SINGAPORE - Hospitals can cease treatment if they think it is futile.
They can do this even if the patient's family disagrees as their responsibility is to the patient.
The Khoo Teck Puat Hospital (KTPH) explained the role of its ethics committee to The New Paper, in light of a dispute between KTPH and a patient's family three weeks ago.
The family of housewife Lee Ah Cheo, 64, claimed the hospital did not follow their wishes to keep her on assisted ventilation.
But KTPH said Madam Lee had multiple organ failure and her condition was terminal.
All artificial methods would sustain her life for days at most.
Madam Lee died at KTPH one day after the dispute on July 3.
The New Paper reported her death.
A KTPH spokesman told The New Paper on Thursday: "This was not an easy decision for the doctors.
"While consideration will be given to the family's concerns, and it would be easier to give an opinion which will favour the family, the doctor's key responsibility is to the patient.
"The artificial sustenance of life can sometimes cause more pain to the patient, and it may be more humane to allow the patient to pass on with dignity and with minimal suffering and pain."
Advance care planning
Advance care planning
The hospital explained that KTPH has an ethics committee which assists the care team in making ethical decisions related to:
- Advance care planning and do not resuscitate (DNR) orders
- Withholding and withdrawing of treatment
- Issues on informed consent
- Assessing mental capacity and decision-making ability
- Situations in which further treatment will not improve the patient's condition.
- Managing situations in which family members withhold health conditions from the patient
The committee's aim is to advise the hospital, so as to decide on the best care for the patient.
The spokesman said: "The committee does not at any time make a decision on behalf of the primary care team."
KTPH's ethics committee has at least nine people including practicing health-care professionals with at least 10 years of experience.
Some are not employed by or connected with KTPH, so as to provide a balanced, neutral view, said the hospital.
The spokesman added that the committee also includes lay persons who do not have any medical background "to reflect the wider views of the community".
On the case, KTPH had said earlier: "The patient was never denied any care which would have given her the slimmest chance of survival. At no time were any drips, medications, aspirations of respiratory secretions withdrawn.
"The medical team had to ensure quality care to our patients, which does not necessarily come with a few more hours of extended life."
Despite KTPH's reply, Madam Lee's family is still not convinced the hospital did its best.
Her daughter-in-law, Madam Alice Fong, told The New Paper that she expected KTPH to continue treating her mother-in-law despite the severity of the latter's condition.
The customer service officer, 43, said: "They should have continued treating her until she got better or died.
"But to stop treating her...I still can't get over it."
Madam Fong added that she has written to the authorities on the matter, and is awaiting a reply.
What committee considers
The ethics committee considers the patient's quality of life and other contextual issues, such as if the patient is involved in a police case. It also notes if the patient has previously indicated his preference for treatment.
- A committee member will first discuss the case with the care team, the patient, or his family.
- If the situation is urgent or clear-cut, this ethics consultant will give his opinion directly to the care team.
- If not, the consultant will discuss and review his recommendation with the rest of the committee, before reaching a consensus.
- The committee's recommendation is non-binding, meaning the hospital still decides what care is most appropriate.
The committee's role is to give an objective third-party perspective.
This article was first published in The New Paper.