Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Background Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students. Objective The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students with and without clinical exposure. (...) Research design A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong. Participants and research context A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire. Ethical consideration Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent. Findings Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the ‘conflicts’ domain with increased clinical exposure. Conclusion Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings. (shrink)

This book is a collection of articles on different aspects of university education in China since the late nineteenth century, addressing how far the ideal of modern university education, which has gradually been developed in the West since the age of European Enlightenment, was adopted or transformed by Chinese universities.

While the movement to ensure patient’s rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients’ best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the (...) practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse’s narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients’ autonomy or safeguarding patients’ right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care. (shrink)

Rgyal ba rdo rje 'chaṅ yab yam gyi rnam thar rin chen gter mdzod -- Saṅs rgyas thams cad kyi rnam 'phrul Rje-btsan Ti-lo-pa'i rnam mgur -- Bde gśegs phag mo gru pa'i rnam thar -- Bram zc chen pos mdzad pa'i ṅoh ha bskor gsum blo gsal mgal brgyan -- Bka' yoṅ dag pa'i tshad ma źes bya ba mkha'i 'gro ma'i man ṅag -- Bya btaṅ stag rtse sku skye'i rtogs brjod med snaṅ chu zla'i zlos gar -- (...) 'Gu-ru rin-po-che'i rnam thar bstod pa dbyid kyi sgra dbyaṅs. (shrink)

This study seeks to trace the boundaries of the sign in the phenomenological tradition of Edmund Husserl. The approach adopted here is largely historical and has no other ambition that to identify those questions that pertain to the sign and have been of interest for phenomenology. The article is divided in four parts : the first examines an essay from 1890 entitled Semiotik and situates it in the context of the young Husserl's work in the philosophy of mathematics ; the (...) second part concerns the first section of the Logical Investigations ; the third one seeks to account for the changes that testify to the evolution of Husserl's thinking regarding the sign between the Logical Investigations (1900-01) and "Origins of Geometry" (1936) ; the last part considers the contribution of post-Husserlian phenomenology, from Martin Heidegger to Merleau-Ponty and beyond, to semiotics. -/- Résumé. Notre étude vise à délimiter l'espace dans lequel la question du signe s'est posée à la tradition phénoménologique depuis Edmund Husserl. Cette étude est largement historique et elle n'a d'autres ambitions que d'identifier certains aspects de la question du signe qui ont suscité l'intérêt de la phénoménologie. Elle se divise en quatre parties : dans la première, nous examinons le texte de 1890 intitulé Semiotik en le situant dans le contexte des recherches du jeune Husserl sur la philosophie des mathématiques ; la deuxième section est principalement consacrée à l'étude de la première des Recherches logiques ; la troisième partie vise à rendre compte des chan-gements qui ont marqué l'évolution de la pensée de Husserl sur le signe, des Recher-ches logiques (1900/1) à "Origine de la géométrie" (1936) ; finalement, nous esquis-serons à grands traits la contribution de la phénoménologie post-husserlienne à la sémiotique, de Martin Heidegger à Maurice Merleau-Ponty, et au-delà. (shrink)

People draw subtle distinctions in the normative domain. But it remains unclear exactly what gives rise to such distinctions. On one prominent approach, emotion systems trigger non-utilitarian judgments. The main alternative, inspired by Chomskyan linguistics, suggests that moral distinctions derive from an innate moral grammar. In this article, we draw on Bayesian learning theory to develop a rational learning account. We argue that the ‘size principle’, which is implicated in word learning, can also explain how children would use scant and (...) equivocal evidence to interpret candidate rules as applying more narrowly than utilitarian rules. (shrink)

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public (...) health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

Historically, scientific and engineering expertise has been key in shaping research and innovation policies, with benefits presumed to accrue to society more broadly over time. But there is persistent and growing concern about whether and how ethical and societal values are integrated into R&I policies and governance, as we confront public disbelief in science and political suspicion toward evidence-based policy-making. Erosion of such a social contract with science limits the ability of democratic societies to deal with challenges presented by new, (...) disruptive technologies, such as synthetic biology, nanotechnology, genetic engineering, automation and robotics, and artificial intelligence. Many policy efforts have emerged in response to such concerns, one prominent example being Europe's Eighth Framework Programme, Horizon 2020, whose focus on “Responsible Research and Innovation” provides a case study for the translation of such normative perspectives into concrete policy action and implementation. Our analysis of this H2020 RRI approach suggests a lack of consistent integration of elements such as ethics, open access, open innovation, and public engagement. On the basis of our evaluation, we suggest possible pathways for strengthening efforts to deliver R&I policies that deepen mutually beneficial science and society relationships. (shrink)

Media guidelines on safe suicide-related reporting are within the suicide prevention armamentarium. However, implementation issues beleaguer real-world practice. This study evaluated the perspectives of the Malaysian media community, persons with lived experience of suicidal behavior, and mental health professionals on suicide-related reporting in terms of the impact, strategies, challenges, and the implementation of guidelines on safe reporting. Three focus group discussions of purposively sampled Malaysian media practitioners, PLE, and MHP were audio-recorded, transcribed, coded and thematically analyzed. Inclusion criteria were: English (...) fluency, no clinical depression or suicidal ideation, no recent previous suicide attempts or suicide bereavement. Three major themes emerged: Unsafe Reporting; Impact; and Safe Reporting. Most described current reporting as unsafe by being potentially triggering to media users and may contribute to contagion effect. Positive impacts identified included raised awareness toward suicide and its prevention. Unsafe reporting was attributed to inadequate awareness, knowledge, and guidance, lack of empathy and accountability, job-related factors, popularity-seeking, lack of monitoring and governance, and information source with unsafe content. Majority agreed on how suicide stories should be framed to produce a safe report. The media community diverged on how detailed a suicide story should be. Safe reporting challenges included difficulties in balancing beneficial versus harmful details, social media ubiquity and its citizen reporters. Participants suggested these safe reporting strategies: stakeholder engagement, educational approaches, improving governance and surveillance, and guidelines revision. Most acknowledged the relevance of guidelines but were unaware of the existence of local guidelines. Implementation challenges included the dilemma in balancing media industry needs vis-à-vis safe reporting requirements, stakeholder engagement difficulties and social media regulation. There is poor awareness regarding safe suicide-related reporting across all groups. PLE and MHP were negatively impacted by current unsafe messaging which aggravated trauma and grief reactions. Postvention support gaps for mental health professionals were highlighted. Safe reporting promotion strategies should include stakeholder engagement to increase awareness on minimizing Werther and maximizing Papageno effects. Strategic re-examination and dissemination of local media guidelines to address new media issues, and effective surveillance mechanisms, are crucial in sustainable improvement of safe reporting practices. (shrink)

ABSTRACTThis article describes our experience using art and theatre to engage rural communities in western Cambodia to understand malaria and support malaria control and elimination. The project was a pilot science–arts initiative to supplement existing engagement activities conducted by local authorities. In 2016, the project was conducted in 20 villages, involved 300 community members and was attended by more than 8000 people. Key health messages were to use insecticide-treated bed-nets and repellents, febrile people should attend village malaria workers, and to (...) raise awareness about the risk of forest-acquired malaria. Building on the experience and lessons learnt in the year prior, the 2017 project which was conducted in 15 villages involved 600 community members and attracted more than 12,000 people. In addition to the malaria theme, upon discussion with local health authorities, secondary theme was added to the 2017 project. We learnt the following lessons from our experience in... (shrink)

While prior research suggests a link between mindfulness and ethical decision-making, most of the evidence for this link is correlational and refers to self-focused ethical behaviors. The paucity of experimental evidence, coupled with a lack of clarity on what mechanisms underlie the effect, limits our understanding of whether and how mindfulness might foster other-focused ethical behaviors. In this research, we hypothesize that state mindfulness might promote other-focused ethical behaviors by increasing resourcefulness, which we define as a perceived state of resource (...) abundance. Across four experimental studies, we report causal evidence for the effects of state mindfulness instantiated through brief mindful meditation exercises on other-focused ethical behaviors, including choice of fair-trade products, charitable giving, and volunteering. Resourcefulness mediates the effects of mindfulness on other-focused ethical behaviors. Our work answers the call for more experimental research on mindfulness and its important implications for ethical decision-making. (shrink)

The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients. An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to (...) patients and their families. Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account. This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results. This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees. (shrink)

Using an analogy in science and everyday life is a double-edged sword because they are accompanied by alternative ideas, in addition to scientific concepts. Schools and public education explain global warming by making a common analogy between this phenomenon and greenhouse effects. Unfortunately, this analogy sometimes produces various incorrect explanatory mental models. To construct a correct understanding of global warming, it is necessary: first, to investigate the attributes of analogical reasoning; second, to understand these features by restructuring the greenhouse analogy; (...) and third, to explore the problems and benefits of the greenhouse analogy. The characteristics of relations, rather than objects, must be mapped according to the principle of systematicity, but the public tends to preserve the attributes of the base domain, which is mapped relatively easily. In conclusion, certain facets of the prevailing greenhouse analogy cause a distorted public view of climate change. We must use the greenhouse analogy and yet simultaneously emphasize the relations and attributes highlighted and hidden in the analogy during evaluation. (shrink)

AI and robotic technologies attract much hype, including utopian and dystopian future visions of technologically driven provision in the health and care sectors. Based on 30 interviews with scientists, clinicians and other stakeholders in the UK, Europe, USA, Australia, and New Zealand, this paper interrogates how those engaged in developing and using AI and robotic applications in health and care characterize their future promise, potential and challenges. We explore the ways in which these professionals articulate and navigate a range of (...) high and low expectations, and promissory and cautionary future visions, around AI and robotic technologies. We argue that, through these articulations and navigations, they construct their own perceptions of socially and ethically ‘acceptable futures’ framed by an ‘ethics of expectations.’ This imbues the envisioned futures with a normative character, articulated in relation to the present context. We build on existing work in the sociology of expectations, aiming to contribute towards better understanding of how technoscientific expectations are navigated and managed by professionals. This is particularly timely since the COVID-19 pandemic gave further momentum to these technologies. (shrink)

This study investigates how abnormally hot temperatures affect firms’ environmental behaviors in China. We find that firms exposed to abnormally hot temperatures participate in more environmental engagement. We also find that this improvement effect is driven mainly by environmental concerns, including public concerns, CEOs, and governments. Our results remain intact after an array of robustness tests. Further analysis shows that the effect of abnormally hot temperatures on corporate environmental engagement is more pronounced in SOEs, heavily polluting firms, and firms located (...) closer to local environmental protection agencies. Based on the political pressure channel, our results indicate that the improvement effect is more prominent in politically connected firms, cities where local officials can wield more influence, local governments have larger financial slack, and local governments disclose their environmental targets. Moreover, the positive impact of environmental engagement on firm value is stronger when firms are exposed to abnormally hot temperatures. Overall, this study sheds light on the potential stimulation of firms’ environmental actions by global warming, which is yet to be fully understood. (shrink)

Two groups of scientists have just announced what is being described as a leap forward in human stem cell research.1–3 Both have found ways of producing what are being called “induced pluripotent cells” , stem cells that they hope will demonstrate the same key properties of regeneration and unrestricted differentiation that human embryonic stem cells possess, but which are derived from skin cells not from embryos. In simple terms, these scientists have succeeded in reprogramming skin cells to behave like hESCs.Stem (...) cell research has been hailed as one of the most important and exciting areas of science, because it is believed that these types of cells will not only play an important part in regenerative medicine, but also yield valuable scientific information. These latest developments in cell reprogramming represent a milestone for stem cell science. No longer does the paradigm of irreversible cell specialisation hold true; instead, almost any type of cell might have the potential to become any other.The advent of techniques for producing these iPCs has also been hailed as an ethical breakthrough. Up until now, the production of hESCs has required a process which involves the destruction of embryos. Many of these embryos are available as by-products of IVF; but in addition, the process of somatic cell nuclear transfer to produce cloned embryonic stem cells requires a supply of human oocytes, which must currently be harvested from female donors at no insignificant cost. In a nutshell, iPCs seem to enable us to produce “embryo-free” human pluripotent stem cells, and in a “gender-neutral” way—that is, without the need for human oocytes.The response from the scientific community, ethical commentators and the public has, however, reflected an inherent confusion over the ethical significance of this research. The anti-embryo …. (shrink)

Comparative study of religions and philosophies, in spite of its significance and urgency, has been neither fully appreciated nor developed in the study of religion or philosophy. Comparative study, historically speaking, is still young and complex in its approach. Religious Studies as an intellectual discipline has traditionally concentrated on the investigation of a single tradition, enabling a student to become an ‘expert’ in that particular tradition. The world in which we live, however, no longer allows us to be content with (...) the idea, the value, the way of thinking in our own tradition alone. In short, we no longer live in a ‘provincial’ age but in a ‘global’ age. (shrink)