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    Apr 09, 2014

    Why many S'poreans don't get their last wish

    THEY don't die where they want to.

    They don't even go the way they'd like to. And the tragedy is that, with a little more homework and a little less sentiment, it could all be so different.

    Singaporeans could improve the quality of their death, shows a study commissioned by philanthropic group Lien Foundation, in which more than 1,000 people were polled.

    As things stand, families go into denial or think that there's a stigma attached to hospice care. Instead of allowing their loved ones to go peacefully at home, they end up denying them their last wish.

    More than three in four Singaporeans want to die at home, but only 27 per cent get their wish. Instead, 61 per cent end up dying in hospital, where relatives cling to hope instead of facing reality.

    The option of palliative care, which would have improved the quality of the remaining life and reduced suffering, is often ignored. Families end up trying to fight the illness instead.

    Dr Ramaswamy Akhileswaran, who chairs the Singapore Hospice Council, said that families have to be realistic.

    "We see this almost every month - at least a few caregivers or the patients themselves will be in denial. For example, some family members keep insisting on sending their loved ones to the hospital, and spending a lot of money on nutritional supplements... but the patients can't even swallow."

    Some don't want to be accused of sending their relatives to a hospice, even when it's the best option.

    "It's like the stigma with putting parents in nursing homes. I hope our cultural norms will evolve to that of what's in the best interests of our loved ones, rather than being fixated with what relatives or others may say," said Dr Jeremy Lim, head of health and life sciences practice at Oliver Wyman.

    It costs about $250 to $350 a day for inpatient hospice services, but subsidies are available. Three hospices, four acute hospitals and one community hospital currently provide inpatient palliative care.

    One could even get such care at home. "The biggest fear of those who want to pass away at home is the medical cost... But, currently, home hospice care service is free," said Dr Akhileswaran.

    Finally, the families could, with some training, learn to look after their dying relatives themselves. It is not a huge burden, even though some are afraid that they may not be able to handle the patient.

    Of course, in some cases, the option of dying at home is ruled out.

    "They may not have family support - there is no one to take care of them. Poorer families also don't have access to resources such as domestic helpers," said Mr Lee Poh Wah, chief executive of Lien Foundation.

    And there are other cases where elderly patients either live alone or with other aged relatives who may not be able to care for them, said Assisi Hospice's medical director, Dr Tan Yew Seng.

    But often it is ignorance of the options available, or a lack of realism that prevents Singaporeans from getting their dying wish.

    In Hong Kong, on the other hand, some people veer to the other extreme of being practical.

    "I've been told that in Hong Kong, some people would choose to die in hospitals so it doesn't affect their property prices," said Dr Akhileswaran.