Assisted Dying in Singapore — Should We Suffer in Silence?
Tian Kuang Kai
Assisted dying includes euthanasia and assisted suicide. The two are distinguished by who actually causes death – who commits the actus reus, if you will. Neither is legal in Singapore by virtue of the Penal Code1 Attempted suicide is an offence pursuant to s309, and read together with s107, abetment of an attempted suicide is also an offence. The question is whether or not this should be the case, and this article seeks to explore the issues, concerns and arguments regarding the state of the law.
At its root, the debate about assisted dying revolves around the two great competing principles of sanctity of life versus freedom of choice. However, it is not simply an exercise in arithmetic to decide which of these wins out and results in whether or not a specific act is legal. In fact, there are countervailing considerations to each of these two principles that complicate matters.
Sanctity of life can be overridden by what is deemed to be the best interests of a patient in a persistent vegetative state. This is the landmark case of Airesdale NHS Trust v Bland2 [Bland], where the House of Lords held that the artificial feeding of Mr Bland, a victim of the Hillsborough disaster who was in a persistent vegetative state after being injured, was allowed to be withdrawn, i.e. he was allowed to die. Crucially, their Lordships’ judgments recognized that the principle of sanctity of life is not absolute. Secondly, freedom of choice also gives way to other considerations. Baroness Campbell, in a letter to The Guardian3, said that “[a]ssisted dying is not a simple question of increasing choice for those of us who live our lives close to death. It raises deep concerns about how we are viewed by society and by ourselves.” She made the point that the very people whom the intended legislation (Bill Assisted Dying for the Terminally Ill [Bill]) was intended for did not support and in fact condemned the Bill. Her view stems from the fear that allowing such choice leads to the presupposition that the life of the disabled is somehow less worth living and would lead to a slippery slope of society further marginalizing the terminally ill and disabled.
However, this does not answer the concern of allowing choice for those who think that they need it. One of the strongest arguments, in my opinion, for the legalization of assisted dying is that death is at times a better option than protracted suffering. Further, there is an obligation to relieve our fellow man of suffering. In the words of Professor Stephen Hawking4, “[w]e don’t let animals suffer, so why humans?” The difficulty with this, of course, is that most medical practitioners swear under the Hippocratic Oath, in which they refuse to administer a deadly drug even if asked for. Thus, this brings us back full circle to the fragile balancing act required if assisted dying is to be legalized.
In Singapore, s3(1) of the Advance Medical Directive Act 5 provides that any person of 21 years and not mentally disordered may make an advance medical directive if he does not wish to be subjected to extraordinary life-sustaining treatment in the event of a terminal illness. This deals with situations such as that in Bland. In that sense, it is a very limited statute given that, while it does give some effect to personal autonomy, it does not go too far beyond the common law in terms of permissible actions of medical practitioners.
There are two potential ways forward: first, the decriminalization of suicide and second, the careful use of prosecutorial discretion. However, any change in the former would be met with at least the same considerations in the above. As to the latter, there would need to be clear and principled guidelines based on good legal or ethical reasons, as the Attorney-General’s Chambers safeguards the public interests and should not be seen to undermine parliamentary intention. As it now stands, it is unlikely that there will be any major changes to this area of the law in Singapore in the near future, but as Singapore’s population rapidly ages, it is anticipated that there will be greater public debate as regards the planning of one’s death.
[1] Cap. 224, 2008 Rev Ed
[2] (1993) AC 789
[3] Campbell, J 2006. ‘Stop trying to kill us off’, The Guardian, 09 May. Accessed at <http://www.theguardian.com/commentisfree/2006/may/09/comment.health> 28 September 2013
[4] Duffin, C 2013. ‘We don’t let animals suffer, says Prof Stephen Hawking, as he backs assisted suicide’, The Telegraph 17 September. Accessed at <http://www.telegraph.co.uk/science/10315476/We-dont-let-animals-suffer-says-Prof-Stephen-Hawking-as-he-backs-assisted-suicide.html> 21 September 2013
[5] Cap. 4A, 1997 Rev Ed