GMC is to instruct all GPs to talk to dying patients about organ donationBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3578 (Published 02 September 2009) Cite this as: BMJ 2009;339:b3578
All rapid responses
In addition to GPs talking to dying patients about organ donation
perhaps GPs may also need to be aware of the Advanced Medical Directive
and be prepared to discuss it with their patients should they bring it up
during the consultation. Or GPs may also want to consider bringing up the
subject of AMD where permissible or appropriate for the patient.
The Advance Medical Directive (AMD) Act was passed in Singapore in
May 1996. The AMD is a legal document that an individual can sign in
advance to inform his or her attending doctor that he or she does not want
any extraordinary life-sustaining treatment to be used to prolong life in
the event that he or she becomes terminally ill or unconscious. Anyone
currently residing in Singapore, is of at least 21 years of age, and of a
sound mind can sign an AMD. The signing must be witnessed by 2 people, one
of whom must be a doctor. The AMD can be revoked at any time, in the
presence of a witness. Currently, the attending doctor is not allowed to
enquire whether the patient has made or intends to make a directive (1).
We are open to this para being removed or edited as the Editors deem fit.
A community-based cross-sectional study was conducted with residents
in the residential estate of Singapore in January 2009. A stratified
random sampling was conducted to obtain a representative sample of the
estate. Only residents who were aged 21 years and older were included. An
interviewer-administered questionnaire was conducted by 36 trained medical
students, and only those who understood the AMD sufficiently were further
evaluated on their knowledge, attitudes and practices. A total of 414
residents were enrolled (50.1% response rate). Of the respondents, 78.4%
(290) saw it necessary to have a doctor present when signing an AMD. The
main reasons were to provide medical knowledge (93.1%), to make the
process more official (71.6%), to prevent coercion by others (43.6%) and
because they are more comfortable having a doctor around (71.8%). Of
those (21.6%) who felt that it was not necessary to have a doctor present
when signing an AMD, factors cited were that of inconvenience (59.3%),
cost (51.2%) and breach of confidentiality (80.2%), respectively.
Our study findings suggested that majority of individuals would
prefer to have a doctor present when they decide on signing the AMD. GPs
can play a pivotal role in preparing and addressing end of life issues
with their patients. After all, all of us want to end well in our lives
(1) Singapore Statutes Online [Internet]. Singapore: Government of
Singapore c2001. [updated 2009 August 15; last access 2009 Sep 9]
Available from: http://statutes.agc.gov.sg/ .
Competing interests: No competing interests