Three Singapore Hospice Council volunteers share their views on end-of-life care planning and why it matters.
When you or your loved ones are faced with life-limiting illnesses, having plans and documents in place which reflect one’s choices, values and beliefs can help to provide a definitive peace of mind. It is key that we talk about end-of-life care with our loved ones, learn about the types of decision-making tools and resources available, and act on them while still healthy and of sound mind. Three Singapore Hospice Council (SHC) volunteers — Edi Wu, Jennifer Lim and Tan Sze Wei — share about what spurred them to action and how you can also get started.
It is key that we talk about end-of-life care with our loved ones, learn about the types of decision-making tools and resources available, and act on them while still healthy and of sound mind.
What sparked your interest to advocate for palliative care and end-of-life care planning?
Edi: My father’s palliative doctor left a lasting impression on me. During my father’s final days, I gained more knowledge on palliative treatment and care. After the experience of my father’s passing, I realised the importance of making preparations for my mother collectively with my siblings. It became the starting point for my desire to understand more about the different caregiver services, facilities and planning such as Advance Care Planning (ACP).
Jennifer: My father was admitted to the hospital after vomiting at home one day. By the time I reached the hospital at 4am, he was on a ventilator but considered brain dead. The doctor asked me to make the decision to take my father off breathing support. I realised that making the decision will release my dad from pain but it will leave me with a mental scar as to whether it was the right decision to make. Therefore, I think as an individual, I should take responsibility in making the decision for my own life by signing a simple document like the Advance Medical Directive (AMD). We should not leave stress or guilt for our loved ones like how my dad left me to make the decision. I am thankful that my dad left peacefully that night without my having to tell the doctor to remove his ventilator.
Sze Wei: It all started one day when I volunteered with “Both Sides, Now”, a community engagement project that uses art and public dialogues to create awareness, encourage reflection and provoke end-of-life conversations among healthcare professionals, caregivers and the public at large. I started to ask myself questions such as what is death and dying to me. I also became inspired by the art exhibitions, discussions and performances they presented. It all gave me lots to think about. Later, I found SHC’s resource website and have relied heavily on it when making many of my end-of-life care decisions.
What do you think about death and dying?
Edi: Dying is more of a concern than death. The endpoint of dying is uncertain whereas death is definitely final. The mental capacity needed to deal with dying is more immense than that for death.
Jennifer: Death is an instant, while dying will take some time. I feel the one living needs to learn how to cope with the one who has already left. I had thought I was ready to part with my father, but I wasn’t prepared when that day came.
Sze Wei: Everyone has to experience dying and death. The question is whether we can make things easier for our loved ones and how do we prepare ourselves well for the end.
Who can speak for you when you’re admitted to hospital?
Edi: My wife, as she is the one who is handling my personal matters.
Jennifer: My husband. We have both signed the Lasting Power of Attorney (LPA) and AMD, entrusting our lives to each other.
Sze Wei: My husband, my brother and my son.
“It’s important to reflect on what matters to us, what makes life meaningful and share it with our loved ones.”
Why is it important to have these conversations and make plans for the end of life as early as possible?
Edi: The dying would be comforted to know that their wishes will be executed accordingly, as usually there are worries of unfinished business. By having the conversations in advance, it gives the assurance that things will be handled in their preferred way. As for the loved ones — in my case, I have siblings — this mitigates arguments and provides direction to execute the desired plan. We served the interests of our dying father in all discussions.
Jennifer: I feel that Singapore is death illiterate. When I bring up this topic during conversations, it usually gets uncomfortable. When my father was still around, I asked from time to time how he would want me to settle matters after he leaves, but was brushed off every time. When he passed on suddenly, thankfully, I knew friends in the funeral industry who helped to ensure the wake went off smoothly.
Sze Wei: My family was devastated when my dad passed away shortly after being diagnosed with cancer. We didn’t have much time for conversations and preparations then, so I definitely agree it’s important to start conversations early, when we are young and healthy. It’s definitely not because I am depressed or having suicidal thoughts. I would feel more ready to live a full life and face life’s challenges after having talked to my loved ones and making plans.
What end-of-life arrangements have you made?
Edi: I’ve completed financial and fixed assets allocation. Also I started the conversation last year about end-of-life care and treatment; the plan would be more concrete this year.
Jennifer: I plan to buy my funeral package for a three-day wake and choose my coffin, so that my husband doesn’t need to be bothered about this matter when I go. I have also written my will and made my CPF nomination.
Sze Wei: I completed my ACP, LPA, AMD and funeral pre-planning. I’m happy to say that not only did I settle this end-of-life care planning for myself, but I also helped my mum do hers at the same time.
Do you have any words of encouragement or advice on how to get started?
Edi: Death is inevitable for everyone and you never know when it will happen. Planning for end-of-life care and matters not only provides peace of mind to you when you are dying but also your loved ones who may be emotionally overwhelmed by the situation. This may not be a one-off conversation. Your preference may change over time so keep an open mind and it is okay to speak about different aspects over time.
Jennifer: I love the wise words I heard from Mr Ang Ziqian, a fourth-generation funeral director and founder of Ang Chin Moh Foundation, along the lines of “You don’t talk about death, you die anyway. You won’t die talking about death”.
Sze Wei: Get some conversation cards to start with from SHC or attend their webinars. Bring the family together to do these activities and just start. We don’t need to do everything in one session as we all need time to think. Start early and don’t give up. It took quite a while because I was also trying to get my family together to understand the importance of all these end-of-life matters and decisions. We can start with reflecting on our beliefs, values and preferences for our healthcare and financial matters. It’s important to reflect on what matters to us, what makes life meaningful and share it with our loved ones. If we are to spend our final days with dignity, we must plan ahead and make our decisions known when we are able to, with sound body and mind.
Photos: Singapore Hospice Council Volunteers