‘Making Difficult Decisions with Patients and Families: A Singapore Casebook‘ has been published by National University of Singapore’s Yong Loo Lin School of Medicine, with support from the Lien Foundation.
The free resource aims to promote learning, teaching and discussion among healthcare professionals, medical students and teachers, by addressing some of the most complex but common issues in Singaporean healthcare, including care for the elderly and end of life care.
The casebook consists of 12 hypothetical cases, including:
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Mrs Kuan
This case concerns a middle-aged professional and parent with metastatic cancer for whom potentially beneficial, highly expensive treatment has failed. It explores clinical uncertainty over how to discuss the goals of care when few options for effective treatment exist.
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Mdm Lee
This case concerns an elderly nursing home resident with advanced Alzheimer’s disease who, while she was competent, completed an advance care plan (ACP) that documented her explicit refusal of artificial nutrition and hydration. Confusion and family conflict arise after a staff member makes an ad hoc decision to insert an NG tube.
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Mr Yung
This case concerns a middle-aged professional and parent in a minimally conscious state, his wife’s emotional and practical challenges in making decisions on behalf of her catastrophically injured spouse, family conflict, and the responsibilities of the healthcare team.
Other case studies consider babies, adolescents, foreign workers and ‘difficult patients’, and cover topics such as artificial nutrition and hydration, clarifying diagnosis and/or goals of care, conflict, treatment decisions, discussing and using patient preferences, truth-telling and uncertainty about patient’s decision-making capacity.
Alongside each case study are questions for reflection, expert commentaries and a perspective of a Singaporean clinician, along with background information and links to other online resources.
Mr Lee Poh Wah, CEO of the Lien Foundation, said: “Doctors, patients and families often struggle with decisions in healthcare. With advances in medical technology and therapeutics, the ground for options and questions has widened. However, the ethical foundations of the healthcare profession must remain in sharp focus even as the field grows more complex.
“The casebook is not only a practical resource for doctors, it is also their litmus response to the quandaries of care as they seek to uphold a competent and compassionate practice, one trusted by patients and the public.”
International interest
The casebook’s editor-in-chief, Dr Jacqueline Chin, said: “Seeing the ways that this web project might be used in Singapore and beyond local settings is an exciting prospect for the project team.
“Already, we’ve been taken by surprise by feedback on its potential uses. A Filipina clinician working in Singapore shared that it would be a good introduction to the Singapore healthcare system and practice setting for newcomers. Project team members have received inquiries from various countries like Australia and Israel, about how such a website might be created for their healthcare communities, so it is hoped that the site may also serve as a useful contribution to global education in healthcare ethics.”
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