Continuing our series on South East Asia, Dr Natalie Evans visits Singapore to find out more about palliative care in this island country. Dr Evans is a Visiting Post-Doctoral Research Fellow at Monash-Seaco Malaysia from the University of Amsterdam and is currently working on a project on health and social care needs of elderly people living alone in Segamat, Malaysia.
“There is an end to everything and I want mine to come as quickly and painlessly as possible, not with me incapacitated, half in coma in bed and with a tube going into my nostrils and down to my stomach.”
Lee Kuan Yew, Former Singaporean Prime Minister 1923-2015
Former Singaporean Prime Minister Lee Kuan Yew made his personal vision of a good death perfectly clear. Following the death of the island state’s former leader in March 2015, now is a pertinent time to reflect on the services that aim to help every Singaporean die according to his or her wishes. Hospice and palliative care services, which trace their origins to mid-80s grassroots initiatives to provide home care for cancer patients, have developed rapidly in Singapore with strong state support. The first hospices were established in the late-80s and the first hospital palliative care services in the mid-90s. Palliative care providers now offer services in hospital, hospice, home, and daycare settings. Palliative care is also a recognized medical subspecialty and an obligatory part of medical undergraduate training. Indeed, the country has a National Strategy for Palliative Care, reflecting a level of acceptance and integration that many countries with longer histories of palliative care services have yet to achieve.
I recently visited Singapore’s Dover Park. This stand-alone facility in central Singapore is similar to hospices found all over the world, with a multidisciplinary team holistically caring for patients’ physical, psycho-social and spiritual needs. Facilities include shared and private patient rooms as well as a garden and multi-faith prayer room. The strong volunteer programme is responsible for activities such as patient outings to pet-assisted therapy. Volunteers also man a special vigil project that aims to ensure no hospice inpatient dies alone. Although many of the hospice’s characteristics are familiar, others are typically Singaporean: inpatients are welcomed with a kopi (traditional coffee) and roti (bread) and the airport is a popular destination for days out.
Singapore’s population mix, primarily ethnic Chinese, Malay and Indian, also means that a variety of before and after death rituals must be catered for. For example, a room is set aside to allow Buddhist patients to be left untouched for up to eight hours after death, the time it takes for the ‘mind’ to leave the deceased’s body.
Whilst service development has been rapid, the acceptance of palliative care sometimes remains a challenge. Strong taboos persist surrounding death and dying. These were apparent before Dover Park hospice was established, when it faced objections from neighbourhood associations about its proposed location; it was eventually constructed in a less residential area. Death taboos also create difficulties discussing the end of life, with many families still preferring to shield patients from full knowledge about their illnesses and prognosis.
Initiatives to raise awareness and encourage open end-of-life discussions include the Agency for Integrated Care (AIC) led ‘Living Matters’ programme. Modelled on the American ‘Respecting Choices’ programme, ‘Living Matters’ focuses on encouraging discussion of end-of-life goals and preferences, rather than specific life sustaining treatment preferences. Special efforts have also been made to provide palliative services to patients with non-malignant conditions. For example, the ‘HOlistic care for MEdically advanced patients’ (HOME) Programme, again led by the AIC, is a palliative home care programme for organ failure patients. Enrolled patients receive a personal care plan, including advance care planning.
Palliative care provision and planning in Singapore is characterized by rapid development and strong coordination and leadership. Although challenges persist, palliative care remains a priority area due to the rapid ageing of Singapore’s population.
Links and further reading
- Lien Centre for Palliative Care, Duke-NUH Graduate Medical School ‘Report on the National Strategy for Palliative Care,’ Ministry of Health, Singapore, 2011.
More posts in the South East Asia series on the EAPC Blog…
Click here to read about the ‘Cloud-based Platform for Palliative Care at Home’ by Dr Yingwei Wang from Taiwan. Next in the series will be a post from Dr Rojim J Sorrosa from the Philippines.