Advance Medical Directives

I certainly have much to say about the fallacies Health Minister Khaw has been trying to propagate.

First of all, there is no essential difference between AMD and euthanasia. I honestly don't understand the distinction Khaw is making. Euthanasia is about killing someone mercifully. It is derived from the greek word which literally means "good death". Whether or not you do it based on the person's wishes doesn't change the fact that you're killing that person, and this is probably the contention most Singaporeans have. Like it or not PAP, I for one will not buy such nonsense.

That aside, PAP's presumptious attitude towards the AMD is indicative of the PAP's governing attitude in general. Riding roughshod over concerns, such as the fact that the AMD takes life away and is essentially euthanasia, the PAP has proven itself once again to be so politically comfortable that some dissension isn't worth addressing. Instead, the PAP encourages 'die-logues' to further entrench the status quo - that of AMD being a fact, rather than a contention.

Necessary as it may be to talk about death, the PAP's approach seems to me as more of encouraging people to take up the AMD. Just look at the following article. (my remarks are in red)

Allow docs, patients to have more 'die-logues': Khaw
[2008] 18 Nov_TODAY

ASK a patient if he has made a living will, and one could be fined up to $5,000 and jailed up to 12 months.

Such are the “severe penalties” faced by doctors and nurses now, and they constitute a major reason for the lack of awareness and low take-up rate of the Advanced Medical Directive (AMD), said Health Minister Khaw Boon Wan yesterday.

Mr Khaw yesterday suggested changes to the AMD Act to remove barriers to openness between medical professionals and patients, as well as to simplify the process of making a living will. At the same time he acknowledged that Singaporeans were not ready for the more drastic scenario of euthanasia.

Under current laws, doctors and nurses can talk to patients about the AMD, but they cannot ask if a patient has signed one. Patients can, however, volunteer the information to doctors.

The result? Only 10,100 Singaporeans have signed an AMD, most in the last four years. Nineteen have revoked it for reasons unknown while six have effected it.

You see boys and girls, ONLY10,100 Singaporeans have signed an AMD. That's too little, because hey, that's what free choice is about right, it's about encouraging you to sign the AMD because it's the PAP's new move to 'liberalise Singapore'.

The United States has a relatively high 20 per cent sign-up rate, because of a more open culture — all adults admitted to Government-funded hospitals are asked if they have an AMD and told of their right to make one, for instance.

So? What are you trying to imply? That we should try to emulate the United States? That we need to have a more 'open culture'? To be honest, I'll much rather be Singaporean thank you. And for your information, that same culture you speak of produces more than just a 20 per cent sign-up rate. Take for instance legalising gay marriages? Like in Ohio? Which Singapore clearly objects to. Or maybe a sky-high crime rate? Or how about a much freer democracy than Singapore's. Emulate that will you.

In Singapore, Mr Khaw said, the restrictions were put in place due to concerns “that a doctor may be less forthcoming in his treatment if he knows that his patient has already signed an AMD”.

Calling these fears groundless, he added: “The restrictions have inadvertently become counterproductive to the intent of the AMD by making discussions on AMD taboo.”

In recent public debate, some have even confused euthanasia with the AMD.

Yes yes, people who try to explain the distinction to you are labeled as confused. Nice way to facilitate dialogue.

His ministry will encourage more “die-logues” to help Singaporeans better understand the difference between AMD and euthanasia.

MP (Ang Mo Kio) Lam Pin Min asked if, theoretically, high AMD sign-up rates would imply that healthcare costs are “too high to maintain or sustain life any longer”.

Mr Khaw said AMDs should never be a game of numbers. “The key really is not so much about AMDs and how many people sign up, as (it is about) advanced planning, particularly among the terminally ill,” he said. “And the earlier it is discussed in an open manner, it should help the terminally-ill and their family members.”

The Ministry of Health will also try reaching out to the estimated 40 per cent of terminally ill cancer patients now without palliative care. “The main obstacle to access is awareness,” he said, adding that hospice care can be subsidised by up to 75 per cent.

Finally, one thing I noticed. It has been quite typical of the PAP recently to ignore the views of Singaporeans. Maybe it's getting too cosy, or perhaps confident of their gerrymandering skills. Whatever the case, don't sue me, few people read my blog so you won't elicit the same level of fear and deterrence.

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Can you blow a whistle?

So Nair got jailed 3 months for insulting a judge and "scandalising the administration of justice in Singapore".

Nair's defence was - it's true, "the judge Belinda Ang was throughout prostituting herself during the entire proceedings, by being nothing more than an employee of Mr Lee Kuan Yew and his son and carrying out their orders".

The verdict - based on the fact that Nair said something against the court, not exactly that it was proven to be untrue. So we come to my next question, what happens if you actually think that some judge is corrupt and at least want some third party to investigate. Should you get jailed for accusing someone of corruption? I'm not sure.

But this is what Justice Kan has to say about free speech.

"The rights of freedom of speech and expression are qualified and...do not entitle you to insult Justice Ang in the way that you have done,' said Justice Kan.

So it seems that the courts understand the meaning of freedom in quite a different way. Yet, to say that freedom must be "qualified" and restrained, is to contradict what it means to be free. This makes perfect sense for a government wishing to stay in power though - keep criticism at a bare minimum and wash not your dirty linen in public.

On a side note, the article by AG Walter Woon in response to Dr Lee Wee Ling's letters regarding the case of Tang Wee Sung trying to buy a kidney made a statement which somewhat resembles my seemingly incompetent history teacher.

"Yet it is contended that he should have been let off because he was a desperately poor man trying to save his family (an unproven assertion). "

Way to go AG Woon. When someone doesn't bother to throw statistics in your face because she is trying to show a basic respect for your ability to make simple deductions, you brush the point aside and refuse to acknowledge it by going, "oh you can't prove that".

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Some other more urgent matters require my attention for the time being. I'll probably only be able to resume writing next month. Till then!

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The Straits Times Wonder

Once again, I was feeling bored. So I decided to take a look at what's on the news. For some odd reason or another, the first choice that came to my mind was The Straits Times. So I went to their website, read a few summaries here and there, and just when I got interested in a particular article and decided to click the link, I got this blasted notification which just makes my blood boil. Guess what. The Straits Times is the only online English news source in Singapore that requires you to subscribe in order to access its contents online.

For your information, the rates are:

For print edition subscribers

• Six-month subscription at S$36 ($6/month)
• 12-month subscription at S$60 ($5/month)
• 24-month subscription at S$102 ($4.25/month)

For non-print edition subscribers

• One-month subscription at S$15
• Six-month subscription at S$72 ($12/month)
• 12-month subscription at S$120 ($10/month)
• 24-month subscription at S$204 ($8.5/month)

Unbelievable. But it's true. TODAYonline is more than willing to provide you with its print version online. It even takes the effort to make its page user-friendly so you can click through it as if you're flipping through a real paper instead of having to scroll around. Channel News Asia has no qualms about providing a free online service either, it even has some nice ads for it to earn money from. And most importantly, even the ELECTRIC New Paper doesn't charge 12 bucks a month.

Well, what can I say? It's quite clear that The Straits Times feels rather confortable with its huge market share in Singapore through its print edition. With around 1mil subscriptions a year, it no doubt has the largest market share in Singapore. But that's for the print edition. To The Straits Times, wake up your idea, print editions are a thing of the past. Even the government has recognised the importance of the internet and set up AIMS. Straits Times, you're being left behind.

Simply inconceivable.

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Another Conspiracy Theory to Boggle Your Mind

I guess many have thought quite positively of Finance Minister Tharman Shanmugaratnam's decision to abolish real estate duty entirely a while back. But is it really all fine and dandy? Or are there deeper darket secrets?

Is estate duty truly resting in peace?

THE government introduced a Bill in Parliament last week to abolish estate duty with effect from Feb 15, 2008. Estate duty presents a nice counterpoint between two branches of economics - public finance and the nascent discipline of behavioural economics.

Estate duty has a long history in Singapore. It was established by the colonial government in 1929. It is actually an inheritance tax and has been widely regarded by public finance economists as one of the most efficient ways for the government to collect revenue.

The government's leading source of revenue is income tax. The major downside of income tax is that it discourages people from working harder. By contrast, the possible disincentive effect of estate duty is to persuade people to live longer.

Until February, estate duty was levied on all estates in excess of exemptions of $9 million for residential property and all other assets for $600,000. Legislators, scholars, and concerned citizens had called for the discrepancy in exemptions between residential property and other assets to be rationalised. Prime Minister Lee Hsien Loong accepted this in principle.

Then, in this year's Budget, Finance Minister Tharman Shanmugaratnam decided to abolish real estate duty entirely. Minister Tharman remarked that estate duty affected 'our middle and upper-middle-income estates disproportionately compared to wealthier ones'.

The Minister's implication was that the very wealthy could use trusts and other legal mechanisms to avoid estate duty. This view was supported by various tax experts.

At this point, it is useful to apply behavioural economics to public finance. Behavioural economics originated with Herbert Simon, economist and psychologist, who famously observed that individuals are subject to bounded rationality. Their decision-making is subject to limited information, cognitive skills, and thinking resources. The lesson from behavioural economics is that individuals are subject to systematic biases in their decision-making.

Revenue statistics show that, contrary to popular belief, not all wealthy people plan their estates perfectly so as to avoid estate duty. In the figure opposite, the vertical bars show estate duty collections in millions of dollars a month.

Over the period 2000-08, the average monthly collection was $11.4 million. However, there were several quite clear spikes in collections. There are two possible explanations for these spikes.

Either a disproportionate number of people died in those particular months. Or one or several persons with immense wealth died and left estates of high value - many millions of dollars more than $9 million in residential property and $600,000 in all other assets.

Let's consider the first possible explanation. In the figure, I also show the number of deaths in thousands on a monthly basis (the blue dots). Unlike estate duty collections, deaths in Singapore have been quite stable at about 1330 per month. In particular, there were no obvious death waves that could possibly account for the spikes in estate duty collections.

So, the only possible explanation of the spikes in estate duty collections is that some rich people had not planned carefully enough to avoid estate duty. Consequently, they (or more precisely, their beneficiaries) had to pay estate duty.

The graph reveals four particular spikes in 2004, including collections of $108.4 million, $63.1 million, $97.9 million, and $114.4 million in March, June, September, and October 2004 respectively.

Consider the highest spike of $114.4 million. Suppose that it was due to a single estate. Subtracting the average monthly collection of $11.4 million, the estate duty payment was $103 million. On a rough calculation, at a 10 per cent rate of estate duty, the estate must have been worth $1.03 billion. The second-highest spike of $108.4 million would have been due to an estate worth only slightly less.

Evidently, two or more multi-millionaires who died around 2004 did not minimise estate duty in the way that tax experts had supposed.

Scanning the obituary pages, it is possible to speculate who might have been responsible for such a large payment of estate duty. Financier and hotelier, Khoo Teck Puat, died in February 2004. He was the richest person in Singapore. Besides controlling major assets in Singapore, he was the largest shareholder in Standard Chartered Bank. The late banker's fortune was reputed to be worth billions of pounds sterling.

The late tycoon was famously secretive. After his death, it became known that he owned substantially more of three listed companies - Goodwood Park Hotel, Hotel Malaysia, and Central Properties - than he had declared. The revelation led an investigation by the Commercial Affairs Department.

It is interesting to contrast the late financier with another banker. Tan Chin Tuan died in November 2005. Nicknamed Mr OCBC, he ran the Oversea-Chinese Banking Corporation for many years. He owned or controlled large blocks of shares in listed companies including OCBC, Great Eastern Life, and Straits Trading.

However, there were no obvious spikes in estate duty collection around the time of Mr Tan's death. The closest was $29.7 million in May 2006, which seems trivial relative to the late banker's wealth. So, probably, the famously meticulous Mr Tan had undertaken very careful estate planning.

It would almost seem axiomatic that people would do their best to avoid taxes. Yet, at least two multi-millionaires who died around 2004 did not do so. With their fabulous wealth, they definitely had sufficient resources to engage lawyers, establish trusts, etc. But they did not do so. Only the taxman knows their identities.

The great claim of behavioural economics is to have identified the direction of systematic biases in individual decision-making. Singapore's experience with estate duty poses a rather challenging question for behavioural economics: How to explain why some multi-millionaires planned carefully for their death and why others did not? It also poses a bit of a challenge to Finance Minister Tharman's rationale for abolishing estate duty.

The writer is the Lim Kim San professor of business policy, and professor of information systems and economics at the National University of Singapore. The opinions expressed here are personal.

Source: Business Times © Singapore Press Holdings Ltd. Permission required for reproduction.

The conspiracy theory? Well it's not all too convincing, yet. Fantasizing about these conspiracies though does give one certain tingly feelings. Besides, it's always best to be prepared for the worst. So here's it.

As reported in this article, rich people may not always end up evading estate duty. According to the principles of behavioural economics, the decision-making of people is subject to limited information, cognitive skills, and thinking resources. In the cases that were mentioned above, such rich people clearly did not manage to escape estate duty through the use of trusts and other legal mechanisms.

The question thus is, why not? Were they unaware? Were they unaware because they couldn't be bothered? Could they not be bothered because it was too much of a hassle? Because it entailed legal fees? My conclusion is this. The abolishment of the estate duty has certainly helped the rich by removing the hassle they would previously have to go through.

On the topic of being rich, anyone notice Ho Ching being ranked No.3 on Forbes' Top 100 Most Powerful Women? I'm also pretty sure our ministers have some nice connections with rich people (apart from being rich themselves), so this change in policy would certainly be of benefit to them.

As usual, that's just one big conspiracy theory. But think about it.

P.S. I'm not saying estate duty shouldn't have been abolished, I'm just saying it's grounds for a new conspiracy theory.

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Survey on Attitudes Toward Foreign Talents

UPDATE: Survey has been closed. Thank you all for your participation and support.

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Beyond all reasonable Doubt

In a recent lawsuit which sees a woman trying to claim maintenance fees for a man she was trying to have an affair with, the court has proven remarkably lax with their adherence to the legal requirement - proving beyond all reasonable doubt. (An article regarding this can be found here)

There are two ways to prove that the man who had sex with the woman was truly the father. The first is to ascertain that he was the ONLY man to have sex with her during that period of time. This remains disputed as no one knows for sure whether this woman did not have any other partners at that time. What it has been left to is a classic case of your word versus mine, something quite inconclusive and not too judicial to rely on.

The other way to find out the facts would be to conduct a DNA test on the accused. The only problem here is that he has refused, for unknown reasons. Under current laws, a judge cannot compel anyone to take a DNA test; nor is the judge supposed to make an unfavourable inference against someone for choosing not to.


Despite the lack of evidence however, Justice Lee still ruled against the man, ordering him to pay a yet-to-be-determined sum in maintanance fee. While his reasons for this judgement were not explicit, his remark that the man would have been caught out lying if he had taken the stand seems to imply that his judgement was made on this man's refusal to take the stand, and his subsequent deduction that he dared not take the stand out of guilt, thus concluding that he was guilty.


While I certainly am not in favour of irresponsible adulterers, I wonder how fair this really is. Should a person's refusal to take the stand, maybe because of some other plausible reason, be deemed guilty immediately? And even if this person did take the stand and give his testimony, (which he actually did do indirectly in his affidavit) should he still be deemed guilty because of his refusal to take the DNA test. In the interests of punishing and deterring such offenders, I would say yes, since it would be better to catch 10 good guys then to let 1 criminal go. However, is this crime control model the way to go, or should Singapore uphold the principles of due process, rather allowing 10 criminals to go then punish 1 good guy.

In general, Singapore has followed the former model of crime control. Maybe it should consider shifting towards the other model given that our society is becoming more modern.

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