Angry Doctor

Friday, September 07, 2007

Death and Other Inconveniences 2

angry doc is not obsessed with death.

Intrigued, perhaps.

Amused, certainly.

But not obsessed.

The minister, however, seems to be.

MOH may change rules hindering patients' preference to die at home

SINGAPORE: Surveys in Japan and London have found that most people prefer to die at home.

But in Singapore, statistics show that 55 per cent died in hospitals and about 28 per cent died at home.

Health Minister Khaw Boon Wan said that anecdotally, up to 90 per cent of patients in Singapore prefer to die at home.

In view of this, he may change current rules and processes that hinder them from doing so.

Mr Khaw was speaking at the official opening of the 18th Children Hospice International Congress in Singapore.

Citing his recent trip to a so-called village of long life in Japan, known for its many centenarians, Mr Khaw recounted how many Japanese lamented that despite their strong preference to die at home, few got their final wish granted.

He said: "At the Ogimi village, I did not find villagers squeamish when talking about it (death). They laughed and joked about it. They realised that treating death as taboo does a disservice to both the dying and the living, adding to loneliness, anxiety and stress for all.

"After a full and meaningful life, I certainly wish to die at home, among my loved ones, in familiar and peaceful surroundings."

No survey has been done in Singapore yet on the preferences of where patients want to die. But Mr Khaw said that he did not expect Singaporeans' preference to be much different from the Japanese and Londoners who prefer to die at home, according to surveys.

"Judging from other countries' experience, for the terminally ill, those who have time to think of their last moments, I think most point to this preference, which is understandable. You want to die where your loved ones are around you and in familiar surroundings. The reality of modern healthcare is that that wish is seldom achieved," he said.

So, Mr Khaw wants to survey Singaporeans on their preferences so that his Ministry can accommodate the last wishes of the terminally-ill.

In fact, Singapore is thinking of setting up a register where people could record their preferences of where they want to die, as recommended in a London report.

To make hospice and home palliative care an important part of Singapore's healthcare delivery system, Mr Khaw said his Ministry will support and grow palliative medicine into an attractive and effective medical sub-specialty.

It will extend palliative care and its benefits beyond oncology to other terminal-stage chronic conditions such as heart failure and chronic obstructive lung disease.

The Ministry will also ramp up the manpower needed to support the growing demand. More nurses, counsellors, medical social workers and therapists will be trained.

Singapore will also do more to educate the public on hospice and end-of-life care. - CNA/ir

It sounds idyllic, doesn't it?

Lying on a bed with white sheets, surrounded by your loved ones, sunlight streaming in through the open window...

You address each of them in turn, telling them how much you love them and thanking them for all they have done to make your life a full and meaningful one.

And when you are done, you look out of the window towards the sky. Then with a smile on your lips, you breathe your last breath.

Except it's just as likely that the first anyone even know you were dead was when your tired and burnt-out family came to serve you your morning pain medication, only to find you stiff in a pool of your own urine and faeces.

Yes, people probably prefer dying in their own home to dying in a hospital.

But how many people have the skills and energy required to nurse a dying relative at home?

How many people *prefer* to look after their own dying relative at home to leaving it to healthcare professionals in a hospital or hospice?

People die in hospitals for the same reason they stay in hospitals: they require skilled, round-the-clock care.

To train and support laymen to care for their dying relatives at home will require much resources. It may be a worthwhile cause, but let's not imagine that it will be a simple matter of "chang[ing] current rules and processes that hinder them from doing so".



  • Of course, it makes all the difference in the world if the dying person could afford skilled, round-the-clock nursing care at home.

    Doesn't it?

    To paraphrase Dr. Crippen, there is no God-given right to a peaceful death.

    By Blogger blacktag, At September 07, 2007 10:44 pm  

  • Of course most patients would prefer to die at home. But would the family or caregivers prefer that?

    In my experience as a clinician, not usually.

    SOmetimes, yes, they do say that; But when they start setting requirements before we can discharge patients, such as getting free oxygen supply at home, I know the game is up.

    Naturally there are some good families who help us out a lot. Too bad I don't see those that often

    By Anonymous Anonymous, At September 08, 2007 1:49 am  

  • I came upon ya site. Read thru this blog. Agreed with ya views n like you, am concern with the pple n healthcare system. Feel ya passion n hope u'll spread it to more pple n more places.

    By Anonymous Anonymous, At September 08, 2007 1:52 pm  

  • sadly seems that the push probably came to free up beds and because of costs to the establishment..not out of the public's wishes naturally.

    By Anonymous Anonymous, At September 09, 2007 4:01 pm  

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