Hanhui Xu

Background Based on the principle of informed consent, doctors are required to fully inform patients and respect their medical decisions. In China, however, family members usually play a special role in the patient’s informed consent, which creates a unique “doctor-family-patient” model of the physician-patient relationship. Our study targets young doctors to investigate the ethical dilemmas they may encounter in such a model, as well as their attitudes to the family roles in informed consent. Methods A questionnaire was developed including general demographic characteristics, the fulfillment of the obligation to fully inform, who will be informed, and the ethical dilemmas in decision-making. We recruited a total of 421 doctors to complete this questionnaire, of which 368 met the age requirements for this study. Cross tabulation and Pearson’s chi-squared test were used to analyze the differences between types of patients for categorical variables, and a p-value < 0.05 was considered statistically significant. Results Our data shows that only 20 doctors (5.40%) stated “informing the patient alone is sufficient” when it comes to informing patients of their serious conditions. The rest of the participants would ensure that the family was informed. When facing elderly patients with decision-making capacity, the data was statistically different (3.8%; P < 0.001) The primary reason for ensuring that family members be informed differs among the participants. In addition, when family members asked doctors to conceal the patient’s medical condition for the best interests of patients, 270 doctors (73.4%) would agree and cooperate with the family. A similar proportion (79.6%) would do so when it comes to elderly patients. Conclusions (1) Chinese doctors pay extra attention to informing the patient’s family, which may not be in the patient’s best interests. (2) Chinese doctors treat adult (but not elderly) patients and elderly patients differently when it comes to informing family members. (3) When family members request that doctors withhold information from patients “in the best interest of the patient,” the majority choose to comply with the request, although this may cause them distress.

Background In China, informal payments in the medical profession, which workers in the public health care system receive from patients in the course of performing profession-related activities, are usually referred to as “red packets” (Hongbao 红包). The phenomenon of red packets is widespread and has become one of the most negative factors affecting the doctor-patient relationship in China. Our study aims to explore the situation concerning the phenomenon of red packets in China after the “Red Packet Ban”. Methods A questionnaire was developed including general demographic characteristics, asking whether they had ever been offered red packets, whether they had ever accepted red packets, their reasons for accepting the first red packet and so on. We recruited a total of 413 doctors to complete this questionnaire and conducted in-depth telephone interviews with 18 doctors from the initial group. Results Our data shows that 73 doctors claimed to have accepted red packets, accounting for 17.7% (73/413) of all respondents and 27.8% (73/263) of doctors who had been provided with red packets. 23.2% of red packets were offered after the operation and 67.1% of the doctors declared that the main reason for accepting the red packet was that they “refused the red packets more than once, but the patients/family members were sincere and it was difficult to refuse.” The total amount of the red packets they received each month accounted for no more than 5% of their income. Conclusions (1) The acceptance of red packets does exist among young doctors in China, but shows a significant decrease compared to previous studies. (2) There has been a sharp rise in the proportion of gratitude red packets. (3) Patients should also be educated regarding their behaviour in providing red packets.

Generally speaking, sex robots are artificial entities designed to be humanlike in appearance and behavior, and which are primarily used for sexual purposes. In the literature on robot ethics, most work is influenced by either deontology or utilitarianism. In this article, I address some issues concerning sex robots from a Confucian standpoint. The first question that will be raised is whether sex robots can be morally permitted. Intuitively, such machines might not be morally acceptable for Confucianism since Confucians seem to hold a negative and mortifying attitude toward sexual desire. However, this intuition is likely incorrect. I argue that sexual desires guided by the heavenly principle are not immoral. Hence, from the Confucian perspective, sex robots, which are created to meet humans’ sexual desires, can at least sometimes be justified. The second question addresses what kinds of sex robots Confucianism can morally allow. As I explore, following Confucian insights, the answer to this question likely depends on the purpose for which one seeks to use sex robots. Sexual thoughts that involve incest, threesomes, fornication, and pedophilia are usually regarded as morally wrong from the Confucian perspective. Thus, it would likely be morally unacceptable to use sex robots to fulfil such illicit and inappropriate desires. By contrast, Confucianism might morally permit other kinds and uses of sex robots. In some cases, people want sex robots because they are unable to find human sexual partners. Sex robots might be able to fulfil such people’s sexual needs, while also enabling those individuals to build emotional bonds with their sex robots. The therapeutic use of sex robots can also be allowed. The paper consists of four sections. The first section demonstrates the specialty of sex robots. The second section explores the Confucian views of yin-yang theory and sex. In the third section, Confucian theories of family relations and sex are illustrated. Lastly, based on the features of Confucianism, I argue that some kinds of use of sex robots can be morally allowed by Confucians.

BackgroundThe acceptance of informal payments by doctors is usually viewed as unethical behavior. However, in China, such behavior is a common practice. In this study, we focus on the gender differences in accepting red packets by young doctors in China.MethodsA total of 413 young doctors were selected for the study, all of whom were grouped by gender. The questionnaire was designed to include general demographic characteristics, whether they had ever been offered red packets, whether they had ever accepted red packets, the reasons for accepting red packets and so on. Wilcoxon rank-sum test, Pearson’s chi-squared test, univariable and multi-variable logistic regressions were used for all analyses by Stata 17.0 SE and p-value < 0.05 was considered statistically significant.ResultsCompared to women, men were more likely to be offered red packets, and the odds ratio was statistically significant after adjusting for age, education, position and geographical areas. In terms of the question of whether or not they had accepted red packets, more male doctors answered “yes” compared to female doctors. However, among those who had accepted red packets, we found that only 42.0% [25/60] of male doctors considered that it was normal to accept such red packets, compared to 85.0% [11/13] of women.ConclusionThe study revealed that Chinese patients and their families were more likely to offer red packets to male doctors. Secondly, among doctors who had been offered red packets, male doctors were more likely to accept red packets than female doctors. In addition, among doctors who had accepted red packets, female doctors were more likely to believe that it was not morally wrong to accept such red packets.

The introduction of in vitro fertilization (IVF) results in a separation of sex and reproduction which has generated enormous ethical debate (Lauritzen 1993). Surrogacy makes this situation more complicated by bringing a surrogate mother into reproduction. A surrogacy case may involve five individuals (in addition to the surrogate child). These are the commissioning couple, the gamete donors, and the surrogate mother. Hence, a surrogate child may have up to five parents, including biological parents, commissioning parents, and a gestational parent. The question is which of these people should undertake parental duty? In terms of the acquisition of parental duty, there are three accounts. They are the biological connection account, the causal account, and the consent account. In this article, I try to argue that only the commissioning parents should undertake the parental duty for the surrogate child based on the latter two accounts. I do not apply the biological connection account because the biological connection account fails to explain one’s parental duty, which I will show in the following sections.