Dying patients have less say in care and treatment than their families do


SINGAPORE – Doctors here are caught between a rock and a hard place when it comes to the treatment and care of people who are dying, according to an inaugural study on end-of-life care.

Conducted by the National University of Singapore’s Centre for Biomedical Ethics, the study, What Doctors Say About Care of the Dying, interviewed 78 doctors and found that contrary to legal obligations, doctors here frequently have to disclose a patient’s condition to the family first.

As a result, tensions flare between doctors and families of patients “when Western-based laws come into conflict with the Asian practice of collective decision-making in families, local values and cultural norms”.

The study said: “One of the most difficult ethical issues doctors face is the issue of withholding their diagnosis from patients at the family’s request. While the legal position makes it clear that doctors have an obligation to give full and frank disclosure to their patients, they often find that they need to work hard on family members to be allowed to talk to patients truthfully.”

According to the study, which was supported by a grant from the Lien Foundation, one of the interviewees noted how the law and actual medical practice appear to be at odds.

Other doctors interviewed also said that decisions for patients who are dying – especially for the elderly and children – are mainly made by their family members.

This runs contrary to the law under which an adult is the only person who can agree to disclose his medical condition and doctors are legally obligated to be fully honest with their patients. In many cases, the patients are not incompetent to give consent to medical treatments.

Dr Tan Yew Seng, clinical director at Assisi Hospice and one of the study’s advisers, reiterted that “rather than to try to make everybody happy, what needs to be done is to enable the patient and family to cope with an inherently unhappy situation where patients’ interests are still best met”.

Doctors interviewed also felt that the Advance Medical Directive Act is limited as it forbids doctors to ask patient if they have signed the document.

This imposes difficulties when stopping life-sustaining treatment is an option for dying patients.

The study also found that families here “find it difficult” to suggest to their relatives that they should make practical preparations for death such as writing wills or stating wishes concerning terminal care. By doing so, they would often be accused of “wishing them dead of wanting their property”, the study noted. Doctors interviewed shared that the religious beliefs of patients and their families also affect how well a patient faces death.

Dr Jacinta Tan, one of the study’s lead researcher, said: “This study is not meant to provide answers but to give the community and healthcare workers an avenue to discuss and raise the awareness on end of life issues, which is an increasingly important topic with the aging population.”

– Today Online