New casebook launched to guide care for the elderly

The second volume of the Singapore Bioethics Casebook focuses on the everyday ethical challenges faced by different groups in society in caring for the elderly.
The second volume of the Singapore Bioethics Casebook focuses on the everyday ethical challenges faced by different groups in society in caring for the elderly.ST PHOTO: JAMIE KOH

SINGAPORE - An ageing caregiver faces a dilemma over asking her daughter to take care of her son with chronic mental illness. A domestic worker is unsure what to do when her employer's elderly mother begins to choke on her food. A nursing director faces concerns about using diapers to save time in nursing home practices.

These are some of the ten case studies of the issues faced by those who care for the elderly highlighted in a new book, Caring for Older People in an Ageing Society.

The publication is the second volume of the Singapore Bioethics Casebook. The open-access casebook, which can be found online, is produced by the National University of Singapore (NUS) Yong Loo Lin School of Medicine's Centre for Biomedical Ethics. It focuses on the everyday ethical challenges faced by different groups in society in caring for the elderly.

The casebook features commentaries by public health experts and insights from local healthcare and social care professionals. It also contains background information on public health information and a teaching and learning guide for medical professionals.

"When you come up with a research report and you surface these problems, we should help to be part of the solution ," said NUS Yong Loo Lin School of Medicine Associate Professor Jacqueline Chin. She developed the book with scholars from the Ethox Centre in Britain and the Hastings Center in the United States.

The casebook was inspired from the observations she made about "moral distress" faced by medical professionals in end-of-life care while doing a research report in 2011.

"Part of the solution was to come up with a resource that was free and open-access, to help healthcare professionals think through and reflect about their practices of care."

Each case features fictional characters that are based on real-life individuals encountered by healthcare and community care professionals. They cover themes such as the experiences of foreign domestic workers hired to care for elderly adults, the role of volunteer befrienders for the aged, and how ageing people cope with chronic conditions.

Scholars spoke to more than 180 professionals including nurses, therapists and social workers for the book, a task that took more than 1.5 years. The case studies were then discussed with medical professionals to ensure that they reflected actual challenges faced by the elderly and their caregivers.

"The signal importance of the Singapore Casebook as a contribution to bioethics is its focus on the home and community contexts that are invisible to most healthcare professionals, but are where most people experience ageing and caregiving," said Dr Nancy Berlinger, a research scholar of healthcare ethics at the Hastings Center, in a statement.

"Understanding the ethical challenges faced by Singaporeans and by other ageing societies worldwide requires attention to the experiences of non-professionals and to non-health-care settings."

For example, one of the case studies is set in a hawker centre between an elderly man named Mr Goh and a hawker named Mr Rasheed. Another took place in an HDB flat between an old man, Mr Tsao, and his befriender Mr Sengupta.

"We try to be the fly on the wall at the hawker centre, at the HDB flat, in an ordinary situation," added Dr Berlinger at a media round-table on Tuesday (May 23).

To connect with a general audience, each case study was kept short and included dialogue to make it more engaging to readers.

The first volume of the casebook, Making Difficult Decisions with Patients and Families, was released in 2014 and focused on problems faced by medical practitioners in clinical settings.

An official launch of the new casebook will be held tomorrow at the Shaw Foundation Alumni House. Caring for Older People in an Ageing Society can be accessed at www.bioethicscasebook.sg from Wednesday (May 24).