Sunday, November 9, 2008


This is Nov 2008… Euthanasia is such a hot topic in Singapore that the only other topic that shadows it is the global financial meltdown. Both are depressing and chilling…

What is Euthanasia? This word, from Ancient Greek means good death - "eu" for good and "thanatos” means death. Doctors are traditionally not keen on Euthanasia because of our oath to our patients - The Hippocratic Oath. This oath states : "To please no one will I prescribe a deadly drug nor give advice which may cause his death.." However, since the 1970s, it has largely fallen out of use.

The truth about euthanasia is that we have been practising this in Singapore for years but in a passive sort of way. Many old and or dying patients usually want to stop treatment and we do so by withdrawing medications that would treat the underlying conditions – this is passive euthanasia. This form of euthanasia is more accepted though there are relatives who still feel strongly against this.

What we are discussing now is active euthanasia – a way for sound minded people to decide when to die…

The key to the answer lies in our mind… These scenarios can happen and we should examine these before making an informed consent for euthanasia.

Scenario A

Mr U is 40 years old, decided that he will go for euthanasia after reading all about the topic. At 50 years old, he was diagnosed with cancer, given a limited life expectancy. He had consented for euthanasia 10 years ago but now, he wants to change his mind because he is scared. How is he going to explain to his loved ones this change of heart? Is he going to appear weak and cowardly? How do we create an avenue for people to opt out with dignity? Does this whole process minimise his pain?

Scenario B

Mr V is an 80 year old who has dementia. He can remember his loved ones but relies on them for activities of daily living. He wants to die because he is a burden and he is going to become worse. His family is reluctant as they have just received a new bundle of joy and do not want to spoil the mood. Who has the right to decide his death? Do they go to court to settle their differences? Does this process minimise pain?

Scenario C

Mrs U is a 60 year old with a terminal disease. She has had treatment but still has significant pain. She is tired of fighting for her life, she wants to die. Her family is not certain but tries to be supportive. She gets her wishes and planned her funeral, the make-up artist, the floral arrangement, the coffin. She felt very excited about all these arrangement. The D day arrived and everyone at home is awkward. Her working children took leave – to witness my mother’s death. No one in the office dared to ask them about their feelings. Are they happy? Are they sad? They feel uncomfortable. Mrs U wants to go ahead. She invites her children and husband to witness her ‘good death’ – they shook their head. She was alone with the doctor. She was walking up and down the flight of stairs. Finally, after a long 45 min of struggle…she …

This is the tensed moment, the auspicious hour and this story is true. In the real story, the patient chose finally to die. Her children who documented the whole event had some regrets but respected her decision. However, we can imagine if she chose to give up, they may even celebrate! But, with all the arrangements made, would these arrangements make her lose face if she changes her mind? Does the 45 min of struggle minimise her pain?

I think that euthanasia is fine – active euthanasia is also fine. However, there are too many details, too many scenarios. Euthanasia should not be equated to painless death. It cannot be… It can be a good death if patient family and all the loved ones feel that the decision is right and that I think is the challenge. My eight year old daughter listened to the Scenario C and commented… “I don’t want you to die like that…I am scared…The aunty was scared too… for 45 min”… my daughter paused …”Death no good, no good death”…she added, switching to her baby talk to show me how the story disturbed her…

There is probably no good death. Death is a permanent separation and a definite step towards unknown. For those with omnipotent powers by their side, perhaps this process is easier but there is no easy way out…

Dr Madeleine Chew Him Lim
MBBS (Singapore)
Senior Physician
MW Medical (Singapore)