| |
SINGAPORE: It may have been available in Singapore for the last 11 years, but even some doctors admit the Advance Medical Directive (AMD) - more commonly known as a living will - is seldom broached between doctors and patients.
36-year-old Azizah has had to face up to the reality of being an end-stage breast cancer patient ever since her third relapse in July. She was first diagnosed with Stage 2 breast cancer in 2002. With her recent relapse, doctors have diagnosed her with Stage 4 cancer.
Azizah just learnt about the Advance Medical Directive from her hospice nurse, Amy Lim, who visits her weekly.
Signing the AMD means that doctors will not take extraordinary measures like putting her on life support to prolong her life.
Azizah said: "I wanted (it) to be natural because I know that the best thing for my illness is going naturally, instead of all the support of all the equipment. Of course it's not easy because I don't want to let my girls see me suffering."
Even though Azizah has not signed the AMD, she has always known from the start that when the final days are upon her, she wants to go naturally with her daughters by her side.
Hospice nurse, Ms Lim, said: "She's going to stop asking all the whys; she's just going to move on to love. So all that she's embracing now is that she wants to love, she wants to remain calm, she just wants to be a legend to her daughters.
"She just wants to do everything positive to make this goodbye so much easier for her daughters."
An AMD can be done by anyone from the age of 21 in the presence of a doctor. Only about 10,000 Singaporeans have taken it up because many do not know about it or may be uncomfortable talking about death.
Dr Akhileswaran, CEO, medical director, HCS Hospice Care, said: "It's just like allowing nature to take its own course over a period of time, but ensuring that this person is comfortable and well taken care of during that period. It's not that once AMD comes into effect you stop everything and that patient dies."
Doctors have come forward to say that this is not the same as euthanasia where one omits treatment or gives treatment with the intention to kill a patient.
Having said that, the issue of the AMD is seldom raised even to hospice patients, and doctors stressed that it has to be an informed decision.
Dr Akhileswaran continued: "Give the patient a bit of time to think about it because sometimes at the spur of the moment they do make decisions which they regret later on. So we don't want that to happen.
"If they are taking a decision, they have to be doing it at an appropriate time and be informed of everything that surrounds this decision-making - it's an informed choice."
In fact, anyone who signs an AMD can also revoke it. There have also been suggestions to make AMD more accessible.
"We may have to look at the process where once a patient is diagnosed to be terminally ill in the hospital or with advanced cancer, maybe this should be routinely brought up to these patients," said Dr Akhileswaran.
Others argue that the crux of what constitutes "extraordinary measures" can be hard to pin down. A ventilator was considered extraordinary 20 years ago, but not today.
Advances in medical science will continue to push that boundary. Some say it may be better to have a power of attorney, appointing someone who shares the same principles of life, to make that decision.
For now, Azizah plans to make a video journal for her daughters.
"I want to say motivational words to them, to encourage them and live on even though without me, but (breaks down) always think that I'm always with them and just keep me in their hearts."
And till then, it is about sharing life's daily moments with them. - CNA/vm
|
