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'Who is Responsible for this Patient?': A Case Study Analysis of Conflicting Interests between Patient, Family and Doctor in a Singaporean Context

Mdm KL was a previously well 46-year-old female who was admitted for complaints of progressively worsening headaches over six months. There were no other neurological symptoms. Despite the usual treatments, her symptoms remained refractory. An MRI (Magnetic Resonance Imaging) of her head demonstrated a lesion in her left temporal lobe. In view of these findings, the patient was referred to the Department of Neurosurgery. The clinical impression was that of a primary brain tumour, possibly an aggressive glioma. A conference was held between Mdm KL, her husband and the neurosurgical team. No other family members were present. The doctors explained the current standard treatment: surgical excision of the lesion, followed by adjuvant chemotherapy and radiation therapy if the lesion was high-grade. The only way to confirm the tumour grade was via intraoperative histology of the excised lesion. If the lesion was indeed high-grade, she was recommended to undergo a course of concurrent radiotherapy and chemotherapy within six weeks post-surgery. She agreed to proceed with the full course of treatment, and signed her own consent for the operation with her husband present. He showed support for her decision. The planned surgery was uneventful. A routine post-operative MRI brain demonstrated adequate excision of her brain tumour. She was transferred to the general ward on the day after her operation.