Abstract
In family-centric societies, maintenance of hope amongst ill family members is a pivotal duty of the family. Meeting this duty often takes the form of continuing treatment even when such options may be futile. This makes efforts to maximize quality-of-life options challenging. We explore Singaporean perceptions surrounding quality-of-life advocates who advice quality-of-life measures over potentially life-prolonging treatment in terminal illness using a novel video vignette based semi-structured interviews. Findings suggest that quality-oflife advocates are viewed as failing in their filial obligations and perceived as ‘selfish’, ‘money-minded’ and ‘immoral’. These findings highlight the need to educate patients and caregivers about quality-of-life approaches.
Highlights
The influence of culture upon end-of-life decision-making is well-established [1]
In Singapore, Confucian-inspired beliefs see the family being responsible for the care of ill family members [2,3,4,5,6]
The expectations to care for family members is manifest in two pivotal ways
Summary
The influence of culture upon end-of-life decision-making is well-established [1]. In Singapore, Confucian-inspired beliefs see the family being responsible for the care of ill family members [2,3,4,5,6]. Provision of effective care encapsulates the maintenance of hope [7] This is interpreted as ‘protecting’ the patient from ‘bad news’ which would likely precipitate a loss of hope, lead to depression, ‘giving up’ and hastening of death [7]. Protecting a patient from ‘bad news’ which may be variously interpreted by the patient leads families to circumnavigate direct patient involvement in care determinations and pursue familial-led determinations of care [2]. Underpinning this practice is the duty of non-abandonment [7]
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