About the Project

The project

This online casebook, Making Difficult Decisions with Patients and Families, is intended as an educational guide for physicians and allied healthcare professionals for understanding key ethical challenges in the care of patients at the end of life and in other complex life-limiting circumstances. It has been designed to be easy for clinicians to use in formal and informal teaching and learning in clinical departments and other settings. It is written in a style that is accessible to a lay audience, and may also serve as a platform for public, patient, and policy education in healthcare ethics.

Our partners

Enabled by the Lien Foundation, this project has brought faculty from the Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, scholars from The Hastings Center and the Oxford Ethox Centre, and Singapore healthcare practitioners together, in workshop sessions for in-depth sharing of healthcare practices in acute, community and home care settings, and collaborative development of its teaching cases and other learning materials

This work has been led by Jacqueline Chin (Assistant Professor, Centre for Biomedical Ethics, National University of Singapore), and co-edited and written with Dr Nancy Berlinger (Hastings Center Scholar), Michael C Dunn (Lecturer, Ethox Centre, University of Oxford), Calvin WL Ho (Assistant Professor, CBmE, National University of Singapore) & Michael K Gusmano (Hastings Center Scholar),  2 academic lawyers, and 14 healthcare professionals in Singapore (See Casebook Authors and Editors). Jacob Moses (Director of New Media at The Hastings Center) created the Casebook design and website.

Special thanks are due to Nancy Berlinger for extensive drafting of the case narratives, Michael Dunn for drafting the Teaching and Learning guide, and several persons who provided expert guidance for interdisciplinary understanding of issues involving healthcare financing, medical law, culture and communication in healthcare contexts: Michael Gusmano, Andy Sim, Eva Chow, Calvin Ho, Sumytra Menon, Peter Loke, Tracey E Chan, Terry Kaan, Ng Wai Chong, Chan Tuck Wai, Akhileswaran Ramaswamy, Fr David Garcia, and Mathew Mathews. Noreen Chan, Devanand Anantham, Christina Oh, Ho Si Ying, Chong Poh Heng, Roy Joseph, Tan Poh Lin, Koh Pei Lin, Marie Villegas, Denise Goh, Chan Mei Yoke, Mark Chan, Donna Tan, and Yehudi Yeo provided early insights into educational needs in difficult-to-resolve encounters commonly experienced by healthcare professionals in patient care across acute, community and homecare settings. We are grateful to the many individuals who reviewed the case materials and commentaries and provided invaluable feedback (See Contributors), and for extensive collaborative efforts on behalf of the project by Anita Lim, Gerald Koh, Sumytra Menon, Devanand Anantham, Noreen Chan, Tan Poh Lin, Grace Tan, Ken Lee, Cyrus Ho, Chua Ying Xian, Laurence Tan, Lisa Anne Wong, and Lydia Wong. We extend our thanks also to Daniela Kucz for research assistance, and Karel Caals, Theodora Kwok, and Rachel Teo for administrative assistance.

This work would not have been possible without the generosity and encouragement of the Lien Foundation and the support of Professor John Wong, Vice Provost of Academic Medicine, Professor Yeoh Khay Guan, Dean of the Yong Loo Lin School of Medicine, Professor Alastair Campbell, Director of the Centre for Biomedical Ethics, Dr Mildred Solomon, President of The Hastings Centre, Professor Michael Parker, Director of the Ethox Centre, Mr Michael Lim, Director of Communications, National University Health System, and his team, National University of Singapore Office of Corporate Relations, the Yong Loo Lin School of Medicine IT Unit and NUS Computer Centre.

Issues and themes presented in the cases

The project team aims to promote learning, teaching, discussion and reflection among healthcare professionals in Singapore about: diverse ways in which serious and life-limiting illness is experienced by patients and their healthcare providers; the intimate involvement of the family, and the needs of caregivers; the provision of complex multi-professional integrated care; and legal rules and principles in healthcare practice. These cases cover the acute, community and family practice healthcare settings, and reflect some of the most difficult but common and everyday practical and ethical challenges that face healthcare professionals in Singapore.