Assisted dying: A matter of life and death
Monday, Mar 25, 2013
The Straits Times
Whatever our political, religious or moral leanings, the assisted dying debate remains an irreducibly human issue. It follows that we must summon all the compassion and kindness in our hearts when broaching this matter. The subject of assisted dying is an intensely complicated one. There are many facets to it with very few ready answers. It would therefore be helpful to begin with some conceptual distinctions and definitions. The most common abstraction used to represent the core principle in the debate on assisted dying has been the "right to die". This encapsulates the competing notions of "sanctity of life" on the one hand and "freedom of choice" on the other. Curiously, it suggests that we are at liberty to die, just as we are at liberty to live. However, as with any conversation of such moral complexity, we must be wary of reductive labels. This leads us to an important set of definitions related to the various modes by which accelerated dying can be effected. Euthanasia entails the termination of the life of a patient by someone other than the patient himself. A working definition of euthanasia as it is commonly understood is: An action that results in the immediate merciful killing by a doctor of a sick and suffering patient who has consented to this action. It is the deliberate and very humane ending of a patient's life to prevent further suffering... and rests on two fundamental principles: autonomy and mercy. Voluntary euthanasia takes place at the patient's request but it is the physician who executes the final act. This is to be distinguished from assisted suicide, where the patient performs the final act and causes his own death. The assistance may come in the form of practical assistance, such as that rendered by friends and family members to those who travel abroad for the purpose of ending their lives. It may also take the form of medical assistance. Physician-assisted suicide is legal in the Netherlands, Luxembourg, Belgium, Switzerland and the states of Washington, Oregon and Montana in the United States. It is most prominently associated with the Dignitas clinic in Zurich, founded in 1998 with the avowed aim of assisting those with "medically diagnosed hopeless or incurable illness, unbearable pain or unendurable disabilities" to end their lives with dignity. Here, I will focus on accelerated dying and the practices of assisted suicide and voluntary euthanasia, which will be collectively referred to as assisted dying. If we begin from the premise of a competent individual's liberty to choose what treatment he receives, we will inevitably have to consider what should be done at the other end of the spectrum, where he is unable to formulate or communicate his choice. One existing solution would be to rely on Advance Medical Directives (AMDs) or living wills which are direct expressions of personal choice, albeit usually at a point in time while the patient was still competent and able. Under section 3(1) of the AMD Act, any person who has attained the age of 21 and who desires not to be subjected to extraordinary life-sustaining treatment in the event of suffering a terminal illness may at any time make an AMD in the prescribed form. However, even such directives cannot simplistically be taken as conclusive of the patient's present preferences as opposed to what was in his mind at the time of making the directive. Where the patient cannot indicate his preference, let alone exercise his will, it is inevitable that some kind of substituted decision- maker will have to be relied upon, even if it is that same patient's younger self. The ethical difficulties become even more acute where there is an absence of any evidence of the patient's preferences. In these cases, an external substitute decision-maker - whether an individual such as next-of-kin, a corporate body such as a medical...