DEATH has been a hot topic in the past few weeks - and a medical Act passed in 1996 is at the centre of the heated debate.
Yesterday in Parliament, Health Minister Khaw Boon Wan proposed changes to the Advance Medical Directive (AMD) Act.
Specifically, he wanted to clarify the confusion regarding the act and euthanasia.
The AMD, also known as a living will, is a legal document which allows an individual to tell doctors that he does not want his life to be artificially prolonged when he is terminally ill and unconscious.
Mr Khaw explained: "AMD is about letting nature take its course for the terminally ill at the last stage of their lives. It is about not mindlessly postponing death through futile medical interventions."
He called for greater openness on restrictions that have made the AMD a taboo subject between doctors and patients.
"Our AMD Act specifically prohibits doctors and nurses involved in the care of a patient from asking whether or not the patient has made or intends to make an AMD. There are severe penalties, including a fine and jail term, for those who do so," he said.
He suggested making it simpler for Singaporeans to sign it.
"The requirement that the signing of the form must be witnessed by a doctor has deterred many as they find it costly and a hassle. Many have asked me to drop this requirement," he said.
Last month, Mr Khaw said the Health Ministry was considering changes to the AMD.
His comments raised concerns from the public that euthanasia, or mercy killing, might be introduced. This led tomuch debate in newspaper forums.
In Parliament yesterday, Mr Khaw highlighted that more than 10,100 Singaporeans had signed AMDs since 1996. Over time, 19 AMDs were revoked and six put into effect.
"Our AMD sign-up rate of 0.4 per cent is low. But this is the experience in many other countries too," he said, adding that the sign-up rate in Australia is even lower, at 0.2 per cent.
However, the United States is unique with a much higher sign-up rate of about 20 per cent among the adult population.
He said: "One major reason for the higher sign-up rate in the US is the openness with which patients and the doctors there are able to actively engage in discussions on advance directives and end-of-life issues."
In contrast, Mr Khaw said that many Singaporeans remain "squeamish" about discussing the AMD.
Therefore, he said, it's time "we should change this attitude and help Singaporeans cope with end-of-life issues".
"However, I do not know if Singaporeans are ready for these amendments," he said, adding that he will seek more advice from Parliament members.
With additional reporting by Dawn Tay
DOCTORS AND SINGAPOREANS SPEAK OUT
Doctors say...
Dr Gerald Koh, 39, family physician:
"I'm glad the minister is raising this taboo topic. It helps us reach a common understanding on end-of-life issues.
"But the current AMD document is generic and doesn't take into consideration the medical complexities associated with end-of-life issues."
Dr Vivien Ang, 37, general practitioner:
"Being open about these matters is definitely welcome. It can be very hard for family members to decide for the patient (when he is terminally ill and unconscious).
"But the suggestion to remove the requirement to have a doctor witness the signing may not be good. The doctor can be there to make clarifications."
Singaporeans say...
Madam Sarifah A., 51, bank executive:
"I've heard about the AMD but I'm not very clear about it.
"Life and death are in the hands of God.
"If it is time for a person to die, I think that we should leave it as it is and let nature take its course."
Mr Jason Wong, 25, NIE student:
"There's a thin line between AMD and euthanasia. Much-needed discussion on the topic would clear things up.
"But it's still good to have a doctor as a witness and to give advice in case people don't know what they're doing.
"If I'm the one signing it, I would like a doctor to be present to clarify any doubts that I may have."
