There are only a few certainties in life: suffering with your football team (Ole in? Ole out!), taxes and deaths.
Societies discuss and debate a lot about taxes. But much less about deaths.
Death somehow remains a taboo subject for many, especially in an Asian context, be it a will (Waste money!); the Lasting Power of Attorney; the Advance Medical Directive or the Advance Care Planning (I can perfectly make my own decision!); dying at home or hospital when the time comes (Choy!).
But Singapore is an aging society – this pertinent fact seems to be lost on many. Here’s how fast we are ageing:
It’s hardly a surprise. Fewer people are having kids and life expectancy is getting longer.
As more people approaches the end of their life journey each year, more healthcare resources are devoted to take care of them. Here is where there is often a mismatch of desires, between patient and their families.
For families, filial piety drives us to do whatever it takes to help our love ones recover, no matter how slim the chances of surgeries and treatments are. But yet, for the patients, many prefer to go peacefully at home, in the presence of people closest to them. They want their final journey to be peaceful and dignified, not traumatic.
They prefer palliative care.
But first, what is palliative care?
According to the World Health Organisation, palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.
Locally, the PAP government developed a national strategy for palliative care in 2012 and has used this to start a few initiatives such as the Home-Based Respite Care pilot in 2019, which allows caregivers of patients under palliative care to tap on short-term custodial care services, and the Caregiver Support Action Plan, which helps offsets caregiving expenses.
Other than help for caregivers, the Ministry of Health has also expanded the number of day hospice places by over 60 percent since 2017, to about 160 places today. Last year, the Inpatient Hospice Palliative Care Service was also launched to provide better access to palliative care. There are also 250 inpatient hospice places, in addition to the aforementioned 160 day hospice places.
We need to talk about dying
Interestingly, Health Minister Ong Ye Kung gave a speech at the 7th Singapore Palliative Care Conference, urging people to discuss about end of life issues.
He said: “Family members must feel comfortable that putting their loved ones through palliative care fulfils the desire of the dying and is in fact an act of love. It is a social attitude, which requires time to shift. When it does, it will be for the better.”
Hopefully with a renewed social attitude on dying, it will only normalise the discussion on palliative care.
In this writer’s opinion, living funerals are probably the best version of a funeral.
For one, the dying is still very much alive and has the opportunity to say goodbyes. The common refrain for funerals is that it is organised by the living for the living, where eulogies and tributes are lavished but the dead can’t hear them.
What’s the point then?
With an open discussion on the topic of death and dying and by extension, palliative care, it would enable someone near the end of his or her life to really enjoy the last moments planning the living funeral, thinking of who to invite, a livestream for those who can’t attend, what’s for makan, the song list, a sea burial or a garden burial.
As for this writer, nothing beats surrounded by loved ones, bar food and cheap drinks while a live band belts out Across the Universe, Wish You Were Here and Space Oddity. And that song list goes on. This writer would like a living funeral like that very much indeed.
There’s so much to think about and some much to plan for even at the end of one’s life.
Dying with dignity is a basic human right and the first step towards it is to talk about dying itself.
And this writer shall close with what Minister Ong said: “We need to discuss the sensitive issue of deaths more openly and more honestly. This is probably the most important thing we need to do. It has to happen within families, between patients and doctors, and amongst members of our society and healthcare fraternity.
“It is one way to bridge the mismatch of expectations and desires between a dying patient and his or her loved ones.”
Talking about death is the only certain way for us to bow out in dignity so that we can really say that, despite all the regrets and mistakes, it is still a life well lived.
Cover photo credit: PSD.gov.sg