Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit.Design—Health care workers recorded daily all dilemmas in caring for each patient.Setting—Palliative care unit of National Taiwan University Hospital in Taiwan.Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8.Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others.Results—The type and frequency of ethical dilemmas (...) encountered were: place of care ; truth-telling ; hydration and nutrition ; therapeutic strategy , and use of medication . Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care , truth-telling and therapeutic strategy . Problems of truth-telling occurred in nearly half of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients .Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care. (shrink)

A growing interest has been observed among K-12 school educators to incorporate maker pedagogy into science, technology, engineering, and mathematics education to engage students in the design and making process. Both cognitive engagement and emotional engagement of students can be promoted through satisfying the psychological need of relatedness that concerns a sense of connection and belonging. How to support relatedness would influence the effective development of students’ cognitive competencies, namely creativity and critical thinking, and non-cognitive characteristics, namely interest and identity. (...) Therefore, the present study investigated how two relatedness support strategies—real-world problems and mentoring influence the development of student’s STEM-related cognitive competencies and non-cognitive characteristics in STEM marker activities. We implemented a 7-week intervention study with three classes of Grade 9 students in Hong Kong. Three intervention conditions were designed in the experiment, comprising textbook problem, RWP, and RWP with mentoring. Our analysis showed that the differences in creativity among the three groups were non-significant, the RWP and RWPM groups showed stronger critical thinking than the TBP group, and the RWPM group exhibited stronger STEM interest and identity than the other two groups. This study revealed the effectiveness of adopting RWP strategy in developing secondary students’ perceived cognitive competencies and the feasibility of employing a mentoring mechanism for cultivating learners’ perceived non-cognitive characteristics. Hence, we also offered practical suggestions for teachers. (shrink)

Creativity and morality are key attributes that stakeholders demand of organizations. Accordingly, higher education institutions and professional training programs also seek to cultivate these attributes in future leaders. However, research has hitherto shown that, under certain conditions, creativity may conflict with morality. This complicates the development of creative individuals who are also moral. We examined the complex relationship between creativity and moral reasoning with data collected from a group of undergraduate students. By considering the cognitive processes behind creativity and moral (...) reasoning, we propose perspective taking as a moderating factor. Specifically, we found that while creative individuals might not necessarily adopt a lower level of moral reasoning, there was a more nuanced moderating relationship among creativity, perspective taking, and moral reasoning. That is, individuals who were weak in perspective taking tended to adopt a lower level of moral reasoning if they were also creative. Perspective taking was also directly and positively associated with moral reasoning. We explore the implications of our findings for future research and curriculum/program design. (shrink)

ABSTRACTDifficulties with inhibiting fear have been associated with the emergence of anxiety problems and poor response to cognitive–behavioural treatment. Fear inhibition problems measured using experimental paradigms involving aversive stimuli may be inappropriate for vulnerable samples and may not capture fear inhibition problems evident in everyday life. We present the Fear Inhibition Questionnaire, a self-report measure of fear inhibition abilities. We assess the FIQ’s factor structure across two cultures and how well it correlates with fear inhibition indices derived experimentally. Adolescent participants (...) from Hong Kong and England completed the FIQ, with the English participants also completing a conditioning and extinction task to assess fear inhibition problems. Across both cultures, the FIQ showed a single factor structure and low FIQ scores, or worse fear inhibition problems, were associated with self-reports of heightened anxiety. Correlation of FIQ scores with experimental indices, whi... (shrink)

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student’s t test, χ2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice (...) care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family’s refusal (28.2%). On a multivariate analysis, patients’ awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. (shrink)