Bioethics Blogs

Singapore Case Notes: Reframing “Family” Caregiving in the World’s Fastest Aging Society

A previous post described theSingapore Casebook project, a collaboration among the Centre for Biomedical Ethics at the National University of Singapore, The Hastings Center, and the Ethox Centre at the University of Oxford. The first edition of this online casebook, Making Difficult Decisions with Patients and Families, is widely used in undergraduate and professional health care education in Singapore and is available to the public and to professionals and scholars in other countries. Our team is now developing the second edition, Care Transitions in Aging Societies.

Our recent project meetings in Singapore coincided with “the Haze,” the transnational smog produced by profitable slash-and-burn land clearing in Indonesia coupled with climate change. Discussions about the public health consequences of the Haze were the backdrop to a week of site visits across this densely populated city-state of 5.5 million people, as we sought to better understand how care transitions worked – or failed – in the world’s fastest aging society.

 Again and again, we heard versions of the problem common to all such societies: what aging people need so often confounds familiar categories such as “medical” versus “social,” or “institutional” versus “family,” especially during the long trajectory of frailty and dementia. Geriatricians described the challenge of respecting the preferences of people who want remain independent but whose progressing dementia compromised their safety in and outside the home. Geriatric social workers, rehabilitation specialists, and health educators described efforts to improve hospital-to-home discharges through investments in caregiver training and closer attention to signs of caregiver burnout.

We also saw innovative uses of Singapore’s ubiquitous public housing – the multistory HDB block, home to 85 percent of citizens – to bring services for aging residents into neighborhoods.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.