As the aging population, including frail older people, continues to grow in Mainland China, quality of life and end-of-life care for frail older people has attracted much attention. Advance care planning is an effective way to improve end-of-life care for people with advanced diseases, and it is widely used in developed countries; however, it is a new concept in Mainland China. The effects of advance care planning and its acceptability in Mainland China are uncertain because of its culture-sensitive characteristics. The (...) objective of this article is to discuss the serious social issue of caring for frail older people and illustrate the possibility of implementing advance care planning in nursing homes in Mainland China through a review of relevant literature, which will focus on legislation, healthcare system engagement, public engagement, and cultural issues. Recommendations to promote and implement advance care planning include choosing nursing homes as a proper setting, establishing an ethical climate, and enhancing public awareness. (shrink)

Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: (...) This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society. (shrink)

As scientific and engineering efforts become increasingly global in nature, the need to understand differences in perceptions of research ethics issues across countries and cultures is imperative. However, investigations into the connection between nationality and ethical decision-making in the sciences have largely generated mixed results. In Study 1 of this paper, a measure of biases and compensatory strategies that could influence ethical decisions was administered. Results from this study indicated that graduate students from the United States and international graduate students (...) studying in the US are prone to different biases. Based on these findings, recommendations are made for developing ethics education interventions to target these decision-making biases. In Study 2, we employed an ethics training intervention based on ethical sensemaking and used a well-established measure of ethical decision-making that more fully captures the content of ethical judgment. Similar to Study 1, the results obtained in this study suggest differences do exist between graduate students from the US and international graduate students in ethical decision-making prior to taking the research ethics training. However, similar effects were observed for both groups following the completion of the ethics training intervention. (shrink)

As scientific and engineering efforts become increasingly global in nature, the need to understand differences in perceptions of research ethics issues across countries and cultures is imperative. However, investigations into the connection between nationality and ethical decision-making in the sciences have largely generated mixed results. In Study 1 of this paper, a measure of biases and compensatory strategies that could influence ethical decisions was administered. Results from this study indicated that graduate students from the United States and international graduate students (...) studying in the US are prone to different biases. Based on these findings, recommendations are made for developing ethics education interventions to target these decision-making biases. In Study 2, we employed an ethics training intervention based on ethical sensemaking and used a well-established measure of ethical decision-making that more fully captures the content of ethical judgment. Similar to Study 1, the results obtained in this study suggest differences do exist between graduate students from the US and international graduate students in ethical decision-making prior to taking the research ethics training. However, similar effects were observed for both groups following the completion of the ethics training intervention. (shrink)

Many lymphokine genes have now been cloned from activated T cells and their products have been expressed in mammalian cells. Use of these recombinant lymphokines has provided the opportunity to evaluate both the spectrum of their biological activities and the mechanisms of their action in promoting proliferation and differentiation of hemopoietic and lymphoid cells. Characterization of the structure of lymphokine genes will provide information about their regulated expression in T‐cell activation.

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

In their paper “Mary, Mary, Quite Contrary” , George Graham and Terence Horgan argue, contrary to a widespread view, that the socalled Knowledge Argument may after all pose a problem for certain materialist accounts of perceptual experience. I propose a reply to Graham and Horgan on the materialist’s behalf, making use of a distinction between knowing what it’s like to see something F and knowing how F things look.

The article explores the private nature of subjectivity in programs of integration the phenomenology with naturalism. It is considered if their tools are relevant for the phenomenological, rather than naturalistic way of subjectivity’s explaining. Justification of the key ideas is provided with the help of such concepts as “body image”, “body scheme”, (Sh. Gallagher), “ontological significance” (L. Baker), “experience”, “cognitive niches” (F. Varela), “transparent body” (T. Fuchs). Based on the traditional phenomenology of E. Husserl, it is shown that a set (...) of approaches that integrate phenomenology and naturalism within the framework of “first-person philosophy” can be characterized as a phenomenology without a phenomenological subject. It is shown that the phenomenological nature of the self-perspective in integrative programs is more likely to be understood as the qualification and privacy of subjectivity, while the transcendental aspect of the unobservable and biased consciousness is practically not taken into account. The article concludes that the logic of some projects of integration of phenomenology and naturalism overlook this transcendental peculiarity of consciousness, its fundamentally unobserved character. The classical phenomenological approach emphasizes on the extra-natural, biased, and non-empirical nature of consciousness. The role and significance of the phenomenological approach is not limited to the idea of “what-is-likeness” and privacy of subjective states. Phenomenology, which preserves the idea of the subject, means a radical break with the ontology of things and, in general, with the ontology of something objective at all. (shrink)

"... Fraser and Bartky have brought the encounter between U.S. and French feminism to a new level of seriousness." —Ethics In the last decade, elements of French feminist discourse have permeated and transformed the larger feminist culture in the United States. This volume is the first sustained attempt to revalue French feminism and answer the question: What has been gained and what has been lost as a result of this intercultural encounter? Interviews with Simone de Beauvoir open the book; essays (...) by French feminists Sarah Kofman and Luce Irigaray follow; the North American contributors are Judith Butler, Nancy Fraser, Diana J. Fuss, Nancy J. Holland, Eleanor H. Kuykendall, Dorothy Leland, Diana T. Meyers, Andrea Nye, and Margaret A. Simons. (shrink)

Meyers examines the question of personal autonomy. She observes the effects of childrearing practices and sexual biases, and reflects upon the results in women. Annotation copyrighted by Book News, Inc., Portland, OR.

Diana Tietjens Meyers examines the political underpinnings of psychoanalytic feminism, analyzing the relation between the nature of the self and the structure of good societies. She argues that impartial reason--the approach to moral reflection which has dominated 20th-century Anglo-American philosophy--is inadequate for addressing real world injustices. ____Subjection and Subjectivity__ is central to feminist thought across a wide range of disciplines.

How is women’s conception of self affected by the caregiving responsibilities traditionally assigned to them and by the personal vulnerabilities imposed on them? If institutions of male dominance profoundly influence women’s lives and minds, how can women form judgments about their own best interests and overcome oppression? Can feminist politics survive in face of the diversity of women’s experience, which is shaped by race, class, ethnicity, and sexual orientation, as well as by gender? Exploring such questions, leading feminist thinkers have (...) reinvigorated work on the concept of self and personal identity, as demonstrated by the discussions in this insightful volume.The concerns that animate feminist scholarship have prompted feminist philosophers to sideline the theme of individualism and to focus on the theme of intersubjectivity. In conceptualizing the self, the contributors to this volume highlight emotional bonds among people, the stories people tell one another, and the systems of categories and behavioral norms that unite and divide groups of people. Topics addressed include sexual violence and the self, the social self and autonomy, the narrative self and integrity, self-ownership and the body, forgetting yourself and your race, group membership and personal identity, grief and gender, sympathy and women’s diversity, emotion and emancipatory epistemology, and dependency and justice. This volume will be important reading for students of feminist theory, ethics, and social and political philosophy. (shrink)

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A response to Susan Hekman's article "Reconstituting the Subject: Feminism, Modernism, and Postmodernism" and to her review of Diana T. Meyers' book Self, Society, and Personal Choice both of which appeared in Hypatia 6.

Recent liberal moral and political philosophy has placed great emphasis on the good of self-respect. But it is not always evident what is involved in self-respect, nor is it evident how societies can promote it. Assuming that self-respect is highly desirable, I begin by considering how people can live in a self-respecting fashion, and I argue that autonomous envisaging and fulfillment of one's own life plans is necessary for self-respect. I next turn to the question of how societal implementation of (...) rights may affect self-respect, and I urge that discretionary rights, which allow people to decline the benefits they confer, support self-respect more effectively than mandatory rights, which forbid people to refuse the benefits they confer. I conclude by examining the import of these contentions for feminist theory. I believe that my arguments are of particular concern to women because women have traditionally been victimized by a mandatory right to play a distinctively "feminine" role which has undermined their self-respect. (shrink)

Ronald Dworkin maintains that particular rights, like the right to free speech and the right to own personal property, can be derived from a foundational right, the right to equal concern and respect. This paper questions the tenability of this program for rights-based rights. A right is an individuated moral or political guarantee which confers a specified benefit on each right-holder and which resists conduct that would derogate it. For there to be rights-based rights, both the foundational right and the (...) rights it implies must satisfy this definition. It is doubtful, however, that the right to equal concern and respect should count as a right since the benefits it confers are at best highly controversial and may not be assignable to individuals. But even if we grant that the content of the right to equal concern and respect can be satisfactorily specified, the status of the derived rights remains problematic. The trouble is that the relation between the right to equal concern and respect and the rights it implies parallels the relation between the principle of utility and the rights it may imply. Both of these foundational principles can extinguish derived rights. Consequently, rights dependent on either of these principles are not trumps, and their standing as rights is suspect. I conclude that Dworkin's method of defending rights is inappropriate for the most important of our rights though it may well serve for less critical ones. (shrink)

In the words of Catharine MacKinnon, "a woman is not yet a name for a way of being human." In other words, women are still excluded, as authors and agents, from identifying what it is to be human and what therefore violates the dignity and integrity of humans. Recognition, Responsibility, and Rights is written in response to that failure. This collection of essays by prominent feminist thinkers advances the positive feminist project of remapping the moral landscape by developing theory that (...) acknowledges the diversity of women. (shrink)