Assisted Suicide: probably going to be the next hotly debated issue in Singapore. As of today, there are some growing voices… wanting the right for Assisted Suicide and arguing from the rationale of autonomy – that the Self has the right to end its own existence and this restore dignity to the dying person. This is especially so since terminal illness could ravage the body in such terrible ways that the only real relief is to end one’s existence before the disease could claim one’s life.
Intuitively, if Assisted Suicide is adopted in Singapore, I truly wonder if we are really becoming more progressive as a society or is this ultimately regressive.
1. The need for Assisted Suicide reflects a failure in the Palliative Care System
According to World Health Organization (WHO), “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Palliative Care ‘approach’ was constructed to deal with end-of-life suffering – not just physical pain, but through the concept of Total Pain (Physical, Psycho-Emotional, Social or Spiritual Pain). Hence, if Assisted Suicide gets accepted in our society, it simply reflects a major failure of the Palliative Care movement because killing yourself becomes a pretty much attractive alternative. Regardless of how we define dignity in death – the point of having to kill yourself insofar as to obtain this ‘dignified death’ simply render all conversations about personalize care, providing relief on suffering and allowing natural death completely meaningless.
The value of palliative care has to be more attractive – whether it is to reconcile relationship, seeking self-forgiveness, creating legacy or having more humane pain-free death.
2. Conflicting values for society
All major religions in Singapore probably have some kind of religious doctrines against taking one’s life intentionally. Even in secular Singapore, by legislation, it is also illegal to attempt suicide. Hence, the introduction of Assisted Suicide would result in conflicting values – that’s the reason why it is illegal to kill yourself because the decision to end one’s life doesn’t solely account on one’s autonomy/rights alone. There are also other equally important factors, such as the impact on others and its implied meaning behind legislative. The state is unable to remain neutral if it chose to endorse Assisted Suicide because the act of endorsing already suggested the side that the government decides to align with – it is an implied alignment. This contentious and politically sensitive matter will surely surface itself in time to come.
3. It is politically and practically challenging to administer in ways that we would like it to work
Politicians would find it difficult to implement this policy as there will always be this conspiracy theory of the government trying to employ cost-benefit analysis to ‘reduce financial burden of the sick in our society’ by masking this intention through legislation of Assisted Suicide. In the long run, politicians will face challenges from conservative groups in Singapore and this may cost votes.
Medically, it is also tremendously difficult to discern if the choice is made purely on self-autonomy or is it simply chosen because the person is depressed. Surely, people will be depressed some ways or another when they are experiencing functioning decline or multiple losses (even if they may not be clinically diagnosed). In fact till now, we don’t really know very much about the real nature of depression – its real cause. The common consensus now is that it is a composite of both nature and nurture – that’s about it.
Socially, would this be a slippery slope? We do know that there are a multitude of factors that bring about depression – not necessary just about the dying process. We have conducted an internal analysis of a depression risk screening done for seniors aged 50 years and above (sample size of 452) and it is honestly no surprise when we found out that the risk of depression is primarily predicted by lower level of Housing Ownership based on a Matrix we have created. In layman term, the ‘smaller’ the size of your housing, your risk of depression increases (especially those living in rental HDB flats). At some level, we could safety conclude that one’s financial ability also allow you some degree of control and how we could also solve some of life’s practical challenges easily. If you are poor, you have fewer choices and options. It also limits your ability to resolve certain practical challenges.
Would that mean in the long run, people at the bottom 20% percentile will be more inclined towards Assisted Suicide because they have ‘less to live for?’ What would become of our society then? At this juncture, we have little answers for these hard questions.
I am neither pro-life nor death; realistically, death does offer some level of escape from life’s inherent struggle to a certain degree. However in introspection, how we manage our dying also reflects the state of our society. There are many paths to relief suffering – we need to consider options that will not inevitably create some kind of monster for us to manage in the future. Legalizing Assisted Suicide may potentially breed an insidious monster.