As we shed a spotlight on the new generation of doctors who are embracing the palliative care approach, we look back at the volunteers who have been and still are at the heart of palliative care

Singapore’s palliative care movement was built on the selfless efforts of volunteers whose compassion laid the foundation for what has become one of the country’s most vital healthcare services.

In the 1970s, long before institutional support, volunteers— both laypeople and medical professionals—stepped in to offer dignity and comfort to the terminally ill. Singapore had long struggled with a deep-seated stigma surrounding death, epitomised by the infamous “death houses” in Sago Lane, where the dying spent their final days in neglect. This grim reality where people saw the dying as already dead moved Dr. Ee Peng Liang, a businessman and philanthropist known as Singapore’s “Father of Charity,” to take action.

Recognising the need for dignified end-of-life care, Dr Ee and a group of friends addressed the Ministry of Health about establishing a hospice facility. Their work, however, faced resistance. The nuns at St Joseph’s Home stepped in, offering two rooms for palliative care. This modest effort became the first palliative care service in Singapore, with 16 inpatient hospice beds.

The Straits Times’ story “A Place to Die Peacefully” in 1986, which highlighted the work of St Joseph’s Home, was a watershed moment. The response to the open call for volunteer doctors, nurses and laypeople was overwhelming — 144 letters of interest poured in, leading to the formation of Hospice Care Group (HCG) under the Singapore Cancer Society (SCS), Singapore’s first volunteer home hospice care service.

HCG eventually separated from SCS and became Hospice Care Association (HCA). By 1992, the hospice movement had grown, with five hospice services up and running. In 1995, to manage the shared needs of these hospice services, the Singapore Hospice Council (SHC) was registered with its four founding members: Catholic Welfare Services, SCS, HCA, and Dover Park Hospice (DPH).

These early volunteers’ dedication laid the groundwork for Singapore’s palliative care system, ensuring that future generations of professionals and volunteers could build on their legacy.

THE EARLY STEWARDS OF PALLIATIVE CARE

For Mr Muhammad Agus Bin Othman, volunteering with DPH in the 1990s marked the start of a 30-year commitment to palliative care. He and his wife had chanced upon a DPH volunteer recruitment roadshow and quickly became committed members, organising monthly birthday celebrations and Hari Raya festivities for patients.

At the time, Mr Agus had little knowledge of palliative care beyond its association with end-of-life support. As he became more involved in volunteering, he discovered that it had a profound emotional and spiritual impact on not only patients but also their families. “We try to bring them some joy and smiles so that they can spend their time meaningfully before the end,” the 68-year-old explained.

Mr Agus found joy in planning birthday celebrations for these patients’ final days. Volunteers would bring homemade dishes, such as lontong, mee goreng and rendang, as well as cakes donated by Goodwood Park Hotel. To liven up the mood, the group played the ukulele, did line dancing, sang Hokkien and Cantonese songs upon request by patients, and ran karaoke sessions. Volunteering became so ingrained in his family life that he brought his children to the hospice. Today, Mr Agus’ 40-year-old son continues the tradition of service by joining his father as a DPH volunteer.

One of Mr Agus’ most memorable experiences was with a young girl suffering from cancer. She had lost her sight and had an artificial eye, and he vividly remembers her birthday celebration at the hospice. He grew so close to the family that he accompanied them to Malaysia to seek alternative treatments. He stayed by her side until her passing, offering quiet companionship in her final days.

The key to palliative care, he believes, is being instinctively attuned to patients’ needs. “Talk less, listen more,” he said. When patients become agitated, he gives them space, gently asking if they need anything rather than overwhelming them with words.

Some people are afraid of dying, especially if they are experiencing hallucinations or uncertainty. Mr Agus provides spiritual support to Muslim patients on request, reading from the Qur’an to soothe them. “Some are petrified, unsure of what will happen next,” he reflects. Death, according to Mr Agus, is not something to fear. “For us Muslims, death is a natural part of life,” he said.

Over time, government recognition and the National Strategy for Palliative Care helped expand and professionalise hospice care, integrating this into Singapore’s broader healthcare system.

Mr Agus has witnessed this transformation firsthand. In the past, he says the system at DPH was more informal, with lean staffing who also doubled up as volunteers. Today, it is more structured, with formal training of the volunteers covering not just physical care — such as wheeling patients on wheelchairs safely — but also the psychological, emotional, and spiritual dimensions of end-of-life support.

For instance, DPH has a structured volunteer programme, with groups named after precious gems since 2008. There are singing groups, a handicraft team that raises funds with handmade items, outing planners, massage providers, pet owners who participate in pet-assisted activity programmes, and others who provide hairdressing, gardening, and weekly grooming services.

Mr Agus continues to advocate for palliative care in his community. One of his most meaningful experiences was organising a wedding celebration for a patient’s daughter, which solidified the strong bonds formed in hospice care. However, society is still struggling to accept death, and more volunteers are needed. “The system has become more professionalised, but we still need volunteers,” he says. “It’s a vital part of the care.”

SPARKING VOLUNTEERISM IN PALLIATIVE CARE

For Teo Yisi, the heart of palliative care lies in walking alongside these palliative care patients, often most overlooked by society. Her lifelong curiosity about death and end-of-life care led her to research the topic deeply, eventually seeking firsthand experience to understand it better. After exploring volunteering opportunities, she is now a regular volunteer at one of SHC’s member organisations.

In a poignant blog post she writes, “As I spend time by the side of the dying, I’ve come to love this way of being. To love people when they have little to give, to be entrusted with their care. That there is a whole practice that’s built not upon resistance and defiance, and not merely of acceding, but of gentle allowing and going with the flow — pain management where required, not forcing meals. An acceptance of what is natural. A practice that recognises and honours what matters most at the end of life — presence, companionship, autonomy, dignity.

All of which are not dependent on human flesh, but an indestructible spirit. And that’s why palliative care will never be a practice of defeat. It is the strongest stance we can take in the face of natural rhythms: we flow, we live. As we can, as we are.”

Yisi’s reflections remind us that palliative care is more than managing life’s end — it’s a compassionate practice that affirms the enduring spirit of each individual. Even as the patient’s body declines, he or she is strengthened by the presence of volunteers who offer companionship and dignity at life’s final stages.

THE FUTURE OF PALLIATIVE CARE: SUSTAINING A LEGACY OF COMPASSION

While hospice care has long included both volunteers and medical professionals, the landscape of palliative care has evolved. More medical professionals now integrate a palliative approach into their patient-centred care for patients facing their final journey.

Dr Lim Kang Le, a hospital clinician at Alexandra Hospital (AH), found himself drawn to palliative care by chance while treating oncology patients.

It was then that he understood that the most rewarding part of his job wasn’t just treating disease but addressing the emotional and spiritual needs of terminally ill patients. “Supporting them during this time of their life was meaningful and a privilege,” says the hospital clinician.

During stints at AH, Tan Tock Seng Hospital and DPH, he was guided by experienced palliative care doctors and volunteers, who shaped his understanding of end-of-life care. Observing colleagues taught him how to listen, empathise, approach difficult conversations with sensitivity, and most importantly “learn how to be present” which is just as important as any medical procedure.

Dr Kang Le reflected on a particularly challenging case of a terminally ill young man who struggled with existential distress when he outlived his prognosis, uncertain when death would take him.

“As doctors, our first instinct is to intervene and find solutions to their problems. It’s not just about managing symptoms in the last hours, but considering a patient’s preferences, psychosocial and emotional needs,” he noted. “Sometimes, we prescribe a standard approach to end-of-life care and overlook or minimise what people truly want. Maybe just being part of a patient’s journey is, in itself, a form of care and healing.”

Though training opportunities exist, such as the Graduate Diploma in Palliative Medicine programme by the National University of Singapore (NUS) Yong Loo Lin School of Medicine, and courses by the Lien Foundation, exposure to palliative patients remains limited, especially for general medical doctors. Dr Kang Le said, “While knowledge is crucial, applying it requires personal adaptation and experience. Each practitioner develops their own approach to patient care, refining it over time.”

Dr Kang Le also advocates for more public education on palliative care, as it remains misunderstood, particularly among older generations who avoid discussing death. He also notes that with growing government support for community-based services, people are increasingly open to discussions about end-of-life care.

THE ENDURING ROLE OF VOLUNTEERS IN PALLIATIVE CARE

Like Dr Kang Le, Loh Pei Yi represents the next generation of medical professionals embedding palliative care into their core ethos. She is a fourth-year medical student at Nanyang Technological University, Singapore Lee Kong Chian School of Medicine and founder of Project Gift of Song.

Her journey into the palliative care field began unexpectedly during the COVID-19 pandemic. Passionate about music, she had always wanted to use it for social good. In 2021, after graduating from NUS High School, she and a group of like-minded friends organised a virtual charity concert on YouTube, raising over $7,000 for terminally ill patients in Singapore.

Through this experience, Pei Yi discovered Ambulance Wish Singapore and the profound emotional impact of end-of-life care. She also collaborated with SHC on a video montage honouring pioneers in the field, including the late Professor Cynthia Goh, Sister Geraldine Tan, Dr Anne Merriman, Dr Rosalie Shaw, Professor Pang Weng Sun and Dr Seet Ai Mee, drawing inspiration from their contributions.

Her belief in music’s unique ability to unlock emotions and spark meaningful conversations was fuelled through personal experience. When her grandaunt became unresponsive in her final days, Pei Yi hummed a familiar Cantonese melody, and recognition flashed. “That was my wake-up call,” she explained. “I realised that music could be a powerful way to honour life.”

Volunteers from Project Gift of Song utilise music to convey joy and make connections with palliative care patients, helping them to create personalised songs to express emotions that might otherwise go unspoken. “We create songs and gifts that celebrate patients’ lives, bringing light and joy in their final days,” Pei Yi said. The team also aims to challenge the stigma around death.

She launched [Death by Music], a structured social programme for mindful music appreciation that brings people together to engage in mediated conversations on grief and end-of-life matters. Songs about life’s final stages, from pop numbers such as Ed Sheeran’s “Supermarket Flowers” to classical compositions such as Frédéric Chopin’s “Funeral March” have been featured.

What started as a small initiative has since grown to 80 volunteers, and Pei Yi hopes to engage more participants, including those from the corporate sector. Despite challenges in funding, technical support and resources for high-quality audio recordings, she finds strength in the community-driven nature of her work.

Pei Yi collaborates with SHC and the Agency for Integrated Care to train her volunteers on knowledge of palliative care and Advance Care Planning, stressing the importance of having these conversations before illness strikes.

Ultimately, Pei Yi views her work as part of a broader movement where citizen advocacy supports national and institutional efforts. “Each of us can make a difference using our hearts and minds,” she said, highlighting the importance of grassroots initiatives and young people in shaping a more compassionate future.