|Implemented in this survey?|
The government has said that it will play a greater role in caring for the dying. It has announced a slate of initiatives to encourage the development of palliative care in Singapore and to help Singaporeans die with dignity.
The aim of these initiatives is to "raise the quality of life of the dying, ease their pain, and preserve their dignity and support their care".
The initiatives include:
Patients in need of palliative care, Hospices and Nursing homes
|Medienpräsenz||sehr gering||sehr hoch|
As Singapore's population ages, end-of-life issues inevitably receive greater attention. Palliative care, however, is an underdeveloped area in Singapore, where it has been left largely to charitable and voluntary welfare organizations.
Currently, 55 per cent of Singaporeans who are sick or at the end of their lives die in hospitals, while 28 per cent die in their homes. And according to the Singapore Hospice Council, about 70% of people with terminal illnesses are dying without hospice palliative care in Singapore.
Presently, all four existing hospices in Singapore are run by voluntary groups that receive generous government subsidies. In 2007, they were about 70 percent full with 1,200 patients. An additional 3,200 patients were cared for through five home-based hospice services. In all, about $5m in subsidies went to 4,400 patients, an amount the Ministry of health has conceded is small, given the 17,000 deaths here every year.
Nursing homes are presently ill-equipped to care for the dying. In fact they frequently send their patients back into the hospitals the moment their conditions deteriorate.
There are currently about 15 doctors working in this area, dedicated to improving quality of life of patients and their families facing the problems associated with life-threatening and or terminal illness.
Currently fewer than 10,000 people have signed an AMD, though it had been available for 11 years. It is thought that steps such as removing the legal requirement for a doctor to witness its signing and allowing download of the form from the internet would help. But before any amendment to the law is made, public consultations would be held on what people wanted from and in an AMD.
|Implemented in this survey?|
Those involved in palliative care expressed strong support for the initiative. The existing five home-hospice services welcome the move. They could do with more money to expand, especially if more people are to get their preference to die at home.Similarly, nursing homes also welcomed the move as they could expect additional funding support to upgrade the level care they can provide.
|Ministry of Health||sehr unterstützend||stark dagegen|
|Hospices||sehr unterstützend||stark dagegen|
|Nursing homes||sehr unterstützend||stark dagegen|
|Ministry of Health||sehr groß||kein|
|Nursing homes||sehr groß||kein|
All these initiatives are expected to roll out in early 2009.
By recognizing palliative care as a sub-specialty, the MoH is countering the lack of enthusiasm among doctors for specialising in that field with an incentive.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The MoH's new approach to end of life issues and the care of the dying has struck a chord with those who feel that society shows its humanity best by succoring its old and terminally ill, and not just investing in the young and the productive. Expanding hospice care will reduce pressures on the hospitals as well as save costs since palliative care is more cost-effectively provided in nursing homes and hospices.
Wong A. Care of the dying. Today newspaper, 15 October 2008, page 1.
Lim Meng Kin