Tube Food for Thought

Today's papers reported the death of a British man who was devastated when the court in London rejected his request for assistance to end his life. The man was paralysed neck downwards since 2006 but was fully  cognitive. He died of natural cause (pnuemonia) 6 days after the court decision. The case reignited the debate on euthanasia.

Curious as to what constitutes euthanasia in Singapore I did some googling. Apparently the witholding of artificial means to sustain life when the patient is deemed terminally ill is legal and not considered as euthanasia. The patient or the family can make a decision to withold "Extraordinary Life Sustaining" procedures if the patient is deemed terminally ill and when such procedures only serve to prolong his dying process. So in Singapore any person can make an AMD (Advance Medical Directive) to direct that his life should not be sustained by artificial means if he is deemed terminally ill. However what is important to note is that palliative care cannot be witheld and this includes feeding by tube etc. Hence even if a person is dying from cancer he can not opt for tube feeding to be stopped.
I thought this is not very justifiable. If the world is not so medically advanced or if the patient has fallen ill in a country without such medical facilities he would have died naturally at home wouldn't he? How come people are trapped by legal constitution which seems rather unethical as in prolonging a person's sufferings? In my mind force feeding a person by tube against his wishes is unnatural because he would have died a natural death through malnutrition etc if he has not sought treatment from a hospital.

However when I google further I come across another big debate, that of whether witholding tube feeding from cognitively disabled patients makes them suffer a long and painful death. From the account of a lady who recovered from a coma,  she had suffered immense pain during a brief period when tube feeding was suspended. In the case of a dying person however,  it is believed that the body  has begun to shut down and to reject food. The dying person will thus not have a painful death from dehydration and starvation.

As such it can be seen that euthanasia even in its passive form is quite a complex and sensitive issue.  However I feel it is good to go back to basics. Medicine is about curing illnesses and saving life. In circumstances when nothing else can be done to save life, a person should have the choice to go home and refuse all types of medical treatment include unnatural procedures like tube feeding. Think of how our great grand fathers died of their illnesses at home without food forced upon them. They probably weakened and deteriorated quickly when eating became difficult. Haven't generations after generations perished in the same manner? This is really tube food for thought.