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Radical moral disagreement in contemporary health care: a Roman Catholic perspective.

This paper addresses the moral challenges presented by the existence of radical moral disagreement in contemporary health care. I argue that there is no neutral moral perspective for understanding and resolving these challenges, but that they must be formulated and resolved from within the various perspectives that generate the disagreement. I then explore the natural law tradition's approach to these issues as a test case for my thesis.

Attitude↗

Heart transplantation in Jehovah's Witnesses. An initial experience and follow-up.

More than 25 years of experience performing heart surgery on Jehovah's Witnesses has culminated in successful cardiac transplantation without administering blood products in five patients (mean age, 44.4 +/- 8.3 years) of this faith. The use of blood-conserving methods, iron supplementation, bone marrow-sparing maintenance immunotherapy, and brisk postoperative diuresis has added to the efficacy of cardiac transplantation in these patients. No perioperative deaths occurred, and early follow-up studies have shown that these patients have not been more susceptible to higher graft rejection rates due to the lack of pretransplant blood transfusions. As more Jehovah's Witnesses undergo heart transplantation in the future, comparison with other recipients who allow pretransplant blood transfusions may lead to a better understanding of rejection immunobiology. We conclude that cardiac transplants may be safely offered to Jehovah's Witnesses without fear of a uniformly poor outcome.

Adult↗

Sharing our body and blood: organ donation and feminist critiques of sacrifice.

Feminist analysis of cultural mythology surrounding organ donation offers a critical perspective on current U.S. transplant policy. My argument is three-pronged. First, I argue that organ donation is appropriately understood as a sacrifice. Structurally, donation accords both to general and to specifically Christian archetypes of sacrifice. The characterization of donation as sacrifice resonates in the cultural psyche even though it is absent in public rhetoric. Second, I characterize widespread feminist concerns about the over-glorification of sacrifice. These concerns provide a helpful framework for considering whether the sacrifice of organ donation is over-glorified in our culture. Third, I consider several specific aspects of organ recruitment and organ allocation. Each demonstrates an over-glorification of sacrifice that leads to a dangerous "routinization" of sacrifice. None of these excesses are addressable without due attention to the symbolic import of organ donation and transplantation. I close by suggesting lessons my analysis offers to Christian churches who support donation, to the discourse of bioethics, and to the general public.

Christianity↗

Health care, equality, and inequality: Christian perspectives and moral disagreements.

Equality is a concept that is often used in health care discussions about the allocation of resources and the design of health care systems. In secular discussions and debates the concept of equality is highly controverted and can take on many different specifications. One might think that Christians hold a common understanding of equality. A more careful study, though, makes it clear that equality is just as controversial among different Christian communities as it is in the secular world.

Catholicism↗

Donum Vitae: civil law and moral values.

The Instruction reminds us that reproductive medicine has become part of our social reality and as such justifies the intervention of public authorities. The Instruction suggests relevant principles which should guide appropriate legislation. This essay analyzes how far the French government has taken these fundamental principles into account.

Advisory Committees↗

Intolerant tolerance.

The Hyde Amendment and Roman Catholic attempts to put restrictions on Title X funding have been criticized for being intolerant. However, such criticism fails to appreciate that there are two competing notions of tolerance, one focusing on the limits of state force and accepting pluralism as unavoidable, and the other focusing on the limits of knowledge and advancing pluralism as a good. These two types of tolerance, illustrated in the writings of John Locke and J.S. Mill, each involve an intolerance. In a pluralistic context where the free exercise of religion is respected, John Locke's account of tolerance is preferable. However, it (in a reconstructed form) leads to a minimal state. Positive entitlements to benefits like artificial contraception or nontherapeutic abortions can legitimately be resisted, because an intolerance has already been shown with respect to those that consider the benefit immoral, since their resources have been coopted by taxation to advance an end that is contrary to their own. There is a sliding scale from tolerance (viewed as forbearance) to the affirmation of communal integrity, and this scale maps on to the continuum from negative to positive rights.

Attitude↗

Method in Catholic bioethics.

Method in Catholic bioethics is distinguished by a specific philosophical and theological anthropology. Human beings are not to be considered simply as selves, but as selves in relation to God and each other. This essay reflects on that claim by reviewing four areas of concern from Catholic social teaching: common good, human dignity, option for the poor, and stewardship.

Bioethics↗

CHA amicus curiae brief on physician-assisted suicide. Catholic Health Association.

The Catholic Health Association of the United States submitted an amicus curiae brief to the U.S. Supreme Court last October in support of petitioners Dennis C. Vacco, attorney general of the state of New York (in the case Vacco v. Timothy E. Quill, MD, et at.), and the state of Washington (in State of Washington, et al. v. Harold Glucksberg, MD, et al.). The brief was filed as the Court agreed to hear arguments on the issue of whether terminally ill people have a constitutionally protected right to physician-assisted suicide. In January 1997 the petitioners went before the Court to argue appeals to federal appellate rulings that struck down New York and Washington laws making physician-assisted suicide a crime. The Court is expected to rule in late June.

Catholicism↗

Bishops' response to Act on Rights of Terminally Ill.

In August 1985 the National Conference of Commissioners on Uniform State Laws drafted a document entitled The Uniform Rights of the Terminally Ill Act, which it recommended for enactment by all U.S. states. The act attempts to set uniform, clear guidelines for advance directives, or living wills--written declarations made by a patient that are used to guide treatment decisions should the patient become incompetent and terminally ill. The act limits the scope of an advance directive to the withdrawal or withholding of "life-sustaining treatment," which is "any medical procedure or intervention that when administered to a qualified patient will serve only to prolong the process of dying." Qualified patients are those with a terminal condition, which is "an incurable or irreversible condition that without the administration of life-sustaining treatment will, in the opinion of the attending physician, result in death within a relatively short time." The National Conference of Catholic Bishops (NCCB) Committee for Pro-Life Activities responded to the act in July 1986. The NCCB wishes to narrow the act's scope to apply only to patients in the "final stage of a terminal condition." Other specific concerns are the withdrawal of artificial nutrition and hydration, the need for communication with the family in making decisions, and the protection of an unborn child's life when the mother fulfills the conditions of the act and her living will stipulates a desire for withdrawal of life-sustaining treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Catholicism↗

Florida law creates artificial sustenance dilemma.

Although a model statute for its inclusiveness, Florida's 1984 Life-Prolonging Procedure Act excludes "sustenance" from its definition of life-prolonging procedures that may be forgone. The majority legal opinion has held that the law prohibits withdrawing or withholding nutrition and hydration by whatever means they must be provided. Also, a Florida circuit court decision has disavowed the applicability of the argument that extraordinary life-prolonging procedures violate a patient's constitutional rights. An amendment to repeal the sustenance clause failed, making the question of whether to withdraw--or even initiate--artificial feeding an entirely legal decision, rather than a clinical and bioethical one. The act will have enormous effects at long-term care facilities, where elderly and debilitated patients, as well as the terminally ill and comatose patients the statute addresses, may be force-fed against their wishes. Society must decide whether providing nutrition and hydration is "medical treatment" or whether, because it is basic to human life, it cannot be considered as such. To make such a determination, one must understand that feeding technology includes invasive procedures which might be considered extraordinary. The Florida law, however, does not distinguish between degrees of invasiveness. The law demonstrates that resolving clinical and ethical dilemmas through legislation may result in society surrendering the freedom and responsibility that are essential to ethical decision making.

Catholicism↗