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Source:
www.moh.gov.sg |
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PARLIAMENT QUESTIONS & ANSWERS
– 17 NOVEMBER 2008 |
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Question No: 846, 848, 860 Question
By: Dr Fatimah Lateef ,Dr Lam Pin Min, Mdm Halimah Yacob |
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Question No. 846
To ask the Minister for Health how many Singaporeans have signed the
Advanced Medical Directive since 1996 and, of these, (a) what
proportion have (i) chronic, debilitating illnesses; (ii) terminal
stage malignancy; and (iii) other conditions such as advanced age
and dementia; and (b) how many have revoked their decision after
signing. |
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Question No. 848
To ask the Minister for Health (a) how many Singaporeans have signed
the Advanced Medical Directive (AMD) since the Act was passed in
1996; (b) how many patients have exercised the AMD since; and (c)
what strategies will his Ministry employ to enhance the awareness of
AMD amongst Singaporeans. |
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Question No. 860
To ask the Minister for Health (a) whether his Ministry will review
the current procedures in order to make it easier for Singaporeans
to sign the Advanced Medical Directive (AMD); (b) how does our
current AMD sign-up rate compare with other countries with a similar
provision; and (c) what are the reasons for the low sign-up rate. |
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Reply from MOH |
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More than 10,100 Singaporeans have
signed Advance Medical Directives (AMDs). Over the years, 19 AMDs
have been revoked and 6 have been put into effect. |
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As signatories are not required to
disclose their medical conditions when making an AMD, I do not have
the breakdown as requested by Dr Fatimah Lateef. |
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Our AMD rate of 0.4% is low. But this is
the experience in many other countries too. For example, in
Australia the sign-up rate is even lower, at 0.2%. The US is unique
in having a much higher sign-up rate compared to the rest of the
world. Their rate is around 20% in adult population. |
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One major reason for the higher sign-up
rate in the US is the openness in which the patients and the doctors
there are able to actively engage in discussions on advance
directives and end of life issues. In fact, they have a Patient
Self-Determination Act which requires Government-funded hospitals,
hospices and nursing homes to ask all adult patients, at the time of
admission, if they have made an advance directive, and if not, to
inform them about their right to do so. Such information is required
to be documented in the patient’s medical records. |
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In sharp contrast, our society remains
rather squeamish about discussions on AMDs. 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. |
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Our AMD Act further requires the AMD
Register to be kept strictly confidential. A doctor may request for
a search of the AMD Register only when his patient is terminally
ill, unconscious and would require extraordinary life-sustaining
treatment. These restrictions are quite unique in the world. |
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Reading the Hansard records of the
debate in the House on AMD, I gather that these restrictions were
put in as there were concerns by some Singaporeans that a doctor may
be less forth-coming in his treatment if he knows that his patient
has already signed an AMD. I am confident that our doctors are
ethical and will do what is necessary for their patients, regardless
of their AMD status. Unfortunately, such fear, though groundless,
remains amongst some Singaporeans. |
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The restrictions have inadvertently
become counterproductive to the intent of the AMD by making
discussions on AMD taboo. This is a major reason for the lack of
awareness and apathy among the public and even healthcare
professions on the AMD. |
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It is my view that we should change this
attitude and help Singaporeans cope with end-of-life issues in a
much more scientific and mature manner. Death is a certainty and
must not be a taboo subject. For the terminally ill, we do need to
engage them and their family members early to understand their
concerns and preferences. |
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I am inclined to amend the AMD Act in
two ways. First, make it simpler to sign up for an AMD. The
requirement that the form must be witnessed by a doctor has deterred
many as they find it a hassle and costly. Many have asked me to drop
this requirement. |
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Second, drop the restrictions that have
made AMD a taboo subject between doctors and patients. We must
promote greater openness the way the Americans have done. |
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However, I do not know if Singaporeans
are ready for these amendments. I will do more sounding and welcome
Members’ advice on this. |
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Meanwhile, we will ensure that written
materials on AMDs will be made easily accessible to the public, at
the clinics, in the hospitals and nursing homes. The recent public
debate on euthanasia, hospice and palliative care has been useful to
get more Singaporeans to think about and discuss end-of-life issues.
My Ministry will also encourage hospitals and nursing homes to
engage their patients and their families in general discussions on
advance care planning including AMD. |
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Source:
www.moh.gov.sg News 17 Nov 2008 |
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