Pluralism and ethical dialogue in Christian healthcare institutions: the view of Caritas Catholica Flanders.

In this article, the place and the nature of an ethical dialogue that develops within Christian healthcare institutions in Flanders, Belgium is examined. More specifically, the question is asked how Christian healthcare institutions should position themselves ethically in a context of a pluralistic society. The profile developed by Caritas Catholica Flanders must take seriously not only the external pluralistic context of our society and the internal pluralistic worldviews by personnel/employees and patients, but also the inherent inspiration of a Christian healthcare institution. This article concludes with ten general orientations that could shape the ethical dialogue from a Christian inspiration in a pluralistic context.     

The Christian physician in the non-Christian institution: objections of conscience and physician value neutrality.

Christian physicians are in danger of losing the right of conscientious objection in situations they deem immoral. The erosion of this right is bolstered by the doctrine of "physician value neutrality" (PVN) which may be an impetus for the push to require physicians to refer for procedures they find immoral. It is only a small step from referral to compelling performance of these same procedures. If no one particular value is more morally correct than any other (a foundational PVN premise) and a physician ought to be value neutral, than conscientious objection to morally objectionable actions becomes a thing of the past. However, the argument for PVN fails. Therefore, Christian physicians should state their values openly, which would allow patients the ability to choose like-minded physicians. Some possible responses to this erosion of conscientious objection include, disengagement from non-Christian institutions, the formation of distinctly Christian medical institutions and political action. However, for the Christian the initial focus should be on a life of holiness which requires each of us to avoid evil.     

In the world but not of it: managing the conflict between Christian and institution.

Christian physicians, nurses and other health care workers must manage a daily conflict of conscience between their Christian faith and predominantly secular health care institutions. This essay examines various efforts for managing these conflicts: a turn towards social justice or a seeking of holiness. Seeking social justice, however, is theologically empty. Traditionally, the Christian requirement that we be "in this world but not of it" requires a journey along a narrow path to holiness. Christian medical morality must, therefore, be understood within this light. However, just as there cannot be generic health care, but rather health care for a particular person's needs and problems there cannot be generic holiness, but only a holiness grounded in worshiping God rightly. In so worshiping the Christian will be assisted in negotiating the inescapable and perilous vocation of being in the world but not of it.     

A Christian philosopher's view of recent directions in the abortion debate.

From the standpoint of a Christian philosopher, heeding the teaching and exhortations of Pope John Paul II and previous popes, I examine three directions in which the recent philosophical debate has developed. In the last seven or eight years there has been 1) a renewed focus on the biological issue of when a human individual comes to be, 2) new arguments for the proposition that personhood is a characteristic acquired after birth, and 3) refinements of the early argument of Judith Thomson. Replying to these developments, I defend, on philosophical grounds, the pro-life position. I argue that a distinct, whole (though immature) human individual comes to be at conception, that he or she is a person, with full moral worth, from the moment he or she comes to be, and the mothers and fathers have a special responsibility to their children which entails (at least) that they ought not to choose to abort them. I conclude by briefly indicating, from the standpoint of Christian faith, why Christian philosophers should vigorously pursue this debate.     

Decisions at the end of life: Catholic tradition.

Medical decisions regarding end-of-life care have undergone significant changes in recent decades, driven by changes in both medicine and society. Catholic tradition in medical ethics offers clear guidance in many issues, and a moral framework accessible to those who do not share the same faith as well as to members of its faith community. In some areas, a Catholic perspective can be seen clearly and confidently, such as in teachings on the permissibility of suicide and euthanasia. In others, such as withdrawal of nutrition and hydration, the Church does not yet speak with one voice and has not closed out the discussion. Yet, it is not in the teaching on individual issues that a Catholic moral tradition offers the most help and comfort, but in its account of what it means to lead a life in Christ, and to prepare for a Christian death. As in the problem of pain and suffering, it is the spiritual support more than the ethical guidance that helps both patients and physicians bear the unbearable and fathom the unfathomable.     

Caring for the Caregivers: An Investigation of Factors Related to Well-Being Among Parents Caring for a Child with Smith-Magenis Syndrome

Smith-Magenis syndrome (SMS) is a complex disorder characterized by numerous challenges, including intellectual disability, speech delay, decreased pain sensitivity, sleep disturbances, hyperactivity, mood instability, and self-injury. Caregivers must readily adapt to the ever-changing needs of the child. Due to these demands, caregivers may encounter difficulties maintaining their own level of well-being. Thus, a total of 112 primary caregivers (i.e., parents) of individuals diagnosed with SMS responded to online questionnaires to assess demographic and psychosocial factors, such as perceptions of child health vulnerability, benefit finding, sleep behaviors, anxiety and depression symptomatology, and caregiver satisfaction and self-efficacy, which may be related to caregiver well-being. Results show that, among mothers, caregiver well-being was directly related to perceived child health vulnerability, caregiver satisfaction, and benefit finding, and a significant moderating effect was observed for depression/anxiety counseling after beginning the caregiver role on the relationship between anxiety symptomatology and caregiver well-being. Results further suggest that maternal caregivers who report high levels of anxiety but do not seek counseling fair the worst in terms of well-being. Among fathers, lower depression symptoms and greater benefit finding were related to higher levels of caregiver well-being. These data show that many factors play roles in influencing coping and well-being among SMS caregivers. Investigating these variables and relationships may reveal additional resources and interventions to assist primary caregivers.     

Sedation and care at the end of life

This special issue of Theoretical Medicine and Bioethics takes up the question of palliative sedation as a source of potential concern or controversy among Christian clinicians and thinkers. Christianity affirms a duty to relieve unnecessary suffering yet also proscribes euthanasia. Accordingly, the question arises as to whether it is ever morally permissible to render dying patients unconscious in order to relieve their suffering. If so, under what conditions? Is this practice genuinely morally distinguishable from euthanasia? Can one ever aim directly at making a dying person unconscious, or is it only permissible to tolerate unconsciousness as an unintended side effect of treating specific symptoms? What role does the rule of double effect play in making such decisions? Does spiritual or psychological suffering ever justify sedation to unconsciousness? What are the theological and spiritual aspects of such care? This introduction describes how the authors in this special issue wrestle with such questions and shows how each essay relates to the author’s individual position on palliative sedation, as developed in greater detail within his contribution.     

Caring for the Care-Giver: The Benefit of a Peer Supervision Group

I presented the following case to my leader-led peer supervisiongroup twice as the case evolved over the course of one year. During my firstmeetings with Mr. and Mrs. M we discussed a prenatal diagnosis of a skeletaldysplasia at thirty-three weeks of pregnancy and the option of a third trimesterpregnancy termination. One year later I presented follow-up on the outcome ofthe affected pregnancy, a new pregnancy, and Mrs. M's suicide. Although bothsegments of the case were completed by the time I presented, my peersupervision group was invaluable. With the encouragement and support of groupmembers, I could openly express and process my sadness and grief for the M'ssituation and the loss of Mrs. M's life.     

The study of a Christian 12-Step Program for Christian Smartphone-Addicted Adolescents: A Biblical Perspective

Journal of Religion and Health - The aim of this study was to explore the suitability of a Christian 12-step program based on a biblical perspective for smartphone-addicted adolescents. The study...     

Care versus treatment at the end of life for profoundly disabled persons

Individuals who are profoundly mentally handicapped do not have the capacity to make their own decisions and also do not have a past record of decisions, from when they had capacity, to guide us in making decisions for them. They represent a difficult group, ethically, for surrogate decision making. Here I propose some guidelines, distinguishing between these patients and patients in a persistent vegetative state (PVS). As the life span of patients becomes shorter, or their level of consciousness becomes permanently impaired, the presumption for comfort care should become an imperative, and the standard of evidence to justify any invasive intervention should become higher. For members of this population, who have no more ability to refuse treatment than to consent to it, protection of the vulnerable must mean allowing a peaceful death as well as a comfortable life. Reasonable legal safeguards are also proposed to allow improved end-of-life decisions to be made for this population.     

Mother versus stranger: a triadic situation of imitation at the end of the first year of life

This study presents two experiments investigating 8‐ and 12‐month‐old infants' imitative behaviour. Seventy‐two 8‐month‐olds and seventy‐two 12‐month‐olds were observed in a triadic situation which included their mother and a stranger. Depending on the condition, either the mother or the stranger acted as the demonstrator and either stayed close or withdrew after the demonstration, during the response period. In addition to imitative acts, visual exploration and smiles addressed, respectively, to each partner were computed. Results showed that at both ages, neither the familiarity nor the position of the partner has an effect on the number of target gestures that are imitated. At 12 months, infants looked and smiled more at the stranger when he demonstrated target actions but no difference was found when the mother acted as demonstrator. Moreover, 12‐month‐old infants looked more at the demonstrating partner immediately after their first imitation. At 8 months, infants paid more attention to the stranger in all conditions except when the mother performed the target actions and moved away, a pattern that suggests a referencing to the mother. Results from the gaze and smile variables suggest that with age different motivations (social contact, exploration of objects) induce imitation. Copyright © 2003 John Wiley & Sons, Ltd.     

浅论《性命圭旨》中的性命观

"性命"是中国传统哲学的一对基本范畴,是儒、释、道、三家都关注的重要问题,但各家对其的理解和解释却不尽相同.<性命主旨>通过三教合通来阐释道教内丹学,融合中国传统文化中儒、释、道三家性命学的精髓,力倡性命双修,坚持性功、命功并重亦即精、气、神兼炼的原则,反对孤修一物.道教内丹是从后天的神气入手,其目的是修先天的元神、元气,最后神气合炼,提炼出元神.正是在这层意义上,该书尤其重视修心,并认为儒、释、道三家得以融合的核心就是"心性".