The ethics of elder care
Eighty-three-year-old Madam Kwok lives alone and her health is deteriorating — she is not managing her diabetes and hypertension well despite her case worker’s advice. However, she is fiercely independent, happy and does not think she needs to change the way she lives. Her case worker is in an ethical dilemma — how to keep Madam Kwok healthy without constraining her in a way that would reduce the value and enjoyment in her life?
This case study is one of 10 in the second volume of the web-based Singapore Bioethics Casebook, titled Caring for Older People in an Ageing Society, developed by Associate Professor Jacqueline Chin, Acting Director of NUS Yong Loo Lin School of Medicine’s Centre for Biomedical Ethics, in collaboration with medical ethics scholars from The Hastings Center, USA and the Ethox Centre, UK. The casebook was officially launched on 24 May at the Shaw Foundation Alumni House.
“There is a pressing need for helpful and practical support to be provided to people who work in community care so that they can make good ethical decisions with older people and their families,” commented Dr Michael Dunn of Ethox Centre, a collaborator in the project. The latest casebook is focused on building ethical awareness and skills among professionals working in people’s own homes, nursing homes, and other community settings.
The first volume, titled Making Difficult Decisions with Patients and Families, published in 2014, focused on ethically challenging situations faced in clinical settings like hospitals and polyclinics. The casebook began as a response to a 2011 report Assoc Prof Chin worked on where doctors shared about their “moral distress” in caring for dying patients.
“Part of the solution was to come up with a resource that is free and open access to help healthcare practitioners to think through and reflect about the practices of care for patients, to take this into training and education, in medical school and beyond, to clinics and every setting in Singapore,” she said.
The authors spoke to more than 180 healthcare professionals, including physicians, nurses, therapists, social workers, and programme administrators, over a period of 1.5 years. The case studies are composites of characters and situations shared by the caregivers, said Assoc Prof Chin, and these were piloted in workshops with Singapore practitioners to ensure the challenges and difficulties depicted are relevant and accurate.
To ensure an engaging read for a general audience, the case studies are kept simple with dialogue, without medical and philosophical jargon. Each case study is supported by expert commentaries, as well as practical advice and insight from healthcare or social care professionals.
The team hopes the casebook will help raise the issue of caregiving in the public sphere. “The quality of caregiving is in how we give respect to each person — the older person who’s being cared for, the caregivers, how we listen to each other’s problems and these things will become a part of a reflective ageing society and help us chart our future,” Assoc Prof Chin shared.
