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41. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
Paul Scherz The Mechanism and Applications of CRISPR-Cas9
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The recently developed CRISPR-Cas9 gene editing technology is transforming basic biomedical research, but it also may have therapeutic applications. This essay examines how the technology works, its possible applications in somatic and germline cell therapy, and the use of gene drives to control disease vectors like mosquito-borne illnesses. While potentially valuable, all of these applications present ethical problems, including the specific risks of unintentional mutations; pre-existing concerns over the relationship between biomedical technology, power, and procreation; and CRISPR’s unintended consequences for the environment.
42. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
Joseph Tham Resisting the Temptation of Perfection
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With the advance of CRISPR technology, parents will be tempted to create superior offspring who are healthier, smarter, and stronger. In addition to the fact that many of these procedures are considered immoral for Catholics, they could change human nature in radical and possibly disastrous ways. This article focuses on the question of human perfectionism. First, by considering the relationship between human nature and technology, it analyzes whether such advances can improve human nature in addition to curing diseases. Next, it looks at the moral and spiritual dimensions of perfection by analyzing the cardinal virtues. It argues that seeking perfection in the physical sense alone may not be prudent or wise and may produce greater injustices and weaken the human spirit in the long run. Understanding our true calling to perfection can help us resist the temptation of hubris to enhance the human race through technology.
43. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
Jennifer A. Doudna Rewriting the Code of Life: CRISPR Technology and Its Impact on the Future of Humanity
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DNA encodes the information necessary for life, but sometimes this code also leads to disease. Scientists have long envisioned the ability to change the DNA sequence in cells to correct disease-causing information. A technology known as CRISPR now enables precise rewriting of DNA sequences, offering unparalleled potential for altering the code of life in human beings as well as other organisms. CRISPR technology holds the promise of curing genetic disease and provides methods to reshape the biosphere for the benefit of human societies and the environment. However, along with these enormous opportunities come safety risks and ethical concerns. This article discusses the uses of CRISPR technology, its potential applications, and the actions we must take to prepare for future developments.
44. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
David A. Prentice The Genetic Engineering of Animals and Plants and the Boundaries of Stewardship
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Genetic engineering can change the biology of a plant or animal by altering its genome. Historically, selective breeding, induced mutation, and screening have been used to adapt animals and plants for human uses. The advent of specific, more accurate gene editing systems, coupled with cellular and embryological systems for selecting genetically engineered organisms, provides even greater possibilities for altering animals and plants to meet human needs but necessitates an analysis of when and how such tools should be used. Bioethical questions concerning the reasonableness of a genetic experiment, the well-being of the modified organism, the integrity of a species and the environment, and the potential benefit to humans should be addressed before any genetic manipulations are undertaken. Animals and plants can be genetically engineered ethically, but certain lines should not be crossed if we are to be good stewards.
45. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
David Albert Jones Editing Out the Embryo: The Debates over Human Genome Editing in the United Kingdom and the United States
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Two conferences on genome editing held in December 2015 offer a lens through which to contrast bioethics policies in the United Kingdom and the United States. The Progress Educational Trust, which has no parallel in the United States, hosted the London conference and illustrates the close collaboration between government departments, scientific bodies, funding organizations, and lobby groups in the United Kingdom. The rhetoric of responsible regulation used in the United Kingdom protects not the embryo, but the practice of embryo destruction, and advocates of embryo experimentation are eager to guide the debate about genome editing. It would be perilous for the international community to allow the United Kingdom to frame the debate in this way.
46. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 1
Kevin FitzGerald Human Genome Editing: A Catholic Perspective
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With this power to edit our own genes comes the enormous responsibility to determine if, when, how, and why we should, or should not, employ this technology. This article addresses this responsibility from the perspective of the moral tradition and reasoning of the Catholic Church. Past, present, and possible future positions of the Catholic Church regarding human genome manipulation are analyzed in light of the fundamental values that undergird Catholic ethical reasoning, and the significant contributions the Catholic perspective can bring to global deliberations on the responsible use of human genome editing are identified. These contributions represent both opportunities and obligations for the Catholic Church in its continuing tradition of providing health care around the world, especially to those who are the most vulnerable and most in need.
47. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
William L. Saunders Washington Insider
48. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Matthew Dugandzic, Becket Gremmels, Francis Etheredge Colloquy
49. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
Stephen L. Mikochik Broken to the Hope: The Right to Life, the UN Convention on the Rights of Persons with Disabilities, and Canada’s Medical Assistance in Dying Act
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The UN Convention on the Rights of Persons with Disabilities is a landmark international agreement recognizing the rights and equal status of disabled people. States Parties commit to protect the right to life of all such people and to promote their equal dignity. Canada ratified the convention in 2010. However, Canada’s Medical Assistance in Dying Act, which received royal assent in 2016, allows for assisted suicide and euthanasia of those dis­abled people who have a grievous and irremediable medical condition. This essay contends that the act violates Canada’s treaty obligations not to enact legislation inconsistent with the convention by jeopardizing the right to life of such people and placing them in a significantly unequal status within Canadian society.
50. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 2
John A. Di Camillo Gender Transitioning and Catholic Health Care
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This essay discusses basic concepts that Catholic health care ministries should understand concerning so-called gender-transitioning interven­tions. Since genuine healing encompasses the whole person, transgender issues must be addressed in the full realistic terms of a body–soul union not merely in relation to experienced desires and feasible physiological modifications. For necessary clarity, the essay explains key distinctions between the terms disorders of sex development, gender dysphoria, and transgender. It argues that only bodily acceptance efforts can offer authentic healing in response to gender dysphoria, while all forms of gender transitioning, from psychological counsel­ing to cross-sex hormones and surgical “reassignment,” always contradict the good of the whole person. The essay concludes by emphasizing the significance of the educational role of Catholic health care and its call to witness even in the face of problematic recommendations by respected medical associations.
51. 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.
52. 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.
53. 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.
54. 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.
55. 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
56. 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.
57. 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.
58. 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.
59. 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.
60. 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.