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Objective: The Advance Care Planning Engagement Survey (ACP-ES) has proven effective in evaluating individuals' engagement in advance care planning (ACP). However, a Traditional Chinese version of ACP-ES (ACPES-TC) has not yet been developed. Therefore, this study aimed to translate and preliminarily validate the ACPES-TC in the Taiwanese context. Material and Methods: A forward and backward translation process was conducted. The translated questionnaire was confirmed by clinical and academic experts. The ACPES-TC was then evaluated for its reliability and validity with participants in the community and from an outpatient clinic in a medical center in Northern Taiwan. The participants comprised healthy people aged 20 to 30 years and patients ≥55 years old, recruited from September 17 to October 28, 2019. Results: Seventy people were recruited, including 20 people aged 20 to 30 years in the community and 50 patients ≥ 55 years old from clinics. The ACPES-TC scores are significantly higher among those of older age, having financial independence, and under long-term medication (p < .05). The patients' preference for health-related decision-making is significantly correlated with the ACPES-TC score; the point-biserial correlation coefficient is 0.46 (p < .001). The discriminant and criterion-related validities are verified. The ACPES-TC demonstrated a good internal consistency (Cronbach's α .97), acceptable one-week test-retest reliability (overall intraclass correlation coefficient 0.86), and low practice effect between the test and retest (Cohen's d .43). Conclusion: The overall reliability and validity of the ACPES-TC are fair, which could be used to evaluate the patients' engagement in ACP in Taiwan. However, further studies with a full-scale psychometric evaluation are needed.

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Should we be allowed to refuse any involvement of artificial intelligence (AI) technology in diagnosis and treatment planning? This is the relevant question posed by Ploug and Holm in a recent article in Medicine, Health Care and Philosophy. In this article, I adhere to their conclusions, but not necessarily to the rationale that supports them. First, I argue that the idea that we should recognize this right on the basis of a rational interest defence is not plausible, unless we are willing to judge each patient's ideology or religion. Instead, I consider that the right must be recognized by virtue of values such as social pluralism or individual autonomy. Second, I point out that the scope of such a right should be limited at least under three circumstances: (1) if it is against a physician's obligation to not cause unnecessary harm to a patient or to not provide futile treatment, (2) in cases where the costs of implementing this right are too high, or (3) if recognizing the right would deprive other patients of their own rights to adequate health care.

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Neurodegenerative diseases (NDs) represent one of the most important public health problems and concerns, as they are a growing cause of mortality and morbidity worldwide, particularly in the elderly. Despite remarkable breakthroughs in our understanding of NDs, there has been little success in developing effective therapies. The use of natural products may offer great potential opportunities in the prevention and therapy of NDs; however, many clinical concerns have arisen regarding their use, mainly focusing on the lack of scientific support or evidence for their efficacy and patient safety. These clinical uncertainties raise critical questions from a bioethical and legal point of view, as considerations relating to patient decisional autonomy, patient safety, and beneficial or non-beneficial care may need to be addressed. This paper does not intend to advocate for or against the use of natural products, but to analyze the ethical framework of their use, with particular attention paid to the principles of biomedical ethics. In conclusion, the notable message that emerges is that natural products may represent a great promise for the treatment of many NDs, even if many unknown issues regarding the efficacy and safety of many natural products still remain.

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INTRODUÇÃO: a hemorragia obstétrica é considerada uma das principais causas de mortes maternas no mundo. Nesse cenário, as gestantes testemunhas de Jeová constituem uma população única, porque recusam transfusões de sangue total e de seus quatro componentes primários. O encontro da Obstetrícia com essas pacientes tem gerado ao longo do tempo muitos conflitos jurídicos, éticos e bioéticos. OBJETIVO: discorrer sobre os aspectos jurídicos, éticos e bioéticos diante da recusa à transfusão de sangue por gestantes e puérperas testemunhas de Jeová. MÉTODO: trata-se de estudo de revisão integrativa, em que foram identificados 14 artigos que compuseram a amostra. RESULTADOS E DISCUSSÃO: do ponto de vista legal e jurídico existe um emaranhado referente aos direitos dos médicos e dos pacientes. A Constituição Federal, o Código Civil e a Carta dos Direitos dos Usuários de Saúde reforçam a autonomia do paciente em recusar qualquer tratamento. E o o Código Penal e o Código de Ética Médica insistem na adoção de condutas que salvam vidas mesmo sem o consentimento da paciente - em casos de risco iminente de morte. Já na ética e bioética, o confronto existe entre a autonomia da paciente e a beneficência do ponto de vista médico. CONCLUSÕES: atualmente temos uma legislação dividida e questões éticas e bioéticas com pontos de vista opostos. É preciso repensar legal e bioeticamente nessas pacientes; entender suas crenças, conhecer tratamentos alternativos e ter instituições e profissionais mais preparados.

INTRODUCTION: Obstetric hemorrhage is considered a major cause of maternal deaths all around the world. In this scenario, the jehovah's-Witness pregnant women constitute a unique population because they refuse total blood transfusions and its four primary components. The encounter between obstetrics and these patients has caused many legal, ethical and bioethical conflicts along the years. OBJECTIVE: Discourse about legal, ethical, and bioethical issues facing blood transfusion refusal by jehovah's-Witness pregnant and breastfeeding women. Method: It is an integrative review study, in which 14 articles were identified to compose the sample,from M EDLINE and LILACS databases, in Portuguese, English and Spanish. FINDINGS AND DISCUSSION: From the legal and juridical points of view, there are some disagreements related to physicians and patients' rights. The Federal Constitution, The Civil Code and the Charter of Consumers' Rights in Health enhance the patients autonomy to refuse any treatment. While both Criminal Code and Medical Ethics Codes insist on adopting a life-saving conduct even without the patients consent, in cases of imminent risk of death. Meanwhile, in Ethics and Bioethics, there is confrontation between the patients autonomy and the benefitfrom the medical standpoint. CONCLUSIONS: Currently we have a divided legislation, ethics and bioethics issues with opposite points of view. It is necessary to legally and bioethically rethink about these patients, understand their beliefs, to know alternative treatments and to have more qualified institutions and professionals.

La hemorragia obstétrica es una de las principales causas de muertes maternas en el mundo. En este escenario, las embarazadas de la religión Testigos de jehová constituyen una población única porque rechazan las transfusiones de sangre total y de sus cuatro componentes primarios. El contacto entre la obstetricia y estas pacientes siempre ha generado conflictos jurídicos, éticos y bioéticos. El objeto del presente estudio es entender los aspectos jurídicos, éticos y bioéticos ante el rechazo a la transfusión de sangre por parte de dichas mujeres. Se trata de una revisión integradora compuesta de 14 artículos que constituyeron la muestra, a partir de las bibliotecas virtuales MEDLINEy LILACS, en portugués, inglés y espanol. Desde el punto de vista legal y jurídico existe un enmaranado de derechos de médicos y pacientes. La Constitución Federal, el Código Civil y la Carta de los Derechos de los Usuarios de Salud refuerzan la autonomia del paciente de rechazar cualquier tratamiento. El Código Penal y el Código de Ética Médica insisten en la adopción de conductas que salvan vidas, incluso sin el consentimiento del paciente, en casos de riesgo inminente de muerte. En la ética y bioética, el conflicto existe entre la autonomía del paciente y la beneficencia desde el punto de vista médico. Actualmente tenemos una legislación dividida y cuestiones éticas y bioéticas con puntos de vista opuestos. Es necesario repensar legalmente y bioéticamente en estas pacientes, entender sus creencias, conocer tratamientos alternativos y tener instituciones y profesionales mejor preparados para tratar el tema.

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