Commentary: What if more terminally ill patients with COVID-19 want to die at home?

When infections and clusters have risen in Singapore, we have at times implemented no-visitor policies in hospitals and nursing homes, with exceptions of up to five designated visitors for those nearing death.

The fluctuating nature of such policies could fuel fears of not being able to see family at all, which could in turn further the desire to die at home.

A DIGNIFIED DEATH IN THE TIME OF COVID-19

Globally, ethical and public health frameworks also lack adequate guidance for elderly patients managing COVID-19 illness at home.

Countries like the United States and United Kingdom saw their hospitals overwhelmed early in the pandemic. Faced with hard choices and the moral distress of rationing resources like ICU beds, the default course of action was to send more COVID-19 patients home to recover – or pass on, for the elderly with little prospect of recovery.

Singapore’s situation arises due to its stricter hospitalisation policy – part of our initial maximum suppression approach to buy time for the development of vaccines and treatments and avoid overwhelming our healthcare system.

We can look at countries like New Zealand who are pursuing a similar endemic approach to Singapore.

New Zealand enforces quarantine for COVID-19 cases, be it at home or in managed facilities, but their home recovery protocols are in a pilot stage and there is no guidance for those who wish to pass away at home.

Thus, public health considerations play a big role. If someone waiting to pass away remained at home, they would only be able to see other household members.