Hanhui Xu

Genetic moral enhancement (GME) aims to morally improve a person by using genetic technology. This paper discusses what kinds of GMEs are morally acceptable (or unacceptable) based on Mencius’ theory of human nature. First, I argue that one kind of GME aimed at improving empathic concern to be more inclined to help others can be defended by Mencius’ view of the heart-mind of pity and compassion (ceyinzhixin, 恻隐之心). Second, I show that one kind of GMEs would be morally unacceptable for Mencius based on the Confucian view of love with distinction (aiyouchadeng, 爱有差等). This approach to GME attempts to modify the biological mechanisms underlying empathy, enabling individuals to “feel and experience” others’ pain or harm as if it were their own, thereby making them more inclined to help others.

Parental obligations are the obligations acquired by parents to their young children. It is believed that parents have special obligations to their children. However, what are the contents of such obligations? Are parental obligations limited to meeting children’s basic needs for food, clothing, and shelter? Do parents have an obligation to best promote children’s welfare? What are the requirements of the children’s right to an open future? And is it possible for parents to meet such requirements? In this article, I try to address these issues by appealing to a philosophical view of parental obligation, according to which parental obligations require parents to ensure their children have a reasonable expectation of a decent life. Thus, parents are obligated to protect their children from abuse and neglect, help their children to become autonomous agents and provide their children with an adequate moral education. In addition, although the children’s right to an open future imposes given obligations on parents, it does not indicate that parents are obligated to expose children to as many activities and much experience as possible. Such an understanding of the children’s right to an open future is incorrect.

Background: While Large Language Models (LLMs) have achieved widespread adoption, malicious prompt engineering—specifically "jailbreak attacks"—poses severe security risks by inducing models to bypass internal safety mechanisms. Current benchmarks predominantly focus on public safety and Western cultural norms, leaving a critical gap in evaluating the niche, high-risk domain of medical ethics within the Chinese context. Objective: To establish a specialized jailbreak evaluation framework for Chinese medical ethics and to systematically assess the defensive resilience and ethical alignment of seven prominent LLMs when subjected to sophisticated adversarial simulations. Methodology: We evaluated seven prominent models (e.g., GPT-5, Claude-Sonnet-4-Reasoning, DeepSeek-R1) using a "role-playing + scenario simulation + multi-turn dialogue" vector within the DeepInception framework. The testing focused on eight high-risk themes, including commercial surrogacy and organ trading, utilizing a hierarchical scoring matrix to quantify the Attack Success Rate (ASR) and ASR Gain. Results: A systemic collapse of defenses was observed, whereas models demonstrated high baseline compliance, the jailbreak ASR reached 82.1%, representing an ASR Gain of over 80 percentage points. Claude-Sonnet-4-Reasoning emerged as the most robust model, while five models—including Gemini-2.5-Pro and GPT-4.1—exhibited near-total failure with ASRs between 96% and 100%. Conclusions: Current LLMs are highly vulnerable to contextual manipulation in medical ethics, often prioritizing "helpfulness" over safety constraints. To enhance security, we recommend a transition from outcome to process supervision, the implementation of multi-factor identity verification, and the establishment of cross-model "joint defense" mechanisms.

STUDY QUESTION: Can large language models (LLMs) effectively and safely perform ethical counseling on human reproduction in a manner consistent with local regulations? SUMMARY ANSWER: While leading LLMs demonstrate foundational knowledge of ethical regulations, they exhibit critical and systemic deficiencies in safety, logical consistency, and humanistic aspects of counseling, making them unreliable for autonomous use in this high-stakes domain. WHAT IS KNOWN ALREADY: The application of LLMs in medicine is rapidly expanding, with studies evaluating their capabilities in answering general reproductive health questions. However, there is a lack of research assessing their performance on the nuanced and culturally specific challenges of reproductive ethics counseling, particularly concerning their safety and reliability under a given national regulatory framework. STUDY DESIGN, SIZE, DURATION: This was a comparative observational study evaluating the performance of eight prominent LLMs on a custom-designed test set. The evaluation was based on 986 questions (906 subjective, 80 objective) generated from 168 specific articles within Chinese reproductive ethics regulations. PARTICIPANTS/MATERIALS, SETTING, METHODS: We evaluated eight LLMs, including both general-purpose models (e.g., GPT-4, Claude-3.7) and specialized domestic models. The test questions were systematically generated based on articles from six official Chinese ethical and regulatory documents covering assisted reproductive technologies. Objective questions were multiple-response items requiring the selection of all correct options. Subjective responses were evaluated using a novel six-dimensional scoring rubric that assessed safety (Normative Compliance, Guidance Safety) and counseling quality (Ethical Issue Identification, Citation of Ethical Guidelines, Provision of Actionable Suggestions, and Empathetic Engagement). MAIN RESULTS AND THE ROLE OF CHANCE: The LLMs exhibited a clear performance hierarchy, with larger models generally achieving higher accuracy on objective questions (highest: 71.25%, lowest: 22.5%). However, significant safety issues were prevalent; the risk rate of providing unsafe or misleading advice in subjective questions was substantial for several models, reaching as high as 29.91%. Across all eight models, a systemic weakness was observed: performance in citing normative sources and expressing empathy was universally poor, even among the top-scoring models. Furthermore, the evaluation revealed instances of anomalous moral reasoning, including logical self-contradictions and responses that violated fundamental moral intuitions, indicating a superficial, pattern-based understanding rather than robust ethical reasoning. LIMITATIONS, REASONS FOR CAUTION: This study's evaluation is based on Chinese ethical regulations, which may not fully reflect the training data distribution of non-domestic LLMs. The quality of the LLM-generated test questions, while systematically controlled, may have inherent limitations. The automated scoring model for subjective responses, despite its high accuracy (88.5%), is not a perfect substitute for human expert evaluation. WIDER IMPLICATIONS OF THE FINDINGS: The findings serve as a critical cautionary note against the premature deployment of LLMs for autonomous ethical counseling in reproductive medicine. The study highlights that current models, despite their knowledge recall capabilities, lack the safety, consistency, and humanistic skills essential for this sensitive task. Future development must prioritize not only knowledge accuracy but also robust logical reasoning, the integration of regulatory justification, and the ability for empathetic engagement to build trustworthy and effective AI counseling tools. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Young Scholars Program of the National Social Science Fund of China (Grant No. 22CZX019) and the China NSFC Projects (No. 62572320 & No. U23B2018). TRIAL REGISTRATION NUMBER: N/A.

BackgroundIn 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”.MethodsA 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.ResultsOur 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.

The application of AI in healthcare has dramatically changed the practice of medicine. In particular, AI has been implemented in a variety of roles that previously required human physicians. Due to AI's ability to outperform humans in these roles, the concern has been raised that AI will completely replace human physicians in the future. In this paper, it is argued that human physician's ability to embellish the truth is necessary to prevent injury or grief to patients, or to protect patients’ feelings. Such embellishments are usually defined as “white lies,” which not only include intentionally providing false, incomplete, or misleading information to patients, but also withholding information. White lies are not uncommon in medical practice, especially in some particular cultures, such as Asia; and to some particular patients, such as children. Here, white lies are defended based on the position of weak paternalism. And although medical AI may surpass human physicians in diagnostic accuracy, efficiency, and treatment, they cannot intentionally lie to patients, which is necessary to prevent injury or grief or to protect patients’ feelings in some cases. From this perspective, it is further argued that AI cannot completely replace human physicians.

Adult children’s particular obligations to their parents are filial obligations. The gratitude of filial obligations that treats one’s filial obligations as duties of gratitude to one’s parents is a mainstream view. However, in terms of the requirements of such obligations, the gratitude account fails to provide practical guidance. The general requirement seems that children should benefit their parents as the beneficiary should benefit the benefactor. The question is what kinds of benefits adult children should provide to their parents? In some cases, adult children feel obligated to provide particular benefits to their parents like paying their medical bills or spending time with them. While in some other cases, it seems that they can use their own discretion to decide how to satisfy the filial obligations so long as what they do benefits their parents. In this article, I am trying to argue that although the general requirement of the filial obligations is to benefit the parents, there are two kinds of benefits that adult children are strongly obligated to provide. These are special goods that parents can only get from their children and things that meet their parents’ basic needs. In addition, although adult children have filial obligations to benefit their parents, there should be some limitations on the requirements of filial obligation. Namely, adult children do not have a filial obligation to meet their parents’ desires that could only be satisfied at the cost of adult children’s liberty related to significant aspects of their lives, or to meet their parents’ desires that could only be satisfied at the cost of infringing their capacity to fulfil other important duties.

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.

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 (informal payments) 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 (69.5% [180/259] vs.53.9% [83/154]), and the odds ratio (OR) was statistically significant after adjusting for age, education, position and geographical areas (adjusted OR 1.81, p = 0.012). In terms of the question of whether or not they had accepted red packets, more male doctors answered “yes” compared to female doctors (33.3% [60/180] vs.15.7% [13/83], adjusted OR 2.80, p = 0.004). 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 (adjusted OR 12.01, p = 0.023).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.