For most people, dealing with the health problems of their elderly relatives and handling their continued fight against disease or impending death can be distressing.
Striking a balance between letting doctors do what they can to sustain life and letting nature take its course leads to a plethora of choices (End-of-life care - Important to know your loved ones' wishes, by Mr Francis Cheng; May 30).
What can patients do?
First, they should use a doctor they trust. They should let him apply his skills, as he has been professionally trained.
If the trust is not absolute, they can get a second or third opinion.
Patients should always get a diagnosis, and possible differential diagnoses, and prognosis from their doctor. This gives other professional caregivers a better reference and offers a timeframe for whatever action needs to be taken, be it personal, business-related or medical.
Patients and their families should be well informed about the medical condition concerned.
They should clarify the stage of disease with the doctor and educate themselves by perusing material from reputable sources on the Internet or from the library. This allows for a more informed and rational decision on their part, and also keeps the doctor on his toes.
Patients must also know the medications, their costs and their therapeutic effects. All medications, including traditional treatments and, indeed, anything a patient puts in his mouth, have side effects.
Towards the end of life, patients and their families have to understand that management may be more palliative than curative, or may involve more invasive procedures which are intrusive and expensive, and can cause as much distress as relief.
Gaining a few more weeks of painful physical existence in a hospital may not be for everyone. For some, a quick death is preferable.
If a terminally ill patient does not want to be resuscitated if he collapses, he should sign the Advance Medical Directive while he is still relatively healthy and compos mentis. It saves his loved ones from having to guess what he wishes, and prevents diametrically wrong decisions.
Yik Keng Yeong (Dr)