- Critical Reflection Revisited
This issue of the Asian Bioethics Review marks a crucial transition. Professor Leonardo de Castro, who has been the journal’s founding Editor-in-Chief, and Mrs Sally Campbell, its Managing Editor, have retired from their respective positions. Under their nearly decade-long leadership, the Asian Bioethics Review has become one of the most visible scholarly publications in the region and among the most cited journals on bioethics internationally. Despite these changes, Asian Bioethics Review remains the flagship publication of Centre for Biomedical Ethics of Yong Loo Lin School of Medicine, National University of Singapore. The Editorial Board and the Centre wish to record their deep indebtedness and gratitude to Professor de Castro and to Mrs Campbell for their sagacious and tireless efforts in building up the journal.
Five articles are presented in this final issue for the year, along with a book review. While clearly differing in context and analytical content, each of them highlights the pre-eminence of reflexivity, or critical reflection more generally. The first article reports on a mixed-method study by Aamir Jafarey et al. on the use of Facebook at five medical institutions in Pakistan. Students and trainees in these institutions were found to be the most active users of Facebook. For them, it has been a highly effective medium that served a range of communicative needs, including sharing opinions from peers and seniors, exchanging notes and finding out about class schedules. Others have reportedly found Facebook to be useful for discussing challenging medical cases. However, Jafarey and colleagues observe that social media exchanges are known to create a false perception of anonymity, thereby encouraging exchanges through instant posts that are less guarded and reflexive. In addition, Facebook feeds could provide or reinforce incorrect and potentially harmful information. For instance, users may seek information on social media that confirms ideas they already hold [End Page 269] without regard to veracity or authenticity. An important insight from this study is that, despite being aware of these vulnerabilities and having personally experienced compromised privacy in some instances, a majority of the study participants did not choose to do anything about it proactively. Latent privacy concerns were found to be an afterthought and unless there is an explicit reference to these concerns, they are unlikely to affect conventional information exchanges on social media. Moving forward, there is a need to consider—in Pakistan and elsewhere—how critical reflection could be encouraged for medical practices that occur in social spaces that are neither clearly nor exclusively professional.
On a broadly similar theme, Vengadasalam Murugam highlights the need for reflexivity through multidisciplinary teamwork in managing terminal discharges. Writing in the context of discharge practices in Singapore, Murugam explains that an unreflective approach to terminal discharge could undermine the effectiveness of legal and professional safeguards against passive euthanasia. Through a hypothetical case scenario, the article illustrates how case-specific and multi-disciplinary assessments could promote reflexivity. Such assessments should be adaptive to changing goals of care and decision-making capacity of the patient, as well as attentive to the terminal care needs of a discharged patient in a home environment. Crucially, the determination of futility should be made by a palliative care multi-disciplinary team, composed of a group of people with different healthcare disciplines and able to devout sufficient time to discuss the diagnostic and treatment decisions about the patient’s care. Any determination should clearly account for the various biopsychosocial, spiritual, and cultural determinants relevant to the provision of care and support to patient and her or his family.
At the core of such an assessment is the deep care and empathy for the patient that has, in a different context, been underscored by the virtue of compassion. In the contribution by Dashjamts Shagdarsuren et al., compassion is presented as a prerequisite to becoming a traditional medicine practitioner in Tibet and Mongolia. In other words, compassion is not merely a professional trait that must be—like a technical competency—demonstrated in professional practice, but is instead intrinsic to what is understood as therapy. For this reason, compassion is to be regarded not only as a characteristic, but more critically the nature...