Singapore's Ageing Population: Managing Healthcare and End-of-life Decisions edited by Chan Wing-Cheong (review)

The policy issue of old-age security has received growing attention as populations age and problems with existing policies begin to emerge. In 1994 the World Bank proposed a three-pillar pension system to meet the objective of old-age security. One of the central elements of the system is to reduce poverty among the old. Recently, Holzmann et al. (2005) proposed a five-pillar pension system to attain the objective of ensuring universal old-age income security for all citizens in a country. Again, it placed considerable emphasis on the need to alleviate absolute old-age poverty. However, poverty is a multidimensional phenomenon. It must be understood in dimensions beyond that of income alone. Indeed, health is one of the most important dimensions in analyses of old-age poverty. While the system proposed by Holzmann et al. placed considerable emphasis on health, it remains unclear how such a system can be financed and managed. As a rapidly advancing industrialized economy with high growth rates, Singapore has started experiencing the pressures of a rapidly ageing population. Unfortunately, the current system of old-age security in the country is not robust in handling old-age poverty.

Against this backdrop the publication of this edited volume is timely. The eleven chapters address several problems relating to old-age healthcare. They provide a multidisciplinary review of the challenges of achieving a humane and effective healthcare system for the elderly in Singapore. The universal relevance of the topic means that lessons from Singapore as drawn in the various chapters can also benefit policymakers, service practitioners and scholars interested in gerontology more generally.

Delivering a sustainable healthcare system for an ageing population — like Singapore's — requires a holistic approach. This volume rises to the occasion by providing a rich multidisciplinary perspective on this important and debated topic. The contributors include authors from myriad backgrounds: medical service professionals; a public prosecutor; academics in sociology, law, medicine, anthropology and psychology and authors from the Singapore Ministry of Health and the country's National Cancer Center.

The conventional approach of addressing the challenges of sustainable healthcare for the elderly through the provision of hospitals will only solve a small part of the problem. The various chapters of this book thus discuss the wider associated challenges and prospects; they incorporate both empirical evidence and other material to support their recommendations. And, rightly, a number of the recommendations put forward are directed not only to authorities and medical service providers but also to scholars and practitioners conducting research involving the elderly.

Examples of some interesting discussions are those on the importance of reducing moral panic caused by an ageing population (Chapter Two), the importance of meaningful relationships (Chapter Four), the place of death (Chapter Seven), conceptions of life and death (Chapter Nine) and the well-being of patients as an integral part of the caregiver's satisfaction (Chapter Five). Chapter Ten invites further consideration of the hotly contested debate on physician-assisted suicide; its author takes a clear position in the debate by advocating physician-assisted suicide. It is the author's view that terminally ill patients experiencing unbearable physical, mental or emotional pain with no prospect of improvement need medical assistance to end their suffering through a Physician-Assisted Suicide Act. Finally, Chapter Eleven concludes the volume by reiterating the point that research involving vulnerable communities should be responsive to the health needs and priorities of the community, and that the community should derive tangible benefits from the results of the research.

Attention to three important matters could have added value to the discussion provided by this volume. First, while Chapters Four and Five examined cases of older Chinese people in Singapore, it would have been beneficial to expand the studies to include other ethnic groups to see if there may be contrasts. Second, a chapter or two addressing economic and financial management would have added substantial value to the volume...