>> ASIAONE / HEALTH / FITNESS / SPORTLIGHT / STORY

It's my life
Sumiko Tan
Sun, Nov 05, 2006
the sunday times

Without my spectacles, the world's a scary mash of vague shapes and blotchy colours. And given that I won't be taking my glasses along when I go, is this how my eternity will look like - 750 degrees of fuzziness?

But I always console myself with how, when I sleep, my dreams appear as if I have perfect eyesight. Shapes are beautifully etched, colours are digital TV-clear and I have the bionic, long-range vision of a hawk.

Maybe that's the way the afterlife will be, not a hellish world of cloudy outlines and sure-to-miss potholes.

I've been thinking about this because living wills, or what's known as advance medical directives, are back in the news.

It was reported last week that only 3,840 Singaporeans have signed them in the 10 years since the AMD Act came into being, and the Health Ministry wants to publicise the issue further.

Singapore's living wills allow you to say in advance that you don't want to be artificially kept alive should you become terminally ill and unconscious.

In that scenario, you'd be unable to communicate your wishes to your doctor.

The advantage of a living will, then, is that should you rather die than go through treatments that merely prolong the process of dying, you can make your preference known before you are no longer able to do so.

There are other advantages: As your wishes are known, you don't have to pass on to relatives the heavy burden of whether to keep you alive or let you die; also, money isn't wasted on treatments that are futile.

I support the concept of living wills.

If I'm in a state where I'm practically dead save for a respirator that gets me to breathe, why prolong the agony? We're all born to die anyway.

Being unmarried also makes signing a living will more imperative.

Chances are, I will have to fend for myself when I'm old. And when I'm on my deathbed, wouldn't it be useful if there's a document doctors can refer to when deciding what to do to me?

By opting out of unnecessary treatments, I'd also save a bundle, which could be willed to loved ones left behind - my niece and nephew, for instance. Why waste money on the living dead when the young and alive can make better use of it?

Signing a living will does sound very rational and noble. But when it comes to the crunch, dare I do it - and stand by it?

WHEN I started writing this column, I thought I'd be one of those who'd have no problems signing a living will, and that the only reason I haven't done so is due to a lack of time.

Then I went to the Health Ministry website to download an advance medical directive form, and I wasn't so sure anymore.

The easy part was filling up the usual information - name, IC, gender, age, address and telephone numbers.

Then came a section called 'The Directive'.

It's actually short, just 16 lines of explanation.

The directive states that 'if I should suffer from a terminal illness and if I should become unconscious or incapable of exercising rational judgment so that I am unable to communicate my wishes to my doctor, no extraordinary life-sustaining treatment should be applied or given to me'.

'Terminal illness' refers to 'an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery'.

This is where 'death would within reasonable medical judgment be imminent regardless of the application of extraordinary life-sustaining treatment', and the application of such treatment 'would only serve to postpone the moment of death'.

Treatment here is defined as 'any medical procedure or measure which, when administered to a terminally ill patient, will only prolong the process of dying when death is imminent, but excludes palliative care'.

Clearly, a lot of care went into crafting the directive; it is concise, easy to understand and not clouded by legalese.

But I hesitated signing it because, as I read it more carefully, so many 'what-ifs' started popping up in my head.

What if the nearing-death situation I am in - or a loved one - isn't as straightforward as sketched in the living will?

What if I'm unconscious 90 per cent of the time but also conscious intermittently? Does such a scenario qualify?

What if I'm actually able to understand what's happening around me even though I appear to be in a vegetative state?

What if the doctors and machines that pronounce me 'incapable of exercising rational judgment' are wrong?

What if medical science progresses such that what's totally incurable today is partially curable in 2016?

What if doctors disagree on my prognosis? What if I'm involved in an accident and extraordinary life-sustaining treatment has been administered before my living will is produced? Will it be halted?

How can you actually predict how you'd react to an unknown health condition?

And the most important what-ifs - what if miracles exist? What if prayers are answered? What if, by a miracle, I could recover if I just gave myself more time not to die?

Because, who wants to die? Very, very few people, I'd think.

I KNOW my father didn't.

Not when he had to be on a feeding tube for the last six years of his life after a major stroke robbed him of his ability to swallow, his sense of balance which meant he couldn't walk, and his ability to speak.

Not when he kept coughing and an X-ray found an alarmingly big shadow in one lung, indicating lung cancer.

I think not even when he lost his eyesight in the last month of his life.

Yes, his quality of life was terrible, and he had an 'incurable condition' with 'no reasonable prospect of a temporary or permanent recovery'.

But in those years when he was ill, even up to the end, I like to think his life was still worth living.

He got to see the birth of my niece and to witness her grow, he got to enjoy birthdays and TV shows, he got to be loved, and he got to feel the warmth of our hands clasped in his.

In any case, he didn't receive any extraordinary life-sustaining treatment, because nothing could have saved him.

This column isn't meant to criticise or promote living wills.

It's pointless to do either because no number of arguments - or advertising campaigns or columns or forums - will persuade people to change their minds if they have made them up, either way.

In the end, signing a living will is a matter of personal choice.

It's your life, and whether or not you want to look death in the eye is up to you, and only you - as it should be.
 

 
STORY INDEX
 
  No fearful symmetry here as Tiger burns bright
   
 
  10 Ironmans in 10 days
   
 
  Getting started on Netball
   
 
  It's my life
   
>> RELATED STORY
Women more likely to get runner's knee
Getting healthy at work
Singapore awards $31.6 million in research grants for 51 biomedical proposals
Why I am a cancer drug guinea pig
Will genital warts affect plans to start a family?

Elsewhere in AsiaOne...

Wine,Dine&Unwind: Ramen, rice balls and green tea make the grade for Japan's space cuisine

Travel: Sarawak, Malaysia

Motoring: Kia Carens: Toyota Wish meets its match

Digital: A*Star part of new MPEG4 audio standard

Business: 'No cause for alarm' on minimum sum

Just Women: Luxe girl

 

We welcome contributions, comments and tips.
a1health@sph.com.sg
Search: