bluuebunny/crossref_metadata_2025 huggingface dataset:
Elastografía en tiempo real (Supersonic), experiencia de un centro en Bogotá
Authors: Prieto Ortiz Jhon Edison , Garzón-Orjuela Nathaly , Sánchez Pardo Santiago , Prieto Ortíz Robin Germán , Ochoa Díaz Andrés Felipe , Soto-Ospina Pedro Hernán , Eslava-Schmalbach Javier H
Published: March 2021

Introducción: la elastografía en tiempo real, 2D-SWE (Supersonic), es una prueba no invasiva que se utiliza para determinar la elasticidad del hígado y, de esa forma, calcular el grado de fibrosis hepática. En Colombia, la prueba se introdujo en 2016 y no existen hasta el momento estudios del comportamiento de la prueba en todos los pacientes hepáticos, solo se han publicado en pacientes sanos y cirróticos.
Objetivo: analizar la experiencia de la aplicación de la elastografía en tiempo real, en sujetos atendidos en el centro de enfermedades hepáticas y digestivas de Bogotá, Colombia.
Materiales y métodos: estudio descriptivo retrospectivo de una cohorte de sujetos atendidos entre marzo de 2016 y julio de 2017. Se realizó una historia clínica completa y una prueba de elastografía en tiempo real (Supersonic).
Resultados: se incluyeron 654 sujetos, con una mediana de edad de 55 años (rango intercuartílico [RIC]: 45-64). La mediana de valores de fibrosis expresada en kilopascales (kPs) fue de 8,3, con un promedio de 5 mediciones. Se observó una diferencia significativa en el grado de fibrosis entre los grupos de edad y en relación con el diagnóstico final, donde se evidenció una mayor fibrosis en el grupo de enfermedades colestásicas (autoinmune, colangitis biliar primaria [CBP] y superposición autoinmune-CBP). La tasa global de fracaso fue menor al 1 %.
Conclusiones: es la primera descripción del comportamiento de la prueba a nivel nacional. Los valores de rigidez hepática observados en los diferentes estadios demuestran la utilidad de la prueba para la determinación de la fibrosis hepática en pacientes con diferentes patologías.
Management of Massive Splenomegaly
Authors: Hudson Victoria , Rogers Priya , Bennett John
Published: March 2021

57-year-old man presented with a 3-month history of fatigue, fever and
increasing abdominal pain.He had completed treatment for follicular
lymphoma and JAK2 positive myeloproliferative disorder 2 months
previously. This case demonstrates therapeutic and diagnostic rationale
for open splenectomy in, to our knowledge, one of the largest recorded
spleens
Allergen Extraction: Factors Influencing Immunogenicity and Sensitivity of Immunoassays
Authors: Soares João Ricardo Almeida , SIlva Airton Pereira e , Guimarães Isabelle , Oliveira Ana Luisa , Faccini Claudia Regina , Mattos Erika , Rodrigues Sónia , Marmello Bárbara , Teixeira Gerlinde
Published: March 2021

Because of the high social impact of Food allergy, it is of great
importance to correctly diagnose this disease using reliable tests.
Knowledge of the allergenicity properties of proteins, how they react in
the body and in diagnostic tests is necessary to adequately assess the
potential immunogenicity of both natural foods and those produced
through biotechnological processes. Thus, our aim was to analyze the
factors that influence the protein extraction of foods in terms of,
immunogenicity and immunoassays sensitivity. Peanut proteins were
extracted using four distinct extraction buffers (physiological saline,
tris buffer, borate buffer with and without β-mercaptoethanol), the
protein concentration was determined by the Lowry method and
polyacrylamide electrophoresis (SDS-PAGE) was used to compare the
protein profile of each extract. The immunogenicity of each extract was
verified by sensitizing two mouse strains (Balb/c and C57/BL6) with
solution containing 100μg of the extracted proteins and determined by
ELISA. Results show that extraction with the distinct buffers resulted
in protein solutions with different yields and profiles. The
immunogenicity of the different extracts also demonstrated distinct
patterns that varied depending on the extraction methods, mouse strain
and in-vitro test. Immunoreactivity varied in accordance to the protein
extract used to coat the microtitration plates. In conclusion, the
protein profile in the extracts is critically influenced by the salt
composition and pH of the extraction buffers, this in turn influences
both in vivo immunogenicity and in vitro immunoreactivity.
Unprecedented dynamics of seminal fluid replenishment after mating
Authors: Korsmit Yvonne , Mariën Janine , Koene Joris , Nakadera Yumi
Published: March 2021

Seminal fluid proteins (SFPs) play vital roles for optimizing
reproductive success in diverse animals. Underlining their significance,
SFP production and transfer are highly plastic, e.g., depending on the
presence of rivals or mating status of partners. However, surprisingly
little is known about replenishing SFPs after mating. It is especially
relevant in multiple mating species, as they would continuously produce
and use SPFs throughout their reproductive life. Here we examined the
expression pattern of SFP genes after mating in the great pond snail,
Lymnaea stagnalis. Our results show that only two of the six SFP genes
investigated here were up-regulated after mating, indicating that L.
stagnalis replenishes seminal fluid in a protein-specific manner. In
addition, we suggest that SFP replenishment is plastic depending on the
mating history of female-acting snails. Our results shed light on
unexplored aspects of SFP replenishment, thereby expanding the
understanding of reproductive strategies in animals.
Impact of systemic anticancer therapy in pediatric optic pathway glioma on visual function: a systematic review.
Authors: Bennebroek Carlien , Wijninga Laura , Limpens Jaqueline , Meeteren Antoinette Schouten-van , Saeed Peerooz
Published: March 2021

Abstract: Background: Systemic anticancer therapy (SAT) is the standard
treatment for unresectable (progressive) pediatric optic pathway glioma
(OPG), which can seriously affect visual function. New SAT modalities
have been introduced the last decennium. Methods: MEDLINE and EMBASE
(Ovid) were searched for studies reporting on change in visual acuity
and visual field after start of treatment with SAT for OPG (1990-August
2020). Results: In 11 studies including 358 patients improvement of
binocular VA was found in 0-45%, stability in 18-77% and decrease in
0-82% of patients. Considerable heterogeneity among included studies
made a meta-analysis not appropriate. Studies on VEGF and MAPK signaling
inhibition did not meet the eligibility criteria. Conclusion. This
systematic review suggests a positive impact of SAT on pediatric OPG.
However, the wide ranges reported in efficacy of SAT and the observed
heterogeneity highlight the need for prospective studies with uniform
definitions.
Message propagation in DTN based on virtual contact of behavior model
Authors: Chan Ho-Hsiang , Tsai Tzu-Chieh
Published: March 2021

Delay Tolerant Network (DTN) is a kind of network structured to deliver message intermittently. Network connections are not persistent between nodes, instead they must rely on nodes making geographic location movements to incur contact with other nodes and establish intermittent communication sessions to allow messages delivery. We will refer to encounters via geographic location movements as ?physical contact.? Many DTN researches mainly focus on message delivery via physical contact. However, this paper believes that in a realistic environment, encounters between nodes not only happen geographically in nature, but also occur virtually in cyberspace. When both nodes go online on the same social media platform, it is an encounter we refer as virtual contact. How messages deliver for virtual contact is store-post-and-forward, just like what happens in a DTN, but it is no longer restrained by geographical locations. This paper considers a scenario in which nodes make virtual contact in cyberspace and incur message delivery based on their own behavior patterns. The verifying experiment is conducted using both survey and simulation. First of all, we handed out questionnaires for students to fill out. The questionnaire inquired them to rank their most frequent activities performed on social media platforms. According to the responses, we conclude the top 3 frequent activities when the students use social media platforms and classify them into 3 groups according to a weighted behavior pattern scheme. The classification includes Social Group, Read-Only Group and Interest Group. It does not matter which group a student is assigned to. In the simulation, he or she will get to decide whether to deliver/receive messages or not based on a randomized selection on 3 behavior pattern. Finally, we analyze the simulation result to determine how messages propagated in different behavior pattern groups. It is derived from the simulation that to quicken message propagation, directing messages to one of the behavior groups yields the maximize benefits. This provides the basis for further researches on collecting data of desired scenarios to establish respective propagation models.
Thermal analysis and parametric optimization of plate fin heat sinks under forced air convection
Authors: Khattak Zulfiqar , Ali Hafiz
Published: March 2021

Heat dissipation is becoming more and more challenging with the preface of new electronic components having staggering heat generation levels. Present day solutions should have optimized outcomes with reference to the heat sink scenarios. The experimental and theoretical results for plate type heat sink based on mathematical models have been presented in the first part of the paper. Then the parametric optimization (topology optimization) of plate type heat sink using Levenberg-Marquardt technique employed in the COMSOL Multiphysics? software is discussed. Thermal resistance of heat sink is taken as objective function against the variable length in a predefined range. Single as well as multi-parametric optimization of plate type heat sink is reported in the context of pressure drop and air velocity (Reynolds number) inside the tunnel. The results reported are compared with the numerical modeled data and experimental investigation establish the conformity of results for applied usage. Mutual reimbursements of greater heat dissipation with minimum flow rates are confidently achievable through balanced, heat sink geometry as evident by the presented simulation outcome. About 12% enhancement in pressure drop and up to 51% improvement in thermal resistance is reported for the optimized plate fin heat sink as per data manifested.
Estimates of age specific death rates in people with diabetes and associated multimorbidity using Australian administrative pharmaceutical data
Authors: Purkiss Shaun Francis , Keegel Tessa , Vally Hassan , Wollersheim Dennis
Published: March 2021

IntroductionEstimating the mortality risk of persons with diabetes can be challenging. Associated conditions such as cardiovascular disease can become the primary cause of mortality and the underlying contribution of diabetes not recorded. Alternative methods to assess mortality risk in people with diabetes would be useful.
ObjectiveTo evaluate an Australian pharmaceutical database to identify multi-morbidity cohorts associated with diabetes and determine mortality rates in these groups using prescription exchange cessation as a proxy event for death.
MethodsAustralian Pharmaceutical Benefits Scheme data covering the period 2003–14 were used. Persons with diabetes, cardiovascular diseases and dyslipidemia were identified using Anatomic Therapeutic Chemical codes allocated to their recorded dispensed treatments. People with combinations of these conditions were followed and the last recorded prescription exchange used as a proxy event for mortality. Age and gender specific mortality rates and mortality rate ratios for the multi-morbidity cohorts were then calculated from the number of deaths occurring within 10 years.
Results346,201 individuals were identified as taking treatments for diabetes, dyslipidemia and cardiovascular conditions in 2004, 86,165 deaths occurred within 10 years of follow up. Overall crude mortality was 26.2/1,000 person years. Age specific mortality rates and rate ratios were calculated for various multi-morbidity groupings. Statin treatments improved the mortality rates associated with diabetes and cardiovascular disease in persons age >54 (Log–Rank <.001).
ConclusionsAdministrative pharmaceutical data can be used to identify persons with diabetes and associated multi-morbidities. Proxy mortality events defined by the cessation of treatment can generate mortality rates, providing an alternative perspective for the assessment of mortality risk.
Stress and anxiety among adolescents, during the covid-19 outbreak
Authors: Ifdil Ifdil , Putri Yola Eka , Amalianita Berru
Published: March 2021

Covid-19 affects every aspect of human life, especially psychological aspects. Furthermore, adolescents experience difficulties because of the pandemic and therefore require extra change due to the occurring situation. In this situation, adolescents felt stress from having to adjust to the unpredictable situation, as well as anxiety, from facing an uncertain situation. Meanwhile, from the previous year, the news has been updated daily, concerning the number of deaths and positive cases. Teens are able to access news through the internet by listening, watching or imagining the current situation. This study used Indonesian adolescent as the research subjects and was conducted online through survey Monkey platform. A total of 98 participants aged above 17 years were obtained from several provinces and region in Indonesia. In addition, the study used DASS as the instrument of research DASS, while the data was analyzed using JASP. According to the results, the stress and anxiety of adolescents during the covid-19 outbreak are in the heavy and very heavy categories, respectively, indicating tremendous pressure is experienced due to the Covid-19 pandemic.
Prinuditel'noe licenzirovanie v farmacii: tekushchee regulirovanie i perspektivy
Authors: Гайдин Т. Ю. , Рожнова С. А.
Published: March 2021

Problema primeneniya prinuditel'nogo licenzirovaniya (PL) aktual'na dlya farmacevticheskih rynkov vo mnogih stranah. Cel'yu raboty bylo proanalizirovat' posledstviya primeneniya PL v sisteme obrashcheniya lekarstvennyh sredstv (LS) dlya obespecheniya ohrany zhizni i zdorov'ya grazhdan v ramkah konkurentnoj politiki na rynke LS. S pomoshch'yu PEST-analiza opredeleny ekonomicheskie, social'nye, tekhnologicheskie i politicheskie problemy, svyazannye s PL v farmacii. Pokazany vozmozhnosti primeneniya PL kak instrumenta konkurentnoj politiki dlya regulirovaniya sluchaev zloupotreblenij farmacevticheskimi kompaniyami-patentoobladatelyami dominiruyushchim polozheniem na rossijskom rynke LS, chto privodit k snizheniyu blagosostoyaniya potrebitelej i ugrozhaet zhizni i zdorov'yu grazhdan. Na segodnyashnij den' zakonodatel'stvom zashchishcheny kak patentoobladateli v sfere farmacevticheskoj razrabotki, tak i sub'ekty obrashcheniya LS. Prodolzhaetsya diskussiya ob effektivnosti vozmozhnogo PL kak instrumenta konkurentnoj politiki dlya ohrany zhizni i zdorov'ya grazhdan, no na segodnyashnij den' PL v Rossii primenyayut v isklyuchitel'nyh sluchayah. Neobhodim poisk ekonomicheskogo balansa mezhdu stimulami k innovacionnoj aktivnosti kompanij, okupayushchih vlozheniya v issledovaniya i razrabotki, dolgosrochnym dohodom s prodazhi LS i dostupnost'yu LS.
以儒家視角探討生命的本質——以人工合成生命為例
Authors: LIU Xianfeng
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.面對科學技術給我們帶來的越來越多的倫理學難題的時候，我們不妨從孔子的教導中尋找答案。美國科學家克雷格．文特爾目前宣佈，他們利用了一段人工合成的DNA 創造了人類有史以來的第一個人造生命，並取名其為“辛西婭”。這也使得人們開始重新思考生命的定義，生命的本質等本源問題。本文將從儒家的哲學視角分析辛西婭的生物學地位，並從儒家的“天命觀”的角度分析合成生物技術。希望能對新技術得出儒家獨到的見解。On May 20, 2010, the Craig Venter Institute, a U.S. private research institution, announced that they had successfully synthesized bacterial deoxyribonucleic acid (DNA) and implanted it in another bacterium. After several attempts, the implanted artificial DNA regained life and began to reproduce in a lab dish. This “artificial life” was named “Synthia” (meaning “man-made children”). The result of this research has attracted broad attention. Even U.S. President Barack Obama expressed concern, and has asked the White House Council on Bioethics to provide a detailed report on synthetic biology within six months, to determine the appropriate ethical boundaries and minimize the potential harm. Indeed, this latest research in synthetic biology requires careful philosophical, ethical and cultural considerations on the essence of life.This essay attempts to analyze the biological status of Synthia and explores the essence of life from the perspective of Confucian philosophy. In particular, it attempts to draw on the Confucian idea of Heaven (tian) or God (shangdi) to disclose unique Confucian insights into new technology in general and artificial life in particular. Indeed, as advanced and pioneering science and technology have brought about more and more ethical difficulties and dilemmas, the Chinese people need to draw on the wisdom of Confucius to work out suitable solutions and guide their actions. Researchers at the Craig Venter Institute recently announced that they could take advantage of man-made DNA to create the first artificial human life. How should Confucians reflect on such actions in terms of their view of the essence and meaning of life?This essay assumes that following the Mandate of Heaven (tianming) is central to Confucian teaching on the essence of life. The Mandate of Heaven is reflected in the natural development and transformation of the myriad things in the universe. However, things like Synthia are outside of this natural process of development and transformation, and cannot be taken as being consistent with the Mandate of Heaven. Just as Confucianism cannot support the creation of human cloning, it cannot support artificial human life such as Synthia, because both violate a fundamental understanding of the essence of life in the Confucian faith. Confucian scholars cannot hold a utilitarian view of maximizing human interests, no matter what those interests are taken to be. Instead, Confucianism must insist that human interests be consistent with the Mandate of Heaven to promote the virtuous essence of human life.DOWNLOAD HISTORY | This article has been downloaded 174 times in Digital Commons before migrating into this platform.
知情同意 ——不同文化，不同價值
Authors: YANG Guoli
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.當下中國的醫患關係非常緊張，看病難、看病貴似乎成了無解的難題。同時，當下中國的生命倫理原則，如“知情同意”， 幾乎都是來自西方的“舶來品”。文章指出，“講信修睦”的中國傳統文化與崇尚競爭的現代西方文化有著本質的不同，因此機械地照搬生命倫理原則，就會使這些原則成為缺乏道德正當性、邏輯合理性，以及醫療建設性的種種教條。文章旨在探討建構儒學生命倫理學的必要性和現實性。作者 認為，以中國文化建構中國生命倫理學不是一個偽命題。依靠中國生命倫理學解決當下中國的問題不僅是一項具有理論必要性和現實迫切性的歷史使命和任務，更是中國學者是否為世界文化發展做出貢獻的挑戰。In the West, informed consent is part of the legal conditions under which people are fully informed about or can participate in their own health treatment. It emphasizes the idea that patients are autonomous and have both the legal and moral rights to control their own bodies. However, in China the original intention of this concept has been changed. The idea of protecting the patient has become a means of protecting medical professionals when they fail to fulfill their duties. A moral dilemma occurs when “foreign” ideas and principles are “imported” into China: they lack the cultural and moral foundation to be implemented effectively.This essay provides a Confucian moral response to bioethical issues such as informed consent, pointing out their limits or even potential dangers when practiced in China. For instance, the tension implicit in informed consent has ruined the traditional model of the doctor-patient relationship that emphasizes the role of the doctor as one of caring and knowing better. As a physician, the author discusses the problems that occur in hospitals when imported ideas are deployed so dogmatically that rational principles lose their reasonableness.DOWNLOAD HISTORY | This article has been downloaded 67 times in Digital Commons before migrating into this platform.
導言: 儒家傳統、知情同意與公正原則
Authors: ZHANG Ellen Y.
Published: March 2021

LANGUAGE NOTE | Document text in Chinese本期論文選自今年暑期由中國內地《醫學與哲學》雜誌社和香港浸會大學應用倫理學研究中心聯合主辦的第七屆“建構中國生命倫理學研討會”的部分演講報告。大多數論文圍繞當今中國醫學倫理學出現的具體問題與實踐，從儒家生命倫理學與西方生命倫理學的雙重面向探討有關知情同意、醫療公正、家庭醫療儲蓄和中國傳統醫學知識論等諸方面的問題。本期每一篇論文都是在面對人們早已熟知的普世價值觀及倫理原則的同時如是發問：什麼是中國生命倫理學所應有的“中國特色”？DOWNLOAD HISTORY | This article has been downloaded 39 times in Digital Commons before migrating into this platform.
臨床知情同意在中國的一些實踐及反思
Authors: ZHAO Wenqing
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.“患者利益至上”知情同意是當代西方生命倫理學的一個核心概念，在規範臨床醫療實踐中的應用十分廣泛，相關的法規和指引更是層出不窮。隨著自由主義理論和權利觀念在全世界範圍內的流行，中國也開始注意到知情同意原則在臨床實踐中的重要意義，並逐步引入西方的相關規範。然而，大部分規範的制定缺乏對知情同意倫理基礎的考察，對臨床知情同意在中國的實踐也沒有足夠的關注。本文分析作為知情同意的道德基礎，並通過對一線醫務工作人員的訪談，了解臨床知情在中國實踐情況及限制，希望能為相關規範的制定提供一些思路。Informed consent is considered to be one of the most important conceptual developments in contemporary bioethics, and is strongly implicated in the regulation of clinical practices in the West. Over the past decade, the growing prevalence of both liberal arguments supporting individual autonomy and rights-based debates focusing on equality has brought the concept of informed consent into the purview of Chinese legislation pertaining to healthcare and clinical practice. However, most of the laws and regulations are made by Chinese authorities in ignorance of the concept’s ethical groundings. In addition, lawmakers have not taken into account the empirical reality and specific situations of clinical practice in contemporary China. This essay contends that the history of informed consent legislation in China since 1994, exemplified by the recently adopted Article 55 of the Tort Law of the People’s Republic of China, reveals conflicting understandings of the ethical foundation of the notion of informed consent. The essay also presents extensive interviews conducted by the author with four frontline medical practitioners in first-tier cities that demonstrate how their experiences with informed consent are largely shaped by current institutional settings and influenced by traditional Confucian ethical norms, (e.g., an emphasis on interdependence among family members, which requires the doctor to consult with the family rather than the patient). The essay concludes that we must take into serious consideration the Chinese ethical tradition and its unique application in practice when cross-fertilizing the concept of informed consent.DOWNLOAD HISTORY | This article has been downloaded 116 times in Digital Commons before migrating into this platform.
儒家正義論及其對醫療公正問題的啟示
Authors: ZHANG Shunqing
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.正義是一個歷史範疇，任何具有實踐品格的正義理論都只能是與特定道德共同體特殊的善的規定相聯繫的正義論，從這一意義上說，儒家當然也有自己的正義論。儒家正義論是以天道性命的邏輯關係為起點，通過仁、禮、義三維一體的倫理結構而表現的正義論。這種正義論將社會正義與個人正義統一起來，總體上體現為一種“厚生”的思想意識和行動。由於“生”具有不同的實踐領域和境界層次，從而使儒家正義論具有多維的展現向度。把這種正義論應用於醫療公正領域，儒家主張醫療保健政策必須以維護國民的生命意義和完整實現為前提，主張政府應提供一種基礎性的全民性的醫療保障和保健制度。但儒家不認同單級的平等主義的分配制度，而是強調資源的差等分配，但資源差等分配的前提不在於每個人實際的貧富狀態，而取決於人的修德程度或者說後天努力與貢獻的程度。個體對自我生命的完整實現負有天定的義務，因此儒家主張在醫療保健領域應當賦予個體和家庭以更多的自主權。In the West, “justice” is a complex ethical principle, with meanings that range from the fair treatment of individuals to the equitable allocation of healthcare resources. Justice in bioethics is perhaps the most contested and controversial principle. This paper argues that the Confucian notion of justice is neither rights-based nor distributive; rather, it is based on the virtues of humanness and benevolence (ren), correct behavior and propriety (li), and uprightness and appropriateness (yi). Those virtues cherished in the Confucian tradition constitute what can be called a Confucian concept of justice, the primary principle of which is to respect human life. This means that in the healthcare system, the Confucian idea of justice is approached from the perspective of equality and fairness. On the one hand, the government should provide basic care for all persons according to the virtue of humanness/benevolence; on the other hand, the government should allow for diversity and differences in medical treatment and healthcare resource allocation according to the virtues of propriety and appropriateness, given that medical resources are limited and China supports a huge population. In other words, the government has the responsibility of providing public health care to those who cannot afford to pay for their own basic healthcare needs. At the same time, the government should allow for alternatives and should permit people to choose between ways of dealing with their medical issues.Clearly, the language of “rights” is absent from the Confucian tradition. However, this essay argues that because the Western notion of justice, particularly in the legal sense, does not take into account what is good, the Confucian virtue-based justice better fits the cultural milieu of medical practice in China. From the standpoint of Confucianism, healthcare and bio-medical ethics should be more concerned about what is good for society, family, and the individual than about absolute equality or the principle of fair equality, which engender both moral and economic hazards.DOWNLOAD HISTORY | This article has been downloaded 259 times in Digital Commons before migrating into this platform.
“家庭共決模式”: 一種明智的臨床選擇
Authors: ZHANG Xinqing
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.Professor Lo strongly argues that family co-determination, rather than self-determination or family-determination, is one of the best choices for protecting the vulnerable in a healthcare setting. The assumption underlying the family co-determination model is that of an individual as a person-in-the-family rather than as an isolated individual. I provide some proofs to enhance the Confucian bioethical base of family co-determination. Based on a national survey of health professionals and patients, I conclude that family member involvement in clinical decision making contributes to better communication between doctors and patients, which is a key factor in alleviating the degree of tension.DOWNLOAD HISTORY | This article has been downloaded 50 times in Digital Commons before migrating into this platform.
儒家“個人”的道德身份與道德責任
Authors: CAI Yu
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.This article reviews Professor Lo Ping Cheung’s paper, “The Family as the Primary Protector of the Vulnerable: Confucian versus Medical Ethics.” The paper describes human behavior by way of historical narrative, thus offering a historical perspective on philosophical research. His notion of “family co-determination” instead of “parent-determination” also brings a developmental attitude to philosophical research. At the same time, we discuss the moral identity and moral responsibility of the Confucian “individual.” The moral identity of the Confucian “individual” includes both specific cultural identities and a specific social identity. Confucian individuals are the successors, developers and creators of Confucian culture, and also the practitioners and successors of family virtues. These are their moral responsibilities. This article also makes recommendations on forming and expressing family decisions in practice. First, family decisions should be taken by those members of the family who have the capacity to make a decision. However, taking the view of the family as the ethical unit, a family decision should be made on the family’s specific circumstances, with no need for administrative or legal provisions. Second, in accordance with current practice, a representative of the family who has the capacity to make medical decisions should sign an informed consent form. When the views of the patient and his or her family are not consistent, the general principle is that the doctor should follow the patient’s decision. Yet there might be some cases in which the doctor should not follow the decision of the patient; for example, if the patient makes a decision that endangers his or her life due to a lack of knowledge, emotional state or other reasons. In this case, the other family members will put forward their different views based on their responsibility to the patient, and the doctor may comply with the latter.DOWNLOAD HISTORY | This article has been downloaded 301 times in Digital Commons before migrating into this platform.
是情結還是希望？
Authors: WANG Xiaolin
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.This article proposes a different view from that offered by Professor Ni in “Regulating the Family and Gongfu.” Professor Ni argues that the family forms the base from which a person’s life can go beyond the individual self, obtain sacredness within the secular, and become immortal, in addition to providing the basis for social harmony. This article agrees that the notion that family serves not only as a refuge in the secular life of Chinese Han people, but also as a sacred place in their soul, is a cultural phenomenon. At the same time, however, this article argues that adopting the family as the basis for rejuvenating our tradition is merely an unrealistic assumption.DOWNLOAD HISTORY | This article has been downloaded 72 times in Digital Commons before migrating into this platform.
家庭共同決策模式在手術知情同意中的應用
Authors: WANG Mingxu , MA Le , YUEN Hui
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.H. Tristram Engelhardt indicates that the ontological or metaphysical account of the family is superior to the libertarian-liberal account of the family with respect to significant issues in bioethics. By appealing to the development of the concept of informed consent and relevant medical laws and institutions, illustrated by examples from China, this essay supports Engelhardt’s view and emphasizes the cultural and ethical importance of the family functioning as a whole in the process of proper medical decision making and the protection of the fundamental interest of the patient.DOWNLOAD HISTORY | This article has been downloaded 94 times in Digital Commons before migrating into this platform.
疾病是倫理中性的嗎？
Authors: WANG Jue
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.Professor Xianglong Zhang’s paper challenges contemporary bioethical discourse by foregrounding questions that have been ignored by modern theorists. One of these questions is whether illness is “ethically neutral.” In my paper, I offer three distinct perspectives on this question. First, I frame the question of ethical neutrality by considering the meaning of illness. Second, I clarify the relationship between ethics and illness. Finally, I discuss the role of illness as a metaphor for aspects of our social and ethical lives. The behavior of the medical profession is commonly linked with moral obligations. There is good reason to believe that the metaphorical relationship between medicine and moral discipline reflects a core dimension of human nature and thus offers useful insights into Wang’s “ethical cure.”DOWNLOAD HISTORY | This article has been downloaded 80 times in Digital Commons before migrating into this platform.
Why Do Bioethics?—Two Questions for Professor Solomon
Authors: KIM Richard T.
Published: March 2021

LANGUAGE NOTE | Document text in EnglishIn his fascinating and challenging essay, Professor Solomon provides a forceful account of the current “crisis in bioethics.” In the following comments, I seek clarification regarding the relationship between culture and bioethics by raising the following two questions: (1) What is the relationship between culture and the deep normative commitments that undergird conflicting normative theories? (2) Given the seemingly interminable nature of normative disagreements, what reasons are there to continue pursuing bioethics? The main concern arising from these two questions is that given the deep cultural divisions in contemporary society, as articulated by Solomon, the point of doing bioethics is no longer clear.DOWNLOAD HISTORY | This article has been downloaded 24 times in Digital Commons before migrating into this platform.
略論儒家養老觀及其當代價值
Authors: ZHANG Shunqing
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.儒家的養老觀念具有深刻的思想根源。它有形上根據，也有現實原因。從表現形式上看，儒家的養老觀蘊含在儒家的“孝道”思想之中，由於孝道在儒家那裏既有著形上的天道根源，亦發揮著宗教性的功能，這使得蘊含在這一孝道思想中的養老觀念也兼具了這兩種思想特徵，即儒家養老觀既是形上的天道的要求，同時又具有宗教性關懷的內蘊。基於血親的自然情感因素和人對老年生活狀態的憂慮則構成了儒家養老觀念現實的、直接的緣由。這種由孝道維繫的養老觀念決定了儒家對“老人”界定的特殊性和養老方式的特殊性。在家庭中，“老”是相對於盡孝的義務而言的，而社會層面的“老”則需要加以特殊規定，以便於社會層面的養老實踐。而在養老方式上，這種由孝道維繫的養老觀也決定了家庭或子女是主要的、基本的養老場所和主體，但國家或政府在宣導、維護這種養老觀念上，以及為家庭養老創造必要的物質條件和保障方面，則負有絕對的義務和責任。China’s citizens are growing old at an alarming rate. The increase in the country’s elderly population has created profound social and economic complications that can be solved only by appropriate policies and moral decisions on caring for aging people. Who will take care of the elderly? Should elderly people depend on their families or on the government? The author of this paper shows that filial or familial piety—the Confucian ideal of moral responsibility for one’s elderly relations—is intrinsic to the traditional Chinese value system, and should continue to shape Chinese society today. The author contends that filial piety is the key ethical principle of Confucianism based on its metaphysical foundation of the Dao. Instead of talking about the rights of elderly people, we should emphasize the moral duty of their adult children.However, the traditional emphasis on filial piety has been challenged by social changes in the last few decades, especially since China’s economic reform. There are fewer and fewer households with “three generations under one roof,” due to China’s urbanization and one-child policy. More and more people are choosing to invest in institutional care (such as nursing-home care and residential care) as an alternative to traditional familial care. Despite these changes, the author maintains that filial piety, as the core value of the Confucian ethical system, should play an important role in modern Chinese society. Supporting one’s elderly relations (both emotionally and financially) offers not only a practical solution to the problem of elderly care in China, but also an ethical way for family members to fulfill their moral duties and maintain family solidarity. Although Western approaches to community care that combine formal and informal sources of support may in some cases help to meet the welfare needs of vulnerable elderly people in China, a complete rejection of traditional filial piety is far from appropriate. The author concludes that commitment to the traditional ethical value of filial piety enables people to live together in peace and harmony.DOWNLOAD HISTORY | This article has been downloaded 2849 times in Digital Commons before migrating into this platform.
支援父母捐獻遺體不孝麼？
Authors: FANG Yao
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在當今中國遺體捐獻中，常常會出現這樣的現象，即子女反對或反悔父母生前留下的有關遺體捐獻的遺願，其最大因素是子女擔心背上“不孝”之名。本文通過徵引《論語》和《孝經》的儒家經典文獻，對“孝”的具體意義進行梳理與論證。作者認為，子女支持並完成父母捐獻遺體的遺願符合儒家孝道的核心思想，因為孝道首先意味著子女應該順從父母的意願，即便這個意願會產生爭議。當然，當父母的意願不合於“道”時，子女有諫爭的義務，但遺體捐獻顯然是符合於道的行為。According to recent statistics, the global organ shortage is particularly serious in China. Some scholars argue that filial piety, a key principle of Confucianism, is the main deterrent to organ donation in China. The same is true of whole-body donation for medical research and education. Most hospitals and medical schools in China refuse to accept bodies even when the donors have provided written consent in their wills, due to pressure from the donors’ children.In this essay, the author uses a recent case in Zhejiang Province to illustrate the difficulties faced by children in carrying out their parents’ planned body donation, even when donation is understood as a moral act. The author shows that children are dissuaded primarily by adherence to the Confucian virtue of filial piety, as keeping the body of one’s parent intact after death is viewed as a form of filial reverence. Many Confucian scholars today argue that the opportunity to save lives by donating one’s organs or body is more valuable than preserving the integrity of the dead body. However, it is not unusual for the relatives of the willing donor, particularly their children, to refuse to carry out the donor’s wishes for fear of accusations of violating the precept of filial piety.The author shows that filial piety is widely considered to epitomize the Confucian value system. According to the Confucian text The Book of Filial Piety, for example, filial piety is “a perfect virtue and all-embracing rule of conduct.” However, the question here is whether children’s fulfillment of their parents’ desire to donate their bodies is a more filial gesture than keeping their parents’ dead bodies intact. The author argues that honoring one’s parents’ wish for body donation is consistent with the Confucian emphasis on family reverence and the provision of ancestral rites for deceased parents. Body donation is an act of ren (benevolence) and yi (rightness), as it benefits medical research and thus society at large. Fulfilling this desire to help others is an appropriate way of remembering and honoring one’s parents.DOWNLOAD HISTORY | This article has been downloaded 166 times in Digital Commons before migrating into this platform.
重審生命倫理學視域下身體話語的地位——以臨終決策為線索
Authors: WANG Jue
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract also in English.對於生命終極的關懷，臨終決策是現代生命倫理學不可忽視的一個重大話題。本文試圖從身體的角度論證當代生命倫理學話語由於失落了身體而陷入一場深刻的危機。具體而言，本文將通過對臨終決策困境的分析展示危機的根源，論證身體經驗及相關倫理關係是生命倫理學不可或缺的基礎。作者認為，只有作為身體倫理，生命倫理學才能充分實現它的學術追問和學科理念。身心二元論只是一個虛構，身體性存在才是人格同一性的真正基礎。因此，建設生命倫理學不只是擁抱某些抽象的自主原則，或是某些精緻的道德主體的體系，更關鍵的問題是要回答“我們希望成為何等樣的人，希望將來生活在怎樣的世界中”。How is the body articulated in language and discourse during end-of-life decision making? How do individuals and their family members represent and define the relationships between person, body, and self? Recently, studies have been conducted on the decision-making process in the field of end-of-life care. Most researchers focus on patients’ determination (vis-à-vis physicians’ beneficence), which gives rise to a plethora of issues, such as patients’ self-identity, self-continuity, relationships, freedom of choice,and rights.In this paper, end-of-life decision making is considered from the perspective of the relationship between the body and one’s personal identity. It is argued that the current bioethical discourse on individual autonomy and patients’ rights is inadequate to address the ethical issues relating to end-of-life decision making. Instead of purely theoretically conceptualizing the sovereignty of the patient over his or her body, the author explores the issue in relation to the phenomenology of lived-body experience as described by the American bioethicist Margret P. Battin. The rights available to the patient are not the only significant issue during end-of-life decision-making; aspects of the patient’s physicality are also relevant. Discourse on representations of the body and embodied action/autonomy aids our understanding of end-of-life choices. Finally, these body-related issues are linked with the Confucian understanding of what a person is. According to Confucian ethics, personal identity should not be viewed as an abstract “thing”; instead, it is defined by a person’s relationships with others, especially family members, in his/her most vulnerable moments.DOWNLOAD HISTORY | This article has been downloaded 138 times in Digital Commons before migrating into this platform.
從身心整合觀點看儒家之醫學哲學: 對李瑞全教授一文之回應
Authors: WONG Wai Ying
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.Prof. S.C. Lee’s essay discusses in detail the characteristics of traditional Western and Chinese medicine. As a response to his essay, I introduce an integrated view of body and spirit that inspires an innovative understanding of illness and healing. I also compare this integrated view with the philosophy of medicine generated from Confucianism, which Lee addresses. The basic idea of the integrated view is that the human body must be taken as a whole-physical body, spirit, and the interplay between them in various dimensions. Healing is not the simple removal of illness or symptoms, but moving into a more complete and perfect state of existence along with heaven and earth.DOWNLOAD HISTORY | This article has been downloaded 89 times in Digital Commons before migrating into this platform.
從“生物醫學模式”到“生物社會心理精神醫學模式”——西方醫學史的教訓
Authors: BISHOP Jeffrey P.
Published: March 2021

LANGUAGE NOTE | Document text in English; abstract also in Chinese.生物－心理－社會－精神醫學在西方世界裡是一個歷史的產物。生物醫學發端於19 世紀後半葉，並在美國醫學中引發了一場大規模的醫學教育改革。這種科學的生物醫學在醫學實踐中表現出的冷冰冰的、無人格的態度，常常與病人的道德和精神需求相抵觸。為改善這種狀況，自20 世紀中葉起，醫生與倫理學家嘗試了多種方式的改革，包括生命倫理學，生物－心理－社會醫學，和生物－心理－社會－精神醫學。這些改革的共同社會歷史背景是世俗主義在美國的興起，而每一種改革也都以不同的方式試圖把握醫療照護中的超越維度，這一超越維度已被生物醫學的還原主義的態度所邊緣化。但是，因為生物醫學的科學主義態度，以上的改革都失敗了。雖然生物－心理－社會－精神醫學意圖以一種整全的方式照護病人，但是因為它仍然延續了一種科學主義的態度，以至於這種醫學模式不能滿足病人的道德和精神需求，也無法把握對病人而言超越的中心意義。Biopsychosociospiritual medicine is a product of the long history of medicine in the Western world. Biomedicine began in the latter part of the 19th century, and, by the early 20th century, major medical education reforms had mandated a revised scientific curriculum for all U.S. medical schools. These reforms resulted in reductive scientific materialism. By the mid-20th century, however, scientific biomedicine was felt to be cold and impersonal, and was often deployed against the patient’s moral and spiritual desires. From the mid-20th century onward, several reforms were attempted that fall under the rubrics of bioethics, biopsychosocial medicine, and biopsychosociospiritual medicine. These reforms took place at a time when secularism was on the rise in the U.S., and each reform attempted to capture the transcendent dimension of medical care that had been marginalized by the reductive attitude of biomedicine. However, the reforms failed because of the scientist attitude of biomedicine. Although biopsychosociospiritual medicine purports to be a comprehensive approach to patient care, because it maintains that scientist attitude it fails to consider patients’ moral and spiritual desires and or to capture the centrality of transcendence for those who are sick and in need of health care.DOWNLOAD HISTORY | This article has been downloaded 73 times in Digital Commons before migrating into this platform.
醫學模式中的精神性: 一個多餘的維度？
Authors: TANG Jian
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.Professor Bishop’s illuminating essay should be commented upon by attending to the three following questions. First, what is the theoretical advantage of the spirituality proposed by Bishop compared with the biopsychosocial model? Second, what is the content of his proposed medical spirituality? Finally, what is its significance to contemporary medical practice? Biopsychosocial medicine is still a form of modernism and reductionism. Neither biomedicine nor biopsychosocial medicine really treats patients as persons. In modern secular society, spirituality can be explained as the individual’s basic understanding of what constitutes a good life and personal integrity without reference to religion. A genuine understanding of spirituality, in contrast, fully recognizes patients’ experiences, needs, emotions, and values and the need to integrate them as a whole. It is also important to distinguish spirituality from the mere psychological dimension or autonomy of the individual. Spirituality as a holistic approach nourishes the discourse of the doctor-patient relationship and what constitutes a good professional life for doctors, whether we are talking about the Western or Chinese medical context.DOWNLOAD HISTORY | This article has been downloaded 99 times in Digital Commons before migrating into this platform.
如何看待“靈性”在世俗醫學－生命倫理學中的位置？
Authors: ZHANG Ellen Y.
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.In a recent article, Jeffrey P. Bishop addresses the biopsychosociospiritual approach to medicine that has gained popularity in the past few decades as a way to correct the reductionism and scientism of biomedical ethics and “personalize” the colder aspects of scientifically and technologically advanced biomedicine. Although he welcomes the attempt to bring religion and spirituality back to contemporary medical discourse and practice, Bishop is quite critical of the “the total care approach” entailed in bio-psycho-socio-spirituality. For him, what is labeled “religious” or “spiritual” is nothing more than a kind of liberal or humanist discourse operating within the framework of secularized medical control via its various metanarratives of social functioning. Bishop’s challenge is significant because it remains open to question how in biomedical ethics we should acknowledge the distinct roles played by different religions and spiritual traditions in biomedical decisions, which very often go beyond the social and technological dimensions of biomedicine.Bishop’s contextualization of Western biomedicine is also useful for helping Chinese bioethicists to understand that any attempt to reconstruct Chinese bioethics will go nowhere if we confine ourselves to concepts that address particular issues in particular contexts in the history of Western medicine. For example, for traditional Chinese medicine and medical practice, the challenge may not be too much depersonalization or too much scientism, but rather how to depersonalize or become more scientific in certain situations. Therefore, Bishop is correct when he points out that rather than embracing Western biomedicine, or biopsychosociospiritual medicine, China should turn to its own spiritual traditions borne out of the life-worlds of its people to fully understand its potential and limits.DOWNLOAD HISTORY | This article has been downloaded 88 times in Digital Commons before migrating into this platform.
導言
Authors: CHAN Jonathan
Published: March 2021

LANGUAGE NOTE | Document text in Chinese本期《中外醫學哲學》的主題是死亡與優生。死亡是千古以來，宗教家和哲學家一直思考的課題：人死是否如燈滅？人除了身體還有死後仍然能存在的靈魂嗎？我們應怎樣看待死亡？優生則是近世由於科學的興起，才漸漸進入宗教和哲學的視野的課題。所謂｢優生｣，顧名思義就是優化生命的意思。沒有科學的幫助，人類在優化生命的事情上，能做到的有限。但是，隨著基因科學和技術的發展，人類通過基因改造的技術，大大提高優化生命的能力。但隨之而來的問題是，基因改造會否對人性構成戕害，違反人的尊嚴？使用此一技術會否為社會帶來新的不平等？DOWNLOAD HISTORY | This article has been downloaded 49 times in Digital Commons before migrating into this platform.
關文讀後——兼談哲學問題與哲學思考的本質
Authors: YUNG Lawrence
Published: March 2021

LANGUAGE NOTE | Document text in Chinese; abstract in English only.This article reviews Kwan Kai Man’s discussion of whether alleged cases of near death experience can give support to the existence of the soul. Kwan’s discussion strikes a balance between scientific explanations of near death experience and traditional religious views of the soul. The existence of the soul has remained a philosophical problem since ancient Greek philosophy. However, Socrates’s attempt to prove the existence of the soul in the Phaedo clearly shows that a purely philosophical approach is inadequate. The existence of the soul is a cross-disciplinary problem that calls for cross-disciplinary investigation. Kwan’s discussion is a good example of how philosophical thinking and methodology can contribute to this cross-disciplinary investigation into the existence of the soul.DOWNLOAD HISTORY | This article has been downloaded 88 times in Digital Commons before migrating into this platform.