Department of Palliative Medicine, National Cancer Centre, Singapore.
Nurs Ethics. 2012 Nov;19(6):787-99. doi: 10.1177/0969733011433316. Epub 2012 Apr 30.
Familialism is a significant mindset within Singaporean culture. Its effects through the practice of familial determination and filial piety, which calls for a family centric approach to care determination over and above individual autonomy, affect many elements of local care provision. However, given the complex psychosocial, political and cultural elements involved, the applicability and viability of this model as well as that of a physician-led practice is increasingly open to conjecture. This article will investigate some of these concerns before proffering a decision-making process based upon a multidisciplinary team approach. It will be shown that such a multidimensional and multiprofessional approach is more in keeping with the inclusive and patient-centred ethos of palliative care than prevailing practices. It will be shown that such an approach will also be better placed to deliver holistic, coherent and sensitive end-of-life care that palliative care espouses.
家庭主义是新加坡文化中的一个重要观念。它通过家庭决定和孝道的实践产生影响，这种实践要求以家庭为中心来决定护理，而不是个人自主，这影响了当地护理提供的许多方面。然而，考虑到涉及的复杂心理社会、政治和文化因素，这种模式以及医生主导实践的适用性和可行性越来越受到质疑。本文将探讨其中的一些问题，然后提出一种基于多学科团队方法的决策过程。研究表明，与流行的做法相比，这种多维度和多专业的方法更符合姑息治疗的包容性和以患者为中心的精神。研究还表明，这种方法更能提供姑息治疗所倡导的整体、连贯和敏感的临终关怀。
