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41. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Marissa L. Mullins When Cardiopulmonary Resuscitation Becomes Harmful
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Cardiopulmonary resuscitation is a standard emergency medical procedure. Since its inception in the late 1960s, CPR has been performed on patients unless they or their proxies refuse it. However, like all medical inter­ventions, CPR has its benefits, risks, and consequences. Although the expected benefits of the procedure often outweigh its potential harm, CPR is not always clinically appropriate, especially for the dying, who have a very small statistical chance of surviving the intervention. Just as antibiotics are not prescribed for viruses and surgeries and treatments are withheld when clinically inappropri­ate, CPR should not be offered as a clinical treatment when it has a very low probability of success and is thought to be futile. Health care providers have an ethical and moral responsibility to withhold clinically inappropriate CPR, even when patients or their proxies request the procedure.
42. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Frederick J. White III, MD Lessons from Recent Polls on Physician-Assisted Suicide
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Physician-assisted suicide is an active political issue, and recent polls have indicated shifts in public opinion in favor of its permissibility and moral acceptability. However, structural errors and biasing effects exist in these polls, including several subtle logical fallacies as well as cognitive and reporting biases. Analysis of the polls suggests that public support for physician-assisted suicide is more conditional and much softer than the popular news headlines indicate. An understanding of how these factors function beneath the headlines provides important lessons for the discussion of physician-assisted suicide.
43. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Francisco Javier Insa Gómez, Pablo Requena Meana Is Medical Futility an Ethical or Clinical Concept?
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The concept of medical futility first appeared at the end of the 1980s, was developed throughout the 1990s, and now is widely cited in medical literature and clinical practice to justify refraining from or limiting the use of life-sustaining therapies. The definition of medical futility, however, is not very clear or universally accepted. In this article, we examine the strengths and limitations of a particular concept of medical futility, based exclusively on clinical considerations, that enables the physician to make unilateral decisions about whether to withhold, withdraw, or continue treatment without being required to consult the patient or his family. To respect the patient’s spiritual, philosophical, and ethical values, several significant ethical issues need to be narrowly defined, and the concept of medical futility must be rarely invoked to justify such unilateral decisions.
44. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Joshua Evans The Catholic Tradition on Vital Conflicts: A Critique of Charles Camosy and James Mumford
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In two important books on the ethics of abortion, Charles Camosy and James Mumford appeal to the concept of “material aggression” to justify direct abortion in cases of vital conflict. Both authors argue that just-war theory justifies the direct killing of merely material aggressors by private citizens and suggest that papal condemnations of unjust-aggressor arguments fail to consider the distinction between formal and material aggression. However, both authors omit any reference to the historical context of the papal condemnations, do not recognize that the justification for killing in just-war theory is fundamentally political, and do not consider how the special relationship between mother and baby might affect the ethics of vital conflicts.
45. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
John M. Haas Incentivizing Cost Reduction through POLST: NCBC Letter to the Secretaries of HHS and the VA
46. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Jacob Harrison Karol Wojtyla, Sex Reassignment Surgery, and the Body–Soul Union
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Dialogue about the moral permissibility of sex reassignment surgery (SRS) in Catholic health care has recently received considerable attention. In an effort to further this discussion and bring clarity to the debate, the author uses Pope St. John Paul II’s robust theological and philosophical anthropology to evaluate the morality of SRS and enter dialogue with current arguments that suggest SRS is morally licit. The author argues that John Paul II’s anthropology renders SRS morally illicit. Moreover, current arguments supporting SRS rely on an anthropology of body–soul dualism. This conclusion suggests that future arguments for the permissibility of SRS in Catholic health care will always be invalid if they fail to uphold the body–soul unity of the person.
47. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
John F. Roth Opiates and the Removal of Life Support: A Moral Obligation of Health Care Providers
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Medical and nursing personnel have an obligation to provide the medication necessary for every patient’s pain relief. This includes patients whose life-supporting mechanical ventilation is being removed, who may not exhibit traditional signs of pain or dyspnea. The purpose of this paper is not to argue a position on withdrawing life support. Rather, it argues that nurses and physicians have an obligation to provide pain-relieving medication, such as opiates, when life support is removed, to ensure that those entrusted to their care do not experience pain or significant distress. This is based on the principle of double effect, by which two actions, one intended and one unintended, may be permissible if there is a proportionate reason. The goal in these situations is never to hasten death intentionally but to make patients’ pain and suffering tolerable as a matter of compassionate and loving care.
48. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
Irene Alexander The Error of Intentionalism
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Some Catholic theologians are redefining the meaning of “direct” and “indirect” by including only the agent’s intention in defining the moral object, while simultaneously excluding the physical actions that the agent consciously and deliberately chooses. The net effect is that these theologians now approve of many kinds of abortions traditionally understood to be morally evil in situations of maternal–fetal vital conflict. Such an error has grave implications for Catholic bioethics and health care. When the intentionalist method is applied to other disputed questions in bioethics, however, it becomes clear that its ideology is fundamentally erroneous.
49. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
John K. DiBaise Euthanasia and Quality of Life: Critique of a Subjective Standard
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Euthanasia advocates argue that end-of-life decisions should be based on patients’ autonomous evaluations of their own quality of life. The question is whether a patient’s quality of life has deteriorated so far as to make death a benefit. Criteria for evaluating quality of life are, however, unavoidably arbitrary and unjust. The concept is difficult to define, and human autonomy has limits. This essay discusses the moral issues raised by quality-of-life judgments at the end of life: who makes them, what criteria they use, and what clinical actions the conclusions justify. It then looks at ways in which quality of life can be considered legitimately, in relation not to euthanasia, which is always illicit, but to specific proposed treatments. If a patient decides to forgo treatment, the decision should be based on the judgment that the treatment, its side effects, or its long-term consequences would be excessively burdensome or useless.
50. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
Christine A. O’Riley Protecting the Free Exercise of Religion in Health Care Delivery
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Not all actions that are legal are necessarily morally correct. However, there are few protections for providers who are pressured to comply with actions and procedures that infringe on their religious beliefs regarding human dignity. The right of health care providers to freely act on religious convictions and refrain from cooperating with morally reprehensible tasks is often eschewed in favor of political correctness or is branded as discrimination. Adequate safeguards are urgently needed for health care workers at all levels to ensure that they can continue to care for the sick and most vulnerable members of the community without violating the dictates of their conscience. This article examines the free exercise of religion as it pertains to medical provider conscience protections. The author argues for conscience protection legislation with a right of action.
51. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
Jane Dominic Laurel Suffering and the Narrative of Redemption
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Central to the message of Christianity is the doctrine of suffering as redemptive; therefore, this doctrine must continue to occupy a central place in the discourse about human suffering. Narrative—like suffering itself—has a unique epistemic value and the power to exert a humanizing influence in this discourse. This presentation, though neither strictly systematic nor exhaustive, illustrates narrative’s illuminative capacity in relation to the concepts and propositions that have been part of the discussion of redemptive suffering. Beginning with the present context, it provides justification for the use of narrative, discusses narrative’s place in the Catholic tradition, and then offers three narrative portraits accompanied by brief reflections on the various propositions that each narrative elucidates.
52. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
Lisa Gilbert Female Genital Mutilation and the Natural Law
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Female genital mutilation (FGM) is the removal or restructuring of healthy genital tissue. Under natural law, mutilation is an intrinsic evil and a grave violation of human dignity. If mutilation alleviates a threat to a person’s well-being, it may sometimes be permissible, but healthy genitals pose no such threat. The purported social benefits of FGM, such as decreased promiscuity, do not justify the practice, because there is no causal relationship between mutilation and virtue. In terms of autonomy, victims are usually children and unable to consent. Parental rights and the rights of religion do not override children’s inherent rights to physical integrity and safety. Current support for minimal forms of FGM in an attempt to reduce the incidence of severe forms will instead prolong the practice and increase the number of victims. Finally, FGM differs from male circumcision in that it destroys the function and integrity of the organs themselves and promotes profound gender inequality.
53. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
Elliott Louis Bedford, Stephen Blaire, John G. Carney, Ron Hamel, J. Daniel Mindling Advance Care Planning, Palliative Care, and End-of-Life Care: A Report Examining Diverse Perspectives of Catholics in the United States
54. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 3
Alex Fleming Striking a Balance between Embryo Transfer and the Goods of Marriage
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Difficulties in the moral assessment of embryo transfer and adoption include distinguishing it from illicit procedures like IVF and cryopreservation, determining the moral status of the human embryo, and reconciling embryo transfer and adoption with the procreative and unitive aspects of marriage. Many scholars who support embryo transfer and adoption limit their discussion to heterologous embryo transfer, the transfer of a genetically unrelated embryo into the uterus of a married woman. In this paper, the author focuses on homologous embryo transfer, the transfer of a genetically related embryo, as a viable option for married couples. It is the responsibility of the genetic mother to implant her embryos regardless of how they were created. When this option is not feasible, heterologous embryo transfer is possible in limited circumstances.
55. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Dominic R. Mangino The Internal Morality of Conscience: A Response to Ronit Stahl and Ezekiel Emanuel
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This essay challenges the relevance of the primary analogy in Ronit Stahl and Ezekiel Emanuel’s article “Physicians, Not Conscripts: Conscientious Objection in Health Care.” The author then proposes an alternative, classi­cally inspired model of conscience based on the work of E. Christian Brugger, Edmund Pellegrino, and Alasdair MacIntyre. This teleological model enables a more robust analysis of conscience claims than does Stahl and Emanuel’s social-constructivist framework.
56. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Timothy Hsiao Why Recreational Drug Use Is Immoral
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This paper argues for two claims. First, recreational drug use is immoral because it undermines cognitive functioning. Second, for similar reasons, the state has a prima facie public policy interest in enacting legal restrictions on recreational drug use. In this context, “recreational drug use” refers to activities in which a person uses some intoxicating substance to impair, destroy, or otherwise frustrate the functioning of his cognitive faculties for the sake of pleasure or enjoyment.
57. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Aldo Rocco Vitale Unified Opposition to Surrogacy: Comparing Feminist and Catholic Views
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This article briefly examines the topic of surrogacy in light of two opposing perspectives, mainstream feminism and Catholicism, which despite very different moral dimensions, arrive at the same conclusion. The author discusses the similarities between these two moral perspectives that are nor­mally considered to be opposed to each other.
58. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Denis A. Scrandis Jacques Maritain on the Rights of Man and the Common Good
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The notion of a properly functioning human nature as a moral standard is a tenet of Western culture and is at the core Western humanism, Christian moral teaching, and natural law theory. Although these traditions recognize that the virtue of justice is exercised by giving one’s neighbor his due, they did not explore a person’s legitimate claims to goods in a modern theory of human rights. Enlightenment thinkers, as materialists and atheists, theorized that human rights are not related to God or human nature but are privileges granted by government. Jacques Maritain (1882–1973) developed theories of natural law and human rights. Maritain’s theory of human rights, employing a Thomistic methodology and founded on God and nature, is applicable to contemporary disputes, such as claims to a right to “same-sex” marriage.
59. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Daniel Patrone Compensation for the Moral Costs of Research-Related Injury
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In the United States, researchers are not legally required to compensate trial participants for research-related injuries. Nevertheless, institutional review boards (IRBs) ought to require that all research proposals include broad compensation plans. However, the standard justifications for mandatory compensation cannot reconcile the need for adequate participant protections with a duty on the part of the research community to provide them. This situation can be resolved only through a deeper analysis of research-related costs. Once mere costs are distinguished from moral costs, a compelling case can be made that the principle of respect for persons, or human dignity, provides a sound moral foundation for assigning responsibility for research-related injuries.
60. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Michael G. Brungardt A Study of Accompaniment at the End of Life
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In discussions of end-of-life care and what the often-used but often-misunderstood buzzword “accompaniment” means, the core of the issue has often been missed, leading to inappropriate responses by physicians, loved ones, and the dying persons themselves. Emphasis is often placed on the care of circumstances rather than the care of persons. In what follows, these issues are systematically addressed to show that when patients face physical death, a truly ethical response is authentic, loving accompaniment of them. This form of such accompaniment is explored.