Chair, Asia-Pacific Hospice Palliative Care Network (APHN); CEO, Hospice Malaysia; physician.
While there have been increasing discussions in many countries with regards to issues that surround death and dying, from customs and ritual to advance care planning, no Asian country has enacted legislation legalizing euthanasia or physician-assisted suicide.
The IAHPC survey on the topic certainly brings up some interesting areas for consideration, mainly concerns about the place of assisted dying and its relationship to palliative care. A significant number of respondents were of the opinion that discussions on assisted dying helps palliative care development, though an even greater number said that such discussions create confusion. A significant proportion agreed with the statement that it removes focus from palliative care, with a minority noting that assisted dying should be part of palliative care.
The levels of agreement with different statements of respondents as well as those who have experienced requests for assisted dying certainly show a spread of diverse views on certain points. Some of these may be due to the maturity of palliative care development and cultural factors in their countries.
Euthanasia and physician-assisted suicide is an emotive area for both health care professionals and patients as well as the public, but it is also a very complex area where evidence—or the lack of it—may affect and attract different viewpoints. Compared to Western countries, there is little public debate on the topic in the Asia Pacific. Personal autonomy, a central pillar in Western orientated debate is seen very differently in Asian societies, where autonomy is seen as relational. Although access to opioids, essential medicines, and palliative care services may be lacking in low-resource countries in the region, there is little clamor for assisted dying. Culture, religion, and tradition may play a part in this. Where there is a desire for hastened death, it is often in situations of severe pain and self-perceived burden rather than for existential suffering.
Even though palliative care development in Asia Pacific has generally yet to match the development in the well-resourced West, my experience is that there is a great desire for patients and clinicians to find solutions in managing pain and suffering.
We do not support the deliberate ending of life and we view with concern moves in certain jurisdictions in the region to legalize physician-administered euthanasia and physician-assisted dying. Licensing doctors to administer or supply lethal drugs to seriously ill patients has no place in the practice of health care. As per a 2017 statement by the Asia-Pacific Hospice Palliative Care Network, such moves devalue the dying and undermine society’s responsibility to protect its most vulnerable members.1
If everyone puts in the same level of advocacy, legislation, and funding into access to pain relief and the development of palliative care services, a great deal of human suffering could be alleviated. Surely this is a better response than advocate for assisted “suicide.”
Palliative care may not be the answer to all aspects of suffering, but the deliberate ending of a life is not part of the solution.
Dr. Hamzah helped build Hospice Malaysia from a fledgling organization to the country’s largest community palliative care service and teaches at several universities at both the undergraduate and graduate levels.
Asia Pacific Hospice Palliative Care Network, 2017. APHN statement on our stand against the deliberate ending of life.