Untreated depression at the end of life may affect treatment and raise ethical concerns. Patients with a major depressive disorder may desire a hastened death, may refuse reasonable and beneficial medical care, or may present with cognitive distortions that hinder their ability to make decisions about care. Treating depression can avert or minimize these problems in many cases. For a patient who does not respond to antidepressant medications and other interventions, however, the unrelieved depression could tip the balance and make (...) additional medical treatments burdensome. In such cases, a proposed medical treatment might be considered extraordinary. National Catholic Bioethics Quarterly 14.4 : 697–710. (shrink)

This work reviews and critically evaluates contemporary American Catholic moral theological reflections, both non-magisterial and magisterial, from 1975 to the present. It also considers relevant reflections from papal and papally related literature, and from the older tradition. It examines the following: criteria used in distinguishing between "ordinary" and "extraordinary" means, e.g., benefit and burden; miscellaneous elements employed in regard to these means, e.g., treatment and care; definitions given for these means. Based on the results of the (...) foregoing, it proposes original working definitions of these two main types of means. ;This work confirms the need, already recognized by some moral theologians, for a broad foundational criterion on which to base contemporary definitions of and distinctions between "ordinary" and "extraordinary" means. It finds the criteria offered thus far to be suggestive but flawed. Accordingly, its own working definitions are grounded in a foundational criterion of "integral human fulfillment in Jesus," a concept taken from the fundamental moral theological system developed by Germain Grisez. (shrink)

This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and (...) life insurance institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (shrink)

ABSTRACT In the Roman Catholic tradition the nature of the ordinary/extraordinary means distinction is best understood in light of its historical development. The moralist tradition that reared and nurtured this distinction implicitly developed a set of general criteria to distinguish the extraordinary from the ordinary. These criteria, conjoined with the context within which they were understood, can play an important role in refereeing the contemporary debate over the agressiveness of medical treatment and the extent of one's moral (...) obligation. (shrink)

Media coverage and statements by various Catholic spokespersons regarding the case of Terri Schiavo has generated enormous and deeply unfortunate confusion regarding Church teaching about the use of life-sustaining treatments. Two weeks ago, for example, I received a letter from the superior of a community of Missionary Sisters of Charity, who operate a hospice here in the United States The Missionary Sisters of Charity are the community founded by Mother Theresa, the 20th Century saint whose primary ministry was to rescue (...) dying Untouch-ables from the streets of Calcutta and bring them into her convent where they were washed, sheltered, fed if they were able to eat, prayed for, and cherished. In other words, the sisters gave these poor souls the gift of a death with dignity. The order Mother Theresa founded has continued this ministry, running hospices in the United States and elsewhere for the homeless, the destitute, those dying of AIDS and poverty and drug addiction, and all those dying alone and otherwise unwanted. (shrink)

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as (...) a matter of conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction. (shrink)

: This article draws upon the Roman Catholic distinction between "ordinary" and "extraordinary" means of medical treatment to analyze the case of "Jodie" and "Mary," the Maltese conjoined twins whose surgical separation was ordered by the English courts over the objection of their Roman Catholic parents and Cormac Murphy-O'Connor, the Roman Catholic Cardinal Archbishop of Westminster. It attempts to shed light on the use of that distinction by surrogate decision makers with respect to incompetent patients. In addition, it (...) critically analyzes various components of the distinction by comparing the reasoning used by Catholic moralists in this case with the reasoning used in other cases that raise similar issues, including women facing crisis pregnancies who prefer abortion to adoption and the Indiana "Baby Doe" case. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extraordinary Rendition:On Politics, Music, and Circular MeaningsRandall Everett AllsupThe purpose of this symposium is to look at music, education, and politics. I will begin with an examination of how musical meanings are politically rendered, and how these understandings are attached to moral consequences. Highly resistant to classification, musical meanings are those things we come to understand about ourselves through music, as opposed to musical knowledge which is demonstrable (...) know-how. While marching bands and flute sonatas can be judged with scores estimated to the 100th decimal point, the meanings that are created between the standards of practice of a given genre and the worldview of the listener or performer are provisional at best. Seen in this light, even seemingly secure or knowable realms like Christian heavy metal or anti-war movies are in fact highly un-objective and unpredictable. (More on Christian rock and movies in a moment). The challenge this paper seeks to uncover is participation on the hither side of fact, where understandings are rendered in a world that is contingent, political, and always in motion. What better example of the unclassifiable than the moving axes of politics and art?So what occurs between art and human or so-called "world" experience? [End Page 144] Let's agree that there is always motion, non-neutral, political movement in this interaction. We need not be students of French post-structuralism to recognize that we are part of many ever-evolving human-made systems, some of control, regulation, reward, punishment, and pleasure, but each with their own gravitation pull.1 I like Susan Sontag's take the best when she wrote that every place, every history has its own "sensibility," its own ineffable way of being in the world.2 Sensibilities—perhaps a clearer way of referring to politics in the context of art and experience—do not exist apart from their environment, yet they are more elusive than an idea or recognizable behavior.3 The sensibility of a time and place makes possible multiple discourses through which we make meaning.4 Some discourses, Foucault would remind us, are intensified by a history's particular sensibility and so appear louder than others. Such a discourse might speak so loudly that it shapes the meanings we make, drowning out options, and thus appearing obvious or commonsensical. The logic of musical assessment and evaluation—scoring marching bands and flute sonatas to the 100th decimal—is one such example.In spite of authoritative voices and reasonable discourses, each history's sensibility has its own escape routes, its own distortions and contradictions. I am fascinated by how we comply with or resist these pulls, as they are matters of agency and identity, matters of equity and social justice. In the present-day context of neo-liberalism and conservative values, especially 21st Century American fundamentalism, we would do well to ask how—not whether—such a fundamentalist sensibility shapes our ways of doing and knowing.5 My attempt is to locate music education in such a project.Shortly after the invasion of Iraq, I wrote a short piece on the fundamentalist imagination and its pull on the arts and education.6 This research took place at the 2003 MENC biennial where Bennett Reimer asks philosophy SRIG participants to consider (among other things) the role of metaphor in music education.7 I viewed the fundamentalist imagination as antithetical to metaphor: to paraphrase, the fundamentalist philosophy of education was "a philosophy for, not with, its initiates. Judgments are passed, not reached; answers are given, not argued... [Most importantly,] it is an educational method that emphasizes and then measures what is literal."8Since then, the voices of American literalism have appeared in increasingly loud volume seeking to discourage interpretation and argument in favor of handed-down teachings and binary logic. Supreme Court Justice Antonin Scalia decries the folly of a "living" constitution, in favor of a strict or literal reading. Retired Cardinal Bernard Law of Boston, in response to a common ground initiative by the late Joseph Bernadin, labels an appeal to "dialogue" a "fundamental flaw."9 Law sniffed, "Dissent from revealed truth or the authoritative [End Page 145] teaching of the church cannot... (shrink)

Weber’s concept of rationalization internally relies on an opposition that is borrowed from a religious semantics: the opposition between the extraordinary and the ordinary. Taking as point of departure the expression ‘the disenchantment of the world’ I argue that this expression, and the concept of rationalization, which is connected with it, have to be understood as elements of a categorical field of tension that is dominated precisely by the mentioned opposition. Referring to the sociology of religion, in which Weber (...) for the first time developed and deployed this opposition as an analytical tool, it appears that 1) the concept of rationalization in Weber is multivocal; 2) that the extraordinary and the ordinary relate to one another as do charisma and institution; and finally 3) that the description of the western rationalization process in terms of ‘disenchantment of the world’ by no means signifies that modern society is no longer characterized by the relationship between the extraordinary and the ordinary. Weber, for that matter, indeed attaches great importance to the extraordinary as a factor of revolutionary change, both in modern history and in modern politics. (shrink)

Providing food and water, even by tube, is in principle an ordinary and proportionate means of preserving life. The Congregation for the Doctrine of the Faith made that clear in its August 1, 2007 statement on the matter. However, a pressing question remains: What about oxygen? Food and water are necessary for life. Is not oxygen equally necessary? So why did the CDF not also declare the use of a mechanical ventilator to be in principle an ordinary and proportionate (...) means of preserving life? Conversely, if the use of a ventilator is extraordinary means, then why is the artificial provision of food and water proportionate means? Is there an inconsistency here? The author argues that there is not. (shrink)

The scope of this extraordinary selection of essays, distilled from nearly a thousand works that the author has written, is literally the entire universe and universe of knowledge. It charts the author's quest for the meaning of life faced with a dominant knowledge system she regards as incoherent, meaningless, and often acting against people and planet. She shows how contemporary scientific findings across all disciplines already provide an authentic knowledge system that's coherent with life and the universe. The aim (...) is to transform science thoroughly from inspiration to research to applications that work for people and planet. This book is simply unique in its scope and content. There is no equivalent. The author surveys and explains contemporary science in depth ranging over philosophy, anthropology, quantum physics and chemistry, neurobiology, psychology, genetics and epigenetics, cosmology, art, humanities, and mathematics. It presents a truly holistic view of nature, with profound implications for life in the social, political, and personal realm. (shrink)

The traditional distinction between ordinary, i.e., obligatory means to preserve life and extraordinary, non-obligatory means is an especially useful tool for HECs in today's secular pluralist health care system, because it gives factors that can override the prima facie good of preserving the patient's life. I first indicate the need for such a tool. I then demonstrate the present misunderstanding of the distinction and give its proper understanding. Finally, I show the applicability of the distinction for HEC (...) deliberations about three important types of cases: the conscious, irreversibly but not terminally ill patient who requests cessation of curative treatment; the provision of artificial nutrition and hydration to permanently vegetative patients; and the allotment of intensive care and other scarce medical resources. (shrink)

The responsible corporate officer doctrine is, as a formal matter, an instance of strict criminal liability: the government need not prove the defendant’s mens rea in order to obtain a conviction, and the defendant may not escape conviction by proving lack of mens rea. Formal strict liability is sometimes consistent with retributive principles, especially when the strict liability pertains to the grading of an offense. But is strict liability consistent with retributive principles when it pertains, not to grading, but to (...) whether the defendant has crossed the threshold from noncriminal to criminal conduct? In this essay, I review the two most plausible arguments supporting an affirmative answer in the context of the RCO doctrine. First, perhaps this doctrine reflects a rule-like form of negligence, akin to a rule that prohibits selling alcohol to a minor. Second, perhaps this doctrine expresses a duty to use extraordinary care to prevent a harm. Neither argument is persuasive. The first argument, although valid in some circumstances, fails to explain and justify the RCO doctrine. The second argument, a duty to use extraordinary care, is also inadequate. If “extraordinary care” simply means a flexibly applied negligence standard that considers the burdens and benefits of taking a precaution, it is problematic in premising criminal liability on ordinary negligence. If instead it refers to a higher duty or standard of care, it has many possible forms, such as requiring only a very slight deviation from a permissible or justifiable standard of conduct, placing a “thumb” on the scale of the Learned Hand test, identifying an epistemic standard more demanding than a reasonable person test, or recognizing a standard that is insensitive to individual capacities. However, some of these variations present a gratuitous or incoherent understanding of “negligence,” and none of them sufficiently explain and justify the RCO doctrine. (shrink)

Catholic end-of-life ethics does not contain a principle that prohibits the excessive use of medical treatment for declining and dying patients. This article fills this lacuna by exploring and developing the principle of unreasonable means. Unreasonable means are present when the burdens to the patient and community far outpace the benefits to the patient and when the use of such means directly or indirectly limits another patient’s access to ordinary means. Unreasonable means reinforce the redistribution (...) of limited medical resources from the poor to the wealthy and from the global south to the global north. The principle of unreasonable means guides individual patients and medical proxies to preferentially opt for the morally ordinary medical needs of others before the patient’s own extraordinary medical needs. The principle underscores the need for patients and proxies to incorporate justice and the common good into end-of-life decisions. (shrink)

This is a steamer trunk of a book! Its chapters, like so many tightly stuffed drawers with their numerous partitions, are full of all the apparel needed for a five‐hundred‐plus‐page voyage across the thirty years of Victorian history that surround the Vestiges of the Natural History of Creation and its anonymous author, Robert Chambers. We find storage places for observations on the new steam presses, on the reading public—both high‐ and lowbrow—on phrenology, on Scottish science and the Free Church movement, (...) on science in the great urban centers of England, on Von Baerian development, on a multitude of reviews, letters, personal journals, and salon gossip, on the contrasting styles of classical gentlemanly and the nouveau commercial science of industrial England, on the career of Chambers and many of his associates, and much more. A list of such static cubbyholes, however, fails to do justice to the unconventional and careful packing by the book's author, James Secord. More revealing is the hanging compartment of this steamer trunk, which meticulously folds the larger vestments against the pullout drawers. Here one finds the central themes that should concern all historians of science. These pertain to the varied recipients as well as the producers of science, publishers and illustrators as well as the technologies of elite and mass production, the nature of professional and amateur science at midcentury, and the clash between various ideologies, theologies, and politics as they bear on all of the above.With this extraordinary marshaling of historical material, backed by years of intensive sleuthing and broad reading, Secord dares to provide a near‐total history of and revision of a traditional minor affair in the history of science. He states one of his important goals at the outset in the form of a challenge: “What once made sense as the ‘Darwinian Revolution’ must be cast as an episode in the industrialization of communication and transformation of reading audiences” . Although the book is not focused on this challenge till the end of the last chapter and epilogue, Secord's endgame becomes clear when he revisits the question about the contrasting style, production, and reception of the Vestiges and the Origin of Species. He finishes with the provocative conclusion that “the Origin was important in resolving a crisis, not in creating one” . By this Secord means that the Origin forged a new alignment of professional and entrepreneurial biologists and the reading public around a new, often misunderstood developmental hypothesis; so “Darwinism” becomes “the science of the future” . It strikes me that the author's conclusions belie his initial claim. Without question Chambers and the Vestiges must now rank as major indicators and an episode of great importance in early Victorian culture. To me, however, Darwin and the Origin in its past, present, and future contexts—pace modern contextualists—still make sense as a broader, contentious episode known as “the Darwinian Revolution.”I profited particularly from Secord's discussions about the revisions and the target audiences of various editions of the Vestiges, his evidence that many professional scientists grew confident of Chambers's alleged authorship, and his demonstration that the evangelical Free Church in Scotland enabled a shift by the 1840s of the historical sciences from Edinburgh to the English urban centers. “From the Chamberses' perspective, the ‘Athens of the North’ had degenerated into a provincial backwater ruled by Calvinist fanatics” . My understanding of the history of science has been permanently altered by Secord's extended attention to communications and the reading public. I would have liked more reflection on the contemporaneous scientific and cultural scene in Germany and a deeper discussion of Herbert Spencer, but you cannot cram everything into a steamer trunk. This book is exhaustively illustrated, broadly researched, and well written. It contains a fine bibliography and index. I strongly recommend Victorian Sensation to anyone concerned about the twin processes of representation and communication in the history of science and for all interested in Victorian cultural history. (shrink)

Is vocabulary destiny? Why do clocks 'talk' to the Nahua people of Mexico? Will A.I. researchers ever produce true human-machine dialogue? In this mesmerizing collection of essays, Daniel Tammet answers these and many other questions about the intricacy and profound power of language. Tammet goes back in time to explore the numeric language of his autistic childhood; he looks at the music and patterns that words make, and how languages evolve and are translated. He meets one of the world's most (...) accomplished lip readers in Canada, learns how endangered languages like Manx are being revived and corresponds with native speakers of Esperanto in their mother tongue. He studies the grammar of the telephone, contemplates the significance of disappearing dialects, and also asks: will chatbots ever manage to convince us that they are human? From the art of translation to the lyricism of sign language, "Every Word is a Bird We Teach to Sing" is a fascinating journey through the world of words, letters, stories and meanings, and an extraordinary testament to the stunning range of Tammet's literary and polyglot talents. (shrink)

The subject of the study is the color meaning in the film of the famous Chinese director Zhang Yimou "Hero", the conceptual understanding of color as the main semantic element of the artistic solution. The object of research is the techniques of visual solutions in cinema. The perception of color in the culture of different peoples differs in certain nuances and depends on many factors, including national traditions and historically established stereotypes. Films by Chinese, Korean, and Japanese filmmakers are interesting (...) from the point of view of color solutions, as they differ in artistic originality and often offer the Russian audience an extraordinary semantic solution of the idea not only at the level of comprehension of the content, but also at the level of a specific color palette. The author similarly examines the color symbolism of Zhang Yimou's film "Hero". The conceptual content of the visual-figurative series, the originality of the coloristic solution of the film is comprehended. The scientific novelty of the article lies in the study of the color symbolism of Zhang Yimou's film "Hero" in the aspect of the correlation between the perception of the coloristic solution of the visual series and the conceptual content of the film. The author comes to the conclusion that despite the ambivalence of perception of a particular color in visual art, the coloristic solution is predetermined by the conceptual content of each episode, so color becomes the leading semantic concept of Zhang Yimou's film "Hero". (shrink)

For parents wanting their children to get a head start in reading, it can be a challenge to find something that will maintain their attention. Now, learning to read can become a fun and enter- taining thing to do with the help of an extraordinary cat. Join Cleo-cat-tra as she brings reading to life in the charming picture book Rhymes and Times with Cleo-cat-tra by Lucy T. Geringer and illustrated by Bernardita Cox Kollock. Rhymes and Times of Cleo-cat-tra is (...) a picture book about a special cat named Cleo-cat-tra. She is not an ordinary cat, as she cleverly rhymes about animals, people, and things she encounters inside and outside her house. The rhymes are silly which make learning a fun and creative pro- cess for kids and for parents to share. This delightful story makes use of colorful illustrations to heighten a child's imagination. Its simple text and brief sentences make reading easy for the early reader. It is also a great book for children who are learning English and can be enjoyed both at home and in school through lively interactive discussions between students and teachers. It is a book for all ages. (shrink)

My paper picks up a long ignored suggestion of Sheldon Wolin - that we use Thomas Kuhn''s analysis of scientific revolutions to examine the crisis of "normal" political science. This approach allows us to see the connection between the state of the discipline and the larger crisis of meaning afflicting modernity. I then use Eric Voegelin''s notion of a multicivilizational "truth quest" - or search for meaning - to make a case for institutionalizing "extraordinary" or "revolutionary" political science. I (...) attempt such a discipline by following Voegelin - reflecting on "the full amplitude of human experience." Such a meditation takes place within the "first reality of existence" - Plato''s metaxy or the "in-between" - the experience of human existence between the sacred and the mundane. I bring to Voegelin''s exploration of the metaxy the realm of experience which is most radically "other" for modernity - the primal political order of paleolithic and contemporary hunting gathering societies. I argue that shamanic "Urreligion" and Socratic discussion share a boundary crossing logic which provides a basis for a discipline of "extraordinary political science." Finally I suggest that such a discipline is both the quest for, and, in a sense, a realization of, the Good Life - a source of order for the individual and society. (shrink)

This paper deals with the moral issues relevant to medical decisions to terminate the life of a human organism. The expression “termination of life” will be used to cover both (1) active intervention to bring about a state of an Organism that will cause its death, and (2) a failure to intervene in causal processes that will otherwise result in the death of an organism. I shall attempt to distinguish the different cases in which the decision to terminate life is (...) morally justified and to isolate the considerations that are morally relevant to such decisions. -/- Decisions to terminate life: some possibly relevant considerations -/- There are a number of considerations that different people think relevant to medical decisions to terminate life and that are taken into account in actual medical practice. The following questions capture, I hope, the main ones: 1. Can the Organism in question be characterized as a person? 2. If the Organism is not a person, is it at least a potential person; that is such as will develop into a person? 3. If the Organism is a person, does he or she desire his or her own death, and if so is that desire a rational one? 4. If the Organism is a potential person, will this potential person express a rational desire to die once it becomes capable of expressing such a desire? 5. What quality of life will this person enjoy 6. What quality of life will this potential person enjoy? 7. What is the cost of maintaining the life of this person? 8. What is the cost of allowing this potential person to become a person, and then of maintaining his or her life? 9. Are we dealing with an unconscious person whom it is technologically impossible to restore to consciousness? 10. Is the termination of life a matter of active intervention or only a matter of refraining from saving the life of the organism? 11. Are we dealing with the case of “direct” killing or only one of “indirect” killing? 12 Does it require “ extraordinary” or only “ordinary” means to keep the person alive? 13. Is the individual suffering from a fatal illness? There are two ways in which each of these considerations might be relevant to a decision to terminate life. First, it might bear upon the question of whether it is morally permissible to terminate life. Secondly, if termination of life is morally permissible it may be relevant to the question of whether there is any positive reason for terminating life. (shrink)

Sugar consumption has long been linked with a host of chronic health problems, including obesity, diabetes, and cardiovascular disease. To reduce Americans’ intake, many have called for taxing sugary products or limiting access in certain environments like schools and workplaces. These sometimes controversial calls for new public policy to curb consumption may soon be eclipsed by newly emerging links between sugar and addiction.Attaching the label “addictive” to a substance like sugar, which is necessary for human life, challenges widely held beliefs (...) about addiction. But the extraordinary increase in sugar consumption during the past century, with related tripling of chronic diseases like obesity and diabetes, means our common understandings may be outdated.Part I of this paper will define “addiction” — especially as it relates to what was once a naturally occurring food nutrient and now is a highly concentrated food additive — and present evidence of the addictive potential of sugar. (shrink)

The author interprets three stories from recently Neolithic cultures (Melanesian, African Bushman, and Inuit) and a fourth story from an oral tradition of Haitian women. All four are about women and perhaps, judging by their content, composed by women. The author trained with Edward Whitmont and developed his interpretation technique in decades of practice with dreams as a Jungian analyst. He adds a new tool, the use of repetition, in which the same point is made by a series of different (...) details. Repetition provides an internal test for the accuracy of an interpretation. The author updates Jung’s concept of archetypes to incorporate an understanding of Darwinian evolution (which Jung lacked), new knowledge of the function of genes, and new knowledge of the emergence of complexity in dynamic and adaptive systems. He compares his interpretations of the four stories with other scholars’ interpretations, in particular the extraordinary work of Michael Wessels on African Bushman legends. Though Wessels criticized Jung for imposing his ‘colonial’ theory of universal archetypes, both Jung and Wessels insisted that interpretation requires a dialogue between two agents in which both are subjects, neither being dominated or objectified. In the four stories, the author shows, symbolic consciousness began with women. The anthropologist Chris Knight proposed something similar in 1991 in his controversial book Blood Relations: Menstruation and the Origins of Culture. (shrink)

The Buddha -- The Buddha's teachings -- The approaches and their philosophical systems -- The path of the cause-based approaches -- The fruition-based secret Mantra approach -- The Sarma tradition -- The Ningma tradition -- The extraordinary teachings: the Vajra heart essence.

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

The paper describes the historical and intellectual foundations on which the European political system was built after the Second World War; this system pursued the goal to prevent any war in Europe, but proved unable to prevent the russian-Ukrainian war. The paper shows that this system was built not only because of the trauma of the First and Second World Wars, but also in accord- ance with the liberal attitude to war, which M. Vatter called «war with “war”»; at the (...) same time, such a clear attitude does not refer to real wars, but to an imaginary «war of all against all». Based on the analysis of the principles and results of the research project “War and Society” under the direction of J. Baechler, the author outlines the principles of liberal Realpolitik as the implementation of the mentioned attitude in the realm of wars: it consists in their rationalization both at the level of goals and at the level of means of warfare; such a rationalization finally makes war irrational and unacceptable. From the point of view of such Realpolitik, war is only an extraordinary means of politics, and the russian-Ukrainian war is only an excess of violence, while in the opinion of the author, it is an inevitable consequence of the irrational and violent russian-Ukrainian extrapolitical conflict, whose stakes is the existence self of Ukraine. The author believes that one of the reasons for the inability of the European political system to prevent the russian-Ukrainian war is the belief that with the end of the Cold War, the “century of total war” in Europe also ended, and that the economic and cultural integration of post-communist countries into the European space makes such conflicts impossible. The author refers to the description of the own logic of wars of the 20th century, proposed in R. Aron’s book «The century of total war», and suggests considering the russian-Ukrainian war as a continuation of these wars. In the perspective pro- posed by R. Aron, the mentioned «century of total war» can be considered as a «long 20th century», which continues to this day. (shrink)

The term “medical futility” was developed in the 1980s to enable physicians to withdraw life-prolonging procedures over the objections of patients or family members. Using clinical expertise, the physician determines that a particular treatment would be futile in a particular clinical situation. A futility judgment is clear cut when the procedure does not work, but a difficulty arises when a physician believes that a procedure provides too little benefit and then invokes futility. In that case, a patient might consider if (...) the relatively small medical benefit might contribute to appropriately defined goals of treatment, and if so request “extraordinary means.” This article places the concept “medical futility” in relation to the principle of ordinary and extraordinary means, clarifies the concept of futility, and explains the problem of redefining futile means to include procedures that retain some benefit. It advocates very limited use of the term “medical futility” and suggests an alternative reason to withhold or withdraw treatment. National Catholic Bioethics Quarterly 14.1 : 39–45. (shrink)

The Catholic moral tradition has consistently offered the distinction between ordinary and extraordinary means as a framework for making end-of-life decisions. Recent papal allocutions, however, have raised the question of whether providing artificial nutrition to patients in a persistent vegetative state is to be considered ordinary and thus morally obligatory in all cases. I argue that this “revisionist” position is contrary to Catholic teaching and that enforcing such a position would endanger the ability of Catholic health care institutions (...) to minister to all their constituents. (shrink)

Defective newborn children are to be considered human persons. Thus, primary duty in proxy consent is to act with the infant's best interest in mind. This duty may at times override the otherwise prima facie right to life, but only under restricted circumstances. Refinements of McCormick's “relational potential” criteria and of ordinary-extraordinary means analysis prove useful in such decisions. Utilitarian considerations of social consequences have impact but can be kept subsidiary. The importance for decision making of available child (...) support services is considered. Spina bifida is used throughout as an example of issues discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Handbook of Roman Catholic Moral Terms by James T. Bretzke, SJJohn J. FitzgeraldHandbook of Roman Catholic Moral Terms James T. Bretzke, SJ washington, dc: georgetown university press, 2013. 260 pp. $24.95The Handbook of Roman Catholic Moral Terms continues the recent sequence of concise dictionaries published by Georgetown University Press, including the Key Words volumes for various religions and A Handbook of Bioethics Terms. James Bretzke’s contribution is especially (...) welcome as it is the first such English-language reference work in Catholic moral theology since the Second Vatican Council. The author covers fundamental, social, medical, and sexual issues while providing frequent cross-references and further readings. Special attention is also given to scripture and ethics, the history of moral theology, the nature and authority of the Magisterium, canon law, Protestant thought, and moral philosophy. The longest entries are those on dissent (67–70), Humanae vitae (111–16), infallibility (122–24), and the Pontifical Commission on Births (180–82), which in advance of Humanae vitae produced the well-known Majority Report favorable to the use of contraception. The sections on these vexed issues delve into some of the relevant arguments from different sides.Given its space constraints as a portable paperback, the Handbook covers an impressive amount of historical and contemporary ground. The eight-hundred-plus entries are generally clear and irenic, and often illuminating. Consider the page-long entry on just war theory (131–32), which succinctly summarizes its development from Augustine to the present-day Catechism, calls attention to the importance of ius post bellum alongside the traditional categories of ius ad bellum and ius in bello, and outlines four possible critiques of the theory. Particularly helpful throughout are the various examples the author provides. For instance, in the course of explaining that moral norms and human laws may not bind at all times, he suggests that it is justifiable to forgo the duty to sustain life when this can only be done through extraordinary means (140), or to exceed the speed limit in case of a medical emergency (15, 81; see also 183 and 239–40 for other relevant examples).On the other hand, a few key topics are either overlooked or not fully dealt with. This book rightly highlights ecumenical ethics (77–78 and passim), but there is essentially no coverage of Eastern Orthodoxy and very little on pre-twentieth-century Protestant thought. In addition, considering the prevalence of a “morality-of-happiness” perspective in historical and modern-day Catholic thought, and given Bretzke’s own thorough attention to law, the book might have incorporated separate entries on happiness and grace, law’s complement. [End Page 221] (To his credit, he does mention grace several times—a fact that the preface points out—and includes the beatific vision, Gloria Dei vivens homo, and Summum Bonum among his definitions.) And speaking of law, the author’s treatment of the divine law is slightly confusing; he appears to alternately conflate it with and differentiate it from both the eternal law and the law of the Old and New Testaments (70–71, 136, 138).In the end, despite Bretzke’s best efforts to remain above the ideological frays of moral theology, one’s overall evaluation of his book may depend somewhat on one’s place within them. Some will chafe at his suggestions that contraception (116), certain forms of assisted reproduction (198–99), and artificial nutrition and hydration that sustain those in a persistent vegetative state (10, 224–25) remain open questions to an extent. Others will point out, as Bretzke does, that Church doctrine has previously undergone substantial development on other issues, such as religious freedom (65–66, 151, 193, 229) and the charging of interest (107, 241). What most should be able to agree upon is that in many respects the Handbook is a valuable resource, one that will help professionals and students alike come to a much better understanding of the key terms and debates within the field. [End Page 222]John J. FitzgeraldSt. John’s University (New York)Copyright © 2015 Society of Christian Ethics... (shrink)

Life-support technology may become a death-prolonging horror, and some people may fear that an over-intellectualized interpretation of traditional moral teaching has led us astray from what a compassionate God wills for the dying. The author addresses this fear. Those who defend “orthodox” teaching on end-of-life issues have a serious obligation not to obscure the compassion implicit in the traditional distinction between ordinary and extraordinary means. There is no medical or moral obligation to prolong dying or make it more (...) burdensome with interventions that offer little benefit, and there is nothing immoral about pain relief. What is prohibited is killing: any action or omission that has the express or implicit purpose of ending a life. National Catholic Bioethics Quarterly 10.4 (Winter 2010): 695–705. (shrink)

Theological basis -- Religion and health care -- The dignity of human life -- The integrity of the human person -- Implications for health care -- Theological principles in health care ethics -- Method -- The levels and questions of ethics -- Freedom and the moral agent -- Right and wrong -- Metaethics -- Method in Catholic bioethics -- Catholic method and birth control -- The principle of double effect -- Application -- Forgoing treatment, pillar one: ordinary and extraordinary (...) means -- Forgoing treatment, pillar two: killing and allowing to die -- Forgoing treatment, pillar three: decisions by competent patients -- Forgoing treatment, pillar three: decisions for incompetent patients -- Forgoing treatment, pillar three: advance directives -- Hydration and nutrition -- Physician-assisted suicide and euthanasia -- Medical futility -- Pain and pain management -- Ethics committees -- Embryonic stem cells and the beginning of human personhood -- Genetic engineering -- Allocating health care resources -- The use and misuse of the allocation argument. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Procreative Liberty, Biological Connections, and MotherhoodMargaret Olivia Little (bio)Given the complex and dramatic array of issues currently facing us in reproductive ethics, bioethicists working on the topic might be forgiven feelings of trepidation when they cast their minds toward the next century. Currently, technologies such as artificial insemination by donor (AID), once the source of intense controversy, are used on a routine basis; mainstream newspapers carry advertisements offering “excellent (...) compensation” to ova “donors;” courts are arguing whether women who serve as gestational or “surrogate” mothers have any parental rights; and proposals resurface to jail pregnant women who take street drugs. Sorting out which developments are to be welcomed and which are to be resisted—and why—will require us not only to clarify some of our most basic value commitments, but also to reflect on our understanding of concepts, such as motherhood, that we previously had the luxury of thinking obvious. Let me highlight two issues I think we will be forced to confront as we try to navigate the ethics of reproduction into the twenty-first century—namely, the value of biological connection and the meaning of motherhood.Procreative Liberty and the Value of Biological ReproductionPeople who are unable to conceive a child or to carry one to term now face a variety of extraordinary means of procreative assistance: they can buy sperm and ova, undergo in vitro fertilization, or contract another woman to gestate and give birth to the baby. Those who are enthusiastic about these new technologies [End Page 392] and arrangements often explain their support in terms of many people’s deep desire or even right to bear children biologically related to them; those who are suspicious of the techniques often explain their resistance by criticizing our culture’s “pronatalist” emphasis on biological rather than social relations with children. Focusing on such clear-cut positions, though, undersells the complexity and difficulty of the issues involved. Few want to dismiss altogether the importance of biological connection; but the question remains, what measure of importance should it be granted? Or again, while most agree that procreative liberty is one of our most fundamental rights, the question remains, whose procreation, in what context, and by which means? The truly difficult questions, that is, pertain to how we are to value biological relatedness and how we are to draw the contours of procreative liberty.One perspective emerging in current debates urges an expansive answer to these questions, arguing that the new reproductive technologies and arrangements deserve constitutional protection. Procreative liberty is deeply important, it is urged, given how fundamental the decision to have or to refrain from having children is to our sense of dignity, identity, and meaning of life. But if we recognize a right to reproduce coitally, it is claimed, we should also recognize a right to reproduce noncoitally: people with infertile partners should no more be barred from exercising their right to “beget, bear, and raise” children biologically linked to them by using surrogate arrangements or AID than those who are blind should be barred from exercising their right to written information by using Braille texts. 1The fundamental question is whether the value of biological reproduction persists when pursued outside of the intimacies of marriage and family that form its traditional home. The new reproductive technologies and arrangements, after all, represent a departure not simply because they are noncoital but because they involve reproduction with strangers, under contract, and for pay. One question that demands our reflection, then, is whether the procreative liberty we value attaches to individuals atomistically, as it were, or to individuals only insofar as they are in relationships of an intimate and ongoing nature.Other developments on the horizon sound a restrictive note about procreative liberty. Many IVF clinics, for instance, have denied services to would-be single parents or to gay or lesbian couples. Some legislators have proposed making certain welfare payments for women conditional upon their use of contraceptives such as Norplant—an odd view if one regards procreative liberty as a fundamental right. After all, we do not usually make the receipt of public aid contingent on waiving a constitutional right. (Imagine the government stipulating that... (shrink)

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by double-effect (...) reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick. (shrink)

The use of the respirator is a major technological breakthrough for modern medicine. However, like other technologies, its use has caused new moral problems. This article concentrates on the moral and ethical components of decisions to employ the respirator. In developing a moral policy for its use, the author attempts to circumvent the standard distinction of ordinary and extraordinary means in favor of a policy of reasonable means which respects a number of values in crisis situations. The (...) article ends with some applications to cases to demonstrate the viability of the proposed moral policy. (shrink)

The question of whether it is permissible to deactivate a pacemaker at the end of life has been addressed in medical journals but rarely in ethics journals. The ethics of pacemaker deactivation is especially challenging because of the disparate ways the devices are viewed by both medical professionals and patients. Some consider pacemakers replacement therapy, and some consider them substitutive therapy. If they are the former, then deactivation would not be permitted, since a replacement device is considered a part of (...) the body, akin to a new heart. Some ask whether pacemakers are natural or artificial; if pacemakers are artificial, deactivation would be permissible. Another factor is whether a patient is pacemaker dependent. Some medical experts decide the issue of deactivation on the basis of patient autonomy. Others weigh in on whether pacemakers are ordinary or extraordinary means of care. This paper examines each proposal and concludes tentatively that pacemaker deactivation is not permissible at the end of life. National Catholic Bioethics Quarterly 15.1 : 39–51. (shrink)

The Court of Appeals of Indiana upheld the trial court's judgment and refused to create a new tort for “wrongful prolongation of life” because existing law offers a remedy to those who do not wish to be kept alive through artificial measures. Specifically, the court affirmed the trial court's dismissal in favor of Muncie Medical Investors, LP, the operator of Woodlands Nursing Home since the plaintiffs could have sought relief under I.C. § 16-36-1-8 which provides for court resolution of disputes (...) regarding an individual's treatment at the end of life.In 1992, Rebecca Taylor suffered a stroke that left her paralyzed on her left side and confined to a wheelchair. Taylor executed a living will in late 1993 directing that if she was suffering from a terminal illness with “no reasonable possibility of recovery,’’ then no “extraordinary means” to prolong her life should be used. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Peter Singer and Christian Ethics: Beyond Polarization by Charles E. CamosyWerner WolbertPeter Singer and Christian Ethics: Beyond Polarization CHARLES E. CAMOSY Cambridge: Cambridge University Press, 2012. 278 pp. $29.99Peter Singer’s “Copernican revolution” against a sanctity of life ethic may be regarded, from a Roman Catholic viewpoint, as an expression of the “culture of death” denounced by John Paul II. One must keep in mind, however, that “we know (...) that historically there have been times where those participating in discussions about ethics disagree deeply about theory, but nevertheless come to important and even broad agreement about applied or practical ethics” (179). The aim of Camosy’s book is to sketch the various areas of agreement and disagreement between Peter Singer and Catholic moral theology as well as the possibilities of working together.There are issues even about the subject of abortion on which Singer and the Church agree: that moral relativism is wrong; that it is seriously wrong to kill a person; that the right to privacy (see Roe vs. Wade) does not apply to acts harming others; and that the right to abortion is not a constitutional matter (chapter 1). Both positions see a connection between abortion and infanticide, but both draw different conclusions. The disagreements between them are about who is to count as a person, which Camosy comments on in the rest of chapter 1 (27–37). In the area of euthanasia, the Church and Singer share some skepticism about brain death (chapter 2). Camosy discusses the church’s position on one’s moral status at the end of life and the Roman Catholic understandings of ordinary and extraordinary means, acts, and omissions. Commenting on public policy in that field, Camosy gives some useful and convincing illustrations of the slippery slope effect in different countries that have legalized active euthanasia or assisted suicide (68–81).With regard to problems of killing, however, Helga Kuhse’s The Sanctity of Life Doctrine in Medicine (Oxford University Press, 1987) should perhaps have been considered. On the subject of acting and refraining, I would recommend Dieter Birnbacher’s Tun und unterlassen (Reclam 1995).Commenting on Singer’s championing of the moral status of nonhuman animals, Camosy points to elements in the Christian tradition that may support Singer’s issue of animal liberation (chapter 3). I wonder why the discussion concentrates on domestic animals and the problems of eating meat or [End Page 225] vegetarianism but omits problems of environmental ethics (e.g., ecological balance). Would the aim of avoiding animal harm include saving animals from predators? And if some animals are to be regarded as persons, we may get in trouble with our basic conviction of the equality (of the dignity) of human beings—as the debate on the margins of human life shows.Duties to the poor are not in dispute except for “partial preferences” (166) for members of our family, kinship, or country (chapter 4). Speaking of “partiality” in this context is, however, a bit misleading. Since no one can care for all people, preferences of an ordo caritatis (order of love) are a necessary part of a system of coordination from which—ideally—all humans can benefit. (Recall Augustine in De doctrina Christiana, 1.28–29: “The interests of society, however, and its common bonds will be best conserved if kindness be shown to each individual in proportion to the closeness of his relationship.”) Chapter 5, which compares Singer’s ethical theory with Catholic moral theology, would need more discussion (e.g., on double effect, object, and act), which I cannot cover within the limits of this review. Overall, Camosy’s book makes a valuable contribution to the dialogue between Christian and secular ethics.Werner WolbertUniversity of SalzburgCopyright © 2014 Society of Christian Ethics... (shrink)