End-of-life care

Important to know your loved ones' wishes

Associate Professor Chin Jing Jih is right to say that aggressive treatment may not be in the best interests of patients facing imminent death (Tackling end-of-life issues in community; May 26).

However, it is often the family members who implore the doctors and the hospital to do everything possible to save their loved one, with whom they never had a frank conversation about end-of-life issues.

Such zealous intervention can be agonising for all concerned. For example, cancer patients who die in hospital may experience more pain, stress and depression than patients who die in a hospice or at home.

Their families are likely to argue with doctors if doctors decline to do more, knowing that at that stage of illness, it is useless to pursue further treatment. But the problem is that some patients and their families will still want to fight until all hope is lost.

Too often, patients receive drastic and pointless treatment despite facing imminent death. That results in delaying death instead of facing the inevitable.

The paradox of modern medicine is that people are living longer but also with more diseases.

With it comes a surge of treatments which are often pointless, especially for intubated patients who may never recover.

Terminal cancer patients may still ask for chemotherapy in their final fortnight even though it offers no benefit at such a late stage.

How did we arrive at this?

Many people who may need intubation are not in a condition to indicate consent or withdrawal of treatment.

Families may hate the idea of a feeding tube, but grudgingly accept one when the alternative is death.

The problem is also compounded by doctors who overestimate how long the terminally ill will live. They may err on the side of caution and recommend drastic treatments that have little chance of success.

The answer to having a quality life, and a good death, is for families to find out their loved ones' wishes for medical treatment if they become seriously ill. That means people must have a serious conversation about their wishes for end-of-life medical care.

Better still, have end-of-life wishes for medical treatment stated in a written document.

Francis Cheng

A version of this article appeared in the print edition of The Straits Times on May 30, 2017, with the headline 'Important to know your loved ones' wishes'. Print Edition | Subscribe