Professor Christopher Cheng
CEO, Sengkang Health
Senior Consultant, Department of Urology, SGH

Some time ago, I bade farewell to a good friend. I have operated on him to cure his cancer barely three months earlier, but his condition still progressed rapidly. At his last hospital admission, he said, “I have strong faith and no unfinished business. Don’t let me suffer pain and I won’t want more chemotherapy.” Palliative care controlled his pain and he went home.

That same day, I saw another patient at urgent request. He was very worried about his “cancer” after a health screening, when he was found to have a slightly elevated tumour marker. After biopsy and testing, this was confirmed to be a minute focus of low-grade incidental prostate cancer. It was not likely to progress or cause problems, by all probability.

After spending an inordinate amount of time answering the patient’s questions from diet to genetics, he finally accepted that there were no serious problems with his health. He came back within minutes of leaving and asked, “What Chinese medicine should I take to control the cancer?”

Willet Whitmore, considered the dean of urologic oncology, had said: “Is cure necessary in those for whom it is possible, and is cure possible in those for whom it is necessary?”
For a large range of cancers, cure may be necessary but not possible, as in the case of my friend. For the rest, cure is unnecessary, even though it is possible. We should question if more medicine is better. An honest opinion from someone trustworthy and well-versed with the condition should guide decision making.

Today, there is a whole host of medical offerings in the name of health screening, most of them not recommended by health authorities. Meanwhile, many diabetic and hypertensive patients go undiagnosed in the community.

Instead of putting large numbers of people through unnecessary medical procedures, we should make tests and treatment available to those who need them. As Singapore, and the world, is ageing rapidly, these issues are likely to be much more urgent and poignant.

Most healthcare spending in developed countries are for the “six-million-dollar funeral”. Paying for that last glimmer of hope is expensive and futile, and usually does more harm than good.
Often the dignity and final wishes of the individual suffer due to interventions. Medical professionals are also faced with the difficulties of defending omission of more treatment, against accusation of not doing enough.
Advanced medical directives are legally binding, but the take-up rate is low, and their information and proper execution are often found wanting.

The government is encouraging advance care planning to urge family members towards having a rational conversation before any life-changing events strike. Hopefully, an enlightened public will eventually be ready to accept the concept that sickness and death are but part of life’s journey. We must not wait until it’s too late to make plans, otherwise someone else will have to play God.