Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact (...) care determinations. Evaluation of a number of alternative decision-making frameworks set out to address the shortcomings of prevailing atomistic and family-centric decision-making models within the confines of end-of-life care prove these alternative frameworks to be little better at protecting the best interests of vulnerable patients. As a result, we propose the Welfare Model that we believe is attentive to the relevant socio-culturally significant considerations of a particular case and better meets the needs of end-of-life care goals of preserving the welfare of patients. Employing a multi-professional team evaluation guided by regnant psychosocial, legal, and clinical standards and the prevailing practical and clinical realities of the particular patient’s setting the Welfare Model provides a clinically relevant, culturally sensitive, transparent, and evidence-based approach to care determinations. (shrink)

Two widespread assumptions concerning networks, including guanxi networks, are that they function in terms of trust relations and that their structure is dyadic. This article subjects both assumptions to critical assessment and proposes alternative formulations. When the distinctions between trust and trustworthiness and between trust and assurance are made, then broader understandings of guanxi relationships emerge. The article shows that the assurance mechanism of guanxi is public exposure of transgressions against network norms, leading to the transgressor’s loss of face (mianzi). (...) The necessity of third-party intervention of this type, typically but not exclusively through gossip, indicates the triadic rather than dyadic structure of guanxi relationships when sanction of reputation is included in the conceptualization of guanxi. Changes in guanxi during economic transition in China, from strong-to weaker-tie associations, require careful consideration of the changing nature of the mechanisms of face-loss. (shrink)