This is precisely why Euthanasia is still not allowed in SG as it opens many cans of worms.
Nobody can gives an absolute answer to WHEN is the right time to administer and WHO to execute... Legal Liability.
Law makers will set the rules. Doctors will be trained to assess whether patients meet the eligibility criteria set out in the law. Is not like Singapore has nothing to base on. Got example from other countries.
Who will administer the medications? Likely doctors again.
Use of the term EUTHANASIA goes to show the depth of understanding on this topic. Anyone who says EUTHANASIA is referring more to putting animals down. EUTHANASIA does not involve choice and decision from the person themselves.
You also use "execute". Wah lao eh.
If Medical Assistance in Dying is made legal, there would be no legal liabilities if all conditions were met within the law.
And there is this ethical dilemma if patient wants Euthanasia.
Who are the people to determine and set a list of "eligiblity criteria"?
For the sick, dying, last 6mths, mental torture to see loved ones wasting away etc?
It's just too open-ended morality decisions and deep actions to undertake by anyone, especially in Asian culture & perspectives.
First and foremost, the patient must request for Medical Assistance in Dying.
Then they are assessed by a doctor.
They would likely need to have some incurable illness or have tried all possible treatment options to both cure the condition and relieve the suffering that comes from the condition/s.
The law makers will determine the set of eligibility criteria. In consultation with the public.
It is less about what other people think. Other people see.
More about the patient themselves. They are the ones suffering.
Pain.
Difficulty breathing.
Swelling.
Build up of fluid in lungs or abdomen.
FATIGUE.
Constipation.
Diarrhea.
Nausea.
Vomiting.
Insomnia
Bladder and Bowel incontinence.
Loss of autonomy.
Loss of dignity.
Inability to partake in activities that bring meaning to their lives.
Isolation or loneliness
Preoccupation with future symptoms
Anticipatory suffering - not wanting to reach a state where they are incoherent, unable to do personal self hygiene or care. Lying in soiled diapers waiting for someone to change.
No quality of life. Everyday just waiting to die.
The key is that these choices are initiated and requested by the suffering patient themselves. They will need a totally independent witness to initiate that request. Someone who does not stand to gain through inheritance or any means from that person's death.
Following which they have 2 independent medical doctors do assessments to determine their medical condition is grievous and irremediable.
That the request for MAiD is made voluntarily and not under pressure or duress.
That the patient is in an irreversible state of decline.
There is no chance they will get better.
That they have exhausted all options for treatment or all options that they are willing to undergo. Not everyone will want to have surgery or chemotherapy with the suffering that goes along with it.
It is about whether we give people and individuals this choice. Or do we force them not to have the choice. That they either suffer all the way to the end and what nature or God intends for them. Or do we let them compassionately choose to have medications administered to them so they can end their suffering and avoid that eventual painful outcome?
Bear in mind that this choice does not FORCE anyone to have to have MAiD. Even after assessment and deemed eligible people can choose to die naturally as long as their suffering is still within their tolerance and choice to keep going. But it is an option if they can't.
Or do we force people NOT to have such a choice? Because other people's opinions over ride their choices?
People argue well they can commit suicide right? Well that means die without dignity. And painfully. Also family cannot be present or be at risk of abetting suicide. Die alone. Sad.
Just to share this is typically what happens on the day of MAiD Provision In Canada when the patient has already been deemed eligible and finally requests for MAiD provision.
1. The MAiD navigation team will arrange for a nurse and a doctor (doctor is usually one of the 2 assessors for MAiD and has met the patient) to be present for the stated date and time of provision.
2. Provision can be performed at home, at a hospice, or even a park or garden. Wherever the patient wishes and when it can be arranged.
3. The nurse will set 2 IV lines. Medications are given intravenously. 2nd IV line is back up in case the first one fails.
4. Patient signs the consent form for Medical Assistance in Dying via intravenous medication administration.
5. Patient and family indicate they are ready. They have said goodbye to their loved ones. Their loved ones and family are by their side. Sometimes they lie in bed next to the patient. All questions are answered by the doctor and nurse
6. Medications are administered intravenously.
7. There are usually 4 medications.
a.Midazolam - a sedative to put the patient to sleep. After they fall asleep they are out. Idea is to fall asleep and then they die peacefully in their sleep.
b. Lidocaine - local anesthetic so that the vein used for injection does not have pain when the 3rd medication is given
c. Propofol - a general anesthetic. Is like putting the patient under GA for surgery. Breathing slows and sometimes stops after this medication
d. Rocuronium - neuromuscular blocker that stops diaphragm and accessory muscles of breathing. Patient stops breathing. Oxygen levels fall. Heart gives out due to ischemia.
8. Doctor examines the patient and then pronounces death. "X has passed. I am sorry for your loss".
9. Medical examiner is called and informed that MAiD has been provided. No post mortem is required. Coroner does not need to examine body.
10. Funeral home (family/patient has chosen) is informed. They come to take the body into care about 30 min later.
11. MAiD documentation is faxed to the Medical Examiner. Medical Examiner writes the death certificate.
Takes about 7 -15 minutes from first medication to pronouncing death. After the patient falls asleep, they may breathe like someone sleeping even snore. Eyes usually closed. Then with the third medication they will stop breathing. There is no movement. No struggling. Very peaceful.
Personally I would want to die this way. Can plan to have all my friends visit me beforehand. On day I die my loved ones, pets all by my side. Hold my hand. Hug by my side. Say goodbye. Die peacefully.
It is dying as good as it gets.
Here's a documentary about MAiD
