Understanding the Practice of Collusion on End of Life Care in Singapore

Abstract

The practice of collusion is commonplace within Asian healthcare settings. Here we study a typical case of collusion within the Singapore setting to highlight the rationale and the predisposing factors behind this practice. Through such understanding, it is believed that a better means of practice is possible-ostensibly through the use of a multidisciplinary team approach to ensure that the best interests and goals of the patient are protected.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals

“…Findings further reinforce the common practice within Asian healthcare systems of making privately negotiated agreements between clinicians and the patient's family to moderate or even omit pertinent information regarding a patient's life-threatening diagnosis (Chaturvedi et al, 2009; Low et al, 2009; Krishna and Menon, 2014). While such acts may be intended to protect loved ones from the distress associated with a terminal diagnosis, to preserve hope for a cure, and to fulfill one's filial duty to care for family members, collusion can place healthcare professionals in a tight spot between the patient-centered care, respect for the individual and concerns about inflicting psychosocial harm on their patients (Krishna and Menon, 2014). With a view to safeguarding the ethical principles of healthcare provision, healthcare professionals can explore potential reasons for collusion with the family, ask relevant questions to elicit the patient's view of what may be happening to him and facilitate interpersonal communication between patients and their families (Chaturvedi et al, 2009).…”

Studying Cost as a Factor in the Choice between Quality and Quantity of Life amongst Patients with Cancer and their Caregivers at a Cancer Centre in Singapore

“…The wider family and community police compliance of filial obligations [29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Failure to meet these societal and familial standards is said to result in a 'loss of face' or personal honour for the immediate family, a fate fearfully avoided within the local community [4,14,29,31,33].…”

“…Third, mounting care costs do create potential for conflicts of interests in meeting the duty to care for the patient and the primacy placed on protecting the interests of the family. On one hand financial costs of caring for the patient at the end of life may see families conflicted over the pursuit Quantity of Life (QuoL) options that seek to prolong life such as chemotherapy or a Quality of Life (QoL) approach where available treatments such as chemotherapy is declined in favor of maximizing comfort and quality of life [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. On the other social expectations to provide continued care of patients see families sometimes opt for sometimes 'futile' treatments in order to meet their filial obligations.…”

The welfare model: A paradigm shift in medical decision-making

“…The concept of secondary coercive factors is introduced purely for convenience to encapsulate those considerations that lie beyond simple clinical considerations. These include the impact of social considerations such as the willingness or ability of the family to meet the wishes of the patients and the financial, practical, social, familial and cultural factors that curb choice and critically pressure decisions towards a specific direction [9,13]. This could include cultural pressure to die at home particularly in the eighth month of the Chinese calendar which would see patients who die away from home susceptible to becoming 'hungry ghosts', the social considerations of the impact of dying at home and the future value of their home and the inheritance of their children, the practical limitations of a discharge home when family members would have to give up their jobs to care for the patient, the financial considerations of prolonged stay at hospital or a hospice and the wish to die in hospital where care can be better met by professionals that must be balanced against the need to help the family show their filial duties which is important for their own social standings within the local settings.…”