CENTRES 12th International Clinical Ethics Conference 2024
About
CENTRES Clinical Ethics Conference 2024 is on the theme “Revisiting Best Interests” and will be held on 11th & 12th January at the Kent Ridge Guild House.
The CENTRES Clinical Ethics Conference 2024 will focus on enhancing clarity on the principle of best interests. Although this complex topic has garnered significant attention in bioethics and legal literature, uncertainties persist when applying the principle in clinical practice. It is not always clear what ‘best interests’ is, leading to misinterpretations and conflicts in the care process.
The CENTRES Clinical Ethics Conference 2024 will focus on enhancing clarity on the principle of best interests. Although this complex topic has garnered significant attention in bioethics and legal literature, uncertainties persist when applying the principle in clinical practice. It is not always clear what ‘best interests’ is, leading to misinterpretations and conflicts in the care process.
Objective
The goal is to enable healthcare professionals to better understand what best interests mean in various contexts – patient welfare, beneficence, capacity, mental illness. The broad nature of best interests offers us the flexibility to select nuanced issues and cases for discussion.
Session 1: Vulnerable Adults
- This represents a large and wide-ranging group of patients, including persons with dementia and other cognitive impairments, patients with mental health issues, and those suffering from abuse.
- Decision-makers in these cases may also vary, and may include primary caregivers, social workers, community befrienders, etc. The best interests standard to be applied in these cases will also be evaluated.
Session 2: Persons with Psychiatric Issues
- Detaining and forcing treatment, use of physical and chemical restraints, and other forms of liberty restrictions often have built-in ‘best interests’ justifications. While the law (Mental Capacity Act and the Mental Health Care and Treatment Act) lays down what kind of decisions can be made, this ethically tenuous area demands further introspection into the nature of care that ought to be provided to such patients.
Session 3: Persons at the End-of-Life
- A considerably different set of guiding factors and complexities underlie the process of making decisions for incapacitated persons at the end of their life, whose wishes and desires about their care may, or may not have been made known in advance.
- Professionals are left facing difficulties in eliciting glimpses of these wishes and desires, and balancing family members’ requests and the patient’s clinical needs.
Session 4: Minors
- It is sometimes hard to identify what is in a child’s best interests, especially when there are conflicts between the medical team and the parents. This is usually compounded in emotionally charged situations where “difficult” decisions must be made. Limits of parental involvement may be tested, and the Courts may be approached to clarify what would be in the child’s best interests.
- As a child’s autonomy develops as they age, different ethical tensions may come into play when the child disagrees with their parents and/or medical team on treatments in their best interests.
- Burgeoning innovations and technologies are enhancing paediatric care and simultaneously amplifying the challenges in making decisions for this group when pitting the potential for a good outcome against a large set of unknowns (e.g., somatic gene therapy for children with rare conditions).
Who should attend
Clinical Ethics Committee (CEC) chairpersons and members, doctors, nurses, medical social workers, allied health professionals, lawyers, academics, care workers and policy makers.
Continuing professional education points: Will be awarded for doctors, nurses and pharmacists.
Continuing professional education points: Will be awarded for doctors, nurses and pharmacists.
Programme
DAY 1 – Programme
Session 1: 11th January 2024 (Thursday): Vulnerable Adults
| Time | Mode | Speakers/Panelists | Title/Topic |
|---|---|---|---|
| 9.00 to 9.10 | Welcome | Dr Sumy Menon | Opening remarks |
| 9.10 to 10.00 | Pre-recorded talk | Prof Richard Huxtable | In the Best Interests of the Patient? Best Interests Decision-Making in Healthcare in England and Wales |
| 10.00 to 10.35 | Talk | Dr Crystal Lim | Managing the tension between autonomy and protection of the vulnerable adult |
| 10.35 to 11.05 | Break | ||
| 11.05 to 11.40 | Talk | Dr Titus Lau | Safeguarding the vulnerable: MCA and best interest |
| 11.40 to 1.00 | Case Discussion | Prof Richard Huxtable Dr Sharon Kaur Dr Titus Lau Dr Crystal Lim |
|
| 1.00 to 2.00 | Lunch |
Session 2: 11th January 2024 (Thursday): Psychiatric / Mental Health Issues
| Time | Mode | Speakers/Panelists | Title/Topic |
|---|---|---|---|
| 2.00 to 2.35 | Talk | Dr Giles Tan | What weight should be given to the preferences and values of the person with mental illness when considering whether a treatment decision is in their best interests? |
| 2.35 to 3.10 | Talk | Dr Marcus Tan | Covert medication: an ethical choice or moral hazard? |
| 3.10 to 3.40 | Break | ||
| 3.40 to 5.00 | Panel | Ms Nawira Baig Ms Chan Lay Lin Dr Giles Tan Dr Marcus Tan |
|
| 5.00 to 5.15 | Summary |
DAY 2 – Programme
Session 3: 12th January 2024 (Friday): End of life
| Time | Mode | Speakers/Panelists | Title/Topic |
|---|---|---|---|
| 9.00 to 9.10 | Opening | Welcome back | |
| 9.10 to 9.45 | Talk | Prof Lalit Krishna | Unwise patient preferences – what about their best interests? |
| 9.45 to 10.20 | Talk | Adj. A/P Neo Han Yee | Patient’s best interests and life prolongation – compatible or not? |
| 10.20 to 10.55 | Talk | A/P Chan Mei Yoke | Healthcare team, family or legal representative – who should decide in the patient’s best interests? |
| 10.55 to 11.25 | Break | ||
| 11.25 to 12.50 | Case Discussion | A/P Chan Mei Yoke Prof Lalit Krishna Adj. A/P Neo Han Yee |
|
| 12.50 to 1.50 | Lunch |
Session 2: 11th January 2024 (Thursday): Psychiatric / Mental Health Issues
| Time | Mode | Speakers/Panelists | Title/Topic |
|---|---|---|---|
| 1.50 to 2.30 | Pre-recorded talk | Prof Dominic Wilkinson | Ethical issues in neonatal end of life care |
| 2.30 to 3.10 | Talk | Kumu Rajasegaran | Decision making in adolescents – capacity and competence |
| 3.10 to 3.40 | Break | ||
| 3.40 to 5.00 | Panel | A/P Chan Mei Yoke Dr Jonathan Choo Dr Kumu Rajasegaran |
|
| 5.00 to 5.15 | Summary | Closing of Conference |
Speakers
Associate Professor Chan Mei Yoke is currently a Senior Consultant in Paediatric Haematology/Oncology and Paediatric Palliative Care and is the Chair of the Clinical Ethics Committee in KK Women’s and Children’s Hospital (KKH).
She graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery. She trained in Paediatrics in Singapore and subspecialised in Paediatric Haematology/Oncology in Royal Marsden Hospital and Great Ormond Street Hospital in London, United Kingdom. She has an interest in Paediatric Palliative Care and helped set up a comprehensive paediatric palliative care service in KKH in Singapore in 2004. She also has a keen interest in medical ethics and completed a Masters in Bioethics from Harvard University, USA in 2022.
She graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery. She trained in Paediatrics in Singapore and subspecialised in Paediatric Haematology/Oncology in Royal Marsden Hospital and Great Ormond Street Hospital in London, United Kingdom. She has an interest in Paediatric Palliative Care and helped set up a comprehensive paediatric palliative care service in KKH in Singapore in 2004. She also has a keen interest in medical ethics and completed a Masters in Bioethics from Harvard University, USA in 2022.
Professor Richard Huxtable is the Professor of Medical Ethics and Law in University of Bristol. His research primarily concerns legal and ethical issues in end-of-life decision-making, surgery and paediatrics. He is the author of Law, Ethics and Compromise at the Limits of Life: To Treat or Not to Treat? (Routledge-Cavendish, 2012), Euthanasia, Ethics and the Law: From Conflict to Compromise (Routledge-Cavendish, 2007) and (with Dickenson & Parker) The Cambridge Medical Ethics Workbook (CUP, 2nd edn, 2010), plus numerous articles and chapters. His research has been funded by organisations including the Wellcome Trust and the European Commission and he has given invited presentations at the Royal Society of Medicine and the Royal College of Surgeons, as well as conferences worldwide.
Clinical Professor Lalit Krishna is a Senior Consultant at the Division of Supportive and Palliative Care, National Cancer Centre. He is also currently a Visiting Consultant at Bright Vision Hospital and Assisi Hospice.
Prof Lalit Krishna also holds the appointments of Clinical Professor at Duke-NUS Medical School, and Clinical Senior Lecturer at Yong Loo Lin School of Medicine, National University of Singapore. He is the chairman of the Clinical Ethics Committee and the Internal Audit Committee at NCCS. He is actively involved in teaching and continues to participate in medical, nursing and allied health education and is undertaking a PhD in Medical Education.
Prof Lalit Krishna also holds the appointments of Clinical Professor at Duke-NUS Medical School, and Clinical Senior Lecturer at Yong Loo Lin School of Medicine, National University of Singapore. He is the chairman of the Clinical Ethics Committee and the Internal Audit Committee at NCCS. He is actively involved in teaching and continues to participate in medical, nursing and allied health education and is undertaking a PhD in Medical Education.
Dr Titus Lau is a Senior Consultant, Division of Nephrology at the University Medicine Cluster, National University Hospital – National University Health System, Singapore.He is also the Program Director for Hemodialysis at the same institution and plays vital roles in Singapore’s medical community. Dr. Lau chairs the Chapter of Renal Physicians and serves as a council member at the College of Physicians, Academy of Medicine, Singapore. He is also a panel member at National Residency Training Committee, for Internal Medicine and for Nephrology.
Dr Crystal Lim is a Master Medical Social Worker at Singapore General Hospital (SGH) and Transplant Ethics Lead of SingHealth-Duke NUS Transplant Centre. She is a Clinical Assistant Professor at Duke-NUS and bioethics co-lead for SingHealth-Duke NUS Medical Humanities Institute. She is appointed to the Clinical Ethics Committee (CEC) of SGH, NUHS and AH.
Dr Lim attained her Ph.D. in Social Work and M.A. Bioethics from University of Pittsburgh in 2014 and 2015 respectively, and her Master of Social Work from University of Washington in 2001. She has extensive experience in developing and delivering education and training in transplant social work, clinical communications, bioethics and the medical humanities. She has received several awards for her work including: Outstanding Educator from Academic Medicine Education Institute of SingHealth-Duke NUS in 2023, Outstanding Social Worker Award from His Excellency S.R. Nathan in 2007 and SingHealth Group CEO Service Excellence Award in 2008.
Dr Lim attained her Ph.D. in Social Work and M.A. Bioethics from University of Pittsburgh in 2014 and 2015 respectively, and her Master of Social Work from University of Washington in 2001. She has extensive experience in developing and delivering education and training in transplant social work, clinical communications, bioethics and the medical humanities. She has received several awards for her work including: Outstanding Educator from Academic Medicine Education Institute of SingHealth-Duke NUS in 2023, Outstanding Social Worker Award from His Excellency S.R. Nathan in 2007 and SingHealth Group CEO Service Excellence Award in 2008.
Adjunct Assistant Professor Neo Han Yee is the incumbent Head and senior consultant at the Department of Palliative Medicine in Tan Tock Seng Hospital. He obtained his specialist board accreditation for Geriatrics Medicine in 2012 and subsequently pursued a second specialization in Palliative Medicine. In 2013, he was awarded a Health Manpower Development Plan to further his interest in Clinical Ethics in Hawaii. Upon his return, he joined the TTSH Clinical Ethics Committee, where he now serves as its chairperson.
Dr Neo is also an Adjunct Assistant Professor with Lee Kong Chien School of Medicine, where he teaches Clinical Ethics and Palliative Medicine modules. In addition to his interest in clinical ethics, Dr Neo has a research interest in the domain of palliative care for chronic dyspnea, prognostication in advanced lung diseases, palliative rehabilitation, as well as palliative healthcare service integration.
Dr Neo is also an Adjunct Assistant Professor with Lee Kong Chien School of Medicine, where he teaches Clinical Ethics and Palliative Medicine modules. In addition to his interest in clinical ethics, Dr Neo has a research interest in the domain of palliative care for chronic dyspnea, prognostication in advanced lung diseases, palliative rehabilitation, as well as palliative healthcare service integration.
Dr Kumudhini Rajasegaran is a Paediatrician & Senior Consultant in the Adolescent Medicine Service, at KK Women’s & Children’s Hospital. Dr. Kumu is also a Visiting Consultant at the Eating Disorder Unit, at Singapore General Hospital and is an Adjunct Assistant Professor at Duke National University Singapore Medical School. She received her medical training at the University College Dublin, Ireland.
Dr Marcus Tan
Dr Marcus Tan is the Chief of the Department of Recovery Care at the Institute of Mental Health (IMH). He is a Senior Consultant Psychiatrist and has a special interest in geriatric mental health. He is also actively involved in the IMH Pharmacy & Therapeutics Committee, IMH Medication Safety Workgroup and other patient safety initiatives in the hospital.
Dr Tan Ming Yee Giles
Dr Tan Ming Yee Giles is Senior Consultant with the Department of Developmental Psychiatry and Chief of General Psychiatry for the East region at the Institute of Mental Health (IMH) and Chair of the IMH Clinical Ethics Committee.
He is Associate Programme Director of the National Psychiatry Residency Programme and holds teaching appointments with the three local medical schools. He is Associate Director of the Singapore Medical Association – Centre for Medical Ethics and Professionalism (SMA-CMEP), Honorary Secretary of the College of Psychiatrists at the Academy of Medicine, Singapore and Vice-President of the Singapore Psychiatric Association.
He is Associate Programme Director of the National Psychiatry Residency Programme and holds teaching appointments with the three local medical schools. He is Associate Director of the Singapore Medical Association – Centre for Medical Ethics and Professionalism (SMA-CMEP), Honorary Secretary of the College of Psychiatrists at the Academy of Medicine, Singapore and Vice-President of the Singapore Psychiatric Association.
Professor Dominic Wilkinson is Professor of Medical Ethics at the University of Oxford, and Director of Medical Ethics and Deputy Director at the Oxford Uehiro Centre for Practical Ethics. He is a consultant in newborn intensive care at the John Radcliffe Hospital, Oxford. He is a senior research fellow at Jesus College Oxford.
Dominic has published more than 200 academic articles relating to ethical issues in intensive care for adults, children and newborn infants. His co-authored books include ‘Medical Ethics and Law, third edition’ (Elsevier 2019); ‘Ethics, Conflict and Medical treatment for children, from disagreement to dissensus’ (Elsevier, 2018) (BMA President’s Award in 2018 British Medical Association Book Awards). He is also the author of ‘Death or Disability? The ‘Carmentis Machine’ and decision-making for critically ill children’ (Oxford University Press 2013). He was Editor and Associate Editor of the Journal of Medical Ethics from 2011-2018.
Dominic has published more than 200 academic articles relating to ethical issues in intensive care for adults, children and newborn infants. His co-authored books include ‘Medical Ethics and Law, third edition’ (Elsevier 2019); ‘Ethics, Conflict and Medical treatment for children, from disagreement to dissensus’ (Elsevier, 2018) (BMA President’s Award in 2018 British Medical Association Book Awards). He is also the author of ‘Death or Disability? The ‘Carmentis Machine’ and decision-making for critically ill children’ (Oxford University Press 2013). He was Editor and Associate Editor of the Journal of Medical Ethics from 2011-2018.
Panelists
Ms Nawira Baig
Ms Nawira Baig is Peer Support Specialist with the Institute of Mental Health (IMH). She first started with the Slow Stream Rehabilitation and pilot Recovery Centre wards and currently works with the Medical Social Work Department, covering East Region acute wards, where she continues to leverage her lived experience to journey with persons in recovery. With over a decade of experience in mental health advocacy, she advocates recovery and wellness for all — individuals, communities, organisations, and nations. Coupling her background in mass communication with her current academic pursuit of psychology, she strives to bring forth ‘voices unheard’ to shape narratives, co-create solutions and influence discourse on mental health and stigma. She currently volunteers as Community Engagement Director for the Singapore Psychological Society Youth Wing and Expert Mentor for the ASEAN-Australian Youth Mental Health Fellowship Program, led by Orygen Global. Nawira has also served on the Board of Directors for the National Association of Peer Supporters (USA). She is passionate about youth and women’s mental health and developing recovery oriented and culturally informed services.
Ms Chan Lay Lin
Ms Chan Lay Lin is Principal Medical Social Worker at Institute of Mental Health (IMH). Lay Lin holds masters degrees in Social Work, and in Family and Systemic Psychotherapy. Currently with IMH, Lay Lin is the Social Work Education Lead, and carries a case load in family therapy. She has extensive experience in community-based social work, and medical social work having worked in both general and tertiary hospitals.
Lay Lin serves as a member of the Review Board for Vulnerable Adults with MFS, and with the IMH Clinical Ethics Committee. She also serves as a scientific member of the National Healthcare Group (NHG) research ethics board; and is the deputy chair with the IMH Institutional Research Review Committee. Lay Lin’s passion is in couple and family therapy, family violence, grief work, and qualitative research.
Lay Lin serves as a member of the Review Board for Vulnerable Adults with MFS, and with the IMH Clinical Ethics Committee. She also serves as a scientific member of the National Healthcare Group (NHG) research ethics board; and is the deputy chair with the IMH Institutional Research Review Committee. Lay Lin’s passion is in couple and family therapy, family violence, grief work, and qualitative research.
Dr Jonathan Choo is a paediatric and fetal cardiologist at KK Women’s and Children’s Hospital. He was trained in both paediatrics and cardiology in Singapore. His research interests are in cardiac genetics, developmental origins of cardiac disease and health, vascular disease and echocardiography. He is also involved in clinical ethics, being on ethics committees at hospital and national levels.
Dr Sharon Kaur is an Associate Professor at the Faculty of Law, Universiti Malaya, where she has designed modules on healthcare law and ethics for undergraduate as well as postgraduate students including a number of modules on the Masters of Health Research Ethics (MOHRE) at the Faculty of Medicine. Her research interests primarily revolve around global health bioethics. She is keen on developing her work on migrant health ethics, particularly in relation to health research; as well as issues relating to the intersection of bioethics, law, and public policy. She is a member of the WHO Covid 19 Ethics and Governance Working Group, the Steering Committee of the Global Forum for Bioethics in Research (GFBR) and the International Expert Network of the Global Infectious Disease Ethics Collaborative (GLIDE). She is working with colleagues on a Wellcome Trust funded project to set up the Southeast Asian Bioethics Network.
Directions to the venue
Conference Venue Address:
Kent Ridge Guild House
9 Kent Ridge Drive
Singapore 119241 (Map)
Public Transport Information:
Nearest MRT Station: Kent Ridge (CC24)
Bus Services at Kent Ridge Terminal: 10, 33, 95, 151, 151E, 189, 200
Bus Services at Heng Mui Keng Terrace: 10, 30, 30E, 51, 143, 183, 188, 200
Parking Information: Guests arriving by car can park directly opposite Kent Ridge Guild House at Car Park 15.
Note: Click here for the map and more public transport information.
Kent Ridge Guild House
9 Kent Ridge Drive
Singapore 119241 (Map)
Public Transport Information:
Nearest MRT Station: Kent Ridge (CC24)
Bus Services at Kent Ridge Terminal: 10, 33, 95, 151, 151E, 189, 200
Bus Services at Heng Mui Keng Terrace: 10, 30, 30E, 51, 143, 183, 188, 200
Parking Information: Guests arriving by car can park directly opposite Kent Ridge Guild House at Car Park 15.
Note: Click here for the map and more public transport information.
Videos
Opening Address by Dr Sumytra Menon
In the Best Interests of the Patient? – Professor Richard Huxtable
Safeguarding the vulnerable: MCA and best interests – Dr Titus Lau
Balancing Respect for Autonomy and Protecting Vulnerable Adults – Dr Crystal Lim
Session 1: Vulnerable Adults – Case Discussions
Considering Treatment Decisions: Mental Illness & Best Interests – Dr Giles Tan
Covert medication: an ethical choice or moral hazard? – Dr Marcus Tan
Session 2: Psychiatric/Mental Health Issues – A Panel Discussion
Unwise patient preferences and their best interests – Professor Lalit Krishna
Is patient’s best interests & life prolongation compatible? – Dr Neo Han Yee
Who should decide in the patient’s best interests? – A/P Chan Mei Yoke
Session 3: End of life – Case Discussions
Ethical Issues in Neonatal End of Life Care – Professor Dominic Wilkinson
Decision-making in Adolescents: Capacity and Competence – Dr Kumu Rajasegaran
Session 4: Minors – A Panel Discussion
Photos
Day 1
Day 2
