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The Physician and Community of Faithful in the Integrated Care of the Mentally Ill: An Orthodox Christian Discussion of the Physician’s Moral and Professional Obligations

Mariana Cuceu, Theodote Pontikes

Abstract
This article presents the case of a Romanian Orthodox Christian patient in the United States suffering from bipolar disorder. The patient had no family in the United States, and a community of parishioners from the Romanian Orthodox Church, including one of the authors, Mariana Cuceu (MC), cared for him after he was discharged from a psychiatric ward. The case serves as a starting point for exploring the duty of physicians not only to avoid harm but to do good, the importance of coordinating care for such patients and attending to their religious and spiritual needs, as well as the role of the community of Orthodox Christian faithful in responding to the command that we love one another.

Cuceu M, Pontikes T. The Physician and Community of Faithful in the Integrated Care of the Mentally Ill: An Orthodox Christian Discussion of the Physician’s Moral and Professional Obligations. Christ Bioeth (2016) 22 (3): 301-314 doi:10.1093/cb/cbw010

A Christian Physician: Combining Conscience, Philanthropia, and Calling

Gregory W. Rutecki, Michael J. Sleasman

Abstract
When physicians today appeal to “conscience,” it has been alleged such exercises pejoratively reflect “conscience without consequence” as contemporary practitioners are said to be insulated from the consequences of such decisions. It has also been implied these physicians avoid traditional professional responsibilities—including providing charity care and making house or night calls. The assertions demand clarification. Fundamentally, what traits constitute an integrated professionalism specific to Christian physicians? Historical evidence verifies sanctity-of-life affirmations by Christian physicians throughout Church history. However, surveying Christian medical practices in the initial centuries of the Common Era, and more recently in the United States, supports integration of conscience with philanthropy and a rigorous definition of a medical vocation. These suggest there may be deterioration in a holistic commitment to medicine in the United States. Reclaiming an integrated professional paradigm—wherein conscience, philanthropia, and vocation are combined—is essential to an authentic contemporary witness.

Sleasman MJ, Rutecki GW. A Christian Physician: Combining Conscience, Philanthropia, and Calling. Christ Bioeth (2016) 22 (3): 340-362

Implications of Christian Truth Claims for Bioethics

J. Clint Parker

Abstract
Christian bioethics starts with different metaphysical, epistemological, and teleological assumptions. It starts with God as Creator and Sustainer of the universe who as the second person of the Godhead became incarnate as our Redeemer and Lord. Morality reflects God’s nature and is known through reason and intuition guided by revelation. The end of a Christian bioethics is to discover the way our God intends for us to live and to discover the type of person He intends for us to be in order to live a holy and sanctified life. Christian bioethicists will seek integration among their core beliefs and between their beliefs and actions, and they will bear witness to their beliefs in a world that is not yet redeemed. Each contribution in this issue represents an example of these types of Christian integration. Each bears witness to the fact that a Christian bioethics is different.

Parker C. Implications of Christian Truth Claims for Bioethics. Christ Bioeth (2016) 22 (3): 265-275 doi:10.1093/cb/cbw013

Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil

Stephen Napier

Abstract
Many proponents of euthanasia eschew appeals to religious premises as good reasons for thinking that human life has intrinsic worth. The reasons offered are that religious reasons do not meet some theory-neutral epistemic standard. My first argument is to show that pro-euthanasia arguments fail to meet those same standards. In order to avoid this incoherence, the rejection of religious reasons is a function of thinking that such reasons are simply false. Arguing against religious belief has typically fallen to the evidential argument from evil. My second argument is to show that the argument from evil must hold to a basic goods account of human life. Such an account is contrary to the view of human life held by most euthanasia proponents. So, euthanasia proponents who reject religious belief on the basis of an argument from evil must hold to a contradictory view of human worth. One cannot both be a euthanasia proponent and reject arguments against euthanasia (that are based in part on religious premises). I explore ways to resolve this tension, but none save pro-euthanasia arguments.

Napier S. Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil. Christ Bioeth (2016) 22 (3): 276-300 doi:10.1093/cb/cbw012

Rationing and professional autonomy

George J Agich

Extract
Rationing is an inevitable consequence of practicing medicine under conditions of scarcity of resources. Unfortunately, appeals to professional autonomy have muddled the issues associated with limited resource availability in medicine by alleging conflicts that are irresolvable in principle between rationing under prospective payment systems and medical ethics. Such appeals do little to address the real problems involved or to help clarify the important ethical and public policy issues that surround this ineliminable fact of life. Careful analysis of rationing and professional autonomy, however, leads to the conclusion that rationing is a problem for medical ethics at least in the sense that it forces important and difficult questions to the surface regarding the proper nature and structure of medical practice. Some of these questions are precisely the ones at which prospective payment initiatives are aimed.

Agich GJ. Rationing and professional autonomy. J Law Med Ethics. 1989;18(1-2):77-84.

Beneficent Voluntary Active Euthanasia: A Challenge to Professionals Caring for Terminally Ill Patients

Ann-Marie Begley

Abstract
Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his ‘conscience is clear’ and that the time has come to confront the issue of euthanasia.

For the purposes of this article, the term ‘beneficent voluntary active euthanasia’ (BVAE) will be used: beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means ‘good death’.

This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community.

The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths.

Begley A-M. Beneficent Voluntary Active Euthanasia: A Challenge to Professionals Caring for Terminally Ill Patients. Nurs Ethics. 1998;5(4):294-306.

Meeting ethical challenges in acute nursing care as narrated by registered nurses

Venke Sørlie, Annica Kihlgren, Mona Kihlgren

Abstract
Five registered nurses were interviewed as part of a comprehensive investigation by five researchers into the narratives of five enrolled nurses (study 1, published in Nursing Ethics 2004), five registered nurses (study 2) and 10 patients (study 3) describing their experiences in an acute care ward at one university hospital in Sweden. The project was developed at the Centre for Nursing Science at Örebro University Hospital. The ward in question was opened in 1997 and provides care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The registered nurses were interviewed concerning their experience of being in ethically difficult care situations in their work. Interpretation of the theme ‘ethical problems’ was left to the interviewees to reflect upon. A phenomenological hermeneutic method (inspired by the French philosopher Paul Ricoeur) was used in all three studies. The most prominent feature revealed was the enormous responsibility present. When discussing their responsibility, their working environment and their own reactions such as stress and conscience, the registered nurses focused on the patients and the possible negative consequences for them, and showed what was at stake for the patients themselves. The nurses demonstrated both directly and indirectly what they consider to be good nursing practices. They therefore demand very high standards of themselves in their interactions with their patients. They create demands on themselves that they believe to be identical to those expected by patients.

Sørlie V, Kihlgren A, Kihlgren M. Meeting ethical challenges in acute nursing care as narrated by registered nurses. Nurs Ethics. 2005;12(2):133-142.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Timothy Christie, John Sloan, Dylan Dahlgren, Fred Koning

Abstract
Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions.

Objective: The objective of this paper is to critically assess, within the Canadian context, the moral probity of individual or institutional objections to MAID that are for either religious or conscientious reasons.

Methods: Deontological ethics and the Doctrine of Double Effect.

Results: The religious or conscientious objector has conflicting duties, i.e., a duty to respect the “right to life” (section 7 of the Charter) and a duty to respect the tenets of his or her religious or conscientious beliefs (protected by section 2 of the Charter).

Conclusion: The discussion of religious or conscientious objections to MAID has not explicitly considered the competing duties of the conscientious objector. It has focussed on the fact that a conscientious objection exists and has ignored the normative question of whether the duty to respect one’s conscience or religion supersedes the duty to respect the patient’s right to life.

Christie T, Sloan J, Dahlgren D, Koning F. Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections. Bioethique Online. 2016 Aug 17;5(14):1-9.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Dylan Dahlgren, Fred Koning, John Sloan, Timothy Christie

Abstract
Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions.

Methods: Deontological ethics and the Doctrine of Double Effect.

Christie T, Sloan J, Dahlgren D, Konging F. Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections. BioéthiqueOnLine, 2016, 5/14

Referrals for Services Prohibited In Catholic Health Care Facilities

Debra B. Stulberg, Rebecca A. Jackson, Lori R. Freedman

Perspectives on Sexual and Reproductive Health

Abstract
Context: Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored.

Methods: Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011–2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis.

Results: Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions.

Conclusions: Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.

Stulberg DB, Jackson RA, Freedman LR. Referrals for Services Prohibited In Catholic Health Care Facilities. Perspect Sex Repro H, 48:111–117. doi:10.1363/48e10216