S’pore families often interefere with care of dying patients: study
Doctors in Singapore often find it difficult to involve dying patients in healthcare decisions because of interference from the patients' families, according to a study on local end-of-life care.
The principle of patient autonomy -- respecting an individual's right to self-determination, privacy and bodily integrity -- is hard to apply in Singaporean family culture, the study "What Doctors Say About Care of the Dying" commissioned by the Lien Foundation found.
Conducted by researchers from the National University of Singapore's Centre for Biomedical Ethics, the study said doctors reported facing significant pressure from families regarding how much the terminally-ill patient is told about his or her condition.
The study surveyed the views and attitudes of 78 doctors from the private and public sectors, including general practitioners and specialists from a wide range of practices.
"The Singapore family favors collective decision making, and this can interfere in the doctors' duty of care in providing the patients with information about their diagnosis and involve them (patients) in healthcare decisions," a statement on the study's findings said.
By Singapore's law, adult patients are entitled to exercise their own decisions with regard to care administered to them, although relatives should be consulted in advance.
Parents may be responsible for making decisions for patients below the age of 21, although the opinions of "mature minors" should also be taken into consideration.
"Doctors not only carry the dual burden of disclosure and advice, they also come under numerous pressure points," said Lien Foundation CEO Lee Poh Wah.
"(These include) having to weigh the implications of healthcare costs for the patients and society, and coping with the taboo of talking about death and moral dilemmas of suffering," he added, in part explaining why the foundation commissioned the study.
Other key issues that surfaced in the course of the study included a general disapproval among doctors of euthanasia and physician-assisted suicides, as well as their opinion that Singapore's healthcare system does not support patients who choose to die at home.
The study also found that doctors see themselves as responsible for deciding when to signal to patients that their conditions have exceeded plausible means of treatment, and to start preparing them for the end of their lives.
Doctors also said that religion and societal attitudes of patients and their families also affect the ease with which patients accept their fates.
Where families held traditional Chinese beliefs, talk about death was often discouraged, making the discussion of end-of-life difficult for doctors.
Buddhist, Christian and Muslim patients and their families found the acceptance of death easier, however, with one doctor who said that patients who lack belief in any religion tend to be more fearful.
