http://newpaper.asia1.com.sg/news/story/0,4136,181324,00.html?
Choosing a 'good death'
Living wills let nature takes its course with focus on care: Khaw
By Ng Wan Ching
October 26, 2008
THEY'RE young, but they are ready to confront issues related to dying, opting for a 'good death', as Health Minister Khaw Boon Wan describes it.
About 150 people aged between 20 and 29 have declared that they want to be allowed to die naturally.
They have signed an advance medical directive (AMD) and do not want to be sustained artificially should they become terminally ill and unconscious.
Going by age groups, the largest number of people who have signed - more than 2,700 - are between 50 and 59.
That's followed by the 60 to 69 age group - in which 2,400 have signed up.
As of last month, almost 10,000 people have stated their wishes in a living will.
Women seemed to be more proactive than men - 6,155 of them have signed up. Only 3,780 men have done so.
The AMD came into effect in 1997, and the take-up rate has picked up in the last three years.
There were 1,328 signing in 2005, 2,158 in 2006, and 2,761 last year.
So far, five living wills have been effected - one each in 2003, 2005, 2006, and two last year. The Ministry of Health (MOH) hopes to get more people to sign living wills.
Mr Khaw, who signed one a few years ago, said: 'I believe in it.
'Medical technology can now postpone death artificially without any quality of life. Without such artificial intervention, death would have taken its natural course.'
To him, the AMD is to enable nature to take its course.
Care, not cure
'This way, the care providers can focus on care, rather than futile efforts to 'cure', at great pain, discomfort and stress to the patient and the family,' he said in response to questions from The New Paper.
For the terminally ill, with impending death, an appropriate care plan based on the AMD is more likely to deliver a 'good death'.
He admitted it took some work to sign a living will.
'I took a form, filled it up, got a doctor and a friend to witness it and sent it to MOH,' he said.
'It took some effort and I can understand why few do so. I personally feel that we should simplify the process, to help reduce the inertia.'
Over family dinners, he often discusses life and death issues.
'I bring back to the dinner table, actual human stories of patients in our hospitals and their plight.'
Although his three grown-up children are all supportive of the AMD, none of them has signed it yet.
'So inertia to act is a real thing. Not unlike organ pledging. Most support it but few would take the trouble to come forward,' he said.
So he wants to make it easier for people, for example, by removing the need for a doctor to witness the signing, which is the current requirement.
Explanations in the two-page AMD form may also be made plainer and clearer, and in different languages.
But before any amendment to the law is made, public consultations will be held, by the end of the year, on what people want from, and in, an AMD.
--------------------------------------------------------------------------------
What is an AMD?
It is a legal document that you sign in advance to inform the doctor treating you (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your life.
Making an AMD is a voluntary decision. No one can force you to make one against your will.
What is meant by 'terminal illness'?
It is an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery.
For such a condition, death is imminent even if extraordinary life-sustaining measures were used. These measures would only serve to postpone the moment of death for the patient.
Who can make an AMD?
Anyone who is 21 years old and above, and of sound mind, can make an AMD. All you need to do is to complete a form, sign it in the presence of two witnesses, and return it to the Registrar of AMDs.
Where can I get a form?
From clinics, polyclinics and hospitals. It can also be downloaded from the Ministry of Health website.
For more information, go to http://www.moh.gov.sg/mohcorp/default.aspx
Choosing a 'good death'
Living wills let nature takes its course with focus on care: Khaw
By Ng Wan Ching
October 26, 2008
THEY'RE young, but they are ready to confront issues related to dying, opting for a 'good death', as Health Minister Khaw Boon Wan describes it.
About 150 people aged between 20 and 29 have declared that they want to be allowed to die naturally.
They have signed an advance medical directive (AMD) and do not want to be sustained artificially should they become terminally ill and unconscious.
Going by age groups, the largest number of people who have signed - more than 2,700 - are between 50 and 59.
That's followed by the 60 to 69 age group - in which 2,400 have signed up.
As of last month, almost 10,000 people have stated their wishes in a living will.
Women seemed to be more proactive than men - 6,155 of them have signed up. Only 3,780 men have done so.
The AMD came into effect in 1997, and the take-up rate has picked up in the last three years.
There were 1,328 signing in 2005, 2,158 in 2006, and 2,761 last year.
So far, five living wills have been effected - one each in 2003, 2005, 2006, and two last year. The Ministry of Health (MOH) hopes to get more people to sign living wills.
Mr Khaw, who signed one a few years ago, said: 'I believe in it.
'Medical technology can now postpone death artificially without any quality of life. Without such artificial intervention, death would have taken its natural course.'
To him, the AMD is to enable nature to take its course.
Care, not cure
'This way, the care providers can focus on care, rather than futile efforts to 'cure', at great pain, discomfort and stress to the patient and the family,' he said in response to questions from The New Paper.
For the terminally ill, with impending death, an appropriate care plan based on the AMD is more likely to deliver a 'good death'.
He admitted it took some work to sign a living will.
'I took a form, filled it up, got a doctor and a friend to witness it and sent it to MOH,' he said.
'It took some effort and I can understand why few do so. I personally feel that we should simplify the process, to help reduce the inertia.'
Over family dinners, he often discusses life and death issues.
'I bring back to the dinner table, actual human stories of patients in our hospitals and their plight.'
Although his three grown-up children are all supportive of the AMD, none of them has signed it yet.
'So inertia to act is a real thing. Not unlike organ pledging. Most support it but few would take the trouble to come forward,' he said.
So he wants to make it easier for people, for example, by removing the need for a doctor to witness the signing, which is the current requirement.
Explanations in the two-page AMD form may also be made plainer and clearer, and in different languages.
But before any amendment to the law is made, public consultations will be held, by the end of the year, on what people want from, and in, an AMD.
--------------------------------------------------------------------------------
What is an AMD?
It is a legal document that you sign in advance to inform the doctor treating you (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your life.
Making an AMD is a voluntary decision. No one can force you to make one against your will.
What is meant by 'terminal illness'?
It is an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery.
For such a condition, death is imminent even if extraordinary life-sustaining measures were used. These measures would only serve to postpone the moment of death for the patient.
Who can make an AMD?
Anyone who is 21 years old and above, and of sound mind, can make an AMD. All you need to do is to complete a form, sign it in the presence of two witnesses, and return it to the Registrar of AMDs.
Where can I get a form?
From clinics, polyclinics and hospitals. It can also be downloaded from the Ministry of Health website.
For more information, go to http://www.moh.gov.sg/mohcorp/default.aspx
