Tuesday, November 11, 2008

Mercy-Killing Debate

06 November 2008 1259 hrs (SST)
SINGAPORE: It would be a mistake to see euthanasia, voluntary or otherwise, as an act that affects only the individual patient and their families, said the National Council of Churches of Singapore (NCCS). Days after the Archbishop of Singapore condemned euthanasia in an open letter to Catholics and priests, the council, too, has joined in the growing public debate in the media, yesterday releasing a strong statement decrying the act of so-called mercy killing. Legalising and accepting the act, the NCCS warned, would have serious consequences for society, creating a “euthanasia mentality”. “Death becomes the solution to many social ills. Just as abortion is seen as the answer to ‘problem or unwanted’ pregnancies, so euthanasia becomes the solution to pain and suffering,” said the association of Singapore churches and Christian organisations. This would “very subtly” impress upon the elderly and dying that “it is their ‘duty to die’” and “diminish the value of human life itself”. The issue of euthanasia was last month highlighted by Health Minister Khaw Boon Wan as an ethical “dilemma” Singaporeans had to confront as the population aged. The proposed changes to encourage more Singaporeans to make an Advanced Medical Directive (AMD) have been seen, by some, as condoning euthanasia — even though the AMD Act clearly states it does not “condone, authorise or approve abetment of suicide, mercy killing or euthanasia”. The NCCS said euthanasia, which it described as “societal killing”, would “open the door to serious abuses that would threaten the rights and dignity of persons and society”. Like the Archbishop’s letter, its statement likened euthanasia to suicide, both — as acts of terminating human life — prohibited by their teachings that consider life sacred. “Human beings do not have the right to die,” the NCCS maintained. Euthanasia also went against the Hippocratic oath taken by doctors. “The duty of the physician is not merely to ‘minimise suffering’ but always to ‘maximise care’.” Similarly, society should “care for those who are suffering and those who are dying”, given that “there is strong evidence to suggest that patients whose symptom and pain control has been inadequate often request for euthanasia” — and that such requests usually cease after proper care is administered. “More funds should therefore be directed at the establishment of hospices, the training of physicians and nurses, and research in palliative medicine and symptom relief techniques,” said the NCCS. Mr Khaw has already called for more discussion on issues like AMD and palliative care to better care for the dying in Singapore. Among other things, the ministry is supporting the expansion of hospice care in the community, and extending palliative care to address the needs of the dying person’s relatives. A scheme to bring palliative care in nursing homes is also being piloted. - TODAY/sh

Experts call for clearer difference between euthanasia and AMD

Experts call for clearer difference between euthanasia and AMD

10 November 2008 1956 hrs (SST)

SINGAPORE : Doctors, caregivers and religious groups in Singapore have said there is a distinct difference between euthanasia and the Advanced Medical Directive (AMD) which the Health Ministry wants to simplify. While the AMD extends a person's autonomy on how he would like to die, euthanasia is seen as an act of killing. As Singapore's population ages, the country is in the midst of a debate on how one can die with dignity. At the centre of it is the Advanced Medical Directive. The Health Ministry is studying how to make it easier for people to sign up for the AMD - a document, where you can explicitly state how you want your final days to be, if you are terminally ill. The issue now is a confusion between what is AMD and what is euthanasia. Singapore's Health Ministry has stressed there has been no proposal to legalise euthanasia. Experts said it is all in the definition. They said signing the AMD to say you would rather have the plug pulled - than be kept alive by machines if you are terminally ill - is not euthanasia. Dr Chin Jing Jih, Executive Director, Centre for Medical Ethics and Professionalism, Singapore Medical Association, explained: "A lot of times, people think that when doctors switch off these life support systems, it is as if it is that act of stopping that kills the patient. "But in actual fact, it is not. It is the underlying disease that has killed the patient. We are merely removing an intervention that is no longer effective on the patient. Emotionally, it looks as if that act has ended the patient's life but it is actually the underlying illness. "We know that if we do not remove the life support, the patient will perish too in a matter of days. That is not euthanasia because if we remove these cumbersome machines and the patient is still alive, we accept that and we palliate the patient. "But if it is euthanasia, I remove the machine and the patient is still alive, then I would say... what else do I have to do to make sure the patient dies. So the intent is very clear. When doctors remove these machines, death is foreseeable, but it is not intended, so we make that ethical decision and intent is central to euthanasia." Experts believe the AMD is not a slippery slope towards euthanasia. Doctors said a key issue is in ensuring optimal palliative care to ease the pain of patients. Dr Cynthia Goh, head, Palliative Medicine Department, National Cancer Centre Singapore, said: "Palliative care includes care that takes care of physical symptoms and physical pain, but we also do a lot of psycho-social support, which is to support the person emotionally and to sustain hope. "Much of it is about treating that person as a person... showing that person that he is worth something, and he will also be worth something provided that he is alive. "And showing respect and showing that we are there for them and we won't abandon them - I think these are common things that people are afraid of, and they say, 'I would rather be dead before I am abandoned or before the pain becomes unbearable or before my suffering becomes unbearable'. "But if we can encourage them and say we would do our best to ensure that it does not become unbearable and we will stand by you, very often people will feel encouraged and they generate a little hope for themselves to say that things can get a little bit better." Another point medical professionals agree on is that if euthanasia is allowed, then doctors should not be the ones administering death because it affects the integrity of the profession. Instead, euthanasia should be done by trained personnel. Major religious groups in Singapore are also strongly against euthanasia, saying it is tantamount to killing. The National Council of Churches of Singapore has condemned the act as "diminishing the value of human life", while both the Singapore Buddhist Federation and the Islamic Religious Council of Singapore see euthanasia as tantamount to the act of killing. However, it is a grey area for Hindus. Channel NewsAsia understands that the terminally ill can choose to fast till death or refuse medical treatment, but subject to certain conditions. These include getting the blessing of the family and so long as the dying process is unaided. Meanwhile, all four religious groups support AMD. The Buddhist Federation said that in AMD, "the patient is dying in a natural way as no device is used just to prolong his/her life". - CNA/ms

Mosque has been his home for 5 years - Mosque has been his home for 5 years

By Genevieve Jiang
November 11, 2008

HOMELESS people, abused maids, troubled foreign workers, the elderly destitute, and even tourists who cannot find a hotel room for the night.

HOMELESS: Mr Awang Mustakim. TNP PICTURE: MOHD ISHAK
They may sound like unlikely room mates. But they all seek refuge at the Darussalam mosque on Commonwealth Avenue West, Singapore's only 24-hour mosque.
Said the mosque's executive chairman, Mr Abdul Mutalif Hashim: 'We get five or six requests every month from people who walk in asking for a roof over their heads.
'We do not provide permanent shelter, but we cannot turn away people who need help.
'We usually let them stay a few days, or up to a week or two, until we can refer them to relevant welfare organisations.'
But the mosque has made an exception for one man.
Mr Awang Mustakim, 73, has been staying at Darussalam for the past five years, making him the mosque's longest-staying resident.
The old man is a familiar sight there, often walking around with a small black bag slung across his shoulders.
In it are all that he owns - a shirt, a pair of pants, an old transistor radio, some toiletries, medicine, a second-hand handphone with a pre-paid card, and his personal documents.
Mr Awang has diabetes and kidney failure.
Because of his age and illness, he cannot work. He survives on $270 given to him every month by the Islamic Religious Council of Singapore (Muis), and another $50 given to him by his son.
Mr Awang, who is divorced and has four grown-up children, is rarely in touch with his family.
The last time he saw his children was during Hari Raya last year, when he visited his daughter at her Tampines home.
His family does not visit him at the mosque.
Mr Awang said he spends most of his days at Changi Airport, watching planes fly by.
He said it takes his mind off his unhappiness.
Said Mr Awang in Malay: 'Sometimes, as I watch the planes, I talk to myself about how I ended up in such a state.
'It's my fault. In the past, I worked irregular hours and was never there for my family. I could not give them a stable income. That is why I am estranged from them today.'
Mr Awang declined to give more details of how he fell out with his family.
He told The New Paper that he was a fireman in his younger days.
He then became a contract safety officer.
He said that in 1993, he became a security officer, but resigned after he got diabetes in 1998.
He tried to look for other work, but was unable to get a stable job, he said, and started doign odd jobs.
In 2001, he discovered he had kidney failure and started going for for dialysis twice a week at a private clinic. This cost him $700 amonth.
He did not know about subsidised treatment at the National Kidney Foundation (NKF) at the time.
To pay his medical bills, he sold his four-room flat in Woodlands, where he was then living with his wife.
His two sons and two daughters, all intheir 30s, had married and moved out by then.
He moved in with one of his daughters at Tampines and stayed for about two years, while his wife moved in with their other daughter.
Clash with family
But Mr Awang said he could not get along with his son-in-law and decided to move out.
He approached Muis for help and asked to stay at the Darussalam mosque.
Initially, staff at the mosque tried to help the family reconcile, but they could not work out their differences.
Said Mr Mutalif: 'After he had stayed with us for some months, we got in touch with his family and his children came to visit him at the mosque.
'They wanted to take him home, but he refused. Mr Awang said he didn't want to be a burden to them. And maybe it's because of his age and illness, he said he wanted to be near God.'
When Mr Awang moved to the mosque, his savings had already run dry. That was when he decided to stop having dialysis.
Said Mr Awang: 'I endured for two weeks until I fainted suddenly one day. I was sent to the intensive care unit at the National University Hospital (NUH) for a few days.'
But when he was discharged, he again skipped dialysis for another week. He collapsed a second time at the mosque.
When he blacked out a third time, doctors at NUH recommended him to the NKF, where he could get free dialysis.
These days, he goes for dialysis at NKF's Tampines branch three times a week.
He currently owes NKF about $1,700 in fees, but the welfare group has agreed to absorb his bill.
Mr Awang spends his days at the airport, walking around the neighbourhood, or resting at the mosque.
When he runs out of money, he approaches hawker centres, asking if he can help wash dishes in exchange for a free meal.
Sometimes, he asks devotees at the mosque for donations.
Son gives cash
Every month, he gets a call from his son to collect $50 from his letter box at Bedok.
Mr Awang refused to let us speak with his family for this report, saying he didn't want to burden them.
But Mr Mutalif and the executive director of a help group for men, the Adam Association (Association for dedicated and active family men), Mr Izuan Rais, confirmed his story.
The Adam Association helped Mr Awang with food rations and $100 food vouchers last month. Mr Izuan is also helping him look for a rental flat, and to get other forms of financial help.
Said Mr Awang: 'I don't have any wishes or hopes. I just want to live out the rest of my life quietly, and not give my family any trouble.'

(From The New Paper)

Why can't we live and let die?

By Jazmin Kelly Six
November 11, 2008

ONE would not allow an animal to go through what I have endured.
That was Chantal Sebire's cry in March, for her right to depart peacefully after getting, eight years earlier, a rare form of cancer that left her blind and in intense pain.
The 52-year-old woman in France also had to endure the humiliation of children fleeing on seeing her severely disfigured face.

Her plea was denied. Two days later, she died an unnatural death at home.
Isn't it perplexing that while we can actively ease the pain and suffering of a beloved pet dog (by euthanasia), we cannot grant a fellow human being the same repose?
Pro-life and religious advocates can disagree, but with my birth comes my right to live and, consequently, my right to die.
Make no mistake, I do not condone suicide as an escape from life's problems. I value life deeply, but above all, I am pro-choice. I campaign for the freedom to live as I desire and the right to be granted a coup de grace should the need arise.
All life is sacred, you say, and to end one's life is immoral, voluntarily or not. What then does this make of the executioner standing at the gallows?
In relation to the practice of capital punishment, doesn't the pro-life stance on euthanasia seem hypocritical? We take away lives because of crime but we deny a sick man's crimeless right to do the same for himself.
To quote Ramon Sampedro, a 55-year-old quadriplegic who fought 29 years but failed to be granted his death wish, 'A life without freedom is not a life.'
Unable to move his body from neck down after a diving accident, he called himself 'a live head stuck to a dead body'.
He was eventually relieved after friends gave him a lethal cyanide potion on his request. The story of his battle was later made into a movie named The Sea Inside.
The true accounts of Ms Sebire and Mr Sampedro point to the same conclusion: Little can be done to deter one when the mind is set on dying.
Yes, we need to protect the weak from predators who nudge them to die for private gain or convenience.
But for others of sound mind, give them freedom of choice.
Life is a right, not an obligation.
Give the medically suffering what they own - their right to decide their own fate.

(This article is taken from The New Paper - 10th Nov 2008)

Monday, November 10, 2008

What set me thinking about this topic?

I was driving home after visiting my mother who was hospitalised a few days earlier with a bad cough...

But you see ...she is already in her 80s and has been bedridden for several years and has gone senile. Ever since she retired from teaching to look after her grandchildren she has been house bound with practically no social life of her own. Since the kids have grown up one by one and they no longer need her attention...and the passing away of my father from stroke she only have my unmarried sister for company. Then my sis too was called away by cancer leaving poor mum alone with a maid to look after and keep her company.

So as she aged, her eye sight gave way and she could no longer read the papers or watch TV. Slowly her strength also left her and she could no longer cook for her extended families or take walks around the neighbourhood. So as the years pass by she just lost interest in life, resigned to a vegetative state in bed. Her eyelids have grown so heavy that she cannot even open her eyes!

No doubt she has to swallow a handful of pills every day...for this or that ailment...but she is relatively healthy with a strong heart that refuses to give way...But what is life without the ability to live???

Then there is my mother-in-law. She is in her 90s and also bedridden! Has been so for the past 2 years. She too was in relatively good health...could go to the market and cook for her children and their families right up to the day she suffered a minor stroke. From that day onwards her life went downhill. From weakness in her legs, couldn't walk to couldn't get up from bed...bedridden and soon the mind too began to go. Again her strong and healthy heart refuses to give up on her!

Two healthy and fiercely independent women reduced to 2 lumps of flesh totally dependant on others for all their needs...suffer the indignity of having others to feed you, wash you, change for you, wear pampers like babies....So sad...

So I began to ask myself...Do I want to live until nature (or God) decides its time for me to die? Why do we not have the right to die just as we have the right to live? Is it not better that we be allowed to decide when we are tired of living and are able to plan our death in the way we want...with dignity!