. However making this a law is not as easy as quoting a few examples of people in these situations and then making a law based on that. How will you draw the line? Who decides when it is ok? The day you come up with a full proof plan on how you can execute this law without any loopholes is the day you can decide if you really want to implement such a law. We are often asked not to make any important decisions when we are stressed or when we are not in a good frame of mind. How is this any different? How can we ever be sure that we have (with a clear mind) actually exhausted every other option and so we are allowed to decide that we should die?Anyone who is told they are terminally ill would be shattered and broken. But we human beings have it in us to fight. If we already know we can take the easy way and choose to end it how will we even know what we are capable of? There could be a cure just around the corner. But we will never know if we do not give it a chance. And finally let us look to places that have already made this a law and learn from them. Read the article posted by Denise. Many chooseing this path are the aged, the lonely and the bereaved. Is that why we want? How are we sure we can prevent that here?

    Jessica Posted on: Sep 22, 2014

  • Rather than focus on the ‘right’ to die, our nation should be focusing on the right to live. The right to die debate presents a false dilemma. It assumes that there is little resource left available for our terminally ill patients, and goes on to present them the choice between delaying death and accelerated death. However, the truth of the matter is that resources are available, and that their dispensation is controlled by the authorities. A nation that focuses more on economy and less on people will be left with ‘no choice’ but to choose between delaying and accelerating death. A nation that focuses on people, will instead be active in seeking out ways and means to give the patient the best welfare, and this could include firstly, giving family members and close friends paid leave from work and excusing the children from schools. Scientific research has shown that the presence of loved ones help in recovery. Secondly,making treatment more affordble. Thirdly, improving social and family policies and education, which means more investments should be made into this sector rather than trade, defense, transport, communications, etc. After all, Singapore exists for its people, not the other way around. Parents should be taught how to be role models for their children, and incentives at work should not motivate them to strive to the extent of neglecting their family. Similarly, children should not be challenged to strive in CCAs or for academic results but to spend more time with their family. Morals and values should be taught in society, to tackle the growing culture of individualism, narcissism and consumerism. This last approach will go a long way in the long term, because it will build healthy families, secure in love, with individuals confident of their identity, and eager to contribute to society.

    Jerick Tan Posted on: Sep 18, 2014

  • Can one leave one’s values and principles at the door of the public-square and marketplace, yet maintain one’s integrity and conscious? Would this individual be in any situation, be as the blowing of the wind?

    Can we indicate to be for diversity and inclusiveness, when an individual requires atypical number of supports for daily living activities, to face these challenges, be allowed to request for one’s life to be terminated? Pause, consider, it be a disproportionate number of the vulnerable young and elderly with daily living challenges to confronted with this issue.
    As the situation is, a positive for Downs Syndrome, is likely for the doctor to advice the couple to terminate the life. Would the elderly faced with multi-factorial issues in family and societal domains, throw in the towel too?

    It be the vulnerable who shall be at risk most. Pause, consider, the intangible cost upon society, if such a pathway be established and normalized.

    Koh Gay Posted on: Sep 18, 2014

  • Article 6(1) of the International Covenant on Civil and Political Rights provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

    This article makes two important points. Firstly, the right to life is inherent. This means that there is no “right to die”. Neither does the value of life or its protection depend on its quality. Secondly, this right shall be protected by law. Regardless of one’s personal views in favour or against euthanasia and assisted dying, States are required to protect life as an inherent right.

    The relaxation of laws protecting life does not only affect some, but also fundamentally alters the value of all human life, especially that of the vulnerable or those perceived as having a lower “quality of life”.

    There is also a real prospect of abuse. For example, a 2010 study reported that 32 per cent of the assisted deaths in the region of Flanders in Belgium between June and November 2007 were done without explicit request.

    Hence, I agree with Bishop Emeritus Robert Solomon that 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.

    In doing so, we respect the inherent value of all human life, and indeed the value of living with dignity.

    Darius Lee Posted on: Sep 18, 2014

  • Introducing assisted suicide in any society will inevitably lead to its moral decline. The Dutch euthanasia experience started with very strict criteria. Patients had to prove intolerable suffering and consistent desire and more than one doctor had to be consulted. 5 years later, large surveys showed that doctors were involved in causing 5,000 patient deaths without their consent. These doctors started out with altruistic intentions, but ended up killing their patients! Once assisted suicide is allowed, it introduces a logic to society that some lives are simply not worth living. Once such logic is in place, then Prof Tommy Koh’s utilitarian logic will take precedence due to limited healthcare resources, and no safeguards are left to prevent the subsequent killing of disabled children or frail elderly whose lives are deemed “not worth living”. Imagine a society where the most vulnerable are not only not protected, but are removed and discriminated against by law!

    Furthermore, contrary to what Prof Tommy Koh suggests, death with dignity does not necessarily entail dying without suffering at the time of one’s choosing. Rather, the true meaning of Compassion is “to suffer with” and not to eliminate suffering at all costs. Today, palliative care is a viable option which provides significant pain relief and comfort at the end of life. It promulgates a harmonious departure from one’s life at peace with one’s loved ones in a way which suicide can never achieve.

    colin ong Posted on: Sep 16, 2014

  • Hindsight is always perfect vision. Take it from the forerunners, they have already changed their minds about euthanasia.

    http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

    “Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.”

    Denise Posted on: Sep 15, 2014

comments

  • 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

  • The bishop’s response is fraught with logical fallacies.

    The debate at hand is about regulating suicide through a right-to-die bill, which implies setting up a framework to ensuring that proper conditions are put in place before a person may choose to end his life. The bishop has instead set up a straw man argument by empathetically stating that one cannot possibly have absolute autonomy to choose premature death. There is critical difference between freedom that is qualified and freedom that is absolute – the bishop’s failure to draw the distinction is an unnecessary detraction from the main issue at hand, because the motion does not ask the debaters to consider granting Singaporeans absolute freedom to end their lives.

    The next assertion that the bishop made is that a patient cannot make a free and voluntary decision to end his own life because (a) information regarding diagnosis and prognosis may not be perfect; and (b) there may be ‘potential pressure from family and caregivers and society at large’ that impinge on the patient’s decision to be euthanised.

    The bishop’s definition of making ‘free and voluntary’ decision is flawed. Almost all decisions we make in life are based on whatever information we have at hand, which may not be perfect; they will also undoubtedly be affected by opinion and pressure of the people around us. If we are unable to make ‘free and voluntary decisions’ because of the abovementioned considerations, which are inherent in life, then we would soon arrive at a conclusion that most of the decisions we make are made involuntarily. By extension, according to the bishop, our consent to marriage, contract, would all be invalid – surely that is impracticable.

    The bishop also made some ill-substantiated claims:

    For example, where he had said that euthanasia and assisted suicide are not as humane as they may seem, the only support he could conjure was that a Pope had said so – this could hardly seem convincing in light of medical advances today.

    The bishop also sought to conjure up a boogeyman by claiming that legalizing euthanasia and assisted suicide for the terminally ill may lead to an opening of floodgates for something no less than an absolute freedom to take one’s life. Insomuch as checks are in place to ensure that legislation is a reflection of societal views and goals, whether a bill legalizing a right-to-die will lead to an opening of floodgates would depend on how the bill is being drafted, and whether it is compatible with the views and goals of society in time to come – anything more than that would be pure speculation.

    Bin Hong Posted on: Sep 27, 2014

  • I can sincerely understand the pain suffered by both patients and their families, when there is no hope or only meaningless effort.
    We can give kind advice and best wishes to others, but we should not speak for them.
    We should respect those desperate patients’ will which way they want to go, without harming others and the society.
    However, the decision should not only be solely made by the patient himself/herself, but based on a consensus from his/her family as a whole.

    SUN Xi Posted on: Sep 26, 2014

  • Human rights should extend to the right of each person to decide when he or she should decide to die should it be physically unbearable for to continue living. I won’t bother quoting examples as I have too many to choose from, but I have seen the pain, the prolonging of life brings to both the patient, caregiver and family. I have heard such patients express their wish to discontinue their treatment and even to appeal to the Gods to take them away but modern medicine continued to keep them alive till they lost all dignity and self respect. Everyone should have the right to decide whether or not modern medicine should prolong their lives if it means that quality of life is degraded to the point where they lose both dignity and self respect.

    HH Tong Posted on: Sep 26, 2014

  • I think that a key feature of democratic societies is that we value rights, choice and freedom, and that as a society we should aim to facilitate pursuit of these freedoms insofar as they do not impinge on the choices, rights or freedoms of others, a view enunciated originally by J.S. Mill. Before proceeding with my explanation, the version of this law that I am in support of would need a few caveats and conditions to prevent abuse. I would only support a bill that ensures the following conditions are met:

    (A) Absence of duress;
    (B) Mental capacity;
    (C) Express consent;
    (D) Exhaustion of all reasonable options in seeking a cure, within means.

    Having said that, I see no further reason for us to deprive anyone of the right to die. To assume that the right to live is mutually exclusive to the right to die is a fallacy. In fact, I would say the opposite; the right to live necessitates the right to die because they share the same underlying principle i.e. self determination. I would personally not sign up for the AMD, but that does not mean I should prevent someone else from doing it. Choice is the key operator here, not whether it takes up resources, or whether you, me, or someone else thinks its ‘dignified’. If a suffering person wanted to live as long as possible, then lets do our best to make sure it happens. But lets also remember to do the same if they think death is preferable, and not deprive them of their rights just before they leave us.

    Ali Ahmad Yaakub Posted on: Sep 24, 2014

  • The inconvenient truth is that Singaporeans have been killing themselves because the pain of their illness can be unbearable. Hence, it is preferable to let those who want to die to do so with dignity through professionally-assisted suicide. And to help us come to terms with euthanasia, we need to understand it within the context of medicine. If we remove our rose-tinted lenses, we see medicine for what it is: A practice that has killed countless number of people via iatrogenics – where the healer causes more harm than good. This is where the infirm go to the doctor for a cure, only to wind up dead. But mercy killing has shown that we have actually made medical progress: We have developed the means to assist people in dying as painlessly as possible, rather than killing them on the pretext of curing them. If this isn’t a step forward for the practice of medicine, then I don’t know what is. Plus, allowing people to die has to be seen in the context of humanity’s evolution through the past millions of years. For the longest time, humans have lived short brutish lives. Our Savannah-dwelling ancestors barely made it past 30 years old. Now we live till 75. Even our closest ape cousins do not experience such artificially extended lifespans. Ipso facto, what medicine and technological advances giveth, what medicine and technological advances taketh away. Living to 75 is already considered living on borrowed time. What’s the benefit of a few extra weeks or months?

    Belmont Lay Posted on: Sep 23, 2014

  • “Life is sacred”. “Right to live”. These are noble ideals.

    Tell these ideals to the man lying in the hospital bed, suffering from pain and grief. Tubes all over his body. Defecating on himself uncontrollably. That he knows his end is near, and there is no more to look forward to.

    The only difference between the man who jumped down, and the man in the hospital is that the latter is imprisoned and thus able to do what he wishes to do.

    Rick Posted on: Sep 18, 2014

  • Just this morning, I read the sad news of a son who could not bear the suffering of his father who was terminally ill; he helped his father to jump down from his high floor HDB flat and he followed suit. Two deaths ! While we are still debating, people have already made their choice with or without the bill.
    Would this tragedy be prevented if we had the a “Right-TO-Die” bill ? probably. One life could have been saved. From what I read , it was the father who urgred his son to kill him, and probably the son suffered from guilt and depression when he conceded. No body will ever know the real reasons now.
    Life is never measured by its length but its quality. Only people who suffer long enough really understand what pain means. All men are made differently, while some might be able to endure and believe that suffering makes them strong and profound, many of us earth mortals would find such pain unbearable. I fully agreed with the article “The day I wanted my father to die”, I went through the same experience. Prolonged life has no meaning at all, it is no longer a life, merely a “living”.
    Eventually life is transient, I agree that all lives shall have their purpose in this world, but when the purpose is fulfilled, there is no point to linger further. We shall have the given freedom to decide for our living.
    Having said the above, I believe this is not an issue to be debated just in the cognitive realm, the poll will give us the conclusion.

    Ong Eng Kian Posted on: Sep 17, 2014

  • Bishop Emeritus Robert Solomon states that, “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 caregivers or incur significant medical costs.” However, in his last paragraph, he mentioned that Advanced Medical Directive can be made rationally and carefully by the person. Which can Mr Robert make it clear to me, if a terminally-ill person has the ability to make a rational and clear decision to sign AMD, without the pressure imposed by others or themselves to seek their own death?

    I read up on the guidelines for making an AMD,under “Terminal illness”, which I quote, “It is actually best to make an AMD when there is no pressure to do so – when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.”. This means that a terminally ill person can make make an AMD when they are terminally ill, even if there’s a possibility of pressure from others and themselves.

    Source: http://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/making_an_amd.html

    Alyssa Goh Posted on: Sep 16, 2014

  • With respect, I think the issue could be more precisely formulated to focus on the substance of the contention (whether Singapore should have a right-to-die bill), rather than focus on whether the present time is appropriate for such a debate, on which the answer would likely be yes, for the reason that such a moral issue is a timeless one, given its relevance and impact on people who suffer pain from physiological infirmities. For that reason, my view on the issue, as it is presently worded, must be ‘yes’.

    However, if the issue was focussed on whether a right-to-die bill is justifiable for Singapore, my answer is no, until we have considered the repercussions, and are satisfied that we are willing to bear them. On this, there are many implications, some of which presently unforeseeable. Assisted suicide has reversible effects on the person who elects to undergo the same.

    Philosophically and ethically, this is problematic because, even assuming that the person’s autonomy should be given the highest priority, it is uncertain whether such autonomy is freely exercised. Pressures, self-induced and external, bear on a patient in such situations as terminal illness, etc. Could assisted suicide result in e.g. middle-income patients who suffer significant but non-critical illnesses opting death over life, notwithstanding the prospect of cure, because of cost concerns or suasion (conscious or unwitting) from doctors managing resource constraints?

    Ronald Wong Posted on: Sep 14, 2014

  • Man may like to think that he can be master of his own destiny. The truth is that he is not in control. Man does not decide when he is born. Nor does he determine the length of his life. He can be well in one moment and gone the next when calamity unexpectedly strikes. What man does have is his unique capacity to make choices, notwithstanding he is no master of his own life. At the crux of this debate is the wisdom of the choice that man and, by extension, society chooses. Experience shows there is a sad human tendency to make poor, ill-advised choices. These choices have led to a state of decline in societies today. On the surface, we see ourselves as progressing, celebrating freedoms in various spheres of life. But the reality is that we as a human race are increasingly abandoning what is good for the licence to do as we see fit. It is a great platonic shift in values that we used to hold dear! The question we need to ask ourselves on this issue (and others) is this: Do our choices make us better people? Does it contribute to society’s moral well-being? Or will it lead to further decline? I share Bishop Solomon’s points and concerns.

    Gerald Ng Posted on: Oct 09, 2014

  • I disagree with the passing of the euthanasia law. Even if one might argue that Singapore is not a religious society (that argument by itself is flawed as 83% of our society profess to be attached to a faith community as Bishop), Singapore is still a moral society which is governed by law.
    As such, the law has stated that suicide is illegal, murder is illegal – having the right to die I feel must in the same light – also be illegal.
    Life is sacred. As Hipprocrates has put it – a doctor’s goal is to cure sometimes, to relief often, to comfort always. While we cannot make light of the suffering of terminally ill patients, as a society, we can stand together with them in their suffering: to comfort them. The practice of palliative medicine exists for this reason- so as to help the dying pass on in dignity and in comfort. The Singapore government has also recognized this – and the ministry is putting in more effort and money in growing the palliative care community.
    Should the law for euthanasia and assisted suicide be passed- we will find ourselves on that slippery slope, and soon you will see that vulnerable people (handicapped/mentally impaired children for example) would be at risk of being euthanised : so as to prevent further ”suffering” – as per what is happening in the Netherlands. This is happening in the Netherlands- even though safeguards are supposedly present to prevent abuse of the system.
    Should Singapore still believe in herself as a moral society – it should not pass this euthanasia bill.

    Shirlyn Posted on: Oct 08, 2014

  • With the right to die bill, patients and their family may be pressured to make the ‘right’ decision be it for self or their loved ones. No one can give a definite timeline on when a patient will die, miracles do happen. The Advance Medical Directive bill is already in place to ensure that patients (who opt in) will not need to prolong their suffering via futile medicines / technology. I advocate for palliative medicine which can help patients relieve their pains, spend their precious last moments with their loved ones and die with dignity when the time comes.

    Bernice Posted on: Oct 08, 2014

  • reading the comments from both sides i realise that they fall into generally 2 categories. Those that Agree talk about Self. Those that Disagree talk about Community (others). So what kind of society do we want? For Self, or for Others? I choose to give, not to take.

    Sheldon Posted on: Oct 08, 2014

  • I hope that this shall never come to pass … It promotes the “self” over family, friends and society at large. We belong to not only ourselves but our dear family and friends. As much as we give love, we also receive love. It would be morally selfish to deny others the right to care and love us, even when we are stricken with terminal illness. When we suffer, they lovingly suffer with us to the end. We need love in society to persist over personal desires !

    Goh Chu Teng Posted on: Oct 03, 2014

  • According to Professor Tommy Koh, “in the public sphere, our policies should be governed by secular and not religious principles.” And he goes on to argue his case based on two points ; moral and utilitarian.

    While Singapore is a secular state, we cannot run away from the fact, as Bishop Solomon pointed out in his reply to Prof. Koh’s response to his opening statement, that “Singapore being a multi-religious society with 83% of the population being connected to faith communities, their views based on their fundamental beliefs cannot be ignored.”

    Furthermore, in Chief Justice Menon’s speech at the Singapore Medical Association Annual Lecture, on “Euthanasia: A matter of life or death?” on March 9, 2013, http://www.straitstimes.com/breaking-news/singapore/story/euthanasia-matter-life-or-death-20130324#sthash, quoting the American experience amongst others, he said that “The important lesson which one draws from the American experience is that, at the level of abstraction, human rights may be universal. …At the level of application, however, the messy detail of concrete problems, the human rights which these abstractions have generated are national. Their application requires trade-offs and compromises, exercises of judgment which can be made only in the context of a given society and its legal system.”

    Taking together the above two points, I beg to differ with Prof. Koh’s contextual reference because national consensus on the issue reflecting our collective beliefs of our multi-faith society is crucial not only for its acceptance and implementation, but more importantly, the collective voice of Singaporeans on such important decisions concerning their lives, should be heard. Otherwise, we might unwittingly be risking ourselves to the tyranny of the vocal minority deciding for the silent majority in a contextual vacuum. As the good professor says that religious beliefs must be kept private in the public space, like wise private right-to-die beliefs should not impinge on our societal values.

    Not withstanding this, I would also have to disagree with his moral and utilitarian arguments to justify a right-to-die bill.

    On his moral argument, he basically says that a person who is terminally ill with six months left to live or suffering from an incurable illness which gives him constant and intolerable pain should be empowered with the legal right to end his life at the time of his own choosing and the doctor(s) assisting him to die should not be criminalize(s) for his(their) action(s) in doing so. This he argues is to allow the patient to die with dignity.

    While it is laudable to want to relieve a person from unbearable pain, to give him the right to end his own life is an entirely different matter and I hope it shall never be legalized to ending one’s suffering, whether mental or physical. It has been the collective and the time honored wisdom of many societies to promulgate laws against the taking of one’s life because of the value placed on the sanctity of life to the extent that the larger societal family has the right to prevent you from ending your own life.

    But should there be an exception for a person who is suffering intolerable pain whether mental or physical to be given the right to end his own life with the assistance of doctors so that he can die with dignity ?

    Before I state my views, let us first come to some common understanding of the meaning of the word dignity. According to Wikipedia, traditionally, moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment. However, In the modern context dignity can function as an extension of the Enlightenment-era concepts of inherent, inalienable rights.

    So, I suppose it would not be presumptuous for me to say that the proposed notion can be rephrased to say that to die with dignity, a Singaporean should have the inherent and inalienable right to end his or her life when he is suffering intolerable pain from an incurable illness or that he/she has less than six months to live because of a terminal illness. This basically says that the person involved has complete control over his destiny and nobody else, only conditions to effect his rights have to be met.

    As much as a person who claims that it is his right to choose premature death because of his intolerable suffering, I would argue as strongly that his suffering should not have any bearing on his right to die and even go to the extent to suggest that his suffering should instead be the very reason why he should live on, in the wider context of societal values and norms.

    Regardless of our private opinions or inclinations, once we claim to be part of the Singaporean society, we cease to be a person unto ourselves and will have to be inextricably linked to our societal values and norms whether we like it or not.
    The option of taking away a person’s life because he/she is suffering from intolerable pain, be it mental or physical is anathema to our collective psyche, as seen from the laws against suicide. Another situation which can amply demonstrate our societal values on the dignity (defined in the traditional way) of human life is the treatment of likely war casualties. God forbid that we be caught up in a war ! But a more realistic scenario would perhaps be that of one of our young man being fatally wounded in a peace keeping mission. It is a foregone conclusion that no efforts will be spared to save him and failing to do so, the doctors will do all they can to reduce his pain and suffering as much as they medically can, but taking away his life is definitely not an option. The sanctity of human life and to die with dignity in the traditional sense is aptly illustrated here. Do we want to change this value system to one that ends this soldier’s life at the operating table because he claims it is his right to end his life in this irrecoverable and painful situation ?

    Otherwise, where is the heroism, where is the dignity of dying, how can such human values of perseverance, pride, courage and sacrifice which we treasure so much be preserved ! Imagine if the right-to-die bill was in existence when our navy serviceman Mr. Jason Chee was badly injured in the accident that cost him three of his limbs and three fingers of his right arm. In his mental anguish and unbearable physical pain he might have opted for the soft option to end his life ! But thanks to his indomitable spirit, the exemplary care, support and encouragement given by his medical team and his organization, and most importantly the value placed on him as a human being and not just another digit by his organization, he has overcome all odds and has developed a healthy and robust attitude towards life inspite of all that has happened to him.

    With significant improvements in palliative medicine and good hospice care, the intolerable pain element in the right-to-die equation thus becomes invalid. Terminally ill patients under hospice care in Singapore on average die within 3 months of being admitted, where they receive compassionate and palliative care. From my personal experiences with dying relatives, intolerable pain comes only towards the last few days of the very end. But by then, most of them are already in a semi-conscious or comatose state. When the ultimate finality comes, they die with dignity and human decency, surrounded by loved ones.

    The very societal values we hold dear like resilience, courage, character even in the terminally ill, tampered by the utmost humanistic and compassionate care for them, together provide too compelling a reason why the terminal ill and those suffering intolerable pain should live on and eventually die naturally with dignity.

    In contrast, it would be ironic if the right-to-die bill is legalized, as it allows for a selfish, parochial, and cowardly way to commit suicide but passing the responsibility and accountability to someone else to legally pull the trigger, thus dying devoid of dignity.

    Beyond the conceptual level, there are also issues that many people have already brought up about the abuses and the negative experiences of such a right-to-die law in countries practicing it, and should be predicated only on the strength or otherwise of the conceptual arguments.

    On the utilitarian argument, there is not even the need to debate it as our Eastern culture on filial piety which is being encouraged in our society, runs counter to its very core. As it is, seniors in our society beyond a certain age, already feel marginalized when trying to find employment. It would be a sad day and the whole nation should go into mourning should the day come when the law is passed on account of the utilitarian argument ! For what it amounts to is the extension to the national level of children telling their parents that it is pointless and too costly to keeping them alive, even if they can afford to continue to do so. At best, the utilitarian argument might convince a person to perform his last economic service for the nation in taking his or her own life prematurely, devoid of all human decency and compassion, and dignity and at worst, it debases the very soul of our nation.

    Therefore, my answer as to whether it is time for Singapore to consider a right-to-die bill, is not only a big no, but that I don’t even see the need to initiate further discussions on it.

    Cyril Chiam

    Cyril Chiam Posted on: Oct 02, 2014

  • Having read all the comments thus far, I am still positively sure that I will disagree with the endorsement to exercise the right-to-die bill for “healthy” individuals. I understand that there are grey areas in which we define the process of prolonging life or death; as pointed out by George Yeo. However, I would like to add to his points for us to further deliberate on the subject topic of prolonging death.

    In the likeliest possibility, we may all die one day. The duration in which we remain in this World is definitely finite. Thus, the topic of prolonging life ought to be less emphasized. The main discussion should revolve around whether we should naturally or unnaturally prolong or hasten someone’s death.

    Should it be a choice that individuals make on their own? With a group of professionals like how Martino Tan mentioned? Or with family members? I would say that it should be none of the above. The choice ought to be natural; and unlike how Jerick Tan had mentioned in his post about how the right to die presents a false dilemma of little resource to assist terminally ill patients, I believe that natural death can be assisted too.

    For example, if someone is suffering from pain; physically or mentally, we may employ the use of medical equipment or consumables to reduce the pain that they are experiencing. While we reduce their pain and suffering, it is unlike assisting them to die faster, but a means for us to assist them through a natural transition. I wish to emphasise again, that I believe that such an option should only be applied to individuals who are suffering terribly. Thus, it should not be a subject of the lack of resources, but with adequate resources, we may still assist someone to die naturally and with dignity.

    I disagree with the process of hastening the process of death, because it raises the topic of a criminal act of murder. With or without consent from the patient, I believe that the process of death should not be prolonged or hasten. We may prolong the process of death unless there is an absolute possibility of ensuring that the patient will indeed have a more good years in our World.

    However, if the process of prolonging death results to a prolonged period of pain and suffering, we should allow nature to take its place by reducing their pain; not through death as an option, but to minimise their pain and suffering.

    Edmond Wong Posted on: Sep 26, 2014

  • I notice that humans when besotted by a problem or disease or illness would often seek an escape route rather than facing up to it. Euthanasia is just a form of escape from pain and suffering. Do we not agree that such is life? And have we not also suffered at a younger age, events and circumstances which shaped us to be who we are now?
    Truly Life is sacred and a gift. It is not created by our own selves or our parents. In fact we must agree that we don’t choose where and how we are born. Unfortunately, throughout life, when things are going well, we would often think that we are self-made in every sense of the word until an illness strikes, we realise we are not in control anymore. And grasping at whatever possible, we hope to control our own death by determining how and when we should die. Though it seems like control, it is in actual fact a surrender to fate and a finality that is totally out of our hands.
    The only time that one can TAKE is when one can GIVE. If I take your freedom or rights or money, I too must have the power to give you back what I have taken. Therefore if one chooses to take a life, he or she must be able to also give life back to whoever’s life he/she has taken. If a mistake has been made, make sure you can undo the mistake or rectify it.
    Can anyone then guarantee that in every act of Euthanasia there be no mistake made? No regrets? No repercussions on those left behind? If not, then I think we need not visit this question ever again.

    Simon Chong Posted on: Sep 26, 2014

  • Much research has been done in jurisdictions where euthanasia has been legal for decades. References to scholarly studies cannot be cited here for length constraints but are available on request. These studies provide insights into this important social experiment and reveal some consequences thereof.
    People seek euthanasia mainly because of depression, hopelessness, loss of independence, desire for control, fear of the future and low social support. Low spirituality (a diminished sense of life’s purpose and meaning; not religiosity) is a strong predictor of euthanasia-seeking behaviour. Physical symptoms are generally unimportant to those pursuing euthanasia. There is evidence that euthanasia engenders distrust of physicians.
    The utilitarian argument is troubling. Terminally ill people know that they cause financial, social and emotional strain to their families and society by draining resources. Thus, in the Oregon experience “relief of burden” has become a more common reason after euthanasia was legalised. Taken to its logical end, utilitarianism demands a “duty to die” of all unproductive and resource-consuming people.
    The autonomy argument overlooks the truism that autonomy cannot be absolute and inviolable. Unfettered autonomy has clearly negative consequences for society. Is the decision to live or die a consumerist choice? This debate must engage all levels of community to hear more than the views of the intelligentsia. Euthanasia of neonates is now legal in the Benelux region, and euthanasia for organ donation has been advocated. We need to go beyond emotive anecdotes to envisage how giving all physicians the potential to kill their patients will likely corrode and corrupt society – and whether this is what we really want.

    Kon Oi Lian Posted on: Sep 26, 2014

  • Disagree. I remember the Parliamentary consultations and debate when the Advance Medical Directive Bill was introduced around 1995. There is a difficult grey area between prolonging life and prolonging death which AMD seeks to address sensitively. Euthanasia as assisted suicide takes it too far.

    George Yeo Posted on: Sep 26, 2014

  • When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

    gp Posted on: Sep 25, 2014

  • The right to die imposes an obligation on the society (one’s family, relatives, friends and doctors etc). One’s right to die becomes a doctor’s obligation to kill.

    Should we grant the medical profession the license to kill? The ethical foundation of Western medicine (Hippocratic Oath) is the idea that the doctor should seek to preserve and enhance life, and cause no harm. Such a bill perverts that role and places responsibility on the shoulders of a profession that are asked to implement it.

    A “right” is a moral claim. Do we have such a claim on death? It is not up to us to decide when our life will end or when it will began.

    So where do we draw the line? The advance medical directive in S’pore is instructive. It states that one can inform his/her doctor that he/she does not want to use any life-sustaining treatment to prolong one’s life. This appears to be an ideal state situation now.

    I don’t think a society should have a situation where an individual or a group of people think they have the right to put someone else to death.

    Suppose we go down this slippery slope. Will a change in legislation mean that a right to die becomes a “duty to die”?

    Perhaps our compassion is too focused on a few cases and does not consider the most vulnerable people in society. Such a legislation would apply enormous pressure on the elderly, the sick and the disabled to “do the right thing” and not be a burden on others.

    Martino Tan Posted on: Sep 24, 2014

  • It is indisputable that everyone has the right to die with dignity. However, we must be careful not to equate this with dying painlessly or without suffering. Dignity is the state or quality of being worthy of honour or respect. There are countless stories of cancer patients & people who have put up a brave fight against their illness. And when they pass on, can we say they did not die with dignity? Prof Koh also mistakenly assumed that all who are against assisted dying are religious. I believe the non-religious would agree that life is precious and therefore, every effort must be made to save it. Prof Koh also argued that because resources are scarce, society should not waste efforts on treating some persons. Not every terminally ill wants to die. Many treasured whatever “extra time” they have with their families through life extension treatment. There are some things in life that we cannot and should never adopt a utilitarian approach towards it. Especially not in a society where we want to encourage Compassion. Lives are not disposables. We are not commodities, ready to be traded or crushed when there’s no use.

    Oneida Posted on: Sep 23, 2014

  • It is very hard to come to a solid conclusion on weather someone has to right to decide when they would like to die. I cannot and will not judge someone who feels the need to end pain through death becasue I have not sufferd that pain and do not know someone who has. However making this a law is not as easy as quoting a few examples of people in these situations and then making a law based on that. How will you draw the line? Who decides when it is ok? The day you come up with a full proof plan on how you can execute this law without any loopholes is the day you can decide if you really want to implement such a law. We are often asked not to make any important decisions when we are stressed or when we are not in a good frame of mind. How is this any different? How can we ever be sure that we have (with a clear mind) actually exhausted every other option and so we are allowed to decide that we should die?Anyone who is told they are terminally ill would be shattered and broken. But we human beings have it in us to fight. If we already know we can take the easy way and choose to end it how will we even know what we are capable of? There could be a cure just around the corner. But we will never know if we do not give it a chance. And finally let us look to places that have already made this a law and learn from them. Read the article posted by Denise. Many chooseing this path are the aged, the lonely and the bereaved. Is that why we want? How are we sure we can prevent that here?

    Jessica Posted on: Sep 22, 2014

  • Rather than focus on the ‘right’ to die, our nation should be focusing on the right to live. The right to die debate presents a false dilemma. It assumes that there is little resource left available for our terminally ill patients, and goes on to present them the choice between delaying death and accelerated death. However, the truth of the matter is that resources are available, and that their dispensation is controlled by the authorities. A nation that focuses more on economy and less on people will be left with ‘no choice’ but to choose between delaying and accelerating death. A nation that focuses on people, will instead be active in seeking out ways and means to give the patient the best welfare, and this could include firstly, giving family members and close friends paid leave from work and excusing the children from schools. Scientific research has shown that the presence of loved ones help in recovery. Secondly,making treatment more affordble. Thirdly, improving social and family policies and education, which means more investments should be made into this sector rather than trade, defense, transport, communications, etc. After all, Singapore exists for its people, not the other way around. Parents should be taught how to be role models for their children, and incentives at work should not motivate them to strive to the extent of neglecting their family. Similarly, children should not be challenged to strive in CCAs or for academic results but to spend more time with their family. Morals and values should be taught in society, to tackle the growing culture of individualism, narcissism and consumerism. This last approach will go a long way in the long term, because it will build healthy families, secure in love, with individuals confident of their identity, and eager to contribute to society.

    Jerick Tan Posted on: Sep 18, 2014

  • Can one leave one’s values and principles at the door of the public-square and marketplace, yet maintain one’s integrity and conscious? Would this individual be in any situation, be as the blowing of the wind?

    Can we indicate to be for diversity and inclusiveness, when an individual requires atypical number of supports for daily living activities, to face these challenges, be allowed to request for one’s life to be terminated? Pause, consider, it be a disproportionate number of the vulnerable young and elderly with daily living challenges to confronted with this issue.
    As the situation is, a positive for Downs Syndrome, is likely for the doctor to advice the couple to terminate the life. Would the elderly faced with multi-factorial issues in family and societal domains, throw in the towel too?

    It be the vulnerable who shall be at risk most. Pause, consider, the intangible cost upon society, if such a pathway be established and normalized.

    Koh Gay Posted on: Sep 18, 2014

  • Article 6(1) of the International Covenant on Civil and Political Rights provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

    This article makes two important points. Firstly, the right to life is inherent. This means that there is no “right to die”. Neither does the value of life or its protection depend on its quality. Secondly, this right shall be protected by law. Regardless of one’s personal views in favour or against euthanasia and assisted dying, States are required to protect life as an inherent right.

    The relaxation of laws protecting life does not only affect some, but also fundamentally alters the value of all human life, especially that of the vulnerable or those perceived as having a lower “quality of life”.

    There is also a real prospect of abuse. For example, a 2010 study reported that 32 per cent of the assisted deaths in the region of Flanders in Belgium between June and November 2007 were done without explicit request.

    Hence, I agree with Bishop Emeritus Robert Solomon that 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.

    In doing so, we respect the inherent value of all human life, and indeed the value of living with dignity.

    Darius Lee Posted on: Sep 18, 2014

  • Introducing assisted suicide in any society will inevitably lead to its moral decline. The Dutch euthanasia experience started with very strict criteria. Patients had to prove intolerable suffering and consistent desire and more than one doctor had to be consulted. 5 years later, large surveys showed that doctors were involved in causing 5,000 patient deaths without their consent. These doctors started out with altruistic intentions, but ended up killing their patients! Once assisted suicide is allowed, it introduces a logic to society that some lives are simply not worth living. Once such logic is in place, then Prof Tommy Koh’s utilitarian logic will take precedence due to limited healthcare resources, and no safeguards are left to prevent the subsequent killing of disabled children or frail elderly whose lives are deemed “not worth living”. Imagine a society where the most vulnerable are not only not protected, but are removed and discriminated against by law!

    Furthermore, contrary to what Prof Tommy Koh suggests, death with dignity does not necessarily entail dying without suffering at the time of one’s choosing. Rather, the true meaning of Compassion is “to suffer with” and not to eliminate suffering at all costs. Today, palliative care is a viable option which provides significant pain relief and comfort at the end of life. It promulgates a harmonious departure from one’s life at peace with one’s loved ones in a way which suicide can never achieve.

    colin ong Posted on: Sep 16, 2014

  • Hindsight is always perfect vision. Take it from the forerunners, they have already changed their minds about euthanasia.

    http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

    “Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.”

    Denise Posted on: Sep 15, 2014

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Professor Tommy Koh

Yes

I thank my friend Bishop Solomon, whom I respect and admire, for joining me in this debate.  The exchange of views between us has helped to frame the issues and has elucidated our competing points of view on those issues.

This debate takes on a special salience in Singapore because we are living into our 80s.  Sadly, many of our senior citizens are not in good health.  Statistics show that towards the end of their lives, many of them are very ill.  As I approach the end of my life, my aspiration is to remain healthy.  However, if I am unlucky and find myself struck down with an incurable disease which robs me of my quality of life or leaves me with constant and unbearable pain, my aspiration is to die with dignity.  I hope that our laws will be amended to make this possible.

Bishop Solomon has pointed out that our laws will have to be changed in order to legalise assisted suicide and euthanasia.  I agree.  Laws should be changed when they no longer reflect our values or have become obsolete.  To cite an example, I support the repeal of Section 377A of our Penal Code.

Bishop Solomon’s second argument is that doctors may be pressured, against their will, to perform assisted suicides.  I think this fear is unfounded.  At present in Singapore, abortions are permitted under certain circumstances.  No doctor in Singapore has ever been forced to perform an abortion against his or her will.  At present, an Advanced Medical Directive (AMD) is legal in Singapore.  If a doctor has any religious reservations against taking a patient off the ventilator or other life-sustaining machines, he or she will be excused from performing that task.  Has the introduction of the AMD altered the patient’s attitude towards his doctor?  Not at all.  Speaking as the son of a patient who had requested that she be taken off the ventilator, I am grateful to the doctor for having carried out my mother’s wish.

Finally, Bishop Solomon said that the experience in countries such as Belgium and the Netherlands has been problematic.  In a recent article in the New York Times (2 April 2012) entitled, “Push for the right to Die Grows in the Netherlands”, the writer, David Kelly, found that the Dutch system, which had many safeguards, had worked well and enjoyed the overwhelming support of the Dutch people.

In his recent article, “Keep Dying Issues Alive and Kicking”, in the Sunday Times (28 Sept 2014), Han Fook Kwang wrote:  “Ultimately though, it is up to the individual to make their own decision and to take control of the last phase of their lives.”  I agree.

Bishop Emeritus Robert Solomon

No

I consider Professor Tommy Koh as an irenic and much-respected intellectual and have often found myself agreeing with him on many issues. However, on this matter I have to disagree with him. I will address the points raised in his response and then conclude.

Prof Koh attributes the legal prohibition against suicide to religious views and sees it as a historical relic of British colonial rule. This argument, however, is weakened by the fact that most states, including atheistic and secular ones, prohibit suicide. In my opening statement, I referred to the ruling of the secular European Court of Human Rights – that the right to life does not lead logically and legally to the right to die. To dismiss a view as being religious is to preclude careful examination of that issue on philosophical and other grounds.

The good professor also argued that there is no evidence to show that euthanasia and assisted suicide affect doctor-patient relationships. The British Medical Association has asserted, based on professional experience, that “if doctors are authorised to kill or help kill…(t)heir relationship with all their patients is perceived as having changed and…some may come to fear the doctor’s visit”. Considering the significant numbers of patients being euthanised without their consent in Belgium and the use of utilitarian reasons to justify the practice, it is difficult to imagine that the patient’s trust in the doctor would not be eroded.

Thirdly, Prof Koh dismissed the “slippery slope” argument by asserting that there is no evidence for it. In my earlier response, I showed that the slippery slope is no mere conjecture but an actual emerging landscape in Belgium and the Netherlands. That the laws and rules have been abused is amply shown in many studies. In his SMA lecture in 2013 (mentioned in my earlier response), Chief Justice Sundaresh Menon noted: “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…”
It is time to sum up.

There are serious problems connected with legalising euthanasia and assisted suicide. Supporters use personal autonomy as an argument. But as I have argued: in reality personal autonomy is limited by philosophical and social constraints. The existing legal framework in most countries does not allow the right to die. To legalise euthanasia and assisted suicide necessitates amending laws related to suicide and murder; in fact it may require a more significant and precarious dismantling of legal frameworks.

Physicians will be under pressure to attend to patients who want assisted suicide. Though their involvement 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.”

I have also shown from the experience in Belgium and the Netherlands that legalising euthanasia and assisted suicide will inevitably result in various abuses as well as a widening of application to include those who are vulnerable or considered “useless” in society. There is great danger of abuse and the loss of human dignity and value. We have to decide what kind of society we want – one that cares for all its members including those who are dying or vulnerable, or one that readily disposes of them.

There may be people who do not fear death per se but fear that they will do so in pain and misery. To help them, society can pursue two paths. Firstly, we need to publicise the Advance Medical Directive (AMD) and get greater participation so that people can be assured that their lives will not be unnecessarily prolonged by modern heroic but futile medicine. Secondly, palliative medicine must become mainstream so that it is part of the normal course of health care. As a medical science and art, palliative medicine 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.

These are far better solutions than resorting to euthanasia and assisted suicide. A study in the Netherlands showed that in 10% of euthanasia and 30% of assisted suicide instances, untoward complications arose. Worse, these solutions, besides creating serious ethical and philosophical problems, would affect private and public conscience and alter our society. Utilitarianism will dominate and social responsibilities will diminish.

No, it is not time, now or in the future, for Singapore to consider a right to die bill.

comments

  • 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

  • The bishop’s response is fraught with logical fallacies.

    The debate at hand is about regulating suicide through a right-to-die bill, which implies setting up a framework to ensuring that proper conditions are put in place before a person may choose to end his life. The bishop has instead set up a straw man argument by empathetically stating that one cannot possibly have absolute autonomy to choose premature death. There is critical difference between freedom that is qualified and freedom that is absolute – the bishop’s failure to draw the distinction is an unnecessary detraction from the main issue at hand, because the motion does not ask the debaters to consider granting Singaporeans absolute freedom to end their lives.

    The next assertion that the bishop made is that a patient cannot make a free and voluntary decision to end his own life because (a) information regarding diagnosis and prognosis may not be perfect; and (b) there may be ‘potential pressure from family and caregivers and society at large’ that impinge on the patient’s decision to be euthanised.

    The bishop’s definition of making ‘free and voluntary’ decision is flawed. Almost all decisions we make in life are based on whatever information we have at hand, which may not be perfect; they will also undoubtedly be affected by opinion and pressure of the people around us. If we are unable to make ‘free and voluntary decisions’ because of the abovementioned considerations, which are inherent in life, then we would soon arrive at a conclusion that most of the decisions we make are made involuntarily. By extension, according to the bishop, our consent to marriage, contract, would all be invalid – surely that is impracticable.

    The bishop also made some ill-substantiated claims:

    For example, where he had said that euthanasia and assisted suicide are not as humane as they may seem, the only support he could conjure was that a Pope had said so – this could hardly seem convincing in light of medical advances today.

    The bishop also sought to conjure up a boogeyman by claiming that legalizing euthanasia and assisted suicide for the terminally ill may lead to an opening of floodgates for something no less than an absolute freedom to take one’s life. Insomuch as checks are in place to ensure that legislation is a reflection of societal views and goals, whether a bill legalizing a right-to-die will lead to an opening of floodgates would depend on how the bill is being drafted, and whether it is compatible with the views and goals of society in time to come – anything more than that would be pure speculation.

    Bin Hong Posted on: Sep 27, 2014

  • I can sincerely understand the pain suffered by both patients and their families, when there is no hope or only meaningless effort.
    We can give kind advice and best wishes to others, but we should not speak for them.
    We should respect those desperate patients’ will which way they want to go, without harming others and the society.
    However, the decision should not only be solely made by the patient himself/herself, but based on a consensus from his/her family as a whole.

    SUN Xi Posted on: Sep 26, 2014

  • Human rights should extend to the right of each person to decide when he or she should decide to die should it be physically unbearable for to continue living. I won’t bother quoting examples as I have too many to choose from, but I have seen the pain, the prolonging of life brings to both the patient, caregiver and family. I have heard such patients express their wish to discontinue their treatment and even to appeal to the Gods to take them away but modern medicine continued to keep them alive till they lost all dignity and self respect. Everyone should have the right to decide whether or not modern medicine should prolong their lives if it means that quality of life is degraded to the point where they lose both dignity and self respect.

    HH Tong Posted on: Sep 26, 2014

  • I think that a key feature of democratic societies is that we value rights, choice and freedom, and that as a society we should aim to facilitate pursuit of these freedoms insofar as they do not impinge on the choices, rights or freedoms of others, a view enunciated originally by J.S. Mill. Before proceeding with my explanation, the version of this law that I am in support of would need a few caveats and conditions to prevent abuse. I would only support a bill that ensures the following conditions are met:

    (A) Absence of duress;
    (B) Mental capacity;
    (C) Express consent;
    (D) Exhaustion of all reasonable options in seeking a cure, within means.

    Having said that, I see no further reason for us to deprive anyone of the right to die. To assume that the right to live is mutually exclusive to the right to die is a fallacy. In fact, I would say the opposite; the right to live necessitates the right to die because they share the same underlying principle i.e. self determination. I would personally not sign up for the AMD, but that does not mean I should prevent someone else from doing it. Choice is the key operator here, not whether it takes up resources, or whether you, me, or someone else thinks its ‘dignified’. If a suffering person wanted to live as long as possible, then lets do our best to make sure it happens. But lets also remember to do the same if they think death is preferable, and not deprive them of their rights just before they leave us.

    Ali Ahmad Yaakub Posted on: Sep 24, 2014

  • The inconvenient truth is that Singaporeans have been killing themselves because the pain of their illness can be unbearable. Hence, it is preferable to let those who want to die to do so with dignity through professionally-assisted suicide. And to help us come to terms with euthanasia, we need to understand it within the context of medicine. If we remove our rose-tinted lenses, we see medicine for what it is: A practice that has killed countless number of people via iatrogenics – where the healer causes more harm than good. This is where the infirm go to the doctor for a cure, only to wind up dead. But mercy killing has shown that we have actually made medical progress: We have developed the means to assist people in dying as painlessly as possible, rather than killing them on the pretext of curing them. If this isn’t a step forward for the practice of medicine, then I don’t know what is. Plus, allowing people to die has to be seen in the context of humanity’s evolution through the past millions of years. For the longest time, humans have lived short brutish lives. Our Savannah-dwelling ancestors barely made it past 30 years old. Now we live till 75. Even our closest ape cousins do not experience such artificially extended lifespans. Ipso facto, what medicine and technological advances giveth, what medicine and technological advances taketh away. Living to 75 is already considered living on borrowed time. What’s the benefit of a few extra weeks or months?

    Belmont Lay Posted on: Sep 23, 2014

  • “Life is sacred”. “Right to live”. These are noble ideals.

    Tell these ideals to the man lying in the hospital bed, suffering from pain and grief. Tubes all over his body. Defecating on himself uncontrollably. That he knows his end is near, and there is no more to look forward to.

    The only difference between the man who jumped down, and the man in the hospital is that the latter is imprisoned and thus able to do what he wishes to do.

    Rick Posted on: Sep 18, 2014

  • Just this morning, I read the sad news of a son who could not bear the suffering of his father who was terminally ill; he helped his father to jump down from his high floor HDB flat and he followed suit. Two deaths ! While we are still debating, people have already made their choice with or without the bill.
    Would this tragedy be prevented if we had the a “Right-TO-Die” bill ? probably. One life could have been saved. From what I read , it was the father who urgred his son to kill him, and probably the son suffered from guilt and depression when he conceded. No body will ever know the real reasons now.
    Life is never measured by its length but its quality. Only people who suffer long enough really understand what pain means. All men are made differently, while some might be able to endure and believe that suffering makes them strong and profound, many of us earth mortals would find such pain unbearable. I fully agreed with the article “The day I wanted my father to die”, I went through the same experience. Prolonged life has no meaning at all, it is no longer a life, merely a “living”.
    Eventually life is transient, I agree that all lives shall have their purpose in this world, but when the purpose is fulfilled, there is no point to linger further. We shall have the given freedom to decide for our living.
    Having said the above, I believe this is not an issue to be debated just in the cognitive realm, the poll will give us the conclusion.

    Ong Eng Kian Posted on: Sep 17, 2014

  • Bishop Emeritus Robert Solomon states that, “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 caregivers or incur significant medical costs.” However, in his last paragraph, he mentioned that Advanced Medical Directive can be made rationally and carefully by the person. Which can Mr Robert make it clear to me, if a terminally-ill person has the ability to make a rational and clear decision to sign AMD, without the pressure imposed by others or themselves to seek their own death?

    I read up on the guidelines for making an AMD,under “Terminal illness”, which I quote, “It is actually best to make an AMD when there is no pressure to do so – when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.”. This means that a terminally ill person can make make an AMD when they are terminally ill, even if there’s a possibility of pressure from others and themselves.

    Source: http://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/making_an_amd.html

    Alyssa Goh Posted on: Sep 16, 2014

  • With respect, I think the issue could be more precisely formulated to focus on the substance of the contention (whether Singapore should have a right-to-die bill), rather than focus on whether the present time is appropriate for such a debate, on which the answer would likely be yes, for the reason that such a moral issue is a timeless one, given its relevance and impact on people who suffer pain from physiological infirmities. For that reason, my view on the issue, as it is presently worded, must be ‘yes’.

    However, if the issue was focussed on whether a right-to-die bill is justifiable for Singapore, my answer is no, until we have considered the repercussions, and are satisfied that we are willing to bear them. On this, there are many implications, some of which presently unforeseeable. Assisted suicide has reversible effects on the person who elects to undergo the same.

    Philosophically and ethically, this is problematic because, even assuming that the person’s autonomy should be given the highest priority, it is uncertain whether such autonomy is freely exercised. Pressures, self-induced and external, bear on a patient in such situations as terminal illness, etc. Could assisted suicide result in e.g. middle-income patients who suffer significant but non-critical illnesses opting death over life, notwithstanding the prospect of cure, because of cost concerns or suasion (conscious or unwitting) from doctors managing resource constraints?

    Ronald Wong Posted on: Sep 14, 2014

  • Man may like to think that he can be master of his own destiny. The truth is that he is not in control. Man does not decide when he is born. Nor does he determine the length of his life. He can be well in one moment and gone the next when calamity unexpectedly strikes. What man does have is his unique capacity to make choices, notwithstanding he is no master of his own life. At the crux of this debate is the wisdom of the choice that man and, by extension, society chooses. Experience shows there is a sad human tendency to make poor, ill-advised choices. These choices have led to a state of decline in societies today. On the surface, we see ourselves as progressing, celebrating freedoms in various spheres of life. But the reality is that we as a human race are increasingly abandoning what is good for the licence to do as we see fit. It is a great platonic shift in values that we used to hold dear! The question we need to ask ourselves on this issue (and others) is this: Do our choices make us better people? Does it contribute to society’s moral well-being? Or will it lead to further decline? I share Bishop Solomon’s points and concerns.

    Gerald Ng Posted on: Oct 09, 2014

  • I disagree with the passing of the euthanasia law. Even if one might argue that Singapore is not a religious society (that argument by itself is flawed as 83% of our society profess to be attached to a faith community as Bishop), Singapore is still a moral society which is governed by law.
    As such, the law has stated that suicide is illegal, murder is illegal – having the right to die I feel must in the same light – also be illegal.
    Life is sacred. As Hipprocrates has put it – a doctor’s goal is to cure sometimes, to relief often, to comfort always. While we cannot make light of the suffering of terminally ill patients, as a society, we can stand together with them in their suffering: to comfort them. The practice of palliative medicine exists for this reason- so as to help the dying pass on in dignity and in comfort. The Singapore government has also recognized this – and the ministry is putting in more effort and money in growing the palliative care community.
    Should the law for euthanasia and assisted suicide be passed- we will find ourselves on that slippery slope, and soon you will see that vulnerable people (handicapped/mentally impaired children for example) would be at risk of being euthanised : so as to prevent further ”suffering” – as per what is happening in the Netherlands. This is happening in the Netherlands- even though safeguards are supposedly present to prevent abuse of the system.
    Should Singapore still believe in herself as a moral society – it should not pass this euthanasia bill.

    Shirlyn Posted on: Oct 08, 2014

  • With the right to die bill, patients and their family may be pressured to make the ‘right’ decision be it for self or their loved ones. No one can give a definite timeline on when a patient will die, miracles do happen. The Advance Medical Directive bill is already in place to ensure that patients (who opt in) will not need to prolong their suffering via futile medicines / technology. I advocate for palliative medicine which can help patients relieve their pains, spend their precious last moments with their loved ones and die with dignity when the time comes.

    Bernice Posted on: Oct 08, 2014

  • reading the comments from both sides i realise that they fall into generally 2 categories. Those that Agree talk about Self. Those that Disagree talk about Community (others). So what kind of society do we want? For Self, or for Others? I choose to give, not to take.

    Sheldon Posted on: Oct 08, 2014

  • I hope that this shall never come to pass … It promotes the “self” over family, friends and society at large. We belong to not only ourselves but our dear family and friends. As much as we give love, we also receive love. It would be morally selfish to deny others the right to care and love us, even when we are stricken with terminal illness. When we suffer, they lovingly suffer with us to the end. We need love in society to persist over personal desires !

    Goh Chu Teng Posted on: Oct 03, 2014

  • According to Professor Tommy Koh, “in the public sphere, our policies should be governed by secular and not religious principles.” And he goes on to argue his case based on two points ; moral and utilitarian.

    While Singapore is a secular state, we cannot run away from the fact, as Bishop Solomon pointed out in his reply to Prof. Koh’s response to his opening statement, that “Singapore being a multi-religious society with 83% of the population being connected to faith communities, their views based on their fundamental beliefs cannot be ignored.”

    Furthermore, in Chief Justice Menon’s speech at the Singapore Medical Association Annual Lecture, on “Euthanasia: A matter of life or death?” on March 9, 2013, http://www.straitstimes.com/breaking-news/singapore/story/euthanasia-matter-life-or-death-20130324#sthash, quoting the American experience amongst others, he said that “The important lesson which one draws from the American experience is that, at the level of abstraction, human rights may be universal. …At the level of application, however, the messy detail of concrete problems, the human rights which these abstractions have generated are national. Their application requires trade-offs and compromises, exercises of judgment which can be made only in the context of a given society and its legal system.”

    Taking together the above two points, I beg to differ with Prof. Koh’s contextual reference because national consensus on the issue reflecting our collective beliefs of our multi-faith society is crucial not only for its acceptance and implementation, but more importantly, the collective voice of Singaporeans on such important decisions concerning their lives, should be heard. Otherwise, we might unwittingly be risking ourselves to the tyranny of the vocal minority deciding for the silent majority in a contextual vacuum. As the good professor says that religious beliefs must be kept private in the public space, like wise private right-to-die beliefs should not impinge on our societal values.

    Not withstanding this, I would also have to disagree with his moral and utilitarian arguments to justify a right-to-die bill.

    On his moral argument, he basically says that a person who is terminally ill with six months left to live or suffering from an incurable illness which gives him constant and intolerable pain should be empowered with the legal right to end his life at the time of his own choosing and the doctor(s) assisting him to die should not be criminalize(s) for his(their) action(s) in doing so. This he argues is to allow the patient to die with dignity.

    While it is laudable to want to relieve a person from unbearable pain, to give him the right to end his own life is an entirely different matter and I hope it shall never be legalized to ending one’s suffering, whether mental or physical. It has been the collective and the time honored wisdom of many societies to promulgate laws against the taking of one’s life because of the value placed on the sanctity of life to the extent that the larger societal family has the right to prevent you from ending your own life.

    But should there be an exception for a person who is suffering intolerable pain whether mental or physical to be given the right to end his own life with the assistance of doctors so that he can die with dignity ?

    Before I state my views, let us first come to some common understanding of the meaning of the word dignity. According to Wikipedia, traditionally, moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment. However, In the modern context dignity can function as an extension of the Enlightenment-era concepts of inherent, inalienable rights.

    So, I suppose it would not be presumptuous for me to say that the proposed notion can be rephrased to say that to die with dignity, a Singaporean should have the inherent and inalienable right to end his or her life when he is suffering intolerable pain from an incurable illness or that he/she has less than six months to live because of a terminal illness. This basically says that the person involved has complete control over his destiny and nobody else, only conditions to effect his rights have to be met.

    As much as a person who claims that it is his right to choose premature death because of his intolerable suffering, I would argue as strongly that his suffering should not have any bearing on his right to die and even go to the extent to suggest that his suffering should instead be the very reason why he should live on, in the wider context of societal values and norms.

    Regardless of our private opinions or inclinations, once we claim to be part of the Singaporean society, we cease to be a person unto ourselves and will have to be inextricably linked to our societal values and norms whether we like it or not.
    The option of taking away a person’s life because he/she is suffering from intolerable pain, be it mental or physical is anathema to our collective psyche, as seen from the laws against suicide. Another situation which can amply demonstrate our societal values on the dignity (defined in the traditional way) of human life is the treatment of likely war casualties. God forbid that we be caught up in a war ! But a more realistic scenario would perhaps be that of one of our young man being fatally wounded in a peace keeping mission. It is a foregone conclusion that no efforts will be spared to save him and failing to do so, the doctors will do all they can to reduce his pain and suffering as much as they medically can, but taking away his life is definitely not an option. The sanctity of human life and to die with dignity in the traditional sense is aptly illustrated here. Do we want to change this value system to one that ends this soldier’s life at the operating table because he claims it is his right to end his life in this irrecoverable and painful situation ?

    Otherwise, where is the heroism, where is the dignity of dying, how can such human values of perseverance, pride, courage and sacrifice which we treasure so much be preserved ! Imagine if the right-to-die bill was in existence when our navy serviceman Mr. Jason Chee was badly injured in the accident that cost him three of his limbs and three fingers of his right arm. In his mental anguish and unbearable physical pain he might have opted for the soft option to end his life ! But thanks to his indomitable spirit, the exemplary care, support and encouragement given by his medical team and his organization, and most importantly the value placed on him as a human being and not just another digit by his organization, he has overcome all odds and has developed a healthy and robust attitude towards life inspite of all that has happened to him.

    With significant improvements in palliative medicine and good hospice care, the intolerable pain element in the right-to-die equation thus becomes invalid. Terminally ill patients under hospice care in Singapore on average die within 3 months of being admitted, where they receive compassionate and palliative care. From my personal experiences with dying relatives, intolerable pain comes only towards the last few days of the very end. But by then, most of them are already in a semi-conscious or comatose state. When the ultimate finality comes, they die with dignity and human decency, surrounded by loved ones.

    The very societal values we hold dear like resilience, courage, character even in the terminally ill, tampered by the utmost humanistic and compassionate care for them, together provide too compelling a reason why the terminal ill and those suffering intolerable pain should live on and eventually die naturally with dignity.

    In contrast, it would be ironic if the right-to-die bill is legalized, as it allows for a selfish, parochial, and cowardly way to commit suicide but passing the responsibility and accountability to someone else to legally pull the trigger, thus dying devoid of dignity.

    Beyond the conceptual level, there are also issues that many people have already brought up about the abuses and the negative experiences of such a right-to-die law in countries practicing it, and should be predicated only on the strength or otherwise of the conceptual arguments.

    On the utilitarian argument, there is not even the need to debate it as our Eastern culture on filial piety which is being encouraged in our society, runs counter to its very core. As it is, seniors in our society beyond a certain age, already feel marginalized when trying to find employment. It would be a sad day and the whole nation should go into mourning should the day come when the law is passed on account of the utilitarian argument ! For what it amounts to is the extension to the national level of children telling their parents that it is pointless and too costly to keeping them alive, even if they can afford to continue to do so. At best, the utilitarian argument might convince a person to perform his last economic service for the nation in taking his or her own life prematurely, devoid of all human decency and compassion, and dignity and at worst, it debases the very soul of our nation.

    Therefore, my answer as to whether it is time for Singapore to consider a right-to-die bill, is not only a big no, but that I don’t even see the need to initiate further discussions on it.

    Cyril Chiam

    Cyril Chiam Posted on: Oct 02, 2014

  • Having read all the comments thus far, I am still positively sure that I will disagree with the endorsement to exercise the right-to-die bill for “healthy” individuals. I understand that there are grey areas in which we define the process of prolonging life or death; as pointed out by George Yeo. However, I would like to add to his points for us to further deliberate on the subject topic of prolonging death.

    In the likeliest possibility, we may all die one day. The duration in which we remain in this World is definitely finite. Thus, the topic of prolonging life ought to be less emphasized. The main discussion should revolve around whether we should naturally or unnaturally prolong or hasten someone’s death.

    Should it be a choice that individuals make on their own? With a group of professionals like how Martino Tan mentioned? Or with family members? I would say that it should be none of the above. The choice ought to be natural; and unlike how Jerick Tan had mentioned in his post about how the right to die presents a false dilemma of little resource to assist terminally ill patients, I believe that natural death can be assisted too.

    For example, if someone is suffering from pain; physically or mentally, we may employ the use of medical equipment or consumables to reduce the pain that they are experiencing. While we reduce their pain and suffering, it is unlike assisting them to die faster, but a means for us to assist them through a natural transition. I wish to emphasise again, that I believe that such an option should only be applied to individuals who are suffering terribly. Thus, it should not be a subject of the lack of resources, but with adequate resources, we may still assist someone to die naturally and with dignity.

    I disagree with the process of hastening the process of death, because it raises the topic of a criminal act of murder. With or without consent from the patient, I believe that the process of death should not be prolonged or hasten. We may prolong the process of death unless there is an absolute possibility of ensuring that the patient will indeed have a more good years in our World.

    However, if the process of prolonging death results to a prolonged period of pain and suffering, we should allow nature to take its place by reducing their pain; not through death as an option, but to minimise their pain and suffering.

    Edmond Wong Posted on: Sep 26, 2014

  • I notice that humans when besotted by a problem or disease or illness would often seek an escape route rather than facing up to it. Euthanasia is just a form of escape from pain and suffering. Do we not agree that such is life? And have we not also suffered at a younger age, events and circumstances which shaped us to be who we are now?
    Truly Life is sacred and a gift. It is not created by our own selves or our parents. In fact we must agree that we don’t choose where and how we are born. Unfortunately, throughout life, when things are going well, we would often think that we are self-made in every sense of the word until an illness strikes, we realise we are not in control anymore. And grasping at whatever possible, we hope to control our own death by determining how and when we should die. Though it seems like control, it is in actual fact a surrender to fate and a finality that is totally out of our hands.
    The only time that one can TAKE is when one can GIVE. If I take your freedom or rights or money, I too must have the power to give you back what I have taken. Therefore if one chooses to take a life, he or she must be able to also give life back to whoever’s life he/she has taken. If a mistake has been made, make sure you can undo the mistake or rectify it.
    Can anyone then guarantee that in every act of Euthanasia there be no mistake made? No regrets? No repercussions on those left behind? If not, then I think we need not visit this question ever again.

    Simon Chong Posted on: Sep 26, 2014

  • Much research has been done in jurisdictions where euthanasia has been legal for decades. References to scholarly studies cannot be cited here for length constraints but are available on request. These studies provide insights into this important social experiment and reveal some consequences thereof.
    People seek euthanasia mainly because of depression, hopelessness, loss of independence, desire for control, fear of the future and low social support. Low spirituality (a diminished sense of life’s purpose and meaning; not religiosity) is a strong predictor of euthanasia-seeking behaviour. Physical symptoms are generally unimportant to those pursuing euthanasia. There is evidence that euthanasia engenders distrust of physicians.
    The utilitarian argument is troubling. Terminally ill people know that they cause financial, social and emotional strain to their families and society by draining resources. Thus, in the Oregon experience “relief of burden” has become a more common reason after euthanasia was legalised. Taken to its logical end, utilitarianism demands a “duty to die” of all unproductive and resource-consuming people.
    The autonomy argument overlooks the truism that autonomy cannot be absolute and inviolable. Unfettered autonomy has clearly negative consequences for society. Is the decision to live or die a consumerist choice? This debate must engage all levels of community to hear more than the views of the intelligentsia. Euthanasia of neonates is now legal in the Benelux region, and euthanasia for organ donation has been advocated. We need to go beyond emotive anecdotes to envisage how giving all physicians the potential to kill their patients will likely corrode and corrupt society – and whether this is what we really want.

    Kon Oi Lian Posted on: Sep 26, 2014

  • Disagree. I remember the Parliamentary consultations and debate when the Advance Medical Directive Bill was introduced around 1995. There is a difficult grey area between prolonging life and prolonging death which AMD seeks to address sensitively. Euthanasia as assisted suicide takes it too far.

    George Yeo Posted on: Sep 26, 2014

  • When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

    gp Posted on: Sep 25, 2014

  • The right to die imposes an obligation on the society (one’s family, relatives, friends and doctors etc). One’s right to die becomes a doctor’s obligation to kill.

    Should we grant the medical profession the license to kill? The ethical foundation of Western medicine (Hippocratic Oath) is the idea that the doctor should seek to preserve and enhance life, and cause no harm. Such a bill perverts that role and places responsibility on the shoulders of a profession that are asked to implement it.

    A “right” is a moral claim. Do we have such a claim on death? It is not up to us to decide when our life will end or when it will began.

    So where do we draw the line? The advance medical directive in S’pore is instructive. It states that one can inform his/her doctor that he/she does not want to use any life-sustaining treatment to prolong one’s life. This appears to be an ideal state situation now.

    I don’t think a society should have a situation where an individual or a group of people think they have the right to put someone else to death.

    Suppose we go down this slippery slope. Will a change in legislation mean that a right to die becomes a “duty to die”?

    Perhaps our compassion is too focused on a few cases and does not consider the most vulnerable people in society. Such a legislation would apply enormous pressure on the elderly, the sick and the disabled to “do the right thing” and not be a burden on others.

    Martino Tan Posted on: Sep 24, 2014

  • It is indisputable that everyone has the right to die with dignity. However, we must be careful not to equate this with dying painlessly or without suffering. Dignity is the state or quality of being worthy of honour or respect. There are countless stories of cancer patients & people who have put up a brave fight against their illness. And when they pass on, can we say they did not die with dignity? Prof Koh also mistakenly assumed that all who are against assisted dying are religious. I believe the non-religious would agree that life is precious and therefore, every effort must be made to save it. Prof Koh also argued that because resources are scarce, society should not waste efforts on treating some persons. Not every terminally ill wants to die. Many treasured whatever “extra time” they have with their families through life extension treatment. There are some things in life that we cannot and should never adopt a utilitarian approach towards it. Especially not in a society where we want to encourage Compassion. Lives are not disposables. We are not commodities, ready to be traded or crushed when there’s no use.

    Oneida Posted on: Sep 23, 2014

  • It is very hard to come to a solid conclusion on weather someone has to right to decide when they would like to die. I cannot and will not judge someone who feels the need to end pain through death becasue I have not sufferd that pain and do not know someone who has. However making this a law is not as easy as quoting a few examples of people in these situations and then making a law based on that. How will you draw the line? Who decides when it is ok? The day you come up with a full proof plan on how you can execute this law without any loopholes is the day you can decide if you really want to implement such a law. We are often asked not to make any important decisions when we are stressed or when we are not in a good frame of mind. How is this any different? How can we ever be sure that we have (with a clear mind) actually exhausted every other option and so we are allowed to decide that we should die?Anyone who is told they are terminally ill would be shattered and broken. But we human beings have it in us to fight. If we already know we can take the easy way and choose to end it how will we even know what we are capable of? There could be a cure just around the corner. But we will never know if we do not give it a chance. And finally let us look to places that have already made this a law and learn from them. Read the article posted by Denise. Many chooseing this path are the aged, the lonely and the bereaved. Is that why we want? How are we sure we can prevent that here?

    Jessica Posted on: Sep 22, 2014

  • Rather than focus on the ‘right’ to die, our nation should be focusing on the right to live. The right to die debate presents a false dilemma. It assumes that there is little resource left available for our terminally ill patients, and goes on to present them the choice between delaying death and accelerated death. However, the truth of the matter is that resources are available, and that their dispensation is controlled by the authorities. A nation that focuses more on economy and less on people will be left with ‘no choice’ but to choose between delaying and accelerating death. A nation that focuses on people, will instead be active in seeking out ways and means to give the patient the best welfare, and this could include firstly, giving family members and close friends paid leave from work and excusing the children from schools. Scientific research has shown that the presence of loved ones help in recovery. Secondly,making treatment more affordble. Thirdly, improving social and family policies and education, which means more investments should be made into this sector rather than trade, defense, transport, communications, etc. After all, Singapore exists for its people, not the other way around. Parents should be taught how to be role models for their children, and incentives at work should not motivate them to strive to the extent of neglecting their family. Similarly, children should not be challenged to strive in CCAs or for academic results but to spend more time with their family. Morals and values should be taught in society, to tackle the growing culture of individualism, narcissism and consumerism. This last approach will go a long way in the long term, because it will build healthy families, secure in love, with individuals confident of their identity, and eager to contribute to society.

    Jerick Tan Posted on: Sep 18, 2014

  • Can one leave one’s values and principles at the door of the public-square and marketplace, yet maintain one’s integrity and conscious? Would this individual be in any situation, be as the blowing of the wind?

    Can we indicate to be for diversity and inclusiveness, when an individual requires atypical number of supports for daily living activities, to face these challenges, be allowed to request for one’s life to be terminated? Pause, consider, it be a disproportionate number of the vulnerable young and elderly with daily living challenges to confronted with this issue.
    As the situation is, a positive for Downs Syndrome, is likely for the doctor to advice the couple to terminate the life. Would the elderly faced with multi-factorial issues in family and societal domains, throw in the towel too?

    It be the vulnerable who shall be at risk most. Pause, consider, the intangible cost upon society, if such a pathway be established and normalized.

    Koh Gay Posted on: Sep 18, 2014

  • Article 6(1) of the International Covenant on Civil and Political Rights provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

    This article makes two important points. Firstly, the right to life is inherent. This means that there is no “right to die”. Neither does the value of life or its protection depend on its quality. Secondly, this right shall be protected by law. Regardless of one’s personal views in favour or against euthanasia and assisted dying, States are required to protect life as an inherent right.

    The relaxation of laws protecting life does not only affect some, but also fundamentally alters the value of all human life, especially that of the vulnerable or those perceived as having a lower “quality of life”.

    There is also a real prospect of abuse. For example, a 2010 study reported that 32 per cent of the assisted deaths in the region of Flanders in Belgium between June and November 2007 were done without explicit request.

    Hence, I agree with Bishop Emeritus Robert Solomon that 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.

    In doing so, we respect the inherent value of all human life, and indeed the value of living with dignity.

    Darius Lee Posted on: Sep 18, 2014

  • Introducing assisted suicide in any society will inevitably lead to its moral decline. The Dutch euthanasia experience started with very strict criteria. Patients had to prove intolerable suffering and consistent desire and more than one doctor had to be consulted. 5 years later, large surveys showed that doctors were involved in causing 5,000 patient deaths without their consent. These doctors started out with altruistic intentions, but ended up killing their patients! Once assisted suicide is allowed, it introduces a logic to society that some lives are simply not worth living. Once such logic is in place, then Prof Tommy Koh’s utilitarian logic will take precedence due to limited healthcare resources, and no safeguards are left to prevent the subsequent killing of disabled children or frail elderly whose lives are deemed “not worth living”. Imagine a society where the most vulnerable are not only not protected, but are removed and discriminated against by law!

    Furthermore, contrary to what Prof Tommy Koh suggests, death with dignity does not necessarily entail dying without suffering at the time of one’s choosing. Rather, the true meaning of Compassion is “to suffer with” and not to eliminate suffering at all costs. Today, palliative care is a viable option which provides significant pain relief and comfort at the end of life. It promulgates a harmonious departure from one’s life at peace with one’s loved ones in a way which suicide can never achieve.

    colin ong Posted on: Sep 16, 2014

  • Hindsight is always perfect vision. Take it from the forerunners, they have already changed their minds about euthanasia.

    http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

    “Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.”

    Denise Posted on: Sep 15, 2014

comments

  • 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

  • The bishop’s response is fraught with logical fallacies.

    The debate at hand is about regulating suicide through a right-to-die bill, which implies setting up a framework to ensuring that proper conditions are put in place before a person may choose to end his life. The bishop has instead set up a straw man argument by empathetically stating that one cannot possibly have absolute autonomy to choose premature death. There is critical difference between freedom that is qualified and freedom that is absolute – the bishop’s failure to draw the distinction is an unnecessary detraction from the main issue at hand, because the motion does not ask the debaters to consider granting Singaporeans absolute freedom to end their lives.

    The next assertion that the bishop made is that a patient cannot make a free and voluntary decision to end his own life because (a) information regarding diagnosis and prognosis may not be perfect; and (b) there may be ‘potential pressure from family and caregivers and society at large’ that impinge on the patient’s decision to be euthanised.

    The bishop’s definition of making ‘free and voluntary’ decision is flawed. Almost all decisions we make in life are based on whatever information we have at hand, which may not be perfect; they will also undoubtedly be affected by opinion and pressure of the people around us. If we are unable to make ‘free and voluntary decisions’ because of the abovementioned considerations, which are inherent in life, then we would soon arrive at a conclusion that most of the decisions we make are made involuntarily. By extension, according to the bishop, our consent to marriage, contract, would all be invalid – surely that is impracticable.

    The bishop also made some ill-substantiated claims:

    For example, where he had said that euthanasia and assisted suicide are not as humane as they may seem, the only support he could conjure was that a Pope had said so – this could hardly seem convincing in light of medical advances today.

    The bishop also sought to conjure up a boogeyman by claiming that legalizing euthanasia and assisted suicide for the terminally ill may lead to an opening of floodgates for something no less than an absolute freedom to take one’s life. Insomuch as checks are in place to ensure that legislation is a reflection of societal views and goals, whether a bill legalizing a right-to-die will lead to an opening of floodgates would depend on how the bill is being drafted, and whether it is compatible with the views and goals of society in time to come – anything more than that would be pure speculation.

    Bin Hong Posted on: Sep 27, 2014

  • I can sincerely understand the pain suffered by both patients and their families, when there is no hope or only meaningless effort.
    We can give kind advice and best wishes to others, but we should not speak for them.
    We should respect those desperate patients’ will which way they want to go, without harming others and the society.
    However, the decision should not only be solely made by the patient himself/herself, but based on a consensus from his/her family as a whole.

    SUN Xi Posted on: Sep 26, 2014

  • Human rights should extend to the right of each person to decide when he or she should decide to die should it be physically unbearable for to continue living. I won’t bother quoting examples as I have too many to choose from, but I have seen the pain, the prolonging of life brings to both the patient, caregiver and family. I have heard such patients express their wish to discontinue their treatment and even to appeal to the Gods to take them away but modern medicine continued to keep them alive till they lost all dignity and self respect. Everyone should have the right to decide whether or not modern medicine should prolong their lives if it means that quality of life is degraded to the point where they lose both dignity and self respect.

    HH Tong Posted on: Sep 26, 2014

  • I think that a key feature of democratic societies is that we value rights, choice and freedom, and that as a society we should aim to facilitate pursuit of these freedoms insofar as they do not impinge on the choices, rights or freedoms of others, a view enunciated originally by J.S. Mill. Before proceeding with my explanation, the version of this law that I am in support of would need a few caveats and conditions to prevent abuse. I would only support a bill that ensures the following conditions are met:

    (A) Absence of duress;
    (B) Mental capacity;
    (C) Express consent;
    (D) Exhaustion of all reasonable options in seeking a cure, within means.

    Having said that, I see no further reason for us to deprive anyone of the right to die. To assume that the right to live is mutually exclusive to the right to die is a fallacy. In fact, I would say the opposite; the right to live necessitates the right to die because they share the same underlying principle i.e. self determination. I would personally not sign up for the AMD, but that does not mean I should prevent someone else from doing it. Choice is the key operator here, not whether it takes up resources, or whether you, me, or someone else thinks its ‘dignified’. If a suffering person wanted to live as long as possible, then lets do our best to make sure it happens. But lets also remember to do the same if they think death is preferable, and not deprive them of their rights just before they leave us.

    Ali Ahmad Yaakub Posted on: Sep 24, 2014

  • The inconvenient truth is that Singaporeans have been killing themselves because the pain of their illness can be unbearable. Hence, it is preferable to let those who want to die to do so with dignity through professionally-assisted suicide. And to help us come to terms with euthanasia, we need to understand it within the context of medicine. If we remove our rose-tinted lenses, we see medicine for what it is: A practice that has killed countless number of people via iatrogenics – where the healer causes more harm than good. This is where the infirm go to the doctor for a cure, only to wind up dead. But mercy killing has shown that we have actually made medical progress: We have developed the means to assist people in dying as painlessly as possible, rather than killing them on the pretext of curing them. If this isn’t a step forward for the practice of medicine, then I don’t know what is. Plus, allowing people to die has to be seen in the context of humanity’s evolution through the past millions of years. For the longest time, humans have lived short brutish lives. Our Savannah-dwelling ancestors barely made it past 30 years old. Now we live till 75. Even our closest ape cousins do not experience such artificially extended lifespans. Ipso facto, what medicine and technological advances giveth, what medicine and technological advances taketh away. Living to 75 is already considered living on borrowed time. What’s the benefit of a few extra weeks or months?

    Belmont Lay Posted on: Sep 23, 2014

  • “Life is sacred”. “Right to live”. These are noble ideals.

    Tell these ideals to the man lying in the hospital bed, suffering from pain and grief. Tubes all over his body. Defecating on himself uncontrollably. That he knows his end is near, and there is no more to look forward to.

    The only difference between the man who jumped down, and the man in the hospital is that the latter is imprisoned and thus able to do what he wishes to do.

    Rick Posted on: Sep 18, 2014

  • Just this morning, I read the sad news of a son who could not bear the suffering of his father who was terminally ill; he helped his father to jump down from his high floor HDB flat and he followed suit. Two deaths ! While we are still debating, people have already made their choice with or without the bill.
    Would this tragedy be prevented if we had the a “Right-TO-Die” bill ? probably. One life could have been saved. From what I read , it was the father who urgred his son to kill him, and probably the son suffered from guilt and depression when he conceded. No body will ever know the real reasons now.
    Life is never measured by its length but its quality. Only people who suffer long enough really understand what pain means. All men are made differently, while some might be able to endure and believe that suffering makes them strong and profound, many of us earth mortals would find such pain unbearable. I fully agreed with the article “The day I wanted my father to die”, I went through the same experience. Prolonged life has no meaning at all, it is no longer a life, merely a “living”.
    Eventually life is transient, I agree that all lives shall have their purpose in this world, but when the purpose is fulfilled, there is no point to linger further. We shall have the given freedom to decide for our living.
    Having said the above, I believe this is not an issue to be debated just in the cognitive realm, the poll will give us the conclusion.

    Ong Eng Kian Posted on: Sep 17, 2014

  • Bishop Emeritus Robert Solomon states that, “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 caregivers or incur significant medical costs.” However, in his last paragraph, he mentioned that Advanced Medical Directive can be made rationally and carefully by the person. Which can Mr Robert make it clear to me, if a terminally-ill person has the ability to make a rational and clear decision to sign AMD, without the pressure imposed by others or themselves to seek their own death?

    I read up on the guidelines for making an AMD,under “Terminal illness”, which I quote, “It is actually best to make an AMD when there is no pressure to do so – when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.”. This means that a terminally ill person can make make an AMD when they are terminally ill, even if there’s a possibility of pressure from others and themselves.

    Source: http://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines/making_an_amd.html

    Alyssa Goh Posted on: Sep 16, 2014

  • With respect, I think the issue could be more precisely formulated to focus on the substance of the contention (whether Singapore should have a right-to-die bill), rather than focus on whether the present time is appropriate for such a debate, on which the answer would likely be yes, for the reason that such a moral issue is a timeless one, given its relevance and impact on people who suffer pain from physiological infirmities. For that reason, my view on the issue, as it is presently worded, must be ‘yes’.

    However, if the issue was focussed on whether a right-to-die bill is justifiable for Singapore, my answer is no, until we have considered the repercussions, and are satisfied that we are willing to bear them. On this, there are many implications, some of which presently unforeseeable. Assisted suicide has reversible effects on the person who elects to undergo the same.

    Philosophically and ethically, this is problematic because, even assuming that the person’s autonomy should be given the highest priority, it is uncertain whether such autonomy is freely exercised. Pressures, self-induced and external, bear on a patient in such situations as terminal illness, etc. Could assisted suicide result in e.g. middle-income patients who suffer significant but non-critical illnesses opting death over life, notwithstanding the prospect of cure, because of cost concerns or suasion (conscious or unwitting) from doctors managing resource constraints?

    Ronald Wong Posted on: Sep 14, 2014

  • Man may like to think that he can be master of his own destiny. The truth is that he is not in control. Man does not decide when he is born. Nor does he determine the length of his life. He can be well in one moment and gone the next when calamity unexpectedly strikes. What man does have is his unique capacity to make choices, notwithstanding he is no master of his own life. At the crux of this debate is the wisdom of the choice that man and, by extension, society chooses. Experience shows there is a sad human tendency to make poor, ill-advised choices. These choices have led to a state of decline in societies today. On the surface, we see ourselves as progressing, celebrating freedoms in various spheres of life. But the reality is that we as a human race are increasingly abandoning what is good for the licence to do as we see fit. It is a great platonic shift in values that we used to hold dear! The question we need to ask ourselves on this issue (and others) is this: Do our choices make us better people? Does it contribute to society’s moral well-being? Or will it lead to further decline? I share Bishop Solomon’s points and concerns.

    Gerald Ng Posted on: Oct 09, 2014

  • I disagree with the passing of the euthanasia law. Even if one might argue that Singapore is not a religious society (that argument by itself is flawed as 83% of our society profess to be attached to a faith community as Bishop), Singapore is still a moral society which is governed by law.
    As such, the law has stated that suicide is illegal, murder is illegal – having the right to die I feel must in the same light – also be illegal.
    Life is sacred. As Hipprocrates has put it – a doctor’s goal is to cure sometimes, to relief often, to comfort always. While we cannot make light of the suffering of terminally ill patients, as a society, we can stand together with them in their suffering: to comfort them. The practice of palliative medicine exists for this reason- so as to help the dying pass on in dignity and in comfort. The Singapore government has also recognized this – and the ministry is putting in more effort and money in growing the palliative care community.
    Should the law for euthanasia and assisted suicide be passed- we will find ourselves on that slippery slope, and soon you will see that vulnerable people (handicapped/mentally impaired children for example) would be at risk of being euthanised : so as to prevent further ”suffering” – as per what is happening in the Netherlands. This is happening in the Netherlands- even though safeguards are supposedly present to prevent abuse of the system.
    Should Singapore still believe in herself as a moral society – it should not pass this euthanasia bill.

    Shirlyn Posted on: Oct 08, 2014

  • With the right to die bill, patients and their family may be pressured to make the ‘right’ decision be it for self or their loved ones. No one can give a definite timeline on when a patient will die, miracles do happen. The Advance Medical Directive bill is already in place to ensure that patients (who opt in) will not need to prolong their suffering via futile medicines / technology. I advocate for palliative medicine which can help patients relieve their pains, spend their precious last moments with their loved ones and die with dignity when the time comes.

    Bernice Posted on: Oct 08, 2014

  • reading the comments from both sides i realise that they fall into generally 2 categories. Those that Agree talk about Self. Those that Disagree talk about Community (others). So what kind of society do we want? For Self, or for Others? I choose to give, not to take.

    Sheldon Posted on: Oct 08, 2014

  • I hope that this shall never come to pass … It promotes the “self” over family, friends and society at large. We belong to not only ourselves but our dear family and friends. As much as we give love, we also receive love. It would be morally selfish to deny others the right to care and love us, even when we are stricken with terminal illness. When we suffer, they lovingly suffer with us to the end. We need love in society to persist over personal desires !

    Goh Chu Teng Posted on: Oct 03, 2014

  • According to Professor Tommy Koh, “in the public sphere, our policies should be governed by secular and not religious principles.” And he goes on to argue his case based on two points ; moral and utilitarian.

    While Singapore is a secular state, we cannot run away from the fact, as Bishop Solomon pointed out in his reply to Prof. Koh’s response to his opening statement, that “Singapore being a multi-religious society with 83% of the population being connected to faith communities, their views based on their fundamental beliefs cannot be ignored.”

    Furthermore, in Chief Justice Menon’s speech at the Singapore Medical Association Annual Lecture, on “Euthanasia: A matter of life or death?” on March 9, 2013, http://www.straitstimes.com/breaking-news/singapore/story/euthanasia-matter-life-or-death-20130324#sthash, quoting the American experience amongst others, he said that “The important lesson which one draws from the American experience is that, at the level of abstraction, human rights may be universal. …At the level of application, however, the messy detail of concrete problems, the human rights which these abstractions have generated are national. Their application requires trade-offs and compromises, exercises of judgment which can be made only in the context of a given society and its legal system.”

    Taking together the above two points, I beg to differ with Prof. Koh’s contextual reference because national consensus on the issue reflecting our collective beliefs of our multi-faith society is crucial not only for its acceptance and implementation, but more importantly, the collective voice of Singaporeans on such important decisions concerning their lives, should be heard. Otherwise, we might unwittingly be risking ourselves to the tyranny of the vocal minority deciding for the silent majority in a contextual vacuum. As the good professor says that religious beliefs must be kept private in the public space, like wise private right-to-die beliefs should not impinge on our societal values.

    Not withstanding this, I would also have to disagree with his moral and utilitarian arguments to justify a right-to-die bill.

    On his moral argument, he basically says that a person who is terminally ill with six months left to live or suffering from an incurable illness which gives him constant and intolerable pain should be empowered with the legal right to end his life at the time of his own choosing and the doctor(s) assisting him to die should not be criminalize(s) for his(their) action(s) in doing so. This he argues is to allow the patient to die with dignity.

    While it is laudable to want to relieve a person from unbearable pain, to give him the right to end his own life is an entirely different matter and I hope it shall never be legalized to ending one’s suffering, whether mental or physical. It has been the collective and the time honored wisdom of many societies to promulgate laws against the taking of one’s life because of the value placed on the sanctity of life to the extent that the larger societal family has the right to prevent you from ending your own life.

    But should there be an exception for a person who is suffering intolerable pain whether mental or physical to be given the right to end his own life with the assistance of doctors so that he can die with dignity ?

    Before I state my views, let us first come to some common understanding of the meaning of the word dignity. According to Wikipedia, traditionally, moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment. However, In the modern context dignity can function as an extension of the Enlightenment-era concepts of inherent, inalienable rights.

    So, I suppose it would not be presumptuous for me to say that the proposed notion can be rephrased to say that to die with dignity, a Singaporean should have the inherent and inalienable right to end his or her life when he is suffering intolerable pain from an incurable illness or that he/she has less than six months to live because of a terminal illness. This basically says that the person involved has complete control over his destiny and nobody else, only conditions to effect his rights have to be met.

    As much as a person who claims that it is his right to choose premature death because of his intolerable suffering, I would argue as strongly that his suffering should not have any bearing on his right to die and even go to the extent to suggest that his suffering should instead be the very reason why he should live on, in the wider context of societal values and norms.

    Regardless of our private opinions or inclinations, once we claim to be part of the Singaporean society, we cease to be a person unto ourselves and will have to be inextricably linked to our societal values and norms whether we like it or not.
    The option of taking away a person’s life because he/she is suffering from intolerable pain, be it mental or physical is anathema to our collective psyche, as seen from the laws against suicide. Another situation which can amply demonstrate our societal values on the dignity (defined in the traditional way) of human life is the treatment of likely war casualties. God forbid that we be caught up in a war ! But a more realistic scenario would perhaps be that of one of our young man being fatally wounded in a peace keeping mission. It is a foregone conclusion that no efforts will be spared to save him and failing to do so, the doctors will do all they can to reduce his pain and suffering as much as they medically can, but taking away his life is definitely not an option. The sanctity of human life and to die with dignity in the traditional sense is aptly illustrated here. Do we want to change this value system to one that ends this soldier’s life at the operating table because he claims it is his right to end his life in this irrecoverable and painful situation ?

    Otherwise, where is the heroism, where is the dignity of dying, how can such human values of perseverance, pride, courage and sacrifice which we treasure so much be preserved ! Imagine if the right-to-die bill was in existence when our navy serviceman Mr. Jason Chee was badly injured in the accident that cost him three of his limbs and three fingers of his right arm. In his mental anguish and unbearable physical pain he might have opted for the soft option to end his life ! But thanks to his indomitable spirit, the exemplary care, support and encouragement given by his medical team and his organization, and most importantly the value placed on him as a human being and not just another digit by his organization, he has overcome all odds and has developed a healthy and robust attitude towards life inspite of all that has happened to him.

    With significant improvements in palliative medicine and good hospice care, the intolerable pain element in the right-to-die equation thus becomes invalid. Terminally ill patients under hospice care in Singapore on average die within 3 months of being admitted, where they receive compassionate and palliative care. From my personal experiences with dying relatives, intolerable pain comes only towards the last few days of the very end. But by then, most of them are already in a semi-conscious or comatose state. When the ultimate finality comes, they die with dignity and human decency, surrounded by loved ones.

    The very societal values we hold dear like resilience, courage, character even in the terminally ill, tampered by the utmost humanistic and compassionate care for them, together provide too compelling a reason why the terminal ill and those suffering intolerable pain should live on and eventually die naturally with dignity.

    In contrast, it would be ironic if the right-to-die bill is legalized, as it allows for a selfish, parochial, and cowardly way to commit suicide but passing the responsibility and accountability to someone else to legally pull the trigger, thus dying devoid of dignity.

    Beyond the conceptual level, there are also issues that many people have already brought up about the abuses and the negative experiences of such a right-to-die law in countries practicing it, and should be predicated only on the strength or otherwise of the conceptual arguments.

    On the utilitarian argument, there is not even the need to debate it as our Eastern culture on filial piety which is being encouraged in our society, runs counter to its very core. As it is, seniors in our society beyond a certain age, already feel marginalized when trying to find employment. It would be a sad day and the whole nation should go into mourning should the day come when the law is passed on account of the utilitarian argument ! For what it amounts to is the extension to the national level of children telling their parents that it is pointless and too costly to keeping them alive, even if they can afford to continue to do so. At best, the utilitarian argument might convince a person to perform his last economic service for the nation in taking his or her own life prematurely, devoid of all human decency and compassion, and dignity and at worst, it debases the very soul of our nation.

    Therefore, my answer as to whether it is time for Singapore to consider a right-to-die bill, is not only a big no, but that I don’t even see the need to initiate further discussions on it.

    Cyril Chiam

    Cyril Chiam Posted on: Oct 02, 2014

  • Having read all the comments thus far, I am still positively sure that I will disagree with the endorsement to exercise the right-to-die bill for “healthy” individuals. I understand that there are grey areas in which we define the process of prolonging life or death; as pointed out by George Yeo. However, I would like to add to his points for us to further deliberate on the subject topic of prolonging death.

    In the likeliest possibility, we may all die one day. The duration in which we remain in this World is definitely finite. Thus, the topic of prolonging life ought to be less emphasized. The main discussion should revolve around whether we should naturally or unnaturally prolong or hasten someone’s death.

    Should it be a choice that individuals make on their own? With a group of professionals like how Martino Tan mentioned? Or with family members? I would say that it should be none of the above. The choice ought to be natural; and unlike how Jerick Tan had mentioned in his post about how the right to die presents a false dilemma of little resource to assist terminally ill patients, I believe that natural death can be assisted too.

    For example, if someone is suffering from pain; physically or mentally, we may employ the use of medical equipment or consumables to reduce the pain that they are experiencing. While we reduce their pain and suffering, it is unlike assisting them to die faster, but a means for us to assist them through a natural transition. I wish to emphasise again, that I believe that such an option should only be applied to individuals who are suffering terribly. Thus, it should not be a subject of the lack of resources, but with adequate resources, we may still assist someone to die naturally and with dignity.

    I disagree with the process of hastening the process of death, because it raises the topic of a criminal act of murder. With or without consent from the patient, I believe that the process of death should not be prolonged or hasten. We may prolong the process of death unless there is an absolute possibility of ensuring that the patient will indeed have a more good years in our World.

    However, if the process of prolonging death results to a prolonged period of pain and suffering, we should allow nature to take its place by reducing their pain; not through death as an option, but to minimise their pain and suffering.

    Edmond Wong Posted on: Sep 26, 2014

  • I notice that humans when besotted by a problem or disease or illness would often seek an escape route rather than facing up to it. Euthanasia is just a form of escape from pain and suffering. Do we not agree that such is life? And have we not also suffered at a younger age, events and circumstances which shaped us to be who we are now?
    Truly Life is sacred and a gift. It is not created by our own selves or our parents. In fact we must agree that we don’t choose where and how we are born. Unfortunately, throughout life, when things are going well, we would often think that we are self-made in every sense of the word until an illness strikes, we realise we are not in control anymore. And grasping at whatever possible, we hope to control our own death by determining how and when we should die. Though it seems like control, it is in actual fact a surrender to fate and a finality that is totally out of our hands.
    The only time that one can TAKE is when one can GIVE. If I take your freedom or rights or money, I too must have the power to give you back what I have taken. Therefore if one chooses to take a life, he or she must be able to also give life back to whoever’s life he/she has taken. If a mistake has been made, make sure you can undo the mistake or rectify it.
    Can anyone then guarantee that in every act of Euthanasia there be no mistake made? No regrets? No repercussions on those left behind? If not, then I think we need not visit this question ever again.

    Simon Chong Posted on: Sep 26, 2014

  • Much research has been done in jurisdictions where euthanasia has been legal for decades. References to scholarly studies cannot be cited here for length constraints but are available on request. These studies provide insights into this important social experiment and reveal some consequences thereof.
    People seek euthanasia mainly because of depression, hopelessness, loss of independence, desire for control, fear of the future and low social support. Low spirituality (a diminished sense of life’s purpose and meaning; not religiosity) is a strong predictor of euthanasia-seeking behaviour. Physical symptoms are generally unimportant to those pursuing euthanasia. There is evidence that euthanasia engenders distrust of physicians.
    The utilitarian argument is troubling. Terminally ill people know that they cause financial, social and emotional strain to their families and society by draining resources. Thus, in the Oregon experience “relief of burden” has become a more common reason after euthanasia was legalised. Taken to its logical end, utilitarianism demands a “duty to die” of all unproductive and resource-consuming people.
    The autonomy argument overlooks the truism that autonomy cannot be absolute and inviolable. Unfettered autonomy has clearly negative consequences for society. Is the decision to live or die a consumerist choice? This debate must engage all levels of community to hear more than the views of the intelligentsia. Euthanasia of neonates is now legal in the Benelux region, and euthanasia for organ donation has been advocated. We need to go beyond emotive anecdotes to envisage how giving all physicians the potential to kill their patients will likely corrode and corrupt society – and whether this is what we really want.

    Kon Oi Lian Posted on: Sep 26, 2014

  • Disagree. I remember the Parliamentary consultations and debate when the Advance Medical Directive Bill was introduced around 1995. There is a difficult grey area between prolonging life and prolonging death which AMD seeks to address sensitively. Euthanasia as assisted suicide takes it too far.

    George Yeo Posted on: Sep 26, 2014

  • When we reduce the value of human life to dollars and cents, we diminish human dignity and will think the same way about those who are considered a “burden” to society. Our society should not go down this dangerous path.

    gp Posted on: Sep 25, 2014

  • The right to die imposes an obligation on the society (one’s family, relatives, friends and doctors etc). One’s right to die becomes a doctor’s obligation to kill.

    Should we grant the medical profession the license to kill? The ethical foundation of Western medicine (Hippocratic Oath) is the idea that the doctor should seek to preserve and enhance life, and cause no harm. Such a bill perverts that role and places responsibility on the shoulders of a profession that are asked to implement it.

    A “right” is a moral claim. Do we have such a claim on death? It is not up to us to decide when our life will end or when it will began.

    So where do we draw the line? The advance medical directive in S’pore is instructive. It states that one can inform his/her doctor that he/she does not want to use any life-sustaining treatment to prolong one’s life. This appears to be an ideal state situation now.

    I don’t think a society should have a situation where an individual or a group of people think they have the right to put someone else to death.

    Suppose we go down this slippery slope. Will a change in legislation mean that a right to die becomes a “duty to die”?

    Perhaps our compassion is too focused on a few cases and does not consider the most vulnerable people in society. Such a legislation would apply enormous pressure on the elderly, the sick and the disabled to “do the right thing” and not be a burden on others.

    Martino Tan Posted on: Sep 24, 2014

  • It is indisputable that everyone has the right to die with dignity. However, we must be careful not to equate this with dying painlessly or without suffering. Dignity is the state or quality of being worthy of honour or respect. There are countless stories of cancer patients & people who have put up a brave fight against their illness. And when they pass on, can we say they did not die with dignity? Prof Koh also mistakenly assumed that all who are against assisted dying are religious. I believe the non-religious would agree that life is precious and therefore, every effort must be made to save it. Prof Koh also argued that because resources are scarce, society should not waste efforts on treating some persons. Not every terminally ill wants to die. Many treasured whatever “extra time” they have with their families through life extension treatment. There are some things in life that we cannot and should never adopt a utilitarian approach towards it. Especially not in a society where we want to encourage Compassion. Lives are not disposables. We are not commodities, ready to be traded or crushed when there’s no use.

    Oneida Posted on: Sep 23, 2014

  • It is very hard to come to a solid conclusion on weather someone has to right to decide when they would like to die. I cannot and will not judge someone who feels the need to end pain through death becasue I have not sufferd that pain and do not know someone who has. However making this a law is not as easy as quoting a few examples of people in these situations and then making a law based on that. How will you draw the line? Who decides when it is ok? The day you come up with a full proof plan on how you can execute this law without any loopholes is the day you can decide if you really want to implement such a law. We are often asked not to make any important decisions when we are stressed or when we are not in a good frame of mind. How is this any different? How can we ever be sure that we have (with a clear mind) actually exhausted every other option and so we are allowed to decide that we should die?Anyone who is told they are terminally ill would be shattered and broken. But we human beings have it in us to fight. If we already know we can take the easy way and choose to end it how will we even know what we are capable of? There could be a cure just around the corner. But we will never know if we do not give it a chance. And finally let us look to places that have already made this a law and learn from them. Read the article posted by Denise. Many chooseing this path are the aged, the lonely and the bereaved. Is that why we want? How are we sure we can prevent that here?

    Jessica Posted on: Sep 22, 2014

  • Rather than focus on the ‘right’ to die, our nation should be focusing on the right to live. The right to die debate presents a false dilemma. It assumes that there is little resource left available for our terminally ill patients, and goes on to present them the choice between delaying death and accelerated death. However, the truth of the matter is that resources are available, and that their dispensation is controlled by the authorities. A nation that focuses more on economy and less on people will be left with ‘no choice’ but to choose between delaying and accelerating death. A nation that focuses on people, will instead be active in seeking out ways and means to give the patient the best welfare, and this could include firstly, giving family members and close friends paid leave from work and excusing the children from schools. Scientific research has shown that the presence of loved ones help in recovery. Secondly,making treatment more affordble. Thirdly, improving social and family policies and education, which means more investments should be made into this sector rather than trade, defense, transport, communications, etc. After all, Singapore exists for its people, not the other way around. Parents should be taught how to be role models for their children, and incentives at work should not motivate them to strive to the extent of neglecting their family. Similarly, children should not be challenged to strive in CCAs or for academic results but to spend more time with their family. Morals and values should be taught in society, to tackle the growing culture of individualism, narcissism and consumerism. This last approach will go a long way in the long term, because it will build healthy families, secure in love, with individuals confident of their identity, and eager to contribute to society.

    Jerick Tan Posted on: Sep 18, 2014

  • Can one leave one’s values and principles at the door of the public-square and marketplace, yet maintain one’s integrity and conscious? Would this individual be in any situation, be as the blowing of the wind?

    Can we indicate to be for diversity and inclusiveness, when an individual requires atypical number of supports for daily living activities, to face these challenges, be allowed to request for one’s life to be terminated? Pause, consider, it be a disproportionate number of the vulnerable young and elderly with daily living challenges to confronted with this issue.
    As the situation is, a positive for Downs Syndrome, is likely for the doctor to advice the couple to terminate the life. Would the elderly faced with multi-factorial issues in family and societal domains, throw in the towel too?

    It be the vulnerable who shall be at risk most. Pause, consider, the intangible cost upon society, if such a pathway be established and normalized.

    Koh Gay Posted on: Sep 18, 2014

  • Article 6(1) of the International Covenant on Civil and Political Rights provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

    This article makes two important points. Firstly, the right to life is inherent. This means that there is no “right to die”. Neither does the value of life or its protection depend on its quality. Secondly, this right shall be protected by law. Regardless of one’s personal views in favour or against euthanasia and assisted dying, States are required to protect life as an inherent right.

    The relaxation of laws protecting life does not only affect some, but also fundamentally alters the value of all human life, especially that of the vulnerable or those perceived as having a lower “quality of life”.

    There is also a real prospect of abuse. For example, a 2010 study reported that 32 per cent of the assisted deaths in the region of Flanders in Belgium between June and November 2007 were done without explicit request.

    Hence, I agree with Bishop Emeritus Robert Solomon that 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.

    In doing so, we respect the inherent value of all human life, and indeed the value of living with dignity.

    Darius Lee Posted on: Sep 18, 2014

  • Introducing assisted suicide in any society will inevitably lead to its moral decline. The Dutch euthanasia experience started with very strict criteria. Patients had to prove intolerable suffering and consistent desire and more than one doctor had to be consulted. 5 years later, large surveys showed that doctors were involved in causing 5,000 patient deaths without their consent. These doctors started out with altruistic intentions, but ended up killing their patients! Once assisted suicide is allowed, it introduces a logic to society that some lives are simply not worth living. Once such logic is in place, then Prof Tommy Koh’s utilitarian logic will take precedence due to limited healthcare resources, and no safeguards are left to prevent the subsequent killing of disabled children or frail elderly whose lives are deemed “not worth living”. Imagine a society where the most vulnerable are not only not protected, but are removed and discriminated against by law!

    Furthermore, contrary to what Prof Tommy Koh suggests, death with dignity does not necessarily entail dying without suffering at the time of one’s choosing. Rather, the true meaning of Compassion is “to suffer with” and not to eliminate suffering at all costs. Today, palliative care is a viable option which provides significant pain relief and comfort at the end of life. It promulgates a harmonious departure from one’s life at peace with one’s loved ones in a way which suicide can never achieve.

    colin ong Posted on: Sep 16, 2014

  • Hindsight is always perfect vision. Take it from the forerunners, they have already changed their minds about euthanasia.

    http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

    “Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.”

    Denise Posted on: Sep 15, 2014

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