Singapore scored 5.66 on the index, which is considered moderate level death literacy. This translated to less than one in three people knowing how to navigate the healthcare system to support a dying person, and only a quarter knowing the regulations and procedures involved with dying at home. 20% of people said they would have difficulty talking to a newly bereaved person about death.

Death Literacy is “the knowledge and skills that make it possible to gain access to, understand and act upon end-of-life and death care options” (Kerrie Noonan, Debbie Horsfall, Rosemary Leonard & John Rosenberg, 2016). Like financial literacy, this is an important life skill that helps us to manage in an increasingly complex world. But like financial literacy, it is not taught and people are expected to pick it up along the way, so to speak.

With Singapore reaching “superaged society” status in 2026, we need to be better prepared. Knowing how to access care and support, and how to deal with decisions around death and dying, are no longer optional extras. Information and services are not always easy to find, and trying to navigate a complex and seemingly fragmented system can be exhausting and overwhelming.

In my experience, most people are not troubled by the notion of death, but by the road leading up to it. Surveys done in Singapore consistently show that the top concerns revolve around being a burden, medical costs and suffering before dying¹.

Illness, dependence, dying and death are not pleasant subjects, but ignoring the elephant in the room is not a solution. Far better, in my opinion, to be open to talk about it, and proactive in seeking information and support.

*	The Death Literacy Index is a questionnaire with four parts, covering different aspects of death and dying: • Practical knowledge—including talking support and providing hands-on care • Experiential knowledge • Factual knowledge • Community knowledge

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What do we need to prepare for as we age?

Frailty is a complex syndrome that affects multiple aspects of health, including physical strength and cognitive abilities. It manifests through aspects of function like mobility and agility, as well as the capacity to “bounce back” from crises.

It is not ageing itself that is solely responsible, but also the cumulative impact of illness. Bit by bit, the body’s reserves are whittled away, so that even a mild illness like a cold could cause very serious decompensation. Think of it like walking a tightrope or narrow bridge—most of the time, you are able to keep yourself in balance; there might be the occasional small ‘wobble’ but you can manage. But a large ‘wobble’, like a bout of pneumonia, could knock you sideways and it can be difficult to find your footing again.

Frailty and decline may come on rapidly in advanced cancer for example, where patients can go downhill over a matter of weeks or months. Or it may be gradual, like in dementia. But for many of us, that decline will come: it is only a matter of why and how.

As more and more of us live with chronic diseases, there is a chance that death may come during an acute exacerbation of one of those longstanding conditions. Or from some other acute event like a fall and fracture, or an infection, that leads to a rapid downward spiral. These may make death feel sudden, but really, that vulnerability was already building up.

What is dying like? Is it painful?

The good news is, for most of us, dying is pretty peaceful. Think of it as “winding down” towards the close of life; the dying person will eat less, drink less and finally stop eating and drinking altogether. Energy levels drop so it is common to spend more time in bed, and sleep more. Sometimes the person’s world seems to contract, so that he or she only wants to spend time with a few people.

Closer to death (in the last days), he or she may be sleeping most of the time. There may be times when he or she behaves in a confused manner. The hands and feet might start to feel cool. Occasionally the breathing may change— become irregular, or there might be pauses in between regular breaths, or sometimes there are noises due to phlegm at the back of the throat. By this time, the person is usually drowsy and not responding. Finally, the heart and breathing will stop.

The changes above do not happen for everyone, and do not happen at a fixed rate, but they are common enough to be included in “Last Hours” advice that hospice and palliative care services give to patients and families.

As for whether dying is inherently “painful”—there can be symptoms, which could be pre-existing from the underlying disease (like pain from cancer), or which develop during the dying process. But by and large such symptoms can be controlled with good palliative care.

Ultimately, it is not whether we die, but how and when, and how we live until that last day. And even though I write this as a doctor, I would be the first to acknowledge that death is not a medical issue. It is a social, psychological and spiritual phenomenon with deep cultural significance, that happens to have some medical dimensions. As individuals, families and as a society, we can choose to be avoidant, or we can choose to be empowered. What will you do?

Click here to read the full article published by The Straits Times.

Click here to see an example of “Last Hours” advice from the Singapore Hospice Council.