Different approaches to a good and dignified death

Mr S. Ratnakumar called for palliative care to provide euthanasia for patients who would like to "die with dignity" (Room for both palliative care and euthanasia; Dec 20).

He thinks euthanasia could help terminally ill patients die peacefully and avert the traumatic experience of dying of dehydration or starvation.

In truth, as one nears the end of life, the desire and need for nutrition and water diminish.

Studies suggest that patients do not generally suffer at the end of life as a result of thirst and hunger.

The evidence also suggests that withdrawal or withholding of artificial feeding does not hasten death in dying patients.

If at all, this practice is conducted carefully with safeguards and only when the continuation of artificial forms of feeding is deemed futile and burdensome and causes suffering.

Although palliative care and euthanasia share the goal of a "good and dignified death", there are fundamental differences in how they seek to achieve this.

Palliative care's raison d'etre is to improve quality of life and provide relief from suffering; this being enshrined in the words of the late Dame Cicely Saunders, founder of the modern palliative care movement: "You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die."

In euthanasia, the intent is to "administer death" at request. It is a deliberate act that can erode the trust and undermine the therapeutic relationship between patient and doctor.

It is chilling to conceive that the hand that is meant to offer comfort, hope and relief can be the one that extinguishes life.

At a societal level, we need to be sensitive to the core values of Singapore, which respects the person's right to self-determination, but not the "right" to self-annihilation, whether by suicide or euthanasia.

Our communitarian and family-centric values hold that all have value, worth and dignity at whichever stage of their lives.

While these values estrange us from the practices of liberal Western societies, they continue, however, to align us with the vast majority of the world which continues to repudiate euthanasia.

Misunderstandings of concepts and the use of vague terms continue to pervade discussions about care at the end of life and perpetuate notions about the viability of alternative practices.

It is imperative that discussions continue among the key segments of society on how to proceed from here. Certainly, this will not be the last word on this emotive topic.

Lalit Krishna (Associate Professor) and James Low (Associate Professor)

Co-chairs, Ethics Advisory Committee Singapore Hospice Council

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A version of this article appeared in the print edition of The Straits Times on December 28, 2017, with the headline Different approaches to a good and dignified death. Subscribe