The Weak and the Disabled - Whose Responsibility Is It?

Yesterday I read a letter written by Dr. Lee Wei Ling in the forum page of the Straits Times. It touched on a highly controversial issue concerning the long term care for the disabled. I used the word controversial because it relates to the basic question of how far should one be asked to suffer before the state and the community steps in. She was referring to the case of a father who took his own life because he was overwhelmed by the burden of not knowing who will look after his epileptic son, 47 years of age, when he is gone from this world.

The issue at the heart of the matter is, are we doing enough to help those in our society who are genuinely in need? In this instance, the father had been the principal care giver for his son. The father knew he was getting old and was worried about no one looking after his son when he dies. The prospect must have worried and unsettled him greatly. He sought the help of many institutional care givers. His problem was that he did not have the means to make a lump sum payment upfront to cover the cost of institutional care. It seems that his pledge of his single major asset, a house at Upper Changi Road, was not sufficient to induce the institutions to take his son in. Feeling greatly depressed by it, the father must have decided to end his life. He had wanted to take his son along; but it would seem that he just did not have the heart to.

Dr Lee mused, and I quote: “As a First World country where millions of dollars are being poured into making us a cultured and vibrant society, could a few million dollars be spared to build nursing homes for disabled patients whose parents are getting too old to look after them any longer?”

While the sad story of the father strikes a chord in our heartstrings, and would no doubt resonate deeply with many Singaporeans, we should perhaps step back and take a hard note look at the episode.

In this case, we note that the man was being looked after by the father and has siblings who could take over as care givers after the father is gone. The father did not want to burden his other children to be saddled with this added responsibility. As it turned out, the man is now being cared for by his sisters.

Here is a situation where on the face of it, there is a solution of asking his other children to look after the epileptic man; but he chose not to as he felt it was too big a burden for his other children to bear. Should the state and other institutional care givers step in at this stage to provide the necessary help and support? Or should public assistance only come in when all else fails and the person concerned is now running the risk of being totally abandoned.

As a society we must decide. The choice we make today will have much implication on our public finances and our disposable income. In this instance, should we have forced the issue by asking the sisters to look after the brother first, and if that fails, public care givers will then be asked to step in? As a matter of public policy, if we allow ourselves as public to step in easily, it may send the wrong signal, and increase the prospect of abuse on the part of the family by encouraging them to pass that responsibility early to the state. Perhaps our greatest human failing is that we tend to take the lines of least resistance. In other words, while our intention is well meaning, how do we guard against abuse? It is rather unfortunate that in the realm of public policy, we must learn to grow calluses around our heart or we will end up having to pay more in taxes to fund the additional expenditure.

The point remains though, that a case could still be made out where the state should be the care giver of last resort. Dr Lee Wei Ling does have a point that we should and could perhaps do a little more for people who fall through the crack. The guiding principle must surely be the assurance to all Singaporeans that the state and the community will always be there should all else, including the family, fails.

The principle that governs our approach to welfare and charity must be right. We adopt a concentric circle of support. First, a person must be responsible in looking after himself. If that fails, the next line of defence must surely be his immediate family and friends; and only if that fails, the community and the state will step in. Taking this approach will help us avoid the pitfalls of the excesses of a welfare state.