The Straits Times (9 April 2015) - For several months, Mr T’s family noticed
he was becoming increasingly gaunt, and
that his abdomen looked bloated.
The elderly man, who was suffering
from chronic diseases, such as diabetes,
high blood pressure and high blood
cholesterol, refused to see a doctor.
He was finally admitted to the hospital after
suffering a fall.
While warded, he developed breathing
difficulties and his condition declined swiftly.
An X-ray scan confirmed that he had a
Soon, he was in the intensive care
unit (ICU) and placed on a respirator.
Another scan revealed a large
mass in the lung, as well as spots in
his liver and abdominal cavity.
He was diagnosed with advanced
lung cancer which had spread.
Within two days, Mr T had to depend
fully on the machine to breathe.
His condition was “terminal”.
The traditional goals of the ICU are
to prolong life and decrease the
chances of death and any adverse
outcomes. Despite technological and
medical advances, some patients will
not have any prospect of meaningful
recovery and death will be inevitable.
I was part of the palliative care team
that received a call from the ICU team to
help Mr T and work with his family on a
palliative care plan.
When we sat down with the family and
talked, we found out that Mr T was a very pious
As a health-care attendant working in a hospital
operating theatre, he had witnessed unsuccessful
attempts at resuscitation and did not wish to
undergo the same treatment.
His family said he believed that living and dying
are part of the circle of life.
To him, a good death would be one where he is
surrounded by loved ones and in his own home
instead of the hospital.
CARING FOR THE DYING
Mr T was dying.
He was put on medication to ease his pain. At
the same time, support was given to family
members as they were faced with the reality of
having to say goodbye soon.
On top of the sea of emotions they were
grappling with, the family had to make the difficult
decision of whether to keep Mr T on the respirator
or respect his final wishes.
After several discussions with the palliative
care team, they decided there was nothing
more important than to honour Mr T’s wish to
spend his final days at home.
With the assurance that the hospital and
the home hospice team will support them,
plans to bring Mr T home swung into action.
The day came and he was taken home
on a portable ventilator and a portable
device to administer medication for
breathlessness and pain. The home hospice
team took over the care at home and his
breathing tube was removed.
He passed away peacefully the following
day, surrounded by his loved ones, in the
comfort and familiarity of his own home.
His family were able to carry out the ritual
cleansing and prayers for him, in
accordance with his religious beliefs.
DIGNITY IN DEATH
Death can be dignified, and in a manner
consistent with the values and wishes that the
patient holds dear to.
According to the World Health Organisation,
palliative care is an approach that improves
the quality of life of patients and their families
facing the problem associated with
life-threatening illness, through the prevention and
relief of suffering.
This can be done by means of early
identification, as well as the timely and accurate
assessment and treatment of pain and other
problems, be they physical, psychosocial and/or
Outside of the ICU, palliative care helps to
reduce patients’ pain and symptoms so as to
provide the highest quality of life.
Inside the ICU, palliative and critical care go
hand in hand to help patients – and their families
– in their final days.
Doctors, nurses and therapists work together to
provide medical care to the patient. Social workers
provide much-needed counsel to families to help
them make decisions based on what is important
and meaningful to the patient.
While death may be inevitable, the process
need not be painful, lonely or traumatic.
When patients die, the manner in which they do
so will live on in the memories of their loved ones.
A peaceful death often provides some comfort
for those who live on.
In the words of a family member of another
patient who had received palliative care in the ICU:
“It was a difficult decision to have the tube
removed, but thank you for making the process
more humane and for giving us the chance to have
Dr Poi Choo Hwee is a consultant in general medicine at the
Palliative Care Clinic at Tan Tock Seng Hospital,
which is the flagship of the National Healthcare
Group (NHG), the Regional Health System for
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.