Doc won't witness medical directive

15 May 2006, The Straits Times

Question

Name of the Person: Tervor Reginald

Doc won't witness medical directive

Doc won't witness medical directive 

MY WIFE and I, aged 73 and 80 respectively, read in The Sunday Times that one can make a legal directive stating that if one is terminally ill and in a coma with no hope of recovery, no life sustaining treatment should be given ('When death strikes'; ST, April 16).So my wife, who is a stroke victim, and I went to the nearest doctor, each with a prepared advance medical directive, with our daughter who was to be a witness, with a request for the doctor to be the second witness. It was stated in the article that two witnesses are required, one of whom must be a registered medical practitioner.Imagine my surprise when the doctor declined to be a witness, saying it is not clear she is empowered to do that. She also said that as we had no medical records at her clinic, she could not witness our signatures. In my wife's case, she suggested she go to Tan Tock Seng Hospital where she was admitted for her stroke and ask a hospital doctor to be her witness as her records are there. She suggested I go to Ang Mo Kio Polyclinic as I was treated there for asthma.From my observations, I believe ours was the first such request this doctor has had, as the advance medical directive is new, and I suspect she decided to play safe and not get involved.There must be many elderly poor who want to make an advance medical directive, but are either unaware that such a scheme is available or don't know how to do it.Can the authorities kindly enlighten us what one has to do to get an advance medical directive validated?

Name of the Person: Ang Kim Thye

May 17, 2006 

Docs, back Advance Medical Directive MY EXPERIENCE with the Advance Medical Directive (AMD) was the reverse of that of Mr Trevor Reginald ('Doc won't witness medical directive'; ST, May 15). My sister, who is semi-ambulant, has been treated at a polyclinic for a long time. I take her there to get her medication and injection.Recently, when we presented a completed AMD form, the doctor refused to be the witness and asked my sister to go to a private doctor instead. May I suggest that the Ministry of Health issue a directive to all medical practitioners to provide such a service?

Name of the Person: Dr George Wong Seow Choon

IT IS time the medical profession showed clear support for the Advance Medical Directive (AMD). Many doctors are still uncertain as to what to do because of their religious beliefs, and tend to shy away from being witnesses. The authorities, like the Singapore Medical Association and the Singapore Medical Council, should make it clear that it is not against medical ethics or religious beliefs to act as a witness for patients signing up for the AMD. It is not euthanasia. Doctors have a professional duty to help patients who want to sign up. It is the patient's choice.Doctors should be neutral and professional in the practice of medicine.

Reply

Reply from MOH 

All medical practitioners have been informed of the AMD 

We refer to recent letters on Advance Medical Directive (AMD). In "Doc won't witness medical directive" (ST, May 15), Mr Reginald Trevor enquired about the process of making an AMD. In "Docs, back Advance Medical Directive" ( ST , May 17), Mr Ang Kim Thye and Dr George Wong asked for stronger support from all medical practitioners when a patient asks them to be witness to an AMD. 

The AMD is a legal document which allows a person to state and register his wish in advance so that he would not be subjected to extraordinary life-sustaining treatment in the event that he becomes terminally ill and is unconscious or unable to make rational judgment. Making the AMD is a serious and voluntary decision. The term "extraordinary life-sustaining treatment" refers to any medical intervention which serves only to prolong the process of dying for terminally ill patients but does not provide any temporary or permanent recovery. 

Any person of sound mind and aged 21 years and above can make an AMD. He needs to complete an AMD form, sign it in the presence of a doctor and another person who must be at least 21 years old and who does not have any vested interests in the patient's death. The form must be returned to the Registrar of AMDs, and will be kept confidential until the time the patient needs it. 

MOH wrote to all medical practitioners in April 06 about the AMD, their role as witnesses, and availability of forms and information resources. The Ministry also briefed nursing home administrators on the AMD in October 05. 

The AMD form itself is free but there may be some fees payable to the doctor for the servicesrendered. The form can be obtained from private clinics, polyclinics and hospitals, and is also downloadable from the MOH website at www.moh.gov.sg More information on AMD is available on the website as well. 

We have since contacted Mr Trevor and Mr Ang and have helped them in their requests.