The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating to (...) patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. (shrink)

We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...) conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer. D’Angelo,2 Lemma3 and Wren4 highlight the importance of considering Phoenix as a ‘whole person in context’ 2 prior to initiating treatment or care. In this way, they advocate for a process of ‘therapeutic exploration’,4 which includes taking sufficient time to explore Phoenix’s personhood with them so as to support them in achieving an ‘authentic self-discovery’.2 We agree with these authors that identity development is a complex, life-long process that is influenced by biological, psychosocial and relational aspects, all of which may contribute to an individual’s desire to pursue gender-affirming interventions. To explore the various factors—both conscious and unconscious—that might be motivating Phoenix’s decision to pursue ongoing puberty suppression, D’Angelo,2 Lemma3 and Wren4 describe a comprehensive psychological approach to working with transgender and gender diverse individuals and propose questions to guide such discussions. Consistent with this approach, we stipulated that Phoenix had undergone regular psychological counselling and that the psychologist had judged that ‘Phoenix’s distress is significant and enduring…not a symptom …. (shrink)

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the ethical defensibility (...) of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)

La tension entre domination et resistance est au centre de la notion du pouvoir politique chez Hobbes. Or, celui-ci opere une mutation dans l'histoire de ces deux notions. La mutation intervenue dans la figure du gouvernant s'opere avec la notion de souverainete, c'est-a-dire avec la mise en place d'un concept uniquement politique du pouvoir, la rupture correlative intervenue dans la notion resistance consiste dans le passage du droit de resistance collectif du peuple au tyran a la notion de droit de (...) resistance individuel face au pouvoir quel qu'il soit. Sont abordes ensuite, les lieux de tension entre domination et resistance : la rebellion, la guerre civile, le droit de punir, le statut de la liberte et la guerre interetatique. Enfin, on trouvera une analyse de la lecture critique que Foucault fait de Hobbes. (shrink)

Preface--I. The definition of pragmatism and humanism--II. From Plato to Protagoras.--III. The relations of logic and psychology.--IV. Truth and Mr. Bradley.--V. The ambiguity of truth.--VI. The nature of truth.--VII. The making of truth.--VIII. Absolute truth and absolute reality.--XI. Empiricism and the absolute.--X. Is absolute idealism solipsistic? XI. Absolutism and the dissociation of personality.--XII. Absolutism and religion.--XIII. The papyri of Philonous, I-II.--XIV. I. Protogoras the humanist.--XV. II A dialogue concerning gods and priests.--XVI. Faith, reason, and religion.--XVII. The progress of psychical research.--XVIII. (...) Freedom.--XIX. The making of reality.--XX. Dreams and idealism.-- Index. (shrink)

In this paper, we explore the traditional conception of a prioricity as epistemic independence of evidence from sense experience. We investigate the fortunes of the traditional conception in the light of recent challenges by Timothy Williamson. We contend that Williamson’s arguments can be resisted in various ways. En route, we argue that Williamson’s views are not as distant from tradition as they might seem at first glance.

Although many bioethicists have given attention to the special health issues of Africa and to the ethics of research on the continent, only a handful have considered these issues through the lens of African moral thought. The question has been for the most part neglected as to what a distinctively African moral perspective would be for the analysis and teaching of bioethics issues. To address the oversight, the authors of this paper describe embarking on a project aimed at incorporating African (...) moral perspective, values and philosophy into a teaching curriculum. The authors clarify the rationale for the project and discuss the strategies employed in Africanizing the bioethics curriculum. (shrink)

Nietzsche colocou-se como um antípoda a Platão. Mas em questões cosmológicas, o eterno retorno nietzschiano tem também alguns pontos em comum à cosmologia platônica descrita no Timeu. A finitude espacial, a ciclicidade cósmica e a ética cosmológica dizem respeito às semelhanças, já a infinitude temporal, a teleologia e a necessidade afastam os filósofos. Então, neste trabalho, aponto proximidades e afastamentos entre os dois filósofos em questões cosmológicas, além de sugerir alguma atualidade de suas concepções em relação à nossa ciência. Como (...) veremos, a relação entre ética e cosmologia ainda se mostra atual. (shrink)