The Influence of Evolving Confucian Beliefs in the Selection of Proxy Decision-Makers at the End of Life in Singapore

Abstract

In Singapore, care of patients is often seen as part of the duty of the family unit with care decisions and treatment costs determined by the eldest son. Rising costs and increasing care needs, however, have led to the diversification of care roles. Understanding how these roles are determined is critical to decision-making, better patient care and effective communication with the family. This study seeks to explore the factors behind the selection of the main caregiver, who provides the majority of physical care to the patient, and the decision-maker, who is tasked with deciding on treatment plans. Twenty-one oncologic patients and caregivers attending an ambulatory treatment unit at a tertiary oncology centre viewed a video vignette and were asked about the suitability of the three children who suggest different options to care of their mother following her diagnosis of metastatic terminal cancer. Participants were also asked what factors they considered when selecting a surrogate. Contrary to traditional reliance upon gender roles to determine care roles and duties, nearly 60% of caregivers and 40% of patients prioritised the availability, willingness and capability of family members, and their financial and personal situations in determining their choice of caregiver and surrogate decision-maker. The shift away from gender-determined roles stems from the evolving nature of Confucian beliefs that are influenced by practical and sociocultural considerations. These findings remind healthcare professionals that gender stereotypes have begun to fade and that they should continually review familial and cultural beliefs in care determinations at the end of life.