| Advance Medical Directive: What It Is All About? |
| Written by The Editor | |
| Sunday, 08 February 2009 07:50 | |
|
With the advancement in medical sciences, and the introduction of new drugs and methods of treatment, it is now possible to extend the life of a terminally ill patient beyond what was once possible. In many instances, the patient can still make independent decisions. But what happens when they lose this ability? Take, for example, a person who has advanced breast or liver cancer. Surgery, chemotherapy and radiotherapy have already been given but the disease does not seem to be responding to treatment. Death appears to be inevitable, but the patient still has a choice. When the time comes, she can choose to pass on naturally, surrounded by the people she loves, and not having to burden those left behind with the difficult decision of when to let go.This is someone who has signed the Advance Medical Directive (AMD), a legal document that informs your doctor in advance that in the event one becomes terminally ill or unconscious, that no extraordinary life-sustaining treatment be used to prolong one’s life. She can live the rest of her life in peace, knowing that when death comes, there will be closure for the rest of the family, without the fear that her life may drag on, and the rest of the family will be dragged down. In another situation, in scene that plays itself out in every hospital around the world everyday, Jane Doe, a terminally ill breast cancer patient is hospitalized with pneumonia. She has been diagnosed with terminal cancer and has multiple admissions into the Intensive Care Unit. She is unconscious due to the overwhelming lung infection and would need to be intubated again and sent to the Intensive Care Unit, otherwise she will certainly die. She relies on the next of kin to make medical decisions for her. One group of family members feel that she has suffered enough and another stay in intensive care would simply be prolonging the inevitable. Moreover, she would need more intravenous lines, medication and mechanical ventilation which will surely cause more suffering. It would simply be more humane to let nature take its course. The other group of well-meaning relatives want all means to sustain her. Even if there is a glimmer of hope, we must not give up, right? So, she is brought to the Intensive Care Unit again, intubated and her life sustained with intravenous drugs, nutrition and mechanical ventilation. She is not conscious but at least her heart is still beating. Meanwhile, the hospital bills start piling up and the family breaks up because of the shear emotional and financial drain. Is this what Jane would have wanted? Could she not have made her wishes known before she became terminally ill? Yes, we see this in Singapore hospitals every day. It is even more heart-breaking when the patient suddenly loses consciousness, like with severe strokes, brain aneurysms or head injury in road traffic accidents. The family experiences a sense of guilt and want all measures to artificially sustain the patient’s life. So hours turn to days, and days to weeks. The doctors have said that the chances of recovery are almost nil. The patient never regains consciousness but his heart is still beating. He gets weaker by the day, his muscles atrophy and he catches another hospital-acquired infection. Meanwhile, the family see him daily, deteriorating. Nobody wants to be the one to “pull the plug”. So the weeks turn to months. Arguments arise because emotions run high and the bills are accumulating. Mercifully, he passes on months after the accident. Could this have been avoided? Many young people think that the AMD is only for those who are old and dying? Is it? Will it be difficult for your family to decide to let your 90 year old grandfather “go naturally”, or would it be more difficult for them to say that of you, an otherwise healthy 30 year-old? Do you know when you would be struck down with a brain haemorrhage or be involved in a nasty road traffic accident? Why not sign your AMD today, YOURSELF? Do you really want to burden your loved ones with this heavy decision on your behalf? We are certainly signing ours today. What about you? "Terminal illness" is defined in the Act as an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery. For such a condition, death is imminent even if extraordinary life-sustaining measures were used. These measures would only serve to postpone the moment of death for the patient.
|
|
| Last Updated ( Sunday, 08 February 2009 21:27 ) |
General Advance Medical Directive Advance Medical Directive: What It Is All About?