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SINGAPORE: Surveys in Japan and London have found that most people prefer to die at home. Yet most ended up dying in hospitals.
In London, only 20 per cent of deaths occurred at home, with 66 per cent occurring in hospitals.
In Japan, over four-fifths of people died in hospitals while the rest died at home.
But in Singapore, statistics showed 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.
The Health Minister said he hopes more people in Singapore would discuss the question of 'where do I want to die', just like the Japanese at a so-called village of long life he recently visited.
"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," Mr Khaw said.
He also recounted how many Japanese lamented that despite their strong preference to die at home, few got their final wish granted.
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.
"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. If indeed that's the case, then let's find out what's stopping this. What are the factors that hinder this," he said.
"Off-hand, some people told me that to get doctors to certify death (at home) is not the easiest thing to do in the world. Whereas, if a person dies in the hospital, there're ready doctors there. I'm sure if a person has a family GP for many years, the GP would go there to certify the death. But I may be speculating. So let's find out," said Mr Khaw.
"Or, it could be because of money, the way subsidies are being given....Dr Seet Ai Mee just told me that for those who die in hospital, they receive subsidies. Once they go into home hospice, they don't receive subsidies. Likewise, insurance may insure, may cover if the person is dying in hospital but not at home. If that's the case, then we'll have to look at some of these distortions. I suspect there are many factors.....let's find out what are the obstacles and whether it makes sense to remove these obstacles," he said.
But for now, 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.
Mr Khaw also said that to make hospice and home palliative care an important part of Singapore's healthcare delivery system, 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
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