By Salma Khalik, Health Correspondent

THE Government is set to play a bigger role in end-of-life issues and in the care of the dying.

It will expand hospice care, rope nursing homes into caring for the dying and ramp up the number of doctors and nurses trained in palliative care.

It will also make it easier for people to make Advance Medical Directives or living wills, so doctors know what to do when these individuals become terminally ill.

Opening the Lien Centre for Palliative Care yesterday, Health Minister Khaw Boon Wan acknowledged that the state has so far played a limited role in this aspect.

But the country has come a long way from the depressing Sago Lane death houses of the 60s, where the sick were taken to die and then immediately removed for burial.

With advances in medical science, and in view of the ageing population here, he said the Government was now in a position to 'do much more to raise the quality of life of the dying, to ease their pain, to preserve their dignity and to support their care'.

So even as he lauded the efforts of volunteers who pioneered hospice care here, he made it clear that the State had come round to accepting it should play a bigger role.

'Fortunately, the limited support from the Health Ministry has not been disastrous, as our population is still young. But we cannot stay young forever,' he said.

He plans to increase the 125 hospice places now available by 20 per cent over the next five to seven years. The four hospices, which are run by voluntary groups, are about 70 per cent full and had 1,200 patients last year. Another 3,200 patients were cared for through five home-hospice services.

About $5 million in subsidies went to 4,400 patients, an amount which Mr Khaw conceded as small, given the 17,000 deaths here every year.

He also wants to involve nursing homes which look after the elderly and chronically ill in 'end-of-life planning' so that their patients' wishes are more easily respected.

Dr Noreen Chan, medical director of Dover Park Hospice, said that more than half of nursing home patients are sent to hospitals to die. Many could be living out their last days in these homes instead.

Next year, a pilot project will start with six nursing homes near Tan Tock Seng Hospital. Their staff will be trained in palliative care, which includes how to give pain relief to patients when conventional pain killers will no longer do. They can call a specialist to assess if a deteriorating patient needs hospital care before he is rushed there.

Also on the cards are 'die-logues' - a term Mr Khaw borrowed from Singapore's 'Mr Charity' Gerard Ee - to get people thinking about what they want for the end of their lives. It was time to talk about death and 'not sweep it under the carpet', he said.

'Western countries are beginning to come to grips with an ageing population, and Singapore would have to confront this too.

The Lien Centre will produce courses to equip doctors and nurses to deal with the dying. It will also generate essential data, such as where people live out their last days, so it is clear where resources are most needed.

'Everybody should be able to die with dignity, without pain, surrounded by loved ones. Where do we stand today? I don't know. Let's find out,' he said.

salma@sph.com.sg

This story was first published in The Straits Times on Oct 15, 2008.

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