BackgroundAmidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality (...) of CECons.MethodsGuided by Levac et al’s (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings.ResultsNine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified – the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations.ConclusionThis review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy.To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards. (shrink)

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. (shrink)

The primary question this article deals with is one of ontology. In a dystopian world populated with genetically engineered windups and hybrids, what constitutes ‘the human’? This article looks at how the posthuman body in a dystopian novel like The Windup Girl, set in a world where geographical, political, social, economic and religious norms and boundaries are erased and reconfigured, can in no way simply remain a mere body, but transmutes into a highly complex political and social site from whence (...) multiple relations of power originate, travel and culminate in. The titular character in the novel, Emiko, is a genetically engineered windup created in a laboratory, with obedience and the need to please etched right into her DNA. This makes her a prized possession for a brothel owner in Bangkok, once her Japanese master abandons her. She is both desirable and revolting to her customers at the same time – her perfect body is too perfect, her genetic urge to please at any cost draws them in, but her involuntary shaking and robot-like jerking disgusts them. The windup can thus be seen as both the Lacanian object cause of desire and Kristeva’s abject body. (shrink)

Familialism is a significant mindset within Singaporean culture. Its effects through the practice of familial determination and filial piety, which calls for a family centric approach to care determination over and above individual autonomy, affect many elements of local care provision. However, given the complex psychosocial, political and cultural elements involved, the applicability and viability of this model as well as that of a physician-led practice is increasingly open to conjecture. This article will investigate some of these concerns before proffering (...) a decision-making process based upon a multidisciplinary team approach. It will be shown that such a multidimensional and multiprofessional approach is more in keeping with the inclusive and patient-centred ethos of palliative care than prevailing practices. It will be shown that such an approach will also be better placed to deliver holistic, coherent and sensitive end-of-life care that palliative care espouses. (shrink)

Most writings on Indian philosophy assume that its central concern is with moska, that the Vedas along with the Upanishadic texts are at its root and that it consists of six orthodox systems knowns as Mimamasa, Vedanta, Nyaya, Vaisesika, Samkhya, and Yoga, on the one hand and three unorthodox systems: Buddhism, Jainism and Carvaka, on the other. Besides these, they accept generally the theory of Karma and the theory of Purusartha as parts of what the Indian tradition thinks about human (...) action. The essays in this volume question these assumptions and show that there is little ground for accepting them. A new counter-perspective is presented for the articulation of the Indian philosophical tradition that breaks from the traditional frame in which it has usually been presented. (shrink)

Ali comparative studies imply simultaneously an identity and a difference, a situation that is replete with intellectual difficulties which give rise to interminable disputes regarding whether we are talking about the same thing or different things. One may cut the gordian knot by deciding either way, but the situation would reappear again as it is bound up with the comparative perspective itself and not with any particular example of it. How long shall we go on “naming”, for the process is (...) unending and ultimately “everything is what it is. and not another thing”. Or, if we do not like “names” as they hardly give us any knowledge and if we opt for “description” which gives us “facts”, then they too are as unending as the “names”, for, as the Jains taught us long ago, they are a function of the dṛṣti that we have or the point of view that we adopt. (shrink)

Application of sedation at the end of life has been fraught with ethical and clinical concerns, primarily focused on its potential to hasten death. However, in the face of clinical data that assuage most of these concerns, a new threat to this treatment of last resort has arisen. Concern now pivots on its effects on the personhood of the patient, underpinned by the manner in which personhood has been conceptualised. For many authors, it is consciousness that is seen to be (...) the seat of personhood, thus its loss is seen to rob a patient of their moral and ethical worth, leaving them in a state that cannot ethically be differentiated from death. Here I proffer a clinically based alternative to this view, the Ring Theory of Personhood, which dispels these concerns about sedation at the end of life. The Ring Theory envisages personhood as a coadunation of three domains of concern: the innate, the individual and the relational elements of personhood. The innate element of personhood is held to be present among all humans by virtue of their links with the Divine and or their human characteristics. The individual elements of personhood pivot on the presence of consciousness-dependent features such as self-awareness, self-determination and personality traits. The relational component of personhood envisages an individual as being ‘socially embedded’ replete with social and familial ties. It is these three equally important inter-related domains that define personhood. (shrink)

Facing the possibility of a surge of COVID-19-infected patients requiring ventilatory support in Intensive Care Units, the Singapore Hospice Council and the Chapter of Palliative Medicine Physicians forward its position on the guiding principles that ought to drive the allocation of ICU beds and its role in care of these patients and their families.

Background Supporting physicians in Intensive Care Units s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for (...) ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support. (shrink)

Transcript of papers presented in a seminar and meetings.

Type II DNA topoisomerase activity is required to change DNA topology. It is important in the relaxation of DNA supercoils generated by cellular processes, such as transcription and replication, and it is essential for the condensation of chromosomes and their segregation during mitosis. In mammals this activity is derived from at least two isoforms, termed DNA topoisomerase IIα and β. The α isoform is involved in chromosome condensation and segregation, whereas the role of the β isoform is not yet clear. (...) DNA topoisomerase IIβ was first reported in 1987. Here we review the research on DNA topoisomerase IIβ over the last 10 years. BioEssays 20:215–226, 1998.© 1998 John Wiley & Sons, Inc. (shrink)

The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical (...) impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family. (shrink)

ABSTRACTApproach-avoidance training has been shown to be effective in both clinical and laboratory research. However, some studies have failed to show the effects of AAT. Therefore, finding m...

'Saṃvāda' is the live report of a dialogue between two philosophical traditions, the Indian and the western, transcribed and edited from the tapes of a week-long seminar held at Pune in 1983. The central issue whether one need postulate 'propositions' as entities to account for our understanding of sentences which are false or those whose truth and faksity is not yet known. The Indian answer is a definitive 'No.'.

BackgroundThe COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may (...) have profound effects on their mental and physical health, personal relationships and professional efficacy.MethodsWith mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria.ResultsA total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms.ConclusionIt is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19’s impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as ‘compensatory’ to one another, with coping mechanisms buffering and fortifying the physician’s overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures. (shrink)

The application of continuous deep sedation in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia, which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care (...) approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient’s situation and the engagement of a multidisciplinary team guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process. (shrink)

The Development In Nyaya, Mimamsa, Vedanta And Samkhya From The End Of Seventeenth Century Onwards Is Delineated In This Book And Which Reveals That It Is Not Only A Period Just Of Pariskata Or Subtle Refinement As Is Generally Believed But Also That Of Genuine Creative Innovation. The Same Can Be Said In The Field Of Alamkarasastra, Vyavaharasastra And Dharmasastra And Also In The Thinking Done In The Field Of Philosophy, Written In English Language, Since The Coming Of The British. (...) It Also Tries To Develop A New Methodology For The Historiography Of Thought, Which May Be Relevant To Other Fields Of History Writing As Well. It Also Suggests The Direction Which Further Works May Take In Future. (shrink)

Natural selection is commonly seen not just as an explanation for adaptive evolution, but as the inevitable consequence of “heritable variation in fitness among individuals”. Although it remains embedded in biological concepts, such a formalisation makes it tempting to explore whether this precondition may be met not only in life as we know it, but also in other physical systems. This would imply that these systems are subject to natural selection and may perhaps be investigated in a biological framework, where (...) properties are typically examined in light of their putative functions. Here we relate the major questions that were debated during a three-day workshop devoted to discussing whether natural selection may take place in non-living physical systems. We start this report with a brief overview of research fields dealing with “life-like” or “proto-biotic” systems, where mimicking evolution by natural selection in test tubes stands as a major objective. We contend the challenge may be as much conceptual as technical. Taking the problem from a physical angle, we then discuss the framework of dissipative structures. Although life is viewed in this context as a particular case within a larger ensemble of physical phenomena, this approach does not provide general principles from which natural selection can be derived. Turning back to evolutionary biology, we ask to what extent the most general formulations of the necessary conditions or signatures of natural selection may be applicable beyond biology. In our view, such a cross-disciplinary jump is impeded by reliance on individuality as a central yet implicit and loosely defined concept. Overall, these discussions thus lead us to conjecture that understanding, in physico-chemical terms, how individuality emerges and how it can be recognised, will be essential in the search for instances of evolution by natural selection outside of living systems. (shrink)

God as a term denoting that which is ultimately real and absolutely valuational is simultaneously the necessary presupposition of all thought and action and also their ultimate goal. Yet, it is equally true that it is neither known nor even knowable in principle in the sense that any finite being or set of such beings may hope to know it in any determinate manner. Being generally conceived as beyond both space and time and transcending them in the sense that, even (...) when considered as immanent in the world, It can never be regarded as completely revealed at any particular point in space or time, it cannot but be unknown and unknowable in the deepest sense of the word. Yet, however paradoxical the idea of God may be, it is a symbol of that which man as a self-conscious reflective being, who both knows and acts, has to encounter at every turn. (shrink)

Philippa Foot, like others of her philosophical generation, was much concerned with the status and authority of morality. How universal are its demands, and how dependent on the idiosyncrasies of individuals? In the early years of her career, she was persuaded that Kant and his twentieth-century followers had been wrong to insist on the centrality to morality of absolute and unconditionally binding moral imperatives. To that extent, she wrote, there was indeed ‘an element of deception in the official line about (...) morality’. In this paper, I shall explore her early alternative: a system of merely ‘hypothetical’ imperatives, imperatives that depend on the motivations of particular individuals. Could so contingent a system deserve to be termed a morality? How revisionary a proposal was this, and how serious its costs? And how might we reconcile ourselves to a morality stripped of what she called the ‘fictions’ that surrounded it? Foot's early answer, tentative and exploratory, remains of interest, long after she herself abandoned it. (shrink)

To talk of God is almost a presumption, for who can say with any certainty that it is or if it is, in what sense of “is” it is, and what is its nature. And, perhaps, of all those who talk of God, the philosopher is the least qualified, as by temperament and training he lives in a world where concepts and arguments and ratiocinative thought are more real than anything else. And God, whatever it may or may not be, (...) is not an idea or a concept or the conclusion of a well-reasoned chain of argumentation. Nor is it even a hypothesis to be tested or a necessary postulate without which our experience would make no sense and life cease to have a meaning. (shrink)

BackgroundDiagnostic ultrasound has long been a part of a physician’s armamentarium, but transcranial focused ultrasound (FUS) is an emerging treatment of neurological disorders. Consequently, the literature in this field is increasing at a rapid pace.ObjectiveThis analysis was aimed to identify the top-cited articles on FUS to discern their origin, spread, current trends highlighting future impact of this novel neurosurgical intervention.MethodsWe searched the Web of Science database on 28th May 2021 and identified the top 100 cited articles. These articles were analyzed (...) with various scientometric parameters like the authors, corresponding authors, country of corresponding author, journal of publication, year of publication. Citation based parameters including total citations, mean citations per article and mean citations, citation count, and the citation per year, citations per year and co-authors per document were studied as well in addition to Hirsch h-index, g-index, m-index, Bradford’s Law, Lotka’s law and Collaboration index.ResultsThe 100 top-cited articles were published between 1998 and 2019 in 45 different journals. The average citations per document and citations per document per year were 97.78 and 12.47, respectively. The most prolific authors were Hynynen K (Medical Biophysics—Toronto), Elias WJ (Neurosurgery—Virginia), Zadicario (InSightec). The Journal of Neurosurgery published the most top-cited articles (n = 11), and most articles originated from the United States, followed by Canada. Among individual institutions, the University of Toronto was the most productive.ConclusionFUS is an emerging treatment of neurological disorders. With its increasing application, the FUS literature is increasing rapidly. Eleven countries contributed to the top 100 cited articles, with the top 2 countries (the United States and Canada) contributing to more than half of these articles. (shrink)

Monitoring and evaluation is an essential part of public health programmes. Since M&E is the backbone of public health programmes, ethical considerations are important in their conduct. Some of the key ethical considerations are avoiding conflicts of interest, maintaining independence of judgement, maintaining fairness, transparency, full disclosure, privacy and confidentiality, respect, responsibility, accountability, empowerment and sustainability. There are several ethical frameworks in public health, but none focusing on the monitoring and evaluation process. There is a need to institutionalise the ethical (...) review of M&E proposals. A theoretical framework for ethical considerations is proposed in this paper. This proposed theoretical framework can act as the blueprint for building the capacity of ethics committees to review M&E proposals. A case study is discussed in this context. After thorough field testing, this practical and field-based ethical framework can be widely used by donor agencies, M&E teams, institutional review boards and ethics committees. (shrink)