More people make living wills as awareness rises

SINGAPORE - More people here have been making living wills which tell doctors they do not want to be put on life support when they are terminally ill and death is imminent.

The growing number reflects a rising awareness of the Advance Medical Directive (AMD) scheme, and the need for end-life planning.

Between 1997 - when the AMD Act took effect - and last year, more than 20,000 people made a living will. It is more than five times the 3,840 who did so by end-2005.

Last year, more than 2,000 directives were registered, up from 1,800 in 2013 and 1,328 in 2005.

This comes as a record number of 3,250 people appointed guardians last year to act on their behalf if they lose their mental faculties - a 37 per cent jump from 2013.

The number who gave the Lasting Power of Attorney (LPA) to trusted relatives surged after The Straits Times reported the high-profile court case involving Chinese national Yang Yin, who is accused of manipulating an elderly widow into handing him control of millions of dollars in assets.

Similarly, experts attribute the growth in number of AMDs to greater awareness.

Numbers first spiked in 2005, after the widely publicised Terri Schiavo case in the United States. The 41-year-old woman, who had been in a vegetative state for 15 years, died after a court ordered the removal of her feeding tube, ending a prolonged legal battle between her husband and parents.

From 2006, the Ministry of Health (MOH) stepped up publicity efforts, and has been distributing educational material as well as holding discussions and seminars for healthcare professionals.

Dr R. Akhileswaran, Singapore Hospice Council chairman, said: "Public education is paying off and people who have experienced the consequences of not making such preparations have also been passing the word around."

Member of Parliament for Sembawang GRC Ellen Lee, who sits on the Government Parliamentary Committee for Health, said that people, especially those without medical insurance, fear soaring medical costs and think that making their preference known early is better for their relatives.

"The numbers show that we are on the right track," she added.

A person signs the AMD to tell doctors that if he becomes terminally ill and unconscious, he does not want any extraordinary life-sustaining treatment, such as respirators, to prolong his life. This is aimed at minimising pain.

The AMD Act does not authorise any act that causes or quickens death from the natural course, an MOH spokesman said.

The Sunday Times understands that unlike a new French law, it does not allow for terminal sedation because the practice is considered to hasten death.

Last month, France passed a law that allows medics to place terminally ill patients into continuous sedation - or a "deep sleep" - until they die, to avoid suffering.

The sedation go-ahead will be taken from patients' advance medical directives, or made by their appointed attorneys if the patients can no longer express their wishes.

Ms Lee and Dr Akhileswaran said Singapore is not ready to include this option in the AMD.

Ms Lee said: "Family members sometimes already find it hard to accept the wishes made in the AMD when it comes into force due to sudden loss, and so they may find terminal sedation even harder to accept."

Anyone here above the age of 21 and of sound mind can make a living will for free. The application form, available online or at polyclinics and private clinics, also has to be signed by a doctor and another witness.

Retired finance director Hey Bong Koi, 67, made his living will two years ago, around the same time that he made an LPA. He saw the urgency of making an LPA after a stressful time dealing with his parents' assets after his father died and his mother could not execute the will as she had dementia.

"I feel strongly that there is no point to prolong suffering and cause undue stress to my family members to make those decisions," he said.

jantai@sph.com.sg

This article was first published on April 5, 2015.
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