Clinical Ethics In Context: Perspectives From Southeast Asia

Establishing a robust clinical ethics infrastructure in resource-limited settings requires a strategic blend of education, structured training, and responsive consultation. This presentation shares the journey of pioneering the Clinical Ethics Service in Sabah, Malaysia.

We highlight the evolution of our educational initiatives, including the annual Sabah Medicolegal and Clinical Ethics Conference, which draws widespread regional participation. To sustain internal capacity, we implemented regular, structured in-house training for Clinical Ethics Committee members. Since its formal launch in October 2023, our consultation service has navigated diverse ethical dilemmas; this session will analyze the core themes and trends emerging from these referrals. Furthermore, our efforts have expanded into regional advocacy, organizing and providing clinical ethics training across neighbouring districts.

Looking ahead, bolstered by the presenter’s Graduate Certificate in Clinical Ethics issued by Albany Medical College, through the Alden March Bioethics Institute (AMBI), the vision centers on scaling local capabilities to safeguard high-quality, ethically sound patient care. By sharing our challenges and milestones, we aim to inspire future cross-border collaborations, fostering a unified, resilient clinical ethics network across the region.

Sreymom Pol will be presenting the report’s findings from the SEABION Project, a mixed-methods study evaluating the impact of a newly designed Bioethics and Professionalism course at the University of Puthisastra (UP), Cambodia.

The result will draw on a pre-post survey, Focus Group Discussions (n=22 students), and In-Depth Interviews with faculty and medical education experts, the study examines changes in students’ knowledge, attitudes, and applied competency readiness.

A central argument of the presentation is that effective bioethics education in Cambodia cannot be a transplanted Western curriculum. Two contextual challenges are foregrounded. First, the “hidden curriculum” problem: students arrive at clinical placements where senior clinicians do not explicitly model ethical behaviour, rendering classroom ethics training invisible at the ward level. Second, a linguistic and cultural gap: the four core bioethical principles (Autonomy, Beneficence, Non-maleficence, Justice) are taught in English but lack standardized Khmer equivalents, making them cognitively abstract and difficult to internalize or pronounce in a first-language context.

The presentation further demonstrates how Cambodian culture connecting to ethical values in which could potentially merge naturally onto the four principles, offering a culturally resonant bridge between international bioethics frameworks and local moral vocabulary.

Quantitative findings show a mean knowledge gain of +21.5 percentage points, with the largest improvements in core conceptual items (four principles: 35%→93%; non-maleficence: 56%→97%). Eighteen of twenty attitude items improved post-course. Qualitative themes include: confusion of medical deontology with applied bioethics; a “delayed appreciation” effect among students and faculty; and convergent recommendations for earlier curriculum integration, case-based learning, mandatory grading with OSCE, and hospital-level preceptor training. The study represents the first mixed-methods evidence base for bioethics curriculum reform in Cambodia.

Hope occupies a paradoxical place in healthcare. It is often celebrated as essential to resilience and coping, at the same time it may imply denial, unrealistic expectations, or requests for treatment perceived as futile. In pediatric care, these tension pronounced as uncertainty, vulnerability, and profound moral responsibilities intersect. Parents, children, and healthcare professionals must often make decisions in circumstances where outcomes are unclear and responsibility extend beyond clinical evidence.

This presentation develops the concept of an ethics of hope as a novel framework for pediatric clinical decision-making. Rather than understanding hope merely as an emotion, psychological coping mechanism, or obstacle to rational deliberation, an ethics of hope conceives hope as an ethical practice that shapes how individuals and communities respond to uncertainty, suffering, and moral responsibility. It is neither blind optimism nor denial of reality, but a disciplined and relational commitment to seeking meaningful possibilities while remaining grounded in clinical truth.

Drawing on insights from medical humanities, bioethics, pediatric practice, and relational ethics, we argue that an ethics of hope provides a richer account of decision-making than approaches centered primarily on medical futility. The framework recognizes that clinical decisions are embedded within relationships, evolving narratives, and shared responsibilities, and that ethically sound deliberation requires attention not only to what treatments can achieve, but also to what forms of care, meaning, and flourishing remain possible for children and families.

Through real-world pediatric case dilemmas, this framework can guide communication, support shared decision-making, and help clinicians navigate uncertainty while preserving both professional integrity and compassionate care.

The presentation concludes by arguing that an ethics of hope offers a valuable contribution to pediatric care by reframing hope not as a barrier to good decision-making, but as one of its essential moral foundations.