Thursday, May 30, 2013

Advance Medical Directive = Waiting to die in hospital

My aunt in her late seventies had a stroke and was hospitalized on 23/5/13. She has back problem for years and was house bound for the last few years. So when the doctor told the family that the chance of a successful operation to remove the blood clot in her brain is low and that she would be severely paralyze should she recovered, my uncle (her brother) made the decision for no medical intervention and to remove life supporting system. 

When my uncle sent out the sms to relatives on this decision, all of us rushed down as we thought that she would die within a few hours after removal of the life supporting system. In the hospital we learned that the doctor said  that patient would die 'naturally' within a few days or a few weeks.

Her life support system was removed on 25/5/13 and she was transferred out of ICU. Currently she is still lying in hospital - literally waiting to die.  Recently we have been told it could be months before she die - basically- the doctor don't know!

It is distressing is to see her lying there. We do not know if she is aware of her condition, if she is in pain or suffering emotionally.  Her condition is not as severed as we thought as she still has responses, her eyelid moves, she tears and there is also slight body twitching when she is spoken to.

We were under the impression she is in coma initially. But she has exhibited responses and that means she is conscious of her surrounding. Those of us who agreed with our uncle decision, now are having doubt. What happen if she continues in this state for years ?  Would it not be better for her to have the operation. Even if she dies during the operation, it is a quick death rather than this prolong suffering.

My uncle decision for no medical intervention and to remove life supporting system is the same procedure prescribed in Advance Medical Directive. The only difference is the patient make the decision in advance to sign the directive. In my aunt case, as she is incapable to make the decision, her brother authorized the procedure.

No wonder the public response to the Advance Medical Directive is so poor even decades after its legalization in Parliament in May 1996.  The law permits no medical intervention and removal of life supporting system for terminally ill patients but prohibits euthanasia. Euthanasia in the eyes of the law is assisted suicide, while Advance Medical Directive is not.  It is a pretty grey line and a matter of interpretation and playing with words.

For those who are religious, it is unlikely they will take up the Advance Medical Directive. For those of us we have no issue with euthanasia, Advance Medical Directive is no substitute and a lousy option.

Euthanasia allows a dignify and peaceful death.  It relieves prolong physically and emotional suffering for the patient and reduces distress for family members.  Advance Medical Directive provides no relieve for the patient nor the family members. In fact, the long waiting period for the patient to die is torturing. Most patients prefer to die surrounded by love ones. Family members too would like to be around during the last moment. Euthanasia could fulfill such wishes, while Advance Medical Directive could not as no one knows exactly when the patient would die.

But knowing our S'pore govt, humane appeal will not work with them.  Only economic $$ make sense to our govt. So it is high time they review Advance Medical Directive which is a White Elephant. They have been screaming to us about our aging population. Our hospital beds are limited and we are short of health care professional.  Advance Medical Directive procedure will only worsen the problem as more and more patients will be lying in hospital waiting to die in years to come. Besides with the medical cost sky high, there will be many who could not afford to pay the medical bill due to the prolong hospitalizaton period. The govt would hate to increase subsidy for patients and we the citizen would hate the govt should they keep increasing our Medisave minimum sum and raising our Medishield premium in order to keep up with the escalating medical cost.

They should consider introducing 'Assisted Departure' into Advance Medical Directive - which is the doctor would do an injection to let the patient go peacefully should he/she not go after the life supporting system has been removed for a certain duration (perhaps 3 days?).

By all means avoid the word 'euthanasia', if this word is so sensitive. I am sure there are enlightened doctors who have no issue helping terminally ill patient to go peacefully if the law permits it.

note : no medical intervention in Advance Medical Directive is term 'Extraordinary life-sustaining treatment' which is any medical intervention that serves only to prolong the process of dying for terminally ill patients but does not cure the illness on either a temporary or permanent basis eg. respirator that assist patient to breathe. Patient is given only palliative care such as food and water and treatment to relief pain.

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