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61. 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.
62. 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.
63. 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
64. 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.
65. 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.
66. 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.
67. 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.
68. 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.
69. 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.
70. 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.
71. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Paul W. Hruz The Use of Cross-Sex Steroids in the Treatment of Gender Dysphoria
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Current clinical guidelines for the treatment of individuals who experience gender dysphoria include the administration of testosterone to women who desire to appear as men and estrogen to men who desire to appear as women. Despite the rapid and widespread adoption of this practice, strikingly little scientific evidence supports this treatment approach as a safe and effective medical intervention to prevent associated depression and suicide. Although low-quality, short-term studies have demonstrated a reduction of dysphoria, emerging evidence reveals significant bodily harm from this practice and a lack of long-term benefit in preventing depression and suicide. From an ethical perspective, this practice distorts a proper view of human nature and violates bodily integrity by directly inducing sterility. The use of exogenous cross-sex hormones reinforces rather than alleviates underlying psychiatric dysfunction while significantly increasing the risk of other medical morbidities. Despite the valid goal of alleviating suffering, this practice cannot be justified by the use of the principles of totality or double effect.
72. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Marie T. Hilliard Religious and Moral Exemptions and Accommodations for Coverage of Certain Preventive Services: NCBC Letter of Comment on the Contraception Mandate
73. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Birgitta Sujdak Mackiewicz Essential Goals of Ethics Committees and the Role of Professional Ethicists
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Ethics committees in Catholic health care are responsible for con­sultation, education, and policy development and review. Historically, ethics committees were reactive and had no articulated goals. This article argues that the essential goals of Catholic ethics committees are (1) to promote the human dignity of patients and staff; (2) to promote the common good; (3) to promote institutional identity, integrity, and ethical climate; and (4) to improve quality of care. These goals are most effectively met when ethics committees are proactive and integrated in the institution, embrace systems thinking, and utilize professional ethicists locally or regionally.
74. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Mark Repenshek Examining Quality and Value in Ethics Consultation Services
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The American Society for Bioethics and Humanities poses a chal­lenge in Core Competencies for Healthcare Ethics Consultation: health care ethics consultation services “should be able to demonstrate their value to those who pay for the service, as well as to those whom the service is intended to serve.” To respond to this challenge, this article provides a brief review of the literature on evaluating ethics consultation in its traditional frameworks of quality outcomes. The author follows this discussion with a new methodology to evaluate ethics consultation on the basis of the intrinsic good of the service. He ends with a novel risk-based assessment to complement the evaluation of clinical ethics services grounded in the Ethical and Religious Directives for Catholic Health Care Services.
75. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Greg Schleppenbach Washington Insider
76. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Courtenay R. Bruce, Jocelyn Lapointe, Peter Koch, Katarina Lee, Savitri Fedson Building a Vibrant Clinical Ethics Consultation Service
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The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.
77. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Jason Lesandrini, Alan Muster Practical Steps for Integrating an Ethics Program
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The field of health care ethics continues to grow as the ethics structures in health care organizations become well established. While the literature is saturated with reports on clinical ethics consultation services, very little is known about the development and success of ethics programs. The following describes the development and growth of an ethics program at the largest health care provider in Georgia. With a focus on nine key components of an ethics program, the paper reviews what one system did on its path to a flourishing program and what others can learn from it.
78. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Mary E. Homan Factors Associated with the Timing and Patient Outcomes of Clinical Ethics Consultation in a Catholic Health Care System
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Little is known about how certain patient characteristics can affect the timing of an ethics consultation, which has been hypothesized to affect patient length of stay. This study assessed how specific patient characteristics affect the timing of an ethics consultation, namely, age (over 65 years), race, Medicaid status, the presence of a living will, the presence of a health care proxy, and the absence of decisional capacity. Moving beyond the typical case-series evaluation of an ethics consultation service, this study used an innovative approach to model how predisposing, enabling, and need factors affect health behavior and subsequently affect health outcomes for patients who received an ethics consultation at a Catholic health care system in Oklahoma.
79. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Matthew R. Kenney A System Approach to Proactive Ethics Integration
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Although ethics consultation services often engage in some of the most complex and delicate clinical situations, little is known about the qual­ity of these services or their effect on patient care and patient and provider satisfaction. There is still significant work to be done in the areas of training, credentialing, and standardization. This article articulates the essential “build­ing blocks” of the Proactive Ethics Integration model developed at Ascension as well as the lessons we have learned along the way.
80. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Nicholas J. Kockler, Kevin M. Dirksen Integrating Ethics Services in a Catholic Health System in Oregon
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At Providence St. Joseph Health in Oregon, many factors contribute to the integration and success of the ethics services. There are three principal lenses through which one can understand the distinct way in which the ethics services are operationalized and integrated: the theological foundations of ethics as a service, the institutional ecology, and the professionalization of the field of health care ethics. The authors review key realities that have shaped their work through these three lenses and then describe the activities of the Providence Center for Health Care Ethics regarding its strategic objectives and clinical and administrative integration.