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Introduction
I am an Associate Professor at the Centre for Biomedical Ethics, in the Yong Loo Lin School of Medicine at the National University of Singapore.
I work across bioethics, health law, socio-legal studies and health/social care services research.
My research interests focus predominantly on the ethical aspects of community-based, integrated, and long-term care practice, policy and law.
I specialise in teaching ethics and law to medical students and to health and social care professionals.
Additional affiliations
January 2009 - October 2021
Education
September 2012 - August 2014
October 2004 - September 2008
September 2001 - June 2004
Publications
Publications (131)
Risk prediction in emergency medicine (EM) holds unique challenges due to issues surrounding urgency, blurry research-practise distinctions, and the high-pressure environment in emergency departments (ED). Artificial intelligence (AI) risk prediction tools have been developed with the aim of streamlining triaging processes and mitigating perennial...
Healthcare delivery and access, both in the United States and globally, were negatively affected during the entirety of the COVID-19 pandemic. This was particularly true during the first year when countries grappled with high rates of illness and implemented non-pharmaceutical interventions such as stay-at-home orders. Among children with special h...
Singapore, located strategically at the meeting point of the Malacca Strait and the South China Sea, has established itself as a global financial and economic hub. Despite its small geographical size, Singapore is home to over 5 million people from diverse cultural backgrounds. The city-state's medical education landscape has evolved significantly...
Despite the necessary focus on clinical skills and knowledge during the tertiary education of healthcare professionals, the literature highlights the importance of developing psycho-social competencies. Empathy, a cognitive-behavioral attribute linked to various benefits for patients and healthcare professionals, is one such competency. Pedagogical...
The place of values in legal and judicial practice has long been debated in academic discussions of the ideal/non-ideal functional roles of lawyers and judges in applying the law. Values in the law evoke various overlapping concerns, ranging from the ways in which values (legal or extra-legal) provide an implicit or explicit heuristic structure tha...
The Mental Capacity Act 2005 in England and Wales and Singapore’s Mental Capacity Act 2008 (which substantially transplants provisions from the former statute) might appear to be twins on paper, but they have gone on to lead very different lives. In this article, we examine how two broadly identical laws have taken on divergent identities within th...
This article discusses the application of artificially intelligent robots within eldercare and explores a series of ethical considerations, including the challenges that AI (Artificial Intelligence) technology poses to traditional Chinese Confucian filial piety. From the perspective of Confucian ethics, the paper argues that robots cannot adequatel...
The widespread use of Chat Generative Pre-trained Transformer (known as ChatGPT) and other emerging technology that is powered by generative artificial intelligence (GenAI) has drawn attention to the potential ethical issues they can cause, especially in high-stakes applications such as health care, but ethical discussions have not yet been transla...
Background
During Covid-19 nurses were redeployed to new teams and specialties at a level never previously experienced. Little is known about how nurses made sense of and coped with this situation and what we can learn from this for future redeployment approaches.
Objectives
We sought to understand how nurses made sense of ongoing redeployment dur...
This chapter sets out the framework and rationale for Capacity, Participation and Values in Comparative Legal Perspective. We explore how core themes of values (that is, the values embedded within a legal framework and whose values are given effect) and participation (that is, whether and how the person’s voice and agency is fostered in decision ma...
This chapter concludes the book Capacity, Participation and Values in Comparative Legal Perspective. We draw together key themes and observations from across the book’s chapters, which focus on mental capacity – or guardianship – laws across different jurisdictions, seeking to learn whether and how a person for whom a decision is being made under s...
In recent years, the case has been made for special attention to be paid to a branch of research in the field of bioethics called ‘translational bioethics’. In this paper, we start by considering some of the assumptions that those advancing translational approaches to bioethics make about bioethics and compare them to the reality of bioethics as an...
Objective: We hypothesized that the reasons behind this tension are complex and can be understood better by applying social psychology theory.Design: A qualitative methodology was drawn on for data collection and thematic analysis, with focus group discussions adopted for interviews with patient families and ICU physicians. Additionally, we used a...
The equality and rights of persons with mental impairments have become an important focal point of reference for policy developments and legal reform. In the 21st century, the normative shifts in law and policy are often said to be driven by the United Nations Convention on the Rights of Persons with Disabilities. However, comparative analyses of t...
Introduction
Since the start of the 21st century, policy developments and legal practice have increasingly sought to express and implement changes that recognise the equality and rights of persons with mental impairments, including persons with learning disabilities and mental disorders. A great deal of academic scholarship, legal commentary and po...
Introduction
This volume has taken an international approach to learning about, and critically exploring, how legal systems may, or may fail to, assure the (meaningful) participation in decision-making by, with and for individuals who are subject to mental capacity laws (P). Equally, the contributors have explained how laws bring individuals’ value...
While the ethics of involuntary admission for psychiatric inpatient care is widely contested, the practice is legally permissible across most jurisdictions. In many countries, laws governing the use of involuntary admission set out core criteria under which involuntary admission is permitted; these parameters broadly related to either risk of harm...
This book is the first to consider comprehensively and systematically the law and practice of advance directives across Asia. It will thus be important not only as a reference volume that documents how advance directives are regulated and used throughout Asia, but also as an exploration of the concept of the advance directive itself, in context. By...
Under the Mental Capacity Act 2005 in England and Wales (MCA), the participation of persons in making decisions that affect their lives is embedded within the legislation and has also been addressed directly in Court of Protection (CoP) rules and guidelines. Nonetheless, various studies and reports have indicated a potential gap between practice on...
Precision psychiatry is an emerging field with transformative opportunities for mental health. However, the use of clinical prediction models carries unprecedented ethical challenges, which must be addressed before accessing the potential benefits of precision psychiatry. This critical review covers multidisciplinary areas, including psychiatry, et...
The context-and person-specific nature of the Mental Capacity Act 2005 (MCA) in England and Wales means inherent indeterminacy characterises decision-making in the Court of Protection (CoP), not least regarding conflicting values and the weight that should be accorded to competing factors. This paper explores how legal professionals frame and influ...
Background
Research proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal...
Quality improvement (QI) provides a rigorous and innovative approach to improving patient's lives in the healthcare system. Still, it can pose challenges in understanding what ethical considerations apply to some projects to minimise the possibility of patient harm or prevent other ethical wrongs and potential staff burden. While many commentaries...
Background
Global health is the study, research, and practice of medicine focused on improving health and achieving health equity for all persons worldwide. International and national bodies stipulate that global health be integrated into medical school curricula. However, there is a global paucity of data evaluating the state of global health teac...
The balance sheet is commonly used as a deliberative approach to decide best interests in Court of Protection cases in England and Wales, since Thorpe LJ in Re A (Male Sterilisation) described the balance sheet as a tool to enable judges and best interests decision-makers to quantify, compare, and calculate the different options at play. Recent jud...
Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement shoul...
Tragic choices arise during the COVID-19 pandemic when the limited resources made available in acute medical settings cannot be accessed by all patients who need them. In these circumstances, healthcare rationing is unavoidable. It is important in any healthcare rationing process that the interests of the community are recognised, and that decision...
The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideratio...
Bioethics is gradually becoming an important part of the drive to increase quality healthcare delivery in sub‐Saharan African countries. Yet many healthcare service‐users in Africa are familiar with incidences of questionable health policies and poor healthcare delivery, leading to severe consequences for patients. We argue that the overarching rig...
As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to...
As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the ITU and emergency department pose additional risks to themselves, and...
There is a rich tradition in bioethics of gathering empirical data to inform, supplement, or test the implications of normative ethical analysis. To this end, bioethicists have drawn on diverse methods, including qualitative interviews, focus groups, ethnographic studies, and opinion surveys to advance understanding of key issues in bioethics. In s...
https://authors.elsevier.com/c/1a5kHaR~~Q8ID
This article explores and outlines four possible pathways for law reform in the area of compulsory mental health admission and treatment in Hong Kong: the (i) abolition, (ii) risk of harm, (iii) mental capacity and (iv) consensus pathways. The discussion of each pathway takes into account local challenge...
Population-level biomedical research has become crucial to the health system's ability to improve the health of the population. This form of research raises a number of well-documented ethical concerns, perhaps the most significant of which is the inability of the researcher to obtain fully informed specific consent from participants. Two proposed...
Background:
In many countries, committees make priority-setting decisions in order to control healthcare costs. These decisions take into account relevant criteria, including clinical effectiveness, cost-effectiveness, and need, and are supported by evidence usually drawn from clinical and economic studies. These sources of evidence do not include...
Following the Mental Capacity Act (MCA) becoming law in 2005, and prior to its coming into force in 2007, there was a sustained effort to train support staff in the many social care settings where this new law was applicable. This training drive was necessary because, prior to the MCA, mental capacity law had evolved in the courts through considera...
The law of informed consent to medical treatment has recently been extensively overhauled in England. The 2015 Montgomery judgment has done away with the long-held position that the information to be disclosed by doctors when obtaining valid consent from patients should be determined on the basis of what a reasonable body of medical opinion agree o...
Judges face a challenging task in determining the weight that ought to be accorded to the person’s (P) values and testimony in judicial deliberation about her capacity and best interests under the Mental Capacity Act 2005 (MCA). With little consensus emerging in judicial practice, incommensurable values drawn from divergent sources often collide in...
This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the...
The issue of medical ethics, from thorny moral questions such as euthanasia and the morality of killing to political questions such as the fair distribution of health care resources, is rarely out of today's media. This area of ethics covers a wide range of issues, from mental health to reproductive medicine, as well as including management issues...
Cultural differences within and across societies can also challenge our assumptions and approaches to medical ethics and require us to reconsider our ethical obligations to individuals. Medical research involving collaboration between widely varying cultures is one context that is particularly problematic. ‘Culture, consent, and community’ discusse...
The future of medical ethics, the ways in which it will develop and change, will be largely determined by the nature of the new situations that arise. ‘A glance into the future’ suggests that these are likely to be of two broad types: scientific and technological developments such as gene therapy, stem cell research, synthetic biology, and advances...
‘Helping the helper’ shows how ethics support can be introduced to shape ethical understanding and good healthcare practice using an example from a care home setting where everyday care is provided to people with dementia. This case is one example of an ethical issue that arises frequently in the care of people with dementia: how to balance the per...
‘A toolbox of reasoning’ discusses a further four tools of ethical reasoning: distinguishing facts from values; reasoning from principles; thought experiments; and spotting and avoiding fallacies in reasoning. Five fallacies are discussed: the no-true Scotsman move; the ten-leaky-buckets tactic; the argument from nature; the argument from playing G...
‘Inconsistencies about madness’ examines the different standards used in enforcing treatment and secure accommodation for those with and without mental disorder and considers the links with criminal acts. It is argued that those with mental disorder are subject to a double injustice. Under legislation such as the UK’s Mental Health Act, they are di...
No healthcare system in the world has sufficient money to provide the best possible treatment for all patients in all situations. When is the extra benefit of a new, better, and expensive treatment worth the extra cost? ‘Establishing fair procedure’ explains that medical ethics can provide practical support to assist policy-makers in the allocation...
Medical ethics is under challenge from developments in medical science and technology, raising new ethical questions or old questions in new ways. The work of genetics clinics worldwide is forcing us to re-think the traditional ways in which we think about medical confidentiality. A genetic test from one person can provide information about a relat...
‘On why medical ethics is exciting’ provides an introduction to medical ethics, which deals with some of the big moral questions: easing death and the morality of killing, for example. It takes us into the realm of politics. How should healthcare resources, necessarily limited, be distributed; and what should be the process for deciding? It is conc...
Euthanasia is one form of assisted dying. Other forms include assisting suicide and the withholding or withdrawing of life-extending medical treatment. The practice of euthanasia—killing a patient for the patient’s benefit—under some circumstances, is morally required by the two most widely regarded principles for guiding good medical practice: res...
‘People who don’t exist; at least not yet’ discusses the non-identity problem by considering the analogy between the rules governing assisted reproduction and those governing adoption. It looks at the issues involved with comparing existence with non-existence, which considers the best interests of a child that is yet to be born, and then outlines...
Biomedical research funding bodies across Europe and North America increasingly encourage—and, in some cases, require—investigators to involve members of the public in funded research. Yet there remains a striking lack of clarity about what ‘good’ or ‘successful’ public involvement looks like. In an effort to provide guidance to investigators and r...
One central and unfortunately unavoidable characteristic of the aging process is its association with chronic physiological deterioration. Frailty, cognitive impairment, and physical conditions such as cardiovascular disease and vision and hearing loss are more frequent in this phase of life, and these conditions translate into an increasing need f...
Background:
This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of...
In this response, we first tackle what we take to be the core disagreement between ourselves and Hammersley, namely the justification for our model of social research ethics governance. We then consider what follows from our defence of governance for ethics review and show how these claims attend to the specific concerns outlined by Hammersley. © 2...
There is a growing body of literature that has sought to undermine systems of ethical regulation, and governance more generally, within the social sciences. In this paper, we argue that any general claim for a system of research ethics governance in social research depends on clarifying the nature of the stake that society has in research. We show...
The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In t...
http://www.bioethicscasebook.sg/caring-for-older-people-in-an-ageing-society/
Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article...
Bioethics has long been accepted as an interdisciplinary field. The recent 'empirical turn' in bioethics is however, creating challenges that move beyond those of simple interdisciplinary collaboration, as researchers grapple with the methodological, empirical and meta-ethical challenges of combining the normative and the empirical, as well as navi...
Bioethics has long been accepted as an interdisciplinary field. The recent 'empirical turn' in bioethics is however, creating challenges that move beyond those of simple interdisciplinary collaboration, as researchers grapple with the methodological, empirical and meta-ethical challenges of combining the normative and the empirical, as well as navi...
Bioethics has long been accepted as an interdisciplinary field. The recent 'empirical turn' in bioethics is however, creating challenges that move beyond those of simple interdisciplinary collaboration, as researchers grapple with the methodological, empirical and meta-ethical challenges of combining the normative and the empirical, as well as navi...
Background:
More than 400,000 older people reside in over 18,000 care homes in England. A recent social care survey found up to 50% of older people in care homes felt their dignity was undermined. Upholding the dignity of older people in care homes has implications for residents' experiences and the role of Registered Nurses.
Aims and objectives:...
Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able...
One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across di...
The idea of the Internet as Gutenberg 2.0—a true revolution in disseminating information—is now a routine part of how bioethics education works. The Internet has become indispensable as a channel for sharing teaching materials and connecting learners with a central platform (such as a professional society's website or a course page on a university'...
Background
Despite the increased prevalence of bioethics research that seeks to use empirical data to answer normative research questions, there is no consensus as to what an appropriate methodology for this would be. This review aims to search the literature, present and critically discuss published Empirical Bioethics methodologies.
Methods
MedL...
Enabled by the Lien Foundation and in partnership with The Hastings Center and University of Oxford’s Ethox Centre, the online Making Difficult Decisions with Patients and Families: A Singapore Casebook, aims to promote learning, teaching and discussion among healthcare professionals and ethics students on some of the most complex but common issues...
Background
Leverage is a particular type of treatment pressure that is used within community mental health services to increase patients’ adherence to treatment. Because leverage involves practitioners making proposals that attempt to influence patients’ behaviours and choices, the use of leverage raises ethical issues.
Aim
To provide guidance tha...
Ethical dilemmas often arise as a consequence of having dementia or caring for a person with dementia, which are difficult to resolve. Sometimes problems seem insurmountable and it is difficult to decide what to do because it is not clear what is right or wrong, ethically speaking. This report entitled "Ethical dilemmas faced by carers and people w...