Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate decision in a university in Hong Kong, and the factors affecting their attitudes.Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated.Results: A total of 766 students participated in the study. There were statistically (...) significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient’s own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR.Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient’s own wish as most important in DNR decisions. Family wishes were considered less important than the patient’s own wishes. (shrink)

Using a classical conditioning technique, this study investigated whether nonconscious associative learning could be indexed by event-related brain activity . There were three phases. In a preconditioning baseline phase, pleasant and unpleasant facial schematics were presented in awareness . A conditioning phase followed, in which stimuli were presented outside awareness , with an unpleasant face linked to an aversive shock and a pleasant face not linked to a shock. The third, postconditioning phase, involved stimulus presentations in awareness . Evidence for (...) acquisition of a conditional response was sought by comparing suprathreshold pre- and postconditioning phases, as well as in the subthreshold conditioning phase itself. For the pre-postconditioning phase analyses, significant ERP component differences differentiating CS+ and CS− were observed for N1, P2, and especially P3. For the conditioning phase, significant differences were observed in the 100–400 ms. post-stimulus region reflecting a CS+ processing negativity. Brain activity does indeed index the acquisition of a conditional response to subthreshold stimuli. Associative learning can occur outside awareness. (shrink)

Recent research argues that the use of information and communication technology has created a new channel through which transnational mothers can fulfill their maternal duties from afar. However, the literature pays little attention to the diversity of mothering practices via telecommunication. To fill this gap, our qualitative research on Filipina domestic workers in Hong Kong elaborates on the complexity and diversity of transnational mothering via mobile communication by demonstrating three patterns for the performance of maternal duties: intensive, collaborative, and passive (...) mothering. We argue that transnational mothering via telecommunication is shaped by the intersection of mothers’ agency, children’s responses, and substitute caregivers’ role in child care. (shrink)

This paper examines an overlooked aspect of interpersonal love: Like morality, love demands a certain kind of impartial or disinterested vision from us. We cannot love another person well, I argue, without being capable of such impartiality. Unfortunately, our self-interested nature makes meeting love's demand for impartiality extremely difficult if not impossible. This paper unpacks and offers a solution to this difficulty. Drawing on Iris Murdoch's work on love, I suggest that we can come to appreciate our beloveds as we (...) should through unselfing, a state of self-forgetful, disinterested appreciation of an object outside the self. When we unself, we are so deeply moved by an external object's value—e.g. a stunning sunset—that all our subjective cares and concerns disappear from view. In concluding, I suggest that the capacity for impartiality we must develop to love someone well is relevant to understanding what our moral relations demand of us. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

This paper discusses why speech regulations are logically necessary for any account of a moral right to free speech. My argument for limiting the right to free speech (and more widely any right to freedom) will be grounded in compossibility. Rights to freedom, formally speaking, are claims by an agent that other people not interfere with them; a compossible set of rights is one where the domains of permissible actions—permitted by each claim (and its correlative duty) within the set—do not (...) contradict one another across claims. I will argue that in order for claims to be coherent, they cannot generate contradictory domains, and that for a claim to non-interference to not generate contradictory domains across multiple people with the same claim, the claim must be restricted. This account as it currently stands can at least generate conclusions on the permissibility of incitement. (shrink)

Although in modern times and clinical settings, we rarely see the old characteristics of tribal shamanism such as deep trances, out-of-body experiences, and soul retrieval, the archetypal dreams, waking visions and active imagination of modern depth psychology represents a liminal zone where ancient and modern shamanism overlaps with analytical psychology. These essays explore the contributors' excursions as healers and therapists into this zone. The contributors describe the many facets shamanism and depth psychology have in common: animal symbolism; recognition of the (...) reality of the collective unconscious; and healing rituals that put therapist and patient in touch with transpersonal powers. By reintroducing the core of shamanism in contemporary form, these essays shape a powerful means of healing that combines the direct contact with the inner psyche one finds in shamanism with the self-reflection and critical awareness of modern consciousness. The essays draw from the contributors' experiences both inside and outside the consulting room, and with cultures that include the Lakota Sioux, and those of the Peruvian Andes and the Hawaiian Islands. The focus is on those aspects of shamanism most useful and relevant to the modern practice of depth psychology. As a result, these explorations bring the young practice of analytical psychology into perspective as part of a much more ancient heritage of shamanistic healing. Contributors: Margaret Laurel Allen, Norma Churchill, Arthur Colman, Lori Cromer, Patricia Damery, C. Jess Groesbeck, Pansy Hawk Wing, June Kounin, Carol McRae, Pilar Montero, Jeffrey A. Raff, Janet S. Robinson, Meredith Sabini, Dyane N. Sherwood, Sara Spaulding-Phillips, Bradley A. Te Paske and Louis M. Vuksinick. (shrink)

Why was Anti-Slavery International (ASI) so effective at changing norms slavery and even mobilizing the support that ended the transatlantic slave trade at the end of the nineteenth century, and why has that success not continued on into subsequent eras? This article claims that ASI's organizational structure is the key to understanding why its accomplishments in earlier eras have yet to be replicated, and why today it struggles to make modern forms of slavery, such as human trafficking, salient political issues. (...) Organizational structure is defined by how an NGO distributes power over agenda-setting (proposal and enforcement power) and its implementation. Those NGOs that centralize agenda-setting and decentralize the implementation of that agenda will be most effective at changing international norms. This paper demonstrates the tractability of that claim with a comparative analysis of ASI past and present to show that changes in organizational structure have led to differences in their effect on international norms, in spite of the fact that slavery in its modern forms persists as a political and social problem. (shrink)

Guanxi is perceived as a major determinant for successful business in China. This research paper investigates the importance of Guanxi from the Hong Kong Businessmen's viewpoint. It confirms previous findings in this area and adds on new dimensions. Therefore, practitioners and academics may further refine their knowledge in this subject.

Drawing on the general ethics and social psychology literature, this study presents a model to delineate the major factors likely to affect consumers’ intentions to bring their own shopping bags when visiting a supermarket (called “bring your own bags” or “BYOB” intention). The model is empirically validated using a survey of 250 Chinese consumers. Overall, the findings support the hypothesized direct influence of teleological evaluation and habit on BYOB intention, as well as that of deontological evaluation and teleological evaluation on (...) ethical judgment about the BYOB practice. Teleological evaluation exerts a much stronger influence on ethical judgment than does deontological evaluation. In addition, the findings reveal that consumers who perceive the BYOB practice to be more important are more inclined to rely on their ethical judgment to derive their BYOB intention. Academically, these findings provide some encouraging evidence for the application of general ethics theories to explain green consumption-related practices. Practically, the findings also suggest that a utilitarian approach (i.e., emphasizing the consequences of BYOB) may represent an effective means for the Chinese government to promote BYOB practice among consumers. (shrink)

One of the hot research topics today is relationship marketing. However, little research has been carried out in understanding the complex concepts of Guanxi (relationship) in a Chinese society. This research describes a study to operate the constructs of guanxi and explores the importance of guanxi in relationship development in order to present a new Guanxi framework. A study of both Western and Chinese literature provides foundations of the Guanxi perspectives. The constructs of adaptation, trust, opportunism and favour are identified. (...) Adaptation and trust are found to be positively correlated with sales stability and quality. Whilst, adaptation is negatively correlated with relationship termination costs. Both theoretical framework (a new perceptual map) and managerial implications are given. In addition, recommendations for future research are made. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

Like a great work of literary art, which indeed it is, Alexis de Tocqueville's extraordinary analysis of American society grows more impressive with each exposure to it. Everything has changed and nothing has changed since Democracy in America was published in the 1830’s. Its author grasped with remarkable perception both the mutable and the immutable qualities of man. There could be nothing more salutary for us today than to assimilate his fine sense of what was permanent in a world which, (...) like ours, was undergoing deep convulsions. Committed to the classical economics of Adam Smith, Tocqueville did not share Smith's illusions about the eternal nature of the market. On the contrary, as Albert Salomon has emphasized, his point of view was Heraclitean, the specter of continual change and ceaseless transformation dominating his thought. Surely such a perspective, which antedates both Darwin and Marx, is more appropriate for sociologists in a revolutionary age than elegantly constructed theories of social equilibrium which treat change as a special problem or a deus ex machina. (shrink)

The COVID-19 pandemic has presented a global threat to physical and mental health worldwide. Research has highlighted adverse impacts of COVID-19 on wellbeing but has yet to offer insights as to how wellbeing may be protected. Inspired by developments in wellbeing science and guided by our own theoretical framework, we examined the role of various potentially protective factors in a sample of 138 participants from the United Kingdom. Protective factors included physical activity, tragic optimism, gratitude, social support, and nature connectedness. (...) Initial analysis involved the application of one-sample t-tests, which confirmed that wellbeing in the current sample was significantly lower compared to previous samples. Protective factors were observed to account for up to 50% of variance in wellbeing in a hierarchical linear regression that controlled for a range of sociostructural factors including age, gender, and subjective social status, which impact on wellbeing but lie beyond individual control. Gratitude and tragic optimism emerged as significant contributors to the model. Our results identify key psychological attributes that may be harnessed through various positive psychology strategies to mitigate the adverse impacts of hardship and suffering, consistent with an existential positive psychology of suffering. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

In this paper, we report the case of an Inclusive Design workshop. Inclusive Design is a design method that includes elderly and disabled people not only in interviews, but also in the upstream design process such as basic design and survey analysis. In the workshop, participants designed scientific educational materials that visually impaired and sighted people can use together. To work together regardless of visual disability, participants used the image-processing system and the stereo copying machine to make images tactile. We (...) think that collaborative work with elderly and disabled people in Inclusive Design can teach participants different perspectives and help to correct their biased view of each other. In fact, participants of the workshop noticed several facts that they were not aware of before. That is, the Inclusive Design workshop can improve social awareness. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients exhibited contralateral grasping actions during electrical stimulation. (...) All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex directly supports the concept of the cingulate cortex being crucially involved in the grasping network. This opens an opportunity to explore this region with deep brain stimulation as a motor neuromodulation target for treatment in specific movement disorders or neurorehabilitation. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Neuropsychiatrist Michael T. H. Wong argues that the notions of soul, mind, brain, self and consciousness are no longer adequate on their own to explain humanity. He formulates a “third discourse” that brings philosophy neuroscience theology and psychiatry together as an innovative multilayered narrative for the person in the twenty-first century.

Several important physical implications left out in The Five Dimension Space-Time Universe: A creation and grand unified field theory model. Book, are presented under rigorous mathematical theorems. It was found that Temperature, a classical variable, must be added as an imaginary component to time, under the Quantum uncertainty dt∙dE = h/2π, so that the Gell-Mann Quark model can be verified, with gauge invariance, to form hadrons at the Bethe Fusion Temperature. Accordingly from the corresponding uncertainty dp∙dr = h/2π. Pairs of (...) Diagonal Long Range Ordered gravitons, with continuous frequency spectrum together with those represented by magnetic monopoles must be formed within the space r, of the homogenous 5D manifold, without the presents of photons, thus defines the 5D as a Black Hole. Then from which we can derive the classical Newtonian Law of attractive Gravity, as the 5D manifold is mapped by Perelmann Ricci-flow entropy mapping and the DLRO graviton pair symmetry is broken and converted into two masses, with motions satisfying Special Relativity in the doughnut shape Lorentz manifold, thus indirectly verifies the principle of Covariant Riemannian curvatures and General Relativity theory. (shrink)

:Empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements in the context of serious illness. Patients often understand treatability statements as conveying good news for prognosis and quality of life. In contrast, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, though this may not be (...) intended by physicians. This radical divergence in understandings may lead to severe miscommunication. This paper seeks to better understand this divergence through linguistic theory—in particular, H.P. Grice’s notion of conversational implicature. This theoretical approach reveals three levels of meaning of treatability statements: the literal meaning, the physician’s intended meaning, and the patient’s received meaning. The divergence between the physician’s intended meaning and the patient’s received meaning can be understood to arise from the lack of shared experience between physicians and patients, and the differing assumptions that each party makes about conversations. This divergence in meaning raises new and largely unidentified challenges to informed consent and shared decision making in the context of serious illness, which indicates a need for further empirical research in this area. (shrink)

A framework for “improvisational” social acts and communication is introduced by referring to the idea of “relationalism” such as natural farming, permaculture and deep ecology. Based on this conception, the notion of Existential Graph by C. S. Peirce is introduced. The notion of extended self in deep ecology is substantiated based on the Roy Adaptation Model in Nursing Theory and Narrative approaches. By focusing on Leibnizian notions of space and time and by introducing Petri net, a spatio-temporal model of improvisation (...) is constructed. This model is expected to substantiate the interesting notion of “Ba” proposed by H. Shimizu reflecting Japanese culture. (shrink)