Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists

Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle.     

Christian Bioethics: Challenges in a Secularized Europe

This article summarizes in three specific sections the key challengesfaced by Christian and, particularly Orthodox, ethics in a secularizedsociety. The first section, focusing on the task and aim ofethics, defines Orthodox ethics, which is linked with asceticism(man's attempt to keep the commandments of Christ) and aimsat overcoming death and encountering the personal God. Put differently,the purpose of Orthodox ethics is the deification of human beings.The second section defines secularization and explores its consequencesfor the theology and pastoral work of the Church. Europe isdominated by scholasticism and moralism, whereas Orthodox theology,without rejecting it, transcends such a narrow preoccupationwith our own world. Orthodoxy does not regard human beings solelyfrom the perspective of their biological existence but assiststhem in going beyond mechanistic theories and the pursuit ofhappiness. The third section briefly describes how what canbe termed "bio-theology" surpasses anthropocentric ethics withregard to the relationship between creation and grace, birthand rebirth, cloning and incarnation, transplantation and deification,and death and resurrection. The article concludes that Orthodoxtheology (a) does not reject the achievements of biotechnologyor biomedicine; (b) assists humans in overcoming mortality byfinding meaning for their existence and fullness of life, and(c) does not simply postpone death, but overcomes the fear ofdeath and leads people to deification by grace.     

Clinical Geropsychology: Implications for Practice in Medical Settings

Older adults are a rapidly growing segment of the population, who have high rates of chronic illness and who utilize health care resources heavily. Psychologists must become better prepared to work with older patients in geriatric settings, including geriatric assessment units, memory disorders clinics, and nursing homes. In addition, all psychologists will increasingly encounter older patients in environments such as primary care clinics, rehabilitation settings, and disease management programs focusing on problems that are prevalent in older patients (e.g., cancer, diabetes). Suggestions are offered for adaptation of usual clinical practice to address the special needs of older patients and their families, and recommendations made for advancing and expanding the practice of clinical geropsychology.     

Help seeking for alcohol problems in a college population

Despite the availability of effective treatments for problem drinkers, only a minority seek professional assistance. The authors investigated the influences on help seeking for alcohol-related difficulties in two separate studies. In Study 1, 59 men and 74 women completed questionnaires regarding their alcohol use, related problems, readiness to change, and help-seeking interest. The authors also developed a measure of stigma related to alcohol help seeking. Problem recognition, anxiety symptoms, and stigma predicted a global rating of help-seeking. Students (22 men and 60 women) participated in Study 2, which incorporated a multi-item measure of help-seeking intentions as well as attitude and personality measures. Positive attitudes, less perceived stigma, and greater self-efficacy increased help seeking. The findings highlight the importance of both approach and avoidance factors that affect help-seeking decisions, and the authors suggest directions for further research.     

Towards a Confucian Virtue Bioethics: Reframing Chinese Medical Ethics in a Market Economy

This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics.     

Helper-Sufferer Similarity and a Specific Request for Help: Bystander Intervention During a Peace Demonstration

Eighty randomly selected male participants in the April 1971 pcace demonstration in Washington, D.C. were approached by a young women E v ho asked them to help her friend who was feeling ill. The "friend" was a young male E , in either conventional or "hip" clothing, who was displaying either a "Support Nixon" or a "Dump Nixon" sign. The dependent variable was a 5-point ordinal scale of cooperation with a series of specific requests, which ranged from going over to the distressed E to providing bus fare and help for both Es to leave the area and go home. All 80 Ss went to the E and 79 helped to some extent. There was more helping behavior in the morning than in the afternoon, when the program of activities had intensified; with Ss who were tested in the afternoon, the E displaying a "Support Nixon" sign attracted less helping behavior than the "Dump Nixon" condition. The dress manipulation (implicit attitudinal similarity) had no effect.     

Epilogue: Master of Health Science (MHSc) in Bioethics,International Stream at the University of Toronto Joint Centre for Bioethics

A major strength of this capacity building programme is that it encourages cross-cultural considerations in the application of research ethics principles to research in developing countries.