title: Limits to relational autonomy--the Singaporean experience.
abstract: Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms and adopted Western led atomistic concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered "content neutral" not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and "operationalize" the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore.
authors.affiliation: National Cancer Center Singapore, Singapore lalit.krishna@nccs.com.sg.
authors.forename: Lalit Kumar Radha
authors.initials: LK
authors.lastname: Krishna
authors.affiliation: National Cancer Center Singapore, Singapore.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Watkinson
authors.affiliation: Singapore General Hospital, Singapore.
authors.forename: Ng Lee
authors.initials: NL
authors.lastname: Beng
mesh_terms: D018864:Cultural Diversity; D003657:Decision Making / Q000941:ethics*; D005190:Family / Q000523:psychology; D006801:Humans; D010166:Palliative Care / Q000941:ethics*; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D012846:Singapore; D019366:Western World
keywords: End of life; Ring Theory of Personhood; multidisciplinary team; palliative care; personhood; relational autonomy; welfare