The aims of this paper are threefold. The first aim is to provide a critique of the reform proposal of the Harvard School of Public Health for Hong Kong's health care system through privatization of the public sector services. The second aim is to argue for the duty of society to guarantee every member equal access to a basic level of health care based on the values of equity, care and free choice. The third aim is to explore some suggestions (...) about delivery structures and financial arrangements of a dual sector health care system which will better enable society to provide a basic level of health care that is sustainable and affordable, while being at the same time consistent with the values of care, equity and free choice. (shrink)

Richard Nisbett's The Geography of Thought is one of several recent works that have highlighted purported differences in thinking patterns between East Asians and Westerners on the basis of empirical research. This has implications for teaching and for other issues such as cultural integration. Based on a framework consisting of three distinct notions of rationality, this paper argues that some of the differences alleged by Nisbett are either not real or exaggerated, and that his geography of thought fails to provide (...) an adequate account of thinking styles across cultures. The paper concludes with a discussion of the implications for teaching and learning critical thinking that can be drawn from the framework developed. (shrink)

ABSTRACT This paper critically examines the liberal model of decision making for the terminally ill and contrasts it with the familial model that can be found in some Asian cultures. The contrast between the two models shows that the liberal model is excessively patient‐centred, and misconceives and marginalises the role of the family in the decision making process. The paper argues that the familial model is correct in conceiving the last journey of one's life as a sharing process rather than (...) a process of exercising one's prior or counterfactual choice, and concludes by suggesting a policy framework for the practice of familialism that can answer the liberal challenge that familialism cannot safeguard the patient from abuse and neglect. (shrink)

This paper examines the practice of informed consent in Hong Kong by drawing on structured interviews conducted with eleven physicians, three patients, and four family members primarily at a well-established public hospital in Hong Kong. The findings of this study show that the Hong Kong approach to medical decision-making lies somewhere between that of America on the one hand, and mainland China on the other. It is argued that the practice of medical decision-making in Hong Kong can be modeled by (...) a moderate familism that is directed towards achieving the best interests of the patient (1) as understood by the physician, (2) in consultation with the family, (3) under the prima facie presumption that consent is not required for disclosure of information to the family, (4) while aiming at an eventual albeit frequently partial and vague disclosure to the patient. (shrink)

This article reveals the outcome of a study on the perceptions of elders, family members, and healthcare professionals and administration providing care in a range of different long-term care facilities in Hong Kong with primary focus on the concepts of autonomy and dignity of elders, quality and location of care, decision making, and financing of long term care. It was found that aging in place and family care were considered the best approaches to long term care insofar as procuring and (...) balancing the values of dignity, autonomy, family integrity and social sustainability were concerned. An elder having the final say was generally accepted. The results also initiated the importance of sharing of financial responsibility among elders, children and government albeit the emphasis was placed on individuals. Furthermore, dignity of elders was not considered purely a synonym of autonomy, but it had also to do with respect, family and social connections. (shrink)

This chapter gives an outline of the development of the human organ transplant system in Hong Kong, whose key features are a soft opt-in system and strict prohibitions on commercial dealings in human organs for transplant. It is argued that under such a system, there is a lack of incentives for either cadaveric or living organ donations and for family members to endorse deceased donation. This argument is followed by an investigation of the shortage of organ donations in Hong Kong, (...) the limited success of the government promotion to improve the number of donations, and a discussion of new alternatives for improvement that have been initiated or proposed. It is argued that the feasibility and effectiveness of these alternatives are limited and uncertain. More radical reform of the existing system in terms of honorary, compensationalist, and familist incentives is needed and they all need to be taken into consideration. (shrink)

This chapter contains sections titled: A Naturalistic Account of Human Rationality Geography of Thought: A Tale of Two Versions Nisbett on Logic and Contradiction How Radical are East‐West Differences in Thinking Style? Some Implications for the Education of Critical Thinking Acknowledgements Notes References.

This work examines the importance of distinguishing different levels of psychological explanation and the primacy of the computational level over implementational levels. The framework of levels allows us to recognize the role of formal theories as tools for specifying reasoning tasks at the computational level. It is shown that formal specifications of reasoning tasks allow us to analyze the complexity of the specified tasks and also serve to define reasoning competence and performance errors. Complexity analysis helps us identify tractable, practically (...) significant, subclasses of inference. The identification of these subclasses provides useful ante hoc and post hoc specifications for AI programming projects and psychological modeling. Formalization and complexity analysis also enable us to examine tradeoffs between tractability and range of applicability of implementations of a reasoning task. It is undesirable to obtain tractability at the expense of limiting the applicability of a cognitive mechanism to an unreal situation or a toy domain. It is argued that this undesirable result can be avoided if we examine the structure of the environment in which a mechanism is supposed to work and the environmental assumptions that make the computation tractable. Finally, it is demonstrated that many problems the human mind needs to solve in normal environments are indeed tractable and that the mind is equipped with adaptive mechanisms to solve them efficiently. This demonstration undermines a skeptical challenge to human rationality based on claims that many problems are intractable and that the capacity of the human mind is limited. (shrink)

Richard Nisbett's The Geography of Thought is one of several recent works that have highlighted purported differences in thinking patterns between East Asians and Westerners on the basis of empirical research. This has implications for teaching and for other issues such as cultural integration. Based on a framework consisting of three distinct notions of rationality, this paper argues that some of the differences alleged by Nisbett are either not real or exaggerated, and that his geography of thought fails to provide (...) an adequate account of thinking styles across cultures. The paper concludes with a discussion of the implications for teaching and learning critical thinking that can be drawn from the framework developed. (shrink)

This chapter discusses some legal implications of Hong Kong’s three types of organ donation incentive and presents further thoughts about their ethical and policy implications. It aims to transform the useful findings presented in previous chapters into legal solutions and policy innovations in practice. We argue that the Hong Kong law is able to incorporate mixed incentive measures and further suggest detailed legal rules regarding organ incentives for the government to consider. In terms of ethical and policy implications in a (...) wider context, we suggest a paradigm shift in incentive structure and the adoption of mixed incentive measures for the promotion of organ donation and procurement. However, we agree that the exact choice or combination of organ incentive measures ultimately depends on how each country or jurisdiction will assess their practical effectiveness, political legitimacy, and ethical justification. (shrink)

Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy (...) of a 4-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after four weeks of treatment as usual. Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. Jumping to conclusions and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to treatment as usual, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. Jumping to conclusions bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approach. (shrink)

Some scientists or philosophers argue that multiverse theories are unfalsifiable and thus not scientific. However, some advocates of multiverse theories have recently argued that although the multiverse is not observable, multiverse theories are indeed falsifiable in principle. Therefore, they share similar features with a conventional scientific theory. On the other hand, the proposals of an epistemic shift and nonempirical theory assessment have possibly revived the discussions of the scientific nature of multiverse theories. In this article, I revisit the falsifiable arguments (...) made by the advocates of multiverse theories and show that these arguments do not justify arguing the scientific nature of such theories. Moreover, even if we accept the proposals of the epistemic shift and the nonempirical theory assessment, I argue that multiverse theories still cannot pass or satisfy the required assessments based on the new theoretical virtues and the nonempirical arguments. (shrink)

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha (...) Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support. (shrink)

In a recent article Merritt has claimed that current observational data provide “severe tests” falsifying the standard cosmological model. Based on Popper’s idea of conventionalism, he concludes that the introduction of some essential components of the standard cosmological model—including dark matter and dark energy—are a consequence of conventionalist stratagems. In this article, I provide more recent discoveries and discussions showing that the standard cosmological model is not built on any conventionalist stratagem.

Increasing the tax compliance of self-employed business owners—particularly of trade-specific service providers such as those involved in construction and repair work—remains an ongoing challenge for tax authorities. From a compliance point of view, cash transactions are particularly problematic when services are paid for on the spot, as these exchanges are difficult to audit. We present experimental evidence testing ten different policy strategies rooted in the enforcement, service, and trust/social paradigms, in a setting that allows payment either via a transaction that (...) directly reports income for tax collection purposes or in cash, where taxes are only collected on reported income. Our sample includes both a typical subject pool of students, as used in most previous studies, and non-students who are active within service industries characterised by the opportunity to engage in cash transactions. While our comparative results show that, for both student and non-student participants, interventions that rely on greater enforcement by the tax authority have the greatest effect on compliance in our cash economy setting, treatments involving cooperative elements may be similarly effective in enhancing tax compliance. Given their effectiveness, cooperative approaches should therefore be considered for addition to the policy mix if implemented at relatively low costs, making both carrot and stick approaches promising to increase compliance in an environment where cash-for-service payments offer a common benefit for small businesses and their customers from implicit collusion that enables tax evasion. (shrink)

For scholars, practitioners, and legislators concerned about sexual minority adolescents, one of the main goals is to create more positive and inclusive learning environments for this minority group. Numerous factors, such as repeated patterns of homophobic bullying by classmates and others in school, have been a significant barrier to achieving this goal. In addition, lesbian, gay, bisexual, transgender, and queer adolescents encounter substantial inequality across a broad spectrum of wellbeing and education consequences. Compared with their heterosexual counterparts, LGBTQ adolescents experience (...) more anxiety, depression, suicidal thoughts, antisocial behavior, poorer academic performance, less school attachment and protection, and a weaker desire to finish their studies. Such discrepancies based on gender and sexuality were linked to more maltreatment encountered by LGBTQ adolescents. It is crucial to recognize the backgrounds and expectations of LGBTQ adolescents to offer them the best resources. To overcome the inequality and obstacles faced by these LGBTQ adolescents, it is essential to examine tools and techniques that can be utilized. This study examined the literature that explains why society fails to provide enough support to LGBTQ students. Specifically, mechanisms explaining how LGBTQ adolescents interact with others in the learning environment and how such discrepancies arise will be examined. Following that, violence and prejudice, which are fundamental causes of psychological problems among LGBTQ adolescents, will be explored. This review paper thus provides supportive strategies for schools to develop more inclusive learning environments for LGBTQ adolescents. (shrink)

Background Care homes have been disproportionately affected during the COVID-19 pandemic. Practical challenges of enacting infection control measures in care home settings have been widely reported, but little is known about the ethical concerns of care home staff during the implementation of such measures.. Objectives To understand the ethical challenges perceived by care home staff during the early months of the COVID-19 pandemic. Research design An exploratory qualitative study. Participants and research context A purposive sample of 15 care home staff (...) in different roles and ranks in Hong Kong was recruited to take part in semi-structured interviews between June and August 2020. Ethical considerations Ethical approval for this study was obtained. Participation was voluntary and anonymous. Participants had the right to withdraw from the study at any time without reprisal. Findings Three themes were identified: unclear legitimacy regarding infection control measures, limited autonomy in choices over infection control measures and inevitable harms to residents’ well-being. While the participants expected that they would have legitimated power to implement infection control measures, they were resistant when their right to self-determination of testing and vaccination was infringed. They also felt trapped between ethical duties to protect care home residents from infection risk and the anticipated detrimental effects of infection control measures. Conclusions The findings of this study reveal tensions among the ethical obligations of care home staff in response to a public health emergency. They highlight the importance of strengthening ethical sensitivity and ethical leadership in identifying and resolving the challenges of pandemic responses. (shrink)

This article investigates the structure of trust in China and compares it with the U.S., using the 2000 and 2005 waves of the World Value Survey (WVS). We analyze two dimensions of trust - trust in people and trust in major companies. It is found that the level of trust has remained stable in China within the 5-year period. On the other hand, trust in major companies has declined dramatically in U.S. while trust in people has increased slightly. The structure (...) of trust in companies is different from trust in people. For both countries, individuals with higher education tend to have a higher level of trust. Individuals who are divorced tend to have lower trust in people. Individuals who think that other people are fair are more likely to trust in people. Preference for competition has a positive effect on trust in major companies. On the other hand, some differences between the two countries are observed. Perception of fairness does not affect trust in major companies in China, while it has a positive effect in U.S. in year 2006. Preference for equality has a negative effect on trust in major companies in U.S. but no significant effect in China. The pattern of trust and its changes over time may reflect differences in market conditions in the two economies. (shrink)

Segregation Distorter (SD) is a meiotic drive system in Drosophila that causes preferential transmission of the SD chromosome from SD/SD+ males owing to induced dysfunction of SD+ spermatids. Since its discovery in 1956, SD and its mode of action have baffled biologists. Recently, substantial progress has been made in elucidating this puzzle. Sd, the primary gene responsible for distortion encodes a mutant RanGAP, a key protein in the Ran signaling pathway required for nuclear transport and other nuclear functions. The mutant (...) protein is enzymatically active but mislocalized to nuclei, which apparently disrupts Ran signaling by reducing intranuclear Ran‐GTP levels. Some evidence suggests that a defect in nuclear transport may be the main cause of sperm dysfunction. Although important questions remain, the basic mechanism of distortion is now understood sufficiently well that specific hypotheses can be formulated and tested. This previously mysterious genetic system may now offer unique insights into novel aspects of regulation by Ran. BioEssays 25:108–115, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Background Supporting physicians in Intensive Care Units s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for (...) ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support. (shrink)

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer (...) patients assessed at six-months post-cancer treatment, 593 previously worked; detailed work status, psychological distress, physical symptom distress, supportive care needs, health-related quality of life, and illness perception were assessed. Six months later, work productivity and activity impairment were assessed. Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% were working, 26% on sick leave, and 35% were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity. (shrink)

Many clinical and psychological constructs are conceptualized to have multivariate higher-order constructs that give rise to multidimensional lower-order traits. Although recent measurement models and computing algorithms can accommodate item response data with a higher-order structure, there are few measurement models and computing techniques that can be employed in the context of complex research synthesis, such as meta-analysis of individual participant data or integrative data analysis. The current study was aimed at modeling complex item responses that can arise when underlying domain-specific, (...) lower-order traits are hierarchically related to multiple higher-order traits for individual participant data from multiple studies. We formulated a multi-group, multivariate higher-order item response theory (HO-IRT) model from a Bayesian perspective and developed a new Markov chain Monte Carlo (MCMC) algorithm to simultaneously estimate the (a) structural parameters of the first- and second-order latent traits across multiple groups and (b) item parameters of the model. Results from a simulation study support the feasibility of the MCMC algorithm. From the analysis of real data, we found that a bivariate HO-IRT model with different correlation/covariance structures for different studies fit the data best, compared to a univariate HO-IRT model or other alternate models with unreasonable assumptions (i.e., the same means and covariances across studies). Although more work is needed to further develop the method and to disseminate it, the multi-group multivariate HO-IRT model holds promise to derive a common metric for individual participant data from multiple studies in research synthesis studies for robust inference and for new discoveries. (shrink)

Chinese Chan or Zen Buddhism is renowned for its improvisational, atypical, and perplexing use of words. In particular, the tradition’s encounter dialogues, which took place between Chan masters and their interlocutors, abound in puzzling, astonishing, and paradoxical ways of speaking. In this chapter, we are concerned with Chan’s use of paradoxical language. In philosophical parlance, a linguistic paradox comprises the confluence of opposite or incongruent concepts in a way that runs counter to our common sense and ordinary (...) rational thinking. One naturally wonders about Chan masters’ rationales for their use of paradox. There are also concerns about whether the use violates the logical principle of noncontradiction to the effect that nothing can be both P and not-P all over in the same way at the same time. Chan became a viable Chinese Buddhist tradition during the Tang dynasty (618−907) and continued to develop for several centuries. The tradition had produced a huge literature; consequently, our investigation of its use of paradox cannot but be limited and selective. In the second section, I first sketch key ideas of Chan that are pertinent to our investigation and then examine the use of paradox in the sermons associated with certain Tang masters of the southern Chan. In the third section, I analyze the presence of paradoxical language in post-Tang encounter dialogues. The fourth section concludes. (shrink)

The coming of bioethics to Singapore / W. Calvin Ho and Sylvia S.N. Lim -- The impact of the bioethics advisory committee on the research community in Singapore / Charmaine K.M. Chan and Edison T. Liu -- Engaging the public : the role of the media / Chang Ai-Lien and Judith Tan -- Confucian trust and the biomedical regulatory framework in Singapore / Anh Tuan Nuyen -- The clinician-researcher : a servant of two masters? / Alastair V. Campbell, Jacqueline (...) Chin, and Teck Chuan Voo -- The US model for oversight of human stem cell research / Lindsay Parham and Bernard Lo -- Genetics and stem cell research : models of international policy-making / Bartha Maria Knoppers, Emily Kirby and Rosario Isasi -- Public engagement and bioethics commissions / Thomas H. Murray and Ross S. White -- Norm-making on human-animal chimeras and hybrids in Singapore, the United Kingdom and the international domain / W. Calvin Ho and Martin Bobrow -- How will future bioethical issues engage Singapore? / John Elliott. (shrink)