Singapore must begin a courageous conversation about assisted dying as it becomes a "super-aged" society in 2026, says Dileep Nair, chairman of the Sree Narayana Mission’s Board of Trustees.
The nation excels in active ageing and preventive care but avoids discussing how people want to die. With over one in five citizens now aged 65 or older, Nair argues dignity must extend beyond life into death.
Assisted living remains underdeveloped. Most options are limited to home care or clinical nursing homes. Pilot programs like Community Care Apartments and Shared Stay-In Senior Caregiving Services show promise but rely on private providers, risking inequity.
Palliative care is strong but cannot relieve all suffering. Some patients endure refractory distress-physical or existential-that no treatment can ease. For them, prolonging life prolongs pain.
Medical prognosis is often uncertain. A 2023 UK study found clinicians correctly judged short- or long-term survival but were accurate in only 32% of cases predicting survival in weeks or months. Yet jurisdictions with assisted dying laws use multiple safeguards-not perfect prediction-to prevent misuse.
Oregon, Canada, and the Netherlands show assisted dying does not lead to abuse when tightly regulated. In Oregon, fewer than 1% of deaths are physician-assisted; most patients are in hospice. Canada reports rising numbers but maintains strict reporting. The Netherlands enforces independent review and sanctions violations.
There is no evidence these systems target vulnerable groups or weaken palliative care. Instead, they complement end-of-life support.
Nair urges Singapore to adopt a staged, governance-focused approach: public consultation, expert panels, narrow eligibility (terminally ill, mentally competent adults), mandatory palliative review, cooling-off periods, and national oversight with annual audits and sunset clauses.
Silence protects no one. A mature society must balance moral pluralism with personal autonomy. Dignity should not end at death’s door.