Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

Religious Influences on the Reproductive Health Decisions of HIV-Positive Latinas on the Border

The number of HIV-positive Latinas of child-bearing age living on the US–Mexico border is a growing concern. Little is known about how religious beliefs influence the reproductive health decisions of these women in light of disease demands and cultural and religious norms that support high fertility rates and childbearing. Such decisions may be further complicated by the stigma of HIV/AIDS and structural issues related to immigration status and trans-border lives. This paper analyzes extant literature and supports the need for further research so that policy makers and heath and social service providers can develop meaningful and comprehensive reproductive-health related interventions.     

Training and Education in Religion/Spirituality Within APA-Accredited Clinical Psychology Programs: 8 Years Later

This study was a follow up investigation of Brawer et al.’s (Prof Psychol Res Pr 33(2):203–206, 2002) survey of education and training of clinical psychologists in religion/spirituality. Directors of clinical training were surveyed to determine whether changes had occurred in the coverage of religion and spirituality through course work, research, supervision, and in the systematic coverage of the content area. Results indicated an increased coverage in the areas of supervision, dedicated courses, inclusion as part of another course, and research. There was no increase in systematic coverage, but significantly more programs provided at least some coverage. The current study also assesses other areas of incorporation as well as directors’ opinions regarding the importance of religion/spirituality in the field of psychology.     

Defining and Exploring Modesty in Jewish American Women

Whether culture-based modesty may be a barrier to women’s health care has been a longstanding question. Numerous studies have noted that, in certain cultures, modesty is considered a barrier to mammography screening and breast feeding. Though modesty has been noted as an inherent aspect of the lived experience of many cultures, no extant measures or clear definitions were found. Jewish women, some having strict rules regarding modesty, were sampled to understand their definition of modesty. These perspectives were objectively analyzed using Q methodology. We found that although some perspectives on modesty may be accounted for by culture, there are others that are not.     

‘There is a Time to be Born and a Time to Die’ (Ecclesiastes 3:2a): Jewish Perspectives on Euthanasia

Reviewing the publications of prominent American rabbis who have (extensively) published on Jewish biomedical ethics, this article highlights Orthodox, Conservative and Reform opinions on a most pressing contemporary bioethical issue: euthanasia. Reviewing their opinions against the background of the halachic character of Jewish (biomedical) ethics, this article shows how from one traditional Jewish textual source diverse, even contradictory, opinions emerge through different interpretations. In this way, in the Jewish debate on euthanasia the specific methodology of Jewish (bio)ethical reasoning comes forward as well as a diversity of opinion within Judaism and its branches.     

Correlates of Genetic Counseling and Testing Among Orthodox Jews

One hundred and thirty-six Orthodox Jews responded to questions about their family background, disability attitudes, and their participation in genetic counseling and testing. Findings showed that only birth order and the presence of a disabled family member correlated with increased chances of an individual going for genetic counseling/testing. Results are discussed in the context of the contemporary sociology of Orthodox Judaism, with a particular focus on better understanding the experience of having a disabled family member.     

Gregory the Great’s Metaphor of the Physician of the Heart as a Model for Pastoral Identity

The identity of the Roman Catholic priesthood remains in serious crisis. Scholars have called for a return to traditional sources to find possible solutions, including the Early Church Fathers and the Hebrew Bible. Following Oden, this article further explores Pope Gregory the Great’s The Book of Pastoral Rule and his ideals regarding pastoral identity. Of unique importance is his notion of the pastor as a “physician of the heart,” unrecognized previously as central to his project.     

Health Care Behaviours and Beliefs in Hasidic Jewish Populations: A Systematic Review of the Literature

Cultural issues impact on health care, including individuals’ health care behaviours and beliefs. Hasidic Jews, with their strict religious observance, emphasis on kabbalah, cultural insularity and spiritual leader, their Rebbe, comprise a distinct cultural group. The reviewed studies reveal that Hasidic Jews may seek spiritual healing and incorporate religion in their explanatory models of illness; illness attracts stigma; psychiatric patients’ symptomatology may have religious content; social and cultural factors may challenge health care delivery. The extant research has implications for clinical practice. However, many studies exhibited methodological shortcomings with authors providing incomplete analyses of the extent to which findings are authentically Hasidic. High-quality research is required to better inform the provision of culturally competent care to Hasidic patients.     

A Review of Carolyn Chen’s <Emphasis Type="Italic">Getting Saved in America: Taiwanese Immigration and Religious Experience</Emphasis>

Becoming religious among immigrants to the U.S. is undoubtedly a complex transformation. It takes place with both external sociocultural conditions and internal spiritual and psychological volitions. While marveling at Carolyn Chen’s fine scholarship on Taiwanese immigrants’ conversion experience, this review offers a critical reading of Chen’s equation: becoming American = becoming religious or vice versa with the reviewer’s own experience as both an Asian immigrant and a cultural anthropologist. It also discusses Chen’s assessment of the gendered identity of both Asian-American men and women, be it religious, cultural, or political.