Talking Death X Dr Andy Ho

Snow White. Little Mermaid. Frozen. These popular fairytales are adored by children (and even adults) worldwide. What do they all have in common? The inevitability of life’s ending passage – death.

If we’re lucky, death is a constant that passes us daily, leaving our lives uninterrupted. But what about those who had to count their days?

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Meet Dr Andy Ho, Assistant Professor of Psychology and Fellow in Thanatology, School of Social Sciences, Nanyang Technological University, Singapore.  He has been doing death and dying research for over 13 years and counting. Dr Andy has since created and pioneered the first death and dying undergraduate course in Singapore, ‘The Last Dance’.

How did you first became involved with death and dying?

Dr Andy:  I was previously doing research on family affairs, moving on to aging research, before finally being recruited to death and dying research. It started off as a job to me, but as I progressively worked with patients that are terminally ill – with patients in hospices and nursing homes. It then became more apparent to me that society could do a lot more, to improve the quality of care at life’s most vulnerable phase. That’s when it became a life mission for me to help improve health and care qualities for those patients with terminal illnesses, so they can have better experiences in times of adversity.

When I moved to Singapore, I realised that Nanyang Technology University and actually most or all universities didn’t have a specific course in death and dying. Hence, I decided to develop a new course known as ‘The Last Death’. Offered by the School of Psychology, it’s a full credit course with a 13 week programme that talks about the entire aspect of life and death. We take a look at how death is, in the contemporary context, and how death is conveyed through media and news outlets. To look at how death plays an important role in our life. All the Disney movies such as ‘Cinderella’ and ‘Frozen’ that are supposedly childhood movies, actually revolves around death, but we have never really known, to look at it directly in that context.

 

‘The tragedy of suicide and disasters puts a very negative light on death and dying.’

Dr Andy: A century ago, if death happens in a family, it happens in a community where families and neighbours come together to grief. But now death becomes mechanical as they happen behind closed doors in hospitals and becomes institutionalised. When we don’t have the opportunity to make decisions for ourselves, it becomes hidden from society. The tragedy of suicide and disasters puts a very negative light to death and dying. Thus it’s not surprising that the majority are afraid of death. My course is to provide a holistic way of understanding death and dying that focuses on cultural and practical components of how the society deal with death and dying nowadays. We started with 30 slots in the initial stage 2.5 years ago and it soon became full, as we increased the class size with a full waiting list. It shows that young people are curious about death and dying, thus having a course like this is very useful.

It’s important to implement a course in the hospital for the nurses and doctors as well. But in their years of curriculum, there isn’t any course related to death. That has great consequences, especially when doctors blame themselves due to failures of not providing a cure for patients. It becomes common as doctors try to remove themselves from situations of talking to dying patients, as they don’t know how to, nor feel comfortable talking about death and dying.

 

‘Death is a blessing and not a curse.’

Dr Andy: In order for Advance Care Planning (ACP) to be more known, we need to create a paradigm shift where death is a blessing and not a curse. We’re often not prepared for it and become dependent on the medical professionals to make decisions for us. But they are not accurate, as doctors don’t really know what we want. It becomes a burden especially to families, when their children may want different things for their parents. It will be a huge burden to carry as they don’t know what the patient truly wants. It will be more useful if people are more accepting of death as a natural process and really changing their attitude towards death.

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‘Why are we not learning about death when it’s the only constant in life?’

Dr Andy: I believe ACP(Advance Care Planning) is a great initiative, although the implementation is not without it’s problem, such as how it affects the cultural context. Despite having the most advanced healthcare in the world, Singapore still is a society that finds it hard to talk about death. In order to make ACP more accessible and successful, we need to change the mindset of people in terms of getting people to perceive and accept death as a natural process. To start having the topic of death incorporated into schools and have young children learn about life and death as with other subjects. In fact, why are we not learning about death, when it’s the only constant in life? We have lessons for driving or cooking but not everyone learns it, but everyone dies. We have limited information and education to enhance the awareness and emotional capacity to deal with death when it happens. I believe, it’s important to have formal education in secondary schools and primary schools.

Why can’t we use the same capability and mentality to promote death in public campaigns, to advise the public to talk about death? We need a sustainable long term plan of advocacy, so that people are consistently exposed to this area. Introducing classroom learning and experiential learning is important.  A lot of these programmes to promote death, are time limited and one-off. We need a sustainable long term plan of  advocacy, so that people are consistently exposed to this area.

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An experiential learning encounter: ‘I Died Today X NTU’

Dr Andy: I did the programme called ‘I Died Today’, an experiential learning encounter where we invited people to go through their own living funeral. We invited them to write their eulogy and write about themselves, their values and things they wanted people to know. We invited them to come, as a group funeral with an entire spread of paper ‘coffins’. We asked people to lie down in our school foyer, as a symbolic resting place and covered the entire place with a white cloth. We have a violinist playing ‘live’ and let them experience what it’s like to be dead. There were two objectives, one was to experience your own mortality and the second was a performance art to get people passing by to be curious about it and to create more dialogue about death and dying. Afterward, we resurrected them and asked them to sit in their ‘coffins’ and to use different art materials to express what happened in their minds while experiencing ‘death’, which became an art exhibition. We have people write on the board ‘If I Died Today’ what would they want to do. Channel 8 came to do an interview and event coverage for the event.

(Watch the entire clip here: http://bit.ly/NTUIfIDiedToday)

 

How should we start the conversation of Advance Care Planning(ACP)?

Dr Andy: For young people, they may not to want to talk about it since their still young, so they don’t find a reason to talk about it. But through my experience, older people are not that adverse to talking about death. What we found actually, are that middle age children are more reluctant to talk about death, as they find it unfilial to talk about death with their parents. If we can have courses in school where students learn about death from a young age and they can go back home to talk to their parents about it, then they will become agents of change. There’s a book called ‘The Last Dance’ and it’s one of the most prominent textbook about death and dying. It’s at the 10th edition and we’re writing an 11th edition. The book is written by a couple and they know that the legacy will continue and were looking for people to continue it. They approached my wife and I, so we are co-writing an 11th edition in which the four of us will write it together. It should come in late 2018 or early 2019.

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What are your future plans?

Dr Andy: I will continue to develop life and death education in schools and community. I want to do more work in the community by providing training on reflecting on our own mortality and exploring what life and death means. To help doctors and nurses especially, in dealing with their own grief when a patient dies.  To provide training as well as self-care to improve the quality of care, are things I would like to do. Coming next in early October, NTU together with local hospitals are developing a new centre for palliative care research to enhance palliative care services, which I will be a part of. With that, hopefully we can create some real possibility for social change.

 

The Good Death seeks to transform the negative notion of death itself and is focused on promoting early planning for one’s end-of-life care, especially so for adults over the age of 50. Find out all about The Good Death, ACP and Palliative care here!

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