Motivators for family carers of persons with dementia in Kenya.

OBJECTIVES: The number of people with dementia is on the rise in Kenya and across Africa. Although family carers act as the main providers of dementia care in Kenya, there is still a significant knowledge gap regarding why family members care for someone with dementia. This study explores perceived drivers of care for people with dementia in a rural Kenyan context. METHODS: Participants were recruited in Makueni County, Kenya. Primary data were derived from a focus group discussion (FGD) and five individual interviews with family carers of people with dementia. To complement interpretation, triangulation occurred through using data from FGDs with healthcare workers and members of the general public. All audio recordings were transcribed verbatim and inductive thematic analysis performed using NVIVO 12. RESULTS: Using the Positioning Theory, we sought to generate information pertaining to motivation for becoming a family carer. Five themes emerged from the analysis and included: (i) self-fulfillment, (ii) familial obligation, (iii) cultural and religious beliefs, (iv) reciprocity, and (v) societal pressures. These themes described the nature of care given to people with dementia, based on what the participants perceived as compelling and/or motivating factors. CONCLUSIONS: Our findings describe the unique motivators of family carers for people with dementia in Kenya. The ability to find meaning in the caregiving experience could contribute to development of effective support systems, interventions and policies for dementia carers with the aim of improving the overall quality of dementia care in Kenya.

Abolishing morality in biomedical ethics.

In biomedical ethics, there is widespread acceptance of moral realism, the view that moral claims express a proposition and that at least some of these propositions are true. Biomedical ethics is also in the business of attributing moral obligations, such as "S should do X." The problem, as we argue, is that against the background of moral realism, most of these attributions are erroneous or inaccurate. The typical obligation attribution issued by a biomedical ethicist fails to truly capture the person's actual obligations. We offer a novel argument for rife error in obligation attribution. The argument starts with the idea of an epistemic burden. Epistemic burdens are all of those epistemic obstacles one must surmount in order to achieve some aim. Epistemic burdens shape decision-making such that given two otherwise equal options, a person will choose the option that has the lesser of epistemic burdens. Epistemic burdens determine one's potential obligations and, conversely, their non-obligations. The problem for biomedical ethics is that ethicists have little to no access to others' epistemic burdens. Given this lack of access and the fact that epistemic burdens determine potential obligations, biomedical ethicists often can only attribute accurate obligations out of luck. This suggests that the practice of attributing obligations in biomedical ethics is rife with error. To resolve this widespread error, we argue that this practice should be abolished from the discourse of biomedical ethics.

Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility.

The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information-AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples-Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a "garbage in, garbage out" phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth.

The impact of coronavirus disease 2019 (COVID-19) pandemic experiences on attitudes towards vaccinations: on the social, cultural and political determinants of preferred vaccination organization models in Poland.

BACKGROUND: The article describes attitudes towards vaccinations in Poland in relation to issues such as voluntary versus compulsory vaccinations, the method of financing vaccinations, the method of organizing and carrying out vaccinations, the cognitive and educational aspect of vaccines (how to obtain knowledge about vaccines) and the preferred model of work and research on new vaccines. Taking into account these issues, the authors have created four ideal models of preferred vaccination policies: (a) the market model; (b) the state model; (c) the vaccine hesitancy model; and (d) the civic-social model. This perspective makes it possible to better understand and learn about the various motives behind the attitudes of anti-vaccination movements, as well as to notice cracks and divisions among vaccination supporters and their attitudes towards the financing and organization of vaccinations. METHODS: The study was carried out using the CATI method on a representative random-quota sample of Polish society of 1000 people aged 18 and over. The study took age, sex, education and the size of the place of residence into account. Additionally, in the Socio-demographic factors influencing attitudes towards vaccination practices in Poland section, we used the chi-squared test and regression analysis of factors influencing vaccination practices in Poland. PASW Statistics 18 (a version of SPSS) software was used for statistical analysis. Significant correlations were demonstrated at a significance level of 0.05% Pearson. RESULTS: This article has shown that attitudes towards vaccinations are embedded in broader divisions and orientations related to the vision of the social order: the role of the state, the organization of healthcare and payments for vaccinations and medical services, as well as preferred ways of knowledge production in society and work on new vaccines. The political sympathies and the age of the respondents were the most important variables influencing vaccination behaviour. The education of the respondents was less important. CONCLUSIONS: A few years after the peak of the pandemic, the scope of anti-vaccination attitudes in Polish society ranges from 20% of the population (dogmatic anti-vaxxers) to 30% (vaccine hesitancy occurring depending on attitudes towards vaccinations).

Feeding Infants: Choice-Specific Considerations, Parental Obligation, and Pragmatic Satisficing.

Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard's work critically engages with two distinct views of parental obligation that might ground such an obligation-based on maximal benefit and avoidance of significant harm-to reject an obligation to breastfeed. While agreeing with Woollard's substantive conclusion, this paper (drawing on philosophical discussion of the 'right to rear') argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one's child, but from what we call 'choice-specific' obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation-the Dual Interest view, and the Best Custodian view-to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. Finally, we argue that not only is there no general obligation to breastfeed children, but that it is often morally right not to do so. Since much advice from health institutions on this issue implies that exclusive breastfeeding on demand is the best option for all families, our argument drives the feeding debate forward by showing that this advice often misrepresents parents' moral obligations in potentially harmful ways.

Family obligation in Chinese adolescents: Consequences and parental antecedents.

Adolescents' family obligation is a cultural strength that shows enduring prevalence in China. Given that the meaning of family obligation has undergone rapid changes in recent decades, it is crucial to examine the role of family obligation in adolescent adjustment in contemporary China. More importantly, although past research has investigated the consequences of family obligation on adolescents' adjustment, little is known about the antecedents of Chinese adolescents' family obligation. Using a two-wave longitudinal sample of 450 Chinese adolescents (mean age = 13.78 years, SD = .71 years; 49% female) and their parents, the current research explored two questions. First, this study examined the role of family obligation in adolescents' academic achievement, externalizing problems, and internalizing problems over early adolescence. Second, this study explored the role of parents in predicting Chinese adolescents' family obligation, specifically whether parental expectations or parental acceptance was predictive of adolescents' family obligation over time. Third, this study investigated whether family obligation is an underlying mechanism between parenting and Chinese adolescents' adjustment. Results showed that Chinese adolescents' family obligation was longitudinally associated with increased academic achievement and reduced externalizing problems. Moreover, perceived parental acceptance, but not parental expectations, was longitudinally associated with Chinese adolescents' greater family obligation. Notably, family obligation mediated the longitudinal effect of parental acceptance on Chinese adolescents' externalizing problems. By studying both the consequences and antecedents of Chinese adolescents' family obligation, this study helps provide a comprehensive understanding of this cultural strength.

Balancing public health and privacy rights: a mixed-methods study on disclosure obligations of people living with HIV to their partners in China.

BACKGROUND: In 2021, a Chinese court, based on the newly enacted Civil Code, first revoked a marriage license due to the spouse's failure to disclose their HIV infection before the marriage. This landmark case ignited a fresh debate on whether people living with HIV (PLHIV) have a legal duty to inform their spouses and sexual partners. Advances in medicine have partially isolated HIV transmission from sexual contact, extending the legal basis for the obligation to disclose beyond disease prevention. This study investigates some possibly unforeseen challenges for PLHIV in China to fulfill this duty, and the outcomes of their decisions in light of the government's goal to promote health. METHODS: This study aims to provide a detailed examination of the legal provisions and practices concerning partner notification among PLHIV in China. A mixed-methods research approach was employed between 2019 and 2020, combining questionnaire surveys, in-depth interviews, and participatory observations. A total of 433 valid responses were obtained through a questionnaire posted on a Chinese online platform for PLHIV. Following the collection and random coding of the questionnaire data, 40 individuals living with HIV were selected for in-depth interviews. Subsequently, a six-month field investigation was conducted in Guan ai jia yuan (Caring Home) in Jinhua City to further explore this issue. RESULTS: A considerable proportion of PLHIV exhibit a high rate of disclosure to their spouses (nearly 80%). In the context of sexual partners, 56% of PLHIV stated that their sexual partners were aware of their HIV infection. Whether married PLHIV disclosing to their spouses or unmarried/divorced PLHIV disclosing to sexual partners, however, a substantial majority expressed apprehension about the potential disruption to their relationships that the disclosure might cause. The sole exception was observed among married PLHIV in extramarital relationships who demonstrated a slightly diminished level of concern in this context. Reasons for non-disclosure predominantly included undetectable viral load and the adoption of protective measures. DISCUSSION: This study reveals that a prevailing "HIV stigma" hinders PLHIV from voluntarily fulfilling the disclosure duties bestowed by Article 38 of the Regulations on the Prevention and Control of HIV/AIDS, and the unclear legal provisions of the new Civil Code play a significant role in this regard. Addressing this issue necessitates not only increasing societal tolerance toward PLHIV and reducing instances of social exclusion but also shifting the legal basis of disclosure duties from disease prevention to rights and obligations within the legal relationships of the parties involved. When it comes to the recipients of disclosure, for instance, it is crucial to differentiate between spouses and sexual partners. As for PLHIV failing to fulfill their disclosure duties, apart from interventions involving indirect notifications, the addition of further legal responsibilities may not be advisable. Intentional transmission actions, on the other hand, should still be subject to severe penalties. CLINICAL TRIAL NUMBER: Not applicable.

How Decent Work Influences Internal Whistleblowing Intentions in Nurses: The Parallel Mediating Roles of Felt Obligation and Organisational Identification-A Cross-Sectional Survey.

INTRODUCTION: Fostering nurses' intentions to blow the whistle internally is a salient issue in healthcare. However, there are debates on the antecedents of these intentions, and the explanation of how these antecedents influence such intentions is missing in the nursing literature. AIM: Based on the social exchange theory and the social identity theory, this study aimed to unveil how decent work influences nurses' internal whistleblowing intentions, specifically through the parallel mediating roles of felt obligation and organisational identification. METHODS: A cross-sectional survey was conducted with a convenience sample of 268 clinical nurses from three tertiary public hospitals in Mansoura, Egypt. Data were collected between June and November 2023 using the Decent Work Scale, the Felt Obligation Scale, the Organisational Identification Scale and the Internal Whistleblowing Intentions Scale. Study hypotheses were tested using structural equation modelling. RESULTS: Decent work significantly influenced nurses' internal whistleblowing intentions. Felt obligation and organisational identification partially mediated the positive relationship between decent work and internal whistleblowing intentions. CONCLUSION: Decent work is a significant predictor in nurturing felt obligation and organisational identification, leading to an increased willingness among nurses to engage in internal whistleblowing. IMPACT: This study offers valuable insights into how hospital administrators can leverage internal whistleblowing intentions among nurses. It showed that securing decent work conditions, fostering felt obligation and organisational identification contribute to an increased willingness to blow the whistle. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Adoption of Deep-Learning Models for Managing Threat in API Calls with Transparency Obligation Practice for Overall Resilience.

System-to-system communication via Application Programming Interfaces (APIs) plays a pivotal role in the seamless interaction among software applications and systems for efficient and automated service delivery. APIs facilitate the exchange of data and functionalities across diverse platforms, enhancing operational efficiency and user experience. However, this also introduces potential vulnerabilities that attackers can exploit to compromise system security, highlighting the importance of identifying and mitigating associated security risks. By examining the weaknesses inherent in these APIs using security open-intelligence catalogues like CWE and CAPEC and implementing controls from NIST SP 800-53, organizations can significantly enhance their security posture, safeguarding their data and systems against potential threats. However, this task is challenging due to evolving threats and vulnerabilities. Additionally, it is challenging to analyse threats given the large volume of traffic generated from API calls. This work contributes to tackling this challenge and makes a novel contribution to managing threats within system-to-system communication through API calls. It introduces an integrated architecture that combines deep-learning models, i.e., ANN and MLP, for effective threat detection from large API call datasets. The identified threats are analysed to determine suitable mitigations for improving overall resilience. Furthermore, this work introduces transparency obligation practices for the entire AI life cycle, from dataset preprocessing to model performance evaluation, including data and methodological transparency and SHapley Additive exPlanations (SHAP) analysis, so that AI models are understandable by all user groups. The proposed methodology was validated through an experiment using the Windows PE Malware API dataset, achieving an average detection accuracy of 88%. The outcomes from the experiments are summarized to provide a list of key features, such as FindResourceExA and NtClose, which are linked with potential weaknesses and related threats, in order to identify accurate control actions to manage the threats.

Extending the theory of planned behavior to predict the behavior of farmers in choosing low-water-intensive medicinal plants.

Water scarcity has become a serious challenge in many parts of the world due to increasing demands and the impacts of climate change. The agriculture sector globally accounts for a major portion of water consumption, yet it also holds substantial potential for water conservation. Among the most effective ways to conserve water is to cultivate low-water-demanding crops, such as medicinal plants (MPs), instead of water-demanding crops (WDC). However, the voluntary participation of farmers, largely influenced by socio-psychological drivers, is crucial for successfully implementing most water conservation programs and needs to be addressed. Therefore, the main objectives of this paper were: (1) to identify the determinants that explain farmers' intention and behavior in cultivating MPs instead of WDC; and (2) to examine the effectiveness and performance of an extended version of the theory of planned behavior (TPB) in predicting farmers' intention and behavior toward cultivating MPs by innovatively incorporating four new variables into the original TPB model: perceived barriers, moral norms, compatibility, and relative advantage. The applicability of the theoretical framework was evaluated in the Sojasroud Plain, Zanjan province, Iran. The results of the structural equation modeling revealed that: (1) farmers' intention to cultivate MPs instead of WDC is significantly influenced by perceived barriers, moral norms, subjective norms, and perceived behavior control (the strongest predictor); and (2) farmers' behavior in cultivating MPs instead of WDC is predicted by relative advantage, compatibility, and intention (the most prominent determinant). The R2 values for predicting intention and behavior were 55% and 53%, respectively. Based on the results, some practical policies were proposed to increase the cultivation of MPs in the study area.

Epistemic Trust in Scientific Experts: A Moral Dimension.

In this paper, I develop and defend a moralized conception of epistemic trust in science against a particular kind of non-moral account defended by John (2015, 2018). I suggest that non-epistemic value considerations, non-epistemic norms of communication and affective trust properly characterize the relationship of epistemic trust between scientific experts and non-experts. I argue that it is through a moralized account of epistemic trust in science that we can make sense of the deep-seated moral undertones that are often at play when non-experts (dis)trust science.

Standards of proficiency for registered nurses-To what end? A critical analysis of contemporary mental health nursing within the United Kingdom context.

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of 'proficiency' in nurse education-prescribed by the regulator-impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical-legal challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self-determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain.

A Defense of the Obligation to Keep Promises to the Dead.

It is widely held that to break a promise that one made to a person who is now dead would be to wrong her. This view undergirds many positions in bioethics, ranging from those that concern who may access a person's medical records after she has died, to questions concerning organ procurement and posthumous procreation. Ashley Dressel has argued that there is no reason to believe that promissory obligations can be owed to people who are dead. Although her arguments are unsuccessful, others establish that neither of the promissory obligation accounts that she considers (the "Authority Account" and the "harm-based view") can justify the standard view that directed posthumous promissory obligation is possible. However, this does not mean that the received view that we should keep our promises to the dead is mistaken. First, the theoretical commitments and argumentative strategies of those who endorse the possibility of posthumous promissory obligations preclude them from grounding such on either of these accounts of directed promissory obligation. They are thus already committed to justifying such obligations in other ways. Second, the obligation to keep promises to the dead could be justified on the grounds that not to do so would adversely affect the living.

Cultural values, parenting, and child adjustment in China.

To examine whether parents' cultural values are related to parenting practices and children's behavioural adjustment, mothers, fathers and children (N = 218) from two cities in China (Jinan and Shanghai) were interviewed when children were, on average, 10 years old. Mothers and fathers reported their endorsement of cultural values (individualism, collectivism, conformity), which were used to separately predict warmth and family obligation expectations reported by each parent, as well as children's report of parental psychological control, rule setting, knowledge solicitation and perceived family obligation expectations. Cross-informant (parents and child) composites of internalising and externalising behaviours were also obtained. The results showed that maternal individualism positively predicted parents' knowledge solicitation. Parental collectivism positively predicted their own warmth and family obligation expectations. Mothers' conformity positively predicted mothers' family obligation expectations, paternal warmth and children's perception of family obligation, whereas fathers' conformity only positively predicted fathers' family obligation expectations. These effects were largely consistent across regional subsamples, although mothers in Jinan were more collectivistic than mothers in Shanghai, and parents in Shanghai adopted less psychological control and more knowledge solicitation in parenting.

How Reasons Make Law.

According to legal anti-positivism, legal duties are just a subset of our moral duties. Not every moral duty, though, is legal. So what else is needed? This article develops a theory of how moral duties come to be law, which I call the constitutive reasons account. Among our moral reasons are legal reasons-and those reasons make moral duties into legal duties. So the law consists of moral duties which have, as one of their underlying reasons, a legal reason. Such legal reasons arise from a relationship with the body for which it is the law of. The legal reasons in America, then, are the moral reasons flowing from a relationship with the United States. These reasons include consent, democracy, association and fair play. They are law's constitutive reasons. By looking for them, we can better explain why some moral duties form part of the law, while others do not.

Towards full clinical trial registration and results publication: longitudinal meta-research study in Northwestern and Central Switzerland.

OBJECTIVE: The registration of clinical trials is required by law in Switzerland. We investigated (1) the proportion of registered and prospectively registered clinical trials, (2) the availability of results for ethically approved trial protocols, (3) factors associated with increased registration, and (4) reasons for non-registration. DESIGN AND SETTING: We included all clinical trials with mandatory prospective registration, which were approved by the ethics committee of Northwestern and Central Switzerland between January 1, 2016, and December 31, 2020. METHODS: We extracted relevant trial characteristics from the Swiss Business Administration System for Ethics Committees and systematically searched the International Clinical Trials Registry Platform and primary trial registries for corresponding registry entries. We used multivariable logistic regression to examine the association between trial characteristics and registration. We qualitatively assessed reasons for non-registration of trials through an email questionnaire for trial investigators. RESULTS: Of 473 included clinical trials, 432 (91%) were registered at all and 326 (69%) were prospectively registered. While the percentages of registration and prospective registration of investigator-sponsored trials increased from 85 to 93% and from 59 to 70% over 5 years, respectively, industry-sponsored trials consistently remained at a high level of prospective registration (92 to 100%). Trials with multiple centres, higher risk category, or methodological support from the local clinical trials unit were independently associated with increased registration rates. Of 103 clinical trials completed before August 2020, results were available for 70% of industry-sponsored trials and 45% of investigator-sponsored trials as peer-reviewed journal publications or in trial registries. Most common reasons for non-registration provided by investigators were lack of time or resources (53%), lack of knowledge (22%), and lack of reminders by the ethics committee (36%). CONCLUSIONS: In Northwestern and Central Switzerland about 10% of clinical trials remained unregistered despite the obligation by law. More support for investigators and stricter enforcement by regulators are needed to improve the transparency of investigator-sponsored trials in particular.

'Guidance should have been there 15 years ago' research stakeholders' perspectives on ancillary care in the global south: a case study of Malawi.

BACKGROUND: Medical researchers in resource-constrained settings must make difficult moral decisions about the provision of ancillary care to participants where additional healthcare needs fall outside the scope of the research and are not provided for by the local healthcare system. We examined research stakeholder perceptions and experiences of ancillary care in biomedical research projects in Malawi. METHODS: We conducted 45 qualitative in-depth interviews with key research stakeholders: researchers, health officials, research ethics committee members, research participants and grants officers from international research funding organisations. Thematic analysis was used to analyse and interpret the findings. FINDINGS: All stakeholders perceived the provision of ancillary care to have potential health benefits to study participants in biomedical research. However, they also had concerns, particularly related to the absence of guidance to support it. Some suggested that consideration for ancillary care provision could be possible on a case-by-case basis but that most of the support from research projects should be directed towards strengthening the public health system, emphasising public good above individual or personal benefits. Some researchers and ethics committee members raised concerns about potential tensions in terms of funding, for example balancing study demands with addressing participants' additional health needs. CONCLUSION: Our findings highlight the complexities and gaps in the guidance around the provision of ancillary care in Malawi and other resource-constrained settings more generally. To promote the provision of ancillary care, we recommend that national and international guidelines for research ethics include specific recommendations for resource-constrained settings and specific types of research.

Original and Low-Cost ADS-B System to Fulfill Air Traffic Safety Obligations during High Power LIDAR Operation.

LIDAR is an atmospheric sounding instrument based on the use of high-power lasers. The use of these lasers involves fulfilling obligations with respect to air safety. In this article, we present a low-cost air traffic surveillance solution integrated into an automated operating system for the Rayleigh-Mie-Raman LIDAR of Clermont Ferrand and the statistical elements of its application over more than two years of operation from September 2019 to March 2022. Air traffic surveillance that includes the possibility of shutting off lasers is required by international regulations because LIDAR is equipped with a class four laser that presents potential dangers to aircraft flying overhead. The original system presented in this article is based on software-defined radio. ADS-B transponder frames are analyzed in real-time, and laser emission is stopped during LIDAR operation when an aircraft is detected within a 2 km radius around the LIDAR. The system was accredited in 2019 by the French air traffic authorities. Laser shutdowns due to the detection of aircraft near the Clermont Ferrand LIDAR caused a data loss rate of less than 2% during the period of application.

Ethical obligation and legal requirements: On informed consent practices in Bangladesh.

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.

'You have to put a lot of trust in me': autonomy, trust, and trustworthiness in the context of mobile apps for mental health.

Trust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to? Whether and when can an avatar be considered trustworthy? Our study aims to analyze different dimensions of trustworthiness in the context of mobile health app use. We integrate O'Neill's account of autonomy, trust, and trustworthiness into a model of trustworthiness as a relational concept with four relata: B is trustworthy with respect to A regarding the performance of Z because of C. Together with O'Neill's criteria of trustworthiness (honesty, competence, and reliability), this four-sided model is used to analyze different dimensions of trustworthiness in an exemplary case of mobile health app use. Our example focuses on an app that uses an avatar and is intended to treat sleep difficulties. The conceptual analysis shows that interpreting trust and trustworthiness in health app use is multi-layered and involves a net of interwoven universal obligations. At the same time, O'Neill's approach to autonomy, trust, and trustworthiness offers a normative account to structure and analyze these complex relations of trust and trustworthiness using mobile health apps.