In this first instalment of a four-part article — a first-ever serialised piece in the year the Singapore Hospice Council celebrates its 30th anniversary — we look at how palliative care pioneers worked tirelessly to ensure everyone can have the dignified end-of-life journey they deserve.
Like all new disciplines in the past, palliative care in Singapore started with a few visionaries who witnessed the plight of dying patients and courageously did something about it. They were the sparks that lit the night, helped by the ‘movers and shakers’ of the time and brought to fruition by the many who have stood up to take palliative care to greater heights, expanding and sustaining it, transforming the night into a light of love and hope.
A humble beginning was made in the early 1980s with the introduction of palliative care to Singapore by the late Professor Cynthia Goh and Sister Geraldine Tan, two remarkable leaders who were deeply interested in and passionate about caring for individuals nearing the end of life. The establishment of the first-ever hospice beds in Singapore, carved out from the nursing home beds of St Joseph’s Home, took place in 1985.
At around the same time, Dr Anne Merriman, a geriatrician from the United Kingdom (UK), joined National University of Singapore as a senior teaching fellow in Social Medicine and Public Health (later renamed Community, Occupational and Family Medicine). She, too, had an interest in developing palliative care but faced many challenges developing the discipline in the busy acute hospital setting. Undaunted, she started
a voluntary home palliative care service with Prof Goh and a team of volunteers, which later became Hospice Care Association (HCA) in 1989, before returning to the UK.
HCA provided the first-ever palliative home care service for people with terminal illnesses in Singapore. At the time, the majority of the personnel consisted of volunteer doctors and nurses who stepped in whenever needed, including on nights and weekends. A few years later, in 1992, Dr Rosalie Shaw, a palliative medicine physician from Perth, Australia, and another pioneer of palliative care in Singapore
and Australia (having established Australia’s first-ever hospital-based palliative care unit in 1981) assumed the role of medical director at HCA. She subsequently became medical director of Singapore’s Dover Park Hospice, which started accepting patients in 1995.
PALLIATIVE CARE IN THE ACUTE SETTING
The seeds of palliative care in the acute hospital setting were sown by Dr Francis Jayaratnam during the mid-1980s when, as Head of Medical Unit I at Tan Tock Seng Hospital (TTSH) and after study trips to the UK, he started the Geriatric Medicine department and conceived a hospital-based palliative care service. Registrars (advanced trainees) who posted overseas for geriatric medicine training were mandated to spend some time in palliative care units; this was with the endorsement of the Ministry of Health (MOH). One of these young registrars was Professor Pang Weng Sun, who, after spending some months with Dr Claude Regnard (a palliative care physician and author of palliative care textbooks) at St Oswald’s Hospice in Newcastle, felt a strong calling to develop the speciality of palliative medicine in the acute care setting. Prof Pang guided the setting up of palliative care services in TTSH and Alexandra Hospital in 1996 and 2001, respectively. Dr Angel Lee, one of the first doctors to practise palliative care in an acute setting, also played a key role in developing Singapore’s first palliative care service in an acute hospital.
The then Director of Medical Services at MOH, Professor K Satkunathan foresaw the rapidly greying population of Singapore and anticipated the need for good end-of-life care in the years ahead.
In 2007, he worked to establish palliative medicine as a subspeciality of oncology, internal medicine
and geriatric medicine. Most public hospitals set up palliative care departments, whose services were initially integrated into the departments of Geriatric Medicine, General Medicine and Oncology.
The Palliative Care Department of the National Cancer Centre of Singapore became the first to go independent in 1999, which was headed by Prof Goh. In 2002, the World Health Organization redefined palliative care to include non-cancer patients who were at the end of life. This move was especially relevant in Singapore, whose population was rapidly ageing and where the incidence of end-stage degenerative conditions such as dementia was increasing exponentially.
Such patients, whose death trajectory cold take years to pan out, often suffered the same problems and had the same needs as advanced cancer patients. The palliative care approach or principles had to be applied to such elderly patients regardless of whether they were in the acute hospitals, their own homes or in nursing homes.
To be continued…
Look out for Part 2 in The Hospice Link September-November 2025 issue where we find out more about how palliative care pioneers brought this service into the community with the first non-religious standalone hospice.