Overview

In a Singaporean survey:

Only 50% have ever talked about death or dying with their loved ones.
Only 36% feel comfortable talking about their own death. (Lien Foundation Survey on Death Attitudes, 2014)
You do not need to be seriously ill or dying to start talking.

Think & Talk

Think about what is important for you in the areas of:

Thinking through these issues on your own before sharing them with someone you trust allows you to reflect on what matters to you. This process will help you prepare and be more comfortable when you are ready to share with your loved ones.

The following site is a useful resource to help you think through the issues: https://www.aic.sg/care-services/advance-care-planning

Opportunities to Start

#1 Use news or social media or a movie/play

“I read an article about end-of-life planning and it really got me thinking about these things for myself – and for you.”“There was this episode on TV recently, and it was about a man who is terminally ill. This got me thinking about what is important for me.”

#2 Use a recent hospital visit (yours or someone you know)

“I have been following what Ah Ma went through. If something like this happens to me, I want to let you know that…”

“Even though I am alright now, I want to be prepared if something happens to me such that I cannot speak for myself.”

#3 Many find that family gatherings are natural places to start (especially funerals and death anniversaries)

“Grandpa went very peacefully at home. This is how I will like to go. Peacefully and at home. Other things important to me are…”

#4 Just do it! Invite your loved one to a discussion about your values and what it means for you to live well.

“I have been thinking about how I want the end of my life to be like and I would like to share this with you.”

Doing so allows you to share what is important to you, what you hope to do and what is meaningful for you to live well.

#5 Writing to your loved ones. Some even audio tape their wishes for their families.

Doing so allows you to share what is important for you, what you hope to do and what is meaningful for you to live well.

However way you wish to start, remember that such conversations need not be completed in one sitting.

Care to Listen!

Not everyone will be comfortable with such conversations.

If you are on the receiving end, don’t kill the conversation…

… by responding like this	Instead, try this …
Touch wood, this will never happen! Don’t say such things!	Help me understand what is important for you.
Don’t worry, things will be alright.	Tell me what you are worried about.
I am not going to let you die!	What are the things I can do to help you?
No, this is not what you should do.	I can see this is important to you.

Listening to someone who wishes to share what is important to them as they reach the end of their lives is a privilege. Consider it a gift. Reciprocate with respect and love. So…

1. Hold your own views first. Respect that this is their journey and what they share stems from their experience and values.

2. Encourage them to share. Your body language is important. Leaning forward with good eye contact shows you are interested. Nod your head as a sign of acknowledgement and if necessary ask questions that helps you clarify what is important.

3. Stay calm. This is not always easy as there can be tears. You may also be feeling awkward or embarrased. Breathe in slowly to calm yourself if you have to.

4. Be honest. Don’t deny your feelings or the reality. Often, we do not know the ‘right thing’ to say, but just acknowledging these feelings (uncertainty, grief, fear, love) can be liberating and helpful. You may also have your views and may wish to share them. Do so respectfully (“I know that this is important to you. I wonder if you will consider…”).

5. Accept silence. You can remain quiet. Don’t feel either of you have to talk all the time. The conversation can be emotional. Allowing for silence and just being present is a sign of respect and affirmation of your care and concern.

Die logues...

…are important as we all die one day.

…are conversations that address our personal views on death and dying.

…are conversations focusing on matters that are important to us as we approach the end of life. These include:

Dare to Talk, Care to Listen

"I wanted to talk about it, but my sister just said “Choy! Don’t talk about such things.”

“We never talked much to each other anyway. I am not about to start with such a topic.”

“It is sad enough without having to talk about it. Talking about what may happen just makes it more sad.”

“Knowing what she wanted lifted a burden off me.”

“I did not want to add to their worries by leaving all my stuff for them to sort out.”

“We were having conflicts as to what was the best thing to do. If only we knew what he wanted.”

Some find it hard as they…

Do not wish to face their own mortality. But we know that,
- Talking about dying won’t make it happen.
- Not talking about dying does not prevent it.
Fear upsetting others.
- Yes, it can be an emotional conversation but your views and concerns need to be heard. Likewise, be a good listener when your loved ones share theirs.
Do not know how.
- The biggest reason for discomfort with talking about death/ dying is that they do not know how to broach the topic (45%).

Everyday about 55 people die in Singapore

For many of us, we leave words unsaid and things undone until it is too late.
Many have found that by talking openly about dying, they got to make the most of life and gained mutual support in the process.
Conversely, when we avoid talking about dying, we can feel isolated as others fail to understand the concerns and provide the necessary support.
Without clear instructions, those left behind may also face difficulties tidying up loose ends. This may result in guilt, regrets and conflicts.

We had a patient with a severe neurological condition. She was bed-bound and deteriorating very rapidly. She was also suffering from recurrent chest infection. Her husband had said that she was very clear that she only wanted to be kept comfortable if she could no longer communicate with others. However her relatives came and demanded that she be sent to the intensive care unit. That would not have helped much except maybe increase her suffering with all the tubes and lines. Fortunately, she had documented her preferences in an advance care plan. This helped to resolve the conflict between her husband and her siblings. She died peacefully 2 weeks later.

Dr Beverly Siew

Palliative Care Physician