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Halachic perspective on involuntary psychiatric care of the mentally ill.

According to most mental health statutes in force around the world, doctors may involuntarily treat only acutely psychotic patients who present some danger to themselves, others or property. Chronic patients who, owing to volitional or cognitive defects, present a similar danger may not be thus treated. This may cause situations to arise where dangerous chronically ill patients who refuse treatment may cause serious harm because of physicians' inability to treat them. This article suggests changes to contemporary mental health statutes, in line with Judaic Halachic codes, which view all mentally ill patients as potentially harmful, and require physicians to treat--voluntarily or involuntarily--all mentally ill persons.

Adult

Using awareness of religious factors to enhance interventions in consultation-liaison psychiatry.

Religion plays an important role in the lives of most Americans and often influences the ways patients react to medical illness. However, the religious aspects of patients' lives are often ignored or only superficially explored by consultation-liaison psychiatrists. Building on an existing typology, the authors use six dimensions of religious experience to discuss approaches to incorporating religious factors in the psychiatric evaluation and treatment of the hospitalized medical patient; the dimensions include religious beliefs, participation in religious rituals, and affiliation with a religious community. Case examples illustrate how these approaches can enhance the work of the consultation-liaison psychiatrist and improve the patient's coping ability.

Adaptation, Psychological

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

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

Revisiting New York State's proposed surrogate decision-making legislation.

More than 2 years have passed since legislation was first proposed in New York to remedy the absence of legal authority for family members who must make important health care decisions for incapacitated loved ones who have left no advance directives. This legislation, the "Family Health Care Decisions Act," included standards for surrogate decision-making and safeguards for surrogate decisions about the use of life-sustaining treatments. This article argues in favor of the legislation and discusses the concerns presented in opposition.

Advance Directives