Commentary: Super-aged Singapore must talk about assisted living – and assisted dying

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Commentary: Super-aged Singapore must talk about assisted living – and assisted dying​

Singapore does not need to rush to conclusions about assisted dying, but it needs to have the courage to begin the conversation, says Sree Narayana Mission’s Board of Trustees chairman Dileep Nair.

A person holds the hand of an elderly patient in a hospital bed. (File photo: iStock)

Dileep Nair
24 Mar 2026 06:00AM

SINGAPORE: In Japan, many seniors speak fondly of Pin Pin Korori. It means to live independently and energetically until the very end, and then to pass away quickly and peacefully. It is a simple but profound aspiration: living well and dying well as one continuous trajectory.

That feels unfamiliar in Singapore, not because we treat them as two separate conversations but because we focus mainly on half of one. Singapore invests heavily in active ageing, preventive health and better long-term care. But we stop short of confronting the full reality of ageing: how people want to live in their final decades, and how they want to leave.

That seems out of step with Singapore expected to become a “super-aged” society this year, when more than one in five will be 65 years or older.

If dignity matters at every stage of life, then we must talk about assisted living, and also – carefully and thoughtfully – about assisted dying.

A COMPREHENSIVE ASSISTED-LIVING STRATEGY​

Singapore has not embraced assisted living in a truly substantial way. There are pilot projects, in the form of specially designed Housing and Development Board flats known as Community Care Apartments.

There has been a strong push toward ageing-in-place. Seniors stay in their own homes and get support through home visits or eldercare and active ageing centres in the community.

But for seniors who cannot fully manage at home, the dominant residential care model remains the nursing home. But this is institutional, clinically focused and in limited supply.

Assisted living can fill the gap between these two options, to allow seniors to live independently while having timely access to healthcare, support services and, crucially, a social community life.
Recently, the government announced that the Shared Stay-In Senior Caregiving Service will soon be introduced as a mainstream option. This is an excellent initiative, for seniors to live together and share access to caregiving staff.

But it seems it will be left to private companies to manage and run. As a sandbox initiative, five companies served a total of 232 clients, according to the health ministry.

In 2023, the ministry said that around 100,000 seniors will require help with at least one daily living activity. It would be necessary for the government to step in if private companies cannot scale to meet this need, especially if it wants to reframe nursing homes as part of a broader ecosystem, rather than a place where older Singaporeans “end up”.

Some higher-income families, including those in private housing, may make ad hoc arrangements that come close to assisted living – hiring a domestic helper, engaging part-time caregivers, or retrofitting homes for ageing. But they are not substitutes for purpose-built assisted-living communities.

A domestic helper model, for instance, places significant responsibility on a single caregiver, often without medical training, and does not provide the social and communal environment that structured assisted living can provide. As family sizes shrink and care needs increase, this model may prove fragile.

Even if the higher-income can afford such arrangements, the point is that assisted living should not depend primarily on individual households assembling private solutions.

Instead, if assisted living is to be a pillar of our ageing policy, Singapore could consider clearer regulatory frameworks, land-use planning incentives and integrated care standards that enable professionally managed assisted-living communities – whether public or private – to operate at a meaningful scale.

PALLIATIVE CARE IS ESSENTIAL YET NOT ENOUGH FOR ALL​

But if we care about how people live in their final years, then we must also be willing to discuss how they may want to die.

First, this concerns palliative care. Singapore has made commendable strides in this area and many patients benefit greatly from palliative medicine and hospice support.

Yet even the strongest palliative systems acknowledge that some patients experience refractory suffering – where physical, psychological or even existential distress cannot be fully relieved despite treatment efforts.

Medicine has limits, and compassion requires recognising these limits and not diminishing palliative care. For these individuals, prolonging life simply means prolonging anguish.

This is a reality that means any candid conversation about ageing up to palliative care must also touch on assisted dying.

UNCERTAINTY OF MEDICAL PROGNOSIS​

One of the major concerns about assisted dying is the uncertainty of medical prognosis. How can doctors be sure when a patient might die? This concern is well-founded.

A 2023 UK study involving over 98,000 patients found that clinicians were reasonably accurate in predicting imminent death (within 2 weeks) and long survival (more than 1 year). However, accuracy fell to about 32 per cent when estimating whether a patient might live for “weeks or months”. Other studies similarly show that predictions of survival in palliative care are often inaccurate.

This uncertainty is precisely why assisted-dying frameworks, where they exist, do not rely on a single prognostic judgment. Instead, they emphasise process safeguards such as repeated assessments, independent opinions, cooling-off periods and ongoing review.

The question, therefore, is not whether doctors can predict perfectly – they cannot – but whether systems can be designed to minimise error and prevent misuse.

A POLICY VACUUM ON ASSISTED DYING​

Assisted suicide and euthanasia remain illegal in Singapore, and public discussion on them has been minimal.

Meanwhile, attitudes have shifted - today's seniors value autonomy, self-determination and clarity about end-of-life choices. But discussion of end-of-life choices tends to stop at the Advanced Medical Directive, a legal document to refuse “extraordinary life-sustaining treatment”.

The concerns around assisted dying are understandable: There are fears of a slippery slope, coercion of the elderly or disabled, and conflict with deeply held religious beliefs. In our plural society, these issues must be taken seriously.

Saying that “society is not ready” does not replace the need for honest debate and engagement. Silence does not protect the vulnerable and leaves families suffering behind closed doors. A mature society must find ways to respect religious and moral convictions while recognising that no single moral framework can speak for all.

Singapore has always prided itself on scouring the world for examples of policies that have succeeded. Countries with robust frameworks for assisted dying provide decades of data and the evidence is not one of chaos or unchecked expansion.

In Oregon, assisted deaths have consistently accounted for under 1 per cent of total deaths over more than 25 years, with the vast majority of patients enrolled in hospice care. In Canada, while numbers have increased as reporting systems matured, assisted dying still accounts for a small proportion of deaths, and cases are subject to mandatory reporting, review and audit. In the Netherlands, independent review committees examine every case and physicians have been sanctioned when safeguards were breached.

Across these jurisdictions, there is no evidence of systematic targeting of vulnerable populations or erosion of palliative care. On the contrary, assisted dying typically coexists with – and often reinforces – strong end-of-life care systems.

A MEASURED PATHWAY FOR SINGAPORE​

Any discussion of assisted dying in Singapore must focus less on ideology and more on governance. If society ever chooses to explore this issue, a cautious, staged approach would be essential.

This could start with consultation, with the public and expert panels covering medicine, law, ethics, disability advocacy and religious groups. This should be accompanied by a transparent review of international data.

The next step would be to define the narrow scope of policy, such as limiting eligibility to terminally ill, mentally competent adults; requiring mandatory palliative care consultation; instituting safeguards like an independent medical assessment and a cooling-off period; and centralised oversight by a national review body.

Then there is the all-important phase of evaluation and accountability. To assuage fears, there must be strict reporting, annual public data, independent audit, and sunset clauses requiring parliamentary review before any continuation or expansion.

Such an approach does not presume an outcome. It simply acknowledges that difficult questions deserve structured, evidence-based consideration.

COMPLETING THE CONTINUUM​

Dignity should not end at the threshold of dying. If assisted living represents the way we want our seniors to live, assisted dying – with strict safeguards – may be the way some wish to die.

Pin Pin Korori reminds us that living well and dying well are not separate aspirations. Both are expressions of the same principle: that the individual matters.

To talk about dying well is not to abandon hope or compassion. It is to recognise reality with honesty.

Singapore does not need to rush to conclusions. But we do need to have the courage to begin the conversation.

Dileep Nair is chairman of the Sree Narayana Mission Board of Trustees, a Board member of the National Council of Social Service, and a former diplomat and Administrative Officer in the Singapore Civil Service.