Angry Doctor

Sunday, June 11, 2006

WMD (Witness of Mass Directive-signing)

The question of uptake rate of AMD was raised on a previous discussion, and the answer from the ministry has attracted this letter to the ST Forum:

June 5, 2006
Need for better way to sign advance medical directive

I READ with shock in the article on advance medical directives (AMDs) that the Advance Medical Directive Act was passed 10 years ago, yet only 3,840 Singaporeans have signed it ('A measure of control when the end comes'; ST, May 26).

I was first aware of the AMD when the Terri Schiavo case in the United States brought much publicity last year. My husband and I agreed we should both sign an AMD. Procrastination is the thief of time. However, we still haven't done it.

I am sure many Singaporeans feel the same as us but have delayed an AMD because it is inconvenient.

Look at the requirements.

First you must find a doctor who knows what the AMD is and is willing to act for you. It was reported that many doctors do not know how the AMD works. This is understandable.

Then you need a witness aged 21 or above.

Finally, consultation charges range from $10 to $30.

If not for the second requirement, we would have done it without hesitation. It is just unfair to impose something like this on a friend who knows also knows next to nothing about AMDs. Moreover, we will have to inconvenience the witness to go to the clinic to wait for the signing.

Besides, the witness may worry about what may happen in future should complications arise from the AMD.

To encourage more people to come forward and sign the AMD without delay, I would like to make a few suggestions.

First, have a team of doctors familiarised with explaining the AMD and form signing.

Second, have two doctors sign the form, one as the witness. If not, a doctor and a lawyer or someone appointed by the Government.

Third, as more people will be expected to sign when the requirements are made easier, why not arrange the signing at a specific place, for example a school, for a week initially and then on a certain day on a monthly basis?

Fourth, since a crowd can be expected, rather than doctors having to explain the AMD to every individual, why not have a doctor go on stage to explain to an 'audience' in front of the witness and have a mass signing after that? This will be more productive and can be repeated at hourly or two-hourly intervals. Recording and replaying a tape to the audience can also be considered if acceptable.

Finally, a standard charge can be imposed but should be kept low.

Won't this be better for us if we don't have to mingle with the sick in the clinic and add extra time to the queue when priority should be given to patients who need to be attended by the doctor?

We also need not give stress to friends by asking them to be our witnesses.

I hope the authorities will amend the requirements to facilitate signing of the AMD.

Emily Tai Kim Mooi (Mdm)

People who write to the ST Forum seem to be easily shocked or astonished.

Well, angry doc is shocked at Mdm Tai's proposal.

The signing of the AMD is and should remain a personal choice. I do not understand why Mdm Tai is so keen to 'encourage more people to come forward and sign the AMD without delay', or why she expects that crowds will rush to have AMDs signed if it was made more convenient.

As I said before I do witness AMDs, but I find the idea of a mass-signing a little creepy.

Call me old-fashioned, but I prefer to handle something as personal as a Living Will in a more personal manner. As I illustrated in a previous post, people have different understanding of the AMD and they may have different reasons for wanting to sign an AMD. It is important that the doctor who witnesses an AMD ensures that the patient understands its implications and that the doctor is convinced that the patient is not under duress to sign the AMD. It is a legal requirement, and for many doctors it will also be an ethical requirement on their part. You can't always do that in a single visit.

'Just listen to the recording and sign on the dotted line' isn't going to satisfy most doctors and patients, nor should it.

It isn't expensive to see a doctor. Really. And in the case of a Living Will there isn't really any rush. In fact, if there was any rush, your doctor probably shouldn't witness the AMD for you. In any case, having two doctors involved is not going to make it any cheaper, let alone throwing in a lawyer!

As for the need to for a second witness, the default is usually the clinic nurse (so much so that the ministry made a provision for the nurse to use the clinic address as 'her' address in the AMD), so this shouldn't be an issue in most cases.

Is getting an AMD signed inconvenient? Well, some letter-writers seem to have encountered difficulties getting an AMD witnessed.

Should it be made convenient? Well, it shouldn't be made inconvenient, and doctors who turn patients away should base their decision on their knowledge of the Act, the patient's personal circumstances and state of mind, and their own morals, and not ignorance of the Act. Patients who understand the implications of the AMD and are certain they want to sign one should be given access to a witness. Or witnesses.

But to turn it into a regular walk-in event where you make a decision involving a literally 'the rest of your life' issue after listening to a prepared speech or recording?

Well, if that is the alternative, then give me inconvenience anytime.

I for one certainly do not want to be the doctor sitting at one of these mass-signing sessions, witnessing AMDs for complete strangers, just so we can all be 'productive'.

If having an AMD is so important to you, then at least take some time and trouble to have it done properly. Please.

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  • Mass signing of AMDs?

    What do they think this is? FFI in the SAF?

    $10-$30 for consult..interestingly I have a friend in the States right now and he says going to see a doctor there would set you back USD$100 at LEAST!

    I agree with you angrydr. Better to have it personal. Why the rush? Scary to think of the reasons for such a rush right? As it is the current system is such that patients will be kept alive for as long as possible unless the family members chose not to etc. The number of situations where the AMD would be used is not very common anyway.

    Otherwise I have an EVEN BETTER SOLUTION (not suggestion) for Emily.

    Why not just have an "OPT OUT" scheme. Play the "recording" over the TV, RADIO, print in papers for 1 month, then that's it. Everyone would have "signed" the AMD unless they chose NOT to sign.

    Face it Emily, if it's so darn popular people WILL BE queing to see the doctor to get the AMD signed. Just look at the Progress Package.


    By Blogger Dr Oz bloke, At June 12, 2006 3:03 pm  

  • I have mixed feelings regarding AMDs.

    I feel AMDs are just like committing sucide. Do we have the right to end our life in advance? Is it what God really wants us to do?

    On the other hand, AMDs can really end the torture of the patient and the family.

    I just hope signing of AMDs will not become a trend just because people are signing it. It will be even worse if the old people in the family are forced by their family members to sign it.

    By Anonymous Anonymous, At June 12, 2006 6:14 pm  

  • I can't believe she suggested such a thing. It makes AMDs sound so...flippant! AMDs are the same as wills and should be treated that way. Mass signing...pah!

    By Blogger tscd, At June 12, 2006 10:23 pm  

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