Saturday, October 8, 2011

One Flew Over The Cuckoo's Nest

An Advance Medical Directive (AMD) is a legal document that you sign in advance to inform the doctor treating you (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your life. The law allows Singaporeans who wish to make an advance medical directive to do so. The AMD Act was passed in Parliament in May 1996.

Dr Lee Wei Ling, director of the National Neuroscience Institute, told The Straits Times why she was among the first to sign the Advance Medical Directive, "When I say I will carry on until I cannot carry on any more, I have no intention of lingering." According to her, dad also signed an AMD years ago, but said not to tell her mom. Although some doctors took pains to stress that the AMD is not the same as euthanasia whereby one omits treatment or gives treatment with the intention to kill off a patient, the practical reality of cost to sustain life is obviously in the equation when the Government is not prepared to pick up the bill. Not everybody in Singapore can afford round the clock nursing to care for someone diagnosed as terminally ill.

But what the fish is the Office of the Public Guardian trying to achieve with the "Lasting Power of Attorney"? The Mental Capacity Act, which took effect in March last year, allows people to appoint a third party to make decisions for them "if and when they become unable to make decisions for themselves". The OPG is tasked to protect vulnerable people who have lost their ability to take care of themselves as a result of intellectual disability or problems associated with illness and old age, such as dementia. Apparently 1 in 12 Singaporeans aged 65 and above is likely to develop dementia by 2020 - which sets you wondering what is the mental state of an 88 year old. With this piece of paper, authority and responsibility is passed to the nominated caregiver. Which means Ah Kong can be kicked to a dump in Batam, Bintang or Johore even if the old geezer wants spend his last days, and last penny, at a resort style nursing home in the Bahamas, or marry Anna Nicole Smith like the elderly oil tycoon J. Howard Marshall did at age 89. But if grandpa has zilch in his CPF, do you think his kin will want to be legally committed? It's probably another variant of the Maintenance of Parents Act, which provides for Singapore residents aged 60 years old and above, who are unable to subsist on their own, to claim maintenance from their children instead of the State. If you are looking for Guaranteed Income Supplement for seniors like the Old Age Security (OAS) program, you'll have to move to Canada.

Acting Minister for Community Development, Youth and Sports Chan Chun Sing decided to lead by example by appointing his wife to take charge of his welfare should he turn cuckoo prematurely. Maybe he is in a better position to recognise his own mental state. Which kind of explains his televised antics at the Tanjong Pagar nomination center in May.
I sign off here, and I'm set for life, right?


  1. Would be good if u did some homework on lasting power of attorney (LPA) before u make some of the frivolous comments. AMD and LPA serve different purposes. The former on end of life care, the latter on such matters as personal welfare and finance when one loses mental capacity even when not at end of life. For LPA, one can choose what areas to grant powers and what not to, and even tailored to unique circumstance, eg omit power to deal with family house. The powers can be amended or revoked anytime And no,LPA cannot cover matters of marriage and divorce, among several others, so no Anna N Smith. It may not suit you, but it is useful for many who want a say in how their lives to be lived.

  2. I see a PAP troll......

  3. I wrote the first comment, and no, I don't consider myself a PAP supporter. Pl assess the LPA and other laws of the land on their own merits without needing to politicise every public initiative. If this is introduced by a non-PAP government and fronted by a non-PAP minister, how would u assess it?

  4. "If this is introduced by a non-PAP government and fronted by a non-PAP minister, how would u assess it?"

    Want to argue also please take your medicine first.

  5. So have a read it here again. It is different from AMD indeed. But the LPA premise is such (if you read the examples they give) you can get a glimpse of what they (PAP) have in mind.

    If you're cash rich & go into dementia, LPA can protect yr "appointed donees"(may/maynot be next of kin) to rip off remainder money so you can retire "soundly" in nursing home despite yr "unsound' state of mind. Why let the state pay when you've the money?!

    But if you're cash poor & go into dementia, LPA have no use for you. Your next of kin have no choice but to pay for your nursing care, whether you have sound/unsound mind, if they're so willing & kind to do so. Why let state pay when your children have the money?!

    To sum it up -- In both instances, why should State pay?! You have $, we want it to take care of you. You have no $, your children should take care of you. That's the win-win outcome for PAP govt. Thanks for having a calculating President & PM. Life can only gets better. Every dollar and cents are accounted for. Except their own.

  6. It's ironic isn't it. When you are sound and alive, they won't trust or give you choices to decide how/when your CPF money can be used for retirement.

    But they will trust or give you so many choices to give the state the rights of a share of your money the moment you're unsound/dead, while you're still alive! I am convinced those blood-sucking bedbugs and mosquitoes must be all breeded by PAP.

  7. What is Chan Chun Sing trying to say?

    So marriage contract is no guarantee nowadays that your partner will treat you right you must go into another contract to grant this govt the right to make decisions for you, then why bother to marry and have children? They so scared the rise of single old folks will increase their cost they must come up with such pre-emptive moves first. They better go secure $100,000 deposit upfront from the new imported citizens first so that Mdm Ho Jinx can go and gamble them into $1m by end of their decades to justify their existence here. Although I suspect most will return home to china where they still keep their "hukou" despite holding the red passport.

  8. What happens if the person outlive the money he ballparked aside for the nursing house? Will MCYS then turn around to the PA and say "Here, you take him back, your responsibility since the kitty has dried up"?

  9. Many 'xiucai' talking about a soldier here.

    You will never meet with him anywhere la in looking at solution to problem.

    'Xiucai e tao phing, you li chiang bu qing', one can never reason with a military and militant man.

  10. In more civilised countries, a patient in a vegetative state may be kept alive for years, in the hope that a cure may be found. Some may debunk this as wistful thinking, but such is the noble way for science and medical research.
    The AMD provides a legai instrument to pull the plug and not have to pay for the medical expense of sustaining life. For a patient in a mentally incapacitative state, the LPA provides the instrument to avoid the expense of his upkeep, through using his own money signed away by a piece of paper. Either way, the government shirks from caring for its citizens' welfare. Quite simply, whether one is at a stage of physical demise, or mental demise, the government does not give a hoot. You die, your problem.

  11. In the Tiny Land Of Sin
    there is no conscience.

    In the eyes of the Sinner
    no life is too precious
    except that of his/her own.

    In the mind of a pragmatist,
    once a person is no more
    productive; he/she is useless.

    We may not be living in the Era
    of the worst evil, however,
    Singaporeans have placed their
    fates in the hands
    of the Heartless.