Fecal microbiota transplantation has demonstrated efficacy and is increasingly being used in the treatment of patients with recurrent Clostridium difficile infection. Despite a lack of high-quality trials to provide more information on the long-term effects of FMT, there has been great enthusiasm about the potential for expanding its applications. However, FMT presents many serious ethical and social challenges that must be addressed as part of a successful regulatory policy response. In this article, we draw on a sample of the scientific (...) and bioethics literatures to examine clusters of ethical and social issues arising in five main areas: informed consent and the vulnerability of patients; determining what a “suitable healthy donor” is; safety and risk; commercialization and potential exploitation of vulnerable patients; and public health implications. We find that these issues are complex and worthy of careful consideration by health care professionals. Desperation of a patient should not be the basis for selecting treatment with FMT, and the patient's interests should always be of paramount concern. Authorities must prioritize development of appropriate and effective regulation of FMT to safeguard patients and donors, promote further research into safety and efficacy, and avoid abuse of the treatment. (shrink)

Artificial intelligence (AI) has attracted an increasing amount of attention, both positive and negative. Its potential applications in healthcare are indeed manifold and revolutionary, and within the realm of medical imaging and radiology (which will be the focus of this paper), significant increases in accuracy and speed, as well as significant savings in cost, stand to be gained through the adoption of this technology. Because of its novelty, a norm of keeping humans “in the loop” wherever AI mechanisms are deployed (...) has become synonymous with good ethical practice in some circles. It has been argued that keeping humans “in the loop” is important for reasons of safety, accountability, and the maintenance of institutional trust. However, as the application of machine learning for the detection of lumbar spinal stenosis (LSS) in this paper’s case study reveals, there are some scenarios where an insistence on keeping humans in the loop (or in other words, the resistance to automation) seems unwarranted and could possibly lead us to miss out on very real and important opportunities in healthcare—particularly in low-resource settings. It is important to acknowledge these opportunity costs of resisting automation in such contexts, where better options may be unavailable. Using an AI model based on convolutional neural networks developed by a team of researchers at NUH/NUS medical school in Singapore for automated detection and classification of the lumbar spinal canal, lateral recess, and neural foraminal narrowing in an MRI scan of the spine to diagnose LSS, we will aim to demonstrate that where certain criteria hold (e.g., the AI is as accurate or better than human experts, risks are low in the event of an error, the gain in wellbeing is significant, and the task being automated is not essentially or importantly human), it is both morally permissible and even desirable to kick the humans out of the loop. (shrink)

Fecal microbiota transplantation is reportedly the most effective therapy for relapsing Clostridium Difficile infection and a potential therapeutic option for many diseases. It also poses important ethical concerns. This study is an attempt to assess clinicians’ perception and attitudes towards ethical and social challenges raised by fecal microbiota transplantation. A questionnaire was developed which consisted of 20 items: four items covered general aspects, nine were about ethical aspects such as informed consent and privacy issues, four concerned social and regulatory issues, (...) and three were about an FMT bank. This was distributed to participants at the Second China gastroenterology and FMT conference in May 2015. Basic descriptive statistical analyses and simple comparative statistical tests were performed. Nearly three quarters of the 100 respondents were gastro-enterologist physicians. 89% of all respondents believed FMT is a promising treatment modality for some diseases and 88% of whom chose clinical efficacy as the primary reason for recommending FMT. High expectation from patients and pressure on clinicians was reported as the most frequent reasons for not recommending FMT. The clinicians who had less familiarity with FMT reported significantly more worry related to the dignity and psychological impact of FMT compared to those who have high familiarity with FMT.More than half of the respondents were concerned about the commercialization of FMT, although almost one in five respondents did not see this as a problem. We found most respondents have positive attitudes towards FMT but low awareness of published evidence. Informed consent for vulnerable patients, privacy and protection of donors were perceived as the most challenging ethical aspects of FMT. This study identified areas of limited knowledge and ways of addressing ethical issues and indicates the need to devise the education and training for clinicians on FMT. (shrink)

This article discusses the application of artificially intelligent robots within eldercare and explores a series of ethical considerations, including the challenges that AI (Artificial Intelligence) technology poses to traditional Chinese Confucian filial piety. From the perspective of Confucian ethics, the paper argues that robots cannot adequately fulfill duties of care. Due to their detachment from personal relationships and interactions, the “emotions” of AI robots are merely performative reactions in different situations, rather than actual emotional abilities. No matter how “humanized” robots (...) become, it is difficult to establish genuine empathy and a meaningful relationship with them for this reason. Even so, we acknowledge that AI robots are a significant tool in managing the demands of elder care and the growth of care poverty, and as such, we attempt to outline some parameters within which care robotics could be acceptable within a Confucian ethical system. Finally, the paper discusses the social impact and ethical considerations brought on by the interaction between humans and machines. It is observed that the relationship between humans and technology has always had both utopian and dystopian aspects, and robotic elder care is no exception. AI caregiver robots will likely become a part of elder care, and the transformation of these robots from “service providers” to “companions” seems inevitable. In light of this, the application of AI-augmented robotic elder care will also eventually change our understanding of interpersonal relationships and traditional requirements of filial piety. (shrink)

With the advancement of human microbiome research, it is inevitable that a growing number of biobanks will include a collection of microbiota specimens to characterize the microbial communities that inhabit the human body and explore the relationships between the microbiota and their human hosts. Biobanks of human microbiota and their associated genetic information may become a valuable health resource. But, this area of research also presents ethical and social problems, some of which are distinct from those faced by biobanks that (...) store human tissue samples. This paper examines four core issues which are considered highly relevant to microbiome biobanking: the nature of human microbiome samples and how different understandings have an impact on benefit/risk evaluation, privacy, informed consent, and returning the result to participants. We argue that these issues should be addressed early on in microbiome research projects and also call for adjusting or developing new governance mechanism to better accommodate these changes. (shrink)

The utilisation of human organoids has the potential to expedite the cycle of biological innovation significantly, yet it also raises a series of ethical and societal concerns. This study aims to evaluate the perceptions and attitudes of researchers regarding the ethical and social challenges associated with the research and application of human organoids. A 20-item questionnaire was developed to assess various aspects: four items evaluated the overall understanding of organoids, 13 items addressed ontological, ownership, informed consent and additional ethical issues, (...) while the remaining four items focused on ethical governance and regulatory concerns. This questionnaire was distributed to attendees of the 3rd China Symposium on 3D Cell Culture and Organoids in May 2023. Basic descriptive statistical analyses and chi-square tests were conducted. The work has been reported in line with the ARRIVE guidelines 2.0. A substantial majority (over 70%) of participants expressed concerns that the research and application of human organoids might raise ethical issues, such as moral status, informed consent and commercialisation. In contrast, a minor segment (4.5%, n = 8) reported feelings of disgust or nausea towards human-animal neural chimeras, with a significant gender difference (p = 0.004). Regarding informed consent for human organoid samples, over 90% of researchers rejected blanket consent for all purposes, and more than half preferred a model of continuous consent, which entails resoliciting consent for new uses. Further, over 40% of participants believed that the commercialisation of human organoids is dependent on their specific type. Our findings show that some researchers held that as long as human embryonic stem cells are not utilised in human organoid research and application, there are no ethical relevant issues. Most researchers also showed indifference towards the concern of moral status and humanisation of animals. The majority believe that the “consent for governance” model is preferable than broad consent or specific consent. We believe to realise the promise of human organoids for medicine, navigating complex ethics tensions and proactively engaging diverse stakeholders are required. Only with prudent, thoughtful and effective guidance, mutual understanding and trust between scientists and public can be fostered; the promising field of organoids can progress rapidly and responsibly. (shrink)

Introduction: Broad issues relating to filial piety and ethical dilemmas of families and care practitioners in residential care were discussed as part of an international networking project. It is meaningful to explore the different roles and responsibilities of participants in residential care in the context of China’s filial piety. Older residents and their children are part of this caring process, which might be significantly different from that in Western countries. However, only a little amount of research related to this topic (...) has been conducted. Objective: This study aimed to identify and describe the roles and responsibilities of a nursing professional, manager, older person, and her children, as well as other mutual contacts in residential care, based on the context of Chinese filial piety culture. Methods: The study was conducted as a case study. The product of the analysis, themes, or categories that describe the phenomenon, content analysis method was applied. After a consultation with a group of experts on research on older adults, a specific nursing home was selected in Xiamen City, China. This case study emphasized the roles and responsibilities of a nursing professional, manager, the older resident, and her children as they related to the care of older adult. The data, which consisted of interviews with four participants, were collected using a semi-structured interview method. Inductive content analysis was applied to analyze data. Ethical considerations: Permission to conduct the interviews received ethical approval from the participating organization based on national standards. The elements of voluntary participation, anonymity, and confidentiality on the part of the respondent were explained. Findings: The analysis resulted in four participants, with some variation of roles and responsibilities, describing staffing level and competence and their behavior for reducing the accident of the older adult, and the children of older adult influencing the quality of taking care of the older adult, based on the filial piety. The nursing home residents were described as becoming increasingly complex with a subsequent demand for increased spiritual support. There was variation in roles and responsibilities among four participants, but their contributions adjusting was an overall focus. Manager plays a considerable role in the future development of the institution, as a resource allocator, and decision-maker. Nursing professional is the main personnel serving as a link among staffs. The older adult herself adjust mentally and actively with the aging process, and some of them can be able to burden in taking care of her grandchildren or can be rehired and still have a distinct role in society. Children are required to fulfill their obligations to their parents, which involves supports of care, spiritual and economy. Several factors such as managers and nursing professional competence and their cooperation, various aspects of supports from their children based on the filial piety, and adequate communication and self-adjusting of the older adult, were recognized as factors affecting the process of taking care of the older adult. Discussion: New information was produced to serve as theoretical guidelines in managing nursing homes, the training of nursing staff, preservation of the filial piety culture, and encouraging self-care among older people in the new era. Conclusion: A variety of roles and responsibilities for a nursing professional, manager, MrsWang and her children was identified in the older adult care process. Several factors to manager’s and nursing professional’s experience of the resource situation and competence level, and also adequate communication and self-adjusting of the older adult were suggested to affect the effect of taking care of the older adult. The older adults were perceived as more complex with more physical and mental problems but inadequate care from family members forcing the older adult from home care to a nursing home. A nursing home seems to have a higher nursing competence and be well-suited for the needs of the older adult, on the other hand, filial piety and self-care are also needed to play an important role in taking care of the older adult. (shrink)

This study is a contribution to Chinese-Western dialogue of bioethics but perhaps the first one of its kind. From a Chinese-Western comparative ethical perspective, this work brings Chinese ethical theories, especially Confucian ethics, into a contemporary context of the epidemic of HIV/AIDS, and to see how the deeply-rooted thoughts of Confucius interact, compete, or integrate with concepts from Western ethical traditions. An underlying belief is that some ideas in Confucian ethics are important and insightful beyond their cultural and historical origins (...) in China and other Confucianism influenced societies.Methodologically, this thesis employs two approaches, conceptual normative analysis combined with critical interpretation. The ‘interpretive’ approach I employ, as an important methodology supplementing my normative analysis, not only deals with Chinese ancient texts, but also explains specific beliefs and practices in China.With a critical eye, this thesis carefully examines a number of key topics in the ethics of AIDS in China from a cross-cultural perspective. Topics including: views on personhood and the vulnerability of People Living with HIV/AIDS; prioritising and balancing the role of ‘harm reduction’ and the role of ‘eradication of deviant behaviour’ in AIDS policy in China; rights-based opt-out approach and duty-based family-centred approach in HIV testing and Biobanking; blood donation; moral responsibility and personal responsibility for health; and the popular rhetoric of ‘innocent infection’ versus ‘guilty infection’ in AIDS. My overall aim in this work is to present a cross-cultural bioethics study through the investigation of some ethical issues in AIDS in China from a Chinese-Western comparative perspective and also attempt to suggest a humane and effective policy for HIV/AIDS which I believe is appropriate to both traditions. I believe this work has contributed to our knowledge in three related but independent areas: the control of the epidemic of HIV/AIDS in China; medical ethics in China; and to both the methods and the utility of cross-cultural study of bioethics between China and the West. (shrink)

Some countries are legalizing same‐sex marriage and assisted reproductive technologies (ART) for homosexual couples. One unique form of ART, ROPA (Reception of Oocytes from Partner), recently stirred up controversy in China, when a custody dispute between a female same‐sex couple who used ROPA brought this reproductive model into the public eye. Some Western scholars have argued for the legitimacy of ROPA from the perspective of autonomy and reproductive rights. Yet, these arguments do not easily translate into all cultural contexts, as (...) this case will show. There is a need to articulate the ethical considerations of such technologies in light of local philosophical traditions. To that end, this paper will explore the permissibility of ROPA from a Confucian lens, exploring Confucian perspectives on naturalness, filial piety, family and social harmony. Accordingly, we hope to further the discussion of cross‐cultural bioethics. (shrink)

Our understanding of the complexity of the oral biome and of the role of the various constituent bacteria in the aetiology of dental disease is growing. Probiotics and their relationship with prebiotics, as well as other microbiome‐based interventions, could be useful in preventing and treating dental disease and in promoting oral health. However, given the promise and early stage of this treatment approach, there are also a number of ethical, social and regulatory issues associated with innovative probiotic therapy. In this (...) article, a brief update is given on contemporary theories of the aetiology and management of the two commonest dental diseases, and on the roles of pre‐ and probiotics and oral biome transplant in the management of these diseases. The focus is primarily on four core issues: informed consent, risk–benefit assessment, how to determine suitable healthy donors, and commercialization and regulation. We discuss the safety and benefits of oral probiotics, not only concerning the products and quality control during their manufacture, but also regarding the depth of public knowledge about this topic. We point out that the requirement of listing ingredients honestly might be insufficient, and that the prevalent rhetoric of ‘natural’ and ‘organic’ as well as some health claims in the translational, innovative probiotic industry and markets are themselves misleading and should be carefully scrutinized. Finally, we suggest an ethical imperative to find a balance between scientific research and industry, and public health in the regulation of probiotics. (shrink)