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)

One of the core goals of Digital Health Technologies (DHT) is to transform healthcare services and delivery by shifting primary care from hospitals into the community. However, achieving this goal will rely on the collection, use and storage of large datasets. Some of these datasets will be linked to multiple sources, and may include highly sensitive health information that needs to be transferred across institutional and jurisdictional boundaries. The growth of DHT has outpaced the establishment of clear legal pathways to (...) facilitate the collection, use and transfer of potentially sensitive health data. Our study aimed to address this gap with an ethical code to guide researchers developing DHT with international collaborative partners in Singapore. We generated this code using a modified Policy Delphi process designed to engage stakeholders in the deliberation of health data ethics and governance. This paper reports the outcomes of this process along with the key components of the code and identifies areas for future research. (shrink)

Working memory is developed in one region of the brain called the dorsolateral prefrontal cortex. The dysfunction of this region leads to synaptic neuroplasticity impairment. It has been reported that several biochemical parameters and anthropometric measurements play a vital role in cognition and brain health. This study aimed to investigate the relationships between cognitive function, serum biochemical profile, and anthropometric measurements using DLPFC activation. A cross-sectional study was conducted among 35 older adults who experienced mild cognitive impairment. For this purpose, (...) we distributed a comprehensive interview-based questionnaire for collecting sociodemographic information from the participants and conducting cognitive tests. Anthropometric values were measured, and fasting blood specimens were collected. We investigated their brain activation using the task-based functional MRI, specifically in the DLPFC region. Positive relationships were observed between brain-derived neurotrophic factor and Mini-Mental State Examination ; however, negative relationships were observed between serum triglyceride and serum malondialdehyde with right DLPFC activation while the participants performed 1-back task after adjustments for age, gender, and years of education. In conclusion, higher serum triglycerides, higher oxidative stress, and lower neurotrophic factor were associated with lower right DLPFC activation among older adults with MCI. A further investigation needs to be carried out to understand the causal-effect mechanisms of the significant parameters and the DLPFC activation so that better intervention strategies can be developed for reducing the risk of irreversible neurodegenerative diseases among older adults with MCI. (shrink)

Access to legal information is fundamental to access to justice. Yet accessibility refers not only to making legal documents available to the public, but also rendering legal information comprehensible to them. A vexing problem in bringing legal information to the public is how to turn formal legal documents such as legislation and judgments, which are often highly technical, to easily navigable and comprehensible knowledge to those without legal education. In this study, we formulate a three-step approach for bringing legal knowledge (...) to laypersons, tackling the issues of navigability and comprehensibility. First, we translate selected sections of the law into snippets (called CLIC-pages), each being a small piece of article that focuses on explaining certain technical legal concept in layperson’s terms. Second, we construct a Legal Question Bank, which is a collection of legal questions whose answers can be found in the CLIC-pages. Third, we design an interactive CLIC Recommender. Given a user’s verbal description of a legal situation that requires a legal solution, CRec interprets the user’s input and shortlists questions from the question bank that are most likely relevant to the given legal situation and recommends their corresponding CLIC pages where relevant legal knowledge can be found. In this paper we focus on the technical aspects of creating an LQB. We show how large-scale pre-trained language models, such as GPT-3, can be used to generate legal questions. We compare machine-generated questions against human-composed questions and find that MGQs are more scalable, cost-effective, and more diversified, while HCQs are more precise. We also show a prototype of CRec and illustrate through an example how our 3-step approach effectively brings relevant legal knowledge to the public. (shrink)

In highly routinised service encounter interactions, communication is often guided by service scripts that are the material embodiment of institutional expectations of how the service interaction is to be conducted. However, counter to common belief that scripted communication is well-controlled and homogeneous in its execution, observation of actual talk reveals interesting patterns and variations that reflect the ways in which participants make meaning of and perform their respective roles within the interaction towards achieving the overall goal of the service communication. (...) Applying the analysis of speech functions and sequential order of talk in audio-recorded verbal exchanges between servers and customers at the service counter of a fast-food restaurant, acts in the fast-food service interaction are interpreted and explained in relation to management-prescribed service script, servers’ script-in-use and customers’ script within an institutional discourse framework. Findings from the study have important implications for service management and training as it addresses the tension between the practices on the ground and those sanctioned by the organisation. (shrink)

Macau, as a society, is a crossroads where East–West encounters have been taking place for centuries. This paper examines some of the contemporary issues and implications for moral education. After a brief introduction to the social background of Macau, the paper describes the characteristics of Macau's education in general and the development of its moral education in particular. This has taken place in the context of the strong influences on morality of both Catholicism and Confucianism. An outline of the current (...) curriculum of moral and civic education is followed by a critical appraisal of its implementation over the last few years. By means of this case study of Macau, the paper argues that a communitarian‐oriented morality in Macau is justified, and it also suggests how, by turning attention to its history, a minimal set of values can be constructed for Macau's particular social setting. Finally, some further educational challenges for Macau's future moral and civic education are reviewed. (shrink)

The pressure on companies to practice corporate social responsibility (CSR) has gained momentum in recent times as a means of sustaining competitive advantage in business. The pharmaceutical industry has been acutely affected by this trend. While pharmaceutical product recalls have become rampant and increased dramatically in recent years, no comprehensive study has been conducted to study the effects of announcements of recalls on the shareholder returns of pharmaceutical companies. As product recalls could significantly damage a company's reputation, profitability and brand (...) integrity, this paper investigates the effect on shareholder wealth and the extent to which the adoption of CSR practices by pharmaceutical companies in the United Kingdom (U.K.) and the United States (U.S.), the two largest markets for pharmaceutical products in the world, affected market reactions surrounding product recall announcements. The analysis of product recall announcements from 1998 to 2004 compiled from The Pharmaceutical Journal and U.S. Food and Drug Administration enforcement reports revealed marked differences in the way market participants in the two countries responded to news of product recalls. U.S. investors penalised firms according to the severity of product defects while U.K. investors were indifferent. While U.K. investors rewarded product recalls by firms which were not usually CSR-active, U.S. investors punished non-CSR active firms that performed recalls. These observations could pose strategic challenges to pharmaceutical firms operating in both countries. (shrink)

Without doctors being able to explain medical decisions to patients, I argue their use of black box AIs would erode the effective and respectful care they provide patients. In addition, I argue that physicians should use AI black boxes only for patients in dire straits, or when physicians use AI as a “co-pilot” (analogous to a spellchecker) but can independently confirm its accuracy. I respond to A.J. London’s objection that physicians already prescribe some drugs without knowing why they work.

As emerging technologies support new ways in which people relate, ethical discourse is important to help guide designers of new technologies. This article endeavors to do just that by presenting an ethical analysis and design of technology intended to gather and act upon information on behalf of its users. The article elaborates on socio-technological factors that affect the development of technology to support ethical action. Research and practice implications are outlined.

Questions about sincerity play a central role in our lives. But what makes an assertion insincere? In this paper we argue that the answer to this question is not as straightforward as it has sometimes been taken to be. Until recently the dominant answer has been that a speaker makes an insincere assertion if and only if he does not believe the proposition asserted. There are, however, persuasive counterexamples to this simple account. It has been proposed instead that an insincere (...) assertion that p is one made by a speaker who (a) does not express his belief that p; or (b) does not believe that he believes that p; (c) does not assent to p; or (d) does not express any of these cognitive states. We show that these .. (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)

The emergency department (ED) is a fast-paced, highly stressful environment where clinicians function with little or suboptimal information and where time is measured in minutes and hours. In addition, death and dying are phenomena that are often experienced in the ED. Current end-of-life care models, based on chronic illness trajectories, may be difficult to apply in the ED. A philosophical approach examining end-of-life care may help us understand how core medical and nursing values are embodied as care practices and as (...) ethical comportment. The integration of Aristotle's notions of phronesis and praxis with Merleau-Ponty's ontological notions of intentional arc and maximum grip in the context of the culture and practices of the ED offers a unique view of clinical and ethical practice at the end-of-life in the emergency setting. Caring for people at the end-of-life calls us to act virtuously based on previous experience, meanings and local practices. The maximum grip of the ultimate particulars of the situation combined with one's experiential and theoretical knowledge opens up situated possibilities for the expert clinician. (shrink)