Online casebook helps docs facing ethical dilemmas

SINGAPORE - How do you answer a father who asks you not to tell his teenage daughter that she has cancer? How do you deal with a patient who refuses treatment that might save his life?

And when do you stop treatment for an elderly patient who is dying?

These are some "day to day" ethical challenges doctors face, especially those who work with children or the elderly.

To help doctors who struggle with these issues, the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) has launched an online casebook.

Featuring 12 cases with accompanying commentaries and "thinking questions", the online resource hopes to give doctors "food for thought".

These cases highlight typical ethical problems that confront doctors in real life.

For instance, the issue of not telling a teenager she has cancer pits the parent's role as decision-maker in the family against the patient's individual right to knowledge.

"By and large, these sorts of dilemmas don't have a concrete black-and-white answer," said Dr Peter Loke, an adjunct senior lecturer at the Yong Loo Lin School of Medicine's Centre for Biomedical Ethics.

What the writers hope to do is provide a structured framework for doctors and other readers to begin thinking about these issues.

The casebook was put together by about 80 health-care professionals, including experts from the United States and Britain. The writers also hope to give health professionals overseas an insight into ethics in Singapore.

"In the US and UK, the primary responsibility is to the patient. The cultural context is important," said Associate Professor Gerald Koh, from the Saw Swee Hock School of Public Health in NUS.

"You cannot transplant what works in one culture to another," he added.

The public can access the casebook at

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