Of Learning Curves, Chess and the Art of Translation in Medical Ethics

73 A r t o f Tr a n s l a t i o n i n M e d i c a l E t h i c s J C h i n , V T C h u a n , N P e a r t & R J o s e p h Of Learning Curves, Chess and the Art of Translation in Medical Ethics Across Asia, the implementation of medical ethics teaching is gaining momentum. While many medical schools in developed countries within Europe, America and the Pacific Rim have formalised ethics teaching within the medical curriculum and developed staffing, core curricula and teaching materials relevant to their social and cultural contexts, Asian medical schools may best be described as being at the stage of “capacity-building”. Key research studies comprising “situation analyses” of the teaching needs of various Asian countries in the area of medical ethics have been undertaken in recent years (Miyasaka et al. 1999, Kasturiaratchi et al. 1999, de Castro et al. 2003).1 All have pointed to the urgency of implementing medical ethics teaching in view of social changes including flows of medical technology to the region, radical changes in macro-allocation policies, the promotion of market economies and globalisation which pose serious challenges to accepted principles of justice and respect for persons in medical practice worldwide. However, medical ethics is a complex creature; teaching needs vary from country to country, depending on differing social conditions and distinct histories which influence the way that ethics finds expression. In Singapore, the medical school of the National University of Singapore (NUS) founded a Centre for Biomedical Ethics (CBmE) in September 2006. It appointed Professor Alastair Campbell, an international expert in medical ethics who had established centres at the Universities of Otago (New Zealand) and Bristol (UK), as the CBmE’s first director. Part of the Centre’s remit is to develop a teaching programme at both the undergraduate and postgraduate levels in health ethics, law and professionalism. To this end, it was necessary to start identifying what ethical issues clinicians in Singapore face in their clinical practice. Simply adapting core curricula, cases and texts from other countries I N S I G H T Asian Bioethics Review December 2008 inaugural edition 73–80 A s i a n B i o e t h i c s R e v i e w D e c e m b e r 2 0 0 8 i n a u g u r a l e d i t i o n 74 was not wholly satisfactory. Singapore’s medical practices are influenced by its unique cultural, social, religious, economic and political circumstances.2 We decided to embark on a survey of the medical literature on abortion, end-of-life care and organ procurement in Singapore because they seemed to raise important ethical challenges for clinical practice in Singapore and were therefore more likely to be discussed in the medical literature. Our aim was to collect and synthesise information on the ethical issues identified and discussed by medical professionals in Singapore, so as to construct a provisional picture of real-world medical ethics and its implications for teaching. Journal articles on each of the chosen topics were collected through a Pubmed search (using MeSH terms and/or other appropriate parameters) of the Medline database, as it is widely accessed by clinicians in Singapore and around the world. The abstracts were checked and articles identified by a clinician as purely technical or irrelevant (for example, articles not dealing with the topic area or clinical practice in Singapore) were excluded. The remaining articles (including those without abstracts) were retrieved and reviewed; articles that did not raise ethical issues or were authored by non-medical professionals (such as legal professionals and social scientists) were further excluded. A reiterative search using the same methodology was done for medical journals published in Singapore, namely the Singapore Medical Journal (published by the Singapore Medical Association) and The Annals of the Academy of Medicine (published by Singapore Medical Council), so as to uncover articles not captured by the Pubmed search due to limitations in the input parameters. As the data collected from academic journals turned...