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101. 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.
102. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Greg Schleppenbach Washington Insider
103. 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.
104. 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.
105. 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.
106. 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.
107. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 1
Pontifical Academy for Life Note on Italian Vaccine Issue: July 31, 2017
108. 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.
109. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
William L. Saunders Washington Insider
110. 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.
111. 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.
112. 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.
113. 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.
114. 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.
115. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 2
Patrick Lee God and New Natural Law Theory
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New natural law theory (NNLT) holds that the basic moral principles are prescriptions to pursue the goods to which our nature orients us. Since God is the author of our nature and intelligence, these moral principles are part of his plan for creation. These principles can be known prior to knowing that God exists and prior to knowing that they are in fact directives from him. Nevertheless, since God’s plan includes our active cooperation, morally good acts cooperate with God’s providence, and morally bad acts substitute one’s subjective preference for God’s truth. Thus natural law principles direct us to a unified ultimate end, namely, the fulfillment of God’s plan. Therefore God and our relationship with him have a central place in NNLT.
116. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 3
Greg Schleppenbach Washington Insider
117. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 3
Marcus William Hunt Asymmetry and the Afterlife: A Christian Response to David Benatar
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According to David Benatar’s asymmetry argument, the transition from nonexistence to existence is always a harm, and procreation always a pro tanto wrong. This argument fails to reach its anti-natalist conclusion if we maintain the view that there is no temporal relationship between our worldly lives and our afterlives. On this view, since anyone who will be freely procreated has an existence in the afterlife that is atemporal with respect to worldly time, procreators do not move those they procreate from nonexistence to existence and so do not harm them. This view provides a reason to reject Benatar’s stringent “life worth starting” criterion for procreation.
118. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 3
Rev. Paschal M. Corby, OFM Conv. The Fear of Being a Burden on Others: A Response to the Rhetoric of Euthanasia and Assisted Suicide
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In the sphere of end-of-life care, the fear of being a burden on loved ones is a significant factor in patients seeking assisted suicide or euthanasia. The claims of altruism and love that support such decisions are misplaced, and the possibility of being a burden must be reimaged within a proper anthropology. Allowing oneself to be a burden is a significant aspect not only of loving human relationships, but of a human nature that is essentially dependent and created in the image of God.
119. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 3
Francis Etheredge The First Instant of Mary’s Ensoulment
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The Fathers of the Second Vatican Council recognized that the doctrine of the Incarnation is specifically concerned with the coming of Christ to free mankind from bondage to both original and personal sin. Original justice and original sin also can be examined through the dogma of the Immaculate Conception. By considering these concepts through the original moment of Mary’s conception, we gain a better understanding of the moment that each person is conceived. Thus a proper understanding of the Immaculate Conception will help us develop a better definition of human conception.
120. The National Catholic Bioethics Quarterly: Volume > 19 > Issue: 3
Kevin Wilger Embryo Models Derived from Stem Cells: A Response to Nicolas Rivron and Colleagues
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In their article “Debate Ethics of Embryo Models from Stem Cells,” Nicolas Rivron and colleagues call for a debate on stem cell–derived human embryo models. They first ask four questions regarding ethics and embryo models, and then give four recommendations to investigators and regulators. Understanding the nature of embryo models is crucial to determining their treatment. If they are human organisms, they should be protected by existing guidelines for ethical research. For instance, the good—which for humans includes organismal flourishing—precludes experimentation on embryonic humans. However, investigators do not know with certainty whether embryo models are equivalent to embryos. Therefore, investigators must halt experiments, evaluate data, and engage in debate before continuing with research.