Three research projects will be established and completed within the framework of the grant. These projects address important contemporary challenges in i) ensuring ethical practice in health and community care ethics and ii) understanding the nature, conduct and practice of interdisciplinary approaches to bioethics in Asia.

Each project is outlined in turn:

Project 1 – Care at home: Addressing new ethical challenges in contemporary ageing societies
Singapore, like other ageing societies, is reconfiguring its health and social care policy framework and practices to address an ageing population and changing health needs as people increasingly require long-term health interventions, management and social supports. One key component of these changes within Singapore and other high-income countries is an increasing trend to decentralise and relocate health care services away from the acute clinical setting to the domestic and community setting.

This gives rise to new expectations and shifts in the organisation of care services, including:

1. an emphasis on primary care to ensure continuity of care, and the roll out of novel care planning mechanisms;
2. an increasing reliance on families, foreign domestic workers, volunteers, neighbours and other para-professional caregivers to play key roles in the day-to-day management the health, care and activities of daily living (ADLs) of older adults at home;
3. the use of new technologies, including assistive technologies, smart home design, robotics and e-health apps to enable arms-length care surveillance and management.

It has been recognised that these transitions in policy and practice give rise to distinctive ethical challenges that need to be interrogated carefully. Thus far, however, progress has been limited to mapping out the broad landscape of these issues, rather than scrutinising the precise contextual realities of how they manifest, or in trying to address these issues through extensive ethical analysis.

Project 2 – Theorising Asian Bioethics
Bioethics in Asia is in its infancy. Attempts to articulate the distinctive form of, or specific approaches to, bioethics in Asia have been dominated by essentialist notions of ‘the East’ and the ‘the West’ [REF], becoming bogged down in unproductive debates about ethical relativism and oversimplified accounts of communal/familial vs. individual responsibilities.

Over the last 3 years, I have undertaken work with colleagues in Hong Kong University, supported by a network of academic collaborators across 13 other Asian countries, to produce a novel sociological account of the contemporary development of bioethics in the region that is founded on the theoretical concept of ‘generative accommodation’

Drawing on regulatory science, socio-legal studies and the sociological study of bioethics, we have argued that the evolution of legal, ethical and political responses in different Asian countries hinges on the unique social, geopolitical and cultural circumstances of those countries as they attempt, in different ways and for various reasons, to align international expectations around ethical practice with local values, religious commitments, political frameworks and social conventions. Thus far, we have explored this overarching account of Asian bioethics only in the context of the emergence of new laws, policies and regulatory responses to the use of advance directives in Asia. Important work remains to examine the viability and application of this theoretical approach in the context of other recent developments in the region concerning the ethical assessment and regulation of new technologies, including the use of AI, reproductive technologies, and genomics.

Project 3 – Empirical Bioethics 2.0
Over the past 20 years, empirical bioethics has emerged as a major sub-field of bioethics, focused on producing interdisciplinary approaches to bioethics methodology that integrate qualitative social science research with philosophical ethical analysis. I have been at the forefront of work that has been undertaken to explicate the theoretical and methodological foundations of empirical bioethics approaches (e.g. [6, 7, 8]). Whilst much progress has been made in establishing and defending overarching methodological frameworks, less progress has been made in determining how empirical bioethics research activities should be conducted, and how deliberative engagement with stakeholders about arguments, reasons and ethical considerations should be navigated in an interview/focus group context.

Empirical Bioethics 2.0 will aim to address this gap, providing detailed guidance around empirical bioethics methods, and the conduct of specific methodological activities in the sub-field to produce academic papers and a research methods handbook, in the following ways:

1. Identifying and navigating research ethics tensions in the conduct of empirical bioethics, when engagement by stakeholders in normative debates about their personal and professional lives can be disruptive and potentially harmful
2. The practices of integration: how, for example should consensus be reached, or coherence be achieved, in the iterative design of empirical bioethics studies. What are the markers of alignment between intuitions/experiences/attitudes and ethical values/principles/concepts in the analytic process?