Abstract This investigation develops in three steps. First, we seek to complexify the opioid crisis in a way that helps us to see how the issues of misguided desire and misplaced attachments are fundamentally important for a theological account of opioid addiction.1 Second, acknowledging the connections between pain and opioid addiction, we explore some of the ways in which our understanding of pain can influence our understanding of and responses to opioid use. Finally, we offer some tentative reflections on the theological and ecclesial dimensions of the opioid crisis which hold the potential to influence the nature of a Christian response to the issues. Having laid out these steps, we argue for the church’s calling, where she complexifies the narratives about the opioid crisis and provides individuals suffering from opioid use “homeful” encounters with God and the community.
{"title":"Faithfully Describing and Responding to Addiction and Pain: Christian “Homefulness” and Desire","authors":"John Swinton, Emmy Yang","doi":"10.1093/cb/cbad022","DOIUrl":"https://doi.org/10.1093/cb/cbad022","url":null,"abstract":"Abstract This investigation develops in three steps. First, we seek to complexify the opioid crisis in a way that helps us to see how the issues of misguided desire and misplaced attachments are fundamentally important for a theological account of opioid addiction.1 Second, acknowledging the connections between pain and opioid addiction, we explore some of the ways in which our understanding of pain can influence our understanding of and responses to opioid use. Finally, we offer some tentative reflections on the theological and ecclesial dimensions of the opioid crisis which hold the potential to influence the nature of a Christian response to the issues. Having laid out these steps, we argue for the church’s calling, where she complexifies the narratives about the opioid crisis and provides individuals suffering from opioid use “homeful” encounters with God and the community.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"9 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134909071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract For most of the past generation, clinicians have been taught to treat patients' pain until the patient says it is relieved. The opioid crisis has forced both clinicians and patients to reconsider that approach. This essay considers how Christians in particular might assume and seek to overcome their experiences of persistent pain. Wise and faithful responses to pain, especially chronic pain, can take their bearings from how early Christians made sense of the place of both medicine and suffering in a faithful life. This results in not asking medicine to resolve persistent pain, especially not through the use of opioids. Resisting the impulse to medicalize chronic pain will require patience on the part of those who suffer, and both patience and fortitude on the part of the clinicians to whom they present.
{"title":"Responding Wisely to Persistent Pain: Insights from Patristic Theology and Clinical Experience","authors":"Farr A Curlin","doi":"10.1093/cb/cbad020","DOIUrl":"https://doi.org/10.1093/cb/cbad020","url":null,"abstract":"Abstract For most of the past generation, clinicians have been taught to treat patients' pain until the patient says it is relieved. The opioid crisis has forced both clinicians and patients to reconsider that approach. This essay considers how Christians in particular might assume and seek to overcome their experiences of persistent pain. Wise and faithful responses to pain, especially chronic pain, can take their bearings from how early Christians made sense of the place of both medicine and suffering in a faithful life. This results in not asking medicine to resolve persistent pain, especially not through the use of opioids. Resisting the impulse to medicalize chronic pain will require patience on the part of those who suffer, and both patience and fortitude on the part of the clinicians to whom they present.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"13 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134909080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract This essay examines the interconnected nature of salvation and health, and it does so by engaging both recent qualitative research and three scriptural accounts from the life, death, and resurrection of Jesus. In doing so, the essay argues that salvation and health—and their conceptual pairings, sin and disease—are never individualistic. These realities are always cosmic, communal, and interpersonal, even as sin and disease are fundamentally disintegrating and isolating. The salvation and health of people suffering with substance use issues are bound up with the transformations of governing principalities and powers, social realities, and relationships. Health care practitioners and clergy should be wise, communal guides offering care and accompaniment in the pursuit of salvation and health.
{"title":"Salvation and Health in Southern Appalachia: What the Opioid Crisis Reveals about Health Care and the Church","authors":"Brett McCarty","doi":"10.1093/cb/cbad019","DOIUrl":"https://doi.org/10.1093/cb/cbad019","url":null,"abstract":"Abstract This essay examines the interconnected nature of salvation and health, and it does so by engaging both recent qualitative research and three scriptural accounts from the life, death, and resurrection of Jesus. In doing so, the essay argues that salvation and health—and their conceptual pairings, sin and disease—are never individualistic. These realities are always cosmic, communal, and interpersonal, even as sin and disease are fundamentally disintegrating and isolating. The salvation and health of people suffering with substance use issues are bound up with the transformations of governing principalities and powers, social realities, and relationships. Health care practitioners and clergy should be wise, communal guides offering care and accompaniment in the pursuit of salvation and health.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135753947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract While the COVID-19 pandemic riveted public attention on questions regarding how to respond reasonably to risk of illness, everyday medical care involves more mundane forms of pharmaceutical risk management for conditions like high blood pressure, prediabetes, or high cholesterol. This essay, and the collection it introduces, explore medicalization of risk as a theological problem, drawing on resources such as the Sermon on the Mount that caution us about the potential dangers of risk management to Christian discipleship. Medicalization of risk threatens to become an idol that promises immanent security at the cost of one’s relationship with God and others. It misleads contemporary society as to the true human end and medicine’s own capabilities to provide temporal salvation. The essays in this special issue illustrate these problems with respect to pharmaceutical risk management.
{"title":"Theological and Ethical Problems with Medicalizing Risk","authors":"Farr Curlin, Paul Scherz","doi":"10.1093/cb/cbad011","DOIUrl":"https://doi.org/10.1093/cb/cbad011","url":null,"abstract":"Abstract While the COVID-19 pandemic riveted public attention on questions regarding how to respond reasonably to risk of illness, everyday medical care involves more mundane forms of pharmaceutical risk management for conditions like high blood pressure, prediabetes, or high cholesterol. This essay, and the collection it introduces, explore medicalization of risk as a theological problem, drawing on resources such as the Sermon on the Mount that caution us about the potential dangers of risk management to Christian discipleship. Medicalization of risk threatens to become an idol that promises immanent security at the cost of one’s relationship with God and others. It misleads contemporary society as to the true human end and medicine’s own capabilities to provide temporal salvation. The essays in this special issue illustrate these problems with respect to pharmaceutical risk management.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135380513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract This article reflects on the intersection of the New Testament’s witness with current questions of illness, medication, risk, luck, death, and hope. Drawing principally on the Gospel of Matthew and the letters of Paul, I argue that, for Christians, hope in the resurrection—not the ability to avoid suffering and death—provides the best context for prudential judgment in light of the inscrutability of the future and the concomitant opacity that attends medical decision-making. We do not and will not know what we would need to know in order to make decisions we can count on with surety, and we thus read Scripture in order to become the people who can make wise judgments in the meantime called hope.
{"title":"Theology, Medicalization, and Risk: Observations from the New Testament","authors":"C Kavin Rowe","doi":"10.1093/cb/cbad008","DOIUrl":"https://doi.org/10.1093/cb/cbad008","url":null,"abstract":"Abstract This article reflects on the intersection of the New Testament’s witness with current questions of illness, medication, risk, luck, death, and hope. Drawing principally on the Gospel of Matthew and the letters of Paul, I argue that, for Christians, hope in the resurrection—not the ability to avoid suffering and death—provides the best context for prudential judgment in light of the inscrutability of the future and the concomitant opacity that attends medical decision-making. We do not and will not know what we would need to know in order to make decisions we can count on with surety, and we thus read Scripture in order to become the people who can make wise judgments in the meantime called hope.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135288213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Beginning in the nineteenth century, social statistics inspired a vision of society as a population characterized by a certain distribution of risks. The introduction of the risk paradigm has deep implications for central concepts in Christian social ethics like distributive justice, with this vision leading to a new concept of distributive justice as the equal distribution of risk. This essay describes tensions that arise due to the risk paradigm in relation to distributive justice: risks can always be further reduced, risk mitigation creates other risks, and there is no inherent rule of justice for balancing risks. While recognition of shared risk can create social cohesion, it also leads to interest groups struggling over which risks to confront. The essay illustrates these problems with two examples from health care: preventive health programs that manage disease risk through medication, and debates over school closures in respond to the Covid pandemic. Christian bioethics, as it wrestles with issues of justice, must address the problems created by the risk paradigm.
{"title":"No Acceptable Losses: Risk, Prevention, and Justice","authors":"Paul Scherz","doi":"10.1093/cb/cbad013","DOIUrl":"https://doi.org/10.1093/cb/cbad013","url":null,"abstract":"Abstract Beginning in the nineteenth century, social statistics inspired a vision of society as a population characterized by a certain distribution of risks. The introduction of the risk paradigm has deep implications for central concepts in Christian social ethics like distributive justice, with this vision leading to a new concept of distributive justice as the equal distribution of risk. This essay describes tensions that arise due to the risk paradigm in relation to distributive justice: risks can always be further reduced, risk mitigation creates other risks, and there is no inherent rule of justice for balancing risks. While recognition of shared risk can create social cohesion, it also leads to interest groups struggling over which risks to confront. The essay illustrates these problems with two examples from health care: preventive health programs that manage disease risk through medication, and debates over school closures in respond to the Covid pandemic. Christian bioethics, as it wrestles with issues of justice, must address the problems created by the risk paradigm.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135288057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract It is common wisdom that today’s medicine focuses too much on treating those who are sick and too little on preventing the sickness in the first place. This essay proposes that Jesus’ teaching in the Sermon on the Mount challenges that assumption and the preventive medicine to which it has given rise. In light of Jesus’ teaching, the essay identifies four apparent problems with much of preventive medicine. It then offers four heuristics that might form a basic Christian logic for medicalizing risk—for discerning when and why it would be fitting, wise, and faithful for Christians to make use of medicine to avoid future illness and death.
{"title":"“Sufficient for the day is its own trouble”: Medicalizing Risk and the Way of Jesus","authors":"Farr Curlin","doi":"10.1093/cb/cbad014","DOIUrl":"https://doi.org/10.1093/cb/cbad014","url":null,"abstract":"Abstract It is common wisdom that today’s medicine focuses too much on treating those who are sick and too little on preventing the sickness in the first place. This essay proposes that Jesus’ teaching in the Sermon on the Mount challenges that assumption and the preventive medicine to which it has given rise. In light of Jesus’ teaching, the essay identifies four apparent problems with much of preventive medicine. It then offers four heuristics that might form a basic Christian logic for medicalizing risk—for discerning when and why it would be fitting, wise, and faithful for Christians to make use of medicine to avoid future illness and death.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135287137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, by treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer.
{"title":"Protecting Life or Managing Risk? Suicide Prevention and the Lure of Medicalized Control","authors":"Warren Kinghorn","doi":"10.1093/cb/cbad010","DOIUrl":"https://doi.org/10.1093/cb/cbad010","url":null,"abstract":"Abstract Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, by treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135269022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Early in the COVID-19 pandemic in the United States, concern that there could be a shortage of ventilators raised the possibility of rationing care. Denying patients life-saving care captures our moral imagination, prompting the demand for a defensible framework of ethical principles for determining who will live and who will die. Behind the moral dilemma posed by the shortage of a particular medical good lies a broad moral geography encompassing important and often unarticulated societal values, as well as assumptions about the nature and purpose of health care and the consequences of long-standing choices about health care as a social good. This article explores what COVID-19 has exposed concerning values and choices around health care in the United States. Employing the lens of Catholic Social Thought, it argues for an approach to rationing that is grounded in respect for human dignity, committed to distributing social goods in light of the common good, and self-conscious about the construction of vulnerability to illness and death.
{"title":"Tragic Choices, Revisited: COVID-19 and the Hidden Ethics of Rationing","authors":"M. Ryan","doi":"10.1093/cb/cbab019","DOIUrl":"https://doi.org/10.1093/cb/cbab019","url":null,"abstract":"Abstract Early in the COVID-19 pandemic in the United States, concern that there could be a shortage of ventilators raised the possibility of rationing care. Denying patients life-saving care captures our moral imagination, prompting the demand for a defensible framework of ethical principles for determining who will live and who will die. Behind the moral dilemma posed by the shortage of a particular medical good lies a broad moral geography encompassing important and often unarticulated societal values, as well as assumptions about the nature and purpose of health care and the consequences of long-standing choices about health care as a social good. This article explores what COVID-19 has exposed concerning values and choices around health care in the United States. Employing the lens of Catholic Social Thought, it argues for an approach to rationing that is grounded in respect for human dignity, committed to distributing social goods in light of the common good, and self-conscious about the construction of vulnerability to illness and death.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"28 1","pages":"58 - 75"},"PeriodicalIF":0.3,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47248071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated.
{"title":"Medicine against Suicide: Sustaining Solidarity with Those Diminished by Illness and Debility","authors":"Farr A Curlin, Christopher Tollefsen","doi":"10.1093/cb/cbab010","DOIUrl":"https://doi.org/10.1093/cb/cbab010","url":null,"abstract":"The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated.","PeriodicalId":42894,"journal":{"name":"Christian Bioethics","volume":"18 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138541056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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