If we knew how many days remain in our lives, it would suddenly be crystal clear what we would and would not do. That is a theoretical assumption that is constantly being challenged and overridden. On the day that my brother-in-law Sim Lie was admitted for liver cancer arterial rupture, he told me categorically that if the diagnosis and prognosis were bad, he was not willing to undergo unnecessary therapy. He said he would rather spend his remaining days doing things he liked. Unfortunately on hindsight, it turned out that not only did he undergo treatment but he had also probably spent three quarters of his four months of life post-diagnosis in the hospital undergoing therapy, waiting to be seen by doctors, waiting to collect medicines from the pharmacy, waiting for his next appointment to be scheduled and talking about medical matters.
How did that happen to a patient who had desired minimal medical intervention? We live in an era where there is always one more diagnostic option or one more therapeutic treatment to exercise. Anybody who did not think thoroughly and profoundly so as to develop a personal stance regarding the role of therapy would find himself swallowed by the tremendous pressure of accepting all the medical options that are offered. Obviously the medical advancements these days really do prolong life, even in terminal diseases. However, more often than not, the trade-off of side effects, unaffordable financial costs, and inordinate amounts of time spent in medical institutions as well as the many false hopes are not thought about. Mindless conformity leads to deep regrets and bitter disappointment; precious time lost is irretrievable.
I know this for sure - what matters most to me in health will matter most in dying. When I am dying, I want to spend more time at the beach and on the forest trails than in the hospital. I want to be infused with the best wines and whiskeys rather than cocktails of chemotherapy. I want to be enthralled by lively conversations of what is happening in my friends’ lives instead of discussions of the doses of drugs. My eyes want to be thrilled by the splendour of the performing arts over images conjured by CT, MRI and PET scans.
How can I safeguard the best of life when life itself is ebbing away? How do I make it easier for my loved ones when I exercise my wisdom and right to decline more futile medical interruptions? Historically, the sage draws up a bucket list and enlists his trusted life companions to assist him fulfill his wishes. These days, we organise our intentions into an advanced care plan (ACP) - https://livingmatters.sg/advance-care-planning/about-acp/
The palliative/hospice movement has matured enough to alleviate suffering. It is now imperative for the next big thing: pushing all things medical into the side or back stage. Let the most important parts of life take centre stage. Only then can those who are dying live fully to the end.