Seeing dad suffer, made doctor sign the AMD himself

IMH's Prof Chong says signing of the directive helps doctors make the right decisions when it comes to the crunch

SUPPORTS AMD: Professor Chong Siow Ann signed the Advanced Medical Directive more than a decade ago, after being influenced by what he saw.
SUPPORTS AMD: Professor Chong Siow Ann signed the Advanced Medical Directive more than a decade ago, after being influenced by what he saw.

In response to a question in Parliament by Workers' Party chief Low Thia Kiang, Health Minister Gan Kim Yong said in a written reply thatfrom the inception of the Advance Medical Directive (AMD) in 1997 until last year, 24,682 Singaporeans had made an AMD. During this period, 10 AMDs were put into effect.

The pain of watching his father slowly dying of chronic respiratory disease in the intensive care unit 21 years ago still lingers for Professor Chong Siow Ann, 54.

He had to watch his once-independent father:

l Be supported by a ventilator with arms restrained

l Be fed through a tube through his nostrils, with a catheter draining urine from his bladder

l Have a breathing tube attached down his windpipe, which prevented him from talking

As the elder Mr Chong's kidneys failed and multiple internal bleeding occurred, doctors fought to keep him alive with drugs and transfused packs of blood products.

Prof Chong, now vice-chairman of the Institute of Mental Health's medical board (research), told The New Paper: "It was bleak, everything in his body was already shutting down."

And after a few days of struggle, the decision was made by the Chong family to stop the treatment. The elder Mr Chong died later in the day.

"It was not a tough decision in some way. Maybe we should have stopped a bit earlier because he was suffering and his situation was utterly hopeless," said Prof Chong.

"The doctors could have continued to ventilate him, but it would have caused complications like bursting his lungs and further suffering. He would still have died in any case."

This incident, along with his work experiences, was a strong influence in Prof Chong's decision to sign the AMD, which tells doctors not to apply life-sustaining treatment in the case of terminal illness.

He said: "It is not just how the patient might feel, but the impact on the rest of the family as well.

"If I am in that situation one day, I hope I would be brave enough to want to stop everything and spare further pain to my family."

The AMD had not been introduced at the time of his father's death, but Prof Chong noted that it could have helped in making the decision to let go earlier and would have assisted the doctors in being more certain of whether or not to extend his life.

Prof Chong made an AMD more than a decade ago, after hearing about it on the job.

According to Mr Gan, 10 AMDs were effected between 1997 to 2015.

A cumulative total of 24,682 Singaporeans have signed the AMD as of last year, and almost half (12,114) of these AMDs were made between 2010 to 2015.

National University of Singapore sociologist Paulin Straughan said that these low figures could be due to lack of awareness about the AMD, fear of the "unknown and unpredictable" in death, and superstition in talking about death.

"Most of us don't want to think of death and dying when we are young and able, so we just ignore discourse on AMD in the belief that when the time comes, should the need arise, we can decide then," she said.

Nanyang Technological University sociologist Kwok Kian Woon also pointed out that most people do not ordinarily think about death or dying, and to increase the number of people signing the AMD, public education about end-of-life issues should be carried out.

He said: "Citizens need to understand various end-of-life scenarios so that they can make an informed decision."

For Prof Chong, the AMD is also important from a medical standpoint.

He said that AMDs would aid in decision making for doctors by making clear the patients' own wish and intent, and also make any decision on prolonging a patient's life less emotional and less dependable on the wishes and interpretation of others.

"As doctors, it is very difficult to make the decision to withhold any kind of life sustaining means to the patients, even if you know the patient's outlook is extremely bleak," said Prof Chong.

BEST INTEREST

"Sometimes, it may be in the patients' best interest that we don't resort to whatever possible and available because we are just prolonging the agony of the patient in a hopeless situation, prolonging the pain of the family and possibly impoverishing the family further," he said.

Prof Chong also had talks with his wife about what they want in the event of a worst-case scenario.

His wife, a gynaecologist, supports his decision, but has yet to sign the AMD, he said.

Although the AMD is revocable, Prof Chong has no intention of doing so more than a decade on, and hopes it is a decision he will stick by.

He said: "I hope I wouldn't be too frightened when faced with a hopeless situation to change my mind and revoke the AMD.

"I hope I will still know that there is a limit to what medical technology can do, and that we will all die no matter what we do."

If I am in that situation one day, I hope I would be brave enough to want to stop everything and spare further pain to my family.

- Prof Chong Siow Ann


If I am in that situation one day, I hope I would be brave enough to want to stop everything and spare further pain to my family.

- Prof Chong Siow Ann

Auditor-General's report: Lapses cost millions

The latest Auditor-General's report for the year 2015/16 was released yesterday. Here are some of the lapses flagged by the Auditor-General's Office (AGO).

MOM

A Document Generator System (DGS) worth $432,407 was left unused since November 2014 after it was found to be unsuitable for integration with an existing system.

The AGO found that the Ministry of Manpower (MOM) did not do a robust evaluation before procuring the DGS.

MOM acknowledged that its evaluation should have been more robust. It is now exploring the redeployment of the DGS assets within the ministry.


 

MOE

As of June 30, former National University of Singapore and Nanyang Technological University students owed the Ministry of Education (MOE) $228.04 million.

For 33 of the 58 loans that were in default for at least two years, the AGO found that banks did not try to recover the loans for prolonged periods of time - ranging from six months to 3½ years.

The two universities outsource the monitoring and recovery of loans to two banks.

MOE also did not follow up promptly - stretching between two and 6½ years - on 23 of 32 loans that were pending its action.

In a media statement, MOE said it is working closely with the universities and banks to ensure prompt follow-up of loans in arrears.


LTA & HDB

Motorists evaded fares at carparks and immigration checkpoints.

At the Woodlands and Tuas Checkpoints, the AGO estimated a $13.93 million revenue loss - 21.9 per cent of the total toll collected - due to under-collection. Vehicles passed without paying. It was not stated in the report how they managed to do so.

Land Transport Authority (LTA) is working with relevant authorities to address the gaps in controls.

Checks on five industrial estate carparks here from April 2014 to last August revealed 113,103 instances of motorists not being charged parking fees amounting to about $159,000.

Further checks revealed 243 instances where motorists allowed another vehicle to evade payment through tailgating past the Electronic Parking System (EPS).

Housing Development Board (HDB) failed to follow up on the monthly reports from carpark operators or take action against those deliberately evading payment.

At 59 residential carparks, there were 2,501 instances from April to September last year where vehicles exited EPS carparks without paying more than thrice a month. Again, HDB did not take any action despite repeated reports of non-payment.

HDB told the AGO that it has since started thorough analyses of reports from carpark operators. HDB will also amend the Parking Places Rules to allow enforcement against motorists for parking fare evasion.

Those found to have manipulated the EPS to evade parking fees in industrial estates have been reported to the police.



HDB

Final payment for contractors working with HDB were delayed for as long as three years and three months, the AGO found.

Of the 71 audited cases, final payments for 44 cases totalling $12.05 million were not made within the contractual 21-day period. In 21 of these 44 cases, the delay ranged from 36 days to 1,204 days.

HDB told the AGO that it recognised the need to comply with contractual requirements.
 It will implement 
a tracking system and modify processes to 
ensure prompt payment.


MFA

Ministry of Foreign Affairs (MFA) continued paying for 28 mobile lines that were no longer needed, wasting $80,744 in public funds.

Eleven of these lines have been left unused for more than two years. The rest belonged to officers who had either left MFA or were assigned other lines three months to three years ago.

MFA has since terminated the 28 mobile lines. Processes are now put in place to monitor the usage and review the need for mobile lines annually. The Ministry also plans to implement a process to trigger the termination or assignment of lines when officers leave.

Pierre Png having a ballet of a time

Pierre Png may have completed shooting for The Gentleman, but he's not giving up ballet yet

KEEP ON DANCING: Pierre Png is still attending ballet classes because he finds them stress-relieving.

Local actor Pierre Png's latest TV drama has unleashed his inner ballet dancer.

The 42-year-old, who plays a ballet teacher in a new Channel 8 series, The Gentlemen, is continuing ballet classes even after filming ended in May because he finds them to be "very stress-relieving".

Png, who had never learnt ballet before, spent almost two months training under a dance choreographer for the part.

He took lessons once or twice a week and each class lasted an hour - the equivalent of "two hours at the gym", according to him.

On why he persisted with ballet even after production for The Gentlemen ended, Png told The New Paper yesterday at the show's press conference: "It came from the stubborn side of me where I wanted to learn the whole (ballet) routine myself.

"I want to learn how to do a proper pirouette.

"A part of it comes from me being a perfectionist. I was very attracted and taken by the precision and beauty of ballet.

"Learning it for the show was very stressful because I was racing against time. Now that I'm learning it for leisure, I'm able to go deeper into it."

The Gentlemen premieres on Aug 9 at 9pm and is about three brothers (Png, Chen Hanwei and Aloysius Pang)working in female-oriented industries.

LAUGHED

Png said that his wife, former actress and host Andrea De Cruz, 42, laughed when she found out about his latest role.

"But she could see that I was really enjoying myself, so she said, 'I never have to worry about you when I see you this engrossed or dedicated to a role,'" he said.

"She said she loves how my thighs have grown ever since I took on ballet. She also loves the elegance and posture."

But Png admitted he is "nowhere close" to De Cruz when it comes to dancing as she is a "natural dancer".

"Beat salsa, beat cha cha, beat anything - her body just moves according to the music," he said.

And Png was, naturally, self-conscious about his thighs as he had to wear white tights.

But when it came to filming dance scenes with his Taiwanese partner Kelly, he did not care how his body parts looked.

Png said with a laugh: "The sad thing is I couldn't be bothered about it because there were other important things to worry about.

"I had to remember the dance routine and choreography.

"But I do realise that the outfit comes with protection to give proper support.

"There is a cup to hold everything in place, so that when we are doing our leaps and movements, not only am I protected, but my dance partner is also protected."

Tags: pierre png, ballet, drama and TV

Grab bans man for harassing its drivers

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Jail, cane for trying to steal phone

He choked a teenage girl from behind while trying to rob her of her mobile phone.

Radin Rizwan Radin Rosman, 24, was yesterday jailed for five years and given 12 strokes of the cane for attempted robbery and voluntarily causing hurt to Miss Grace Lee Shi Min on Nov 27 last year.

When he snatched her phone at Gardenia Road, near Thomson Plaza, at around 10pm, Miss Lee, 18, struggled and shouted for help. She fainted after he choked her.

Nearby residents Adrienne Chew Dan and Marienne Chew Tong, both 20, heard Ms Lee's shouts, and alerted their father.

Mr Chew Kim Soon, 51, chased and caught Rizwan while his daughters called the police.

Ms Lee was taken to Tan Tock Seng Hospital with scalp and neck injuries.

Rizwan's lawyer said he had not planned to choke the girl and had robbed her only out of desperation.

However, District Judge Lee Poh Choo said his actions were clearly violent.

For voluntarily causing hurt in attempting to commit robbery, Rizwan could have been jailed for five to 20 years, with at least 12 strokes of the cane. - Tan Tam Mei

Tags: Crime, jail, Robbery, phone and Cane

Miss Universe Singapore 2006 says experience 'toughened' her

Carol Cheong says the competition moulded her to become more of a people person

WINNER: Carol Cheong (above), winner of Miss Universe Singapore 2006.

It has been a decade since 2006 Miss Universe Singapore (MUS) winner Carol Cheong took home the crown.

But the memories and lessons she gleaned from the experience are still close to her heart.

Cheong, 35, told The New Paper: "Through the people I have met and events I attended during my reign, I was given the exposure not many girls would have.

"This experience has moulded me to become (more of a) people person in dealing with different personalities and characters in life.

"I also learnt stage presence and speech presentation, all very much-needed lifelong skills."

This year, Singapore's most prestigious pageant is back in a big way, with new presenter Singapore Turf Club and new imaging partner Canon Singapore on board.

For the first time, TNP will be MUS 2016's official media partner and co-organiser with the Miss Universe Singapore Organisation.

The winner will receive $10,000 in cash and a Canon camera worth $1,000.

Registration is now open to women aged 18 to 27. (See below.)

Cheong said she "grew up shy and introverted", so joining MUS was a way of pushing herself out of her comfort zone and overcoming stage fright.

Cheong being crowned by Miss Universe Singapore 2005 Cheryl Tay (in white).

"Winning the competition that year was pretty unexpected as all the girls had a very positive, competitive spirit," she said.

"My birthday was the day after winning the title and it was probably one of the most memorable birthdays for me."

The international pageant that year was held in Los Angeles and it marked Cheong's first time going to the US.

She said: "Pageants in Singapore have always been under a lot of scrutiny and it's definitely not the easiest competition to (take part in).

"The experience has toughened me up to deal with different unexpected situations in life.

"It also helped me realise that we need to be proactive in taking steps to overcome some uncertainties and fears," said Cheong, who has a seven-year-old daughter.

CAREER CHANGE

She used to be an art director and is now a headhunter.

"After becoming a mother, it was challenging going back to the long hours in advertising. Recruitment has given me more flexibility to balance work and spend time with my family," she said.

Cheong encourages women to join MUS 2016 as "you'll never know where (it) could take you".

She said: "Girls who want to bring themselves to the next level, be it personally or career-wise, should be part of this competition.

"It is good exposure at both a national and international level and a great opportunity to network and meet people from all kinds of backgrounds and cultures."

Johor proposes ferry service

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Aussie PM orders prison child abuse probe

'BARBARIC': The video showed guards covering a teen's head with a hood and shackling him to a chair with neck, arm, leg and foot restraints.
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Tags: Australia, Crime and police

Attacker: Disabled have no value

Japanese man fatally stabs 19 patients at facility where he used to work

ANGRY: Satoshi Uematsu reportedly told police he had been fired from the facility and held a grudge.
ANGRY: Satoshi Uematsu reportedly told police he had been fired from the facility and held a grudge.
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Tags: Japan, Crime and police

McDonald's to franchise ops in Singapore

People enter a McDonald's restaurant in Singapore

McDonald's Corp said it is seeking franchise partners for its restaurants in Malaysia and Singapore as part of its move away from direct ownership and operation in Asia.

"McDonald's has taken the decision to adopt a development licensee model for the Malaysia and Singapore markets in order to enable focused investment in the brand and speed up growth in these key Asian markets," a Singapore-based spokeswoman at McDonald's said in a statement on Tuesday.

McDonald's said it was negotiating with "suitable candidates" for the Malaysia and Singapore markets, but did not provide any details or a timeline.

Sources told Reuters that some suitors looking at both countries had begun to tap banks for financing options to buy the 20-year franchise rights.

The sources declined to be identified as they were not authorised to speak to the media.

One potential bidder was reportedly in talks with lenders for as much as US$300 million ($408m) in funding.

The company also plans to sell its operations in China, Hong Kong and South Korea.

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