More "die-logues" expected as govt considers changes to AMD
By Imelda Saad, Channel NewsAsia | Posted: 17 November 2008 1603 hrs
SINGAPORE: The government is considering amending the law to encourage more Singaporeans to sign the Advance Medical Directive (AMD).
The AMD is a legal document which allows an individual to tell doctors that he does not want his life to be artificially prolonged when he is terminally ill and unconscious.
Health Minister Khaw Boon Wan told Parliament on Monday that changes to the Advance Medical Directive Act may include doing away with the requirement to have a doctor witness it, and allowing doctors and patients to actively discuss AMDs.
Only 10,100 Singaporeans have made a living will since the AMD came into effect 11 years ago.
Three-quarters did so over the past four years. Six have been put to effect, while 19 AMDs have been revoked over the years.
One factor for the low take-up rate is that the AMD Act does not allow doctors and nurses involved in the care of a patient to ask whether he has made or intends to make an AMD. There are severe penalties including a fine and a jail term for those who do so.
Mr Khaw said: "I gather that these restrictions were put in as there were concerns by Singaporeans that a doctor may be less forthcoming in his treatment if he knows that his patient has already signed an AMD.
"Unfortunately, such fear, though groundless, remains among some Singaporeans. I am confident that our doctors are ethical and will do what is necessary for their patients, regardless of their AMD status.
"The restrictions have inadvertently become counterproductive to the intent of the AMD by making discussions on AMD taboo. This is a major reason for the lack of awareness and apathy among the public and healthcare professions on the AMD."
Mr Khaw said he is keen to remove this restriction as it has made AMD a taboo subject between doctors and patients.
The Health Minister added that his ministry will ramp up its outreach efforts and encourage more "die-logues" to help Singaporeans better understand the difference between AMD and euthanasia or doctor-assisted suicide.
The aim is to help Singaporeans deal with end-of-life issues more openly and in a more mature manner.
Mr Khaw said: "To me, the key is not so much about AMD or how many people sign up. It's about advance planning - particularly among the terminally ill - so that when patients pick up a terminal illness, for example cancer, then I think at a suitable point as healthcare providers, we need to engage the patients and families so as to also mentally prepare them to the possibility of end of life...
"And the earlier it is discussed in an open manner, I think most of the time it should help the terminally ill as well as their family members."
Mr Khaw said that to make the meaning of AMD even clearer, he is considering giving it a new name.
The Health Minister also stressed that the AMD is not euthanasia. Mr Khaw said AMD is about letting nature take its course for the terminally ill in the last stages of their life.
He added that it is about not mindlessly postponing death through futile medical interventions. Instead, Mr Khaw said Singapore should focus on providing good palliative care for the dying. - CNA/vm
http://www.channelnewsasia.com/stories/singaporelocalnews/view/390399/1/.html
By Imelda Saad, Channel NewsAsia | Posted: 17 November 2008 1603 hrs
SINGAPORE: The government is considering amending the law to encourage more Singaporeans to sign the Advance Medical Directive (AMD).
The AMD is a legal document which allows an individual to tell doctors that he does not want his life to be artificially prolonged when he is terminally ill and unconscious.
Health Minister Khaw Boon Wan told Parliament on Monday that changes to the Advance Medical Directive Act may include doing away with the requirement to have a doctor witness it, and allowing doctors and patients to actively discuss AMDs.
Only 10,100 Singaporeans have made a living will since the AMD came into effect 11 years ago.
Three-quarters did so over the past four years. Six have been put to effect, while 19 AMDs have been revoked over the years.
One factor for the low take-up rate is that the AMD Act does not allow doctors and nurses involved in the care of a patient to ask whether he has made or intends to make an AMD. There are severe penalties including a fine and a jail term for those who do so.
Mr Khaw said: "I gather that these restrictions were put in as there were concerns by Singaporeans that a doctor may be less forthcoming in his treatment if he knows that his patient has already signed an AMD.
"Unfortunately, such fear, though groundless, remains among some Singaporeans. I am confident that our doctors are ethical and will do what is necessary for their patients, regardless of their AMD status.
"The restrictions have inadvertently become counterproductive to the intent of the AMD by making discussions on AMD taboo. This is a major reason for the lack of awareness and apathy among the public and healthcare professions on the AMD."
Mr Khaw said he is keen to remove this restriction as it has made AMD a taboo subject between doctors and patients.
The Health Minister added that his ministry will ramp up its outreach efforts and encourage more "die-logues" to help Singaporeans better understand the difference between AMD and euthanasia or doctor-assisted suicide.
The aim is to help Singaporeans deal with end-of-life issues more openly and in a more mature manner.
Mr Khaw said: "To me, the key is not so much about AMD or how many people sign up. It's about advance planning - particularly among the terminally ill - so that when patients pick up a terminal illness, for example cancer, then I think at a suitable point as healthcare providers, we need to engage the patients and families so as to also mentally prepare them to the possibility of end of life...
"And the earlier it is discussed in an open manner, I think most of the time it should help the terminally ill as well as their family members."
Mr Khaw said that to make the meaning of AMD even clearer, he is considering giving it a new name.
The Health Minister also stressed that the AMD is not euthanasia. Mr Khaw said AMD is about letting nature take its course for the terminally ill in the last stages of their life.
He added that it is about not mindlessly postponing death through futile medical interventions. Instead, Mr Khaw said Singapore should focus on providing good palliative care for the dying. - CNA/vm
http://www.channelnewsasia.com/stories/singaporelocalnews/view/390399/1/.html
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