Advance Medical Directives

Posted On // 4 comments

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.


Bernie said...

Hi, I'm writing a paper on Singapore's legislation of AMD's and how its conceived by its population (I'm a grad student from NUS). Do you believe the opposition that AMDs have seen in Singapore is cultural or religious... even though this is a hard distinction. I would love to get your insight into this.

cy said...

Dear Bernie,

I am not so sure if there are any strong culutral influences at play when it comes to the topic of AMDs, but I believe that some religious groups in Singapore have in fact expressed their opposition to the AMDs. To answer your question, I think you'll have to consider two things, (sorry but I can't really provide any conclusive answers here so this is simply a suggestion on how you could approach the issue)

1) The stand of religious groups in Singapore
2) The influence of these religious groups (i.e. how big is their following / how influential are they in terms of public opinion)

On the first point, I recall the Catholic church coming out in opposition to the AMD and the Hindus saying they're fine with it. I'm not so sure about the other religious groups.

On the second point, I would suppose that religious opposition in secular Singapore isn't actually very powerful. In fact, I hardly recall instances where religious groups have had much say in public policy. I think the reason here is simply because multi-racial Singapore needs to be built on a secular concept of governance. That aside, I don't really think there is very strong opposition to AMDs on secular grounds either, at least not as strong as there was to 377A where they even had a petition.

Hope this helps, I'll be more than happy to answer any other questions that you have.

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