When PAP going to legalize euthanasia? See some ppl suffering until bth...

[Jeremy1]

I really hope government will considered legalize euthanasia

 

[Jeremy1]

What is the reason for not legalizing euthanasia in sg?

So that they can collect more $$$ from those dying people

Just imagine how much $$$ need to be spend if a person is suffering and just waiting to die in the hospital.

 

[cyke69sg]

Also the anguish and suffering caused to the living and family.

If I am the one on death bed with no more hope of recovery and in pain, I wouldn't want my love ones to suffer with me. I see my decision for euthanasia as my last loving gift to my love ones to relieve them of the pain and sadness of loss. And give them the assurance that I am at peace with the decision in the medicinal event that necessitates it being carried out.

And that it relives all the suffering.

I think you are the first person on EDMW that has said this.

Indeed it is something I have heard many patients say as well. They do not want to be a burden to their loved ones. Feeling of being a burden is also a mental emotional suffering that can be unbearable to the patient. Subjective. Family will tell the patient they are not a burden and they love them and will continue to care for them but patient will say they know but still feel they are a burden. Patient could be someone so used to being the caregiver and helper for others. Does things for others. Now has to rely on others and it is unsettling. Distressing also. Not who they are. Forced to live how they do not want by being dependent.

Also the patient may want to make it clear also that in the event they lose capacity to make decisions that they would want the MAiD to proceed. And not burden their family to have to make a decision on their behalf.

 

[cyke69sg]

legalizing euthanasia??? Then can remove Advance Medical Directive (AMD).

AMD is nothing more than a wish not to receive resuscitative measures and life prolonging measures.

It is outdated in this day and age. Irrelevant given the very strong focus medical care has switched to patient autonomy and respecting patient's wishes. Doctors will always have these discussions beforehand with the patient.

 

[cyke69sg]

I will add on. What about those with mental illness like depression? You don’t want a debate to start along the lines like “It is more ethical to allow a depressed person to go for euthanasia than to disallow euthanasia for him and watch him jump off. Discuss.” Then what about those with no money? They tell you I don’t go for euthanasia (quiet no fuss), I will jump off right now in front of you. Which is better?

if you say yes better to euthanise than to jump off, they will say no money can use Medisave? Medifund? Govt subsidise?

if you say no cannot euthanise just cos no money or depression in not a reason for euthanasia, they jump off in front of you and now traumatise entire block and he is equally dead

So once you allow euthanasia, you can say only applicable to this and that but eventually things will change

Mental Disorder as Sole Underlying Medical Condition (MDSUMC) for access to MAiD is coming to Canada on 17 Mar 2027.

And many doctors who do not work in the mental health space are not prepared for it. They are uncomfortable with it.

But there are some doctors who are comfortable. Particularly psychiatrist who work in the field of psychedelic assisted psychotherapy using Ketamine, Psilocybin and MDMA.

The current regulations require that the patient has already failed other forms of treatment for eg treatment resistant depression, PTSD, Severe Anxiety, and other Trauma disorders before they can trial MDMA, Psilocybin or Ketamine.

In some cases the patients have already trialed ECT and rTMS.

The same principles apply. We DO NOT give MAiD as first line treatment/option. The patient needs to have tried other forms of treatment. And failed.

But if we have tried everything eg medications SSRIs SNRIs Atypical Antipsychotics, Anxiolytics ECT rTMS Psychedelics couseling, CBT DBT, ART, EMDR etc and still cannot help?

Then? Tell the patient who has tried so hard to get better but cannot.....CONTINUE TO SUFFER SORRY?

And as you said, "can commit suicide"?

That is so heartless. Not only to the patient. But also the family.

Is it better to force the patient to continue to suffer with depression despite all efforts that have failed and also contemplate suicide to relieve their pain and suffering and have to DIE ALONE (cos if family is beside they can be charged with abetting suicide).

Is it not compassionate to allow the patient to die peacefully, painlessly with dignity and with their family by their side?

You rather wife and children wake up to find husband hanging? Or jump off building?

I think that's the debate. Compassion. Relieve suffering.

Remember not first line. Not first thing. LAST RESORT.

 

[Philipkee]

Remember not first line. Not first thing. LAST RESORT.

I remember the cartoon Voltron. Always “let’s use our last resort. Let’s form Voltron”

But machiam every episode also form Voltron

So I think the same risk is here. Need a lot of strong regulations plus a very strong medical community to ensure that while euthanasia for mentally ill remains a last resort, it doesn’t get used too often “as a last resort” especially if the community becomes accepting of it

 

[cyke69sg]

I remember the cartoon Voltron. Always “let’s use our last resort. Let’s form Voltron”

But machiam every episode also form Voltron

So I think the same risk is here. Need a lot of strong regulations plus a very strong medical community to ensure that while euthanasia for mentally ill remains a last resort, it doesn’t get used too often “as a last resort” especially if the community becomes accepting of it

For sure.
This is where the medical professionals have to follow guidelines. Do the assessments properly. Only those who meet the criteria be allowed.

The issue is if the patient has not explored all option then it is NOT the last resort.

There is debate going on now for mental disorder whether to include needing to try psychedelics ECT and rTMS before can consider as e everyrhing has been tried. Or is psychiatrist says not candidate for those treatments.

Have to be strict. Cannot anyhow just say ok everyone can have maid.

 

[Itsthatguy]

I think you are the first person on EDMW that has said this.

Indeed it is something I have heard many patients say as well. They do not want to be a burden to their loved ones. Feeling of being a burden is also a mental emotional suffering that can be unbearable to the patient. Subjective. Family will tell the patient they are not a burden and they love them and will continue to care for them but patient will say they know but still feel they are a burden. Patient could be someone so used to being the caregiver and helper for others. Does things for others. Now has to rely on others and it is unsettling. Distressing also. Not who they are. Forced to live how they do not want by being dependent.

Also the patient may want to make it clear also that in the event they lose capacity to make decisions that they would want the MAiD to proceed. And not burden their family to have to make a decision on their behalf.

I agree the feeling of burden is subjective.

Children should feel fortunate that they have the opportunity to care and share moments with their parents in good health or in sickness. And that such opportunities should not be taken away from them.

But on the other hand, technically the need to care for another person has it's limiting factors on the caregiver regardless of their mindset and willingness.

 

[Itsthatguy]

AMD is nothing more than a wish not to receive resuscitative measures and life prolonging measures.

It is outdated in this day and age. Irrelevant given the very strong focus medical care has switched to patient autonomy and respecting patient's wishes. Doctors will always have these discussions beforehand with the patient.

imo, still relevant. A person can suddenly fall ill, i.e. heart attack.

Or dying of old age natural death.

 

[cyke69sg]

imo, still relevant. A person can suddenly fall ill, i.e. heart attack.

Or dying of old age natural death.

Here's the Singapore AMD from 1996/1997 some 28-29 years ago. It's really old.

https://isomer-user-content.by.gov.sg/3/089249d9-81fa-48c0-856d-c5402c540c2d/form1amd(270905).pdf

THE DIRECTIVE

1. I hereby make this advance medical directive that if I should suffer from a terminal illness and if I should become unconscious or incapable of exercising rational judgment so that I am unable to communicate my wishes to my doctor, no extraordinary life-sustaining treatment should be applied or given to me.

2. I understand that “terminal illness” in the Advance Medical Directive Act 1996 means an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery where - (a) death would within reasonable medical judgment be imminent regardless of the application of extraordinary life-sustaining treatment; and (b) the application of extraordinary life-sustaining treatment would only serve to postpone the moment of death.

3. I understand that “extraordinary life-sustaining treatment” in the Advance Medical Directive Act 1996 means any medical procedure or measure which, when administered to a terminally ill patient, will only prolong the process of dying when death is imminent, but excludes palliative care.

4. This directive shall not affect any right, power or duty which a medical practitioner or any other person has in giving me palliative care, including the provision of reasonable medical procedures to relieve pain, suffering or discomfort, and the reasonable provision of food and water.

5. I make this directive in the presence of the two witnesses named on page 2.


I would argue that, in today’s medical and ethical context, administering life-prolonging treatments to a patient with an incurable condition and no reasonable prospect of recovery—especially when death is imminent and the patient is unconscious or incapable of rational judgment—could be challenged as inappropriate medical practice.

Correct Ethical and Medical Foundations:​

1. Incurable condition with no reasonable prospect of recovery:
   • When a condition is terminal, and there is no hope for improvement, the focus of care typically shifts from curative to comfort-focused (palliative) care.
   • Continuing aggressive treatment in such cases is often considered non-beneficial or medically futile.
2. Prolonging the dying process when death is imminent:
   • Treatments that only extend the dying process—without improving quality of life—can be ethically and clinically inappropriate.
   • Many clinical guidelines (e.g., from the Canadian Medical Association, American Medical Association, and palliative care bodies) support withholding or withdrawing such treatments when they do not serve the patient’s best interests.
3. Patient is unconscious or incapable of rational judgment:
   • When a patient lacks decision-making capacity, decisions should be guided by advance directives, prior expressed wishes, or substitute decision-makers acting in the patient’s best interests.
   • Providing aggressive treatment in contradiction to these principles can raise ethical and legal concerns.
4. Challenged as inappropriate medical practice:
   • Yes, such care could be challenged as inappropriate, particularly if it contradicts:
     • Professional standards
     • Patient’s prior expressed wishes
     • Consensus about futility of treatment
   • It might also be viewed as a violation of the principle of non-maleficence (do no harm) and a failure to respect patient dignity.

---

Exceptions or Caveats:​

• Cultural, religious, or family beliefs can sometimes influence decisions differently.
• Legal definitions and acceptable practices may vary by jurisdiction.
• If no prior wishes or substitute decision-maker are available, the default might still be to provide life-sustaining care—unless deemed futile.

Remember 1996 and 2025 are very different time periods.

Ask any practicing physician now. if the family were to ask them to provide a patient with life-prolonging treatments to a patient with an incurable condition and no reasonable prospect of recovery—especially when death is imminent and the patient is unconscious or incapable of rational judgment— Whether they would still do it? Most likely not.

Hence my conclusion is that the AMD is an outdated irrelevant medical document in today's day and age. It is already the standard for doctors NOT TO provide these life prolonging treatments for incurable conditions and where death is imminent as the standard of care based on current ethical and professional considerations.

 

[cyke69sg]

Yes, medical culture has significantly evolved between 1996 and 2025 regarding the need for patients to sign explicit documents refusing life-prolonging treatment in end-of-life scenarios. Here's how:

---

🕰 Then (1996):​

Default was often to provide life-prolonging care unless explicitly refused.

• The default approach was heavily skewed toward preserving life, even in terminal cases.
• Without a signed Do Not Resuscitate (DNR) order, Advance Directive, or Living Will, health care teams often erred on the side of aggressive intervention.
• There was less cultural emphasis on autonomy and patient-directed care at end-of-life.
• Many clinicians feared legal repercussions for withholding or withdrawing life-sustaining treatment.

Now (2025):​

Greater emphasis on patient autonomy, medical futility, and shared decision-making.

There’s been a clear shift toward recognizing when treatment is non-beneficial, even in the absence of a signed directive.

• Advance care planning is now strongly encouraged, but lack of a signed refusal does not automatically mandate aggressive treatment if it’s deemed medically inappropriate.
• The concept of medical futility is better defined: physicians are not ethically or legally obligated to offer or continue treatments that only prolong the dying process.
• Many jurisdictions now support substitute decision-making guided by the patient’s previously expressed values, even if not written.
• There's a stronger framework in place for palliative care and goals-of-care conversations, which shift the focus from “prolonging life at all costs” to “what matters most to the patient.”

---

Practical Changes:​

• Hospitals and health regions have adopted standardized Goals of Care Designations (GCDs) or POLST/MOST forms that reflect a patient’s values, often determined through discussions—not just signed refusals.
• Courts in many regions have upheld the clinical right to withdraw or withhold treatment that is deemed non-beneficial, even in the absence of an explicit written directive.
• Medical education now includes more training on communication around end-of-life decisions, capacity, and shared decision-making.

---

Legal and Ethical Shift:​

• In 1996: "No signed document = we treat."
• In 2025: "We weigh medical appropriateness, prior wishes, and quality of life—even without a signed document."

---

Summary:​

Yes, the culture has changed. While written advance directives are still helpful and ideal, clinicians today are not strictly dependent on them to avoid life-prolonging treatment in clearly terminal and irreversible situations—especially when such treatment is futile, burdensome, or contrary to known patient values. The focus has moved toward patient-centered care, dignity, and appropriate medical judgment.

 

[cyke69sg]

In Singapore there is Advanced Care Planning (ACP).

https://www.aic.sg/care-services/advance-care-planning/

It's been around since 2011. That's 14 years.

Yet hardly anyone talks about it? Strange don't you think. Still talking about the outdated irrelevant Advanced Medical Directive (AMD)?

Look at the workbook.

https://www.aic.sg/wp-content/uploads/2023/06/ACP-Workbook-EN.pdf

Actually it has many thing in there that are very very relevant. Things like goals of care. Preferred end of life care.

Can have it done with a ACP facilitator.

https://mylegacy.life.gov.sg/listing/acp-providers/results

How come nobody talk about the ACP? I am guessing cos hardly anyone does this at all or even knows it exist and Healthcare Practitioners also not keen to talk to patients about it either.

For a start SGreans should have more ACP discussions first then can even think about Medical Assistance in Dying.

 

[The_King]

How are you?
Good to see you again. Hope you are doing well with your nutrition change efforts.

still the same, what about you?


my nutrition still the same, balancing insulin vs carbo intake

 

[SageWolf]

If you want to die
you can do it anytime, like suicide, no really need permission from govt
The govt cannot officially sanction cause might have religion group kpkb, not that they against it, just that the cost higher than benefit

if there is a high benefit for euthanasia, I believe PAP will even create a TV campaign to encourage every family to do euthanasia maybe even payable by medisave

Do you know that if you commit suicide, if you were a male, they will cane your dead body.

Why is there a need to cane your dead body?
Because it is illegal in Singapore's eyes.

 

[The_King]

 

[cyke69sg]

still the same, what about you?


my nutrition still the same, balancing insulin vs carbo intake

I am good.
Keeping my weight within the range I want.

 

[fulaien]

If we cannot choose how we are born, at least let us choose how to die.

It should be done properly with rules like, only for terminal illness or immense irreversible suffering. For those without terminal illness/suffering, should be beyond a certain age, eg. Above 80.

 

[cyke69sg]

Do you know that if you commit suicide, if you were a male, they will cane your dead body.

Why is there a need to cane your dead body?
Because it is illegal in Singapore's eyes.

No, absolutely not – this is a myth. Singapore does not cane dead bodies as punishment for suicide. Here’s what’s actually true:

1. Suicide is
no longer a crime

• Singapore repealed Section 309 of the Penal Code, which used to criminalize attempted suicide. That law was officially removed on January 1, 2020 .
• This means that attempting suicide is no longer punishable by jail or fines—it’s treated as a mental health issue, not a crime .

2. Why it’s still not “legalizing” suicide

• Police and mental-health professionals can still intervene to protect someone at risk. They are empowered to act—but not to punish .
• Actually, following the repeal, suicide rates fell—in the first nine months of 2020, suicides dropped by about 45% compared to 2019 .

3. No caning after death—and no caning for suicide

• Caning in Singapore is a judicial punishment for certain crimes (like rape, drug trafficking, vandalism), and applies only to men under 50. It’s part of a formal sentence during life, and always paired with imprisonment .
• Only living, legally convicted males get caned—and only after thorough medical clearance .
• Dead bodies are not subject to punishment, and there’s no practice of caning anyone who has died. That’s simply false.

What’s really done when a suicide occurs

• In cases of unnatural death (including suspected suicide), the scene is treated like any crime scene: cordoned off, investigated, followed by autopsy, then release of the body to the family .
• Handling of the scene or body is a forensic procedure only, not punishment.

Final word

• Attempted suicide: decriminalized, treated through intervention and care.
• Caning: only judicially ordered, for living offenders under very specific conditions.
• Cows are not caned after death, and neither are humans—so no, dead bodies are not caned in Singapore.

 

[SageWolf]

means that attempting suicide is no longer punishable by jail or fines—it’s treated as a mental health issue, not a crime .

Din know it was remove in 2020.
The same year which I started working overseas.

Thanks for the info.

 

[Philipkee]

.

The issue is if the patient has not explored all option then it is NOT the last resort.

I don’t know what it’s like in Canada but one thing I realise in medicine is that very rarely is it possible that all options have been explored. There is always one more drug to try, one more procedure that can be done and heck maybe it can even be done overseas. The only issues are the cost and the likelihood of success

Cost aside cos can crowdfund or get govt subsidies, if a very risky procedure or experimental drug offers a 1% chance of recovery, by not taking it, can I say “you have not explored all options and your last resort is not really the last resort?” Would a doctor not have to say I cannot approve of euthanasia since there is this drug or medicine that has a 1% success rate (if 1% is too low then what about 2%, 3% etc)?

So imho, guidelines can be there but ultimately for euthanasia it all boils down to ethics. Which is better for patient, euthanasia or continued treatment that might be 99% futile but got 1% chance of success? And this can be subjective and easily manipulated in the right hands