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1. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Jay Bringman, MD Challenging Underlying Assumptions of Wrongful Birth: Parental Counseling and Self-Perceptions of People with Down Syndrome
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The concept of wrongful birth, which is based on the premise that a person would have been better off never having been born, is a serious mat­ter for Catholic obstetricians, especially in the context of prenatal screening. This principle, in conjuncture with the belief that individuals with disabilities have a decreased quality of life, has been used to promote a eugenic mentality. Consequently, prenatal screening tests often are used to identify fetuses with disabilities, who subsequently are aborted. Not only is this practice ethically reprehensible, but its presuppositions about quality of life find little support in the medical literature. In fact, in the case of Down syndrome, there is consider­able evidence to the contrary: individuals living with Down syndrome have a high quality of life and are accepted by their families. These data illuminate the discrepancy between how physicians portray Down syndrome to expect­ant parents and what the literature shows regarding this condition.
2. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Gwyneth A. Spaeder, MD In This Issue
3. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Jennifer E. Miller, Marie-Catherine Letendre Therapeutic Orphans: The Ethics of Including Children and Pregnant Women in Research
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Children and pregnant women are often excluded from clinical research. This has resulted in a paucity of evidence on how medicines work for fetuses, neonates, infants, and adolescents. It also raises bioethics, scientific, and public health concerns. For over half a century, doctors have prescribed medicines to children largely on the basis of how they work in adults, despite children’s varied physiologies and differences in how their bodies absorb and metabolize drugs. Regulations and legislation have led to an increase in the number of pediatric studies and to better drug labeling. However, children at all stages of their lives often remain “therapeutic orphans” owing to insufficient evidence about how medicines work for them.
4. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Greg Schleppenbach Washington Insider
5. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Jessica M. Meister Berger, MD Parental Obligation and Medical Neglect in Childhood Obesity
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Despite unprecedented medical advancements and the near eradi­cation of many serious diseases, there are growing epidemics of preventable illness brought about in part by the overemphasis on individual autonomy and the neglect of obligations to others. Insofar as these diseases develop because of individual choice, this permissiveness hampers the moral analysis of growing epidemics like childhood obesity. While society has contributed to its rapid progression, childhood obesity finds its origins in lifestyle choices implemented at home. Consequently, parents have an unparalleled duty to prevent and correct obesity and unhealthy lifestyles in their children. Failure to do so undoubtedly violates a parent’s duty and suggests medical neglect. However, our current understanding of medical neglect is too narrow to be applicable to chronic, preventable illnesses. Relevant principles of tort law may broaden our understanding of neglect to better reflect the nature of parental and societal liability in preventable illnesses.
6. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
K. Sarah Hoehn, MD Conflict between Autonomy and Beneficence in Adolescent End-of-Life Decision Making
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The ethics of adolescent decision making is a complicated mine­field with laws that vary from state to state. The case of a fourteen-year-old girl, who simultaneously was diagnosed with cancer and discovered she was pregnant, highlights several weaknesses in our current approach to adolescent decision making in the context of pregnancy. In addition, adolescents with life-limiting conditions face similar challenges that can be examined through the framework of Catholic doctrine.
7. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Thomas Heyne, MD, Nancy Hernandez, MD, Lisa Gilbert, MD A Catholic Approach to Adolescent Medicine
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Adolescence is an important yet vulnerable period of transition from childhood to adulthood. An increasing number of studies support the traditional Catholic view, which sees teens as prone to making poor decisions when influ­enced by emotions or peer pressure but capable of thriving when guided by parents and religion. However, newer policies of medical societies undermine the traditional supports of family and faith with a permissive approach toward sexual exploration. To counter this unhealthy trend, which seems to be based more on postmodern ideology than robust science, Catholic physicians should become experts in adolescent behavior and sexual health. Physicians should be sensitive to opposing viewpoints but participate only in treatments which are ethical and beneficial for their patients. Specifically, Catholic physicians must avoid contraceptives, abortion, and “gender-affirming” therapies. By using good science and emulating the models of service, Socratic dialogue, and accompaniment, physicians can guide adolescents toward a virtuous, healthy adulthood.
8. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Paul W. Hruz, MD Experimental Approaches to Alleviating Gender Dysphoria in Children
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Clinical guidelines now recommend hormonal and surgical interven­tions together with social affirmation for children who experience a gender identity that is discordant with their biological sex. However, fundamental questions regarding the safety, efficacy, and ethics of these approaches remain unanswered. There is an urgent need for high-quality research to establish the overall risks and benefits of the current treatment paradigm. While acknowledging the complexity of the problem, competing interests, and logistical challenges, ethical imperatives and acceptable boundaries for scientific investigation can be set by considering the ultimate good of both the individual person and society as a whole. Within established guidelines for human experimentation, alternative approaches to treatment of gender dysphoria in children can be explored without compromising the dignity and bodily integrity of affected individuals.
9. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Pontifical Academy for Life Note on Italian Vaccine Issue: July 31, 2017
10. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
John S. Sullivan, MD Medicine
11. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Felipe E. Vizcarrondo, MD Medical Futility in Pediatric Care
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The transition from the paternalistic paradigm of the Hippocratic tradition to the present model of shared decision making has altered the patient–doctor relationship. This change has engendered conflicts between patients and physicians, especially in pediatric medicine, where the patients are depen­dent on their parents because of their inability to consent to an intervention independently. Navigating this complex relationship can become particularly fraught when medical futility is invoked. This situation is complicated further by the divergent approaches to shared decision making among physicians and the ethical perspectives these positions reflect. Catholic doctrine on the role of parents in medical-ethical decision making provides insight into navigat­ing these difficult clinical issues and ideologies.
12. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Christopher Kaczor Philosophy and Theology
13. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
William L. Saunders Washington Insider
14. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Ryan T. Anderson In This Issue
15. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Sherif Girgis The Wrongfulness of Any Intent to Kill
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Germain Grisez’s philosophical argument for respecting human life has been developed by fellow new natural law (NNL) theorists and applied to a range of lethal actions, for its conclusion is vast: intending the death of any human being as a means or an end is wrong in itself. For some Thomists, the NNL view on killing is both lax and rigorist: They consider it lax because its narrow criterion for what is “intended” leaves out some acts, especially ones related to abortion, that the critics consider murder. And they consider the NNL view rigorist insofar as it apparently rules out the death penalty, contrary to the Thomistic tradition and perhaps even heretically. However, the most salient philosophical arguments for exceptions to the principle against intending anyone’s death are weaker than the case for any given premise of the contrary NNL argument. Nevertheless, some NNL theorists’ arguments on life are unsound, some can be defended better than they have been, and some nonphilosophical objections based on theological authority require more exploration.
16. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Christopher Tollefsen Terminating in the Body: Concerning Some Errors of Action and Intention
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The New Natural Law (NNL) theory offers a distinctive account of the nature of intention and human action and, accordingly, of what aspects and consequences of a human agent’s performance should be considered outside the intention (praeter intentionem). In part, the distinctive features of the account follow from a methodological decision to consider human action from the perspective of the agent of that action, the first-person agential standpoint. This theory of action and intention has nevertheless been subject to considerable criticism. The view is held by many to be too first-personal and to provide inadequate “constraints” on what an agent intends when his performance will inevitably and foreseeably be accompanied or followed by states of affairs in which individuals are harmed.
17. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
E. Christian Brugger St. Thomas’s Natural Law Theory
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Fifty years of debate have strengthened Germain Grisez’s 1965 interpretation of St. Thomas Aquinas’s famous article on the natural law in Summa theologiae I-II.94.2. Revisiting Grisez’s argument in light of these developments reveals that his “gerundive interpretation” of the first principle of practical reason is not only Thomistic, but essentially Aquinas’s interpretation.
18. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Melissa Moschella Sexual Ethics, Human Nature, and the “New” and “Old” Natural Law Theories
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The major difference between “new” and “old” natural law approaches to sexual ethics is that for new natural law theorists the moral evaluation of sex acts is always determined with reference to that basic form of human flourishing which is called marriage; old natural law theorists determine the morality of sex acts also (or primarily) with reference to the natural purpose of the sexual faculties. Ultimately, the old approach relies implicitly on prior value judgments to distinguish biological facts that are axiologically or morally relevant from those that are not. It also appeals to values to ground the wrongness of immoral sex acts. In its pure form, the old natural law approach to sexual ethics lends itself to a misunderstanding of the unitive aspect of marriage. More broadly, an accurate understanding of new natural law does not run afoul of the correct interpretation of “nature” in natural law.
19. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Daniel Mark New Natural Law Theory and the Common Good of the Political Community
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Some critics question new natural law theorists’ conception of the common good of the political community, namely, their interpretation of St. Thomas Aquinas and the conclusion that the political common good is primarily instrumental rather than intrinsic and transcendent. Contrary to these objections, the common good of the political community is primarily instrumental. It aims chiefly at securing the conditions for human flourishing. Its unique ability to use the law to bring about justice and peace and promote virtue in individuals may make the common good of the political community critically important. Nevertheless, it is still not an intrinsic aspect of human flourishing. Unlike the family or a religious group, membership in a political community is not an end in itself.
20. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Stacy Trasancos Science