Challenges of Bioethics Education in Pediatric Basic Nursing Education: A Faculty Perspective

In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.

Healthcare bioethics: a new proposal of ethics for clinical practice

The expression“patient revolution”is the social,educational,cultural,and political movement initiated at the end of the twentieth century and beginning of the twenty-first century,which sustains the protagonism of the patients in their care as the primary decision maker and holder of human rights.The patient revolution comprises varied approaches and references,such as Patient-Centered Care,Shared Decision-Making,Patient Participation,and Patients’Rights,which combine to uphold that the patient is a moral agent and anchor healthcare in the biopsychosocial model.In this sense,this movement is a new proposal of ethics for clinical practice.This theoretical research primary goal is to develop theoretical contributions that support this new Bioethics dimension,emphasizing the context in healthcare that calls for new ethics in clinical practice,characterized as a patient revolution movement.We concluded that the patient revolution had driven a new paradigm in healthcare based on Patient-Centricity,SDM,and Patients’Rights.Despite this critical change in the health sphere,the patient revolution appears to have reverberated in clinical bioethics.Thus,theoretical contributions must be developed for new ethics in the clinic,a task undertaken in this article through the proposal of Healthcare Bioethics as an adequate frame of reference to be adopted at all levels of clinical care.Thus,it is concluded that having Bioethics Healthcare as a beacon of ethics in clinical encounters can contribute to the quality of care and its ethical provision,confronting practices that violate Patients’Rights.It is imperative to change paternalistic theoretical frameworks that mitigate the Patients’Right to participate in every decision regarding their health.Only with the adoption of new approaches and an insight into the patient’s role in clinical interaction can a new culture in Patient-Centered healthcare take shape.

Methodology of the Relationship between Bioethics, Philosophy, and Law

One can distinguish three levels in the integrative unity of knowledge and norms （assessments）, which is termed bioethics. The first level is theoretical. It is connected with the facts and truths. The second level deals with establishing of certain standards and rules of conduct, with the monitoring of their implementation and the assessment of the results of implementation/violation of norms. The third level is associated with individual behavior, formed on the basis of relevant knowledge （or lack of it, as is evident from the table）, and the rules governing its application. Theoretical Bioethics is an integral part of Philosophy---the practical Bioethics is directly related to Law and applied Bioethics deals with the personal standards of specific behavior in concrete situations. Social need for regulatory control of any activity with living entities has led to rapid development of practical Bioethics, while its philosophical content developed more slowly. This creates a conflict of norms and values, hampering the adoption of individual decisions now in the field of applied Bioethics. Deontologization of Bioethics can lead to the fact that it will lose its philosophical content and become a specific area of Law. This, in turn, leads to the dehumanization of Bioethics. It is therefore necessary to conduct a methodological analysis of the relationship of Philosophy, Bioethics and Law, the results of which will focus the researchers on the synchronization of the axiological, praxeological and ethical components of scientific research in order to preserve the intellectual integrity of Bioethics.

Exploring the Management of Stem Cell Research Based on Bioethics

Stem cell research has brought hope to mankind to overcome various diseases,but ethical issues arise in stem cell research,and people have doubts about how to develop stem cell research healthily and whether it can bring the gospel to mankind.Management of stem cell research based on bioethics is extremely necessary.From the perspective of bioethics,the number of research literature is used to analyze the development of stem cell research and the management of stem cell research in China,to provide suggestions for further strengthening the management of stem cell research.

Modern Bioethics and Human Rights

Ⅰ Since the late 1940s, the ethical studies aimed at safeguarding human dignity to life and health security in the fields of medical and life sciences have witnessed rapid development. The main domains in this regard include the studies of medical ethics, which involve ethical issues concerning the purposes, missions, subjects, technical means, doctor-patient relations in clinical treatments and making of public health policies centering around medical activities; and the studies of bioethics, which touch upon a variety of ethical issues cropping up along with the progress and intervention of bio technologies with regard to human life and its cycles, from human reproduction, medical care, human experiments till the end of the life. In addition, there are also studies of eco-

Human Dignity and Human Rights： A Universal Language for Bioethics

One of the aims of the Universal Declaration on B ioethics and Human Rights （UNESCO） is to ＂promote respect for human dignity and protect human rights＂,l Here are two overarching principles at work, ensuring that the biomedical sciences fulfill their task within an ethical framework. The principle of respect for human dignity is a universal moral concept, meant to be applied in human encounters. Protecting human rights underscores the legal principle of not only affirming the fundamental equality of all human beings, but equally safeguarding it. These two principles are universally defined, but are ordinarily specified by the particular value system of individual cultures in which they are employed. It is within such particular cultural application that their relevance stands out. The thrust of this paper is that, since principles are general action guides, they actually constitute a universal language for the analysis and evaluation of all human conduct. However, there is also recognition of the fact that moral contexts vary from culture to culture, and that while the scope of the two principles above is not restricted by any particular culture, it is indeed those cultural specifics of each moral context that constitute the framework within which the principles become operational. As general action guides, I will argue that these principles lack moral relevance outside of those particular cultural settings wherein they are contextualized. Without such relevance, these principles become meaningless mantras. I will further show that such principles do not merely uphold values informed by particular cultures, but they are an embodiment of values inherent to human nature in general. Consequently, these principles do not just serve as instruments for addressing issues peculiar to ＂Western bioethics＂ or any other particular cultural setting in an exclusive sense, but are also used for moderating bioethics discourse that transcend particular cultural boundaries. I will further explain that such universal discourse is potentially instructive with regards to how cultural universals are viewed in relation to the cultural particulars, and that this discourse essentially becomes a lingua franca for cross-cultural dialogue in bioethics.

Cross-Cultural Bioethics at an International University in Japan

Ritsumeikan Asia Pacific University （APU） in Beppu city, Japan has a large body of students from well over 90 countries, especially from the Asia Pacific region, including Japanese, Korean, Chinese, Thai, Vietnamese, and Indonesian students. To improve analytical thinking skills among college students, a course on ＂bioethics＂ was introduced and offered in two consecutive semesters to undergraduate students for which 245 students registered at each semester. The course was taught in the form of 14 lecture and discussion sessions, each for 95 minutes based on the content of A Cross-Cultural Introduction to Bioethics （2006） edited by Darryl Macer, and reviewed a wide variety of ethical and bioethical issues. In the next semester, the students received a similar teaching content that was rearranged to reflect the 15 universal principles of bioethics and human rights covered in the Bioethics Core Curriculum （2008）. Case studies were also added to each unit of the Core Curriculum with the support of the UNESCO＇s Asia Pacific Regional Office, Bangkok （Case Studies for Bioethics 2010）. To evaluate the results of teaching and to compare the achieved objectives between the two groups of students, a short questionnaire was given to all students who finished the course and took up the final written examination. In the whole, 454 students （225 in group I and 229 in group 2） completed the course and took the final examination and 427 （218 in group 1 and 209 in group 2） responded to the questionnaire which inquired into their interest in the discussion of bioethical issues： why they believed they were important, and what they had learned through them. The results of the questionnaire have been examined and compared to evaluate the success of ＂bioethics＂ in stimulating the interest and thinking ability of the students and enriching their experience of a cross-cultural discussion over bioethical issues using universal principles as general guidance. The result of this examination was so impressive that from 2011 bioethics has been formalized into the reformed curriculum of our international school.

Challenges and Suggestions of Ethical Review on Clinical Research Involving Brain-Computer Interfaces

Brain-computer interface(BCI)technology is rapidly advancing in medical research and application.As an emerging biomedical engineering technology,it has garnered significant attention in the clinical research of brain disease diagnosis and treatment,neurological rehabilitation,and mental health.However,BCI also raises several challenges and ethical concerns in clinical research.In this article,the authors investigate and discuss three aspects of BCI in medicine and healthcare:the state of international ethical governance,multidimensional ethical challenges pertaining to BCI in clinical research,and suggestive concerns for ethical review.Despite the great potential of frontier BCI research and development in the field of medical care,the ethical challenges induced by itself and the complexities of clinical research and brain function have put forward new special fields for ethics in BCI.To ensure"responsible innovation"in BCI research in healthcare and medicine,the creation of an ethical global governance framework and system,along with special guidelines for cutting-edge BCI research in medicine,is suggested.

当代中国生命伦理学研究的缺陷及其历史使命

目前,中国生命伦理学对东西方道德文化传统资源存在着双重的误读,在引进和应用西方理论资源时,没有注意到它们与西方历史文化传统和社会生活背景的复杂关系,轻率地建构评价和指导体系并以此来影响政策制定和科学实践;而中国传统伦理观念已经变成了箴言式的、支离破碎的道德训条,被随意整合进当代生命伦理学规范体系之中,没有机会与外来的生命伦理信条进行真正的对话和交流。这种隔阂的状态必然导致伦理认知和道德实践两个方面的错乱状态。

Grounded theory qualitative approach from Foucault's ethical perspective:Deconstruction of patient self-determination in the clinical setting

This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships,patient-professional relationships,and moral ethics critique.Foucault tried to break loose from the self,which is merely the result of a biopol-itical subjectivation and constituted an interpersonal level.From this,different elements involved in the decision-making capacity of patients in a clinical setting were analysed.Firstly,the context in which decision-making occurs has been explained,distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations.Secondly,an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called"techniques of the self".Finally,the ethical framework for a subject's"self-creation",insisting more on the exercises of self-subjectivation,reinforcing the ethics of the self by itself,the"care of the self",has been explained.The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient’s autonomy in the clinical environment is constituted.All these elements could generate grounded theory on the qualitative methodology of this phenomenon.The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making,relegating to the background their opinions and beliefs.Consequently,a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.

Zika Virus Controversies: Epidemics as a Legacy of Mega Events?

The current knowledge of the Zika Virus epidemic clearly lacks a comprehensive understanding of its determinants and clinical outcomes. Until recently regarded as a “simple” dengue-like infection, it nowadays turned into a real challenge to Public Health around the world. The Zika Epidemic shows a quick spread, affects unprepared health systems, and presents with severe neurological complications of newborns—a concrete threat to pregnancies. This re-emerging infectious disease is a source of deep doubts and harsh debates regarding Public Health and even bioethical issues. Several doubts still remain on how to deal with the various possible transmission ways of the disease, the surge of a generation of thousands of microcephalic newborns (and questions on how to handle them within limited health systems), and severe malformations concentrated so far in Northeastern Brazil. Finally, a debate is raised about how the “Endemic State” of Brazil, deeply merged in a health care crisis for almost 40 years now, currently confronts 3 current epidemics of the arboviruses Dengue, Chikungunya and now Zika, all associated with a lack of basic sanitation. Brazil must deal with these biological threats in the context of the Rio 2016 Olympic Games, since Chikungunya has probably been brought to Brazil during the FIFA Soccer World Cup (2014) and Zika Virus spread is associated with the Soccer Confederations Cup (2013).

Should we use full analgesic dose of opioids for organ procurement in brainstem dead?

Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient.A frequent question they ask to coordinating doctors is:Are you sure he will not feel anything?Currently due to the risk of exacerbation of spinal reflexes and abnormal movements following surgical stimuli,it is recommended to use a curarization and an analgesic agent(most often morphine).The doses of opioids are less important than during usual anaesthesia,whereas the person is considered brainstem dead and there is no longer any cerebral integration of the pain.But what assures us that absolutely no more sensibility exists at this precise moment?Should the use of full analgesic dose of opioids not be continued anyway?Could this make the levies more"ethical"?

What Is the Preferable Idea of Justice in Healthcare?

When we talk about“health”,we can understand very different meanings,if we refer to the Italian context,rather than the American one.In Italy,health is a fundamental right,and the healthcare system is a model for making this right concrete.In this paper,we will discuss how the American healthcare system is very different from a philosophical and bioethical point of view.We will try to figure out what reasons can be adduced to argue that“health”is a right and not a commodity like others on the market.This paper focuses on philosophical and bioethical issues related to health and healthcare,analyzed in both the Italian and American contexts.Emphasis will be given,using bioethical and legal arguments,to both concepts of health as a right and a good,taking into consideration the current economic and social crisis.In particular,the paper analyzes the theoretical models adopted by the two aforementioned countries and highlights fundamental differences between them.Analysis of the best and most fair allocation of resources leads to a proposal for new definitions for“resource”and preferable idea of justice for healthcare.

The Dying Process across Human Life Cycle: Ethical Considerations on Terminal Care

Dying is an event that affects human development throughout the life cycle—impacting individuals, communities, and society. Providing terminal care may mitigate the suffering of patients and families. Notwithstanding, it poses challenges concerning patients’ decision-making and autonomy, in regard to communicating bad news, resuscitation orders, and voluntary termination of life. This study seeks to discuss ethical issues underlying terminal care, showing how the problem of patients’ decision-making and autonomy can be addressed at the end of life. It distinguishes the notion of worthy death, which could ground ethical decisions for health attention across different developmental stages.

The Conflict between Patient Autonomy and the Dying Patient Law in Israel

The Dying Patient Law is very controversial in Israel; there are opinions that the reason for the Law was to prevent the court from making decisions on the subject of end of life according to democratic principles. I decided to do this study because I wanted to know if the legal principles of the Law are democratic as were the court rulings or they are only, or mostly, Jewish principles and meant to prevent a democratic ruling in the courts. The work is a review of the Law and the Dying Patient Committee discussions as well as the chairman＇s writings on the Law, critique articles, and a review of democratic and bioethical principles. In this project, I have seen that the underlying basis of the Dying Patient Law is Jewish principles and not democratic principles, although Israel is a declared democratic state. This law illustrates the problem in Israel being both a democratic and a Jewish state. It raises the question： What can be done to resolve the conflict between the Jewish principles and democratic and/or bioethical principles？

Philosophy of Gerontology from the Past to the Future in Japan

Gerontology is not only an interdisciplinary and intra disciplinary study,but also an international and inter-professional study.Gerontology is a study to create awareness on the concept among people,throughout the world.The philosophy of Gerontology is a lively active philosophy to explore the nature of humanity itself and to practice learning.Moreover,Gerontology is considered as a science as well as human philosophy.This paper introduces philosophy of Gerontology in Japan from the past to the present.It explains that Zen has fundamental philosophy of Gerontology.

Global Bioethical Prevention of the Collision of Biological and Cultural Evolution on Miserable Human Survival

With the cultural myth that science can only determine the way the world ＂is＂ （facts）, while humanities, social sciences, lawyers, philosophers, and theologians must determine the way the world ＂ought to be＂ （values）, those in position of global-, national-, and local-political power make major decisions of the use （or non-use） of scientific knowledge and technology. As a result, the human being has created a non-scientifically based cultural environment that is affecting his ability to survive. In effect, cultural evolution is occurring more rapidly than biological evolution that can adapt to the changes brought about in the physical and psycho-social environments. In a pluralistic cultural world, where each society has generated a different view of human nature and different ethical values, the use, misuse, or non-use of scientific and technological advances are derived from these unscientific views of human nature. Since all life depends on limiting interacting environmental and ecological factors, it is imperative that scientific information be used to govern how to minimize irreversible effects on life-sustaining ecological factors, but also scientific information bearing on understanding human nature ought to be integrated into a ＂global bioethics＂. While ethical values cannot be directly derived from scientific factors, it is also true that human values or our ＂ought＂ cannot be maintained in ignorance or defiance of the facts or the ＂is＂.

Purpose, Composition and Function of the Research Ethical Committee in the Sarah Rehabilitation’s Hospital

Introduction: The Research Ethical Committee (REC) is responsible for the ethical evaluation of the projects presented by the scientific community to inform and train the members and researchers. Objective: To describe the purpose, composition and function of the REC of the Association of Social Pioneers (APS) located in the Sarah Rehabilitation’s Hospital (Brasilia, Brazil). Methodology: Descriptive analysis of the REC/APS based on 2013’s collected data was done. Results: The REC/APS is an independent collegiate body, which was established in 1998 in accordance with Brazilian regulation. The main objective is promoting the application of ethical principles and human rights in research involving humans. The REC was composed by chairperson and a substitute;secretary, fourteen regular members and five substitutes. We analyzed 164 projects submitted. The minimum time to a committee member who came up with the first opinion has been estimated as 14 days and the insurance of the consolidation occurred in 30 days. We approved 64 projects, of which 25 had pendencies in the first analysis, one project failed and 99 were excluded. The main problems were related to the writing of informed consent and the multicenter projects that did not include aspects such as costs, schedule and methodological limitations. We observed that the researcher could provide assistance. We considered the important role of the REC/APS to ensure trust between researchers and participants in the research. Conclusion: Despite the purpose, composition and function of the APS research ethical committee, there were encountered many obstacles in its formation, considering monitoring the progress of the research, national normative, international researches and others. The ethical committee does a vital public service with the variety of the specialized views on the meeting. We need to strike a balance and we must weigh up risks and benefits related to knowledge, in its essence, to research’s participant and its relevant social participation.