SINGAPORE - End-of-life planning is never easy. But it is for the best to start the process early, so people can plan the life they want to lead and the legacy they wish to leave behind. 

After all, death is a part of life, and it may be helpful to start thinking about the end years before they come, said a surgeon who does not shy away from talking about death and dying well with her patients, and a palliative care doctor for cancer patients. 

Dr Tan Yia Swam, a former Nominated MP and the past president of the Singapore Medical Association, is a breast surgeon with her own practice at Mount Alvernia Hospital. 

Dr Shirlynn Ho is the deputy head and senior consultant of the Division of Supportive and Palliative Care at National Cancer Centre Singapore. She is also the assistant secretary of the Asia Pacific Hospice Palliative Care Network, which works with the Lien Collaborative for Palliative Care in Singapore. 

They spoke to this reporter about life and death, end-of-life planning, and palliative care in the latest Health Check podcast episode. 

Here are some edited excerpts from the conversation in the first of two parts on death and dying well with them. 

Dr Tan: The Chinese saying “Sheng Lao Bing Si” describes the fate of humankind – it can get translated as “to be born, to grow old, to get sick and to die”. 

Death is a natural occurrence of life. We may not always be able to choose how we go, but as a cancer doctor, I reassure my cancer patients that we have facts to work with, we have certain trajectories to follow. There’s always something to plan for. 

My priority is to get my patients well. When they are doing well and (are) cancer free, I gently ask them if they are aware that cancer can come back at some point. 

I find that it’s better for me to introduce the topic than to have them find this out only when it happens. They would already have been thinking about it for years, and can plan for it – for instance, how to divide and distribute their assets to their children. 

Dr Ho: Sometimes, I’ll ask patients this: As you go on living, what would you have done differently if you have not had cancer before? 

It is to get them to reflect on their priorities. 

Palliative care is not just for cancer patients, it is for anyone with a life-threatening or a life-limiting illness. The mean duration of palliative care that a cancer patient receives is 33 days, but for a non-cancer patient, that is around nine days. 

When people get cancer, there is this shock of bad news, as there’s a chance of death. But when people have diabetes or heart disease, and are advised to diet, for instance, it may not occur to them that their trajectory might be poor. 

The second episode of this Health Check podcast two-parter on death and dying will drop on Dec 20. Dr Tan and Dr Ho will further discuss the importance of advanced care planning, including how it can help in cases where further treatment can sometimes do more harm than good.