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Starting the conversation

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Starting the conversation

Planning for end-of-life early empowers us to make the best decisions for ourselves and also reassures our loved ones. HCA Senior Medical Social Worker Yap Ching Sian shares some tips on beginning the end-of-life conversation.

At what age should I start planning for end-of-life?
Planning for your end-of-life (EOL) requires you to start thinking about how you would like to be cared for when you are diagnosed with a life-threatening illness or when your prognosis is guarded.
It also requires considerations to be given to who you want to appoint as a decision-maker, in the event that you lose your mental capacity. These decisions include how your assets should be managed, funeral arrangements to be made and the legacy you want to leave behind.
As these considerations require significant deliberation, it is advisable that you only start to plan for EOL when you are sufficiently mature. While there is no specific age to start planning for one’s EOL, a good gauge is when one enters adulthood. When planning your EOL, you must have a good understanding of your values and preferences.

I am young and healthy. Why do I have to plan for EOL so soon?
Having a plan for your EOL is about being prepared should unforeseen circumstances arise. We often get emotionally overwhelmed when we find out about a major illness or when we meet with an accident.
Under these difficult situations, it would be challenging for us to think about EOL matters rationally. Hence, EOL plans are ideally made when you are healthy and in a good emotional and mental state. Decisions made under such circumstances would likely be ones that are thought through rationally and carefully.

“Planning for EOL early allows you to prepare for any unfinished business to be completed, reconcile with people whom you might not have spoken to for a while and have proper time to say goodbye to your loved ones.”

Where do I start?
A good place to start is Advance Care Planning (ACP). It involves the process of planning for one’s future personal and health care. It requires you to identify a spokesperson to make medical decisions on your behalf, while being guided by the medical team, when you are unable to make your own decisions.
ACP also reflects your views on what gives meaning to your life, elements of care that are important to you and how you would like to be cared for in the event of an illness or injury.

How do I include my loved ones in the conversation?
You would know your loved ones best. You could start by asking questions to gauge how far your loved ones can go with the conversation. Sometimes, the conversation can begin spontaneously. For example, you and your loved ones might have watched a TV programme, in which one of the characters fell ill, or you and your loved ones might have visited someone at the hospital. These are good opportunities to start having EOL conversations with your loved ones in a more natural and less threatening way.

What are some of the obstacles that I might encounter during the conversation?
Your loved ones may not be ready for the topic due to many reasons. They may find it inauspicious or taboo to be talking about such topics. Others may find it difficult to dive into the conversations as the fear and sadness of losing you are too much to bear.

Care and consideration about your loved ones’ readiness to have these conversations should be taken into account. However, getting your loved ones involved in your EOL conversations is equally important, as they get a chance to hear you out and also to express their views about your EOL plans.
These conversations can lead to powerful moments, where affirmations and words of love and gratitude get conveyed and expressed. These conversations sometimes become shared and precious experiences for you and your loved ones, which can be deeply moving, meaningful and life-giving.

What are the advantages of planning for EOL early?
Planning for EOL early allows you to prepare for any unfinished business to be completed, reconcile with people whom you might not have spoken to for a while and have proper time to say goodbye to your loved ones.
It also gives you the chance for your wishes regarding your care, financial matters and funeral matters to be heard. In doing so, your loved ones will not feel the burden of having to make guesses about your preferences. They can be empowered and assured that they are carrying out your preferences and can even take comfort knowing that things are being carried out in accordance to your wishes.

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