31 October 2006

Advance Medical Directive

An interesting interview with a doctor who has signed an Advance Medical Directive. It's basically Singapore's form of legalised euthanasia, although you can be sure that Health Minister Khaw Boon Wan wouldn't like to hear the E word being used in this context.
Oct 30, 2006
Terminally ill? Doctor has 'no intention of lingering'
Dr Lee Wei Ling, director of the National Neuroscience Institute, tells The Straits Times why she was among the first to sign the Advance Medical Directive

Why did you sign the AMD?
I was among the first to submit the Advance Medical Directive (AMD) - which allows a patient to state in advance that he does not want to be sustained artificially should he become terminally ill and unconscious.

I have also convinced my parents to do so.

In case you didn't know, Wei Ling's parents are Mr and Mrs Lee Kuan Yew.

When I say I will carry on until I cannot carry on any more, I have no intention of lingering.

I have cheated death many times, and I came to a decision long ago that enabled me to remain optimistic day to day while hearing the ticking of the clock.

How have your life experiences shaped your decision?
As an avid hiker, I have had many hiking near misses. My medical and surgical near misses have been even more dramatic. I plan 10 years ahead knowing full well that I might not make it to tomorrow.

Everybody has a clock ticking. Some hear it and are bothered; others like me hear it and remind ourselves not to leave undone things we want to do, for there may be no tomorrow.

Others don't hear it and are not bothered until tragedy strikes them or someone close to them.

Some people feel that this topic is too morbid to address. What are your views?

We have no control over our birth, who we are born to, when we are born, where we are born.

But death is sometimes within our control.

My philosophy is that I control my own life, not someone else, not society, and to a certain extent not even disease or fate.

Knowing I have control gives me confidence to face tomorrow or the next moment.

This is not morbid thinking. I am not depressed or suicidal.

But like a chess player, I have to think several steps ahead.

I take what comes, knowing it is not entirely within my control but not entirely out of my control either.

My dad, like Dr Lee Wei Ling, also signed an AMD years ago. My dad has told me not to tell my mum. My mum doesn't read my blog, so I guess it's ok for me to mention it here. :P

I've never seen Dr Lee Wei Ling but I've been told that she is quite obese. I've also learned that she had had a heart attack (or was it a stroke?), which is a little surprising, because she was quite young - not yet 45, I do believe - when that happened.

I respect her philosophy -
"My philosophy is that I control my own life, not someone else, not society, and to a certain extent not even disease or fate"
... but I wonder how well she manages to execute it. I mean, she was fat, and she had a heart attack (or stroke) in her early 40s, and she's a doctor. It seems that she didn't really have enough control over her life, to manage her body weight and other risk factors relating to cardiac infarction. She probably ate too much, exercised too little and worked too hard.

This post isn't meant to put down Lee Wei Ling in any way - think of it more as a reflection of general human weakness. Very often, we all do know what's best for ourselves. Whether we get around to doing it is another question altogether.

UPDATE (25 Nov 06): Major oops by Mr Wang! I've received word, from the doctor herself, that she isn't or wasn't fat, she is very fit & athletic and she didn't have a heart attack. She had a transient ischemic attack caused by a surgical complication which caused her platlets to rise to a very high level. Thus her condition had nothing to do with high cholesterol or atherosclerosis (in other words, it wasn't caused by an unhealthy diet or a lack of exercise).

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Anonymous said...

self determism only goes so much, sometimes, you only have to say, Why be fat?

(kind of like why be gay?)

there is so much against fat people too...

then again, the elitegirl thinking would be "why be poor?"

easier said then done right...

back to your earlier post, do we really have freewill or just the illusion of freewill as a result of the complexity of the human meat machine

Anonymous said...

IIRC Dr Lee Wei Ling was anything but obese, more anoretic. Also, if the grapevine is correct, like the old man, she's also a exercise nut.

Anonymous said...

... I don't know what she looks like now, but she WAS very fat at the time she had the stroke, and I think she has had more than one major illness episode. In her interview, she alluded to this herself: "I have cheated death many times .... As an avid hiker, I have had many hiking near misses. My medical and surgical near misses have been even more dramatic."

Anonymous said...

LKY's offspring?... hmmmm...

I think it is more important that LKY himself take the lead and sign the AMD.... wontn't want him to prolong his existence anymore than neccessary now do we...
heh heh :)

Anonymous said...

I guess I have to respond to tat part abt "why be gay...". I suppose it can also be phrased as "why be bi" or "why be straight".....

It is a matter of choice and preference. Not all can live or like girls.

Break-ups, divorces and straying even while married,it tells a pathetic story.

If you are bi or gay and you decide to marry, I don't think the feelings will ALL go away.

You will probably do it on the side, etc. So I think we all have to choose and pick one path and stick to it, true to your orientation.

Anonymous said...

have we strayed into yawning bread??? It is interesting that Mr Khaw talked about retirement village some months back, then the ST carried an article about how such homes were cheaper in JB than SG some weeks back. Now Mr Khaw is telling us it is cheaper to just die instead of using retirement home. And I recalled Mrs MM Lee was shipped back from England on board SIA - I don't want to go into that negativity again lah....but then ahhh.... I do wonder, the latest MRT track death at Clement - is that the AMD Mr Khaw is talking about?

Anonymous said...

Dr Lee Wei Ling had a stroke before. I remember reading an article written by her or about her experiences because she was going through a stroke and being a neurosurgeon was the best person to recognise the symptoms.

AMD has its pros and cons. Of course, the more cynical among us will see the positive externality of not lingering in dying, i.e. reduce medical costs of prolonging life through treatment. Dying is a more economical option from a resource allocation perspective.

After all, what is a Singaporean, a factor of production, right?

Lunatic Fringe

Anonymous said...

If you are fat and you don't want to be fat, you can run, swim, skip, cycle, exercise in gym, go on diet, avoid oily food, drink water instead of sugared drinks, go for liposuction ...

If you are gay and you don't want to be gay, you can ____. ????

If you are straight and you don't want to be straight, you can ____. ????

Anonymous said...

Call me paranoid but I see a connection between "voluntary" euthanasia and "involuntary" organ harvesting.

Anonymous said...

The timing of promoting AMD seems to tie with another intention to tweak the MediShield. As the population ages, there will likely increase in cases on life support system. This will take up more resources, consequently the medical expenses. To limit the increase in premium, this may be one of the areas to look at. However, I feel government must rethink its ‘social welfare’ policy. Yesterday in a ST article ‘Time to weave a stronger net’ by Eddie Lee, a former ST economic writer, wrote that ‘Overall, social transfers, including public health expenditure, amount to just 2 percent of gross domestic product. This compares with about 13 percent in the US and an average of 25 percent in Scandinavian countries’. If ours is a first world country as those, then we must be prepared to allocate more in social welfare assistance. Even if our tax rate is to be increased by three times to allow the proportional increase of current level of 2 percent, my guess is our level of assistance will be no way near to the 13 percent in US. This just reflects the current low level of allocation of our public assistance. I wish there is no more increase in the premium.

onekell said...

Personally, I see the Advanced Medical Directive as protecting loved ones from heavy medical expenses, especially in situations where death is imminent.

It also saves them from having to make nerve-wrackingly difficult decisions such as pulling the plug.

Anonymous said...

"I wish there is no more increase in the premium."

I bet more to come(increase of premium) in the future, this will encourage expensive medical costs to go up giving the excuse that the increased premium will cover the medical bills. So who pays & suffers...the Singaporeans! The hospitals are making millions. ..no wonder so many private hospitals are around. "it is cheaper to just die"

Anonymous said...

Speaking in terms of allocation of financial resources, Temasek will be losing billions of dollars in Shin Corp which could have been better spent on the social welfare rather than investment that leads to so much problems.

However, i do agree on this directive. At least we are given a choice, that is to die though. lol.

hugewhaleshark said...

Found an interesting article on LWL. One wonders why she chooses not to marry. The article also mentions her stroke. But I couldn't find anything relating her to obesity or anorexia.

When you are SM's daughter.
Straits Times, 29 March 2003

Heard the story of how Senior Minister Lee Kuan Yew had a heart attack after he learnt that his daughter had married an Indian?

So has his daughter, Dr Lee Wei Ling, 48, who tells Insight that nothing of that sort ever happened - neither the heart attack nor the man who had supposedly captured her heart.

The rumours started swirling between 1981 and 1984 when she studied paediatric neurology in Massachusetts General Hospital, a Harvard-affiliated hospital in Boston.

'My friends who heard the rumour asked me jokingly how come I had kept this Indian man away from them,' she said wryly.

She never had boyfriends, never felt like dating them and decided at age 21 not to marry, she said.

And her parents respected her decision.

In a 1998 book, Lee Kuan Yew: The Man And His Ideas, SM Lee explains why his sons married but not his daughter.

'I suppose in her case, it was more difficult because young men would shy off her.

'But, that's not the only reason, that she's my daughter. She's also a bright student and it didn't help that she became the honours student of her year, as a doctor. The doctors just stayed away, so she had to pay a price for it.'

Dr Lee, however, says that she has now more male than female friends 'because female small talk does not interest me'.

With the men, she talks about computer-related stuff and government policies and civil servants' behaviour.

While she enjoys having mental sparring sessions with her father on policies, she reluctantly accepts the fact that he continues to have a powerful political presence in Singapore.

Referring to the way doctors were extra careful about treating the stroke which she suffered last year, she said: 'If an accident happened, they would be answerable to my father. So the doctors were trying to treat me in a way that would make them appear good in my father's eyes.'

And when he asked hospital staff for information about her medical condition, they obliged, she says, adding: 'Isn't there something called patient confidentiality? And the doctors tell me: 'If SM asks you, how can you say no?' '.

Anonymous said...

Straits Times, 29 March 2003: And when he asked hospital staff for information about her medical condition, they obliged, she [Dr Lee Wei Ling] says, adding: 'Isn't there something called patient confidentiality? And the doctors tell me: 'If SM asks you, how can you say no?' '.

This sounds ominously similar to another medical case leading to a legal case. Extracts from Sack Goldblatt Mitchell lawyer's website: Nair alleged that when he spoke out politically against the Lee government in the late 1980's, Lee attempted to silence him by tabling a white paper in Singapore's parliament which included extracts of a confidential nature from Nair's personal medical records and correspondence.

In the case of Lee v. Globe and Mail (Nair v. Lee) at the (Canada) Ontario Superior Court of Justice, Globe and Mail (Nair) won.

People in any profession should understand the importance of respecting client confidentiality.

family man said...


I caught this on Pseudonymity. http://udhr19.blogspot.com/2006/11/bringing-today-to-its-knees.html

Interesting article. It pains me that from the forum pages, a colon cancer patient had to wait one month for a scan. If he agrees to sign on as a private patient, he will get the scan over the weekend. And the NUH CEO respond was weak. I don't know - probably during Lee Jr watch, the standard of health care has dropped as compared to the yawning bread article above, or Lee senior was mistaken in the first place?