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More willing to think about death
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SINGAPORE: Death may still be a relatively taboo topic in Singapore, but statistics from the Health Ministry (MOH) show that more people are warming up to the idea of signing a "living will", instructing doctors not to prolong their life with extraordinary life-sustaining treatment if they become terminally-ill and unconscious.
While only 500 signed up for an Advanced Medical Directive (AMD) each year between 1997 to 2004, the figure has jumped nearly four-fold to 1,900 a year in the subsequent years to 2010. Current numbers stand at 14,000 and seven have been administered, according to the MOH.
An MOH spokesperson attributed the growing acceptance to how end-of-life care has developed "from a single intervention at the point of terminal illness to a more holistic and comprehensive approach of advance care planning".
The AMD, which was legislated in 1997, is a legal document voluntarily signed by patients. The possibility of signing such a document can come up when patients discuss with medical professionals their future medical care in the event the patient becomes incapacitated from making his own decisions - a process called advance care planning.
Patients can seek clarification about their conditions and their available options, which will assist healthcare workers in clinical decision-making.
"Such conversations can take place earlier in the course of illness and can continue over several consultations," said Associate Professor Pang Weng Sun, senior consultant at the Department of Geriatric Medicine at Khoo Teck Puat Hospital.
The Agency for Integrated Care is aiming to facilitate "end-of-life conversations", and has trained 190 facilitators to do so. It plans to train another 240 by the end of this year.
Its spokesperson told TODAY that the Government has set aside S$18 million to embark on the programme, which includes both training and raising awareness of this scheme.
While there is growing interest in AMDs, a Lien Foundation report found that doctors felt the number of such livings wills are low.
Said Dr Lalit Krishna, a senior consultant in palliative medicine at National Cancer Centre Singapore: "We live in a society which still considers the discussion of death as taboo … Families too remain resistant to such conversations in a society that places a great deal of value upon the idea of hope."
One patient was also concerned that having an AMD insinuated that "he had little faith in the ability of his family to carry out his wishes, and (it) would cause unnecessary consternation amongst the family", he said.
Beyond getting patients to be open to the idea of AMDs and end-of-life planning, the Lien Foundation report also revealed that doctors see limitations in the law that hinder the carrying out of the directives.
For instance, it is illegal to ask patients if they have signed an AMD, and there are stringent conditions to fulfil in order to effect the living will: Two other specialists have to certify the patient's terminal condition and the patient has to be in need of "extraordinary" life-sustaining treatment.
Said Dr Krishna: "It may be the legislature appears too difficult to understand, let alone implement … What is extraordinary for one is not the same for another."
Still, Assoc Prof Pang said that he has seen greater awareness and openness on the ground. And instead of getting more people to sign "living wills", it is more important to get people to think about their preferences to give their families and doctors a better understanding on managing their end of life care when the time comes, he added. - TODAY <!-- Zone Tag : Channel News asia In Text <script type="text/javascript"> innity_pub = "66368270ffd51418ec58bd793f2d9b1b"; innity_zone = "12251"; innity_width = "**"; innity_height = "**"; innity_country = "SG"; </script> <script type="text/javascript" src="http://cdn.innity.com/network.js"></script>-->
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More willing to think about death
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SINGAPORE: Death may still be a relatively taboo topic in Singapore, but statistics from the Health Ministry (MOH) show that more people are warming up to the idea of signing a "living will", instructing doctors not to prolong their life with extraordinary life-sustaining treatment if they become terminally-ill and unconscious.
While only 500 signed up for an Advanced Medical Directive (AMD) each year between 1997 to 2004, the figure has jumped nearly four-fold to 1,900 a year in the subsequent years to 2010. Current numbers stand at 14,000 and seven have been administered, according to the MOH.
An MOH spokesperson attributed the growing acceptance to how end-of-life care has developed "from a single intervention at the point of terminal illness to a more holistic and comprehensive approach of advance care planning".
The AMD, which was legislated in 1997, is a legal document voluntarily signed by patients. The possibility of signing such a document can come up when patients discuss with medical professionals their future medical care in the event the patient becomes incapacitated from making his own decisions - a process called advance care planning.
Patients can seek clarification about their conditions and their available options, which will assist healthcare workers in clinical decision-making.
"Such conversations can take place earlier in the course of illness and can continue over several consultations," said Associate Professor Pang Weng Sun, senior consultant at the Department of Geriatric Medicine at Khoo Teck Puat Hospital.
The Agency for Integrated Care is aiming to facilitate "end-of-life conversations", and has trained 190 facilitators to do so. It plans to train another 240 by the end of this year.
Its spokesperson told TODAY that the Government has set aside S$18 million to embark on the programme, which includes both training and raising awareness of this scheme.
While there is growing interest in AMDs, a Lien Foundation report found that doctors felt the number of such livings wills are low.
Said Dr Lalit Krishna, a senior consultant in palliative medicine at National Cancer Centre Singapore: "We live in a society which still considers the discussion of death as taboo … Families too remain resistant to such conversations in a society that places a great deal of value upon the idea of hope."
One patient was also concerned that having an AMD insinuated that "he had little faith in the ability of his family to carry out his wishes, and (it) would cause unnecessary consternation amongst the family", he said.
Beyond getting patients to be open to the idea of AMDs and end-of-life planning, the Lien Foundation report also revealed that doctors see limitations in the law that hinder the carrying out of the directives.
For instance, it is illegal to ask patients if they have signed an AMD, and there are stringent conditions to fulfil in order to effect the living will: Two other specialists have to certify the patient's terminal condition and the patient has to be in need of "extraordinary" life-sustaining treatment.
Said Dr Krishna: "It may be the legislature appears too difficult to understand, let alone implement … What is extraordinary for one is not the same for another."
Still, Assoc Prof Pang said that he has seen greater awareness and openness on the ground. And instead of getting more people to sign "living wills", it is more important to get people to think about their preferences to give their families and doctors a better understanding on managing their end of life care when the time comes, he added. - TODAY <!-- Zone Tag : Channel News asia In Text <script type="text/javascript"> innity_pub = "66368270ffd51418ec58bd793f2d9b1b"; innity_zone = "12251"; innity_width = "**"; innity_height = "**"; innity_country = "SG"; </script> <script type="text/javascript" src="http://cdn.innity.com/network.js"></script>-->
