SINGAPORE – When a patient is dying or deteriorating and healthcare professionals ask the family if they knew what the patient wanted, the answer is commonly no.

“This places the burden on the loved ones and healthcare professionals, which may not be ideal and creates a lot of stress,” said Dr Raymond Ng, head of palliative medicine in the department of integrated care at Woodlands Health Campus.

This is why it is important to have discussions about death and dying, and find out individuals’ preferences for end-of-life and palliative care.

A graphic novel highlighting the importance of end-of-life and palliative care was unveiled on Saturday (March 20), as part of efforts to spark more discussions on the topic among Singaporeans.

The 72-page book, All Death Matters, commissioned by the Lien Foundation and written and illustrated by local artist James Tan, can be borrowed from public libraries from mid-April.

Another 100 free copies will be given away from Saturday till April 4 to people who submit a request to the Lien Foundation at this website.

The novel, written from the perspective of a young doctor working at a hospital here, takes the reader through an encounter with a family grappling with hard decisions as a loved one is dying.

The book is a part of the Lien Foundation’s ongoing Life Before Death initiative to improve care for the dying in a rapidly ageing Singapore.

The initiative, which started in 2006, seeks to spark “die-logues” through the use of diverse platforms such as digital media, art, design, film, photography and research.

Palliative care has always been relevant, even more so in today’s context as Singapore’s population ages, said Dr Ng.

In addition, the Covid-19 pandemic has shown that anyone can fall suddenly and seriously sick – even patients who are relatively healthy may get sudden infections and die, he added.

Dr Ng said: “Families should discuss topics that are relevant, like what is important to you as a person, what is the meaning of life to you, what is quality of life, what are your values and preferences. These will impact decisions your loved ones or medical professionals make on your behalf.”

These include if a person has a preference for where he or she wants to spend their last days. Or, for instance, if family meals are important, healthcare workers can try to preserve that ability rather than feed the patient through a tube, he added.

Mr Tan took about a year to write and illustrate the novel, in discussion with Lien Foundation. It was then reviewed by healthcare professionals.

Comics are a very accessible medium, Mr Tan noted, and “graphic medicine” has become a trend around the world.

Lien Foundation programme director Gabriel Lim said that the denial of death often deters people from thinking about how they can “leave well”.

“Graphic medicine, which is the use of comics as resources in enabling the discussion of difficult subjects or relating the patient and care provider experience, is a creative and understated way in encouraging Singaporeans to ponder about their end-of-life experience.

“More importantly, we hope to encourage healthcare professionals to reflect the perception of their roles alongside terminally ill patients and their loved ones,” said Mr Lim.

The novel is a potential tool that can be used for outreach to groups in the community, said Dr Ng.

“In the past we used different tools such as card games or other patient narratives like puppet shows. I think the comic would help to educate by engaging the layperson and bringing across these elements in the form of a story to make it interesting and raising awareness.”

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