prolonging life, the need for more measures to deal with end-of-life issues is intensifying. A greater availability of options to dying patients is of increasing significance; the issue of whether assisted suicide should be legalised is a relevant one. This article argues that Singapore should decriminalise physician-assisted suicide2 (“PAS”), in circumstances where terminally ill patients face imminent death, unbearable suffering, and believe that there is no other reasonable solution to their situation3. DEFINITIONS There are various forms of medical intervention by which accelerated dying can be effected. Euthanasia is often referred to more specifically as voluntary active euthanasia (“VAE”). This distinguishes it from involuntary euthanasia and passive euthanasia. For the former, the life of a patient would be ended without their request. For the latter, death is caused through the withdrawal of life-sustaining treatment. Both PAS and VAE take place at the patient’s request. However, PAS differs from VAE in that the patient himself, not the physician, executes the fatal act in his own death. This distinction provides an additional safeguard; it renders PAS a limited activity which can be safely regulated. It is the underlying rationale for advocating the legislation of PAS, and not VAE. CURRENT LAW IN SINGAPORE Attempted suicide is a crime by virtue of s 309 of the Penal Code (Cap 224, 2008 Rev Ed) (“Penal Code”). When read together with s 107 of the Code, it makes the abetting of an attempted suicide an offence. Where the attempt to commit suicide succeeds, s 306 of the Code holds the abettor of the suicide criminally liable. Physicians who commit PAS would thus be subject to prosecution. It must be for Parliament to legislate any changes. First, assisted dying is an intensely complicated 2 PAS is legal in Belgium, Luxembourg, Netherlands, Switzerland and the states of Washington, Oregon, Montana and Vermont in the US. 3 Puay San Toh and Stanley Yeo, ‘Decriminalising Physician-assisted Suicide in Singapore’ (2010) 22 Singapore Academy of Law Journal 381.
and profoundly divisive subject.4 Second, the constitutional validity of ss 306 and 309 are likely to be upheld by the courts, if they were to be challenged.5 Although this has not been done in Singapore, it has been adjudicated in India. In Gian Kaur v State of Punjab6,the Supreme Court of India rejected the appellant’s contention that ss 306 and 309 of the Indian Penal Code violated Articles 14 (Equality before the law) and 21 (Protection of life and personal liberty) of the Constitution of India. In particular, the court held that suicide is an unnatural termination of life and therefore inconsistent with the concept of “right to life” embodied in Article 21. Articles 12 and 9 of the Constitution of Singapore correspond to Articles 14 and 21 of the Constitution of India. The Singapore Penal Code provisions are identical to their counterparts in the Indian Penal Code. Arguably, the constitutional basis for ss 306 and 309 is sound. VALUE OF LIFE: THE GORDIAN KNOT (1)
The intrinsic value of life – the sanctity of life argument
The intrinsic value of life prohibits intentional killing. At its core is the protection of the fundamental human right to life. It finds a clear place in the law. An instance is the prohibition of homicide. As Lord Lowry observed in the House of Lords case of R v Brown7, the intrinsic doctrine resonates among both religious and secular audiences. To atheists, human life has an ineradicable “dignity”. The human mind and body exists as an integrated whole; the mind cannot reject the failing body.8 To theists, the gift of life is for God alone to dispose of – life is sacred.9 The intrinsic doctrine is not vitalistic - it does not require the preservation of life at all costs.10 This can be illustrated in two ways. 4 Sundaresh Menon, ‘Euthanasia: a matter of life or death?’ (2013) 54(3) Singapore Medical Journal 128. 5 Puay San Toh and Stanley Yeo (n 3) 383-384. 6 AIR 1996 SC 1257. 7 [1994] 1 AC 212. 8 John Finnis, ‘Bland: Crossing the Rubicon’ (1993) 109 Law Quarterly Review 334. 9 Luke Gormally, ‘Prolongation of Life: The Principle of Respect for Human Life’ (1978) 1 Linarce Centre Papers 22-24. 10 John Keown, ‘Restoring Moral and Intellectual Shape to the Law after Bland’ (1997) 113 Law Quarterly Review 483.