DR CHONG Siow Ann presented a comprehensive summary of the quandary that terminally ill patients face in the months before their deaths ("Rage, rage against the (prolonged) dying of the light"; last Saturday).

There is incontrovertible evidence that medical advances have improved survival rates.

However, there is still a chance of getting struck by an incurable illness, most common of which is end-stage cancer.

Upon diagnosis of such an illness, most patients are shocked, bewildered and outraged, as are their relatives.

The news that they have only a few months to live further augments feelings of resentment.

Often, the doctor does not want to reveal this prognosis, for the rescue credo is ingrained in the medical profession, as pointed out by Dr Chong. But not telling the patient would also be tantamount to a dereliction of duty.

The dilemmas involved in such life-and-death situations are numerous, and it is normal to experience a tremendous amount of stress, whether you are the patient, doctor or family member.

The human will has traditionally been strong; most patients will opt for various treatment options first.

Even when people are dying, the heart feels a sense of determination to carry on with life, even though the mind does not.

Hence, it is difficult to draw the line when it comes to such end-of-life issues.

On the one hand, the patient wants to live. On the other, treatments often cause more suffering to the patient and undermine his quality of life, while purportedly giving a slim chance of survival.

However, death is an inevitable part of life.

We certainly must give more thought to end-of-life issues and not treat them as morbid.

End-of-life medicine, like palliative care, has become a popular topic in medicine, and I hope that this knowledge will be disseminated more readily to patients and their caregivers, so that their loved ones can bid a dignified farewell.

I envisage more open discussion on end-of-life issues, so that patients and their family members can see the "spots of light" ("Directing the final scene"; last Saturday) in the process and not worry about the impending consternation.

Aaron Low Chin Yong