Singapore Doctor Expertly Presents The Professional Case Against Euthanasia

As both a physician and bioethicist, I believe that the professional case against euthanasia is more compelling and specific than the general moral case against it.

It concerns the nature of medicine itself: what physicians are for, what patients may reasonably expect from them, and what happens to public trust when the profession claims authority not only to heal and care, but also intentionally to end life or hasten death.

I argue that Euthanasia is professionally objectionable because it contradicts the telos (purpose) of medicine, namely, healing. It also destabilizes the fiduciary nature of the doctor-patient relationship, confuses the profession’s response to suicide and despair, risks substituting death for deficiencies in palliative and social care, places pressure on vulnerable patients, burdens professional conscience, and tends toward normalization once admitted into practice.

I would further argue that the distinction between allowing natural death and intentionally causing death remains ethically and professionally indispensable, including in the Singapore context. Sometimes where necessary, I would discuss physician-assisted suicide alongside euthanasia. This is because many major professional bodies address the two practices together and treat them as closely related threats to medical professionalism.¹

Euthanasia Fundamentally Alters Medicine

The most profound professional objection to euthanasia is that it asks medicine to become something other than medicine.

A physician is entrusted with privileged knowledge, authority, and access to the vulnerable body and mind of another human being. That authority is not morally empty. It is ordered towards healing wherever possible, relief of suffering always, and faithful, compassionate care even when cure is no longer available.

For this reason, major medical bodies have continued to oppose euthanasia not merely as one controversial option among others, but as a practice incompatible with the nature of the healing profession.

The World Medical Association (WMA) remains firmly opposed to euthanasia and physician-assisted suicide. Likewise, the American Medical Association (AMA) states that euthanasia is “fundamentally incompatible with the physician’s role as healer,” while the American College of Physicians (ACP) maintains that the ethical arguments against legalization remain the most compelling. A 2020 review of 150 secular U.S. medical and surgical societies also found that, among the relatively few societies that had issued position statements, opposition outnumbered “studied neutrality” for both physician-assisted suicide and euthanasia.²

This objection is best understood as an assertion concerning the telos of medicine. Medicine is not simply a technical service industry whose task is to satisfy whatever a competent patient autonomously requests. A doctor is not functioning like a chef in a Michelin restaurant offering the customer various food options on the menu. It is a fiduciary profession governed by various internal goods and stable norms.

The AMA describes the patient-physician relationship as a “covenant of trust,” and the WMA’s Declaration of Geneva obligates the physician to practice with conscience and dignity, to foster the honor and noble traditions of the profession, and to use medical knowledge for the benefit of the patient.

Once the physician is authorized intentionally to cause or hasten a patient’s death, the profession’s role is altered in kind, not merely in degree.

The ACP therefore argues that physician-assisted suicide affects trust not only in the individual doctor by rupturing specific clinician-patient relationships, but in the profession itself.

By compromising public trust in the medical profession, it “fundamentally alters the medical profession’s role in society.” The professional question is thus not simply whether some patients want euthanasia, but whether killing can be integrated into the physician’s role without changing what a physician is.³

As mentioned above, this concern bears directly on public trust. At the level of professional ethics, if doctors become known not only as healers and carers but as authorised life-enders, the meaning of medical authority changes.

To be sure, the empirical literature on trust is not one-sided. A 2024 randomized controlled survey study in Washington, D.C., did not find a significant difference in patient trust scores when respondents were notified that medical aid in dying was legal in that jurisdiction. That finding should temper exaggeration and overstatement.

Yet it does not dismiss the professional objection. Trust is not merely a polling variable; it is erected within the moral architecture of the profession. Professions often preserve hard normative boundaries not because disintegration in public trust has already occurred, but precisely to prevent it. The absence of dramatic measurable distrust in one setting does not show that the profession can safely erase the line between caring for the dying and intentionally ending their lives.⁴

Euthanasia is Abandonment

A second professional argument is that euthanasia is contrary to the physician’s duty of non-abandonment. The physician’s answer to suffering, especially at the end of life, should be greater compassionate care rather than lethal intervention.

The WMA’s current declaration on end-of-life medical care states that palliative care at the end of life is part of good medical care and that abandonment of the patient is unacceptable medical practice. The World Health Organization (WHO) likewise defines palliative care as the prevention and relief of suffering in its physical, psychosocial, and spiritual dimensions. It also recognizes such care under the human right to health, and further notes that only about 14 percent of those who need palliative care worldwide currently receive it.

The professional implication is obvious: before medicine authorizes the deliberate ending of human life, it must first answer whether it has adequately discharged its own obligations to relieve pain, fear, loneliness, existential distress, and family burden by humane means that do not aim at death.⁵

This argument becomes more compelling when one examines why patients request assisted death.

Oregon’s official 2024 Death with Dignity report found that the most frequently reported end-of-life concerns among those who died under the Act were loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity.

These concerns are real and often profound, but they are not simply problems of sensorineural nociception. They are moral, social, existential, relational, and sometimes psychiatric. When physicians respond to such suffering by causing or hastening death, the profession risks treating the patient’s continued existence as the problem to be solved.

The doctor’s role is very different. The physician is duty-bound to interpret suffering, treat symptoms aggressively, support the family, address depression and fear, involve palliative and spiritual care, and remain present. The AMA expressly says that physicians should not abandon a patient once cure is impossible and should instead provide communication, emotional support, comfort care, and adequate pain control.⁶

Euthanasia is the Medicalisation of Suicide

A third professional objection, taken from a conceptual and social perspective, points toward euthanasia and physician-assisted suicide as the medicalisation of suicide.

The ACP uses that exact phrase. The International Association for Suicide Prevention (IASP), in its 2025 position statement, warns of a “strong potential for overlap or equivalence” between suicide and euthanasia or assisted suicide, especially where such practices are extended beyond the imminently dying.

The IASP adds that jurisdictions that legalize them must guarantee that psychosocial supports, mental-health services, and palliative care are systematically offered and provided. This is because death should never become a substitute for adequate care and support.

This is a powerful professional argument. The healthcare profession that is publicly committed to suicide prevention cannot coherently teach that despair should be met with compassionate intervention and hope in one context, while instructing that despair validated by illness should terminate in a physician’s lethal act in yet another context. The contradiction is not merely semantic. It is embedded in the profession’s public witness concerning whether suffering persons should be helped to live or assisted to die.⁷

Vulnerability Drives Euthanasia

A fourth argument concerns vulnerability, power, and inequality.

The ACP emphasizes that there is a power imbalance within any patient-physician relationship. This power is inherently unequal because of the patient’s vulnerability and the physician’s authority. The AMA adds that euthanasia could readily be extended to the incompetent, the disabled, and other vulnerable populations.

Even where legal safeguards exist, medicine never operates in a social vacuum. Requests for death may be shaped by fear of being a burden, social isolation, disability, poor symptom control, inadequate family support, depression, or economic precarity.

The International Association for Hospice and Palliative Care therefore states that no country or state should consider legalizing euthanasia or physician-assisted suicide until universal access to palliative care services and appropriate medications is ensured.

This is not a merely political point. It is a professional one: when care is thin and support is unequal, the choice for death can become a choice made under conditions of abandonment. A profession worthy of trust should resist becoming the final arbiter and administrator of society’s earlier failures.⁸

Euthanasia is Easily Normalised

A fifth objection is prudential but not trivial. Empirical evidence demonstrates that once euthanasia is admitted into medicine, it tends to become normalized. Official reports from permissive jurisdictions show that assisted dying can move from exceptional transgression to a significant mode of death within healthcare systems.

Canada’s Sixth Annual Report states that 16,499 people received medical assistance in dying in 2024, amounting to 5.1 percent of all deaths in Canada that year. 732 of those cases were “Track 2,” meaning the person’s natural death was not reasonably foreseeable, and mental illness as the sole underlying condition remains excluded only until March 17, 2027.

The Netherlands’ 2024 annual report records 9,958 euthanasia notifications, representing 5.8 percent of all deaths, including 219 psychiatric-disorder cases.

Belgium’s official 2024 figures record 3,991 euthanasia cases, or 3.6 percent of all deaths.

It does not mean that these figures by themselves prove the abuse of legalization. But they do support a professional concern: once physicians are authorized to kill under certain conditions, the practice does not remain symbolically marginal. It becomes one more organized pathway of medical management at the end of life, and sometimes before the very end of life.⁹

If This Was Normal, Why Have an Opt-Out?

A sixth argument concerns the integrity of physicians themselves. Even medical organizations that have moved to a position of neutrality on legalization often do so in a way that indirectly concedes how disruptive assisted dying would be to ordinary medicine.

The British Medical Association (BMA) has been neutral since 2021 on whether the law should be changed. Yet the BMA has asserted that any assisted-dying regime should be strictly opt-in, that doctors should have a broad right to decline direct involvement for any reason, and that assisted dying should be provided as a separate service rather than integrated into standard care pathways.

Those are remarkable concessions. If the intentional ending of life were simply one more type of compassionate medical treatment, there would be no obvious reason to quarantine it institutionally from normal medical roles. Daniel Sulmasy and colleagues therefore argue that professional neutrality is not truly neutral at all. Such a “neutrality” marks a normatively substantive shift from prohibited to optional. For the medical profession, that shift is momentous.¹⁰

There is a Meaningful Difference Between Natural and Assisted Death

A final professional argument, especially pertinent in Singapore, is that one must preserve the distinction between allowing natural death and intentionally causing death.

End-of-life medicine have a general consensus on the following:

1. Doctors are not required or obligated to furnish futile or burdensome treatment;
2. Doctors are expected to respect refusal of life-sustaining interventions from competent patients or Advance Medical Directives;
3. Doctors should treat or manage pain aggressively even when some risk of life-shortening side effects is foreseeable.

But none of these acts is euthanasia. Singapore’s official Advance Medical Directive publications are quite explicit on such a distinction. An AMD is not euthanasia or mercy killing; the Act is “explicitly and categorically against euthanasia”; and nothing in the Act authorizes an act that causes or accelerates death, as distinct from permitting the dying process to take its natural course.

That ethical distinction is professionally indispensable. If medicine loses it, then withdrawal of futile treatment, palliative sedation, terminal care, hospice, and euthanasia collapse into one undifferentiated category of “end-of-life choice.” The profession would then lose the conceptual tools by which it rationalizes to patients, families, and itself why relieving suffering is part of medicine but directly causing death is not.¹¹

A Robust Cumulative Case

The professional case against euthanasia, then, is cumulative. It is not a single slogan, nor is it reducible to religious conviction or dogma, although many religious traditions also oppose it.

Professionally considered, euthanasia corrupts the identity of medicine as the healing art, destabilizes the physician-patient covenant of trust, distorts the profession’s stance toward suicide, proffers death where better care is often the proper response, exposes vulnerable persons to pressures that law cannot fully police, burdens physician conscience causing moral distress and injury, and tends toward normalization once admitted.

Humane medicine must be able to say two things at once. First, that no patient should be abandoned to agony, indignity, panic, or isolation; and second, that the physician’s task is to care for the patient through those realities, not to solve them by causing the patient’s demise. The doctor must remain, to the end of the patient’s life, a healer, comforter, witness, and companion, and not an authorized killer.¹²

Footnotes

1. World Medical Association, “Declaration on Euthanasia and Physician-Assisted Suicide,” adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019; American Medical Association, Code of Medical Ethics, Opinion 5.8, “Euthanasia,” and Opinion 5.7, “Physician-Assisted Suicide”; Daniel P. Sulmasy et al., “Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral nor Appropriate,” Journal of General Internal Medicine 33, no. 8 (2018): 1394–99; Joseph G. Barsness et al., “US Medical and Surgical Society Position Statements on Physician-Assisted Suicide and Euthanasia: A Review,” BMC Medical Ethics 21, no. 111 (2020).

2. World Medical Association, “Declaration on Euthanasia and Physician-Assisted Suicide”; American Medical Association, Code of Medical Ethics, Opinion 5.8, “Euthanasia”; Lois Snyder Sulmasy and Paul S. Mueller, “Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper,” Annals of Internal Medicine 167, no. 8 (2017): 576–78; Barsness et al., “US Medical and Surgical Society Position Statements on Physician-Assisted Suicide and Euthanasia,” 1–10.

3. American Medical Association, Code of Medical Ethics, Opinion 5.7, “Physician-Assisted Suicide,” and Opinion 1.1.1, “Patient-Physician Relationships”; World Medical Association, “Declaration of Geneva,” adopted by the 68th WMA General Assembly, Chicago, United States, October 2017; Snyder Sulmasy and Mueller, “Ethics and the Legalization of Physician-Assisted Suicide,” 576–78.

4. Jessica B. Anderson et al., “The Impact of Legalizing Medical Aid in Dying on Patient Trust: A Randomized Controlled Survey Study,” Journal of Palliative Medicine 27, no. 11 (2024): 1459–66.

5. World Medical Association, “Declaration of Venice on End of Life Medical Care,” adopted by the 35th World Medical Assembly, Venice, Italy, October 1983, revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006, and by the 73rd WMA General Assembly, Berlin, Germany, October 2022; World Health Organization, “Palliative Care,” fact sheet.

6. Oregon Health Authority, 2024 Oregon Death with Dignity Act Data Summary (Portland, OR: Oregon Health Authority, 2025); American Medical Association, Code of Medical Ethics, Opinion 5.7, “Physician-Assisted Suicide”; World Medical Association, “Declaration of Venice on End of Life Medical Care.”

7. Snyder Sulmasy and Mueller, “Ethics and the Legalization of Physician-Assisted Suicide,” 576–78; International Association for Suicide Prevention, “IASP Position Statement on Assisted Suicide and Euthanasia” (2025).

8. Snyder Sulmasy and Mueller, “Ethics and the Legalization of Physician-Assisted Suicide,” 576–78; American Medical Association, Code of Medical Ethics, Opinion 5.8, “Euthanasia”; International Association for Hospice and Palliative Care, “Position Statement on Euthanasia and Physician-Assisted Suicide.”

9. Health Canada, Sixth Annual Report on Medical Assistance in Dying in Canada 2024 (Ottawa: Health Canada, 2025); Regional Euthanasia Review Committees, Annual Report 2024 (The Hague: Regional Euthanasia Review Committees, 2025); Federal Commission for the Control and Evaluation of Euthanasia, “Euthanasia: Publication of the 2024 Figures,” March 19, 2025.

10. British Medical Association, “The BMA’s Views on Legislation on Physician-Assisted Dying,” updated January 2025; British Medical Association, “ARM 2025: BMA Passes Resolution on Assisted Dying,” June 25, 2025; Sulmasy et al., “Physician-Assisted Suicide,” 1394–99.

11. Singapore Ministry of Health, Advance Medical Directive booklet (Singapore: Ministry of Health, n.d.); World Medical Association, “Declaration of Venice on End of Life Medical Care”; American Medical Association, Code of Medical Ethics, Opinion 5.8, “Euthanasia.”

12. World Medical Association, “Declaration on Euthanasia and Physician-Assisted Suicide”; American Medical Association, Code of Medical Ethics, Opinion 5.7, “Physician-Assisted Suicide”; Snyder Sulmasy and Mueller, “Ethics and the Legalization of Physician-Assisted Suicide”; World Medical Association, “Declaration of Venice on End of Life Medical Care”; World Health Organization, “Palliative Care”; International Association for Suicide Prevention, “IASP Position Statement on Assisted Suicide and Euthanasia.”

Bibliography

American Medical Association. Code of Medical Ethics. Chicago: American Medical Association.

Anderson, Jessica B., Maria Cacciapuoti, Hannah Day, Taymour Hashemzadeh, and Benjamin J. Krohmal. “The Impact of Legalizing Medical Aid in Dying on Patient Trust: A Randomized Controlled Survey Study.” Journal of Palliative Medicine 27, no. 11 (2024): 1459–66.

Barsness, Joseph G., Casey R. Regnier, C. Christopher Hook, and Paul S. Mueller. “US Medical and Surgical Society Position Statements on Physician-Assisted Suicide and Euthanasia: A Review.” BMC Medical Ethics 21, no. 111 (2020).

British Medical Association. “ARM 2025: BMA Passes Resolution on Assisted Dying.” June 25, 2025.

British Medical Association. “The BMA’s Views on Legislation on Physician-Assisted Dying.” Updated January 2025.

Federal Commission for the Control and Evaluation of Euthanasia. “Euthanasia: Publication of the 2024 Figures.” March 19, 2025.

Health Canada. Sixth Annual Report on Medical Assistance in Dying in Canada 2024. Ottawa: Health Canada, 2025.

International Association for Hospice and Palliative Care. “Position Statement on Euthanasia and Physician-Assisted Suicide.”

International Association for Suicide Prevention. “IASP Position Statement on Assisted Suicide and Euthanasia.” 2025.

Oregon Health Authority. 2024 Oregon Death with Dignity Act Data Summary. Portland, OR: Oregon Health Authority, 2025.

Regional Euthanasia Review Committees. Annual Report 2024. The Hague: Regional Euthanasia Review Committees, 2025.

Singapore Ministry of Health. Advance Medical Directive booklet. Singapore: Ministry of Health, n.d.

Sulmasy, Daniel P., et al. “Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral nor Appropriate.” Journal of General Internal Medicine 33, no. 8 (2018): 1394–99.

Snyder Sulmasy, Lois, and Paul S. Mueller. “Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper.” Annals of Internal Medicine 167, no. 8 (2017): 576–78.

World Health Organization. “Palliative Care.”

World Medical Association. “Declaration of Geneva.” Adopted by the 68th WMA General Assembly, Chicago, United States, October 2017.

World Medical Association. “Declaration of Venice on End of Life Medical Care.” Adopted by the 35th World Medical Assembly, Venice, Italy, October 1983. Revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006, and by the 73rd WMA General Assembly, Berlin, Germany, October 2022.

World Medical Association. “Declaration on Euthanasia and Physician-Assisted Suicide.” Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019.