It's a family affair: Confucian familist philosophy's potential to improve mental health care for ethnic Chinese in Aotearoa New Zealand.

Many ethnic groups traditionally value familism, which emphasises interdependence and the extended family unit. However, Aotearoa New Zealand's health system remains largely individual-oriented, with the implementation of family-centred care remaining inconsistent. This is known to have negative effects on Maori healthcare experiences and outcomes. Our research, exploring the experiences of ethnic Chinese using mental health services in Aotearoa New Zealand, indicated that this could also be a barrier for ethnic Chinese, who have similarly strong cultural links to familism, accessing mental health care. To balance the cultural importance of family involvement with the protection of individual patient autonomy, we propose a moderate Confucian familist approach, encouraging family involvement and participation in individual patients' care, with patients' consent. The approach acknowledges individual patients as interconnected members of a wider family unit, emphasising their reciprocal, mutual responsibility in maintaining a well-functioning, harmonious family. We highlight Whanau Ora as a potential exemplar for a culturally grounded, family-centred approach to mental health care which could be feasibly implemented and deliver positive outcomes. Parallels between Maori and ethnic Chinese cultural views around whanau, community, and collectivism suggest a Kaupapa Maori approach could also be beneficial to Aotearoa New Zealand's ethnic Chinese populations. However, ethnic Chinese lack the specific legal obligations empowering the implementation of interventions such as Whanau Ora. This is an obstacle which remains to be addressed before mental health services which are sensitive to the needs of ethnic Chinese or of other ethnicities can be effectively implemented.

Who is willing to donate their bodies in China? Perceptions, attitudes and influencing factors among citizens of Changsha.

Body donation has far-reaching significance for modern medical research and education. However, body donation in China lags far behind the demand. To assess the perception and attitude toward body donation, a survey of 2535 community residents was conducted in Changsha. The result showed that 89.5% of the respondents have heard about body donation through different sources, such as public media, medical college, and hospital. However, 61.8% of the respondents have limited knowledge of these body donation programs. The majority of respondents believed that body donation would contribute to researches in neuroanatomy, tumor biology, and ophthalmology, as well as anatomical education for medical students, and surgical training for clinicians/surgeons. Regarding the public's willingness to donate, 27.5% of respondents expressed a clear willingness. Further analysis revealed that people aged above 60 are less willing to donate. Compared with people having Confucianism funeral belief, those without the belief were 9.8 times more willing to donate. Furthermore, it was shown that respondents who had a good understanding of body donation were more willing to donate their bodies. Moreover, people thought body donation was beneficial to medical research and education were almost 10 times more willing to donate compared to those who thought it had no benefit. To promote body donation in China, greater efforts need to be made in promoting body donor programs and so increasing the public's perception toward body donation. Moreover, re-assessing and re-interpreting Confucianism beliefs regarding body donation also needs to be considered for future promotion of body donation in China and other East Asian countries.

Resilience Style Questionnaire: Development and Validation Among College Students and Cardiac Patients in Hong Kong.

The present research aims to develop and validate a measure of resilience that reflects the influence of Confucian philosophies and Chinese cultural lay beliefs. Based on a representative sample of 1,419 college students from universities and a clinical sample of 214 cardiac patients in Hong Kong, reliability, construct validity, and criterion validity of the Resilience Style Questionnaire (RSQ) were examined. A two-factor structure of the RSQ was explored and validated in both samples. Results showed that the two factors of the RSQ (i.e., perseverance and optimistic approach to life) were significantly associated with a variety of mental health indicators in both samples. Furthermore, the RSQ explained additional variances above and beyond those explained by the Ego-Resiliency Scale, the Sense of Coherence Scale (SOC), and the Connor-Davidson Resilience Scale in multiple mental health indicators among college students and cardiac patients. These findings showed that the RSQ is a reliable and valid tool in assessing resilience among Chinese and other groups influenced by Confucianism.

The Gift-of-Life and Family Authority: A Family-Based Consent Approach to Organ Donation and Procurement in China.

China is developing an ethical and sustainable organ donation and procurement system based on voluntary citizen donation. The gift-of-life metaphor has begun to dominate public discussion and education about organ donation. However, ethical and legal problems remain concerning this "gift-of-life" discourse: In what sense are donated organs a "gift-of-life"? What constitutes the ultimate worth of such a gift? On whose authority should organs as a "gift-of-life" be donated? There are no universal answers to these questions; instead, responses must be compatible with local cultural values. This paper argues that from a Confucian point of view, organs should be viewed as a gift from the donor's family, and that final dispositional authority should also rest with the donor's family. The worth of such a "gift" rests on the virtue of ren, the origin of which is family love. Ultimately, I will argue that a family-based consent model for deceased organ donation is not merely justified, but morally required in the Chinese cultural context.

Family-Based Consent for Organ Donation: Benevolence and Reconstructionist Confucianism.

This paper explores organ donation through the perspective of Reconstructionist Confucianism. I argue that for organ donation in China to be morally permissible, public policy must conform to the norms of Confucian benevolence. Reconstructionist Confucianism appreciates benevolence as an objectively important feature of morality deeply connected to moral rules governing propriety, integrity, righteousness, and human freedom. Here, benevolence involves sincere affection for another as an intrinsic good, rather than as a means to achieve other purposes. It requires developing self-restraint and proper respect for others. As I argue, family-based consent is essential for ensuring that organ donation conforms to such an understanding of benevolence and is, thereby, compatible with Confucian culture. Consequently, legislation in China should solidify family-based consent for organ donation to consolidate a benevolent family environment as the basis of morality, law, and social existence.

Building Norms for Organ Donation in China: Pitfalls and Challenges.

In most, if not all, jurisdictions with active organ transplantation programs, there is a persistent desire to increase donation rates because the demand for transplantable organs exceeds the supply. China, in particular, faces an extraordinary gap between the number of organs donated by deceased donors and the number of people seeking one or more transplants. China might look to Western countries with higher donation rates to determine how best to introduce Western practices into the Chinese system. In attempting to increase its organ donation rate, China must not only ensure that its organ donation system reflects different Chinese cultural values, but also that it avoids the ethical problems of the United States and of other Western systems. This article examines four such problems. They concern the family, obtaining permission for organ donation, the definition and diagnosis of "brain death," and trust. Revisions to the Chinese system should involve a careful look to China and Chinese cultural resources rather than to Western models.

Family-Based Consent and Motivation for Cadaveric Organ Donation in China: An Ethical Exploration1.

This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a "hard" opt-out system is unethical, and a "soft" opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right that this model supports, is ethically justifiable in terms of Confucian family-based ethics.

Birth with dignity from the Confucian perspective.

The development of biotechnologies has broadly interfered with a number of life processes, including human birth. An important moral question arises from the application of such medical technologies to birth: do biotechnological advancements violate human dignity? Many valid arguments have been raised. Yet bioethicists are still far from reaching a consensus on how best to protect the dignity of human birth. Confucianism is an influential ethical theory in China and presents a distinctive understanding of human dignity. In this paper, we reconstruct the two Confucian concepts of dignity-namely, universal dignity and personal dignity. We then apply these concepts to human birth in the context of biotechnologies involving embryos and genetic enhancement. We conclude that the dual Confucian understanding of dignity contributes a valuable perspective to the question of whether biotechnologies related to human birth violate human dignity.

Confucian Culture as Determinants of Consumers' Food Leftover Generation: Evidence from Chengdu, China.

Food waste is a worldwide problem due to its effects on carbon emission, water pollution, and arable lands. Previous studies of food waste generation and reduction focus on demographic, psychological, and situational factors, whereas the effects of culture in different countries have been ignored. This paper investigates the influence of Confucian culture on behaviors that waste food, considering additional factors of face saving and group conformity. We used an integrated behavioral intention model combining the TPB model and Lee's modified Fishbein model. The results show that including the constructors of Confucian culture increases the predictive power of the model. Face saving and group conformity are found to significantly influence attitude toward food waste reduction. Face saving can greatly reduce the intention to pack leftovers, and group conformity has a significant effect on the ordering of small portion sizes. Based on these results, we give a discussion and put forward with suggestions to the government and the catering industry. Limitations and implications for future research are provided accordingly.

Does Confucianism allow for body donation?

Confucianism has been widely perceived as a major moral and cultural obstacle to the donation of bodies for anatomical purposes. The rationale for this is the Confucian stress on xiao (filial piety), whereby individuals' bodies are to be intact at death. In the view of many, the result is a prohibition on the donation of bodies to anatomy departments for the purpose of dissection. The role of dissection throughout the development of anatomy within a Confucian context is traced, and in contemporary China the establishment of donation programs and the appearance of memorial monuments is noted. In reassessing Confucian attitudes, the stress laid on a particular interpretation of filial piety is questioned, and an attempt is made to balance this with the Confucian emphasis on a moral duty to those outside one's immediate family. The authors argue that the fundamental Confucian norm ren (humaneness or benevolence) allows for body donation as people have a moral duty to help others. Moreover, the other central Confucian value, li (rites), offers important insights on how body donation should be performed as a communal activity, particularly the necessity of developing ethically and culturally appropriate rituals for body donation. In seeking to learn from this from a Western perspective, it is contended that in all societies the voluntary donation of bodies is a deeply human activity that is to reflect the characteristics of the community within which it takes place. This is in large part because it has educational and personal repercussions for students. Anat Sci Educ 11: 525-531. © 2018 American Association of Anatomists.

Effects of Working Couple's Retirement Sequence on Satisfaction in Patriarchal Culture Country: Probing on Gender Difference.

We examined the effects of the differences in the retirement sequence (i.e., who retires first between spouses) on satisfaction in Korea of patriarchal culture. Our empirical study demonstrates that households where men retired first had a much lower satisfaction than households where women retired first. In addition, men were found to show lower satisfaction than wives in both households where women retire first and the households where men retire first. Retirement sequence affecting their satisfaction at the point when only one of the spouses is retired continues to affect their satisfaction after both of them are retired. This means that the difference in the couple's retirement sequence has an ongoing effect on their later happiness. The analysis of the effect of a couple's retirement sequence on the satisfaction in their old life may be useful for improving an individual and couples' quality of life in countries with similar cultures.

Living with appending a scarlet letter: The lifelong suffering of children of alcoholics in South Korea.

Children of alcoholics (COAs) are those who have grown up with parental alcoholism. The purpose of this study was to understand the lives of Korean COAs within a Korean cultural context, influenced by Confucianism. Prior literature has extensively reported about the adverse life experiences of COAs related to their alcohol dependent parents. Indeed, most of these studies assume the U.S.- or Western-centric perspective. However, in order to provide culture-specific care, health professionals who provide care for diverse ethnic families have to understand the cultural influences on the families which have an ill family member. Data were collected from 20 Korean adult children through semi-structured interviews. All interviews were audio-recorded and fully transcribed. Thematic analysis was used for the data analysis. The lives of Korean COAs were described with four themes, namely: "Losing family," "Life with holding a bomb," "My life ruined," and "Being bound." CONCLUSION: In conclusion, the findings of this study demonstrated how cultural components could shape individual's life experiences in a family having an alcohol dependent family member. This study would be helpful for health professionals to deeply understand the alcoholic family members within a specific cultural background as well as to build a cultural-specific care-plans for them.

What Confucius practiced is good for your mind: Examining the effect of a contemplative practice in Confucian tradition on executive functions.

The short-term training effects on various executive functions (EFs) by a movement-based contemplative practice (MBCP) are examined. Three aspects of EFs (working memory capacity, inhibition, switching) are assessed before and after a month-long 12-h training period using Body-Mind Axial Awareness (BMAA) principles that Confucius followers have practiced for more than 2000years. A mindfulness-based practice (Chan-meditation) and a waiting-list control group served as contrast groups. Our results showed that the BMAA group performed better on the task that measured working memory capacity than did the Chan-meditation and the waiting-list groups after training. In addition, the Chan-meditation groups outperformed the control group on attentional switching, a novel finding for this kind of practice. Our findings not only show a new effect of short-term MBCPs on EFs, but also indicate movement-based and mindfulness-based contemplative practices might benefit development of various aspects of EFs in different ways.

Understanding Korean Families With Alcoholic Fathers in a View of Confucian Culture.

The purpose of this study was to interpret the dynamics of Korean alcoholic family through the lens of Confucianism, using research conducted in South Korea. To gain an in-depth understanding of the family dynamics and the lived experiences of a certain alcoholic family having a specific ethnicity, health professionals must first understand the uniqueness of their own cultural bases and how those cultural components can shape dynamics of alcoholic family. Thus, we reviewed qualitative studies of Korean families with alcoholic fathers to investigate the unique characteristics of Korean alcoholic families in terms of Confucian thoughts and values and discuss how the Confucian thoughts affect family dynamics in those Korean alcoholic families. Relevant literature was found through Korean database Research Information Sharing Service by using several (Korean) searching terms: alcoholic, home, spouse, wife, children, and family. Articles were included if they were studies of a Korean alcoholic family and used qualitative methodology. If the studies did not include familial perspectives or not focused on alcoholism issues, those studies were excluded. Eleven qualitative studies of alcoholic family were searched. The members of alcoholic families in South Korea, including the alcoholic member, have expected roles and duties because of the influence of Confucian thoughts and values. By associating with family member's alcoholism, those expectations are a big burden on those family members. Therefore, future plans for community interventions and programs for this population should incorporate the findings from this study.

A Family-Oriented Decision-Making Model for Human Research in Mainland China.

This essay argues that individual-oriented informed consent is inadequate to protect human research subjects in mainland China. The practice of family-oriented decision-making is better suited to guide moral research conduct. The family's role in medical decision-making originates from the mutual benevolence that exists among family members, and is in accordance with family harmony, which is the aim of Confucian society. I argue that the practice of informed consent for medical research on human subjects ought to remain family-oriented in mainland China. This essay explores the main features of this model of informed consent and demonstrates the proper authority of the family. The family's participation in decision-making as a whole does not negate or deny the importance of the individual who is the subject of the choice, but rather acts more fully to protect research subjects.

Intimacy and Family Consent: A Confucian Ideal.

In the West, mainstream bioethicists tend to appreciate intimate relationships as a hindrance to individual autonomy. Scholars have even argued against approaching a mother to donate a kidney to save the life of her child; the request, they claim, is too manipulative and, thereby, violates her autonomy. For Chinese bioethicists, such a moral analysis is absurd. The intimate relationship between mother and child establishes strong mutual obligations. It creates mutual moral responsibilities that often require sacrifices for each other. This paper argues that while aiding others is a moral duty, helping one's family is a much stronger duty and poses no threat to one's autonomy. For Confucianism, empathetic intimate feelings, the heart and mind of ren, rest at the root of morality. It requires that we, as moral beings, assume duties to relieve the suffering of others. The more intimate the relationship the stronger the obligation to assist. The family is a closely knitted moral community. Family members often share living resources, mutual experiences, and a sense of identity. Family members act as a social unit, and, ordinarily, mutual obligations among members have priority over duties to those outside of the family. For Confucian bioethics, family-based consent to medical treatment is regarded as natural and reasonable. Family-based decision making is a taken-for-granted norm of social life. While close family members have priority, Confucianism extends such obligations outward toward members of the extended family and the society at large. There is a general principle of gradation of love, which reflects different degrees of personal intimacy and, therefore, of moral obligation. In this fashion, Confucianism seeks to treat the whole of society as one extended family. Hence, in bioethics, mutual responsibility and family-based consent are regarded as basic principles. Through a series of case discussions, this paper illustrates that atomistic individual-based autonomy offers but a poor response to bioethical issues.

Taking the Role of the Family Seriously in Treating Chinese Psychiatric Patients: A Confucian Familist Review of China's First Mental Health Act.

This essay argues that the Chinese Mental Health Act of 2013 is overly individualistic and fails to give proper moral weight to the role of Chinese families in directing the process of decision-making for hospitalizing and treating the mentally ill patients. We present three types of reactions within the medical community to the Act, each illustrated with a case and discussion. In the first two types of cases, we argue that these reactions are problematic either because they comply with the law but undermine the patient's interests by refusing the family's request to have the patient hospitalized, or violate the law by hospitalizing patients in response to the real concerns of their families. In the third type of situation, psychiatrists inappropriately encourage families to produce evidence of the patient's behavior that is harmful to self or others in order legally to commit the patient. Each of these problems, we conclude, should be tackled by supplementing Article 30 of the Act with the stipulation that a psychiatrist may authorize the involuntary hospitalization of a patient, who is not at risk of causing physical harm to self or others, with the consent of all major family members. Drawing on the deeply culturally embedded moral traditions of Confucian medical familism, this proposal would facilitate the proper treatment of a significant number of Chinese mentally ill patients under the care of their families.

Medical Individualism or Medical Familism? A Critical Analysis of China's New Guidelines for Informed Consent: The Basic Norms of the Documentation of the Medical Record.

Modern Western medical individualism has had a significant impact on health care in China. This essay demonstrates the ways in which such Western-style individualism has been explicitly endorsed in China's 2010 directive: The Basic Norms of the Documentation of the Medical Record. The Norms require that the patient himself, rather than a member of his family, sign each informed consent form. This change in clinical practice indicates a shift toward medical individualism in Chinese healthcare legislation. Such individualism, however, is incompatible with the character of Chinese familism that is deeply rooted in the Chinese ethical tradition. It also contradicts family-based patterns of health care in China. Moreover, the requirement for individual informed consent is incompatible with numerous medical regulations promulgated in the past two decades. This essay argues that while Chinese medical legislation should learn from relevant Western ideas, it should not simply copy such practices by importing medical individualism into Chinese health care. Chinese healthcare policy is properly based on Chinese medical familist resources.

What my parents make me believe in learning: the role of filial piety in Hong Kong students' motivation and academic achievement.

Chinese students are well-known for their academic excellence. However, studies that explore the underlying mechanism of how cultural factors relate to the motivational process and academic achievement of Chinese students have been limited. This study aimed to examine the role of filial piety in shaping Chinese students' theories of intelligence so as to obtain a clearer understanding of the process by which parent-child connectedness is linked to Chinese students' academic achievement. A sample of 312 university students in Hong Kong were assessed concerning their filial piety beliefs, theories of intelligence and academic achievement. Data were analysed using structural equation modelling. The results indicated that different filial piety beliefs relate to students' academic achievement by shaping different theories of intelligence. Reciprocal filial piety beliefs were found to facilitate an incremental view of intelligence, which in turn contributes to students' academic achievement. Authoritarian filial piety beliefs were shown to be associated with an entity view of intelligence, which consequently deteriorates students' academic achievement. Cultural views of motivational processes can shed light on how motivational beliefs are developed as a product of cultural or socialization processes, which, in turn, contribute to students' academic success.

Collectivism, individualism, and pragmatism in China: implications for perceptions of mental health.

This study aimed to better understand how minor mental health problems (MMPs) are perceived by well-educated urban dwellers in China who are influenced by Western values. Urban China is a rapidly changing society in which traditional Chinese culture and Western thought coexist. As a result, the established processes of interdependent self-appraisal have been challenged and a sense of a bicultural self has developed among a growing proportion of the population. The fieldwork for this study included interviews and observations. The results are derived mainly from interviews with professional practitioners, students, and lay people from three urban sites. One of the main findings was that respondents who referred to traditional and collectivistic Chinese values tended not to label MMPs as psychiatric disorders or illnesses but as challenges in daily life and relationships strain. While the Western medical model of MMPs considers them a form of illness, they were not viewed in this way in traditional collectivistic China in the past, even among educated urban dwellers. However, the urban and educated Chinese who have developed a stronger sense of a bicultural self are now more likely to perceive and deal with MMPs from a Western viewpoint.