Linacre Quarterly最新文献

Although the opioid epidemic and fentanyl crisis are nationwide problems of immense proportions, calming the storm raging across the isolating geo-economic framework of Appalachia demonstrates the need for courageous, culturally effective programs that have the power to address and overcome the grave situation of addiction in this region. In the Appalachian region, unjust social structures are embedded in the communities' socio-economic conditions. As this reality poses even greater barriers to addressing the opioid epidemic in these communities, the restoration of social relationships within a community becomes vital to the development of a broader approach to social functioning and human flourishing. Faith traditions and faith communities can play an important role in helping to establish and support such social cohesion through attention to the individual, social, and spiritual needs of the community. This essay explores the complex problem of the opioid epidemic compounded by the fentanyl crisis. It considers the importance of public health research within the regional geo-economic framework of Appalachia to (a) inform policies that improve health inequities and promote social cohesion, (b) develop social solutions with a spiritual dimension, and (c) reveal remedies capable of informing moral norms in support of building a more just society. Reflecting on the virtue of solidarity, this essay also highlights the witness of the Catholic Church's response to the suffering experienced within the communities and the societies within the Appalachian mountains. While there may be considerable interest in viewing this article as a research document, foundationally, this essay utilizes a literary narrative approach through a Catholic lens to inform ethical deliberations, reasoning, and practice while supporting ethical reflection and consideration of the responses raised. Further, the reader is strongly encouraged to reference the comprehensive footnote system provided for extension and verification of the data presented.

Editor's note: Organ transplantation and the associated ethical topics such as the criteria for brain death continue to be of critical interest to Catholics, both physician and lay. Thirty years ago, Fr. Joseph Howard took a look at the philosophical and moral aspects of organ transplantation, and his words are still relevant today. New, recent insights into the residual functioning of the brain in the face of extensive injuries pose an additional question for Catholic physicians: to what extent do we owe a duty to our patients to explain to them the nature of the uncertainties and debates surrounding both donation and transplantation, in order for them to make an informed decision for themselves or their loved ones? Linacre Quarterly. 1994 Nov;61(4):57-64.

In a published report of suicidal ideation rates drawn from the Turnaway Study, the abortion advocacy group Advancing New Standards in Reproductive Health (ANSIRH) asserted that their findings proved that abortion has no effect on suicidal ideation. Therefore, laws requiring notification of abortion's link to higher suicide rates were not based on good science. But how good is the science ANSIRH offers to displace the evidence of an abortion-suicide connection? The Turnaway Study upon which they rely is drawn from a non-random, non-representative convenience sample that suffered from a 68% refusal rate and a 50% attrition rate. No conclusions applicable to the general population of aborting women can be drawn from such a sample. Moreover, on closer examination, ANSIRH's suicidal ideation trajectory analysis is severely flawed and violates Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Basic and critical information is withheld, specifically the mean scores and number of women identified as having suicidal thoughts. Instead, readers are provided with only highly massaged results from a mixed-effects logistic regression employing thirteen covariates that appear to have been chosen precisely to water down the confidence intervals to such a high degree that virtually nothing was statistically significant. In addition, ANSIRH suggested that an attrition analysis of three of the covariates used strengthened the reliability of their finding. However, the fact that they chose not to report on attrition rates associated with the other ten covariates, much less the two outcome variables related to suicidal ideation, actually exposes the falsity of this reliability claim. Rather than proving that abortion has no effect on suicidal behaviors, ANSRIH's published analysis provides evidence of deliberate obfuscation and disinformation by a group funded and dedicated to the expansion of abortion rates around the world.

The Divine Physician is a traditional title that the Church gives to Jesus Christ. This metaphor helps symbolize Jesus's mission to heal our souls of sin and its effects. In this paper, I consider this metaphor as a source for understanding the vocation of the Catholic physician. Understanding that the role of the laity is to communicate the divine law to the world, I argue that this title raises the human physician's dignity to the status of an image of Christ's saving activity in the clinic. This paper roots this dignity in the supernatural life of grace by giving both a philosophical and a theological exposition of the metaphor of the Divine Physician.

Hopelessness and demoralization following a terminal diagnosis can affect the capacity for self-governance. Such dispositions can increase the allostatic load-the cumulative burden of stress and anxiety-resulting in a neurophysiologic decline that can impair autonomy and influence the desire to end one's life deliberately. An allostatic overload is characterized by the inability to autoregulate stress and is associated with pathological changes to the hypothalamic-pituitary-adrenal axis and hippocampus. These changes raise concerns about the reliability of concepts of autonomy in extremis, potentially undermining arguments that are used to justify voluntary euthanasia and medically assisted death. Studies have associated depression and hopelessness with suicidal ideation in the general population. However, fewer studies have examined how patients without a history of depression or suicidal ideation may suddenly contemplate the act when facing a terminal prognosis. This paper will argue that an allostatic overload can help explain how the spectrum of physical and psychological comorbidities associated with the onset of a terminal illness can influence a decision to hasten death. Data show that patients with a terminal disease wishing to hasten death typically exhibit lower rates of clinical depression, higher rates of demoralization, and a greater likelihood of rational suicide. These differences indicate that suicidal ideation in the terminal disease patient population is different. Changes in autonomous decision-making secondary to pathological alterations in the brain may offer an explanation. Such changes have been shown to dysregulate executive control functions, specifically intentionality and voluntariness. Clinical evidence also indicates that spirituality and hopefulness can help manage the allostatic load during the palliative stages of a disease so that patients can better process end-of-life decisions. Based on these data, this paper will further argue that jurisdictions offering euthanasia are morally compelled to make mental and spiritual counseling available to patients seeking this course of action.

Human dignity refers to the value of the human person. By clarifying distinctions within human dignity, we can conclude that, whereas a person's ontological dignity cannot be lost or diminished regardless of circumstance, a person's existential, moral, or social dignity can be impaired. We describe the state of impaired existential, moral, or social dignity as a dignity disorder, which is defined by the criteria of: impaired rationality; impaired will; impaired capacity to love; and impaired body. We further demonstrate how addiction can be characterized as a dignity disorder with the associated benefit of emphasizing a personalist approach to addiction treatment with the principal intent of promoting existential, moral, and social dignity, which entails: restoring agency, self-efficacy, and freedom of choice; reconciling the internal conflict of akrasia; restoring loving, disinterested relationships; and healing the dysfunctional neuroadaptations and medical sequelae of substance use. This nosology reveals that the distinction between addiction as a choice and addiction as a disease is a false dichotomy; rather, addiction represents an impairment in both body and spirit. By incorporating the criteria of love, this nosology also reveals that addiction is an issue of both personal and societal responsibility.

This paper sets forth some philosophical foundations of the transhumanist project, drawing on its roots in philosophical positivism and its confidence in the liberating power of technology. Such confidence is interpreted within the sphere of hope, departing from transhumanism's negative presumptions regarding the human condition, and embracing its aspirations for a humanity without limits. However, it is the claim of this paper that such hope is deceptive. Since transhumanism is incapable of grasping the depths of the human person, limited by its own philosophical categories, it both underestimates the human capacity for interior transformation and misunderstands the real nature of hope. Thus, transhumanism is marked by a deeply rooted despair that wears the mask of an insufficient hope.

After being outlawed in 1970, psychedelics have reemerged in the consciousness of Western society in the form of the so-called psychedelic renaissance. This has led to widespread interest in psychedelic compounds being used for recreation, treatment of mental illness and addiction, and even the so-called "enhancement" of individuals and society. This renewed interest in psychedelics has resulted in seemingly endless publications in both the popular and the academic press, including authors from fields as diverse as philosophy, theology, pharmacology, neuroscience, and clinical medicine. A common thread in this developing literature is the claim that psychedelic compounds mediate their reported benefits by inducing the so-called psychedelic mystical experience (PME). The nature of PME is hotly debated, with some claiming that it is entirely psychological and others proposing that it involves contact with extramental reality. This raises a number of important questions for Catholics, especially whether PME should be considered properly "mystical," how PME compares with traditionally understood Catholic mysticism, and whether, and if so under what conditions, psychedelics could be licitly used by the Catholic faithful. This paper is an attempt to begin the process of reconciling empiric scientific data regarding psychedelics generally, and PME specifically, with Catholic philosophical and theological considerations, with the goal of both providing recommendations regarding the licitness of the use of psychedelic compounds and inviting conversation about this important and challenging topic.

Summary: Over the past 20 years, there has been a renewed interest in of psychedelics. Many articles have been published extoling the benefits of psychedelics, including for the treatment of mental illness and addiction, recreation, and "enhancement" of individuals and society. A common claim is that the benefits of psychedelics are a result of the psychedelic mystical experience (PME). This paper considers both the use of psychedelics and PME from the perspective of Catholic theology, provides recommendations about their use for the Catholic faithful, and invites further conversation about this important and challenging topic.

Short summary: This paper considers challenges posed by psychedelics, considers licitness of use, and calls for further discussion.