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61. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Paul W. Hruz The Use of Cross-Sex Steroids in the Treatment of Gender Dysphoria
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Current clinical guidelines for the treatment of individuals who experience gender dysphoria include the administration of testosterone to women who desire to appear as men and estrogen to men who desire to appear as women. Despite the rapid and widespread adoption of this practice, strikingly little scientific evidence supports this treatment approach as a safe and effective medical intervention to prevent associated depression and suicide. Although low-quality, short-term studies have demonstrated a reduction of dysphoria, emerging evidence reveals significant bodily harm from this practice and a lack of long-term benefit in preventing depression and suicide. From an ethical perspective, this practice distorts a proper view of human nature and violates bodily integrity by directly inducing sterility. The use of exogenous cross-sex hormones reinforces rather than alleviates underlying psychiatric dysfunction while significantly increasing the risk of other medical morbidities. Despite the valid goal of alleviating suffering, this practice cannot be justified by the use of the principles of totality or double effect.
62. The National Catholic Bioethics Quarterly: Volume > 17 > Issue: 4
Marie T. Hilliard Religious and Moral Exemptions and Accommodations for Coverage of Certain Preventive Services: NCBC Letter of Comment on the Contraception Mandate
63. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Birgitta Sujdak Mackiewicz Essential Goals of Ethics Committees and the Role of Professional Ethicists
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Ethics committees in Catholic health care are responsible for con­sultation, education, and policy development and review. Historically, ethics committees were reactive and had no articulated goals. This article argues that the essential goals of Catholic ethics committees are (1) to promote the human dignity of patients and staff; (2) to promote the common good; (3) to promote institutional identity, integrity, and ethical climate; and (4) to improve quality of care. These goals are most effectively met when ethics committees are proactive and integrated in the institution, embrace systems thinking, and utilize professional ethicists locally or regionally.
64. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Mark Repenshek Examining Quality and Value in Ethics Consultation Services
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The American Society for Bioethics and Humanities poses a chal­lenge in Core Competencies for Healthcare Ethics Consultation: health care ethics consultation services “should be able to demonstrate their value to those who pay for the service, as well as to those whom the service is intended to serve.” To respond to this challenge, this article provides a brief review of the literature on evaluating ethics consultation in its traditional frameworks of quality outcomes. The author follows this discussion with a new methodology to evaluate ethics consultation on the basis of the intrinsic good of the service. He ends with a novel risk-based assessment to complement the evaluation of clinical ethics services grounded in the Ethical and Religious Directives for Catholic Health Care Services.
65. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Greg Schleppenbach Washington Insider
66. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Courtenay R. Bruce, Jocelyn Lapointe, Peter Koch, Katarina Lee, Savitri Fedson Building a Vibrant Clinical Ethics Consultation Service
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The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.
67. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Jason Lesandrini, Alan Muster Practical Steps for Integrating an Ethics Program
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The field of health care ethics continues to grow as the ethics structures in health care organizations become well established. While the literature is saturated with reports on clinical ethics consultation services, very little is known about the development and success of ethics programs. The following describes the development and growth of an ethics program at the largest health care provider in Georgia. With a focus on nine key components of an ethics program, the paper reviews what one system did on its path to a flourishing program and what others can learn from it.
68. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Mary E. Homan Factors Associated with the Timing and Patient Outcomes of Clinical Ethics Consultation in a Catholic Health Care System
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Little is known about how certain patient characteristics can affect the timing of an ethics consultation, which has been hypothesized to affect patient length of stay. This study assessed how specific patient characteristics affect the timing of an ethics consultation, namely, age (over 65 years), race, Medicaid status, the presence of a living will, the presence of a health care proxy, and the absence of decisional capacity. Moving beyond the typical case-series evaluation of an ethics consultation service, this study used an innovative approach to model how predisposing, enabling, and need factors affect health behavior and subsequently affect health outcomes for patients who received an ethics consultation at a Catholic health care system in Oklahoma.
69. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Matthew R. Kenney A System Approach to Proactive Ethics Integration
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Although ethics consultation services often engage in some of the most complex and delicate clinical situations, little is known about the qual­ity of these services or their effect on patient care and patient and provider satisfaction. There is still significant work to be done in the areas of training, credentialing, and standardization. This article articulates the essential “build­ing blocks” of the Proactive Ethics Integration model developed at Ascension as well as the lessons we have learned along the way.
70. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Nicholas J. Kockler, Kevin M. Dirksen Integrating Ethics Services in a Catholic Health System in Oregon
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At Providence St. Joseph Health in Oregon, many factors contribute to the integration and success of the ethics services. There are three principal lenses through which one can understand the distinct way in which the ethics services are operationalized and integrated: the theological foundations of ethics as a service, the institutional ecology, and the professionalization of the field of health care ethics. The authors review key realities that have shaped their work through these three lenses and then describe the activities of the Providence Center for Health Care Ethics regarding its strategic objectives and clinical and administrative integration.
71. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 1
Pope Francis The Limitations of Our Mortality: Message to the European Regional Meeting of the World Medical Association, November 7, 2017
72. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
Charles C. Camosy Defending against Formally Innocent Material Mortal Threats: A Response to Joshua Evans
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In the Summer 2017 NCBQ, Joshua Evans strongly criticized arguments made by Charles Camosy about the possibility of a prenatal child being a material mortal threat to her mother. Here Camosy demonstrates that the formal/material debate remains open for non-dissenting Catholic moral theologians. He also shows that his reference to just-war theory is used to discuss innocence; it is not evidence of a particular methodology. Despite Evans’s claim to the contrary, Camosy notes multiple examples where he affirms the uniqueness of pregnancy and the special duty of parents to children. He argues for full deference to the magisterium in matters where doctrine has been defined and urges solid theological grounding for teachings on abortion when the mother’s life is at risk, especially given the profound personal and political issues at stake.
73. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
Christopher M. Reilly Medical Professionals as Agents of Eugenics: Abortion Counseling for Down Syndrome
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Eugenic thinking divides people into groups according to real or perceived genetic traits, identifies some groups as unwanted, and then promotes the elimination of the unwanted groups. Some American medical professionals are pursuing a eugenic agenda that pressures and misleads parents to abort unborn children with Down syndrome. These counselors have a strong, unwar­ranted bias that influences parents’ decisions significantly. The use of prenatal genetic testing and in vitro fertilization increases the number of deaths of unborn children with Down syndrome. The widespread practice of identifying and aborting children with Down syndrome is properly called eugenics.
74. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
Deacon Gregory Webster Financial Toxicity: Treatment Expense and Extraordinary Means
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The financial toxicity of biotherapeutic treatments is examined. Kymriah, a new gene therapy, has a list price of $475,000 per treatment; Yescarta, from Kite Pharma, costs $373,000 per treatment. Such costs are a significant burden on patients, patients’ families, payers, health care systems, and communities. Studies have shown that financial toxicity—the effect of excessive treatment cost—diminishes patients’ quality of life, compliance, and survival. Some pharmaceutical companies promote outcomes-based pricing and other strategies to offset financial toxicity, but these approaches have not been shown to reduce burdens. Catholic teaching holds that the benefits of treatment should outweigh its burdens, and that burdensome treatments are not obligatory. The financial toxicity of treatments should be included in the ethical assessment of burdens on the patient.
75. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
The National Catholic Bioethics Center Employed Health Care Providers and the Provision of Direct Contraception
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This March 2018 document replaces an earlier template policy, “Model Clinical Practice Ethics Guidelines for Affiliated Health Care Professionals with Respect to Prescription of Contraceptives,” drafted by The National Catholic Bioethics Center in the 1990s. Instead of a template policy, the new document provides definitions and principles to help health care institutions apply Catholic moral teachings if, for whatever reason, they happen to employ providers who prescribe contraception. The three basic principles are (1) distinguishing responsible agents and maintaining organizational integrity, (2) avoiding immoral cooperation, and (3) avoiding and resolving theological scandal.
76. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
Carter Anne McGowan Conscience Rights and “Effective Referral” in Ontario
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In 2015, the Supreme Court of Canada decriminalized euthanasia. Soon after, the College of Physicians and Surgeons of Ontario enacted the Professional Obligations and Human Rights policy and the Medical Assistance in Dying policy. Neither these policies nor the Medical Assistance in Dying Act, the Ontario law permitting euthanasia, contains a conscientious objection clause. Instead, the policies require objecting doctors to provide an effective referral to a doctor who will euthanize the patient. Objecting physicians brought suit against the college. In a recent decision, the Ontario Superior Court of Justice held against the plaintiffs, finding the infringement of the effective referral policy on physicians’ rights to conscience and religious freedom to be appropriate when balanced against a patient’s right to equitable access to health care. Therefore, Catholic physicians in Ontario now must choose to violate either their religious beliefs or their professional obligations. It is imperative that these policies be struck down on appeal, superseded by an amendment, or revised by the college through the addition of a conscience clause.
77. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
James Beauregard Advancing a Personalist Neuroethics
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Neuroethics is a new and rapidly expanding field in the academy and clinical practice. However, there is no comprehensive treatment of it from a specifically Catholic perspective. Nevertheless, the Catholic tradition contains possible criteria for a systematic approach to neuroethics. The personalist philosophical tradition, specifically modern ontological personalism, provides a framework for organizing and articulating those aspects of personhood that are most relevant to neuroscience and neuroethics
78. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
William F. Sullivan, John Heng, Christopher De Bono, Gerry Gleeson, Gill Goulding Healing Relationships and Transformations in Health Care: IACB Consensus Statement on Ethical Discernment and Practical Recommendations
79. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 2
Richard A. Spinello Bioethics and the Human Soul: Pope St. John Paul II’s Reflections on Ensoulment
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Pope St. John Paul II’s work on the Theology of the Body is well known among his many followers. Less well known is his conception of the human soul. Karol Wojtyla’s intricate philosophy of the soul fully endorses Aristotelian Thomistic psychology. Wojtyla’s main contribution is a phenomenological description of human action, which provides a credible basis for inferring the soul’s necessity. In the papal writings, John Paul II develops other resourceful doctrines, especially about the timing of ensoulment. His unelaborated notion of the genealogy of the person has implications for ethics. Following in the tradition of St. Thomas Aquinas, John Paul II presents an integrated wisdom about the soul that weaves together Christian revelation, modern science, and different modes of philosophical reflection.
80. The National Catholic Bioethics Quarterly: Volume > 18 > Issue: 3
Peter J. Colosi Discussing the Spiritual Soul in the Classroom
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There is a pedagogical method of bringing undergraduate students to conceive the body–soul question. Similarly, there is a simple philosophical argument in defense of the existence of the soul via contemporary autobiographical stories, recent neuroscientific literature, and Socrates’s distinction between condition and cause in Plato’s Phaedo. This method has proved helpful in enabling students to gain access to the mystery and grandeur of the body–soul question and its foundational importance with respect to ethics and, indeed, to the meaning of life. There must be a revival of collaboration between neuroscientists and philosophers to coauthor papers that explicitly challenge the materialist assumptions in the fields of neuroscience and psychology.