Wednesday, January 24, 2007

An Interview on Euthanasia

I was interviewed by a secondary school student from Singapore for his school project on euthanasia

Interviewer: I'll be asking you ten questions regarding both medical and religious aspects of Euthanasia of which your most frank and honest answers, coupled with your never-ending words of wisdom would be highly appreciated!

1. Have you ever, in your career as a doctor, ever witnessed or heard of any cases in which a patient, who was deemed incurable before, later managed to be cured due to the discovery of a new kind of medicine?

Yes and no. Yes, if we take into consideration medical history. Syphilis was once considered incurable until the discovery of penicillin in the 1920s. Syphilis has been around since the beginning of human history.

No, if your question is in the context of euthanasia. New medicines take time to be developed. First they have to have to be tested on animal, then human trials and finally FDA (Federal Drug Authority) approval. These take a few years. Most of the time, doctors are aware of these new trials and new medicine coming into the market. Hence we are not taken by surprise at the availability of any new drugs for incurable diseases.

2. Have you ever issued any natural-death directive to any of your patients before? If so, under what circumstances did you decide to do so?

No, it is not the right of a doctor to issue a natural-death directive. This directive can only come from the patient and if he or she is incapable of making such a decision, from their spouse or someone with given authority (letter of attorney).

3. Have you heard of or known of doctors who have given a natural death directive due to a wrong diagnosis and later realized that it was a mistake?


4. Are there any medicines currently in use today that are able to relieve pain, even to those in a coma, without bringing about negative side effects like in cases such as morphine and other drugs of that genre? Have they been tested and deemed effective yet?

NSAID (Non-steroidal anti inflammatory drugs) and COX-2 inhibitors are two classes of drugs that are effective for pain control without the sedative effect of the morphia class of drugs. They have been tested to be effective and are now in common use.

5. Do you think the Hippocratic Oath still applies to doctors today as pivotally as it did before, even though some think it as no longer relevant in the world of today? Please elaborate.

The principles behind the Hippocratic Oath is still followed by all doctors, for example, first do not harm; do not abuse your privilege and take advantage of your patients; do not kill; and respect your teachers. I do not think any doctor will think that these principles are not relevant today. However, many will have problems with the actually wording of the Hippocratic Oath which was culturally and linguistically bound to a different era. For example, the Oath starts with an invocation to a Greek god.

6. Passive Euthanasia is defined as the withholding or refusal of treatment to sustain life or the withdrawing of treatment already begun. So, if a person who is sick and has the ability to but refuses to take his medicine which will heal him and in the long run dies due to that, is it considered passive Euthanasia or active Euthanasia (suicide)? Is it wrong?

If a person decides not to accept any treatment or further treatment for his or her medical condition that is not considered euthanasia. Is it wrong for someone to decide not to accept treatment? That is a moral question. And in some cultic groups also religious question.

7. As a pediatrician, you deal with pregnancies everyday. In the case of severely deformed or marginally viable newborns, do you follow the American Heart Association and National Neonatal Resuscitation Program 2000 consensus statement for international guidelines stating that the “non-initiation of resuscitation in the delivery room is appropriate for infants with confirmed gestation less than 23 weeks or birth weight less than 400g”? If so, have you ever intentionally not resuscitated a baby under these conditions? But isn’t this considered Passive Euthanasia?

No. I always consult with the parents first. I will point out to them that infant with gestation less than 23 weeks or birth weight less than 400g will unlikely to survive even if we institute treatment. I will also emphasis the fact that even if we do save the infant, the infant will likely to be mentally retarded and blind. Then I will let them make the decision whether we should start treatment. As much as possible, we try to have this discussion with the parents before the infant is born. This is informed consent. We will then abide by their decision. Saying that, I once treated a 400g baby that survived and is now a normal healthy 15 years old! If I intentionally unilaterally decide not to resuscitate the baby without the parents’ inform consent, it will be considered passive euthanasia.

8. Since our time of death is in God’s hands, then wouldn’t the presence of someone to extend a person’s life endlessly regardless of the patient’s condition, beyond his or her supposed designated time of death, be God’s will too? Thus, is prolonging a life endlessly really a sin?

This is a religious question and I can only answer from my own religious background which is Christianity. Our time of death is in God’s hands and God does not let us know when that time is. Without this knowledge, there is not way to know whether ‘prolonging a life endlessly’ is acting against God’s timing.

9. In arguing Euthanasia, many Christians would use the 6th commandment which states that “Thou shalt not kill”. However, many say that this commandment is not absolute. If it were really absolute, then shouldn't people also absolutize what Jesus said about giving to those who beg from you (Matt 6:2-4) and give to every beggar on the streets? Thus, how do we know which teachings to absolutize and which not?

In the 6th commandment, the word kill is ‘ratsach’ in Hebrew and ‘phoneuo’ in Greek which means murder. Correctly rendered, it should be “Thou shall not commit murder”. Thus, it is not that the commandment is not absolute but that it allows for killing in wars, self-defence, martyrdom and capital punishment. Hence obeying this commandment cannot be compared with giving alms to beggars.

10. Paul Ramsey states that we should not talk of the beauty of death or even death with dignity. Death is the final indignity to man, and Scripture presents it that way. Do you agree with him? If so, how are we then supposed to die with dignity and what does death with dignity really mean?

I am surprised that Paul Ramsey was quoted to having said that. I believe need to understand the context in which he stated that. My understanding in Christianity is that Jesus Christ defeated death when he died on the cross and was resurrected. St.Paul wrote that he would prefer to die but would stay alive for the sake of other Christians. The general teaching in Christianity is that death is nothing to be afraid of but to be embraced when our time comes.

Death with dignity means to die as a person rather than an object. A person has rights and freedom. Modern medicine with its technology has a tendency to dehumanize a person to an object.


Wow. Don't they ask simple questions anymore?


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