Living well to the end

Living with advanced cancer or being told that treatment is no longer working can cause you to experience a wide range of emotions. You may be anxious about the uncertainties ahead, or you may feel defeated that your cancer has progressed despite everyone’s best efforts. You may feel sad or perhaps worry about leaving your loved ones behind. These feelings are normal, and there is no right or wrong to how you should feel. Many people find that talking to their families, close friends or healthcare team about their feelings and concerns help them feel and plan better during this time.

Making plans

Many of us have the impression that talking about end-of-life arrangements signifies losing hope and is inappropriate unless one is nearing death. However, death is a natural part of life, uncertain yet inevitable. Talking about end-of-life arrangements does not mean giving up; it is in fact an essential first step to making plans about how you want your care to be like for the days ahead. It can also be a meaningful gift to your loved ones, to allow them to be at peace if they have to make hard decisions on your behalf.

Below are some common topics related to end-of-life arrangements that you may want to talk to your loved ones or healthcare team about:

Resolving unfinished matters and legacy work. You may want to take this time to reflect on life, recall good memories or ponder on any past conflicts that you might want to resolve. You may also want to create new memories during this period of time through vacations and birthday celebrations, or show your appreciation and say thanks to your loved ones. Stories, videos, photos, writings or recordings can be very meaningful and precious gifts to the people you will eventually leave behind. Although the above are not checklists that everyone must fulfil, they are examples of things you can do to honour the life and events which shaped you and your loved ones. This process may help you feel more connected to your loved ones, as well as achieve peace and bring about a sense of meaning.
Discussing and recording your preferences for treatment and care. This may be done through making an Advanced Medical Directive (AMD) , or having an Advanced Care Planning (ACP) discussion with your healthcare team. Some of these discussions may include:
- Your preferences with regards to life-prolonging treatments such as feeding tube insertion, kidney dialysis, or cardiac pulmonary resuscitation (CPR).
- Your wishes on where you want to be cared for in days to come. Some people want to be cared for at home, while others prefer to be in a healthcare facility where healthcare professionals are present at all times to provide care. Hospice care may be recommended by your doctor, and this is an approach which focuses on optimizing your quality of life and ensuring your comfort. Regardless on your preferred place of care, hospice care offers you and your loved ones additional support to help you cope better during this time.
- You may also want to appoint your healthcare power of attorney, who is someone you trust to manage your medical information and clearly convey your wishes and preferences to others when you become unable to.
Putting your financial and legal matters in place. You may want to start from things like organizing a will, CPF nomination, estate planning, and letting your family know about your account passwords and insurance policies.
Deciding on funeral arrangements. Talking about funeral arrangement gives you a chance to plan your journey of leaving well. You may choose to be involved in deciding the type of funeral, columbarium, or any other religious arrangements you would want after death. Some people may choose to discuss this with any funeral directors they have in mind. It is also okay if you want to delegate these decisions to your loved ones. Regardless of your choice, it is important to talk to your loved ones about it, so that they are aware of your wishes.
Deciding on tissue, organ and body donations. If you are a Singapore Citizen or Permanent Resident, you would have been included under the Human Organ Transplantation Act (HOTA). Commonly, the corneas may be recovered in the event of death for transplantation to patients who need them. You have the choice to opt out should you have any objections. Some may also want to pledge their organs or body parts for the purpose of medical research or education. It is important to know that regardless of your preference and decision, your medical care and treatment will NOT be compromised. You may wish to speak to your healthcare team if you have any questions about tissue, organ or body donations.

Living well, leaving well

You may have realised by now that end-of-life conversations should start sooner rather than later. These conversations are not only about death and dying; they are also about living, and more importantly living well to the end. While living well and leaving well hold unique meanings from person to person, we hope that by talking about living and dying more openly, you will be able to put life in your days!

Useful Resources and readings

Advanced Medical Directive
Advance Care Planning
Lasting Power of Attorney
Human organ transplant act
The National Environment Agency: Post-death matters
Singapore Hospice Council

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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