Euthanasia is known as mercy killing. It is chosen death chose by terminally ill patients. It refers to the practice of ending a life in a painless manner. It may be volunteered, physician assisted or without consent. The use of Euthanasia has been in a centre of controversy for many years. Few countries have legalized Euthanasia. They are the Netherlands, Switzerland ( physician assisted suicide only ), Belgium and US ( Oregon ).
In Holland, in the event that a doctor has to perform Euthanasia on a patient, he or she can defend him or herself if theses conditions are fulfilled. The conditions are :-
1.) The request for Euthanasia must come from the patient and must be entirely free and voluntary.
2.) The patient’s request must be well – considered, durable and persistent.
3.) The patient must be experiencing intolerable ( not necessarily physical ) suffering, with no respect of improvement
4.) Euthanasia must be the last resort. Other alternatives to alleviate the patient’s situation must have been considered and found wanting.
5.) Euthanasia must be performed by a physician.
6.) The physician must consult with an independent physician colleague who has experience in the field.
In Singapore, Euthanasia is illegal but Singaporeans can still sign the Living Will if they wish not receive treatment if they become terminally ill and death is imminent. By signing the Living Will, patients authorize their physicians to remove them from the life support machine or stop taking measures to keep them alive . Relatives cannot stop the physician from carrying out the instructions requested by their patients once they sign the living will.
There have been a lot of debates on whether Euthanasia should be carried out on a terminally ill person. Some people support the use of Euthanasia some do not. The various debates that have been laid on the table regarding the use of Euthanasia are :
1.) It should not be done because only God has the right to take one’s life away.
2.) Will a terminally ill patient choose Euthanasia to end his or her life in order not to place any financial burdens on his or her family?
3.) Will a doctor take his or her own initiative to decide whether a person should die or not? This is in the case where an incompetent patient due to his or her own illness is not able to make any decision in how to relieve his or her own intolerable suffering
4.) Will a patient choose Euthanasia due to physical disorders?
5.) Will a patient choose Euthanasia because he or she thinks that he or she would die in dignity if they choose it?
6.) Do relatives have any say in deciding whether a terminally ill person should die by Euthanasia?
I shall address these issues one by one.
It should not be done because only God has the right to take one’s life away.
Euthanasia is rejected by various religious organizations. I will concentrate on Christanity, Islam, Judaism, Hinduism and Buddhism.
Christianity
The three major monotheistic religions of the world – Christianity, Islam, and Judaism – all have definite theology related to issues of death and dying. Christianity is the largest of these
and, in fact, the largest religion in the world. Although Christians may be divided in many ways over issues of theology, they do hold the same core values and beliefs. One of these is that there
is an afterlife in which believers will spend eternity with God. Although there may be dissention over smaller matters, in issues of life and death, there tends to be more common ground. Sickness, suffering, and death are viewed by many Christians through their understanding of Christ’s suffering and death on the cross and his subsequent resurrection. Christians also believe that God participates in the affairs of humanity, another tenet that informs their views of death and dying. The New Testament teaches that one’s body is the temple of God, so most Christians believe that life is sacred, although not necessarily to be preserved at all costs. For example, in questions of withholding or with drawing treatment, the official position of the Roman Catholic Church is that there is a distinction between ordinary measures (i.e. those medical treatments that are intended to preserve life such as medicines, treatments, and operations that offer reasonable hope for preserving life and that can be obtained without excessive
expense, pain, or other inconvenience) and extraordinary measures (i.e., medicines, treatments, and operations that do not offer reasonable hope of preserving life and which cannot be obtained without excessive expense, pain, or other inconvenience). There is, of course, no list of procedures that easily fall into one category or another; all such treatment needs to be made with informed consent on an individual basis by the patient or family. For example, a feeding tube or mechanical ventilation at one stage during the course of a disease or illness may provide
sufficient time for other measures to take affect and enable the patient to life; given at another time, however, it may only preserve existence with no hope of recovery.
Islam
The second largest (and youngest) major monotheistic religion is Islam. Although Islam has legal rulings or fatawa (sg., fatwa) about life and death issues such as organ donation and euthanasia,
there is not widespread agreement about these issues between Muslim jurists from different schools of Islamic law (Sachedina, 2005). In general, however, Islam teaches that death
comes to us all and that how we die is of importance. According to Muslims, God is both the origin and destiny of life so that life is therefore sacred. According to the Qur’an, death does
not occur except by God’s permission. Therefore, in Islam, it is necessary to do everything possible to prevent a premature death. The question of preserving life at any cost, however, is the subject of much debate within Islam. Although on the one hand there is the obligation to save or even prolong life, on the other hand there is the argument that one should limit life sustaining
treatment if there is a lack of resources. Further, in Islam, the decision of life-prolonging treatment is not the decision of the individual alone. Islam emphasizes the link between the welfare of the individual and his/her family and community. Decisions about whether or not an aggressive or invasive treatment can prolong life without causing further harm, therefore, is a matter of concern not only for the individual but for all associated with him/her. Regarding pain, the approach of most Muslims is to act in such a way as to alleviate pain through actively removing its cause. As in Christianity, the human body is seen as a temple of God. Therefore, Islamic law does not recognize a patient’s right to die voluntarily (e.g., suicide, assisted suicide, or other types of active human intervention). There are, however, exceptions to this general principle depending on the circumstances: Specifically, the administration of medication to relieve physical and mental suffering in a terminal patient that has the side effect
of shortening life or the withdrawal of futile treatment after informed consent (Sachedina, 2005).
Judaism
The smallest, albeit the oldest, of the major monotheistic religions is Judaism. As with Christianity and Islam, the Jewish religion holds that the body belongs to God. This means that human beings have the obligation to seek both preventative and curative medical treatment. However, as also with the other two religions, Judaism recognizes the fact that all human beings are mortal. Similarly, there is not widespread agreement across all
Jewish traditions about how this is to be interpreted. In addition, culture (in the form of country, generation, or family) may also affect the interpretation of these matters. Because the individual
belongs to God, Judaism does not condone suicide or the enlistment of aid to end one’s life. Judaism has its own criteria for determining death. Traditionally, these have been the cessation of breathing and heartbeat (although sufficient time must be allowed before burial to determine that this is a permanentcondition). After the development of the Harvard criteria forbrain death, Conservative rabbis accepted these criteria as fulfilling the traditional requirements. Criteria for the acceptability of withholding life-sustaining treatment varies, with the strictest
interpretation being the prognosis that the patient will die within 72 hours or less and more liberal interpretations allowing for withholding life-sustaining measures if the patient will
live up to a year or more. However, most rabbis view artificial nutrition and hydration to be the equivalent of food and liquids required by everyone to live, and require them to be used even
when other life-sustaining treatments are withdrawn. Regarding heroic measures, most view these as permissible as long as there is some hope of a cure; however, such measures are not
required and the decision is to be made based on the risk/benefit ratio, the patient’s best interests, and the patient’s desires. Jews are allowed to sign advance directives for health care to specify their wishes in such cases should they not be able to communicate their desires at the time. Pain control, palliative care, and hospice programs in which the goal is to make the patient comfortable but not to cure are all acceptable under Jewish tenets. Further, Jewish tradition holds it to be an obligation to visit the sick, treat them with respect, and pray for them. Ethical considerations continue even after death. Regarding autopsy and organ donation, the ruling principles are that the dead body should be honored as the property of God and that one has an obligation to save the lives of others. Because of the first principle, autopsies are not routinely performed unless required by civil law, three doctors agree that the cause of death cannot be otherwise ascertained, that the autopsy might helps save the lives of others with similar illnesses or that the results of the autopsy might be of benefit to surviving family members with a hereditary disease. These criteria, however, are debated. Although the donation of
cadavers to science or of organs to save others is permitted by most rabbis, there is also disagreement about the circumstances under which these actions are permissible.
Hinduism
Not every religion is monotheistic, however. In fact, the second largest religion of the world is Hinduism. Although this religion does not have an institutional framework or demand adherence
to particular doctrines, most Hindus do hold certain tenets in common that apply to death and dying. Most Hindus believe that a living being (either human or animal) possesses a soul that
moves on from one life to the next. In addition, most Hindus hold that there is a difference between a good death and a bad death. The former occurs in old age either on the banks of the sacred Ganges River or on the ground at home. (For this purpose, many Hindus keep a container of Ganges water to be offered to the dying person and placed on the lips of the corpse.) Hindus prepare all their lives for a good death and enter into it consciously and willingly.
A good death requires the correct rituals in order to speed the soul on its way. Bad deaths, on the other hand, are premature, violent, or uncontrolled, happening at the wrong place and time
(often signified by vomit, feces, urine, and an unpleasant expression). The worst type of death in Hinduism is suicide that happens for selfish reasons. There is a long tradition of voluntary death in Hinduism, typically where such an action is linked to a specific purpose such as gaining freedom. However, Hinduism makes a distinction between the willed death of an individual. Suicide for selfish reasons is considered to be morally wrong and cannot be sanctioned with the appropriate rites of death. Some Hindu authorities also argue that human beings should not take their own lives because of the karmic effect on the next life. In general, Hinduism stands strongly against involuntary euthanasia primarily because it goes against the principle of autonomy and can be easily abused. However, in all these matters, it is difficult to generalize the Hindu attitudes toward death and dying because they are highly correlated with education, class, and tradition.
Buddhism
Another major polytheistic religion (one, in fact, with more adherents than Judaism) is Buddhism. In this religion, the inevitability of death is recognized and emphasis is placed on the psychological preparation necessary to accept death with calmness and dignity. Buddhists place great value on mindfulness and mental clarity because they believe that it can affect the quality of their rebirth. This fact impacts their philosophy of dying. For example, some Buddhists may forego pain relieving drugs or sedatives so that their mental facilities can be unimpaired. The Buddhist definition of death involves the loss of three criteria: vitality, heat,
and sentiency. Although determining the loss of heat is a rather straightforward matter, determining the loss of the other two criteria is not, particularly given the tradition of yogic trance in which life signs may not be observable. On the other hand, there is no disagreement between Buddhist tradition and modern medicine on the status of patients in a persistent vegetative state: Individuals in this state are clearly alive according to both views. From
the Buddhist perspective, irreversible damage to the neocortex is no different than damage to another organ when making ethical decisions regarding treatment. This typically means that unless there are secondary complications, the person should continue to be given nutrition and hydration. Further, Buddhists do not believe in taking a life. Therefore, they do not condone suicide or the incitement of someone to commit suicide. This prohibition also extends to assisted suicide and euthanasia, even though these actions might spare the person unnecessary pain. On the other hand, due to the Buddhist belief in the inevitability of death, Buddhists do not condone attempts to prolong life beyond its natural span through technology, but encourage adherents to prepare to accept death calmly when it comes. This, however, does not preclude hospice or other palliative care.
Will a terminally ill patient choose Euthanasia to end his or her life in order not to place any financial burdens on his or her family?
Some older folks may choose Euthanasia if they become terminally ill. They may choose it as a way to relieve the financial burden’s of their family in looking after them. Their views were aired in a debate that was brought up by the Singapore government in whether they should legalize Euthanasia. At the present moment it is illegal but Singaporeans can still sign the Living Will to authorize their doctor to stop all treatment and let them die if they are terminally ill.
Readers wrote to Lianhe Zaboa calling for Euthanasia to be legalize. They claim that it is better for them to die in dignity when they are terminally ill. It will also be better for them to die in this manner instead of burdening their family members with high medical bills and care giving responsibilities.
My fear is that if Euthanasia is legalize in Singapore, the elderly may use it as an excuse to relieve their family financial burdens of taking care of them. Some family members may even encourage their elder family members to opt for Euthanasia. Why would they do that you may ask? Well there are two circumstances that may encourage some family members to encourage their elderly family members to opt for Euthanasia if they are terminally ill. They are:-
1.) As Singapore globalizes, the income gap between the rich and the poor will widen. Medical cost would increase. There will be those that will not be financially stable and will not afford the medical cost of looking after their terminally ill family members. They would encourage their elderly family members to opt for Euthanasia if they are terminally ill.
2.) As more Singaporeans become career minded, they may become self-centered and may neglect their elder family members. They may send them to the old folks home. They may become lonely and dejected in life. They may consider the use of Euthanasia when they become terminally ill because they will feel that there will be no one to look after them.
Therefore, even though I support Euthanasia, I think Singaporeans are not really ready for the legalization of the use of Euthanasia. I would encourage the government to create a way that would allow all Singaporeans to obtain medical insurance cheaply which would be able to cover their medical costs fully. Presently, Singaporeans can use their medi-shield to pay for their medical cost but it only covers 60% of the medical cost. If free medical coverage can be given to the British citizens in Britain, I do not see what Singaporeans cannot enjoy the same privilege.
The government always say that there is no free lunch in life but when it comes to medical care, I feel that the government has the duty to take care of the citizens and covering their medical cost fully is one way.
Will a doctor take his or her own initiative to decide whether a person should die or not? This is in the case where an incompetent patient due to his or her own illness is not able to make any decision in how to relieve his or her own intolerable suffering.
Critics have argued for the possibility of “ slippery slop” to Euthanasia without request. Doctors would be able to decide to perform Euthanasia on a terminally ill person without his or her permission. Doctors may deem them incompetent to make any decisions on their well being due to their nature of their illness. Doctors may thank that their decision to perform Euthanasia on their terminally ill patients is the best. They can also persuade their patient’s family members to agree with them on the use of Euthanasia.
According to Keown (1995) using data from the Remmelink Commission & Van Der Mass Survey :-
• Of the 1000 cases of Euthanasia performed without request : 14% were totally competent. 11% partially competent.
• Of the 8100 cases of accelerated death by palliative drugs, 60% of those indicated life termination were conmpetent.
• Of all cases where treatment was withdrawn or withheld without request, 11% were competent and 21% partly competent.
Therefore, there is a danger that doctors may make their own decisions on the life and death of their patients. Religious bodies like the Catholic Church are against these. Even though countries like Holland have strict guidelines in the use of Euthanasia, it may still be not enough to prevent doctors from making their own decisions on the life and death of their patient . The data above proves it.
Will a patient choose Euthanasia due to physical disorders?
There have been research that some terminally ill patients who choose Euthanasia had some psychological disorder.
A study was done by the researchers at the Oregon Health & Science University and found that 28 out of the 58 patients that were terminally ill suffered from depression and anxiety. They opted for physician assisted suicide or contacted an assisted death association. Of these 15 met the criteria for depression and 13 for anxiety. The number may be small but there is still a chance that the numbers may increase.
1.) Doctors may persuade them that by choosing Euthanasia they will have a dignified death.
2.) The terminally ill may find that it is the only solution for them.
However, is suffering from depression and anxiety a good excuse to choose Euthanasia? Is choosing Euthanasia a good way to die in dignity? I will address these issues in the next question.
Will a patient choose Euthanasia because he or she thinks that he or she would die in dignity if they choose it?
Some people define their quality of life according to how they can perform in life, serve society fruitfully and live a good life.
Examples of how people gauge how they perform in life are :-
1.) Their ability to take up sports.
2.) Their ability to support their family.
3.) Their ability to perform well in their job.
4.) Their ability to be recognized in society.
5.) Their ability to go on holidays.
6.) Their ability to do well in their studies.
However, once they are stricken down by a terminal illness or are born differently ( example without limbs ). They become depressed and may chose to die in dignity. There are some people even though they were born abnormally have found a way to overcome their depression and live in dignity. Here are some examples of how people have managed to overcome their difficulty & those who choose to end their life due to illness and depression.
One good example is Nick Vujicic. He is a 26 year old man who was born without limbs. He faced a lot of challenges. He even fell into depression when he was 8 years old. However, he found strength to survive. He attributed his strength to survive to God. God have given him a purpose to share his experience with other people who are experiencing depression due to loss of their limbs or born without them. He conducts seminars for them to encourage them not to give up on life.
Nick can now swim, do surfing and conduct talks. He has met some prominent people like Sir Richard Branson and Madeline Albright. He can now live in dignity.
However, there are other people who did not find the strength to survive like Nick. One example is Ramon Sampedro who was paralysed from a sea accident. He became depressed. He felt like he could not live in dignity. He asked his relatives to end his life. They refused. He then asked his girlfriend to feed him poison. There is a movie made about him. It is called the Sea inside.
Another example is Jean – Dominique Bauby. He was 43 years old and editor – in – chief of the world famous fashion magazine called Elle. He was living a good life. However, one day he suffered from Cerebro – Vascular accident which totally paralyzed him. He could not talk. He laid motionless but still could use his mental abilities. He only could use his left eye. He felt useless in life. Loss his dignity to live. Fell into depression. In 1997, he chose to die. A movie was made about his accident and life. It is called the Diving Bell and The Butterfly.
People may choose Euthanasia for different reasons. Reasons differ from people to people who have different belief value systems. Some are strong enough to overcome their difficulties and pain. Some cannot.
Do relatives have any say in deciding whether a terminally ill person should die by Euthanasia.
This question is basically a moral issue face by relatives of those who want to choose Euthanasia. Some relatives may be against the use of Euthanasia like in the case of Ramano Sempredo. However, in a country where Euthanasia is legalize, once a patient gives his or her consent to perform Euthanasia on him or her. Their relatives have no say in it.
In Singapore, where Euthanasia is not legalized, there is the living will for Singaporeans to sign in order to give their physicians authority to stop all treatment if they become terminally ill. If the will is signed when they are competent, accompanied by two witnesses, the will cannot be contested. 10,000 Singaporeans have signed the will.
Doctors may also persuade the relatives of terminally ill patients to let them carry out Euthanasia. They may persuade the relatives that it is the best way out.
Euthanasia is a very sensitive topic to debate on. There are a lot of issues to consider before Euthanasia can be legalized or performed. There is the issue of disapproval of Euthanasia by various religious organizations, whether Euthanasia carried out by doctors will be done ethically, whether relatives of terminally ill patients would have a say in the use of Euthanasia and whether Euthanasia would be carried out against the will of the person because he or she is incompetent to make any decisions.
If a country is going to legalize Euthanasia, then there should be strict guidelines in order to foresee the proper use of Euthanasia. Strict penalties must be imposed on doctors who perform Euthanasia unethically.
I do support the use of Euthanasia but I want it to be used properly and ethically. Doctors must obtain the permission from their patients to perform Euthanasia and family members must have a say in the use of Euthanasia on their terminally family members. It must also be used as a last resort.