Angry Doctor

Monday, October 30, 2006

Perhaps a Discount might make you change your mind?

Today reported on the Health Ministry's latest 'priority' today.

The article is too long to reproduce in full here. I will just highlight certain passages here, but do read the full article to place them in their context.

"About 4,000 Singaporeans have signed an AMD. A third of which did so only after the high-profile case last year of Terri Schiavo, the American whose feeding tube was removed after being in a persistent vegetative state for 15 years.

The numbers worry Mr Khaw: "You know something is not quite right. You should be having hundreds of thousands of people signing on." "

"Although documents to apply for an AMD can be downloaded from the MOH website, Mr Khaw said yesterday that he has received feedback that it is not so easy to get it signed. Two doctors are needed as witnesses, for example.

He hopes to make the process simpler and easier, and also to enhance its public outreach, going as far as to suggest holding sessions in crowded shopping centres."

" "The legislation … may be rather limited. So, part of the discussion I'd like to see is whether it's necessary or desirable to open it up slightly," he said. "But, more importantly, for AMD to really bring about benefits to the person and to the family, you do need many more people to sign on."

angry doc does not get the last point. Unlike immunisation, there is no 'herd immunity' benefit to be had here and as long as a person signs an AMD, it affects ('benefits') him and his family. How many other people sign the AMD is irrelevant to him.

angry doc finds it curious that the Ministry assumes that people will want to sign the AMD in droves, if only they knew about it or if it was easier. Is it not equally probable that they know about it, but just choose not to sign one?

angry doc would like to ask his readers if they have signed an AMD, and why they decided to do so or not to do so.

"Associate Professor Lee Wei Ling, director of the National Neuroscience Institute, agrees that the AMD Act requires further fine-tuning and would like it to also apply before death is impending.

"It just doesn't go far enough now. A person should be allowed to stop life-saving procedures at an early stage. It should be up to each of us to decide what quality of life we're willing to tolerate. That's why it's called a living will in the United States," said Dr Lee, who has written to the press on the issue several times. She believes the best way to make the AMD a success is to make it an opt-out scheme, like the Human Organ Transplant Act. It will also be "politically unacceptable", she said.

"I doubt Singapore society is ready for the AMD. I don't think public awareness is enough to do it. I don't think it will get through without a lot of sweeteners.

"One possibility is that if you sign the AMD, you could reduce your hospital bill by 30 or 40 per cent. It's not just a sweetener. There's logic to it. The biggest cost of medical care is in the last days," said Dr Lee."

Long-time readers of the blog will know angry doc is (sort of) a fan of Prof Lee. Once again she displays an understanding of the Singaporean psyche.

angry doc agrees with Prof Lee that the AMD in its present form is just too 'two-dimensional'. You choose either to have it, and it gets activated when the doctors decide the circumstances are right, or you choose not to sign it and the doctors will (must?) do everything possible/reasonable to keep you alive.

A Living Will can be more detailed and sophisticated than an 'either-or' directive, but as the article points out, Singaporeans may not be ready for such a form of Living Will.

Besides, it will probably necessitate the involvement of lawyers...

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  • what is the role of the dr in AMD? to convince the public that AMD is beneficial in terms of cost?

    so is the dr going to persuade people to sign up for AMD? is it possible to advise without making a judgement?

    dr LWL is too practical. not everyone can stomach that sort of attitude.

    and what constitutes "life-saving" procedures?

    how early a stage does she want? at diagnosis?

    By Anonymous Anonymous, At October 30, 2006 7:35 pm  

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