One contested moral commitment shared by the American Medical Association (AMA) and American Nurses Association (ANA) 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 (and from which to defend) some of the most morally significant values and guidelines endorsed by these contemporary health-professional organizations and their members.
{"title":"The Catholic Moral Tradition, Conscience, and the Practice of Medicine","authors":"P. Tully","doi":"10.1093/CB/CBAA023","DOIUrl":"https://doi.org/10.1093/CB/CBAA023","url":null,"abstract":"\u0000 One contested moral commitment shared by the American Medical Association (AMA) and American Nurses Association (ANA) 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 (and from which to defend) some of the most morally significant values and guidelines endorsed by these contemporary health-professional organizations and their members.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"66 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122446756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Doctors, nurses, and pharmacists who refuse on grounds of conscience to participate in certain legal, expected, and standard practices have been accused of unprofessionally introducing their personal views into medicine. My first response is that they often are not engaging in conscientious objection because that involves invoking convictions external to those of the medical community. I contend that medicine, properly construed, is pathocentric, and so refusing to induce a pathology via abortion, contraception, euthanasia, etc., is actually being loyal to the internal morality of medicine. My second response is that even if such refusals are best considered conscientious objection, there is still no personal hijacking of medicine. Doctors refusing to induce pathologies need not refuse qua Christian, but can do so qua doctor. A pathocentric account of medicine provides a principled way of distinguishing conscientious objection from religious, idiosyncratic, and bigoted refusals. Patients’ refused pathology-inducing procedures are not medically harmed.
{"title":"Conscientious Objection or an Internal Morality of Medicine?","authors":"D. Hershenov","doi":"10.1093/CB/CBAA020","DOIUrl":"https://doi.org/10.1093/CB/CBAA020","url":null,"abstract":"\u0000 Doctors, nurses, and pharmacists who refuse on grounds of conscience to participate in certain legal, expected, and standard practices have been accused of unprofessionally introducing their personal views into medicine. My first response is that they often are not engaging in conscientious objection because that involves invoking convictions external to those of the medical community. I contend that medicine, properly construed, is pathocentric, and so refusing to induce a pathology via abortion, contraception, euthanasia, etc., is actually being loyal to the internal morality of medicine. My second response is that even if such refusals are best considered conscientious objection, there is still no personal hijacking of medicine. Doctors refusing to induce pathologies need not refuse qua Christian, but can do so qua doctor. A pathocentric account of medicine provides a principled way of distinguishing conscientious objection from religious, idiosyncratic, and bigoted refusals. Patients’ refused pathology-inducing procedures are not medically harmed.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115652528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The debate about physician-assisted suicide has long been entwined with the nature of the doctor–patient relationship. Opponents of physician-assisted suicide insist that the traditional goals of medicine do not and should not include intentionally bringing about or hastening a patient’s death, whereas proponents of physician-assisted suicide argue that this practice is an appropriate tool for doctors to relieve a patient’s suffering. In this article, I discuss these issues in light of the relevance of a Christian account of the doctor–patient relationship. I argue that Christians typically object to assist suicide independently of the doctor–patient relationship. I argue that a focus on the Christian virtues of charity, compassion, and humility helps to explain why doctors should not assist their patients in suicide.
{"title":"Physicians, Assisted Suicide, and Christian Virtues","authors":"P. Reed","doi":"10.1093/CB/CBAA021","DOIUrl":"https://doi.org/10.1093/CB/CBAA021","url":null,"abstract":"\u0000 The debate about physician-assisted suicide has long been entwined with the nature of the doctor–patient relationship. Opponents of physician-assisted suicide insist that the traditional goals of medicine do not and should not include intentionally bringing about or hastening a patient’s death, whereas proponents of physician-assisted suicide argue that this practice is an appropriate tool for doctors to relieve a patient’s suffering. In this article, I discuss these issues in light of the relevance of a Christian account of the doctor–patient relationship. I argue that Christians typically object to assist suicide independently of the doctor–patient relationship. I argue that a focus on the Christian virtues of charity, compassion, and humility helps to explain why doctors should not assist their patients in suicide.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124519863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this article, we first give a normative account of the doctor–patient relationship as: oriented to the good of the patient’s health; motivated by a vocational commitment; and characterized by solidarity and trust. We then look at the difference that Christianity can, and we believe, should, make to that relationship, so understood. In doing so, we consolidate and expand upon some claims we have made in a forthcoming book, Ethics and the Healing Profession (Curlin and Tollefsen, 2021).1
{"title":"Solidarity, Trust, and Christian Faith in the Doctor–Patient Relationship","authors":"C. Tollefsen, F. Curlin","doi":"10.1093/CB/CBAA022","DOIUrl":"https://doi.org/10.1093/CB/CBAA022","url":null,"abstract":"\u0000 In this article, we first give a normative account of the doctor–patient relationship as: oriented to the good of the patient’s health; motivated by a vocational commitment; and characterized by solidarity and trust. We then look at the difference that Christianity can, and we believe, should, make to that relationship, so understood. In doing so, we consolidate and expand upon some claims we have made in a forthcoming book, Ethics and the Healing Profession (Curlin and Tollefsen, 2021).1","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130554960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Perinatal palliative and hospice care (hereafter, perinatal hospice) is a novel approach to addressing a family’s varied needs following an adverse in utero diagnosis. Christian defenses of perinatal hospice tend to focus on its role as an ethical alternative to abortion. Although these analyses are important, they do not provide adequate grounds to characterize the wide range of goods realized through this compassionate form of care. This essay draws on an analysis of the Christian virtue of humility to highlight the ways a Christian virtue-based defense of perinatal hospice can account for these goods. I argue that humility can play an important facilitating role in helping Christian physicians to meet the needs of families in profoundly difficult circumstances.
{"title":"Christian Humility and the Goods of Perinatal Hospice","authors":"Aaron Cobb","doi":"10.1093/CB/CBAA017","DOIUrl":"https://doi.org/10.1093/CB/CBAA017","url":null,"abstract":"\u0000 Perinatal palliative and hospice care (hereafter, perinatal hospice) is a novel approach to addressing a family’s varied needs following an adverse in utero diagnosis. Christian defenses of perinatal hospice tend to focus on its role as an ethical alternative to abortion. Although these analyses are important, they do not provide adequate grounds to characterize the wide range of goods realized through this compassionate form of care. This essay draws on an analysis of the Christian virtue of humility to highlight the ways a Christian virtue-based defense of perinatal hospice can account for these goods. I argue that humility can play an important facilitating role in helping Christian physicians to meet the needs of families in profoundly difficult circumstances.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114296159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biological sex should be “acknowledged” and “accepted”—but which responses to gender dysphoria might this preclude? Trans-identified people may factually acknowledge their biological sex and regard transition as purely palliative. While generally some level of self-deception and even a high level of nonlying deception of others are sometimes justified, biological sex is important, and there is a nontrivial onus against even palliative, nonsexually motivated cross-dressing. The onus is higher against co-opting the body, even in a minor and/or reversible way, to make a false communication concerning one’s sex. Hardest to defend is the destruction of sexual–reproductive functions and causally downstream functions such as lactation: due to the transcendent nature of sexual–reproductive functions, an appeal to the “principle of totality” here is misplaced. This is not to say that social, and milder medical, transition is absolutely excluded even for severe unmanageable dysphoria, nor that subsequent to any transition, detransition is necessarily required.
{"title":"Social and Medical Gender Transition and Acceptance of Biological Sex","authors":"H. Watt","doi":"10.1093/cb/cbaa015","DOIUrl":"https://doi.org/10.1093/cb/cbaa015","url":null,"abstract":"\u0000 Biological sex should be “acknowledged” and “accepted”—but which responses to gender dysphoria might this preclude? Trans-identified people may factually acknowledge their biological sex and regard transition as purely palliative. While generally some level of self-deception and even a high level of nonlying deception of others are sometimes justified, biological sex is important, and there is a nontrivial onus against even palliative, nonsexually motivated cross-dressing. The onus is higher against co-opting the body, even in a minor and/or reversible way, to make a false communication concerning one’s sex. Hardest to defend is the destruction of sexual–reproductive functions and causally downstream functions such as lactation: due to the transcendent nature of sexual–reproductive functions, an appeal to the “principle of totality” here is misplaced. This is not to say that social, and milder medical, transition is absolutely excluded even for severe unmanageable dysphoria, nor that subsequent to any transition, detransition is necessarily required.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125375638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Technological change and the growth of technocratic approaches to government have gone hand-in-hand with the development of secular transhumanism in the West. The result is a perfect storm for the onset of cultural or “soft” totalitarianism in what during the Cold War was known as the “Free World.” Accelerating political opposition to traditional and biological definitions of sex, and to traditional marriage and family networks in Christian contexts, has undermined anthropological and value assumptions basic to self-government. Paradoxically, in this post-Cold War environment, Russian culture now provides a model for renewing the Christian understanding of sex related to defining freedom as self-restraint. Specifically, that model is that of the Russian Orthodox Christian anthropology of sex and its related theological tradition.
{"title":"Totalitarian Transhumanism versus Christian Theosis: From Russian Orthodoxy with Love","authors":"A. Siewers","doi":"10.1093/cb/cbaa013","DOIUrl":"https://doi.org/10.1093/cb/cbaa013","url":null,"abstract":"Technological change and the growth of technocratic approaches to government have gone hand-in-hand with the development of secular transhumanism in the West. The result is a perfect storm for the onset of cultural or “soft” totalitarianism in what during the Cold War was known as the “Free World.” Accelerating political opposition to traditional and biological definitions of sex, and to traditional marriage and family networks in Christian contexts, has undermined anthropological and value assumptions basic to self-government. Paradoxically, in this post-Cold War environment, Russian culture now provides a model for renewing the Christian understanding of sex related to defining freedom as self-restraint. Specifically, that model is that of the Russian Orthodox Christian anthropology of sex and its related theological tradition.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133711687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Christian Bioethics: Sex and/or Gender?","authors":"M. Cherry","doi":"10.1093/CB/CBAA009","DOIUrl":"https://doi.org/10.1093/CB/CBAA009","url":null,"abstract":"","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114393937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this article1 is to provide insight into the anthropological framework that could inform the pastoral and therapeutic care of those we encounter, professionally or in our personal lives, who experience same-sex attraction (SSA). Our question here is not whether or not persons are free to ignore the natural order but to consider how to minister to those who wish to engage in the struggle to conform themselves to it—or those whom we hope to persuade to do so. Since entering into such conversations often requires a starting place in experience, we need an approach that will permit us to integrate human experience into a fuller account of the human person. The thesis of this article is that the account of the human person proposed by Pope St. John Paul II, as the philosopher Karol Wojtyła provides the answers we need. I demonstrate that his approach permits us to acknowledge the experience of actual existing persons without compromising the more properly “ontological” framework that we know reveals the unchanging truth about human personhood.2 I show that his account gives us the foothold we are seeking in our efforts to help those struggling with SSA.
{"title":"When the Starting Place Is Lived Experience: The Pastoral and Therapeutic Implications of John Paul II’s Account of the Person","authors":"D. Savage","doi":"10.1093/cb/cbaa012","DOIUrl":"https://doi.org/10.1093/cb/cbaa012","url":null,"abstract":"\u0000 The aim of this article1 is to provide insight into the anthropological framework that could inform the pastoral and therapeutic care of those we encounter, professionally or in our personal lives, who experience same-sex attraction (SSA). Our question here is not whether or not persons are free to ignore the natural order but to consider how to minister to those who wish to engage in the struggle to conform themselves to it—or those whom we hope to persuade to do so. Since entering into such conversations often requires a starting place in experience, we need an approach that will permit us to integrate human experience into a fuller account of the human person. The thesis of this article is that the account of the human person proposed by Pope St. John Paul II, as the philosopher Karol Wojtyła provides the answers we need. I demonstrate that his approach permits us to acknowledge the experience of actual existing persons without compromising the more properly “ontological” framework that we know reveals the unchanging truth about human personhood.2 I show that his account gives us the foothold we are seeking in our efforts to help those struggling with SSA.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131015739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drawing on Hegel, Judith Butler argues that the subject is the product of its desire for subject-ion. The subject, its gender, and even the sexed body itself come into being through reiterating or parodying preexisting norms and discourses of power (“performativity”). Butler rejects the realities of substance and a fixed human nature that would limit the possibilities of performativity. I summarize and assess Butler’s proposals, highlighting both the value and the drawbacks of her theory. I then show how John Paul II’s understanding of meaning and of the body as tasks takes up what is positive in Butler. He escapes the pitfalls of her thought, however, by retaining both metaphysics and revelation. He argues that the subject exists as substance or suppositum, which defends it against the encroachment of power. He also insists on the importance of human nature, which makes the human person to be the kind of substance who can form herself through the God-given task of creative action directed toward meaningful self-gift. Lastly, John Paul II emphasizes that the divine power of God enables the person to transcend the power dynamics of the culture of death.
{"title":"A Wojtyłian Reading of Performativity and the Self in Judith Butler","authors":"A. Franks","doi":"10.1093/cb/cbaa011","DOIUrl":"https://doi.org/10.1093/cb/cbaa011","url":null,"abstract":"Drawing on Hegel, Judith Butler argues that the subject is the product of its desire for subject-ion. The subject, its gender, and even the sexed body itself come into being through reiterating or parodying preexisting norms and discourses of power (“performativity”). Butler rejects the realities of substance and a fixed human nature that would limit the possibilities of performativity. I summarize and assess Butler’s proposals, highlighting both the value and the drawbacks of her theory. I then show how John Paul II’s understanding of meaning and of the body as tasks takes up what is positive in Butler. He escapes the pitfalls of her thought, however, by retaining both metaphysics and revelation. He argues that the subject exists as substance or suppositum, which defends it against the encroachment of power. He also insists on the importance of human nature, which makes the human person to be the kind of substance who can form herself through the God-given task of creative action directed toward meaningful self-gift. Lastly, John Paul II emphasizes that the divine power of God enables the person to transcend the power dynamics of the culture of death.","PeriodicalId":416242,"journal":{"name":"Christian bioethics: Non-Ecumenical Studies in Medical Morality","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122384550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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