The Right to Die?

Dixie Wong was just 24 when she was diagnosed with leukaemia. Now after a decade of agonising treatment with no improvement in sight but just constant decline in her physical condition, she came to this conclusion:

“I’m sick and tired of the treatment because it is clearly not helping. The side effects are more unbearable than the disease itself. I hate my life and there is no reason to carry on living. In my sickness I have become a burden to my family and friends, taking so much of their precious time, funds and other resources. My life is so meaningless…I just want to have a quick death to end my miserable existence. I want to exercise my right to die with dignity and spare my parents, siblings and friends the agony of watching me suffer a slow and painful death.”

Since Dixie is convinced she has the right to die, the following are some possible scenarios:

❦ She takes her own life without help from anyone – then her death will be listed as suicide.

❦ She does not have the means to commit suicide, but someone helps her by providing sleeping pills, making it an assisted suicide.

❦ If she can’t end her life herself, and asks someone to end it painlessly, e.g. a family physician, it is voluntary euthanasia.

❦ If she lapses into a coma and is kept alive on a life support machine and someone in her family makes the decision to take her off the machine to allow her to die, then it is involuntary euthanasia.

❦ She sets up an Advance Medical Directive (AMD) to forgo any artificial means of prolonging her life. This AMD will then be enforced to allow her to die.

The above scenarios are the many forms that euthanasia can take. Euthanasia is a highly controversial topic with many legal, medical, moral and spiritual ramifications. Take
the legal standpoint for instance: all the above scenarios of dying except the last scenario are not legal in Singapore. From a moral standpoint, the last two scenarios would appear less controversial in that withdrawing or not setting up the life support machine is not a deliberate act of killing Dixie but rather, of letting her die. Yet many would argue that a life support machine should not be withdrawn on account of costs or withdrawn at all, since there is always a chance, however slim, that she might recover.

Is unbearable pain the only reason people seek euthanasia? Apparently not, according to the 2012 records of physician-assisted death in Oregon, USA, where euthanasia is legal. Pain and suffering accounted for only 29 per cent or less than a third of all requests for euthanasia. Other reasons cited for assisted dying include loss of autonomy, decreasing ability to participate in activities that made life enjoyable, loss of dignity, loss of bodily functions, burden on family, friends or caregivers, and financial implications of treatment.

The above are some of the same reasons that Dixie gave to insist on her right to die. Because life is precious, many will find it hard to accept Dixie’s conclusion that to die is, for her, the correct decision. Like many critically-ill patients contemplating euthanasia, Dixie suffers from depression, a treatable comorbidity. It is possible that depression is fuelling her current assessment of life. She may be crying out for help, instead of just pursuing a death wish. If provided with a combination of medicine, individualised care, counselling, and a new perspective on life, she may choose to continue living.

Dixie’s wish to end her life quickly is possibly shaped by her concern for her loved ones. She realises all too well the financial and care burden her prolonged illness has imposed on family and caregivers. From the family’s perspective, it is emotionally and physically draining for them to watch Dixie suffer, without chance of recovery, knowing that respite will come only in death.

The “right to die” is a misnomer as Ecclesiastes 3:1-2 tell us there is a time to be born and a time to die. Death is a certainty and most people would agree that when the time comes, they want a “good death.” So how do Christians prepare for a good death?

A good death for Christians is one left in the hands of God and it is therefore a natural occurrence in accordance to His will and timing. Euthanasia or assisted dying is not considered even in the face of pain and suffering because it can be controlled with the help of medicine. It is also true that through suffering we find hope, not necessarily in this earthly, temporal life, but in the life to come.

A good death needs advance planning so that personal affairs are in order with instructions in place (e.g., a will and an Advance Medical Directive) to ensure that the family knows the person’s wishes on matters such as funeral and hospice care arrangements. On the emotional level, unfinished business in important relationships needs closure and reconciliation. Ira Byock suggests that four expressions are needed to be said to significant others as life comes to an end: “I love you, thank you, I forgive you, and forgive me.”

Finally, dying is the ultimate spiritual experience for the believer here on earth. The Bible says: “Precious in the sight of the LORD is the death of his saints.” (Psalm 116:15). Death for the Christians is not the end; it is the beginning of our eternal life (John 3:16, 2 Corinthians 5:8).

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Tony Ting has been a practising counselling psychologist for more than 30 years, with the last 14 years at Wesley Counselling Services. His areas of interest include death and dying issues, marriage counselling, addiction counselling (including gambling), and movie therapy.