Difficult Decisions: Talking About Death

Kenneth Lyen

What is more important, the quantity of life or its quality? In other words, is longevity more desirable than the fulfilment and happiness of one's life? This philosophical conflict forms the core issue explored by James Tan in his graphic novel All Death Matters, commissioned and published by the Lien Foundation.

It follows a young doctor as he navigates through the choppy seas that lie between his dying elderly patient and the patient's relatives. His patient has terminal cancer and is not responding to chemotherapy, but his son does not want the doctor to inform him of the prognosis: "Please do not tell my Dad about his condition. We don't want him to be worried or depressed." In fact, the relatives want him to undergo potentially painful chemotherapy to prolong his life.

The doctor is placed in a dilemma: whether to extend his patient's life but likely increase the suffering? Or should he withhold treatment and allow the cancer to run its course, and give palliative care and do everything to ensure his patient is comfortable and pain-free?

A further question is posed later on: who makes the final decision? The relatives, the patient, or the doctor? James explores this issue through a couple of panels where the son asks the doctor to decide: "Doctor, tell us! What do you suggest? It's your job, right!"

James probes the conundrum by presenting two scenarios in the book. The first is a dream the doctor had, where the patient is in severe pain, and the doctor is about to turn off life support when he is confronted by the son, who accuses the doctor of making a decision against their wishes: "Who are you to decide for my Dad!... I want him to live!"

The second scenario is a colleague of the narrator who describes an elderly female patient whose relatives insist everything must be done to keep her alive, but she suffers terribly before she eventually dies.

How much should a doctor do to prolong life? This honest, thoughtful exploration of the ethics of terminal care makes for compulsive reading. The wonderful advantage of the graphic novel as a medium is that it illustrates the points so clearly, so thoughtfully, so profoundly, and in a heartfelt manner.

I strongly recommend this book to anyone who might have a friend or relative who is currently seriously ill, or who may be terminally ill and about to draw the curtains of life. It is a highly readable and thought-provoking graphic novel.

James Tan is a Singaporean illustrator, animator and art educator, who has published several graphic books, including two graphic novels: Final Resting Place (2017) which is about the Bukit Brown cemetery, and All That Remains (2020) about dementia.

Title: All Death Matters
Author: James Tan
Number of pages: 72
ISBN: 9789811447976
Type of book: Paperback
Publisher: Lien Foundation
Year of publication: 2021

Further readings

  1. Goh YH. New graphic novel aims to spark conversations about end-of-life and palliative care. The Straits Times [Internet]. 20 March 2021. Available at: https://bit.ly/3wEmi1t.
  2. Tan J. Final Resting Place. Singapore: Comics of SG Heritage, 2017. Available at: https://bit.ly/3CZ7zzd.
  3. Tan J. All That Remains. Available at: https://bit.ly/3N7xQjn.
  4. Lien Foundation. Available at: https://bit.ly/3IwyByZ.

Kenneth Lyen is a paediatrician who has written several books and is the founder of the Rainbow Centre for intellectually challenged and autism spectrum disorder children.