Rehab Cell

Physical Medicine and Rehabilitation

SSU2000 – BioMedicine and Singapore Society Video Project 1

Good evening, Board of Directors. I’m Mr.Sum’s Doctor, Dr.Du and I’m here to give you an update of his current status Our patient, Mr.Sum, is a 75-year-old male who was admitted into our hospital on 22 January. He suffered from a stroke while watching a soccer game and has been in a comatose state ever since. He was unable to breathe without the ventilator and has been on life support for two months already.
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We have run multiple tests on his brain, including PEP scan and MRI,
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trying to pinpoint the cause of his coma,
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however, the results lead us to nowhere.
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As much as I would like to provide him with medical treatment, to be frank,
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the likelihood of him waking up is close to zero. I’m also aware that Mr Sum has signed an Advanced Medical Directive which specifically requested that life-sustaining care shall be discontinued if no sign of recovery is seen after a period of 60 days. By 9pm today, it has been 78 days. However, his family members claimed that Mr.Sum was not in a lucid state of mind when signing the AMD, and refuses to pull the plug. As his doctor, I’m committed to do whatever is the best for my patients, which includes reducing the suffering and pain of the patients. Since there’s no sign of recovery, putting him on life support will only prolong the process of dying and inflict lots of suffering on him As his physician, I recommend that we respect his directives and let him go in peace. That’s my recommendation. Thank you very much. We are seeing Mr Pflug? Call Mr Pflug, the lawyer in Good evening ladies and gentlemen of the board of directors I am Mr Pflug, representing one of your patients, and he is my client, Mr Sum It has come to my attention that the board is going to make a decision regarding my client This decision will be with regards to whether to continue treatment, stop treatment, or to transfer him to a public hospital At this jucture, I would like to present to the board’s attention, document A. Document A is an advance medical directive signed by my client prior to him falling ill This AMD, I remind the board, was signed without the consent of his family It was to be kepy confidential and only to be used when the situation called for it This AMD states that if my client, and your patient, Mr Sum was to somehow be in a life threatening situation where he is being kept on life support with little change to his personal health his desire would be that he be taken off life support and left to die peacefully and with dignity If somehow miraculously, he still manages to survive treatment is to be withheld and he is to be left in the care of his loving and adoring wife, and primary caregiver Mrs Sum I would like to remind the board of the remifications of refusing to accede to my client’s request. Of which I representing the estate of Mr Sum, would have to sue your hospital Thank you board of directors for your attention I hope that the decision regarding this issue would be made soon and prompt. Thank you. Next, we will have Miss Qian, the CFO. Please come in. Hi. Good evening, Board of Directors! It is so nice to see you all again Thank you for listening to my perspectives about Mr. Sum Ting Rong’s case. As much as I sympathise with him, and I would like to help him on a personal basis, I would say from the CFO’s stand point, I would insist on discharging him from our hospital. First of all, our financial situation is under tremendous pressure from the past three years on. As you know, the manpower cost has increased so much. It costs so much more now to hire a qualified caretaker for our hospital. And at the same time, we just consolidated our IT system and our archival system. This does not come cheap. And the medical equipments just keep updating every year; this is also a huge amount of costs. Patients like Mr. Sum Ting Rong that stays in our ICU wards, takes up our resources. I would not mind it as long as he is able to pay for it. But I have heard from his daughter, who recently expressed her will to stop supporting her father financially. So this means that there is a risk of Mr. Sum Ting Rong staying in our ward without the ability to pay for it. This will be a drain on our financial resources which can be put on to better use to treat other patients. Furthermore, his case has recently caught on the attention and negative publicities from the media. There are titles such as “Prolonged stay in the ICU wards without any promise of a cure”. This kind of publicity just damaged our reputation so much. It can also harm on the good will from other people to our hospital. I am seriously concerned on how it will affect our financial performance. Therefore, without any guarantee on his financial viability or any promise on any improvement on his treatment, I will not permit him to stay in our hospital any longer. That is my stand. Thank you very much. Thank you. Er..Let his family come in. So who would like to start first? I’ll go first. You are? I’m his wife. You know my husband, he is lying in coma for goodness how long The doctor everyday tell me different stories, tell me he needs to go for this test that test Of course I know he needs to test! I’m the first one who wants him to recover! You know it just pains me…to see him going through all that. All the needles poking through him like he’s some object But you have to believe me, I think i can pay for it I think I can pay for it, i can pay for it, i’ll do anything to pay for his bills

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And I know that he will wake up one day, he told he will never leave me the other day I think i saw his finger move, he is going to wake up And you know that AMD he signed, Please dont take it for real. He was senile by the time he signed it. He didn’t know what he was doing. I mean, how can you guys prove he was in the right state of mind? The only thing i want now is my husband’s life Please rescue him, please save him. He’s my only hope. Ya so like my mum said right why can’t anyone tell us what’s wrong with him? I’m mean aren’t we paying you people to tell us what’s wrong with him and then help him? You know, like I see him lying there all day… like so still… and then you’re all like doing this test and that test, it’s so terrible! What if your treatment’s making him worse? And I mean, if the treatment’s really good then sure, you know, as the daughter, I’m willing to pay, but that’s obviously not the case here. And it’s like, my mother, my mother may not be not concerned about the costs, but I am! You know, everything’s rising! except my pay! And we’re already financially unstable, struggling to make ends meet! And then now the government tells that we are not able to apply for further financial aid! You know, so the situation here now, is not whether or not we are willing to pay, but whether or not we can even pay in the first place, you know! and I’m sure if my father were awake to hear this, I’m sure he would ask us to save the money, I’m sure he would want us to not go through this kind of…terrible situations right now. And anyways, didn’t he already sign the ADM? So why isn’t anyone respecting his wishes? You know, I supposed he signed that ADM just so that he wouldn’t end up in these kinds of situations! Lying there so still with all of you poking this into him and making him go through that kind of tests… you know, So why isnt’t anyone trusting what he wrote on paper?! I’m sure he was fine when he signed it! So ya… as emmm… Even though my mother… she wants to hope further and, but I’m just very concerned about the costs so I’m begging you, regardless of what she says please stop the treatment! Because it’s like what if the treatment’s making him worse? And anyway for all you know, after going one big round with that treatment, that treatment may come up with nothing and then we would be back in square one, if you didn’t even start the treatment in the first place! There are two big issues here The first one we will talk about is this AMD From a legal perspective The law states that it is only applicable to Patients with terminal illness, and those who have to rely on extraordinary life sustaining treatment You all are medical doctors, you all are familiar with the medical meaning, But there’s actually a legal meaning also, And there are requirements to follow, Although the other lawyer says that we have to follow it an all that, It’s not so simple as pulling the plug, We got to get certification and all that, so it’s quite messy I think we can work with doctors on that, The next thing is actually the AMD, what do you all think? There are so many conflicting views here We are going to get sued, if we don’t follow the AMD That’s what his lawyer already said The daughter can’t even pay for the bill, what more is there to decide? Just pull the plug. Yea, we need the certification and all that, but the money can’t wait. We still need to give out the pay. But I think we might get sued if it is so clearly invalid I think we are ultimately a hospital. Our job is to cure patients and what not We are already making a healthy profit every year, So why not just keep him in the ICU for a while longer, see what can be done for him Did you not hear? The CFO said that we’ve been in trouble for the past three years! That’s because she only looks at the profits every year. She doesn’t look at the reserves that we have We should get that checked I’ll check with the other firm also I want to take a look at the AMD. It’s a bit worrying I will check with the Registrar also. The next thing is this thing about continuing treatment At this point, apart from the AMD, We got to decide what we are going to do, I think, first and foremost, what I’ll says is With such a complicated case, and the media has been picking up on it We’ve really got to be extra careful, So, I would suggest that when the doctor comes in We should have more than one doctor there, to make sure that There is some concurrence on their views And also, for medication, be doubly sure Follow all our regulations Take this chance also to take a look at our regulations The bigger problem here is the question of what happens if he has no money, or if they are not paying Do we move him to a public hospital, or, What do you guys think? Is he fit to move? We don’t want him dying on us halfway, right? If he goes in the ambulance halfway and he dies, legally we are not responsible, but the media is going to pick up on it. Again, everything is all about evidence. Try to get more certification. So, What do you think?

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