To develop a philosophical framework to address the specification of sex/gender in humans, I will begin by summarizing what we know about the biology of sex determination in human beings. Basically, sex/gender is specified by several networks of genes anchored in the genetic interaction between the two genes, Sry and Sox9. Next, I will propose that this biological mechanism is best understood within a philosophical anthropology that embraces insights taken from systems biology to articulate a hylomorphism that explains the integrity, dynamism, and teleology of the human organism. The systems perspective described here represents one attempt to reformulate the received philosophical framework of classical Aristotelian-Thomistic hylomorphism so that it incorporates the insights of modern biology. Finally, I will use the systems perspective and key principles articulated by St. Thomas Aquinas in his philosophy of nature to identify criteria that could be used to specify the sex/gender of a particular human being: The most certain criterion for maleness would be the capacity to produce sperm while the most certain criterion for femaleness would be the complementary capacity to produce eggs. Deviations from this criterion would decrease the certitude of our judgment regarding the sex/gender of the individual.

Background: An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore.

Methods: Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software.

Results: The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents.

Conclusions: The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.