Post Page Advertisement [Top]

Talking about how one wishes to die is by far one of the top rated taboo topics. More often then not, it is
(a) too sensitive a topic to bring up with family members
(b) too unknown a topic to bring up amongst friends
(c) too fearful and close to heart a topic to share with a doctor

If there is one thing we all can be dead sure about... its death.

So this topic about Learning The Art of Dying (The Ars Moriendi) has spurred on many interest seen at the full house attendance on the topic of "The Living Will and the Advance Medical Directive - to sign or not to sign?" at CANA.

Since the launch of AMD in 1997, only 6 cases out of the 10,000 plus successful applicants have been put to effect. Considering a population over 4 million, that's an awfully low figure. Why so?

For a while I have been grappling with the understanding of what the AMD is all about and how it applies to my believes, values and faith.

The session opened with moral theologian, Fr. David Garcia speaking on
(1) Extraordinary vs. Ordinary Treatment
Simply put, it is a duty to care for one's life. It is in our being and instinct to live. However, it is not mandatory to circum ourselves to Extraordinary means of treatment to survive. An example was sited in olden times, where amputation of one's body part was considered a painful and Extraordinary act. However, in today's society, with anesthetics, amputation is no longer considered Extraordinary but Ordinary.

(2) Proportionate vs. Disproportionate
Today as medicine become far more advanced, the use of Extraordinary vs. Ordinary considerations are surpassed by Proportionate vs. Disproportionate considerations; factoring type of treatment, complexity of risk and individual circumstances.
An example would be that it is Proportionate (in terms of medicine) for the father to undergo expensive treatment for a terminal illness, but Disproportionate if the children will not have any more means to have a proper education.

(3) Right & Wrong Refusal
When treatment is refused, have the considerations of Burdens & Benefits been weighed. Are we Killing or are we Caring?

When we come to our last moments and if we're not totally sick out of our brains; we'll be hoping that these 2 desires will come true
- that we are not burdened
- that we do not cause burden (to our love one)

Dr. John Lee (or Mr. Straight Face Joker) enlightened us on the details and loop holes of the AMD Act in part two of the talk.

So here's the deal:
An Advance Medical Directive (AMD) seeks to protect the right of a person to want or to refuse medical treatment in the event he or she loses the ability to make decisions. Advance Medical Documents or Living Wills basically serve the same function. As a rule of thumb, it is ethically permissible for one to sign such documents. In which ever circumstance (if) chosen, there should not be any request for euthanasia as this is synonymous with assisted suicide or murder.

Here's the loop hole:
Under the Act, an AMD can only be executed when a patient is certified with a (1) terminal illness; (2) needs extraordinary life-sustaining treatment; and (3) is not capable of making rational judgment. After the AMD has taken effect, a patient with terminal illness will still receive palliative care and medication.

Sounds reasonable?
(1) Terminal illness - often described when the life expectancy is estimated to be six months or less. But again with medical sciences, I have witnessed cancer patients out living their sentenced life span.

(2) From the time an AMD is written till the time it is being invoked, what is medically, financially, emotionally and physically extraordinary may become something very ordinary. Thus, there is the real danger of an AMD not reflecting the true intention of a person.
When we think of 'extraordinary life-sustaining treatment', many will think of a heart support machine, but today in the States, dialysis machines or even respirators can be considered!

(3) The thing is, when it is time for a life or death decision to pull or not to pull the plug; who would you rather rather have to make this decision - the doctor or your family? Signing the AMD passes the legal right of this vital decision making to the doctor attending to you. Some dude whom a few hours ago didn't even know who you are. Many people find the conventional method of consultation between the family members and doctors sufficient.

Often enough, nature has its own way of saying 'Time's Up'. Your bodily functions will just shut down one by one. And the gift to be asking at that very moment, will be the Grace of Letting Go. For yourself and your family.


  1. I think the key is to make voluntary death possible and not popular.

    Make it impossible and the genuine cases suffer. On the other hand, too easy to carry out and the system can be abused.

    Is the patient making an irrational decision due to the pain? Are we being rational to decide whether the patient's suffering is not enough to merit their decision? Can you force a doctor to go against his/her belief on life through a law? The world needs time and more case studies to develop a better solution...

  2. This topic brings to mind an early post I wrote on Death Talk:

    Misc Points:
    (1) Pain or Suffering is subjective
    (2) If voluntary death is euthanasia, in most countries it is considered a crime
    (3) Medical practitioners with a certain believe or value can choose to opt out of exercising on a patient who is effecting an AMD or Living Will
    (4) Medical cost is on the raise
    (5) It is not proven that doctors will treat a patient who have signed such documents differently, but in some countries, premature deaths have increased

    Generally, most people are okay to die when it is the right time and with dignity. Again it's subjective.

    But bottom line, would you rather the law or a will (prone to misinterpretation) to decide on your behalf or people whom you love and trust? If someone cares for you enough, they will do what is best for you. Of cause, if you don't have such a person in your life... I guess you can go ahead and decide however.


Thank you for visting and leaving your comments.

Bottom Ad [Post Page]