Search Results (269)

Background: Thailand is rapidly transitioning into an aging society, creating an intergenerational caregiving gap that strains existing support systems. Objective: This study evaluated the effectiveness of “Young Care,” a community-based intervention designed to enhance youth knowledge, attitudes, and caregiving practices (KAP) toward older adults. Methods: A two-day structured training was conducted in Maha Sarakham Province in 2023 using a pre-post mixed-methods design. Middle and high school students participated in lectures, multimedia sessions, and experiential learning activities related to caregiving. Quantitative data were collected using validated KAP questionnaires, while qualitative insights were obtained from focus group discussions involving students, older persons, caregivers, and local leaders. Results: Post-intervention analysis revealed significant improvements in knowledge and attitudes (p < 0.001), accompanied by increased empathy, caregiving initiative, and a sense of moral responsibility among participants. Conclusions: The initiative fostered formal partnerships among schools, local governments, healthcare providers, and universities through memoranda of understanding. These collaborations enabled budgetary support and outreach to out-of-school youth, positioning “Young Care” as a scalable, youth-centered strategy to address Thailand’s long-term care challenges. Full article

Mitochondria are currently of great interest to scientists. The role of mitochondrial DNA (mtDNA) mutations has been proven in the genesis of more than 200 pathologies, which are called mitochondrial disorders. Therefore, the study of mitochondria and mitochondrial DNA is of great interest not only for understanding cell biology but also for the treatment and prevention of many mitochondria-related pathologies. There are two main trends of mitochondrial therapy: mitochondrial replacement therapy (MRT) and mitochondrial transplantation therapy (MTT). Also, there are two main categories of MRT based on the source of mitochondria. The heterologous approach includes the following methods: pronuclear transfer technique (PNT), maternal spindle transfer (MST), Polar body genome transfer (PBT) and germinal vesicle transfer (GVT). An alternative approach is the autologous method. One promising autologous technique was the autologous germline mitochondrial energy transfer (AUGMENT), which involved isolating oogonial precursor cells from the patient, extracting their mitochondria, and then injecting them during ICSI. Transmission of defective mtDNA to the next generation can also be prevented by using these approaches. The development of a healthy child, free from genetic disorders, and the prevention of the occurrence of lethal mitochondrial disorders are the main tasks of this method. However, a number of moral, social, and cultural objections have restricted its exploration, since humanity first encountered the appearance of a three-parent baby. Therefore, this review summarizes the causes of mitochondrial diseases, the various methods involved in MRT and the results of their application. In addition, a new technology, mitochondrial transplantation therapy (MTT), is currently being actively studied. MTT is an innovative approach that involves the introduction of healthy mitochondria into damaged tissues, leading to the replacement of defective mitochondria and the restoration of their function. This technology is being actively studied in animals, but there are also reports of its use in humans. A bibliographic review in PubMed and Web of Science databases and a search for relevant clinical trials and news articles were performed. A total of 81 publications were selected for analysis. Methods of MRT procedures were reviewed, their risks described, and the results of their use presented. Results of animal studies of the MTT procedure and attempts to apply this therapy in humans were reviewed. MRT is an effective way to minimize the risk of transmission of mtDNA-related diseases, but it does not eliminate it completely. There is a need for global legal regulation of MRT. MTT is a new and promising method of treating damaged tissues by injecting the body’s own mitochondria. The considered methods are extremely good in theory, but their clinical application in humans and the success of such therapy remain a question for further study. Full article

Communication about moral decision-making involves complex emotional and cognitive processes, especially in critical situations. This study adopted a hyperscanning paradigm to explore neural convergence during moral negotiation. Twenty-six healthy young adults (mean age = 23.59 years; 16 women, 10 men), with no neurological or psychiatric conditions, were paired into 13 same-gender dyads at the Università Cattolica del Sacro Cuore. Each dyad discussed a medical moral dilemma while their electrophysiological (EEG) activity was simultaneously recorded. Participants were first categorized according to their Dominant Reasoning Profile (DRP) (cognitive or affective), and subsequently convergence in DRP within the dyads was established. EEG band dissimilarities within each dyad were analyzed across frontal, temporo-central, and parieto-occipital regions. The results revealed significantly greater dissimilarity in frontal delta-band activity compared to parieto-occipital areas, regardless of the dyad’s DRP. Such results might suggest different emotional and motivational reactions between the two individuals, reflecting a broader gap in how the moral decision-making process was interpreted and internalized by each member, despite their DRP. The EEG hyperscanning paradigm proves useful in the study and understanding of the neural mechanisms involved in social interaction about morally sensitive decisions and provides novel insights into dyadic brain dynamics. Full article

This study examines the exercise of religious freedom within the Polish penitentiary system, focusing on the intersection of legal frameworks, religious pluralism, and secularization. While Poland’s Constitution and penal legislation guarantee inmates the right to practice their faith, the practical implementation of this right faces systemic challenges. This research draws on legal analysis, demographic data, and existing empirical studies to assess how pastoral care operates in prisons. The findings reveal that although the prison system is formally open to various denominations, access to non-Catholic chaplaincy is often limited and misaligned with the evolving religious composition of the inmate population, especially following increased immigration. The number of chaplains and volunteers remains low relative to the needs of inmates, and pastoral services vary widely across regions. Despite these issues, religious involvement is shown to support rehabilitation by fostering moral development and reducing recidivism. This study concludes that a more inclusive, pluralistic, and flexible approach to prison ministry—one that accounts for both declining religiosity and growing diversity—is essential. Chaplaincy must adapt not only as a provider of religious rites but also as a facilitator of ethical reflection, emotional support, and reintegration into a secular and pluralistic society. Full article

Background/Objectives: To avoid becoming mired in prolonged deep dementia, some people seek to hasten death by advance instructions rejecting life-sustaining medical intervention (LSMI) at a point of cognitive decline they define in advance as unacceptable. When the time comes to implement such advance instructions and to allow the person in advanced dementia to die, many clinicians experience moral and ethical qualms. The decision makers face a clash between people’s legally recognized self-determination prerogative to control their post-competence medical fate and the decision makers’ conviction that humane treatment dictates sustaining the well-being, i.e., the physical “best interests,” of the patient who no longer recalls prior instructions grounded in concerns about personal dignity. The authors’ objective here is to provide guidance in resolving this anguishing dilemma confronting medical decision makers. Methods: The authors construct and analyze a case scenario involving a patient in a state of advanced dementia with a clear advance instruction rejecting LSMI at the current point of debilitation, but who is not ostensibly suffering, is experiencing a modicum of life satisfaction, and is making life-affirming utterances. The two lead authors present contrasting views on whether legal and moral factors impel the implementation of the advance directive rejecting treatment or rather dictate life-sustaining medical intervention. Results: At this early stage of jurisprudence involving persons in advanced dementia, there can be no definitive resolution of the difficult legal/moral clash confronting decision makers. Some sources would conclude that persons are legally entitled to define precipitous mental decline and complete dependence on others as intolerably undignified and inconsistent with their self-defined life narrative. Other sources would be guided by humane respect for the contemporary well-being of a non-suffering patient, especially one making life-affirming utterances. Conclusion: Through the lens of this illuminating case and contrasting analyses, readers should better understand how clinicians should weigh advance directives against shifting care preferences subsequently articulated by persons with advanced dementia. Full article

Moral injury is increasingly recognized as a significant concern among medical personnel and first responders, particularly in high-stress healthcare and emergency settings. This review aims to synthesize current evidence on the prevalence, risk factors, and outcomes of moral injury among medical personnel and first responders across diverse healthcare and emergency response environments. We included peer-reviewed studies reporting on moral injury among medical personnel or first responders in any healthcare or emergency response setting, excluding studies that did not report original data or focused solely on military populations. We systematically searched PubMed, Google Scholar, and Central, up to April 2025. Risk of bias was assessed directly from the manuscripts. Data were synthesized narratively and, where possible, pooled using random-effects meta-analysis. A total of 41 studies involving 14,500 participants were included. The prevalence of moral injury ranged from 4.1% to 69.44% across settings. Key risk factors identified included exposure to traumatic events, organizational constraints, and lack of support. Meta-analysis indicated a significant association between moral injury and symptoms of PTSD. The evidence is limited by heterogeneity in measurement tools and study designs, as well as a moderate risk of bias in several included studies. In conclusion, moral injury is prevalent among medical personnel and first responders, with important implications for mental health interventions and organizational policy. This review was not funded externally, and is registered in PROSPERO (CRD420251019492). Full article

As climate change continues to endanger a sustainable global condition, a growing literature investigates how to pursue green practices to fight its effects. Individuals are the essential starting point for such bottom-up attempts, with their attitudes towards sustainability driving pro-environmental behaviors (PEBs). Objectives: Based on the available relevant literature, this scoping review aims to delve into the processes underlying people’s sustainable decision-making (SDM) associated with PEBs. Methods: A scientific literature search was performed through (a) an active database search and (b) the identification of studies via reference and citation tracking. Results were screened and selected in Rayyan. Results: Included articles (n = 30) heterogeneously reported cognitive and neural aspects of SDM shaping PEBs. These proved to (a) recruit brain areas involved in mentalizing and moral cognition (likely because of their role in processing the interplay between personal and contextual factors rather than moral considerations in themselves); (b) undergo the same modulatory influences shaping other kinds of prosocial/cooperative behaviors; and (c) include brain areas involved in attentional/monitoring and emotional/motivational processes, alongside those consistently associated with decision-making processes. Conclusions: These results help interpret the available evidence on the neuro-cognitive bases of SDM while focusing on potential interventions to foster better practices and mitigate the adverse repercussions of climate change on human and global health. Full article

The recent birth of genetically modified canids phenotypically resembling the extinct dire wolf (Aenocyon dirus) was hailed as a landmark in synthetic biology. Using genome editing and cloning, the biotech company Colossal Biosciences created three such animals from gray wolf cells, describing the project as an effort in “functional de-extinction”. This case raises significant questions regarding animal welfare, moral justification, and regulatory governance. We used the five domains model framework to assess the welfare risks for the engineered animals, the surrogate mothers used in reproduction, and other animals potentially affected by future reintroduction or escape scenarios. Ethical implications are examined through utilitarian, deontological, virtue, relational, and environmental ethics. Our analysis suggests that the project suffers from ontological ambiguity: it is unclear whether the animals created are resurrected species, hybrids, or novel organisms. While the current welfare of the engineered animals may be manageable, their long-term well-being, particularly under rewilding scenarios, is likely to be compromised. The moral arguments for reviving long-extinct species are weak, particularly in cases where extinction was not anthropogenic. Legally, the current EU frameworks lack the clarity and scope to classify, regulate, or protect genetically engineered extinct animals. We recommend that functional de-extinction involving sentient beings be approached with caution, supported by revised welfare tools and regulatory mechanisms. Full article

This article delves deeply into the moral rationalism advocated by R. M. Hare. Traditionally, the ultimate normativity of morality has been attributed to divine characteristics such as the abstract concepts of universality, transcendence, necessity, and ultimate authority, but Hare explicitly rejects any theological premises and seeks to base moral obligations on a pure structure of linguistic and rational consistency. However, this paper proposes that Hare’s secular rational system inevitably reproduces the functional structure of the divine moral order at its internal logical level. To demonstrate this, the key conceptual attributes involved in “divine normativity” are separated first, and an analytical framework is constructed. At the same time, this paper analyzes how the normative requirements, such as universality and prescriptiveness in the Hare system, relate to the attributes of divine norms. The results show that although Hare appears to maintain thorough secularism on the surface, the moral rationalism emphasis on consistency and universal applicability functionally reproduces a normative structure similar to divine commands. This finding reveals a profound philosophical paradox: even stripped of metaphysical assumptions, human attempts to pursue an objective moral order still tend to appeal to transcendent structures in an implicit way. This paper offers a critical examination of Hare’s theory, affirming both his ambition in the construction of secular moral thought and revealing the underlying tension within it that cannot completely break away from the framework of theological tradition. Full article

Planetary health is a transdisciplinary concept that erases the dividing lines between individual and community health, and the natural systems that support the wellbeing of humankind. Despite planetary health’s broad emphasis on justice, the promotion of science-based policies, and stated commitments to fairness, equity, and harm reduction, the criminal justice system has largely escaped scrutiny. This seems to be a major oversight, especially because the criminalization of mental illness is commonplace, and the system continues to be oriented around a prescientific compass of retribution and folk beliefs in willpower, moral fiber, and blameworthiness. Justice-involved juveniles and adults are funneled into landscapes of mass incarceration with ingrained prescientific assumptions. In non-criminal realms, such as obesity, there is a growing consensus that folk psychology ideas must be addressed at the root and branch. With this background, the Nova Institute for Health convened a transdisciplinary roundtable to explore the need for a ‘Copernican Revolution’ in the application of biopsychosocial sciences in law and criminal justice. This included discussions of scientific advances in neurobiology and omics technologies (e.g., the identification of metabolites and other biological molecules involved in behavior), the need for science education, ethical considerations, and the public health quarantine model of safety that abandons retribution. Full article

As technologies such as Building Information Modeling, the Internet of Things, and cloud computing spread, digital transformation in construction is widely seen as a path to greater efficiency and sustainability. Yet multiple stakeholders and persistent information asymmetry often hamper genuine cooperation, undermining digitalization’s potential. This study constructs an evolutionary game model involving government, contractor, and service providers under incomplete information. A combined subsidies-and-penalties mechanism is introduced to derive replicator dynamics and identify conditions for an evolutionary stable strategy. Numerical simulations show that insufficient subsidies and weak penalties typically result in a “low-level equilibrium,” with superficial or absent cooperation. Strengthening government subsidies and imposing more stringent penalties triggers a threshold effect, significantly increasing contractors’ and service providers’ willingness to participate, thereby leading to a stable cooperative equilibrium. Service providers, in particular, influence success or failure through their cost–benefit structures, which affect contractors’ confidence in adopting digital solutions. This research extends evolutionary game theory to a three-party construction digitalization context, providing practical guidance for balanced subsidy–penalty strategies and incentive-compatible mechanisms. Overall, it underscores how coordinated policies and stakeholder alignment can overcome moral hazard and achieve sustainable digital transformation in the construction sector. Full article

Stories are widely used by parents or educators to teach children the virtue of honesty. However, the existing empirical findings on the effect of story-telling on children’s honesty are limited and mixed. This study examined whether moral stories involving honesty can promote honesty in Chinese preschool children (N = 208). The Temptation Resistance Paradigm (TRP) was used to assess children’s honesty. Study 1 showed that children in the positive moral story condition were more likely to tell the truth than those in the control condition, while negative moral story-telling did not have this effect. Study 2 further examined whether combining external appeals with positive moral story-telling could further promote children’s honesty, and the results showed that the combination of the two techniques was equally as effective as moral story-telling alone. These findings have important implications for moral development and moral education. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Cyberbullying is a violent phenomenon that threatens health and development in adolescence. Some studies suggest that minority groups or those who deviate from socially desirable characteristics are at a greater risk of cyberbullying. However, there have been few studies on social stigma-based cyberbullying (SSB). This study aims to carry out the following: to know the prevalence of roles of involvement in cyberbullying and SSB cyberbullying; to understand the possible relationships between SSB cybervictimization and SSB cyberaggression and the different dimensions of moral disengagement, moral emotions and social and emotional competencies; and to know the possible statistical associations between roles and the variables described above. A total of 601 secondary school students took part in this study, aged 12–19 (M = 14.22, SD = 1.355). A self-report battery of scales was employed to measure the constructs under investigation, and various statistical analyses were conducted. The results show that 22.29% are recognized as cybervictims, 7.82% as cyberaggressors and 35.11% as cybervictims/cyberaggressors in general cyberbullying. In SSB cyberbullying, the percentages were 20.30%, 3% and 8.32%, respectively. Moreover, it was revealed that SSB cyberaggression was related to moral disengagement and SSB cybervictimization was related to moral emotions. Social competence and emotional competence were positively related to social stigma-based cybervictimization. The results are discussed and new lines of research and interventions focused on social competences and moral emotions are proposed. Full article

Background: Research in the intensive care unit (ICU), which involves critically ill patients, families and healthcare professionals, poses significant ethical challenges. The aim of this PRISMA-guided systematic review is to identify major challenges for research ethics in the ICU. Methods: Pubmed and Scopus databases were searched in November-December 2024 for papers discussing theoretical concepts or specific aspects related to ethical issues in ICU research, retaining 70 papers on ICU research challenges, difficulties or controversies. Results: A total of 10 papers described general concepts related to research ethics in the ICU, 16 studies focused on the methodology or some of the study steps, and 6 papers focused on ICU trials, while 38 studies focused on special patient categories or special situations of critical patients. None of the included papers addressed all of the issues we identified regarding the ethical challenges. Conclusions: ICU research is challenging from a moral point of view. Significant ethical difficulties arise during the design and implementation phases, hampering the study's exactness. Being a vulnerable population with limited decision-making capacity and research-associated risks, alternative consent methods need to be considered. This systematic review provides a checklist of aspects that could generate ethical dilemmas and might constitute a starting point in the conduct of research studies, preventing unethical research. Full article