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PubMed1996

Ethical issues in the application of medical technology to paediatric intensive care: two views of the newborn.

Recent advances in medical technology have led to a marked improvement in the chances of survival of sick or preterm infants, thereby stimulating renewed ethical debate on the status of the newborn. Two contradictory attitudes to the medical care of preterm or congenitally malformed newborn infants can be discerned in our pluralistic society. The two attitudes have their historical roots in the classical Graeco-Roman and Judaeo-Christian ethical traditions respectively. The former views newborn infants as of potential value only whereas the latter emphasises the intrinsic worth and dignity of the individual made in God's image. Recent secular philosophical reflection has provided a rationale for infanticide of the sick or abnormal newborn. A Christian approach to the care of the newborn prohibits intentional killing yet may encompass the withdrawal of treatment that is inappropriate or unduly burdensome. Medical care should be based upon respect for the value of the individual, protection of the defenceless from abuse or exploitation, and wise stewardship of limited health-care resources.

Attitude↗

PubMed2001

Bioethics for clinicians: 27. Catholic bioethics.

There is a long tradition of bioethical reasoning within the Roman Catholic faith, a tradition expressed in scripture, the writings of the Doctors of the Church, papal encyclical documents and reflections by contemporary Catholic theologians. Catholic bioethics is concerned with a broad range of issues, including social justice and the right to health care, the duty to preserve life and the limits of that duty, the ethics of human reproduction and end-of-life decisions. Fundamental to Catholic bioethics is a belief in the sanctity of life and a metaphysical conception of the person as a composite of body and soul. Although there is considerable consensus among Catholic thinkers, differences in philosophical approach have given rise to some diversity of opinion with respect to specific issues. Given the influential history of Catholic reflection on ethical matters, the number of people in Canada who profess to be Catholic, and the continuing presence of Catholic health care institutions, it is helpful for clinicians to be familiar with the central tenets of this tradition while respecting the differing perspectives of patients who identify themselves as Catholic.

Adult↗

PubMed1995

Illness, the problem of evil, and the analogical structure of healing: on the difference Christianity makes in bioethics.

A Christian bioethic needs to place the medical approach to sickness, suffering, and death within the context of redemption and the renewal of humanity in the image of God. This can be done by accounting for the way in which the disruptions of the human life-world that attend the illness experience manifest the structure of the problem of evil and point toward an answer that transcends the individual and the medical community. Further, the disease-oriented approach to medicine, when understood in the context of the analogia entis, can be taken as an analogy for a deeper spiritual healing, and can thus become a vehicle through which one can minister to the disruptions of a patient's life-world. An appreciation of the analogical structure of healing provides the basis for a Christian ethic of care.

Attitude to Death↗

PubMed1999

The ethics of funding embryonic stem cell research: a Catholic viewpoint.

Stem cell research that requires the destruction of human embryos is incompatible with Catholic moral principles, and with any ethic that gives serious weight to the moral status of the human embryo. Moreover, because there are promising and morally acceptable alternative approaches to the repair and regeneration of human tissues, and because treatments that rely on destruction of human embryos would be morally offensive to many patients, embryonic stem cell research may play a far less significant role in medical progress than proponents believe.

Aborted Fetus↗

PubMedDate not supplied

Euthanasia, physician-assisted suicide, and Christianity's positive relationship to the world.

This essay addresses the problem of communication between Christianity and the secular world in an area where the latter tends to oppose the moral norms endorsed by the former. How, in the interest of missionary outreach (and with which understandings of what such outreach involves) can the language barriers be bridged? Whereas the Roman Catholic natural law tradition posits a neutral common ground of (traditional or hermeneutical) rationality between Christianity and the world, an Ebeling- and Barth-modified Lutheranism engages in an argument ad hominem by seizing upon an admitted deficiency within that world, and by recommending Christianity for mending that deficiency. Both positions differ from the Evangelical claim that since that which the world politically values is derived from Christianity, it must remain subject to Christianity's moral legislation. An entirely different approach to the communication- and outreach-problem is taken by Orthodox Christianity: The gulf which separates it from the world is acknowledged, and the possibility of trans-gulf-traffic is referred to God's grace. It is only this latter model, however, which preserves Christianity's theological terms (such as "Scripture", "law", and "holiness") from common-ground-securing, deficiency-mending, or authority-imposing secularizing, and thus from compromising that very theological context into which communicative outreach endeavors were to invite.

Catholicism↗

PubMed1992

Jewish theology and bioethics.

This article explores the theological foundations of both classical and contemporary Jewish ethics, with special reference to biomedical issues. Traditional views concerning God's revelation to Israel are shown to underlie the methodological orientation of classical Jewish ethics, which is both legalistic and particularistic. Contemporary Jewish ethicists, by contrast, have tended to embrace more liberal views of revelation which have mitigated both the legalism and the particularism of their approach. Apart from methodological considerations, much of the content of Jewish medical ethics has also been shaped by theological concerns. Specifically, a Jewish theology of creation provides basic norms and values which inform Jewish responses to a range of contemporary biomedical issues. Finally, it is suggested that the theological roots of this ethical tradition do not disqualify it from making a significant contribution to the wider discussion of biomedical issues in our secular, pluralistic society.

Bioethical Issues↗

PubMed1997

The last chapter of the book: who is the author? Christian reflections on assisted suicide.

In this paper the author argues that a narrative approach to understanding assisted suicide has been compromised by the notion that all narratives must be both coherent and unified. He asks what we are to do with those narratives that cannot seem to cohere or be other than full of disunity? Is suicide the only way to make meaning out of suffering? He then proposes that the narrative found in the Gospel of Mark leads Christians to a life in hope and compassion in spite of apparent incoherence and disunity and threats of abandonment and suffering.

Christianity↗

PubMed1985

Two views of the human person. Ethical decisions: why "exceptionless norms"?

Theoretical differences between the teachings of the U.S. bishops and many moral theologians have left Catholic medical professionals puzzled about whose advice to follow. Although three concepts have influenced the development of medical ethics--physicalism, ecclesiastical positivism, and personalism--the real source of disagreement is two different approaches to understanding the person: the objective and the subjective. Objectivists see persons as living organisms subject to natural laws and unique among animals because they can develop cultures, control the environment, and exercise critical thought. According to the subjective approach, persons are free subjects who transform the objective world into one of meaning. They find reality only in the culture and its social forms, arts, history, and theories. The objective approach identifies basic human needs that transcend cultures and it defends exceptionless moral norms; the subjective demands that the person be free to decide each situation's morality. Objectivity is preferable because it is supported by Catholic tradition, which trusts human reason to arrive at universal ethical truths, and leads to an ethics grounded in an understanding that is transcultural and objectively verifiable. In the future the Church's moral teachings on abortion, euthanasia, and other life issues will not change. They will, however incorporate subjective insights that emphasize the person's uniqueness, sociological conditioning, conscientious responsibility, and moral evolution.

Catholicism↗

PubMed1996

A communion of saints ... maybe.

Descriptively many Protestant perspectives on access to health care share much in common with secular accounts ... perhaps too much. A normative account of a Protestant perspective on access to health care must be perceptively qualified by the Christ story. A genuinely theocratic approach may not lead one to the conclusion that the faith commits us to the notion of equality; rather the faith commits us to the notion of care. What counts as care may not be the same in every instance (if this is indeed what equality means; in ordinary use, equality is tantamount to sameness). The Christ story reminds us who we are, beloved, sinful, redeemed. Acting out this story is to accept, to give, and to receive reconciliation. For many Christians this will mean that we are called to deny ourselves "equal" access to the system (as if equality actually existed!).

Christianity↗

PubMed2001

The patient's progress from this world to that which is to come: commentary on the Consensus Statement of the Working Group on Roman Catholic Approaches to Determining Critical Care.

The author comments on the consensus statement from the point of view of an ethics consultant in Germany. Since many hospitals in Germany are under considerable competitive pressure, mission statements are becoming more and more important in order to draw a distinction between the different hospital types and to convey the meaning of the corporate identity both internally and externally. The Consensus Statement, which provides basic orientation without going into too much detail, can be a helpful initial document. However, it does not deal with two specific problem areas which are examined more closely in the commentary: the application of risk-of-death algorithims in ICUs and the question of church membership of the caregivers to enable a proper preparation for death. The commentary also reveals certain difficulties in the discussion taking place in Anglo-Saxon countries and Continental Europe.

Catholicism↗

PubMed1991

RU-486: the "abortion pill".

A report sent by the Vatican to bishops' conferences throughout the world calls RU-486, the so-called abortion pill currently available in France, "a new, serious threat to human life." The report was developed at the Vatican's request by Gonzalo Herranz, a Spanish bioethicist. A cover letter to bishops' conferences from Cardinal Alfonso Lopez Trujillo, president of the Pontifical Council for the Family, suggested that the report be used "to resist the introduction of the abortion pill RU-486 into your country." Related to TU-486 and to new terminology some use to characterize its non-surgical approach to abortion is an intention "to amoralize and thereby place the transmission of human life into an ethically neutral terrain and reduce it to pure biology," says the report. The report discusses possible future uses of RU-486 as a contraceptive, stating: "Women would no longer have to worry themselves about whether they have conceived or not. Each month they would proceed to clean out their uterus chemically." The report refers to RU-486 as "a technical step forward in an area that did not need it." It says, "The abortion pill favors a woman's privacy and secret, but it condemns her to solitude." The English text from the Vatican follows.

Abortion, Induced↗

PubMed1998

In vitro fertilisation: the ethics of illicitness? A personalist Catholic approach.

In line with Professor Brosens' work at the K.U. Leuven, the ethical integration of in vitro fertilisation (IVF) was made possible in the context of personalism, what we will present here in its anthropological and theological foundations. This presentation is necessary to make clear that personalism is always in the making of the clarification of its foundations. The three basic anthropological options are then applied to the ethical integration of IVF. They will lead to three concrete criteria for clinical practice: stable heterosexual infertile couple as indication; the respect for the human embryo and the qualitative social organization of infertility treatment. This position of Catholic personalists is in contradiction with the teaching of the Church, declaring that the IVF practice is in itself illicit. The third and fourth parts of this article are devoted to this statement. First, by debating the official magisterial position, and second, by referring to probably one of the most crucial issues for the ethical debate on IVF in the Church: the moral status of the embryo.

Bioethics↗

PubMedDate not supplied

New models for decision making in moral theology.

The way that the Christian tradition faces moral issues is being reshaped. Rather than focusing solely on Scripture and tradition as the basis for resolving ethical issues, decision makers should investigate human experience as well, some contemporary theologians recommend. In contrast to a traditional notion of natural law, which analyzes "human nature," the revisionist approach analyzes human experiences to discover what is authentic in them. This process looks not only at the physical structure of an act but also at its intentionality and its effect on the parties involved. Absolute material norms do not exist, according to the revisionist school. Instead one must examine an act's effects on a person's relationship to God, to others, to the physical world, and to oneself to determine whether it is morally right or wrong. Although this theological trend could be disconcerting to those who serve on ethics committees--since it does not rely on clear-cut rules--and may make decision making more difficult, its value lies in its potential to bring Christians closer to a divine understanding of reality.

Bioethical Issues↗

PubMedDate not supplied

Quality of life: a focus on the patient's total good.

The quality-of-life factor used in making difficult decisions about life-sustaining treatment should refer to the patient's definition of meaningful survival. The significance of this is founded on theological convictions that respect life's value and promote its meaning according to the ability to actualize life's potential, especially through love. The appropriateness of quality-of-life criteria is entailed in the principle of beneficence: doing good for the patient. Beyond medical good, this must include each aspect of the patient's total good--autonomy, preferences, and ultimate (spiritual) good. The proportionate-disproportionate distinction exemplifies this by weighing treatment effects against patient benefits. The difficulty in applying the quality-of-life factor primarily involves who determines the criteria, as answered by one of three approaches: The "gold standard" gives priority to informed patients capable of deciding for themselves. The "silver standard" is the proxy judgment substituting for patients' previously communicated wishes. The "bronze standard" is the judgment made in patients' best interests when no wishes have been expressed. Healthcare delivery can address quality-of-life considerations using five guidelines: 1. Respect the wishes of informed patients capable of decision making. 2. Treat incompetent patients as similar patients have chosen to be treated. 3. Act to restore patients' capacity for meaningful relationships. 4. Determine if treatment yields a reasonable balance between treatment effects and patient benefits. 5. Refer doubtful treatment decisions to an institutional ethics committee.

Beneficence↗

PubMedDate not supplied

Prolonging life or hindering death? An Orthodox perspective on death, dying and euthanasia.

This article addresses death as a biological event and attempts to approach it as a mystery within the light of the Orthodox Christian theology and tradition. First, the value of the last moments of the life of a human being is analyzed; then the state of living is differentiated from the state of surviving that results, in some extreme cases, from the intrusion of technology in medicine. The article elaborates on the sacred and spiritual character of death which, when viewed within the light of the Christ's resurrection, is transformed into a great blessing. The last part of the article focuses on the newly emerged issue of euthanasia and the reasons behind it. It poses certain vital questions that ought to be answered before legalization gets on its way. Finally, the conclusion summarizes the position of the Orthodox Church of Greece on death, dying and euthanasia.

Death↗

PubMed2000

Body parts and the market place: insights from Thomistic philosophy.

With rare exceptions, Roman Catholic moral theologians condemn the sale of human organs for transplantation. Yet, such criticism, while rhetorically powerful, often oversimplifies complex issues. Arguments for the prohibition of a market in human organs may, therefore, depend on a single premise, or a cluster of dubious and allied premises, which when examined cannot hold. In what follows, I will examine the ways in which such arguments are configured. For example, Thomas Aquinas' (1224-1274) understandings of embodiment and moral uses of the body are usually interpreted as, and cited in support of, foreclosing a market in human organs. Aquinas' principle of totality requires that one preserve the wholeness of the human body. In approaching Aquinas' texts, I will assume the role of a revisionist who takes seriously his core commitments, while at the same time indicating that one can further develop his understanding of the body in ways which are supportive of the sale of human organs while remaining in conformity with the author's core concerns. Such considerations will provide significant grounds for concluding that a market in human organs for transplantation appreciates the embodied nature of the human person, respects the body and its parts as personal, rather than as mere things, is consistent with acknowledging God's dominion over our lives and bodies, and constitutes an appropriate utilization of God's gifts to us. Moreover, such a market would likely create significant opportunities charitably to help others, to enhance human dignity and to protect against the serious dehumanization of current national bureaucratic procedures for organ donation.

Altruism↗

PubMed1995

Euthanasia and the quality of life debate.

Orthodox Christian ethics is grounded in the sacredness of life principle. Yet, it can accept a quality of life approach where "quality" refers not to capacities or states, but to the relationship between the patient's condition and the quest for transcendent life goals (Walter and Shannon, 1990). The true quality of human life derives from the vocation to stewardship, which enjoins an attitude of humble acceptance toward beneficial or "redemptive" suffering. The proper response to suffering in terminal cases is not active euthanasia or physician-assisted suicide but appropriate pain management and personal care. In cases of PVS or deep coma, only the determination of higher brain death can warrant the withholding or withdrawing of food and hydration. Yet, artificial maintenance of biological existence is also immoral. Death is to be accepted and embraced as a transition to eternal life.

Attitude to Death↗

PubMed2002

Bioethics for clinicians: 28. Protestant bioethics.

"Protestant" is a term applied to many different Christian denominations, with a wide range of beliefs, who trace their common origin to the Reformation of the 16th century. Protestant ideas have profoundly influenced modern bioethics, and most Protestants would see mainstream bioethics as compatible with their personal beliefs. This makes it difficult to define a uniquely Protestant approach to bioethics. In this article we provide an overview of common Protestant beliefs and highlight concepts that have emerged from Protestant denominations that are particularly relevant to bioethics. These include the sovereignty of God, the value of autonomy and the idea of medicine as a calling as well as a profession. Most Canadian physicians will find that they share certain values and beliefs with the majority of their Protestant patients. Physicians should be particularly sensitive to their Protestant patients' beliefs when dealing with end-of-life issues, concerns about consent and refusal of care, and beginning-of-life issues such as abortion, genetic testing and the use of assisted reproductive technologies. Physicians should also recognize that members of certain Protestant groups and denominations may have unique wishes concerning treatment. Understanding how to elicit these wishes and respond appropriately will allow physicians to enhance patient care and minimize conflict.

Bioethics↗