By Low Ching Ling

YOU'RE dying and you've signed a document to tell your doctor not to do anything to prolong your life.

That's euthanasia, someone points out.

Wrong.

It's called a 'living will', or an Advance Medical Directive (AMD). Confused? You're not alone.

Contrary to popular belief, euthanasia and living wills are not one and the same. Throw in assisted suicide and the confusion deepens.

That was the point raised by Health Minister Khaw Boon Wan and MPs Ellen Lee and Halimah Yacob in Parliament on Monday. Mr Khaw said: 'Many confuse euthanasia with assisted suicide and with AMD... The three are very different.'

Going by a random poll of 50 people by The New Paper, he's spot on.

An overwhelming 36 people said they did not know the difference between the three processes.

Executive Priscilla Soh, 24, said: 'I have no idea. They all sound like the same thing to me.'

While the end (death) is the same for all three, the means (who pulls the plug) are very different.

But 14 people we asked said they knew the difference.

Really? We probed further and found that most of them were just as clueless.

When we asked them to explain what euthanasia, assisted suicide and AMD meant, only two did so correctly.

Seven gave partially correct answers, while the rest got it all wrong.

Undergraduate Andrew Goh, 23, could explain euthanasia and AMD but was not sure what assisted suicide was.

'Is it the same as euthanasia?' he asked.

Wrong.

Investment executive Serena Cho, 34, tried explaining why people are ignorant about the differences.

'I don't think (the differences are) well-known because death is a topic seldom broached openly in our society,' she said.

Mr Khaw said the same thing in Parliament.

An Asian thing

Madam Halimah told The New Paper: 'It's an Asian thing. People just don't like to talk about death before their time is up. There's also the issue of filial piety, which is very important in Asian society.'

But the issue of euthanasia and living wills have been hotly debated in the media in recent weeks. So why is there still such confusion?

Therein lies the irony.

Madam Halimah pointed out: 'It's good there is a lot of discussion about AMDs. But in talking about AMDs, people started associating it with euthanasia and assisted suicide, and it turned into a very emotional issue.'

While the Government is promoting AMDs, it has never proposed legalising euthanasia. Indeed, AMD is completely different from euthanasia.

(Page 1 of 2)Dr Noreen Chan, medical director of Dover Park Hospice and consultant at the National University Hospital, said: 'You can't deliberately try to kill yourself by taking lethal drugs then say it's okay because you have already signed an AMD.'

She noted that many readers who have written to newspaper forums on the issue seemed to have confused AMD with euthanasia.

'For AMD, you die as a result of the natural disease you're suffering from,' she explained.

'For assisted dying (euthanasia and assisted suicide), you're doing something to hasten the death, so it's death by artificial means.'

It's important that people know the difference, Dr Chan added.

'While some may see a very thin line, it's still a line and we must be careful not to cross it.

'Allowing someone to die from a disease is different from deliberately helping the person to die.'

How can the public be educated?

Madam Halimah feels that healthcare professionals are the best people to do it.

'But now, because of restrictions in the AMD Act, they are not allowed to actively discuss AMD with patients,' she said.

The Act bans doctors and nurses who are caring for the patient from asking whether or not the latter has made or intends to make an AMD.

A doctor can ask for a search of the AMD register only when his patient is terminally ill and already unconscious and would need extraordinary life-sustaining treatment.

These restrictions prevent the public from knowing more about AMDs, Mr Khaw said.

So is it time to pull the plug on some of these obstacles?

Yes, Mr Khaw said.

He proposes two changes to the act. First, make it easier to sign up for an AMD by removing the need for a doctor to be a witness. Second, remove the restrictions that have made AMD a taboo subject between doctors and patients.

It is especially important to educate the young, Madam Halimah said.

'Older people are not likely to understand AMD, so the young must talk to their parents. This can also get young people to start thinking about AMD for themselves.'

Additional reporting by Lediati Tan, Elaine Yeo and Eoin Ee

1) Euthanasia: Doctor pulls plug

Euthanasia, also called mercy killing, is an active act of making a patient die.

It is one of two forms of assisted dying, the other being assisted suicide.

Dr Noreen Chan said: 'In cases of euthanasia, a third party performs the act that kills.'

In countries where euthanasia is legal - Belgium and the Netherlands - the act has to be done by a doctor, Dr Chan said.

2) Assisted suicide: Patient pulls plug

In an assisted suicide, the patient performs the act that kills him, while the doctor provides the lethal prescription.

Assisted suicide is legal in Switzerland and in the US states of Oregon and Washington.

In Switzerland, the 'assistance' does not have to come from a doctor, Dr Chan said.

In 2006, an Australian woman complied with his 71-year-old Alzheimer's-stricken partner's wish to die by handing him a deadly dose of drugs.

Last week, she was sentenced to spend several days a week in jail for nearly two years. Assisted suicide is illegal in Australia.

3) AMD: No plug to pull

An Advance Medical Directive (AMD) is a legal document you sign in advance to inform your doctor (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your life.

It is illegal for anyone to force you to make an AMD against your will.

Under the AMD Act, an AMD can be executed only when the patient is diagnosed with a terminal illness, needs extraordinary life-sustaining treatment, and cannot make a rational decision.

Palliative care, and food and water, still have to be given to the patient.

Over 10,100 Singaporeans have signed AMDs since the Act was passed in 1996. Over the years, 19 have been revoked and six have been put into effect.