OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to (...) set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Objective: The objectives of this study are to understand the current functions, structure and operation of hospital ethics committees (HECs) in Shanghai and to facilitate their improvement. Methods: (1) A questionnaire survey, (2) interviews with secretaries and (3) on-site document reviews of HECs in Shanghai were used in the study, which surveyed 33 hospitals. Results: In Shanghai, 57.56% of the surveyed hospitals established HECs from 1998 to 2005. Most HECs used bioethical review of research involving human subjects as well as (...) bioethical review or consultation regarding medical care services and administrative decision- making. Of the surveyed HECs, 14.3% did not provide any formal bioethical training to the HECs’ members and many HECs had no standard operating procedures. Some HECs had no clear definition of what was “conflict of interest” that should be considered by the HECs, while 44.4% of the HECs did not perform continuing review. Discussion: After the issues of related national regulations, more and more hospitals established HECs in Shanghai, but the functions of HECs need to be further developed and formal training on bioethics should be provided to HEC members. To assure the independence and good performance of HECs, the conflict of interest procedure, the standard operating procedures and bioethical review should be improved. Conclusion: HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement. (shrink)

BackgroundTurnover intention, an employee’s intention to voluntarily leave their jobs, affects workforce sustainability. However, scarce data are available about turnover intention and its associated factors among psychiatrists in China, especially during the COVID-19 pandemic. The current research was designed to address this gap.MethodsAn anonymous, nationwide online survey was disseminated to psychiatrists in 41 psychiatric hospitals in China. We collected demographic data, job-related information, and participants’ turnover intention in the next 12 months.ResultsIn total, 3,973 psychiatrists completed the survey. The sample was (...) predominantly female and married, and nearly three-fourths had children. More than one-third had a master’s or doctoral degree in addition to their medical degree. The overall level of job satisfaction was moderate. The rate of turnover intention was 22.0% and was comparable in males and females. Psychiatrists who had participated in the frontline work of COVID-19 were more likely to report an intention to leave their current job. Multiple regression analyses suggested that turnover intention was significantly associated with having insomnia, longer working hours, and more working days per week.ConclusionDuring the pandemic period, approximately one-fifth of psychiatrists in China reported turnover intention. Factors associated with turnover intention included high job-related burdens, low job satisfaction, participation in the frontline work against COVID-19, and insomnia. To improve psychiatric workforce sustainability, policymakers and hospital administrators need to be aware of this potential challenge and address the concerns of psychiatrists in China. (shrink)

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and (...) third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. (shrink)

Literature on testimonial injustice and ways that perpetrators might combat it have flourished since Miranda Fricker’s ground-breaking work on testimonial injustice. Less attention has been given, however, to the role of bystanders. In this paper, I examine the accountability that bystanders may have for their omissions to redress testimonial injustice. I argue that bystander accountability applies in cases where it is opportune for bystanders to intervene, and if they are also sufficiently equipped and able to redress the testimonial injustice. Moreover, (...) I recommend that we move beyond virtue responsibilism for ameliorative thinking about testimonial injustice. (shrink)

Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more (...) systematic conceptualization of the family—the kind of family that matters morally—is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members. (shrink)

Abortion is the deliberate termination of a pregnancy. In current practice, this involves the death of the foetus. Consequently, the debate on whether those experiencing an unwanted pregnancy have the right to abortion is usually dichotomized as a matter of pro-choice versus pro-life. Pro-choice advocates maintain that abortion is acceptable under various circumstances. The idea that we ought to respect pregnant people’s rights to choose what to do with their bodies – respect for bodily autonomy – is cited as a (...) major reason for granting them abortion rights. Pro-life advocates, on the other hand, claim that abortion is not acceptable under most circumstances. They argue, typically, that the foetus has a right to life. Recent events, such as Poland’s High Court decision in October 2020 to ban most abortions, and the huge protests and outcries this generated around the world, indicate that the abortion debate is far from resolved. (shrink)

Originally published: Oxford: Clarendon Press, 1932.

In this study, we attempt to explain the divergent results found in the relationships between supervisor–subordinate guanxi and employee work outcomes. Specifically, we propose that the relationships between supervisor–subordinate guanxi and participatory management, turnover intentions, and organizational commitment are mediated by job satisfaction. Based on the data collected from a sample of 196 employees of three local manufacturing firms in Zhejiang Province, China, we found that job satisfaction fully mediated the effects of supervisor–subordinate guanxi on participatory management and intentions to (...) leave, but partially mediated the relationship between supervisor–subordinate guanxi and organizational commitment. Theoretical and practical implications are discussed. (shrink)

It was natural and inevitable that his two Aethiopias, in the eastern and western extremities of the world, should be identified with the countries of the two dark-skinned peoples in the Far East and the Far West of the Ancient World: India and Mauretania.There was the difficulty that the real Aethiopia was in Africa, neither in the Far East nor in the Far West. Serious writers on geography tried to reconcile Homer and the geographical facts.I wish to excerpt from Strabo (...) three theories concerning Aethiopia and the Aethiopians which will then be used to elucidate passages in Latin literature. (shrink)

We present the logic K/2 which is a logic with classical implication and only the left part of classical negation.We show that it is possible to define a classical negation into K/2 and that the classical proposition logic K can be translated into this apparently weaker logic.We use concepts from model-theory in order to characterized rigorously this translation and to understand this paradox. Finally we point out that K/2 appears, following Haack's distinction, both as a deviation and an extension of (...) K. (shrink)

It was natural and inevitable that his two Aethiopias, in the eastern and western extremities of the world, should be identified with the countries of the two dark-skinned peoples in the Far East and the Far West of the Ancient World: India and Mauretania. There was the difficulty that the real Aethiopia was in Africa, neither in the Far East nor in the Far West. Serious writers on geography tried to reconcile Homer and the geographical facts. I wish to excerpt (...) from Strabo three theories concerning Aethiopia and the Aethiopians which will then be used to elucidate passages in Latin literature. (shrink)