THE Health Ministry will pay more attention to treating the dying and step up palliative care in a move to raise the quality of life for the acutely ill.

New initiatives include a pilot scheme to bring end-of life planning into nursing homes and developing a set of guidelines for healthcare professionals.

MOH will also promote Advance Medical directive (AMD) more actively so that a patient's wishes can be managed in a dignified and humane way.

The ministry is also now convinced that hospices play an important role in caring for the terminally ill, and sees the need to help pay for such care for needy patients.

It is also encouraging more young doctors to take up palliative care.

These new initiatives were announced by Health Minister Khaw Boon Wan at the opening of the Lien Centre for Palliative Care on Tuesday.

Acknowledging that the government has been "underperforming" in the care of the dying, he pledged that steps would be taken to rectify the limitations.

Mr Khaw said past history has something to do with this.

"MOH has been hesitant in supporting this cause. Its institutional memory has been coloured by that of the Sago Lane death houses, where the dying spent their last months in misery and neglect," said the minister.

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

"We therefore need to ramp up our support, both to cope with the continued ageing of our population as well as to exploit the advances in medical science on the care of the dying.

"We can now 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."

On its part, the ministry has been trying to rectify the shortcomings.

The minister said: 'MOH now recognises the useful role played by hospices and subsidises it for the needy.'

Last year, 4,400 patients benefited from subsidised inpatient hospice and home hospice services. Mr Khaw said hospice care will be expanded in the community.

The government now recognises palliative medicine as a sub-specialty, and is training more doctors and nurses in this area.

A new initiative is to extend palliative care to the family of the dying person. Mr Khaw said doctors have often reported that close relatives get sick 'from profound bereavement and grief.'

It is also trying out end-of-life planning at nursing homes, to find out what the patient really wants.

'Properly cared for, many sick and disabled people can live worthwhile lives,' said Mr Khaw, who also called for more "die-logues" about death.

On the push to promote Advance Medical Directive (AMD), which came into effect in 1997, Mr Khaw said the takeup rate for this is low - fewer than 10,000 Singaporeans have it.

AMD empowers the terminally ill and preserves self-determination into the period in which the patient is unconscious or incapable of exercising rational judgement.

"We have been too cautious and unduly squeamish in promoting the AMD," Mr Khaw admitted.

"But timely discussion and planning about the dying process should be an integral part of holistic care of any patient whosedeath is imminent. This process helps the patient's wishes to be respected in a dignified, humane way."

In the United States, UK and Canada, the patient and loved ones are more confident when confronting end-of-life issues and death when the process is handled well.

MOH will simplify the AMD by providing a multilingual registration form with plain language and clearer FAQs so that the public can understand it better, said Mr Khaw.

"It is not only the public who are confused. Some doctors have told us that they shy away from acting as witnesses for AMDs because they themselves do not fully understand the implications of the AMD," he added.