ILLNESS AND THE FINAL DIRECTIVE

Last Monday, my dad died peacefully at the Singapore General Hospital.

He was admitted on Aug 24; four days later, we were informed that he had end-stage kidney failure. We were given two options.

If we took no action, he would most probably die in a few weeks. But if he went for dialysis treatment, this might kill him immediately as his heart was only partially functioning.

As his children, we wanted to do all we could to save our father's life. We found it difficult to accept that this handsome, once-strong man was going to leave us so soon.

But we still had one last lesson to learn from him: To respect his wish.

The doctor had asked him if he wanted dialysis and he had said, "no". And we asked him ourselves and explained to him the consequence of his decision.

He chose to die with dignity.

We discovered that he had had kidney failure for the past three years but each time he was asked if he wanted dialysis, he had said, "no".

He hid this fact from us. We can only speculate why he did not tell us.

Perhaps, he was afraid of wasting our money, as dialysis is costly.

Or perhaps he was afraid of the process itself after seeing many patients visit the National Kidney Foundation Dialysis Centre near his home.

But most probably, he did not want to be a burden to my mother, as she would have had to take care of him.

By making his wish known to his doctor, he made it easier for his children to respect his wish not to prolong his life, which would also have made him suffer unnecessarily.

He had not known about the existence of the Advance Medical Directive (AMD) but if he had, we believe that he would have signed it.

What is an AMD?

It is a legal document you sign in advance to inform the doctor treating you that in the event you become terminally ill or unconscious, you choose not to have any extraordinary life sustaining treatment to prolong your life.

This is a voluntary decision. It is a criminal offence for anyone to force or coerce you to make an AMD against your will. It is not a popular document and not many have signed one since it was implemented in 1996.

Most of us seldom think about death, about what happens after we die, or how we should die. Many of us think it is bad luck to think about such a morbid subject.

However, new progress in medical knowledge and technology present new options for patients, healthcare givers and family members.

And some of these options will raise new predicaments and dilemmas in the area of ethics and law.

One problem that our family faced was that modern technology could technically prolong my father's life in the final stage of his terminal illness.

When he was at that stage, we came to understand that medical technology could not arrest the dying process, difficult as it was for us to accept it.

Did we commit euthanasia or mercy killing? No, we did not take any action to deliberately end my father's life through unnatural means, such as the administration of lethal chemicals.

His wish was to let the dying process take its natural course.

My father's death made us think: Are we prepared for death?

The family would like to thank the nurses of Ward 64, Room 14 for taking care of Uncle William on his last journey to Singapore General Hospital.