It shows legalisation did not lead to more cases of doctors ending lives without patient’s consent
IN DISCUSSIONS about euthanasia and assisted suicide, opponents to these two ways of ending the life of the terminally ill often invoke two fears.
One is that doctors performing euthanasia may end the lives of patients who have not explicitly asked for it.
The other is that patients seeking physician-assisted suicide, tired of the pain and suffering, may not be mentally competent when they make their request.
But these fears now seem unfounded – at least going by the experience of Belgium, which, with the Netherlands, legalised euthanasia in 2002.
For the first time, researchers there have statistics to back up their claim that legalising euthanasia will not lead to a rise in the number of cases in which the procedure is carried out without the patient’s consent.
In fact, the number of such cases fell. Belgian researchers presented the data at the 10th World Congress of Bioethics held here last week.
The meeting attracted legal and religious scholars, ethicists and academics, and papers were presented on end-of-life issues, including the results of international surveys done to find out the medical and legal points of view.
Papers were also presented on other hot topics in bioethics ranging from the uses of genetic testing to organ transplantation.
Vrije Universiteit Brussel researcher Johan Bilsen, by comparing survey data from 1998 (before euthanasia was legal in Belgium) with that from 2007, observed that the rate at which doctors terminated patients’ lives without the patients’ consent fell from 3.2 per cent to 1.8 per cent of all deaths.
As euthanasia had been legalised there, the rate of euthanasia rose from 1.1 per cent to 1.9 per cent of all deaths.
Prof Bilsen said: “The euthanasia debate has always been based on moral or ideological viewpoints, but now we have statistical data.”
He pointed out, however, that other factors also shaped the situation: When Belgium legalised euthanasia in 2002, it also implemented a law to protect patients’ rights. Doctors must seek patients’ permission for treatments and provisions in the law give patients broader access to palliative care.
Political factors were also at play in this small Western European nation of 11 million people, among whom Roman Catholics are a strong minority.
The issue had been debated in the country for several years but it was the change in government from a conservative to a socialist one that gave the push to legalise euthanasia.
Prof Bilsen’s fellow researchers also made presentations on the philosophical implications of other end-of-life methods such as deep sedation, where a terminally ill patient is given drugs to suppress consciousness until death occurs.
Separately at the congress, Professor Nuket Ornek Buken of Hacettepe University in Turkey presented the findings of a comparative study of doctors’ attitudes to physician-assisted suicides, involving medical professionals
from Turkey, Japan, the United States and Saudi Arabia.
The study found that attitudes among doctors were strongly linked to prevailing cultural, religious and legal norms.
American doctors, for example, were the most receptive to taking part in physician-assisted suicides and Saudi Arabian doctors, the least open to it.
“Culture shapes an individual’s attitudes towards diseases, suffering and death,” said Prof Nuket, adding that social norms would also shape a doctor’s attitude towards ethical dilemmas.
She noted that in Turkey, a moderately conservative Muslim nation, and many other developing countries, a “paternalistic” attitude puts decisions about treatment solely in the hands of doctors.
Madam Halimah Yacob, the former chairman of the Government Parliamentary Committee for Health, said Singapore society still does not deal comfortably with the underlying ethical and religious issues that are bundled with legalising end-of-life decisions.
She said physician assisted suicides thrust doctors into “a position of conflict”, as they enter the murky waters of how much authority they should have over their patients’ lives.
She acknowledged that, with Singapore’s population ageing rapidly, such debates are bound to crop up more regularly.
And when such debates play out, the fear that doctors or terminally ill patients will abuse the right to end a life will invariably be raised.
She said: “The deeply held belief in our society is that people should not be able to take their life. It is so precious and valued.”