Experts call for clearer difference between euthanasia and AMD
Written by Writer on Tuesday, November 11th, 2008
Experts call for clearer difference between euthanasia and AMD
By Imelda Saad/Julia Ng, Channel NewsAsia | Posted: 10 November 2008
SINGAPORE : Doctors, caregivers and religious groups in Singapore have said there is a distinct difference between euthanasia and the Advanced Medical Directive (AMD) which the Health Ministry wants to simplify.
While the AMD extends a person’s autonomy on how he would like to die, euthanasia is seen as an act of killing.
As Singapore’s population ages, the country is in the midst of a debate on how one can die with dignity. At the centre of it is the Advanced Medical Directive.
The Health Ministry is studying how to make it easier for people to sign up for the AMD - a document, where you can explicitly state how you want your final days to be, if you are terminally ill.
The issue now is a confusion between what is AMD and what is euthanasia.
Singapore’s Health Ministry has stressed there has been no proposal to legalise euthanasia.
Experts said it is all in the definition. They said signing the AMD to say you would rather have the plug pulled - than be kept alive by machines if you are terminally ill - is not euthanasia.
Dr Chin Jing Jih, Executive Director, Centre for Medical Ethics and Professionalism, Singapore Medical Association, explained: “A lot of times, people think that when doctors switch off these life support systems, it is as if it is that act of stopping that kills the patient.
“But in actual fact, it is not. It is the underlying disease that has killed the patient. We are merely removing an intervention that is no longer effective on the patient. Emotionally, it looks as if that act has ended the patient’s life but it is actually the underlying illness.
“We know that if we do not remove the life support, the patient will perish too in a matter of days. That is not euthanasia because if we remove these cumbersome machines and the patient is still alive, we accept that and we palliate the patient.
“But if it is euthanasia, I remove the machine and the patient is still alive, then I would say… what else do I have to do to make sure the patient dies. So the intent is very clear. When doctors remove these machines, death is foreseeable, but it is not intended, so we make that ethical decision and intent is central to euthanasia.”
Experts believe the AMD is not a slippery slope towards euthanasia. Doctors said a key issue is in ensuring optimal palliative care to ease the pain of patients.
Dr Cynthia Goh, head, Palliative Medicine Department, National Cancer Centre Singapore, said: “Palliative care includes care that takes care of physical symptoms and physical pain, but we also do a lot of psycho-social support, which is to support the person emotionally and to sustain hope.
“Much of it is about treating that person as a person… showing that person that he is worth something, and he will also be worth something provided that he is alive.
“And showing respect and showing that we are there for them and we won’t abandon them - I think these are common things that people are afraid of, and they say, ‘I would rather be dead before I am abandoned or before the pain becomes unbearable or before my suffering becomes unbearable’.
“But if we can encourage them and say we would do our best to ensure that it does not become unbearable and we will stand by you, very often people will feel encouraged and they generate a little hope for themselves to say that things can get a little bit better.”
Another point medical professionals agree on is that if euthanasia is allowed, then doctors should not be the ones administering death because it affects the integrity of the profession. Instead, euthanasia should be done by trained personnel.
Major religious groups in Singapore are also strongly against euthanasia, saying it is tantamount to killing.
Condemning the act as “diminishing the value of human life” has been the National Council of Churches of Singapore, NCCS, not NCSS (National Council of Social Service) which Primetime Morning had erroneously attributed a statement to about euthanasia.
While both the Singapore Buddhist Federation and the Islamic Religious Council of Singapore say they see euthanasia as tantamount to the act of killing, it remains a grey area for Hindus.
However, it is a grey area for Hindus. Channel NewsAsia understands that the terminally ill can choose to fast till death or refuse medical treatment, but subject to certain conditions. These include getting the blessing of the family and so long as the dying process is unaided.
Meanwhile, all four religious groups support AMD. The Buddhist Federation said that in AMD, “the patient is dying in a natural way as no device is used just to prolong his/her life”. - CNA/ms/sf
