At one time, the American Medical Association had a strong pro-life position regarding unborn human beings. Using an online AMA archives database, this research note contrasts early AMA pro-life commentary with its eventual pro-choice position. Strong pro-life advocacy in the mid-to-late 1800s, led by doctors such as Horatio Storer, gave way in the 1900s to a waning of pro-life zeal, and eventually developed into a pro-choice stance on abortion.

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 545 Haroutunian, would have balked at the notion that their " empiricism " could be abstracted from the christological and trinitarian confession 0£ the church. In general, it would seem that a genuinely " empirical" approach would seek to engage the actual truth claims of religious com· munities on their own terms-even when those claims conflict with historicist suppositions. Second, in so far as Dean thinks there (...) is a uniquely American reli· gious experience or style of thought, privileging that style seems a dangerous move indeed. Dean is not unaware of the dangers. He specifically denies that he is engaging in any form of " American exceptionalism " (p. 25) ; it is simply that an " appropriately American historicism, centering on American culture, would have a greater chance of suggesting practices that work for and are true for America " (p. 24). But I am skeptical that such disclaimers address the real problem. Near the very end of the book, Dean suggests that a modi· fied naturalism might lead to " a notion of God that was more genuinely American than anything earlier," culminating in the recognition that " American thought about God is really the thought of a national com· munity" (p. 144). Descriptively that may well be the case; but then the Christian theologian must seek norms elsewhere. History Making History does not show us how historicist insigh~ might be incorporated into ecumenical, trinitarian theology, but that does not mean the attempt will prove unfruitful. Meanwhile, this bit of philosophical tale-telling will hold the interest of readers theological and otherwise. JOSEPH L. MANCINA Yale University New Haven, Connecticut Medical Ethics: Sources of Catholic Teaching. By KEVIN D. O'ROURKE, O.P. and PHILIP BOYLE, O.P. St. Louis: Catholic Health Associa· tion, 1989. Medical Ethics: Common Ground for Understanding. By KEVIN D. O'RouRKE, O.P. and DENNIS BRODEUR. St. Louis: Catholic Health Association, 1989. Healthcare Ethics: A Theological Analysis. By KEVIN D. O'RouRKE, O.P. and BENEDICT ASHLEY, O.P. 3rd ed. St. Louis: Catholic Health Association, 1989. Sources of Catholic Teaching is a compendium of recent "official" statements by Roman Catholic ecclesiastical bodies on issues concern· ing medical ethics. Arranged alphabetically according to topics, this col- 546 BOOK REVIEWS lection of statements from the papacy, the Roman Congregations, and the conferences of Catholic bishops could prove to he a very helpful reference tool. It contains a brief introduction which seeks to explain the role of these statements in the Catholic moral theology and Catholic medical ethics, a table of contents of the statements included, and then the statements themselves. In most instances it does not contain the entire document or statement hut only excerpts therefrom. There are some weaknesses in this work. First, these statements are not self-explanatory; they are in need of interpretation and explanation in many instances. But the authors present only the bald text and do not offer any explanatory comments. They apparently presume that these statements are pellucid to the reader, hut this is an unwarranted pre· sumption. For example, clarifying comments should have been added to the statement from the Declaration on Euthanasia because the allocution of Pius XII about giving lethal doses of analgesia is not entirely clear. A second difficulty with this work is the brief and somewhat insubstantial introduction on conscience and the role these statements should play in the formation of conscience. This sort of work invites a substantial and extended commentary on the nature of moral judgments, the relationship of conscience to the natural law, and the authority of these statements. The authors note that not all of the official statements issued by various organs of the Church are of equal authority, hut they do not try to identify the specific authoritative status of the various statements they include in their work. The reader is thus left to his or her own devices to determine, for example, the relative weight of statements of the administrative hoard of the NCCB versus statements of state episcopal conferences. A still further problem is that some of the statements are of virtually no significant authority for Catholics. For example, the statement of the administrative hoard of the NCCB on AIDS is of questionable... (shrink)

In The Medical Right, Remaking Medicine in Their Image (2007) (Medical Right Report or Report), the Religious Coalition for Reproductive Choice (RCRC) applies the term "Medical Right" to refer to religiously influenced medical, bioethics and health policy organizations of the Religious Right. This extremely important, well researched Report examines how the political agenda of the Religious Right, a political force comprised of fundamentalists primarily in the Protestant and Roman Catholic traditions, impacts reproductive health care. The (...) growing influence of medical associations that apply fundamentalist Christian "biblical values" to research and policy affecting reproductive health care is explored. The Report reveals that many consortiums, think tanks, institutes, and programs apply Religious Right ideology to medical concerns under the mantle of "bioethics" or "biomedical ethics." These groups work with conservative advocacy, outreach, and legal organizations, along with politicians, to advance the policy agendas of the Religious Right. The confluence of conservative politics, fundamentalist religion, and ideologically influenced medicine and science, poses a threat to reproductive health care services, as discussed in detail in the Report. While the Report is comprehensive in its discussion of the Religious Right's involvement in reproductive health issues, it addresses in only a cursory fashion how the Medical Right engages health law and policy governing end-of-life care. The purpose of this paper is to explore this area of concern more thoroughly. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Ethics in a Time of De-CommunizationRobert Baker (bio)Ethics is often treated as a matter of ethereal principles abstracted from the particulars of time and place. A natural correlate of this approach is the attempt to measure actual codes of ethics in terms of basic principles. Such an exercise can be illuminating, but it can also obscure the circumstances that make a particular codification of morality a meaningful (...) response to specific historic circumstances. This is particularly true of the codes of medical ethics beginning to emerge from the post-Communist societies of Eastern Europe, which are, perhaps, best understood as artifacts of an era, rather than as expressions of abstract principles.The era in question is post-Communist. It is an era informed by a reaction to decades of Communism, which, of course, was more than an economic system or even an ideology; it was a form of life that permeated every aspect of civil society—advertising, art, literature, music. Medicine was not exempt. I recall entering an oncology ward in East Berlin and finding the patients seated around a large table making posters. Wondering whether this was a form of art therapy, I asked the head nurse what the patients were doing. She replied: it is "Party time—the portion of each week every citizen donates to the people and the Party." I looked again at the posters and saw that they honored Karl Marx on the 100th anniversary of his death: "1883-1983, The Struggle Goes On." The Party, the struggle, the people, were everywhere, and they penetrated and informed daily life even for terminal patients on a cancer ward.The interweaving of Communist practices into the warp and woof of daily life has profound implications for the post-Communist era. It means that East Europeans cannot simply rebuild; they must unweave Communist thought patterns—what might be called the ideostructure of Communism—from the fabric of their lives through a deliberate process of deCommunization. What remains after de-Communization depends upon [End Page 363] the historical relationship each country had with Communism. In Russia, removing Communist ideostructure sets the conceptual calendar back to 1918. For the Czechs, the calendar advances to the 1930s, leaving them with thought patterns that are Western, industrial, and democratic. In the rest of Eastern Europe the conceptual clock also tends to turn back to the 1930s, but at that time the conceptual frameworks were nationalist, anti-Western, and frequently fascist, or even Nazi.In Poland the situation is different. World War II opened with the Nazi invasion of the country—which Hitler (later joined by Stalin) subsequently occupied. After the war, the Soviet army controlled the country, which became a captive player in the Soviet sphere of influence (aptly denominated, "the Warsaw Pact"). Poland's pre-Communist thought patterns are nationalist, West-leaning, accepting of parliamentary structures, but also of authoritarian government. They are also Catholic.Catholicism to Poles is not merely a religion, it is a posture of opposition to their German (Nazi, antichristian) and Russian (Orthodox or atheist) occupiers. I toured Polish hospitals several times during the Communist period —always accompanied by one or more "tour guides." (Westerners were not allowed to roam Communist countries unescorted.) Almost all of my guides wore little pins adorned with the face of Lenin (not the hammer and sickle—a symbol of Soviet occupation). Most doctors and nurses, however, adorned themselves with Catholic icons—typically a crucifix. Their conspicuously displayed crosses symbolized less their embrace of Catholicism than their rejection of Communism. Catholicism, in the Polish context, was thus an affirmation of individual and national independence.De-Communizing Polish Medical Ethics: The Abortion ControversyIn Poland, de-Communization was initiated through a series of negotiations between Lech Walensa's Solidarity and the Communist Government. The Polish Code of Medical Ethics is an indirect consequence of these negotiations, which stipulated the dissolution of Communist medical organizations. They were to be replaced by a Polish Medical Chamber—a type of quasi-governmental body, common in Eastern Europe, which combines the functions of a governmental licensing agency with those of a national medical association. Medical chambers also set standards of professional conduct and (unlike... (shrink)

One contested moral commitment shared by the American Medical Association and American Nurses Association has to do with the place of conscience in the practice of medicine. These organizations, each in their own way, urge their respective members to engage in careful moral discernment regarding their professional life, and they assert the existence of an obligation on the part of others to respect the conscientious objections of healthcare professionals and to accommodate objecting individuals. Yet despite the value (...) that these organizations place on conscience and objector rights, these organizations do not offer elaborate philosophical defenses of their positions. This shortcoming is exposed by the light of contemporary philosophical challenges to conscience-friendly policies. What such challenges demand is a philosophical defense of these organizations’ moral commitments and corresponding policy recommendations. The point of this article is to indicate how the Catholic philosophical tradition’s account of the nature and importance of conscience can philosophically underwrite these organizations’ conscience-related principles and practices. It can be seen, then, that the Catholic tradition is far from inimical to the contemporary practice of medicine and that, on the contrary, this tradition offers philosophically serious grounds on which to rest some of the most morally significant values and guidelines endorsed by these contemporary health-professional organizations and their members. (shrink)

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

This code of practice for health professionals was prepared by a multi-professional group and reflects good clinical practice in encouraging dialogue about individuals' wishes concerning their future treatment. It has a broad practical approach, considers a range of advance statements, advises of dangers and benefits of making treatment decisions in advance and combines annotated code of practice with a quick pull out guide for easy reference.

In lieu of an abstract, here is a brief excerpt of the content:FEEDING THE COMATOSE AND THE COMMON GOOD IN THE CATHOLIC TRADITION ROBERT BARRY, O.P. University of Illinois Ohampaign-Urbana, IlUnoi8 AA RECENT convention :sponsored by the Catholic Health Associaition in Boston, Laurence J. O'Connell, vice-president for ethics and theology, ma.de the following comments: I am concerned that some of those who are legitimately alarmed by the potential abuses associated with the public policy that authorizes the withholding and (...) withdrawing of mechanical means of nutrition and hydration are sometimes publicly misrepresenting the Catholic moral tradition. In other words, in their well-intentioned and perfectly legitimate efforts to avoid the slippery-slope-that is, the wrongful withholding or withdrawing of nutrition or hydration from vulnerable dasses of patients-those advocates are placing the Roman Catholic moral tradition itself on the slippery slope. It is mistaken to say it is the church's teaching that we may never withhold or withdraw artificial nutrition and hydration. It is mistaken to uncritically refer to the removal of medically engineered nutrition in all cases as starvation-that is, the willful withholding of nutrition as morally obligatory. It is mistaken to say that the ethical standards of a single Catholic hospital are necessarily coextensive with the ethical standards of the Catholic Church. Just because an individual Catholic facility, for whatever reason, uniformly refuses to allow the withholding or withdrawing of technological feeding, does not mean that the Church itself disallows such withholdings or withdrawals.1 It is not clear how the Catholic moral tradition can be put on the " slippery slope " by opposing certain forms of with1 "Church and State Overlap in Ethical Debate", American Medicai News. February 27, 1987. p. I. 1 ROBERT BARRY, O.P. drawal of feeding from specific classes of patients. Dr. O'Connell has misrepresented the thought of most of those who oppose the recent American Medical Association's new opinion which holds that artificially administered nutrition and fluids can be removed from terminally ill patients, even when they are not imminently dying.2 There are no Catholic moralists who claim that it is always and everywhere morally wrong to withhold or withdraw feeding from patients. However, there are a number of moralists as well as bishops who now hold it to be wrong to withhold or withdraw feeding in those cases where the withholding or withdrawal becomes the fundamental and underlying cause of death. O'Connell is p11obably correct in saying that the policies of one hospital do not necessarily deteJ1IDine the moral doctrines of the universal Church, but neither does one national organization such as the Catholic Health Association with only a loose affiliation with the magisterial hierarchy of the Church necessarily do this either. The debate over the provision of,aissisted feeding is a debate over whether iit is morally legitimate ito withdraw feeding so 1tihat.t:he primary and fundamental reason why the person dies is that withdrawal. It is a debate over whether those with a certain " quality of life " can be permitted to be killed by omission. It is a debate over whether feeding provided by routine nursing measures that can significantly sustain the life is a medical treatment that should he governed by the criteria governing other treatments, or whether it is an 2 "Withholding or Withdrawing Life Prolonging :Medical Treatment" adopted by the Council on Ethical and Judicial.Affairs of the.Amercian Medical.Association on March 15, 1987, In its pertinent parts, it stated: The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the choice of the patient, or his family or legal representative if the·patient to act in his own behalf, should prevail. Life prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition or hydration. In treating a terminally ill or irreversibly comatose patient, the physician should determine whether the benefits of treatment outweigh its burdens..At all times, the dignity of the patient should be maintained.•. FEEDING THE COMATOSE 8 aspect of normal care, like protection from exposure or hygienic care, that is to be accorded to all patients. In this piece, I wish to review the thoughts of some... (shrink)

Those are the words of Pope John Paul II, speaking in March 2004 to an international congress held in Rome. The conference was on "Life-sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," and it was organized by the World Federation of Catholic Medical Associations and the Pontifical Academy for Life. The pope was able to cut through all the ethical dilemmas. Although he acknowledged that a patient in a persistent vegetative state, or PVS, "shows no evident (...) sign of selfawareness or of awareness of the environment, and seems unable to interact with others or to react to specific stimuli," he said that they should be kept alive indefinitely. Such patients, he insisted, "retain their human dignity in all its fullness" and "the loving gaze of God the Father continues to fall upon them." For this reason, he said, it is obligatory to continue to provide them with food and water, even if this can only be done through a tube. The pope added that to withdraw the tube, knowing that it will lead to the death of the patient, is "euthanasia by omission.". (shrink)

Background and aimsFew Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, (...) at least 10% of all chaplains currently working in Polish hospitals.ResultsOf the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy—as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics.ConclusionsIn order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains. (shrink)

Combined oral contraceptives have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception (...) are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching. (shrink)

1. Aim of the guidelines2. Principles of good practice3. Circumcision for medical purposes4. Non-therapeutic circumcision 4.1. The law 4.1.1. Summary: the law 4.2. Consent and refusal 4.2.1. Children’s own consent 4.2.2. Parents’ consent 4.2.3. Summary: consent and refusal 4.3. Best interests 4.3.1. Summary: best interests 4.4. Health issues 4.5. Standards 4.6. Facilities 4.7. Charging patients 4.8. Conscientious objection5. Useful addresses.

*The views expressed are the author's own. This article should not be construed as representing policies of the American Medical Association.

In lieu of an abstract, here is a brief excerpt of the content:PHARAOH'S.MAGICIANS: THE ETHICS AND EFFICA:CY OF HUMAN FETAiL TISSUE TRANSPLANTS ROBERT BARRY, O.P. Program for the Study of Religion University of Illinois, Champaign-Urbana DARREL KESLER Department of Animal Sciences University of Illinois, Champaign-Urbana. IN RECENT YEARS increasing attention ha;s been given to v:rurious types of scientific riese,arch involving the human fetus. In the 1970s, :a tremendous amount of concern was expres1 sed IJ.'egiaroing the fetus,a;.s a rSU!bject of e~erimenrtation. (...) In this debate, the announced " research impeiiat:i:ve " was pos,ed against other moral imperativ;es.1 Following much soctiet :JaJl drebarte, protootlive meiaisumeis 1 WeIDe il!dopited 1by oompireihensive regiutatiions in 1975 estaiblishiing protections foT a number of research sUibjects. These regulrutions protect the fetus from non-beneficiail experimentation. that iworuild pose more than minima;l risk rto the fetus. Current debates in science and ethics now swirl arlOiund a new topic regarding human '.fetal life: the fetus as a sourrce of tissue for triansplaintation into other persons ais run e~erimental thempy. It is an issue that is rapidly moving torward the same Jevel of" research imperative" as did the earlier debate on the 1 See Paul Ramsey, The Ethics of Fetal Research (New Haven: Yale University Press, 1975): "Today one often hears statements like' Fetal Research must be done,' or 'It would be immoral not to do this research'" (P. xv). The validity of such opinions and utterances entirely depends on a netbenefits ethics, and the validity of that moral universe has been called increasingly into question in recent years. 575 576 ROBERT BARRY, O.P. AND DARREL KESLER ~etus as subject. Recently,,a new level of intensity was added to this deharte rby the imposition of an indefinite moratorium on federal support for research on transplantrution experiments inv;olving human.fetirul tissue and other!humans. 1Thls " :indefinite moratorium " w1as a result of a process that 1 began with research p110posaJs considered rby the National In- 'stituites of Health (NIH) in October 1987. In Marich 1988 a momtorium wa;g plaioed on the r:eseareh, and an 1advisory panel was summoned to consider the ethical issues involved. This panel presented 1a cveoommendation for the procedures. However, the Secretary of the Department of Health and Ruman Se1wfoes (HHS), Dr. Louis Sullivan, decided against the research proposal on etmcal grounds. His decision w:as with the 'concU'l'Tenoe of the Assistant Secretary :£m.· Health of HHS, Dr. James Mason, who has Tespons~bility for the NIH. Secretary SulliV1an's decision was oommumcarted to the Acting Director of the NIH, Dr. William Raub, in Nov,ember 1989. A :firestorm of criticism erupted from,rudv;ocates of this research, including the Council of Judicial and Ethical Affairs of tihe American Medical Association, which 5.n June 1989 called for an end to the:ban.2 In this article, we wish to question both the science and the ethics of the rproposed fotal tissue transplantation therapy. We!Will 1support the £edeml funding moratorium and surggest new pmtections for the fetuses (whether po,ssibly living or de2 " Medical Applications of Fetal Tissue Transplantation", JAMA, Vol. 263, No. 4, January 26, 1990, 'PP· 565-570. There has been a.great deal of public debate, not only in the U.S. but also in Europe over whether human embryo research should be supported with public funds. Many Catholic countries in Europe have prohibited such research, while a number of other nations have allowed it. Dickson, D., "Europe Split on Embyro Research", Science, Vol. 242, November 21, 1988, pp. 1117-1118. The most interesting controversy is in West Germany where there is a strong movement to prohibit it because many there believe such an experimentation requires judgments that there are certain forms of human life that do not deserve to survive. Ibid., p. 1117. Many Germans regard these sorts of judgments as too close to those made by Nazis, and there is strong sentiment to prohibit such research altogether. Ibid. HUMAN FETAL TISSUE TRANSPLANTS 577 oea:sed) of elective a.bortfons. We will also describe new reseaooh directions in t~apy.for the diseases in which it is claimed that fetal... (shrink)

Abstract“Conscientious provision” refers to situations in which clinicians wish to provide legal and professionally accepted treatments prohibited within their (usually Catholic) health care institutions. It mirrors “conscientious objection,” which refers to situations in which clinicians refuse to provide legal and professionally accepted treatments offered within their (usually secular) health care institutions. Conscientious provision is not protected by law, but conscientious objection is. In practice, this asymmetry privileges conservative religious or moral values (usually associated with objection) over secular moral values (...) (usually associated with provision). In this article, we first argue for a legal right to one kind of conscientious provision: referral for procedures prohibited at Catholic hospitals. We then argue that a premise in that argument—the principle of comparably trivial institutional burdens—justifies legal protections for some additional forms of conscientious provision that include, for example, writing prescriptions for contraception or medical abortions. However, this principle cannot justify legal protections for other forms of conscientious provision, for instance, the right to perform surgical abortions or gender-affirming hysterectomies at Catholic hospitals. (shrink)

*Disclaimer: The views expressed are the author's and should not be ascribed to the American Medical Association.

For any reader interested in euthanasia, On Dying Well gives an accessible yet detailed account of the Church of England's view on the subject. First published in 1975, this short report is the product of the Church's Board for Social Responsibility, which brought together theologians, philosophers, lawyers, and medical professionals to form a working party with the remit of examining euthanasia. The second edition of On Dying Well leaves most of the original working party report findings unaltered, but adds (...) a new introduction by Professor Stuart Horner, chairman of the British Medical Association's ethics committee from 1989 to 1997. Other changes to the first edition are a redrafted chapter on the legal questions surrounding euthanasia in light of new cases pertinent to the debate and additional reflections on the report's medical content. Also included is an updated bibliography, listing publications produced after 1975 and, in appendix form, the 1993 Joint Submission to the House of Lords Select Committee on Medical Ethics made by the House of Bishops of the Church of England and the Roman Catholic Bishops' Conference of England and Wales. On …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:TRANSIENT NATURES AT THE EDGES OF HUMAN LIFE: A THOMISTIC EXPLORATION PHILIP SMITH, O.P. Providence College Providence, R.I. T:HE CONCEPT OF human nature as the intrinsic and wdical source of characteristic human a;ctivity has great mportanoe for natural law ethics. But olosely allied to the concept of human nature is the possibility of there being tmnsient natures in humans, and this rpossirbility has implications for human life at its (...) outer edges. What transient natures are wiill he discussed 1in detail below. Let us,say for now that they are the life principles of entities transition from one state of being to another. These forms enjoy only a temporary existence before they disappear and are replaced by other emerging forms.1 When applied to the outer limits of human existence, such transient natures offer useful insights for addressing the difficult problems of when personhood begins and when death occurs. Thomistic philosophy defines a human person a;s a combination of mrutte1· and,form, more oommorrly referred to as a unity of hody and soul.2 Relativie to the beginning of Jife and the 1 Such natures are discussed in William A. Wallace, 0.P., "Nature and Human Nature as the Norm in Medical Ethics,'' in Catholic Perspectives on Medical Morals, ed. E.D. Pellegrino et al., Philosophy and Medicine Series, Vol. 24 (Dordrecht-Boston: D. Reidel Publishing Co., 1989). This essay was originally presented at an international conference held at the Joseph and Rose Kenned,y Institute of Ethies of Georgetown UniYersity, October 13-16, 1986. For further background against which Wallace's discussion should be situated, see his "Nature as Animating: The Soul in the Human Sciences,'' The Thornist 49 (l985) : 612-6'18, and "The Intelligibility of Nature: A Neo-Aristotelian View," Rev,iew of Metaphysics 38 (1984): 33-56. 2 Thomas Aquinas, St., Surnrna Theologiae, I, q.29, a.4. 191 19Q PHILIP SMITH, O.P. onset of death, this philosophy of person raises the question of w:hen tihe soul is infused into the body and when :it is 1separated from it. Is the newly-fortiilized zygote capable of :receiving and sustaining the rational soul as its,substantirul form? Or must the genetic materials be informed by one or more transient natures before they achieve ithe internal unity and stability necessary :for personhood? At the end of life, the person dies when the soul leaves the body. Does personail death coincide with the death of the human organism as a whole? Or can the destruction of only an essential part of the body, e.g. tihe cerebral cortex, cause personal death by damaging the body so severely that it is simply incapable of supporting a :rational soul, even though the rest of the body remains intact and spontaneously alive? If so, is the remaining organism informed by a succession of transient substantiail forms that maintain its existence but at ever lower levels of life as it gradually declines toward total death? In examining these questions posed by the possibility of transient natures, my point of departure will be an analysis of transient natures themselves. Recently, William A. Wallace, O.P., has 'begun to eX!plore the philosophical meaning and implications of transient natures for issues such as these.a His findings will he summarized here. The insights gathered from the exploration of transient natures will next he applied to the questions of when personhood begins and when death occurs. This will necessarily employ a fraiilework embracing both tihe empirical and the philosophical, with the empirical looking to the available biological data and the philosophical inquiring about the impact o.f these data for determining the status of human life at its outer edges. Since Aquinas's natural philoss Wallace, "Nature and Human Nature...," pp. 23-51. Additional background for his researches, apart from the essays cited in note l above, will be found in his "The Reality of Elementary Particles," Proceedings of the American Catholic Philosophical Association 38 (1964): pp. 154-166, and "Elementarity and Reality in Particle Physics," Boston Studies in the Philosophy of Science, 2nd ed. (Lanham, Md.: University Press of America, 1983), pp. 171-183 and pp. 185-212. TRANSIENT... (shrink)

Focusing on general texts of moral theology, this study investigates how Roman Catholic medical ethics emerged in North America as a developed and self-conscious discipline. It applies questions that Roman Catholic moralists have been pondering for centuries to the relatively new field of medical ethics.

When the FDA labeled ulipristal acetate an “emergency contraceptive,” Catholic and pro-life leaders criticized the decision, identified Ella as an abortifacient, and agreed it should not be used by Catholic institutions and providers.1 Ron Hamel, senior ethicist for the Catholic Health Association, shared this conclusion. In 2014, however, Hamel ended a review article by stating, “If, however, the consensus is correct, then there would seem to be sufficient moral certitude at this time to make use of (...) UPA in Catholic hospitals.” Below I question whether a relevant consensus exists and argue that the scientific evidence militates against, rather than in favor of, use of UPA/Ella by Catholic providers. (shrink)

In 1964, the American Medical Association invited liberal theologian Abraham Joshua Heschel to address its annual meeting in a program entitled “The Patient as a Person” [1]. Unsurprisingly, in light of Heschel’s reputation for outspokenness, he launched a jeremiad against physicians, claiming: “The admiration for medical science is increasing, the respect for its practitioners is decreasing. The depreciation of the image of the doctor is bound to disseminate disenchantment and to affect the state of medicine itself” [1, (...) p. 35]. Heschel’s reference to “disenchantment” suggests that he may have been familiar with the work, or at least the outlook, of sociologist Max Weber, whose 1917 address “Science as a Vocation” portrays the modern world as disenchanted by the progress of rationalism. Heschel’s life’s vocation had been to uncover the inner meaning of religious faith and to translate that faith into principled action. Heschel saw disenchantment not as an inescapable aspect of modern life but rather as the byproduct of physicians’ conscious choices to seek worldly success and material comfort. Yet, because of their privileged position as witnesses to human vulnerability, physicians possess an obligation to develop their own personhood, to re-enchant medicine, and through medicine to spark a positive transformation in all of modern life. As Heschel says, “The doctor must realize the supreme nobility of his vocation, to cultivate a taste for the pleasures of the soul. … The doctor is a major source of moral energy affecting the spiritual texture and substance of the entire society” [1, pp. 34, 38]. While Heschel’s conception of the physician’s role is romanticized and idealized, changes in the organization and practice of medicine have validated his concerns. (shrink)

As practicing clinicians, physicians are expected to uphold the ethical norms of their profession, including fidelity to patients and respect for patients’ self-determination. At the same time, as individuals, physicians are moral agents in their own right and, like their patients, are informed by and committed to diverse cultural, religious, and philosophical traditions and beliefs. In some circumstances, the expectation that physicians will put patients’ needs and preferences first may be in tension with the need to sustain the sense of (...) moral integrity and continuity that grounds a physician’s personal and professional life. This article examines the implications for patients, physicians, and the medical profession when tensions arise between a physician’s professional commitments and his or her deeply held personal moral beliefs. It offers guidance on when a physician’s professional commitments should outweigh personal beliefs as well as when physicians should have freedom to act according to the dictates of conscience while still protecting patients’ interests. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 158 But his analysis shows how it can distinguish as well as relate opposed positions, and so shows how theology contributes to our hope for a common community in and with vigorous dissent from each other. Loyola College of Maryland Baltimore, Maryland JAMES J. BUCKLEY Religion and Artificial Reproduction: An Inquiry into the Vatican "Instruction on Respect for Human Life in its Origin and on the Dignity (...) of Human Reproduction." By THOMAS A. SHANNON and LISA SowLE CAHILL. New York: Crossroad, 1988. $17.95 (cloth). This volume supplies a great deal of useful information on this in· struction which it prints in full in an appendix. Chapter 1 supplies an up-to-date survey of available reproductive technologies. Chapter 2 summarizes the Catholic tradition on sexual morality. Chapter 3 an· alyzes the Instructions, and 4 compares this to the regulations of the American Department of Health, Education, and Welfare (1979), the American College of Obstetricians and Gynecologists (1983), the American Fertility Society (1986), the British Medical Resarch Council (1982), the British Medical Association (1982) the Warmock Report (1984), the Australian National Health and Medical Research Council (1982) and the Victoria Government Committee (1982, 1983, 1984). Chapter 5 reports American reactions including those of Cardinal Bernadin and Archbishop Daniel E. Pilarczyk, theologians Richard A. McCormick, S.J. and James T. Burtchaell, C.S.C., and the columnist Charles Krauthammer. In Chapter 6 the authors draw their own conclusion. They think the Instruction has performed a service in calling attention to the need to set reasonable limits on the use of reproductive technologies, but they believe " The Vatican's call for legal prohibition of all reproduction technologies that eliminate sexual intercourse extends further than is morally necessary" (p. 138). They show, correctly, Humanae Vitae's principle of the inseparability of the unitive and procreative meaning of the marital act is the guiding principle by which the Instruction limits technological reproduction, but they reject this principle and propose in its stead that it is " the committed love relationship of the couple in its totality that gives the moral texture both to their sexuality and to their subsequent role as parents ", since " it is from the wholeness of the relationship that their specific physical acts of sex and 154 BOOK REVIEWS conception take their moral purpose. " Hence they would only exclude technologies that use gametes from donors other than the married couple. They omit discussion of another important principle proposed by the Instruction, namely the right of the child to be born of legitimate parents in a normal manner. They themselves seem to admit that the principle they propose to limit permissable techniques is not very helpful since after excluding donor methods they add, " although the authors recognize that further discussion may be necessary to clarify this point" (p. 138). In fact, couples consenting to insemination of the woman with a donor's sperm or contracting with a surrogate mother can easily justify their action as contributing to the wholeness of their loving relationship. Theologians who use this principle without further specification are logically forced to accept homosexual marriages and the artificial production of children for such marriages. This book simply ignores such obvious objections to their proposal. Indeed it does not seriously address in any detail the problem which the Instruction faces frankly and honestly, namely, what kind of reproductive acts are consistent with the totality of a committed loving relationship. Certainly, as the authors admit, some kinds of acts are not consistent with such a relationship, but they do not show critically how the principle they want to substitute for that of the Instruction can determine which reproductive technologies are not morally acceptable. The Instruction, on the contrary, took the necessary responsibility of proposing such a specification, by defining the structure of the marital act which is essential to this relationship. This does not mean that it defines it merely in its physical character, but in its specifying moral intention (its moral object) as an act which keps intact the intrinsic relation between the expression of love and the transmission of life. Since the authors never explain why this principle, so deeply rooted in the Catholic tradition, is false, nor... (shrink)

In January 2006, one of the major cases of scientific fraud in recent years broke in the media. It was discovered that the Norwegian researcher John Sudbø had falsified the complete set of data on which an article published in the Lancet in 2005 had been based.1 The article had 14 authors, and Professor Jan Helge Solbakk, Professor of Medical Ethics at the University of Oslo, was quoted in Norwegian media as saying that “… also the 13 other co-authors (...) in the research scandal have muck on their hands…” and: “That none of the 13 has discovered what took place shows clearly that they have not been close to fulfilling the criteria for being co-authors.”2One of the co-authors complained to the Norwegian Medical Association’s Council for Professional Ethics about these comments, …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Walking the Bodhisattva Path/Walking the Christ PathU.S. Conference of Catholic BishopsCatholics and Buddhists brought together by Dharma Realm Buddhist Association, the San Francisco Zen Center, and the United States Conference of Catholic Bishops (USCCB) met 20-23 March 2003 in the first of an anticipated series of four annual dialogues. Abbot Heng Lyu, the monks and nuns, and members of the Dharma Realm Buddhist Association hosted (...) the dialogue at the City of Ten Thousand Buddhas in Talmage, California. The community had transformed their Confucius Hall into a chapel, with a large, newly constructed wooden cross on a wall above an altar facing out from a raised platform, so the Catholic delegation would have a space for worship. A special poster announcing the theme of the conference, "Walking the Bodhisattva Path/Walking the Christ Path," showing a Buddhist dharma wheel at one foot of a bridge and a Celtic cross at the other foot, had been created by the hosting community.The daily schedule for the dialogue did not interfere with the monastic routine at the City of Ten Thousand Buddhas, which included early morning chanting (4:00-5:00 am), daily rituals in the Buddha Hall, and the single large meal for monastics before noon to which all participants were invited. Catholics and Buddhists meeting in the dialogue began each day with an optional forty-five minutes of quiet sitting together in the monastery meditation hall, each following their own form of meditation and prayer. There was a Eucharist on Friday and Saturday evenings for the Catholics and to which the Buddhists were invited, and additional meals of breakfast and supper throughout the meeting at the City's Jyun Kang Restaurant.Fourteen Buddhists and fourteen Catholics participated in the formal discussions. Each participant spoke on what it means to them to follow Christ or the way of the Bodhisattvas or enlightened beings. In addition to speaking, each participant distributed a short passage, usually from a traditional text, on this topic. Several passages from Master Dogen's Shobogenzo and the Gospel of John were among those shared by the group. Other passages shared were taken from the Avatamsaka Sutra and the Shurangama Sutra and from the other gospels and the writings of Zen master HakuinZenji, the Dalai Lama, Korean Zen Master I-sahn Hye-yeon, the teachings of Master [End Page 247] Hsuan Hua, Shantideva, Origen, St. Ignatius, St. Benedict, the author of The Cloud of Unknowing, St. John of the Cross, and Chiara Lubich. A minute of silence separated the fifteen-minute segments for each presentation. With so large a group, most of the time in the formal sessions involved listening to series of presentations; however, during discussion periods the participants asked several challenging questions of one another.Some participants noted the tension they felt between belonging to a particular religious group and the need to let go of any consequential narrowness. The goal of the discussion was to promote understanding of the differences and similarities between Christianity and Buddhism. At one point, the participants noted several concerns about mutual enrichment: whether Buddhist methods can be separated from Buddhism and Christian methods from Christianity, and what specific aspects of Christian practice truly enrich Buddhists and which Buddhist practices likewise enrich Christians. Several times participants discussed their understanding of terms such as transformation, grace, the incarnation and the passion of Jesus, discernment of spirits, prayer, Buddha-nature, and related terms. There was consensus that Buddhists and Catholics can practically help one another regarding mental cultivation and religious precepts. They expressed this consensus in their choice of the topic forthe next dialogue, "Transformation of Hearts and Minds: Chan/Zen-Catholic Approaches to Precepts."The group agreed to reconvene in 2004 to respond to six presentations, three from each side, on different aspects of this topic.Chairing the sessions were Rev. Heng Sure for the Dharma Realm Buddhist Association, Rev. Taigen Dan Leighton for the San Francisco Zen Center, and Bishop John Webster for the United States Conference of Catholic Bishops. Their three organizations are the sponsors of the Northern California Chan/Zen-Catholic Dialogue. Chan and Zen are respectively the Chinese and Japanese terms for the meditation school... (shrink)

Since its formation in 1947, the World Medical Association (WMA) has been a leading voice in international medical ethics. The WMA’s principal ethics activity over the years has been policy development on a wide variety of issues in medical research, medical practice and health care delivery. With the establishment of a dedicated Ethics Unit in 2003, the WMA’s ethics activities have intensified in the areas of liaison, outreach and product development. Initial priorities for the Ethics (...) Unit have been the review of paragraph 30 of the Declaration of Helsinki, the expansion of the Ethics Unit section of the WMA website and the development of an ethics manual for medical students everywhere. (shrink)

Since its formation in 1947, the World Medical Association (WMA) has been a leading voice in international medical ethics. The WMA’s principal ethics activity over the years has been policy development on a wide variety of issues in medical research, medical practice and health care delivery. With the establishment of a dedicated Ethics Unit in 2003, the WMA’s ethics activities have intensified in the areas of liaison, outreach and product development. Initial priorities for the Ethics (...) Unit have been the review of paragraph 30 of the Declaration of Helsinki, the expansion of the Ethics Unit section of the WMA website and the development of an ethics manual for medical students everywhere. (shrink)

In response to reports on embryonic stem cell research in the AMWA Journal, the official publication of the American Medical Writers Association, the author submitted a brief article discussing ethical objections to such research. The Journal editor rejected the article, saying the Journal was not an appropriate place to discuss the ethics of stem cell research. The author challenged this reasoning because the Journal is committed to informing members about relevant ethical issues, ethics were mentioned in one of (...) the original reports, and related ethical concerns were discussed in a previous issue. Further efforts to secure balanced reporting failed. Concerned professionals should be aware of the AMWA bias. National Catholic Bioethics Quarterly 8.4 (Winter 2008): 639–654. (shrink)

By its central terms, the language of the culture of death sends signals that produce life-accepting associations and at the same time mask its intentions against life. On the one hand, the culture of death includes certain behaviors. On the other hand, it includes those social and legal structures that strive to make killing socially acceptable by camouflaging it as a medical service or a social assistance. The culture of death wants to remove killing from condemnation, so that it (...) is no longer cursed as a crime. In the center of the culture of death is the battle for the legalization of abortion, euthanasia, and embryonic stem cell research. National Catholic Bioethics Quarterly 14.4 : 647–657. (shrink)

(2004). From an Exercise in Professional Etiquette to Society's Wish List? Review of American Medical Association, Code of Medical Ethics: Current Opinions with Annotations. The American Journal of Bioethics: Vol. 4, No. 2, pp. 69-70. doi: 10.1162/152651604323097907.

I said at the beginning that some quantum leaps in our thinking would be required as we face up to the challenges and changes that health care delivery will and must undergo.It is not a matter of politics, it is a matter of pragmatism.It is a matter of reality and it's a matter of simply having to face up to what, may I say, has been glaringly obious for some time.I know that doctors come with a strong ethos in terms (...) of their commitment to their patient and that is as it should be, but governments are always going to be constrained by the amount of money that is available to spend in any one particular field of health service.Within the priorities that governments have, health versus education, versus welfare, versus debt, debates will continue to be had.One of the strengths of New Zealand's health services, with its contracting arrangements, is that it is able to respond flexibly to the priorities that the government sets for the health services it seeks to deliver to every person in New Zealand.I am very optimistic that over time this new model of funding of our New Zealand health services will see a fairer distribution of the health dollars available to meet the wide range of medical needs of New Zealanders.Health care delivery is changing rapidly around the world.If we are to keep up in the future we must be realistic now. The challenge is mine as Minister of Health. The challenge is yours as health professionals. The challenge is ours as a community. (shrink)