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Breaking the silence

Creating safe spaces for people to have frank conversations about end-of-life planning is important.
Creating safe spaces for people to have frank conversations about end-of-life planning is important. PHOTO: THINKSTOCK

The grief and shock following the death of a loved one can leave family members bewildered about what to do next. Trina Anne Khoo explains the process to make a difficult journey a little easier

When a loved one dies, it not only marks the start of the grieving process but also the practical task of organising the funeral.

The World Hospice and Palliative Care Day, which was commemorated in October, was a timely reminder that we need to keep the conversation going on death and dying for people faced with life-limiting illnesses.

In 2015, Singapore was ranked 12th globally and second in Asia, behind Taiwan, in the global quality of death index, commissioned by the Lien Foundation. Eighty countries were ranked according to the availability, affordability and quality of end-of-life care. But a survey taken on attitudes towards death, commissioned by the Foundation in 2014, showed that 71 per cent of respondents felt the need for national conversations on dying.

The stress of facing a death is compounded by not knowing what to do, especially if the passing was sudden and the deceased’s last wishes were not discussed with family members.

Housewife Madam Tan recalls the turmoil that ensued in her household late last year when her father-in-law passed away unexpectedly after suffering a stroke late at night.

Says 52-year-old Madam Tan: “When my father-in-law passed on suddenly from a  stroke, we were all stunned at first, but had to steel ourselves in order to make the necessary arrangements.”


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Her father-in-law had not made any end-of-life arrangements before his death, and neither did it occur to the family to do so, says Madam Tan. The most confusing part, she shares, was figuring out which authorities needed to be informed and completing the multiple forms from the mortuary.

“First, we contacted his siblings to break the news to them. The hardest part was telling my mother-in-law the next morning. Then, we contacted the funeral service providers and compared the different types of packages to choose one that suited the family,” she says.

Being emotionally prepared

If a person has a terminal illness, family members have to observe if he or she has come to terms with it. If so, this would be a good time to talk about end-of-life plans. 


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Psychologist Daniel Koh says: “Although families may be anxious about it, it is best to not transfer your own emotions to the person. Instead of having one long discussion, hold a series of conversations. It does not need to be depressing but filled with lightness, grace and care. Listen for cues that they are ready to talk and wait for them to lead, which gives them a sense of control.

“The setting has to be appropriate, filled with comfort, respect, grace, empathy, support, reassurance, love, care and privacy. Build bonding filled with trust, security and safety. Look out for emotional distress and resolve issues. Note that some may be  going through the grieving process.”

This can be a difficult process, as Irene (not her real name) discovered when she was caring for her 73-year-old mother who had terminal colon cancer. She says the toughest part was ensuring her mother’s psychological well-being.

The 37-year-old homemaker adds: “End-of-life planning is complex with older folk, as doing it prematurely can be interpreted negatively. The complicated part was talking her through some of her pre-conceived notions about sickness and death.

“My mother believed that terminal diseases such as cancer were divine punishment for those who were evil at heart. She was very indignant about her condition as she felt she did not deserve to suffer the disease. As her condition worsened and we had to broach the topic of planning for the end, she was resigned but remained indignant, loathing the thought of death.”

For more information, visit www.nirvana.com.sg