The Health Ministry is moving into new territory - death.
It will study what it will take for more people to die a dignified death at home, instead of in a hospital or hospice, said Health Minister Khaw Boon Wan on Friday.
Right now, just under three deaths in every 10 take place at home. Most people die in hospitals.
'Why is the modern healthcare system failing in meeting the preference of the dying? I believe we should try to facilitate dying at home for the terminally ill if this is their preference,' said Mr Khaw.
An ageing population and all its related concerns - staying healthy and active, and having enough savings - have become key concerns of the Government.
Yesterday, Mr Khaw added one more - dealing with death.
End-of-life issues are deeply emotional, but talking about them helps, he said, recalling his recent visit to the Ogimi village in Okinawa, Japan, which has a population with one of the highest percentage of centenarians in the world.
'They realise that treating death as taboo does a disservice to both the dying and the living, adding to loneliness, anxiety and stress for all,' he said.
For a start, his ministry will identify the obstacles, such as the reluctance of some doctors to certify a death at home and the extra costs involved.
For instance, while subsidies help cover medical costs for those dying in hospitals, these subsidies stop once they go into home hospice care, he said. It is a similar case for insurance coverage.
If need be, rules and processes that hinder dying at home will be changed.
Recounting his grandmother's death of old age at home, Mr Khaw said that there was a time when death was an integral part of family life.
'She had never been hospitalised, and the hospital was the last place she would want to draw her last breath,' he said.
In a way, modern health care has made dying a lonelier process, he told reporters after he opened the Children Hospice International 18th World Congress yesterday,
The three-day congress, attended by 150 participants from 25 countries, deals with treating terminally-ill children and hospice care.
Mr Khaw said he wants to make hospice and home palliative care - specialised care of people who are dying - part of the health care delivery system.
The first step is to make palliative medicine an attractive sub-specialty - something many doctors had been lobbying for for many years.
'This way, we can start thinking about the needs and demands of this sub-specialty, such as how many more people we need to train,' he said.
As of last year, there were five doctors in Singapore with in-depth training in this field.
Palliative care will also be extended beyond cancer to other terminal stage chronic conditions.
Taking care of the dying is a labour- and skill-intensive service, so manpower needs will have to be planned for and career prospects improved to make it attractive.
Singapore is not alone in confronting these issues. Last month, a report by the National Health Service for London devoted a section to end-of-life care and lamented the lack of discussion in society about 'what constitutes a good death', noted Mr Khaw.
The report recommended getting patients to declare where they prefer to die, a development which Singapore can study too, he said.
A long-time advocate for terminally ill patients to die at home, HCA Hospice Care's president Seet Ai Mee agreed.
Citing her experience when her father was dying from cancer, she said he summoned all his family members and told them his last wishes. That helped, she said.
'We didn't have to second- guess him or ourselves. It also helped keep the harmony of the children and grandchildren,' she said.
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