When should Law and Policy disregard moral values?

In the large majority of cases, the law reflects moral values – its common sense. It’s morally wrong to murder, there’s a law to state what happens to murderers.  Same for robbery.  Same for whacking up somebody because you felt like it.

But there are some instances, where the law cannot, must not, reflect morality. These are quite a small minority, but a very important minority. What are they? I’ll cover some of these cases here, but these are not exhaustive. They fall mainly into the domain of health. I’m not too sure why; is it because this is the area of my specialty (I’m doing my PhD studying unborn babies….) or because it’s the nature of how our health and psychology works that makes it that way.

Anyway, the areas I’ll be talking about to illustrate my point : 1. Drug use / prostitution     2. Sex with minors (below 16s)/Abortion      3. Euthanasia       

 

1. Drug use / prostitution.

During the recent AIDS conference, a HIV prevention activist from Sydney, Australia gave a keynote lecture, describing some of the more successful strategies. Two of them were providing drug addicts with free clean injection needles and de-criminalizing prostitution.

How does that work? Drug addicts who inject drugs usually share needles – they spend all their money on drugs, no money to buy clean needles. Drug addicts also tend to engage in prostitution to support their habit. So the percentage of HIV cases amongst drug addicts is very high because they are constantly engaging in 2 sorts high-risk behavior.

But the percentage of drug addicts amongst the total number of HIV cases is actually very low – because most people in Sydney are not injecting drug abusers!!! However, because enough “normal” men visit prostitutes/ drug users, the prostitutes/drug users become the “seed” through which HIV is spread to the larger community. The “normal” men then take the HIV back to their wives, girlfriends, boyfriends, casual sex partners etc. Therefore, cutting off the infection at the “seed” will reduce spread into the mainstream.

To do that, the Australians set up places where drug users can get FREE CLEAN needles, without getting arrested for drug use. At the same time, the Australians still maintain their opposition to drug abuse.

In the same way, they also set up education programmes to educate and empower prostitutes to practice safe sex , to use condoms, without arresting them for prostitution. At the same time, the Australians still do not view prostitution as a morally acceptable behavior.

Because the drug users/ prostitutes can adopt healthier practices without the fear of being arrested, they of course do! And in doing so, they prevent the rise of HIV infections.  If they will be arrested, or if the authorities refuse to help them at all and still criminalize them on moral grounds, then it will drive them underground, where the HIV will go up and go into mainstream society. Not that Australia condones drug use or prostitution – they don’t.

 

This is a classic example of how, on one hand, everyone holds to the same moral value – NO to drug abuse and prostitution – but policy, (even if the law must be there still) has to be different from the moral values, and TOLERATE it, because the cost of policy adopting a moral high ground would be a much larger cost to the health of a greater number of people.

 

1. Sex with minors (under 16)/Abortion

In Singapore, having sex with a girl under 14 is considered Statutory Rape , with 20 yrs jail, 12 strokes. Having sex with a girl or boy under 16 carries 10 yrs jail.  That law upholds the moral value that adults should not take advantage of the ignorance and emotional immaturity of the child. Great moral value there, and certainly a very useful law to bring these child exploiters to justice.

What’s the backlash?

In the course of my work with the teen girls, I’ve met girls who really loved their boyfriends( could be teens like them, even more immature, could be adults), so much so that when they get pregnant, or get an STI, they never go to the doctor, never tell a single soul. Because they are so afraid their boyfriends would have to go to jail for 10 or 20 years, when the doctor finds out.

What do they do?

They stick things up their birth canal hoping to DIY abortion, risking a high chance of death. They give birth and abandon their baby. They bear with the STI until it becomes complicated and life-threatening, when it could have easily been cured in the early stage. They do abortions at the late stage – this is a major issue doctors face, because it becomes so dangerous.

So what do I tell them?

 

I tell them, your life and health is the MOST important. No matter what, go to the doctor, ASAP! And no doctor can make you reveal who your boyfriend is. No doctor will imprison you in his clinic for days and days until you confess. If you never reveal, no one can arrest your boyfriend.

I often wonder if what I’m doing is right, because it will defeat the purpose of that law. And I still strongly support the law, because if caught, we cannot let a guy who is blatantly lying and cheating young girls to get away with it, because he manipulated her to consent to sex out of youthful curiosity or ignorance or naivety. But what do I do?

This is the reason why abortions are legal in Singapore, for girls of any age, and they can get it done without parental knowledge or consent, at a very affordable price. For this I applaud the wisdom of the policy makers. If girls who are very young must bring their parents along ,they may be so scared of how the parents might punish her, and go to a backstreet doctor who will keep her secret. And the rate of deaths at backstreet abortion clinics can go up t0 40%, at proper doctors, it is 2% or less.

 

There was a recent case, where people were very appalled because a 12 year old girl went to the abortion clinic and she didn’t dare to disclose or report the rapist. The parents didn’t know and so could not help her. The public felt that parents should be made to know, to help her.  I fully agree with their thoughts, but I will never want to see parental consent made compulsory by law, because the consequences will mean the deaths of even more young girls. I would rather pay the price of having disobedient or even bullied teenagers. Bad as that may be, death is worse.

 

1. Euthanasia

I’ve 2 blog posts on this, but I will say it again. It is one thing to support the MORAL principle of euthanasia – where people choose for themselves death over suffering, versus the LEGALISING of euthanasia – which protects the relatives, the doctors, the State who killed the patient, and NOT the patient, who is already dead and cannot be punished whether or not euthanasia is legal.

 

 

Firstly, bear in mind that medical care, even the most basic, HAVE to be State subsidized, or else it will be beyond the reach of the majority. Even your polyclinic is VERY VERY subsidized. But countries usually subsidise only a specific list of STANDARD medicines. The newer, more expensive, better medicines are not on the STANDARD list and not subsidized. The number and cost of medicines on the STANDARD list will depend on how much subsidies the State wants to provide. Drug companies tend not to sell lousy medicines when good ones are already available, or they will not make lousy medicines more expensive than good ones – that’s common business sense. Furthermore, if the expensive ones are not better than the cheap ones, your doctor won’t even prescribe to you!! So what’s this argument about expensive not being better?

So, if State subsidies are low, people tend to not get the best treatments, and of course they will suffer! Or they will say, don’t waste more money on medicines. And so they will wish for death. And they will be happy that euthanasia is legal. And since they are allowed to die and solve the problem, why should the State increase medical subsidies or palliative healthcare? Why should I care for you when you can just go and die?

We MUST NEVER support LEGALISED euthanasia, because it is iimportant that you have enough medical subsidies from the government and not have them tell you, sorry too expensive, but we allow you to go and die.

 

The second, and very common argument against LEGALISED euthanasia is, how do you prove that someone really wanted it, and not that he was coerced?

For example,  if the daughter-in-law is taking care of her cancer-stricken mother-in-law every day. She’s so sick of it, and rather use the money on a nice European holiday. So every day she says “Mother, don’t worry, we will take care of you no matter what. My husband (your son) working OT again tonight, so he will have the money to take care of you. Mother, we cannot waste electricity, must save money. Mother, don’t worry, Ah boy very smart, no need tution, the money save for your medication better. Mother, actually can I ask uncle to lend us some money or not? Cos we quite tight. But Mother don’t worry, your health more important than money”  The mother-in-law will slowly be persuaded that euthanasia is the best for the family she loves, even though in actual fact , the family has lots and lots of money, but she’s being lied to subtly. How do you prove that she was coerced, when she willingly persuades the doctor she wants euthanasia, and signs all the application forms without her family even knowing?

 

You think such people like the daughter-in-law don’t exist? Then why is there so many old-folks homes? Siblings fighting over who should look after parents? The Parents Act where kids must be forced by law to care for parents?

 

So yeah, I agree with many people that we have the MORAL right to choose our own death, and I might even do so myself. But I will never agree to LEGALISED (read: State ENDORSED) euthanasia.

 

Religion and policy were separated a long time ago – and we need to keep that separate.

 

 

The above post is 3^rd in a series of posts reviewing info brought up during the 6^th Singapore AIDS conference. The first described the conference. The second described the life of someone with HIV in Singapore, and hopefully makes you want to do something about the situation. This third post hopefully establishes the principles on which I evaluate and recommend policies with regards to HIV.

Legalised Euthanasia (Read: STATE ENDORSED)vs the Pro-Choice euthanasia: A Debate

A friend of mine (not local) and I had a conversation over msn, and he was questioning my stand against legalised euthanasia, because he empathises with people who are actually seeking euthanasia to relieve suffering. Here’s our conversation, him (A) and me(Me)

A             http://www.news.com.au/story/0,23599,23283804-2,00.html

it’s REALLY strong to watch

you can google for more images of her and about what she had…. she committed suicide….

it’s about someone that had a weird kind of cancer…. but it deformed her….

Me         here’s what i think. There are some laws which you can’t enforce, and they do more harm then the good it’s supposed to. example. laws against abortions. Whether you legalise them, they happen. When they are legalised, girls go to hospital, where the death rate from abortions are below 2%. Make them illegal, and they STILL do happen, in backstreets where the deathrate is 40%.

If you clamp down on illegal abortions, abortions will still be done — by the girls themselves. And then the deathrate really shoots up. So it’s better to legalise abortions.

Another example. Laws against sex with minors (girls below 16) Again, you can’t enforce them, and girls below 16 will still have sex with their boyfriends. But if they get pregnant or get an STI, they will be terrified to go to the doctor because they love their boyfriends. So they risk their own lives with DIY cures

Another example Laws against homosexuality. You can’t enforce them, and it still happens. But then educationists and the media (in singapore at least) cannot talk about it, so they cannot increase awareness or safe sex or they cannot seek legal protection or anything !

The same thing with euthanasia. I’m pro-choice. Whether or not you legalise suicide or euthanasia, it will happen., But the moment you legalise Assisted suicided, or assisted euthanasia, you’ll get a lot of abuse cases which are hard to prove. In essesne you are legalising murder, not suicide

Plus, what is the incentive for the government to subsidise sophisticated, but expensive healthcare, if death is always an option you can provide?

Many people choose euthanasia because they don’t want to be a financial burden. If the govt does not increase subsidies, but uses legalised euthanasia as an option when medical budgets get “too high” you will have more people opting for legal euthanasia

I agree some people would choose death over suffering , and no one can stop them from suicide if they are really determined. I think they have a moral right to. but its their choice not for the state to endorse or encourage

A             ok, the first 3 I am completely on your side….. the more a subject becomes taboo because it goes against religion or whatever, the worse it gets….. I say religion because sex and homosexuality usually are banned/persecuted/illegal because of a goverment’s proximity with churches and religion….

now, in Euthanasia…. let’s split it in two, let’s talk about health care first, because you said some interesting things about cost and burden there, and then there is the moral and ethic decisions there…

Health care: let’s go utopia for a second, imagine we have a perfect health care system that allows  you to be able to receive the medical attention you deserve for a cost that doesn’t make you a burden on your family, like hopefully Obama will do in the USA……. now, there are a bunch of cases in which euthanasia is practised but not with that name, like stage-4 cancers in which patients are put off life-support because all that is left for them is to suffer….. but on the other hand, and me being in science community feel a little guilty, is that we don’t have answer for every disease that is out there….

I had an aunt (fav aunt) that died in one year and we all knew it was going to happen since the beginning…. or this woman I just showed you, I can’t imagine how she felt, what she thought about, how she managed to go outside without feeling rejected by society, which is why she pleaded for death, and in the end she got it….. now, didn’t she deserve better?

Me         now what if your aunt, or child had a terminal illness, and all the standard cures that were subsidised (in singapore, only certain things are subsidised) were useless to help her. You hear of this potential cure, but it is REALLY expensive. But you really love your child and want him to live. If you were very rich, you give up your holiday to europe, to pay for the treatment for your child.

If you were middle class, you sell your house and belongings for your child. If you were poor, you choose euthanasia for your child because there is no way you can afford and the government will not pay, because euthanasia is a legal option

What if that’s not your child. What if that’s your aged parent? Then would you even sell your house for your parent?

A             I see your point…. and I think your problem is more with the current health care situation than Euthaniasia itself…. yes, I agree that you shouldn’t help someone die if there’s a hope to save him…… although the situation in which the cure might work would maybe would mean more suffering for that person…..

I know I’d without a shadow of a doubt save my child…

I also know my mother would ask me not to lose all my savings for her because she already ‘lived her life’

Me         I’ve no problem with euthanasia itself, i’ve a problem with the state using it as a healthcare option, which is what they are aiming for in legalising it

A             Ok, we are on more common ground then…. because when I think of euthanasia, I think about the patient first….. is he/she suffering (and by that I don’t mean only pain, I also mean mental anguish)? is there hope for him? does he want that hope?…… but yeah, having euthanasia FORCED on you because no one will pay, I’m against that too

Me         where do you draw the line? If the person was poor , could not afford, and choose to let his mother die, is that legal euthanasia? If the person was rich, but chose not to give up his europe holiday, and chose to let his mother die of the same cause as the poor guys, is that legal euthanasia? or if the person did not want to sell his house?

legalised euthanasia does not aim to protect the patient, it aims to protect the people who assisted the patient.

A             Where do you draw the line? I honestly can say I don’t know…. with my aunt we did our best to keep her with us as long as possible…. with this woman, I’m guessing she wanted the total opposite….. But, money or resources should NOT be the main deciding factor of something thinking about life and death…… and when it is, it just throws everything off-balance, for everyone…..

q for you… can you imagine a way in which you had the resources to save yourself but would chose not to?

Me         i can……. and i would support anyone who made that choice….. but it has to be a personal choice, not something other people choose for you. Money should definately NOT be the main deciding factor, but you know humans. The moment you give it that legal loophole, every murder case will become a case of legalised murder…….

A             I know, but I do believe pacients should, in some cases, have access to it, but those “cases” should be entirely medical and not economical….. but actually I think the goverment would make a better health care than private insurance companies….. but you are right, drawing the line is tricky……

Me         in a perfect Utopia, where everyone is perfectly ethical , and the government is perfectly responsible in providing the best health care, i will applaud legalised euthanasia……… but given what reality is …… And the health minister proposed in the context of “an aging population” and “overwhelming cost of medical care” and the “need for creative solutions”

A             “need for creative solutions”? isn’t creativity like one of the utmost principles of life?

Me         its like , should we allow private citizens to keep guns at home, given that we have the right to defend ourselves…. yes……………… it is……….. they just want to market euthanasia and justify capping medical benefits

the sad thing is, few people see it that way

the catholic church came out against it today, and many people opposed the church , because they resent religious decrees….

but no one really looks at the motivation behind the governments proposal

even the right thing made for the wrong reasons is a wrong thing to do……

A             the thing we might not understand is that maybe (based on what my mother has told me) they (older people) are ok with this because they don’t want to burden their families, they don’t want to be tied down to a bed or a hospital, they’d rather go than have a half-quality-life……

Me         sigh……. yeh i can see where your mother comes from

and i can see why people may support it for those reasons

many parents think that way too……