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21. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Greg Schleppenbach Washington Insider
22. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Brother Ignatius Perkins, OP, RN Accompanying the Destitute and Dying: The Character of the Clinician and the Healing Relationship after Treatment Ends
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The experiences of clinicians who care for the sick and dying after withdrawal of treatment are rarely documented. This may be because these narratives, which offer insight into the intentionality and character of the clinician, do not lend themselves to clinical reports. The experience of palliative care touches clinicians in different ways and often confronts them with complex ethical dilemmas about care and treatment. This article explores the character of the clinician in relation to the telos of medicine and the experience of accompanying the dying after withdrawal of treatment.
23. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Teresa Yao Can We Limit a Right to Physician-Assisted Suicide?
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In each US state that has legalized physician-assisted suicide, the law stipulates that it may be pursued only by terminally ill patients with a prognosis of six months or less to live. It appears that this requirement makes euthanasia laws more palatable for the general public. However, this restriction is not justified by the reasoning commonly used to support assisted suicide. The desire to alleviate suffering and uphold personal autonomy should require that assisted suicide be allowed for individuals who do not have a six-month prognosis. The author concludes that a moral contradiction arises for individuals who support limited assisted suicide but oppose unrestricted suicide because acceptance of the former logically leads to acceptance of the latter.
24. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Alan Vincelette Maternal–Fetal Conflict and Periviability
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A recent statement of consensus held that the principle of double effect would allow the induction of a previable fetus in order to eliminate a grave and present danger to the life of a mother suffering from peripartum cardiomyopathy. The author responds to this declaration, points out some limitations preventing it from being a vehicle for broader agreement, and offers an alternative, namely, medical induction of labor in cases of maternal–fetal vital conflict can be justified if the fetus has at least a fair chance of survival. This support of induction in cases of periviability considers the interests of both fetus and mother and, unlike the earlier consensus statement, can be defended by those who hold that one’s moral intention includes both the ultimate and proximate ends, or the immediate consequences of one’s act.
25. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Charles Robertson Navigating an Impasse in the Embryo Adoption Debate: A Response to Elizabeth Rex
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This essay responds to an article by Elizabeth Bothamley Rex titled “The Magisterial Liceity of Embryo Adoption” (NCBQ, Winter 2015), specifically to Rex’s critique that his objections to the liceity of embryo transfer distort magisterial documents. He then draws out the implications of the differences between his view and Rex’s on the relation between maternity and pregnancy. The essay concludes by pointing out that, if they are to change their minds, opponents of embryo adoption need to be convinced that it is morally licit to impregnate, or “introduce an order to birth,” in a woman by means other than the marriage act.
26. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Ann M. Heath Advance Directives to Withhold Oral Food and Water in Dementia: A Surrogate’s Moral Obligations
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Euthanasia advocates have recently begun counseling people to create advance directives calling for oral food and water to be withheld if the person reaches a certain stage of dementia. The author shows that these directives are in fact requests for euthanasia, and they leave vulnerable people subject to poor-quality care. Both surrogate decision makers (health care proxies) and Catholic institutions have a moral obligation not to implement such directives, and surrogates, rather than withdrawing as proxies, have a moral obligation to advocate for the life and proper care of the incompetent person. Finally, the author argues that society is morally culpable if it does not strongly resist euthanasia in all its forms. National Catholic Bioethics Quarterly 16.3 (Autumn 2016): 421–434.
27. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Barbara Golder, MD, E.Wesley Ely, MD, John Raphael, Ashley K. Fernandes, MD, Annmarie Hosie, RN Assisted Nutrition and Hydration as Supportive Care during Illness: Bedside Application of Catholic Moral Teaching
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Confusion surrounds Catholic teaching on the use of assisted nutrition and hydration (ANH), specifically the question of when, if ever, its refusal or removal is ethical. This paper focuses on two often-neglected considerations: (1) the relationship between means (feeding) and mechanism (how the food is delivered), and (2) an assessment of proportionality of the mechanism from the patient’s perspective. The authors draw on two critical principles of Catholic moral teaching: only ordinary means are required, and proportionality is subject to the perspective of the patient, not just that of experts or the culture. The mechanisms that provide food and water have distinct benefits and burdens. Their proportionality is properly subject to analysis by the patient or surrogate, who determines which mechanism is acceptable in the patient’s situation.
28. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Christian Medical and Dental Association Transgender Identification
29. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 3
Janet E. Smith, John S. Grabowski, J. Budziszewski, Maria Fedoryka Self-Gift: The Heart of Humanae vitae
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It is possible to defend the Church’s teaching that contraception is incompatible with God’s plan for sexuality in many different ways. This essay sketches the fundamental views of reality common to all the defenses and the main lines of the most prominent defenses, some based on natural law (of which there are several versions), on the theology of the body, and on the physical, psychological, and social consequences of the use of contraception. While all the defenses have merit, the argument based on the recognition that sexual intercourse is meant to be a complete self-gift has a special power of its own.
30. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
William L. Saunders Washington Insider
31. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
Gwyneth Spaeder, MD Bad Science Hurts Catholic Physicians
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Good intentions have propelled conservative-minded scientists and medical practitioners to argue that certain medical interventions may have dangerous and unintended consequences. Such positions are motivated by a hope that showing the negative consequences of immoral acts, such as abortion and sexual promiscuity, will help curtail the behavior. Unfortunately, when these positions are supported by faulty science—as are claims of a reputed link between certain vaccines and autism, and questions about the safety of the human papillomavirus vaccine, for example—they weaken the already tenuous relationship between Catholic medical professionals and the generally liberal scientific establishment.
32. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
E. Christian Brugger Catholic Hospitals and Sex Reassignment Surgery: A Reply to Bayley and Gremmels
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Catholic health care institutions presently face the question of whether it would be morally legitimate for them to participate in sex reassignment surgery for patients suffering from gender dysphoria. This essay replies to two articles published on this question in the Winter 2016 issue of the Catholic health care journal Health Care Ethics USA. It argues that both articles fail to attend to factors necessary for an adequate moral assessment of the question, and thus provide inadequate solutions. It goes on to argue that it would be intrinsically wrong for Catholic hospitals to counsel or perform sex reassignment surgery if in so doing they affirmed certain widely held erroneous assumptions about the nature of sex and gender. The essay ends by asking whether, if those erroneous assumptions were clearly and publically rejected, it could ever be licit to per­form surgical amputations or plastic surgical reconstructions to assist persons suffering from severe and intractable cases of gender dysphoria.
33. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
Mary Shivanandan Relativism or Relativity: Religious Freedom and the Family
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This article addresses the issue of whether the Church has the right, even the duty, to inform public debate on reproductive issues. It argues that to deny this right is an infringement of religious freedom. Drawing on the writings of Pope St. John Paul II, it shows how truth, freedom, and the good are intrinsically related. Legislating against the good of human life detaches it from both truth and freedom. When secularism separates freedom from any relationship with God, it tends toward individualism, utilitarianism, and hedonism. The relativism at the heart of Roe v. Wade, which enshrined abortion in the Constitution, struck a blow at the dignity of the human person and the family. If the child is seen as an object to be manipulated, not a gift, a pseudo freedom prevails, which ignores the relational character of the human person. This endangers not only the family, but democracy itself.
34. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
Graciela Ortiz The Ethics of Voluntarily Stopping Eating and Drinking
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Encouraging VSED (voluntarily stopping eating and drinking) to hasten a patient’s death is immoral. The practice results in an obvious conflict between the autonomy of the patient and the principles of beneficence and non-maleficence that must guide the physician and other health care workers. Because VSED is an act of passive euthanasia, it harms the patient and thus compromises the integrity of the physician–patient relationship. Health care providers must avoid any involvement in VSED, whether by providing information about the practice or by administering palliative care while a patient is voluntarily starving and dehydrating himself to death. Instead of cooperating in the evil of euthanasia, health care providers need to advocate for the patient by refusing to do any harm and by addressing the reasons why the patient is requesting a hastened death.
35. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
Katarina Lee Ethical Implications of Permitting Mitochondrial Replacement
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Mitochondrial replacement techniques (MRTs) have made headlines as some countries have passed legislation permitting the creation of “three-parent embryos” and because of the recent revelation that a child has already been born following the use of these techniques. MRTs assist women with severe mitochondrial disease to have children who are free from mitochondrial disease. Essentially, the mitochondrial DNA of an ovum or embryo is removed and replaced with the mtDNA of a donor. The purpose of this paper is to argue that MRTs are ethically impermissible but greater regulation is needed. There are five parts to this paper: (1) a brief history of mitochondrial manipulation, (2) a description of the MRT process, (3) ethical arguments in opposition to MRTs, (4) relevant counterarguments, and (5) a proposal for increased regulation.
36. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
The National Catholic Bioethics Center Brief Statement on Transgenderism
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The claim that it is possible to change one’s sex, or that sexual identity is fluid, contradicts scientific evidence, reason, the nature of the human person, and key tenets of the Catholic faith. A small number of persons claiming to be “transgender” mistakenly believe that their true self and sexual identity contradict the sex of their bodies. They frequently experience profound suffer­ing due to intense psychological distress and due to the challenges of forming a healthy self-identity and basic human relationships, including friendships and marriage. Hormonal and surgical interventions, and other behaviors and practices that attempt to validate mistaken beliefs to relieve distress and suffering, are inappropriate responses to their condition. Persons claiming to be transgender must be accompanied on their difficult journey with true charity, and should be offered ethical, effective therapies based on sound anthropology and scientific evidence. The National Catholic Bioethics Center offers considerations to facilitate appropriate efforts to accompany and to help such persons.
37. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
William F. Sullivan, John Heng Promoting Mental Health: IACB Statement toward a Shared Medical and Christian Ethical Framework
38. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
Gerard V. Bradley The Future of Abortion Law in the United States
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In 1971, Judith Jarvis Thomson published what was then and still often is regarded as a trailblazing philosophical defense of a woman’s right to have a lawful abortion. It is time to revisit Thomson’s paper. The aim here is not to engage Thomson’s pro-choice conclusions, which are indeed mistaken, but to show that her question—to what extent can abortion be morally justified, assuming that it is the deliberate killing of one person by his or her mother—is the question today in American law concerning abortion. Pro-life people and groups argue among themselves about the prudence of political efforts to roll back Roe v. Wade by personhood initiatives, that is, by seeking to enact laws expressly recognizing that a human being with an equal right not to killed comes to be at fertilization, thereafter to pursue abortion restrictions as a matter of equal protection for all against unjustified uses of lethal force. Many if not most pro-life activists and bodies oppose such efforts as precipitous and almost certainly politically counterproductive. This article argues that, on the contrary, the unborn are already recognized as persons with a right not to be killed, and that the constitutional question of equal protection of unborn persons is already in the courts. Thomson’s question is, in other words, ripe and urgent, and it has been brought to the fore not by direct attack upon abortion rights, but indirectly by and through the many feticide laws enacted across the country since around the year 2000.
39. The National Catholic Bioethics Quarterly: Volume > 16 > Issue: 4
Jos V. M. Welie, William F. Sullivan, John Heng The Value of Palliative Care: IACB Guidelines for Health Care Facilities and Individual Providers Facing Permissive Laws on Physician Assistance in Suicide and Euthanasia
40. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
Nicanor Pier Giorgio Austriaco Healthier than Healthy: The Moral Case for Therapeutic Enhancement
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How should we morally evaluate protocols to edit the human genome? In this essay, the author argues that the therapy–enhancement distinction commonly used in debates over genetic engineering is not a robust one. Using the example of lipid-lowering pharmacological interventions, he argues that a strong case can be made for the morality of therapeutic enhancements that blur the distinction between therapy and enhancement. He proposes, therefore, that the therapy–enhancement distinction should be replaced by a therapy–nontherapy distinction that acknowledges that some beneficial and morally acceptable therapies are enhancements. However, the benefits–burdens distinction should also be deployed, as it commonly is with other technologies that affect the human person, alongside the therapy–nontherapy distinction, to judge whether a particular technological intervention to edit an individual’s genome should be permitted or not. Gene editing to make patients healthier than healthy should be allowed.