http://magbytes.blogspot.sg/2008/10/doctors-are-against-euthanasia.html
Saturday, October 25, 2008
doctors are against euthanasia
Dr Noreen Chan, 42, medical director of Dover Park Hospice and consultant at the National University Hospital
'I personally am against euthanasia. Also, the World Health Organisation's definition of palliative care states, among other things, that palliative care 'affirms life and regards dying as a normal process' and 'neither hastens nor postpones death'.
What is palliative care?
Palliative medicine is about improving the quality of life of patients with terminal illnesses such as end-stage cancer and advanced organ failure.
It involves managing pain as well as the social, emotional and spiritual needs of the patient and his relatives.
Our response to suffering should be first to acknowledge it, then try to relieve the suffering, rather than to remove the sufferer.
I feel very disturbed when people talk about euthanasia in Singapore. I do not think any society should make euthanasia available when it cannot ensure equal access for all its citizens to pain relief and palliative care.
I am not saying that we can relieve all suffering, or that with palliative care, no one will ask for a hastened death. But if we have not ensured that we have done everything we can for the people and their families who are suffering, and have safeguards to protect the vulnerable and the marginalised, allowing euthanasia could be open to abuse.
Only very few patients express a wish to die sooner. Of those, only a small proportion ask for euthanasia - which is usually expressed as a lethal injection. For example, they may say: 'Doctor, can't you give me an injection so I can go off?'
The wish for a hastened death fluctuates. Most people don't have a sustained desire, and the wish to die faster may be associated with factors such as bad pain or other symptoms, the fear (often unfounded) of unbearable suffering, which are all issues that we can deal with effectively.
Of course, we must be careful that we aren't missing major depression, which is treatable and could be a reason for someone wanting to die.
I don't think people have a problem with the issue of death. We all know one day we will be no more. But it would seem that many people have problems with the process of dying - becoming weaker, more dependent, needing help for even basic needs.
And what are the main reasons for people wanting to die? Not pain, or breathlessness, but losing autonomy, losing the ability to engage in enjoyable activities and losing dignity. There's no medicine for that kind of problem, because it's a state of mind.'
Dr Cynthia Goh, centre director of Lien Centre for Palliative Care and head of department of palliative medicine at the National Cancer Centre Singapore
'I personally disagree with euthanasia and would be against it being allowed in Singapore. This is because we have too many frail and vulnerable people in Singapore whose voices may not be heard properly, and who may become victims of non-voluntary euthanasia.
Also, I am worried that people who are old and sick, who already feel that they are a burden to their families and to society, would ask for euthanasia, not because they wish to die, but because they feel that it is their duty to die.
I often hear patients expressing a wish to die. But they are not asking for euthanasia, and we must not mistake it as such.
Often, it is an expression of sadness, a way of sharing and ventilating their frustration or grief. They often feel better after they have shared their feelings and find the wish to live on a bit longer. Sometimes, finding someone who will listen to the expressions of their hearts is enough encouragement to find a reason to live.'
Dr James Low, 43, senior consultant and head of department of geriatric medicine at Alexandra Hospital
'I disagree with euthanasia because it goes against one of the most fundamental principles of medicine, which is first and foremost to do no harm.
To me, ending someone else's life is the worst harm that can ever be done to another person, what more to a vulnerable population such as the sick, elderly and dying.
It is unthinkable that the profession that takes pride in healing, curing and comforting life be also the one that takes it away. It reminds me of the proverbial wolf in sheepskin, except that now the sheepskin is the white coat.
Countries that legalise euthanasia have set conditions for it to be implemented. For instance, they require patients who request euthanasia to be above a certain age, mentally sound, suffering from a terminal condition, suffering - and most importantly, it has to be voluntary.
Unfortunately, these conditions have on occasion not been met. Can euthanasia always be voluntary? Involuntary euthanasia is murder.
Legalising euthanasia would also set off a slide towards widening its applications, so that certain groups may feel a duty to be killed or coerced into requesting it.
Many patients do not know the implications when asking for death. Many are in utter misery and desperation from uncontrolled pain (physical, emotional, psychological and spiritual). What these patients require more than anything else is palliative care - the speciality that manages the person holistically. Many patients who request euthanasia are depressed and their expression of a desire for euthanasia is actually a cry for help from their loved ones, their nurses, doctors and society.
Patients would want euthanasia if they thought that they would die without dignity, in pain and suffering and in total abandonment and there is no other way out. They would want euthanasia if they thought that this is what society wanted of them (if euthanasia is legalised).
It also has to do with what value we put on life. As it is now, suicide rates are rising - this is also a reflection on how we value life. We really have to teach our young important life skills and why life is so precious.
Many people requesting euthanasia do not realise the implications of this not only for themselves but also for their loved ones, the professional carers and society.
Euthanasia, in a way, is an expression of an individual's right to self-determination. This is patient autonomy and is another very important principle of medicine. However, many believe that autonomy is never absolute. My autonomy does not give me the right to take another person's life, neither does it give me the right to take away my own life. This is why suicides in Singapore are not allowed.'
Dr Tan Yew Seng, 42, medical director of Assisi Hospice
'I do not think that euthanasia should be legalised in Singapore. The legal and ethical issues can be complex and may be difficult for the general public to understand.
There are hospice patients who request the doctor to assist in ending their lives. This, however, tends to represent a 'cry for help', a distress call as a result of physical, emotional or spiritual suffering.
We know that for the majority of them, after we take steps to treat the suffering, such as by treating their pain, bodily distress or depression, the patients no longer express the need to hasten their death.
When patients are able to perceive that the only solution to their suffering is death, they will ask for it.
Therefore, instead of accepting the face value of the request for euthanasia as an individual right, as it is couched in many places, our approach should always be to offer other options to patients to help relieve their suffering.
With choice, almost all patients will choose life instead. Incidentally, enabling patients to live on by managing their suffering is a key tenet in palliative and hospice care.'
Dr Ang Peng Tiam, 50, senior oncologist and medical director of Parkway Cancer Centre
'I do not agree with active euthanasia. I think it is morally wrong. As a doctor, my duty is to save life and not to take life away. If indeed our society wants euthanasia, then let society decide how to carry it out. It should not be put in the doctor's hands.
Doctors can guide you on medical conditions, like for instance, declare that someone is terminally ill. But the act of killing someone is not for us to carry out.
To me, euthanasia is a cheap option. We should be able to relieve the pain of the dying to help them allow nature to take its course. The heart of the issue now is that we are not offering patients enough support as it is very costly and time-consuming.
Patients want love and care. People who want euthanasia are people who are in despair. They may not have family or community support. It is similar to people who commit suicide. They do it because they feel there is no hope.
I don't think the issue of euthanasia is adequately discussed in Singapore. It is certainly not an issue that the Government should decide, but rather, society should take the responsibility to decide.
I think we should go very, very slow with euthanasia and discuss
