How many of us fully understand this?
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Mainly European & some US populations.
ReplyDeleteFor Sinkies, maybe in 20-30 years time lah.
Now most still die in hospitals, nursing homes, hospices.
Since 2005 when I was surveying oldies where they prefer to spend the last few months & where they want to die, it is always at home.
But zui kong nia .... even when know terminal case --- whenever breathless, chest pain, unconscious --- straightaway call ambulance & rush to hospital.
People need to be educated & need to accept once past a certain disease progression, patients & their families need to accept certain death with equanimity.
To ease their passing:-
Doctors / hospitals can allow prescription painkillers like morphine, fentanyl, methadone, etc with cheap subsidized loans of sub-cutaneous line syringe pump, and also oxygen concentrators.
Bottomline:-
Sure die ... so accept no further rushing to hospital & no more treatment ... but ensure die as painless as possible ... while being surrounded by loved ones.
Walau! Is the Doc hinting something that is not aware?
ReplyDeleteHahahaha!!!
ReplyDeleteMost Docs from 3rd world countries won't know about AMD or Living Wills...
Only after practicing in S'pore for a few years then they'll know a bit more.
Most docs who don't really know you, will ask you to go home & read up first... Docs are supposed to spend quite a bit of time to interview you before allowing you to sign AMD.
Becoz when shit happens ... cannot unsign or reject AMD ... The patient will usually be totally comatose or brain dead liao ... surviving on machines & tubes inserted into him. AMD will mean turning off the machines after a 2nd Doc confirms cannot revive liao.
Signing AMD still free lah ... Free also most people don't want to sign ... Imagine if got to pay?!?!
Actually govt should pay people $10K to sign AMD .... at end of day save taxpayers money by not prolonging by futile & expensive medical equipment and procedures.
Hi Temperament,
ReplyDeleteI've already signed mine. But it's a personal thing ... nothing good or bad about it. All got pros & cons.
Although it should be decided personally, but in Asian context important to explain to family members, so that all are aware & respect your decision.
Otherwise wait another Oxley-style drama in the hospital! Papa kena misrepresented ... he was misled!! Papa didn't know what he was signing!! He was senile!!! I get my lawyer to talk to your lawyer!!! Alamak!!
In western countries, their laws allow Living Wills to have quite a wide range of scenarios.
ReplyDeleteHowever in S'pore, AMD can only be carried out if:
1) Patient is unconscious (or coma) AND
2) Terminal illness (certified cannot be cured) AND
3) Imminent death (usually taken as within 12 months, but in practice usually shorter)
To certify that patient is (a) terminally ill and (b) in imminent death,
need panel of 3 doctors to certify --- all 3 have to agree, and 2 of them must be specialists.
After that, it's stopping of "extraordinary life-sustaining treatment".
In S'pore that usually is respirator or ventilator, i.e. the patient is so sick that he cannot breathe on his own liao.
Another type of so-called "extraordinary" treatment is Total Parenteral Nutrition where "pre-digested" liquid food is slowly pumped direct into bloodstream through a big vein near the heart. This is where patient digestive system already cocked up cannot absorb nutrition thru stomach or intestines liao. Need food that is already "digested" and can be distributed throughout body in the bloodstream. So if patient is dying and in coma, but can breathe spontaneously, but need TPN to survive, then withholding TPN can be considered part of AMD. But still got many doctors think this is active killing --- purposely starving people to death.
Things like blood transfusion & dialysis will also be stopped.
ReplyDeleteIn S'pore, if you conscious & alert, then totally up to you to reject any treatment lah!! Kekekeke!!! This is called patient autonomy ... part of patient's rights.
Of course medical practitioners supposed to also confirm that is of sound mind too, but in practice if a person angrily refuses treatment, then we just say Ok lorr ... and make him sign indemnity form & At-Own-Risk (AOR) form. Actually don't sign also Ok one.
Of course we all know it's usually becoz of costs ... cannot afford ... and don't want to jump thru hoops going thru S'pore's medical social welfare system.