Telling Others to Do What You Believe Is Morally Wrong: The Case of Confucius and Zai Wo

Can it ever be morally justifiable to tell others to do what we ourselves believe is morally wrong to do? The common sense answer is no. It seems that we should never tell others to do something if we think it is morally wrong to do that act. My first goal is to argue that in Analects 17.21, Confucius tells his disciple not to observe a ritual even though Confucius himself believes that it is morally wrong that one does not observe the ritual. My second goal is to argue against the common sense answer and explain how Confucius can be justified in telling his disciple to do what Confucius thought was wrong. The first justification has to do with telling someone to do what is second best when the person cannot do what is morally best. The second justification has to do with the role of a moral advisor.     

Analogical Reasoning in Handling Emerging Technologies: The Case of Umbilical Cord Blood Biobanking

How are we individually and as a society to handle new and emerging technologies? This challenging question underlies much of the bioethical debates of modern times. To address this question we need suitable conceptions of the new technology and ways of identifying its proper management and regulation. To establish conceptions and to find ways to handle emerging technologies we tend to use analogies extensively. The aim of this article is to investigate the role that analogies play or may play in the processes of understanding and managing new technology. More precisely we aim to unveil the role of analogies as analytical devices in exploring the “being” of the new technology as well the normative function of analogies in conceptualizing the characteristics and applications of new technology. Umbilical cord blood biobanking will be used as a case to investigate these roles and functions.     

On the subject of homosexuality: What Freud said

The article explores Freud's writing on homosexuality, from his early hypotheses, expressed in his letters to Fleiss to his last observations in The Outline of Psychoanalysis, published in 1940 after his death. We trace the continuities as well as changes in his thinking, and have organized the paper conceptually, under the headings: 1) Bisexuality 2) Narcissism and Object choice, 3) On Normality and Pathology, and 4) The Quantitative factor and Aggression. We show that Freud was the first to confirm the existence of homosexualities, that he offers no black and white solution to the question of normality and pathology, although he contributes to the understanding of the vehemence that surrounds the subject, and that, in the considerable body of work, he has offered a rich and varied foundation for further thinking on the subject.     

Technology in Medicine: Ontology,Epistemology, Ethics and Social Philosophy at the Crossroads

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.     

Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management

This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.     

What Virtue Argumentation Theory Misses: The Case of Compathetic Argumentation

While deductive validity provides the limiting upper bound for evaluating the strength and quality of inferences, by itself it is an inadequate tool for evaluating arguments, arguing, and argumentation. Similar remarks can be made about rhetorical success and dialectical closure. Then what would count as ideal argumentation? In this paper we introduce the concept of cognitive compathy to point in the direction of one way to answer that question. It is a feature of our argumentation rather than my argument or your argument. In that respect, compathy is like the harmonies achieved by an accomplished choir, the spontaneous coordination of athletic teamwork, or the experience of improvising jazz musicians when they are all in the flow together. It is a characteristic of arguments, not a virtue that can be attributed to individual arguers. It makes argumentation more than just the sum of its individual parts. The concept of cognitive compathy is brought into focus by locating it at the confluence of two lines of thought. First, we work up to the concept of compathy by contrasting it with empathy and sympathy in the context of emotions, which is then transplanted into epistemic, cognitive, and argumentative soil. Second, the concept is analytically linked to ideal argumentation by way of authenticity in communication. In the final section, we explore the extent to which argumentative virtues are conducive to producing compathetic argumentation, but reach the unhappy conclusion that the extra value of compathetic argumentation also transcends the evaluative reach of virtue argumentation theory.     

The effectiveness of a proactive coping intervention targeting self-management in diabetes patients

Objective: The study’s aim was to investigate psychological, behavioral and medical long-term outcomes of an existing self-management intervention targeting the development of proactive coping skills (e.g. goal setting and identifying barriers) in type 2 diabetes patients. The study aimed to replicate prior research showing the intervention’s effectiveness, and to extend it by (a) adding booster sessions and (b) prolonging the period of follow-up measurement to capture long-term effects.

Design/outcome measures: A total of 141 type 2 diabetes patients were included in the intervention. The intervention employed a 5-step approach to target proactive coping skills. Psychological (e.g. proactive coping and self-efficacy) and behavioural variables (e.g. self-care, diet and physical activity) were assessed at baseline (T1), after the initial phase of the intervention (T2), after the booster phase (T3) and at follow-up (T4), comprising a total period of 15 months. Medical variables were assessed at T1 and T4.

Results: Employing piecewise Latent Growth Curve Modelling, results showed that participants improved on all psychological and behavioural variables during the initial phase and maintained these improvements over 12 months. The booster phase yielded no further improvements. Mixed findings were obtained on medical outcomes.

Conclusion: The original intervention is effective, but the added value of the booster sessions is uncertain.     

Issues in Parent-Child Agreement: The Case of Structured Diagnostic Interviews

There are three primary purposes of this review. First, the review distinguishes among three types of reliability and describes the importance of evaluating the reliability of child psychopathology assessment instruments for clinical practice and research. Second, parent-child reliability findings from 5 of the more carefully studied and frequently used Structured (semi and highly) diagnostic interviews (The Schedule for Affective Disorders and Schizophrenia for School-age Children, The Child Assessment Scale, The Anxiety Disorders Interview Schedule for Children. The Diagnostic Interview for Children and Adolescents, and the Diagnostic Interview Schedule for Children) are examined. Finally, this review explores factors that have been implicated in terms of their potential effect on parent-child agreement. In addition, future directions for research and clinical practice within this area are identified and potential resolutions to the conundrum of parent-child discordance are discussed.     

Vulnerable Populations in Research: The Case of the Seriously Ill

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces their ability to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research.     

从李丽云事件看生命健康权、患者自主权和医生干涉权

当患方行使自主权所做的决定危及自身生命健康权时,能否赋予医生干涉权以实现生命高于一切的理念？阐明了生命健康权、患者自主权和医生干涉权的关系．并从我国实际出发,论述不能通过赋予医生干涉权来避免类似李丽云悲剧的发生,建议立法完善对民事行为能力的规定,建立司法机关或其他第三方机构提前快速审查机制来解决自主权与生命权的冲突。     

The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes

We examined the effect of diabetes knowledge and attitudes on self-management and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples.     

Analytical Buddhism: The Two-Tiered Illusion of Self

In the contemporary debate on the nature of autonomy, it is generally taken for granted that autonomy is to be understood as rule by the self, with the debate centring on how that self is to be identified. Garnett [2013b Garnett, Michael 2013b. The Autonomous Life: A Pure Social View, Australasian Journal of Philosophy 91/4. [Google Scholar]] has recently proposed a theory that rejects the dominant understanding of autonomy as rule by the self and views it instead as resistance to rule by others. According to that theory, an autonomous agent is one whose various ‘autonomy traits’ render her sufficiently resistant to subjection to foreign wills. I argue that Garnett has not given us good reason to abandon the understanding of autonomy as rule by the self. His account is plausible only if it is understood to require for autonomy the possession of at least one trait with which the agent can be identified. And the best explanation of the necessity of some such trait(s) is offered, not by Garnett's, but by the dominant understanding of autonomy he rejects.     

由临床病例引发对患者医疗自主权的思考

从医务人员视角结合临床病例浅谈患者医疗自主权。阐述患者医疗自主权的概念及涵盖的内容,包括知情同意原则、意定监护、生前预嘱、预立医疗指示、预立医疗照护计划。分析患者医疗自主权在我国实施所存在的阻力,包括受传统孝道束缚、国民对患者医疗自主权的维护意识不强和认知不足、缺乏死亡教育以及医学技术层面等问题。为了有效推广和实施患者医疗自主权,作为医务人员首先要提高自身意识、加强推广力度,其次对于公众要加强死亡教育,另外医患之间、患者与家属之间的交流沟通也非常重要。