Shifting landscapes: law and the end of life in Singapore
An appropriate starting point for this brief survey of the state of the law governing the end of life in Singapore is the Human Organ Transplant Act. In its original incarnation, the Act (1987 HOTA) encapsulated in microcosm many of the principal driving forces, tensions and cross-currents that drive the current debate about rights, obligations and choices in the moral, legal, social and cultural spheres at the end of life. Until the enactment of the 1987 HOTA, there was no statutory deﬁnition
of death in Singapore. The assumption was that the English common law approach to the deﬁnition of death would apply to ﬁll the gap, despite the generous amount of references to death in Singapore legislation (Kaan, 1992). The traditional approach of the common law was simply to leave it to the medical profession: death was a purely medical question, and not a legal one. Until quite recently, the criterion actually applied by the medical profession in the determination of death was one readily understood and universally accepted in most societies – as late as 1981, it could be asserted that the traditional deﬁnition of death in cardiopulmonary terms (the irreversible cessation of heartbeat and breath) was the exclusive controlling deﬁnition of death in the common law. As put by Lord Lane:
There is, it seems, a body of opinion in the medical profession that there is only one true test of death and that is the irreversible death of the brain stem, which controls the basic functions of the body such as breathing.When that occurs it is said the body has died, even though by mechanical means the lungs are being caused to operate and some circulation of blood is taking place.