Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

Vitalism was long viewed as the most grotesque view in biological theory: appeals to a mysterious life-force, Romantic insistence on the autonomy of life, or worse, a metaphysics of an entirely living universe. In the early twentieth century, attempts were made to present a revised, lighter version that was not weighted down by revisionary metaphysics: “organicism”. And mainstream philosophers of science criticized Driesch and Bergson’s “neovitalism” as a too-strong ontological commitment to the existence of certain entities or “forces”, over and (...) above the system of causal relations studied by mechanistic science, rejecting the weaker form, organicism, as well. But there has been some significant scholarly “push-back” against this orthodox attitude, notably pointing to the 18th-century Montpellier vitalists to show that there are different historical forms of vitalism, including how they relate to mainstream scientific practice. Additionally, some trends in recent biology that run counter to genetic reductionism and the informational model of the gene present themselves as organicist. Here, we examine some cases of vitalism in the twentieth century and today, not just as a historical form but as a significant metaphysical and scientific model. We argue for vitalism’s conceptual originality without either reducing it to mainstream models of science or presenting it as an alternate model of science, by focusing on historical forms of vitalism, logical empiricist critiques thereof and the impact of synthetic biology on current theorizing of vitalism. (shrink)

In this article, we develop a measure of complete well-being. The framework is derived from the theoretical model of human flourishing understood as a state in which all aspects of a human life are favorable. The approach extends beyond psychological well-being and reflects the World Health Organization definition of health that not only considers the health of body and mind but also embraces the wholeness of the person. The Well-Being Assessment is a comprehensive instrument designed to assess holistic well-being in (...) six domains: emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. Although each of these domains is distinct, all of them are nearly universally desired, and all but financial security constitute ends in themselves. Data were collected from a representative sample of working adults. A sample of 276 employees participated in the pilot, 2,370 participated in the first wave and 1,209 in the second wave of the survey. The WBA showed a good fitting, satisfactory reliability, test–retest correlation, and convergent/discriminant validity in relation to stability over time and relevant health measures, as well as a good fit to the data that were invariant over time, gender, age, education, and marital status. The instrument can be of use for scientists, practitioners, clinicians, public health officials, and patients. Adoption of more holistic measures of well-being that go beyond psychological well-being may help to shift the focus from health deficiencies to health and well-being promotion. (shrink)

Given that one of the major goals of the practice of Philosophy for Children (P4C) is the development of critical thinking skills (Sharp 1987/2018, pp. 4 6), an urgent question that emerged for one of the authors, who is of Chinese Heritage and a novice practitioner at a P4C summer camp was whether this emphasis on critical thinking might make this practice incompatible with the fabric of Chinese culture. Filial piety (孝), which requires respect for one’s parents, elders, and ancestors (...) is considered an important virtue in Asian culture, as is the preservation of harmony. But if one of the goals of P4C is to teach youngsters to courageously pursue reasoned dialogue, does this not set-up young Asians for serious conflict when they come face-to-face with positions that are articulated by elders, but which are ones to which they are diametrically opposed; a racist grandmother, for instance, or an uncle who insists that those at the Tiananmen Square uprising were nothing but hooligan’s. It is this question that we will explore in this presentation. In the process, we will come to the conclusion that, when positions seem irreconcilable, rather than continuing to pursue rigorous critical interchange that may do little other than escalate insult, the facilitator, rather, ought to move toward creating a deeper understanding of each position juxtaposed against its opposing view (a process that we refer to as ‘collaborative caring’), so as to produce side-by-side understanding, knowing that communal bonds have been maintained and, hence, that the opportunity for genuine reasoned collaborative inquiry on other issues and at future times remains open. (shrink)

The purpose of this study was to develop a Physician's Spiritual Well-Being Scale (PSpWBS). The significance of a physician's spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physician's characteristics; medical practice challenges; response to changes; and overall well-being. The explainable (...) total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician. (shrink)

Models of the work-to-family and family-to-work interface were tested in two heterogeneous samples of workers, one from North America (N = 408) and one from China (N = 442), using the same measures translated from English to Chinese using back translation. Consistent with proposed differences in the centrality of work and family, tolerance of work demands, and the availability of family support, work-to-family spillover effects tended to be stronger in the North American sample, whereas family-to-work spillover effects tended to be (...) stronger in the Chinese sample. However, some inconsistencies across cultures did not conform to this generalization. Results point to asymmetric differences between North America and China in the work–family interface. Theoretical implications for resource scarcity and expansionist perspectives are discussed, as well as those for the applicability of work–family interventions across North America and China. (shrink)

The current public health crisis has exposed deep cracks in social equality and justice for marginalised and vulnerable communities around the world. The reported rise in the number of ‘do not resuscitate’ orders being imposed on people with disabilities has caused particular concerns from a human rights perspective. While the evidence of this is contested, this article will consider the human rights implications at stake and the dangers associated with using ‘quality of life’ measures as determinant of care in medical (...) decision-making and triage assessments. (shrink)

Tax compliance is a concern to governments around the world. Prior research (Alm, J. and I. Sanchez: 1995, KYKLOS 48, 3–19) has attributed unexplained inter-country differences in compliance rates to differences in social norms. Economics researchers studying tax compliance in the United States (U.S.) (see for example J. Andreoni et al.: 1998, Journal of Economic Literature 36, 818–860) have called for more attention to social (as opposed to economic) influences on tax compliance. In this study, we extend this prior research (...) by explicitly examining the role of social norms [Cialdini, R. and M. Trost: 1998, The Handbook of Social Psychology (Oxford University Press, New York)] on tax compliance in three different countries. We test our research hypotheses using a hypothetical compliance scenario, which was administered in Australia, Singapore, and the U.S. There were differences in compliance rates and social norms among the three countries. Factor analysis of the social norm questions identified three distinct social norm constructs. Two of these factors were significant in explaining tax compliance behavior. The first and most influential factor was taxpayers’ own personal moral beliefs, along with the beliefs of those close to them (e.g., friends and important others). The second significant factor represented societal views of proper behavior. We conclude that social norms help to explain tax compliance intentions and why tax compliance rates are higher than would be predicted by strictly economic models. (shrink)

Embedded pragmatic clinical trials (PCTs), like other types of randomized comparative-effectiveness research (CER) studies, are sometimes conducted without informed consent. Indeed, authors of both...

The question, what makes a clinician a healer? may evoke the image of a devoted physician paying a critically important home visit at the end of a long day or the image of an astute nurse—steadfast, empathic, anticipating the patient's needs before they become apparent to others. But health care is no longer provided by lone doctors or nurses. In the modern health care system, multiple professionals must work together to provide safe and effective care. The moral nature of healing (...) has not changed. But what is required of clinicians to facilitate healing has. To be a healer today, a clinician must be a good team player. Medical students have opened our eyes to this new reality. Building on their observations, we articulate a view that, over and above the role of teamwork in providing technically appropriate care and preventing errors, health care requires teamwork to promote healing. Being a good team player is now a moral imperative because it makes an essential contribution to healing. (shrink)

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of (...) Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings. (shrink)

Nucleation and motion of kink pairs on partial dislocations are examined by elasticity theory for materials with a high Peierls stress. Two approaches are used: one considers the change in average stacking-fault energy due to alloying elements and the other considers the change in local SFE due to a nearby solute atom. Both approaches highlight the role of SFE on kink nucleation, propagation and annihilation and both furnish strain rate as a function of stress, temperature and SFE. Model predictions are (...) compared with yield stress data for two systems: firstly, an intermetallic, MoSi 2 , which softens for alloying elements that decrease the SFE and hardens for Re additions that increase the SFE; secondly, a ceramic oxide, MgO-Al 2 O 3 spinel, which softens with increasing addition of excess alumina and at the same time exhibits a decrease in SFE. The average SFE approach agrees qualitatively with the data while quantitative agreement is obtained with the local SFE approach. The possibility is considered that the model applies to other materials, such as TiAl, HfV 2 and Fe 3 Al, which show softening with certain alloying additions. One requirement is that the dislocations are dissociated more than a few atomic distances; otherwise kink nucleation occurs on the perfect dislocation . Hence the model does not apply to materials such as bcc metals which only have a core dissociation. Normal hardening effects of solutes from size and modulus misfits are additive with any softening effects from a decrease in SFE and so may mask the latter, as occurs for W additions to MoSi 2. (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’. 1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous,... (shrink)

Objectives: To quantify the use of do-not-resuscitate orders in a tertiary-care children’s hospital and to characterise the circumstances in which such orders are written.Design: Retrospective study conducted in a 500-bed children’s hospital in Taiwan.Patients: The course of 101 patients who died between January 2002 and December 2005 was reviewed. The following data were collected: age at death, gender, disease and its status, place of death and survival. There were 59 males and 42 females with a median age of 103 months (...) . 50 children had leukaemias, and 51 had malignancies other than leukaemia. The t test and the χ2 test were applied as appropriate.Results: The study found that 44% of patient deaths occurred in the paediatric oncology ward; 29% of patient deaths occurred in the intensive care unit; and 28% of patients died in their home or at another hospital. Other findings included the following: 46 of 101 patients died after attempted cardiopulmonary resuscitation and 55 died with a DNR order in effect. The mean age at death was 9.8 years in both groups with or without DNR orders.Conclusions: From the study of patient deaths in this tertiary-care children’s hospital, it was concluded that an explicit DNR order is now the rule rather than the exception, with more DNR orders being written for patients who have been ill longer, who have solid tumours, who are not in remission and who are in the ward. (shrink)

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation... (shrink)

Information‐theoretic complexity metrics, such as Surprisal (Hale, 2001; Levy, 2008) and Entropy Reduction (Hale, 2003), are linking hypotheses that bridge theorized expectations about sentences and observed processing difficulty in comprehension. These expectations can be viewed as syntactic derivations constrained by a grammar. However, this expectation‐based view is not limited to syntactic information alone. The present study combines structural and non‐structural information in unified models of word‐by‐word sentence processing difficulty. Using probabilistic minimalist grammars (Stabler, 1997), we extend expectation‐based models to include (...) frequency information about noun phrase animacy. Entropy reductions derived from these grammars faithfully reflect the asymmetry between subject and object relatives (Staub, 2010; Staub, Dillon, & Clifton, 2017), as well as the effect of animacy on the measured difficulty profile (Lowder & Gordon, 2012; Traxler, Morris, & Seely, 2002). Visualizing probability distributions on the remaining alternatives at particular parser states allows us to explore new, linguistically plausible interpretations for the observed processing asymmetries, including the way that expectations about the relativized argument influence the processing of particular types of relative clauses (Wagers & Pendleton, 2016). (shrink)

Interdisciplinary research assumes that teams of highly specialized scientists develop new knowledge by bridging their respective horizons. Nurse educators preparing nursing doctoral students to conduct interdisciplinary research need insight into how members of interdisciplinary research teams experience knowledge horizons in these complex contexts. Based on the work of the philosopher Bernard Lonergan, this pilot study uses Transcendental Method for Research with Human Subjects to explore interdisciplinary researchers' experiences with and attitudes toward interdisciplinary research. Results reveal the overarching conceptual category of (...) “engaged interdisciplinary inquiry” which includes six themes: (i) valuing interdisciplinary engagement; (ii) direct engagement; (iii) interior engagement; (iv) disengagement; (v) facilitated engagement and (vi) engaged researcher development. Results also suggest engagement depends on vigorous “back and forth”, or dialogue, with self and others, and demonstrate the study method is fruitful for cognitive inquiry. This pilot supports expanded study to inform preparation for and conduct of interdisciplinary research involving nurses and raises important questions about how the trend toward interdisciplinary research affects nursing science. (shrink)

Over the past generation, the rise of East Asia and especially China, has brought about a sea change in the economic and political world order. At the same time, global warming, environmental degradation, food and water shortages, population explosion, and income inequities have created a perfect storm that threatens the very survival of humanity. It is clear now that the Westphalian model of individual sovereign states seeking their own self-interest will not be able to respond effectively to this win-win or (...) lose-lose crisis. In this volume, a cadre of distinguished scholars comes together to reflect on Confucianism and Deweyan pragmatism as possible resources for a new geopolitics that begins from an ontology of interdependence and recognizes the irreducibly ecological nature of the human experience at every level. Both Confucian and Deweyan traditions emphasize the primacy of experience, the importance of vital relationality, and the moral roots of good governance. The potential benefits of conceptually blending the two are many. Indeed, the contemporary Chinese philosopher Tang Junyi provides us with a cosmological understanding of the "idea" of Confucianism that, in parallel to Dewey's "idea" of democracy, can enable us to anticipate the core values, if not the specific contours, of a "Confucian democracy." Just as Dewey's "idea" of democracy is his vision of the flourishing communal life made possible by the contributions of the uniquely distinguished persons that constitute it, Tang Junyi's Confucianism is a pragmatic naturalism directed at achieving the most highly integrated cultural, moral, and spiritual growth for the individual-in-community. In both, we find an affirmation of communal harmony as a process "starting here and going there" through which those involved learn together to do ordinary things in extraordinary ways. Just such a cosmological understanding of democracy is one way of describing what will be needed to address the many predicaments characterizing the environmental, cultural, socioeconomic, and political dynamics of the twenty-first century. (shrink)

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging for healthcare (...) providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's “authentic” wishes from future “inauthentic” changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. (shrink)

Past research demonstrates that emotion recognition is influenced by social category cues present on faces. However, little research has investigated whether holistic processing is required to observe these influences of social category information on emotion perception, and no studies have investigated whether different visual sampling strategies (i.e. differences in the allocation of attention to different regions of the face) contribute to the interaction between social cues and emotional expressions. The current study aimed to address this. Participants categorised happy and angry (...) expressions on own- and other-race faces, and male and female faces. In Experiments 1 and 2, holistic processing was disrupted by presenting inverted faces (Experiment 1) or part faces (Experiment 2). In Experiments 3 and 4 participants’ eye-gaze to eye and mouth regions was also tracked. Disrupting holistic processing did not alter the moderating influence of sex and race cues on emotion recognition (Experiments 1, 2, 4). Gaze patterns differed as a function of emotional expression, and social category cues, however, eye-gaze patterns did not reflect response time patterns (Experiments 3 and 4). Results indicate that the interaction between social category cues and emotion does not require holistic processing and is not driven by differences in visual sampling. (shrink)

Transcutaneous auricular vagus nerve stimulation, a non-invasive alternative to vagus nerve stimulation with implantable devices, has shown promise in treating disorders such as depression, migraine, and insomnia. Studies of these disorders with resting-state functional magnetic resonance imaging have found sustained changes in resting-state functional connectivity in patients treated with low frequency taVNS. A recent study has reported reductions in pain scores in patients with rheumatoid arthritis after a 12-week treatment of high-frequency sub-threshold taVNS. However, no studies to date have examined (...) the effects of high-frequency sub-threshold taVNS on rsFC. The objective of this study was to determine whether high-frequency sub-threshold taVNS induces changes in rsFC using seed regions from the cingulate cortex and insula, brain regions that play a key role in interoception and processing of pain. With a single-blind placebo-controlled repeated measures experimental design, rsfMRI scans were acquired before and after 15 min of either sub-threshold taVNS treatment or a sham control. Significant taVNS-related changes in functional connections to the cingulate cortex were detected between the anterior cingulate cortex and right superior temporal gyrus and between the midcingulate cortex and right inferior parietal lobule. In addition, significant changes in functional connections to the insula were detected between the posterior insula and right precuneus and between the anterior insula and right cuneus gyrus. These results suggest that high-frequency sub-threshold taVNS can lead to sustained effects on the rsFC of brain regions involved in interoception and processing of pain in a cohort of healthy subjects. This study lays the foundation for future rsfMRI studies of high-frequency sub-threshold taVNS in clinical populations. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Traditional navigation visualization utilizes two-dimensional. maps for road guidance or arrow symbols for turn by turn information. While the advantage of map views is supposed to be the inherent understanding of the surroundings, often these schematic line-drawing bird's eye views are rather confusing than helpful because they cannot provide an overview and an appropriate level of detail in an area of interest at the same time, i.e. the user is forced to change between different resolutions. In this paper we describe (...) a 3D visualization system for vehicle navigation that overcomes these shortcomings by providing a realistic and perspective 3D view of the environment. (shrink)

Cross-cultural research provides invaluable information about the origins of and explanations for cognitive and behavioral diversity. Interest in cross-cultural research is growing, but the field continues to be dominated by WEIRD (Western, Educated, Industrialized, Rich, and Democratic) researchers conducting WEIRD science with WEIRD participants, using WEIRD protocols. To make progress toward improving cognitive and behavioral science, we argue that the field needs (1) data workflows and infrastructures to support long-term high-quality research that is compliant with open-science frameworks; (2) process and (...) participation standards to ensure research is valid, equitable, participatory, and inclusive; (3) training opportunities and resources to ensure the highest standards of proficiency, ethics, and transparency in data collection and processing. Here we discuss infrastructures for cross-cultural research in cognitive and behavioral sciences which we call __Cross-Cultural Data Infrastructures (CCDIs).__ We recommend building global networks of psychologists, anthropologists, demographers, experimental philosophers, educators, and cognitive, learning, and data scientists to distill their procedural and methodological knowledge into a set of community standards. We identify key challenges including protocol validity, researcher diversity, community inclusion, and lack of detail in reporting quality assurance and quality control (QAQC) workflows. Our objective is to help promote dialogue and efforts towards consolidating robust solutions by working with a broad research community to improve the efficiency and quality of cross-cultural research. (shrink)

The apolipoprotein E gene plays an important role in the pathogenesis of Alzheimer's disease , and amyloid plaque comprised mostly of the amyloid-beta peptide ) is one of the major hallmarks of AD. However, the relationship between these two important molecules is poorly understood. We examined how A treatment affects APOE expression in cultured cells and tested the role of the transcription factor NF-B in APOE gene regulation. To delineate NF-B's role, we have characterized a 1098 nucleotide segment containing the (...) 5'-flanking region of the human APOE gene . Sequence analysis of this region suggests the presence of two potential NF-B elements. To demonstrate promoter activity, the region was cloned upstream of a promoterless luciferase gene. This segment was able to drive expression of luciferase in transient transfections of human fetal glial cells. Promoter activity was stimulated twofold by A treatment. Pretreatment with double-stranded DNA decoy oligonucleotides against NF-B reduced A stimulation. Deletion and mutagenetic analyses demonstrated that the distal NF-B element was functional and showed a strong DNA-protein complex band in gel shift analysis, similar to that from control NF-B consensus element. An anti-inflammatory and anti-NF-B drug, sodium salicylate, significantly blocked A-induced APOE promoter function. Our data provide evidence that upregulation of APOE by A in astroglial cells is mediated by an NF-B-element present in the 5'-flanking region of the APOE gene. (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)

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation by prospective parents before deciding whether or how to use NIPW. (shrink)

In this paper we argue that, if it is true that maximum self-development is better both for individuals and society, and if it is true that that self-development is being seriously curtailed by pervasive environmental tech forces, then clearly educational systems, since they are guardians of “developing” young humans, have a moral imperative to push back against forces that diminish the self. On the other hand, if it is not true that “more self is always better,” that perhaps “goodness of (...) fit” between self and society is optimum, then education systems are justified in continuing to pay scant attention to the forces of self-development (or lack thereof). In line with Sherry Turkle’s (2011) argument that tech forces are diminishing the sort of reflective reasoning necessary for self-development, we will argue that since communicative interchange is necessary for self-development, and an ever-developing self is necessary for ever deeper and more meaningful dialogue (hence forming a dialectic), the fact that social media and other forms of tech connection stunts deep and meaningful interchange has serious implications. Specifically, we will argue that, in contemporary high-tech society (what we are calling Society 2.0), the dialectic between self and communication is going the “wrong” way; that genuine dialogue is becoming ever more rare, which in turn is resulting in “diminished-I’s,” which in turn is resulting in ever more complacency in the face of utterly superficial communicative interchange. We will begin with an overview of what we mean by a “diminished-I,” and then follow by noting how social media, the reading vacuum, roboticism, crowd communication, and decreasing social capital are resulting in diminished-I’s. Since this is resulting in an “I-diminished” society, we will reflect on the question of whether those dialogical educational initiatives that promote self-development are, in fact, making dodos, i.e., making youngsters unfit for the environment in which they find themselves. Ultimately, we will argue that, if educators choose to fight back against the I-diminishing forces of Society 2.0, they need to take selves seriously and actively engage youngsters in dialogue with those with opposing viewpoints. Ultimately, youngsters in Society 2.0 will need all the assistance educators can muster to fight the addictive, literally mind-numbing forces of being “happily” “alone together,” and instead chose the riskier often unhappy-making option of diving into the truth-seeking process with varying coalitions of the willing. (shrink)