Conundrum of dealing with 'soon to die' patients

The management of a dying patient, especially one who is suffering intractably with nothing to live for, is anything but simple ("Value of life not linked to its quality" by Mr Tan Jin Yong; Wednesday).

Doctors are faced with a conundrum when dealing professionally with "soon to die" patients.

The definition of "soon to die" itself generates lots of difficulties and is impossible to generalise.

In Singapore, euthanasia in all forms is illegal, no matter the ethical or pragmatic arguments for it. The most that doctors can do is not to actively resuscitate patients who have signed the Advance Medical Directive.

There is little fear that doctors will turn off life support systems when there is no brain death, and even this is done only after consultation with the patient's loved ones.

Where there is a glimmer of hope, or the chance of extending life even by mere weeks, most doctors will push for treatment. The alternative - leaving patients to die without hope or palliative care - is totally unconscionable.

Yet how many doctors have not opted for a strategy of masterly inactivity during the last week or two of a patient's days on earth? They see the futility of extending the inevitable and respect the patient's wish to die with dignity, without the ghastly invasion of intrusive medical equipment.

In hospices, during the patients' last days when the pain is unbearable and unremitting, some are given a bag of morphine to administer as they please to stop their suffering.

It says a lot that even in the face of meeting the most fearsome unknown event, many choose to dose themselves to eternity rather than continue with a meaningless and pain-racked short existence.

It sounds ambiguously like assisted suicide, and the medical fraternity has to live with its conscience.

Letter from Yik Keng Yeong (Dr)

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