EUTHANASIA

Column: 711

EUTHANASIA: 8.

Mdm Halimah Yacob asked the Minister for Health (a) how many countries in the world have practised euthanasia; (b) whether euthanasia is being considered in Singapore; and (c) instead of euthanasia, what more can be done to help Singaporeans better cope with end-of-life issues.

Mr Khaw Boon Wan: Sir, euthanasia is only allowed in Belgium and the Netherlands. In Switzerland and the US states of Oregon and Washington, doctor-assisted suicide is permissible, but not euthanasia. Both involve performing an act that leads to death. The difference is that while euthanasia allows for the doctor to perform the act, in doctor-assisted suicide, the patient performs the act himself and the doctor only provides the lethal prescription.

My Ministry is promoting Advance Medical Directive (AMD) and palliative care. AMD is about letting nature take its course for the terminally ill at the last stage of their lives. AMD is about not mindlessly postponing death through futile medical interventions. AMD is not euthanasia or doctor-assisted suicide. I do not think that Singaporeans are ready to accept euthanasia.

Instead, we should focus on providing good palliative care for the dying and getting people to think about and plan for

Column: 712

the kind of care they want at the end of their lives. Death should not be a taboo subject. There must be more public discussion about death and end-of-life matters. I therefore welcome the recent public debate about euthanasia. It has raised public awareness about palliative care and the frustrations of some terminally ill and their caregivers.

My Ministry will help the terminally ill cope better with end-of-life issues. First, we are working with the hospice and palliative care community to expand their capacity and to extend their reach. We will provide greater support to the dying persons and their caregivers, while managing their needs sensitively.

Second, we are getting more doctors and nurses to train in palliative care. Palliative care is now a medical sub-specialty and we will offer more training opportunities in it.

Third, we are working with nursing homes to consider providing palliative care and to help their residents with proper end-of-life planning.

Death is a certainty and while it is not welcomed, a good death, I assume, is the aspiration of all. A good death may not come naturally and proper advance planning is more likely to deliver one.

Mdm Halimah Yacob: The Minister is quite right in saying that there is a terrible confusion over the three different kinds of situations – the doctor-assisted death, euthanasia as well as AMD. Now that there is this confusion, I think this will stand in the way of people taking up AMD. What strategies and steps is MOH going to embark on in order to help resolve this confusion and push the agenda forward?

Secondly, I would like to ask what other assistance can also be provided to caregivers? The Minister outlined three

Column: 713

areas where attention will be given but there is not much said about how to assist caregivers to take care of those who are terminally ill.

Mr Khaw Boon Wan: I think the reply to the first query is more "DIE-logues". You just got to keep on talking and there is no short-cut to this. The more we talk about death and the dying trajectories, we will develop a more mature attitude towards this. And if we can overcome this squeamishness, I certainly hope to be able to amend the AMD so that doctors and providers of care can discuss end-of-life issues much more openly with their patients.

As for caregivers, I am aware of the pain and sufferings they go through. Indeed, in many areas of palliative care, attention is now extended to care for the caregivers too because, often, they themselves end up ill, either in parallel with the terminally ill or soon after death. So that is a level of sophistication in palliative care that I think we are still under-developed which we should begin to build into our palliative care programme.