Oct 15, 2008
Living wills to be made easier
More people to be encouraged to lodge end-of-life medical directive
By Salma Khalik, HEALTH CORRESPONDENT & April Chong
FEWER than 10,000 people have signed an Advanced Medical Directive, or what is more commonly known as a living will, though it has been available for 11 years.
It is a 'terrible' figure, said Health Minister Khaw Boon Wan, who feels 'we have been too cautious and unduly squeamish' in promoting the concept.
An AMD is a legal document which a person lodges ahead of time to instruct doctors not to take extraordinary measures to prolong one's life if one is terminally ill or unconscious.
This ensures they will not go to extremes such as mechanically helping a patient to breathe, or sending a patient who is in a vegetative state into an intensive care unit to keep him alive.
Instead, they will take steps to ensure that the dying person is made comfortable, with as little pain as possible.
Mr Khaw feels it is important to 'actively' encourage people to sign up, so that their wishes are known ahead of time. One way to make it easier is to remove the need for a doctor to witness its signing, now a requirement.
Other things that might change includes allowing people to download the form from the Internet. It is available now in hospitals and clinics.
Before any amendment to the law is made, public consultations will be held on what people want from and in an AMD.
Speaking at the opening of the Lien Centre for Palliative Care yesterday, MrKhaw said an AMD 'empowers the terminally ill and preserves self-determination into the period in which the patient is unconscious or incapable of exercising rational judgement'.
Decisions should be made in advance, when people are still able to, instead of placing the burden on family members at the end.
Patient care extends to helping them plan their dying, so that the patient's wishes will be 'respected in a dignified, humane way'.
Yet, it is not common to find one who wants to create a directive.
Said Dr Wu Huei Yaw, a consultant in geriatric medicine at Tan Tock Seng Hospital: 'In my last seven to eight years, I've only signed one AMD.'
Doctors in general practice may handle up to 'a few cases' a year.
People may avoid it because of confusion over what the directive involves, said Mr Khaw.
He would like to make the explanations in the two-page form plainer and clearer, and in different languages.
This would clarify matters, not just for patients.
'Some doctors have told us that they shy away from acting as witnesses for AMDs because they themselves do not fully understand the implications of the AMD,' he said.
A check with 12 doctors in polyclinics, hospitals and general practice, found one in four was not comfortable discussing the AMD with their patients, though all agreed it was necessary to increase awareness of such end-of-life decisions among patients and doctors alike.
Another reason for the low uptake is 'sheer inertia', he said.
Dr Noreen Chan, who is developing the palliative care service at the National University Hospital, said there were a few reasons people hesitate to sign the AMD. Among them is the reluctance to talk about death, the misconception that an AMD equates euthanasia, and that it is a 'wordy' document.
'It is a good idea to make the AMD more understandable and accessible to everyone,' she said.
fr ST 16th Oct '08
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materials from today's Paper 1 prep session
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