THE DUTY TO FEED IN CASES OF ADVANCED DEMENTIA

Cases of dementia present us with difficult ethical dilemmas as we strive to care for those unable to care for themselves. In this article, I review the relevant Islamic texts on caring for the ill, alleviating suffering, and feeding the hungry—all in light of the modern clinical environment. I find that the ethical appropriateness of tube feeding at the end of life is not as clear‐cut as it may seem. My analysis, however, suggests that Muslim scholars ought to favor insertion of a feeding tube in patients who can no longer respond to assisted feeding. Nonetheless, several important issues require further clarification in this clinically important but neglected area of ethical inquiry.     

Influence of chronic corticosterone and glucocorticoid receptor antagonism in the amygdala on fear conditioning

Glucocorticoid receptor activation within the basolateral amygdala (BLA) during fear conditioning may mediate enhancement in rats chronically exposed to stress levels of corticosterone. Male Sprague-Dawley rats received corticosterone (400 microg/ml) in their drinking water (days 1-21), a manipulation that was previously shown to cause hippocampal CA3 dendritic retraction. Subsequently, rats were adapted to the fear conditioning chamber (day 22), then trained (day 23), and tested for conditioned fear to context and tone (day 25). Training consisted of two tone (20s) and footshock (500 ms, 0.25 mA) pairings. In Experiment 1, muscimol (4.4 nmol/0.5 microl/side), a GABAergic agonist, was microinfused to temporarily inactivate the BLA during training. Rats given chronic corticosterone showed enhanced freezing to context, but not tone, compared to vehicle-supplemented rats. Moreover, BLA inactivation impaired contextual and tone conditioning, regardless of corticosterone treatment. In Experiment 2, RU486 (0, 0.3, and 3.0 ng/0.2 microl/side) was infused on training day to antagonize glucocorticoid receptors in the BLA. Corticosterone treatment enhanced fear conditioning to context and tone when analyzed together, but not separately. Moreover, RU486 (3.0 ng/side) selectively exacerbated freezing to context in chronic corticosterone-exposed rats only, but failed to alter tone conditioning. Serum corticosterone levels were negatively correlated with contextual, not tone, conditioning. Altogether, these suggest that chronic corticosterone influences fear conditioning differently than chronic stress as shown previously. Moreover, chronic exposure to corticosteroids alters BLA functioning in a non-linear fashion and that contextual conditioning is influenced more than tone conditioning by chronic corticosterone and BLA glucocorticoid receptor stimulation.     

Sin and suffering in a Catholic understanding of medical ethics.

Drawing chiefly on recent sources, in Part One I sketch an untraditional way of articulating what I claim to be central elements of traditional Catholic morality, treating it as based in virtues, focused on the recipients ("patients") of our attention and concern, and centered in certain person-to-person role-relationships. I show the limited and derivative places of "natural law," and therefore of sin, within that framework. I also sketch out some possible implications for medical ethics of this approach to moral theory, and briefly contrast these with the influential alternative offered by the "principlism" of Beauchamp and Childress. In Part Two, I turn to a Catholic understanding of the nature and meaning of human suffering, drawing especially on writings and addresses of the late Pope John Paul II. He reminds us that physical and mental suffering can provide an opportunity to share in Christ's salvific sacrifice, better to see the nature of our earthly vocation, and to reflect on the dependence that inheres in human existence. At various places, and especially in my conclusion, I suggest a few ways in which this can inform bioethical reflection on morally appropriate responses to those afflicted by physical or mental pain, disability, mental impairment, disease, illness, and poor health prospects. My general point is that mercy must be informed by appreciation of the person's dignity and status. Throughout, my approach is philosophical rather than theological.     

Children of Nazi Germany 60 years on

Abstract

Defence against shock, feelings of guilt, and shame about German atrocities during National Socialism (NS) have dominated the public discourse in Germany for decades. Mitscherlich and Mitscherlich have talked about the inability to mourn due to the involvement of most German families in Nazi terror. The research projects “Childhood in War” at the University of Munich and “War Children and their Flight” at the Hamburg DPG Institute are studying the long-term implications of a childhood during World War II and the Nazi period. In most cases, the personal development of the “war children” was affected – in the case of psychoanalysts, their psychoanalytic socialisation and current professional practice as well. The transgenerational transmission forms an NS introject in the personality. Due to their parents’ lack of empathy, war children are unconsciously looking for a containment of their unbearable feelings in their childhood. Psychoanalysis (including training analysis) becomes a stage where the analysee's childhood loneliness, the taboo-forming, the inhibition to ask and the protection of the parents, as well as feelings of guilt and embarrassment in the family, not talking about matters, and silence, occur once more in transference.     

The Greek Orthodox Church and the economic crisis since 2009

In the midst of the raging socio-economic crisis that has hit Greece since 2009 the Greek Orthodox Church, under Archbishop Ieronymos II, has admirably developed its network of philanthropic work and charity meals. Open to both Greeks and immigrants, this project seems to realise Eastern Orthodox Christianity's sense of caritas and civic duty. Low key and efficient, the Orthodox Church's response to the crisis has left behind the nationalistic cries and pietistic/didactic excesses of the recent past. This article asserts, however, that, by failing to grapple with the structural causes of the crisis in a politically relevant manner and by refusing to castigate specific policies and politicians at the national and European Union level, the Greek Orthodox Church has offered a much needed palliative, but in the end has remained discursively distant from theological and political criticism of a rapacious neoliberal system and from effective engagement with Greek modernity.     

The Indonesian Catholic Church 50 years after Vatican II: seven models of church life

The significance and influence of the Second Vatican Council in respect of the reform of the Catholic Church are no longer in dispute. The issue now at stake is how the Vatican II documents are understood and implemented in each church community. This article is the result of research on the significance and implementation of the Council's thinking in the Indonesian Catholic Church (ICC) in the past 50 years. It begins with observations on ICC's history and social context, then highlights the main use of conciliar documents in the reforms it has undertaken. Seven models of church life, illustrative of the implementation of Vatican II, are described. Although these models cannot comprehensively reveal all the realities of the ICC, they are seen as portraying it as it is today, at the point from which its future course may be worked out.     

Personally relevant vs. nationally relevant memories: An intergenerational examination of World War II memories across and within Belgian French-speaking families

We examined whether and how memories and knowledge of World War II (WWII) transmit across generations. We recruited five French-speaking Belgian families and interviewed one member from each generation. As the oldest generation had to be alive during WWII, their interviews constituted “memories” while the interviews of the middle and youngest generation constituted “knowledge”, as they were not alive during WWII. Each individual was asked about four WWII events specific to Belgium (two of which were likely to be controversial, i.e., collaboration and the Royal Question), and the source from which they learned about these four events: was it communicatively (e.g., through familial discussions) or culturally (e.g., social artifacts: books, school, monuments, etc.) transmitted? Our results suggest that transmission of memories and knowledge across generations was limited. The oldest generation, who were children during the war, and the middle generation knew about the WWII events discussed in the interviews, particularly the oldest generation. The youngest generation, however, did not. Furthermore, for the most part, all generations, in discussing memories of the WWII events, told nationally relevant memories. If the oldest generation discussed personally relevant memories, these memories sometimes transmitted to the middle generation and rarely to the youngest. We discuss these results in terms of Assmann and Czaplicka, 1995, Assmann, 2011) distinction between communicative and cultural memory.     

THE MORALITY,POLITICS, AND IRONY OF WAR: Recovering Reinhold Niebuhr's Ethical Realism

The American experience of war is ironic. That is, there is often an intimate and unexamined relationship between seemingly contrary elements in war such as morality and politics. This article argues that without understanding such irony, we are unlikely to reflect in morally comprehensive ways on past, present, or future wars. Traditional schools of thought, however, such as moralism and political realism, reinforce these apparent contradictions. I propose, then, an alternative—“ethical realism” as informed by Reinhold Niebuhr—that better explains the irony of war. Through an ethical realist examination of the U.S. Civil War, World War II, and the Iraq War, I consider how American political interests have been inextricably linked with deep moral concerns. Ethical realism charts a middle path that ennobles traditional realpolitik while eschewing certain perfectionist tendencies of moralism. Ethical realism provides a conceptual framework for evaluating these other frameworks—a distinct form of moral‐political deliberation about war.