The new year began with a robust affirmation of the intrinsic value of all human life, including those of persons with disabilities.
The Straits Times forum on 1 January 2015 featured five letters criticising the views of Dr Yik Keng Yeong in his letter, "Very premature babies face serious risks" (30 December 2014).
In the letter, he wrote:
IT IS hard to disagree that advances in paediatric neonatology have allowed the survival of very premature babies ("Flawed rationale for 24-week rule on abortions" by Mr Darius Lee, Dec 22; and "Concept of foetal viability too subjective" by Mr Edmund Leong Meng Tsi, last Thursday).
Life indeed is sacrosanct, but a reasonable discourse on what constitutes life and the viability and survivability of in-utero products of conception at different stages of development must include long-term morbidity studies of very premature babies.
Let's take babies born prematurely at 23 weeks - one week before the current bone of contention for legal abortions in Singapore.
Even with months of intense paediatric care in the best hospitals, about half will perish. Those who survive face very high risk of physical handicaps including cerebral palsy.
If they survive the first two years, there is also cumulative morbidity as they become young adults with increased learning disabilities, poor motor skills and attention deficit syndromes.
It is sad handling infertile couples, but nobody I know prefers having a grossly handicapped child to being childless.
Doctors cannot determine what an in-utero being wants - to be born with all risks attached or to be unborn, this being an unscientific question to be answered only by moralists.
Yet, from all the official Advance Medical Directives that have been signed and the unofficial opinions gathered from patients, it seems that for those who can choose, death is preferable to long-term severe disability and dependence.
The five responses came from various perspectives, but all were unanimous in their disagreement with his views. There was a woman who was born with brittle bones and was "untouchable" (Ms Ho Lay Ping, "Born 'untouchable', she now touches lives") and an assistant lifeskills coach who teaches adults with intellectual as well as learning disabilities (Bryan Chong King Hung, "Support available for people with special needs"). On the other hand, letters from Wong Seng Yoong ("It's not about choosing between death and disability"), Han Junwei ("Balance interests of all parties") and Edmund Leong Meng Tsi ("Recognise value of disabled people") pointed out various errors in his reasoning.
Speaking Off-topic
At the outset, Dr Yik Keng Yeong appears to have been speaking off-topic from the two letters which he disagreed with.
Both letters were aimed at criticising the principle of foetal viability.
The letter from Darius Lee, "Flawed rationale for 24-week rule on abortions" (22 December 2014) criticised the concept of foetal viability on two grounds:
Singapore's 24-week abortion limit was put in place in 1974. Its rationale is based on the stage of gestation at which the foetus is able to survive outside the womb, otherwise known as "foetal viability".
However, the concept of foetal viability is problematic for at least two reasons.
First, it is based on a mistaken understanding of human dignity. All human beings are entitled to be respected and treated equally irrespective not only of race, sex, nationality and social status, but also of age, size, location, stage of development and condition of dependency.
Second, the survival rate of premature infants depends on the availability and state of medical advancement, which vary across time and space.
For example, Japan reduced its abortion time limit in 1991 from 24 to 22 weeks of gestation because of advances in medical technology.
At the time, the survival rate of infants at 22 and 23 weeks' gestation was around 18 per cent. Around 10 years later, the survival rate of infants at the same stages of gestation had increased to 31 per cent and 56 per cent respectively, as a 2009 Japanese study revealed.
This was echoed in the letter from Edmund Leong, "Concept of foetal viability too subjective" (25 December 2014):
The concept of foetal viability, on which the 24-week rule is based, is subjective and unsustainable. Taken to its logical extreme, not one adult will be viable if the necessities for survival are withheld.
Neonatal medicine has significantly reduced the risks associated with premature births.
According to the Health Ministry, among premature babies born in Singapore before 24 weeks of gestation from 2008 to 2012, 48 per cent survived beyond the first year, compared with 27 per cent from 1998 to 2002.
There are also reports from around the developed world that newborns with gestational ages of less than 22 weeks have survived. James Elgin Gill, the world's earliest premature baby with a gestational age of 21 weeks and five days when he was born in 1987, is still alive.
In biology, a human being's life begins at fertilisation. Conception is the only objective standard for when human life begins.
He reiterated his points in "Recognise value of disabled people" (1 January 2015).
Thus, a discussion of premature birth and risks of disabilities is not quite relevant.
In light of this, Wong Seng Yoong wrote in "It's not about choosing between death and disability" (1 January 2015):
IT IS hard to disagree that very premature babies may not survive outside the mother's womb, and those who do may live with some form of disability ("Very premature babies face serious risks" by Dr Yik Keng Yeong; Tuesday).
However, recommendations to amend the 24-week abortion rule are not aimed at reducing the chances of survival of babies or increasing their risk of disabilities by taking them out of the mother's womb prematurely.
Rather, Mr Darius Lee ("Flawed rationale for 24-week rule on abortions"; Dec 22) and Mr Edmund Leong Meng Tsi ("Concept of foetal viability too subjective"; last Thursday) argued that pegging the time limit for abortion to foetal viability is not logical.
With Singapore having one of the world's lowest infant mortality rates, almost every child, especially those in their second trimester, will survive if given a chance to do so.
Therefore, Dr Yik's conclusion that "for those who can choose, death is preferable to long-term severe disability" is misleading.
The 24-week rule is not about choosing between death and disability, but rather death and life - that is, whether a healthy 23-week-old pre-birth baby is given the chance to continue to grow till birth, or has its life snuffed out prematurely.
Are medical advances a boon or a bane? Some may argue that they have saved many prematurely born babies. Yet, we cannot ignore the fact that modern medicine has also made it easier to abort thousands of unwanted healthy babies each year.
I agree.
The Dignity of Disabled Persons and Unborn Children
Even if Dr Yik had been on point, his assumptions about human dignity are entirely incorrect.
Disabled persons, like any other human being, are people with intrinsic worth and dignity.
Dr Yik's error is one of principle rather than medical fact. The distinction between principle and fact is one which he acknowledges to some extent by referring to the question of whether one would prefer "to be born with all risks attached or to be unborn" as an "unscientific question to be answered only by moralists".
Despite his rather condescending and dismissive attitude, what he refers to as the "unscientific question to be answered only by moralists" has been answered and settled by none other than the fundamental principles of human rights.
As a number of letters pointed out, Singapore ratified the United Nations Convention on the Rights of Persons with Disabilities in 2013.
Article 1 states the purpose of the Convention:
The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.
Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. [Emphasis added]
Among other things, Article 10 of the Convention guarantees the equal right to life of disabled persons:
States Parties reaffirm that every human being has the inherent right to life and shall take all necessary measures to ensure its effective enjoyment by persons with disabilities on an equal basis with others.
In a recent speech at the 50th Anniversary of the Society for the Physically Disabled (SPD) on 27 November 2014, Prime Minister Lee Hsien Loong said:
Every society will have its problems and people who are disadvantaged, disabled or need help. What matters is not whether there are such people, but how we as a society take care of them, embrace them, and how they can contribute to and participate in the society – as [President of SPD Ms Chia Yong Yong] said, be a part of the society. Long ago, Mr S Rajaratnam put this in his usual vivid way, and he said, are we a democracy of deeds, or a democracy of words? We have to be a democracy of deeds, by what we do, by how we value individuals, as a society. Are people with special needs just there to be helped, or should they not be people who matter in our society, who are enabled to contribute to our society in full measure? Our society should value every person, no matter who he is, or what he was born with or without, because every person matters to us. These are the basic principles that should guide us as we build a fair and just society. [Emphasis added]
The principle applies equally to unborn children. Robert P. George writes in "Law and Moral Purpose":
What is centrally and decisively true about human embryos and fetuses is that they are living individuals of the species Homo sapiens ”members of the human family” at early stages of their natural development. Each of us was once an embryo, just as each of us was once an adolescent, a child, an infant, and a fetus. Each of us developed from the embryonic into and through the fetal, infant, child, and adolescent stages of our lives, and into adulthood, with his or her distinctness, unity, and identity fully intact. As modern embryology confirms beyond any possibility of doubt, we were never mere parts of our mothers; we were, from the beginning, complete, self-integrating organisms that developed to maturity by a gradual, gapless, and self-directed process.
Our foundational principle of the profound, inherent, and equal dignity of every human being demands that all members of the human family be respected and protected irrespective not only of race, sex, and ethnicity but also of age, size, location, stage of development, and condition of dependency. To exclude anyone from the law’s protection is to treat him unjustly.
Dr Yik Keng Yeong's claims that "death is preferable to long-term severe disability and dependence" and that "nobody I know prefers having a grossly handicapped child to being childless" simply run counter to all the abovestated principles.
Conclusion
To be sure, Dr Yik Keng Yeong's views are similar to those held by the Ministry of Health, which have been addressed elsewhere on this blog (see "Foetal Viability and Foetal Abnormality: Wrong criteria and double standards in Singapore's refusal to reduce 24-week abortion limit"). However, both are wrong for the reasons stated above.
All human beings are persons of intrinsic worth and dignity, regardless of age, size, location, stage of development, and condition of dependency. The five letters have begun the new year with a resounding affirmation of the fundamental value of all human beings. It is hoped that this will mark a new direction in Singapore.
And may Singapore's Jubilee year, the year 2015, be a year when we affirm and respect the intrinsic value of all human life!
I on Singapore
*The writer blogs at http://ionsg.blogspot.sg/