ObjectiveBulimia nervosa and binge eating disorder are eating disorders characterized by recurrent binge eating episodes. Overlap exists between ED diagnostic groups, with BE episodes presenting one clinical feature that occurs transdiagnostically. Neuroimaging of the responses of those with BN and BED to disorder-specific stimuli, such as food, is not extensively investigated. Furthermore, to our knowledge, there have been no previous published studies examining the neural response of individuals currently experiencing binge eating, to low energy foods. Our objective was to examine (...) the neural responses to both low energy and high energy food images in three emotive categories in BN and BED participants.MethodsNineteen females with BN or BED, comprising the binge eating group, and 19 age-matched healthy control ’s completed thorough clinical assessment prior to functional MRI. Neural response to low energy and high energy foods and non-food images was compared between groups using whole-brain exploratory analyses, from which six regions of interest were then selected: frontal, occipital, temporal, and parietal lobes; insula and cingulate.ResultsIn response to low energy food images, the BEG demonstrated differential neural responses to all three low energy foods categories compared to HCs. Correlational analyses found a significant association between frequency of binge episodes and diminished temporal lobe and greater occipital lobe response. In response to high energy food images, compared to HC’s, the BEG demonstrated significantly decreased neural activity in response to all high energy food images. The HC’s had significantly greater neural activity in the limbic system, occipital lobe, temporal lobe, frontal lobe, and limbic system in response to high energy food images.ConclusionResults in the low energy food condition indicate that binge frequency may be related to increased aberrant neural responding. Furthermore, differences were found between groups in all ROI’s except the insula. The neural response seen in the BEG to disgust food images may indicate disengagement with this particular stimuli. In the high energy food condition, results demonstrate that neural activity in BN and BED patients may decrease in response to high energy foods, suggesting disengagement with foods that may be more consistent with those consumed during a binge eating episode. (shrink)

A company of buccaneers invites comparison with states founded on the social contracts of Hobbes and Locke. These companies were formed by an explicit contract, the articles of agreement, and transgressors risked being marooned in a literal state of nature. Buccaneers were relatively powerful and their authority structure and share system was relatively democratic. The role of venture capitalists in organizing buccaneering may explain why parallels with Locke's social contract are particularly striking. Matthew Tindall attempted to exclude pirates and include (...) privateers in the social contract, but conceded that sufficiently powerful pirates themselves formed states. These comparisons highlight the problem of basing human rights on contract theory. (shrink)

During an initial palliative care assessment, a dying man discloses that he had killed several people whilst a young man. The junior doctor, to whom he revealed his story, consulted with senior palliative care colleagues. It was agreed that legal advice would be sought on the issue of breaching the man’s confidentiality. Two legal opinions conflicted with each other. A decision was made by the clinical team not to inform the police.In this article the junior doctor, the palliative medicine specialist, (...) a medical ethicist, and a lawyer consider the case from their various perspectives. (shrink)

Volume 3, Issue 1, March 2019, Page 95-99.

In New Zealand an advance directive can be either an oral statement or a written document. Such directives give individuals the opportunity to make choices about future medical treatment in the event they are cognitively impaired or otherwise unable to make their preferences known. All consumers of health care have the right to make an advance directive in accordance with the common law. When we consider New Zealand's rapidly ageing population, the fact that more people now live with and die (...) of chronic rather than acute conditions, the importance given to respecting autonomous decision-making, increasing numbers of individuals who require long-term residential care, and financial pressures in the allocation of medical resources, there would seem to be a number of compelling reasons to encourage individuals to write or verbalise an advance directive. Indeed the promotion of advance directives is encouraged. However, caution should be exercised in promoting advance directives to older people, especially in light of several factors: ageist attitudes and stereotypes towards them, challenges in the primary healthcare setting, and the way in which advance directives are currently focused and formulated. This paper considers some of the specific challenges that need to be addressed if the promotion of advance directives are to improve outcomes of patient treatment and care near the end of life. (shrink)

This case concerns aspects of the treatment of a post-surgical patient in a major public hospital in New Zealand during the author's experiences as a fourth year medical student. This case is used to consider the interlinked ethical issues of sympathy, moral virtue, dignity and how the medical environment can realign these values.

:This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand’s medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the “professionalism” and “professional development” in medical curricula.

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a (...) questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the ‘four principles’ determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in ‘real’ settings and this information may help educators prepare students for these clinical ethical dilemmas. (shrink)

This introduction explores the relationship between Europe and its Christianities. It analyses different diagnostic and evaluative approaches to Europe's Christian or post-Christian identity. These are grouped around the concepts of diverse traditional, and, on the other hand, post-Enlightenment Christianities. While the first revolves around a liturgical and mystical account of the church, a Christ-centred humanism, an emphasis on man's future life, noetic theology and a foundationalist claim to universal truth, the second endorses a moralization of the “Christian message,” political implementation (...) of “Christian goals,” rationalism, a this-worldly humanism, and tolerance for religious diversity. Since even the concepts of “traditional” and “post-Enlightenment” Christianity turn out to be deeply ambiguous, the essay concludes with exploring the different ways in which the Christianity of the Apostolic Church, the Enlightenment (along with the “Western” Christianities it shaped), and contemporary liberalism each conceive of their respective endorsements of human freedom as either normative, that is obligatory, value-laden, or contingent, and arbitrary. In each case, a different notion of “tradition” (as well as familial and church authority) is placed either in harmony or in opposition to such freedom. As a result of this conceptual analysis, the deeply fractured identity of Europe, as exemplified by the diverse bioethical positions adopted by the authors in this issue, becomes visible. (shrink)

Paternal authority is recommended as a valid Christian resource for conflict resolution in biomedical (and other inner-familial) decision making. Its bases are explored in view of the two-fold creation account in Genesis, interpreted in the light of the Pauline theology. In addition, a theological account is proposed that portrays the taxis between husband and wife as a condition under which humans can seek to emulate the inner-Trinitarian love. The relationship between that love (as portrayed in St. Basil’s On the Holy (...) Spirit), the love between God and man, and the love between the sexes (as further extended to the children in a family that constitutes a “small church”), is described in terms of an interplay between the Divine offer of grace and the human response of obedience. In framing their marital love according to the model of Christ and His Church, couples can also profit from the ascetical therapy predicted for their fallen nature in the “curse” that drove our forefathers from Paradise. (shrink)

Corinna Delkeskamp-Hayes; Sin and Disease: An Introduction, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 12, Issue 2, 1 January 2006.

One of the lamentable characteristics of our contemporary age is the way in which abortion has been adopted as a natural part of the culture. This essay describes this adoption as a symptom of that culture’s profound de-Christianization. As that culture sheds its once Christian commitments, persons change the way in which they relate to their body in its sexually differentiated physiology, its physical drives and impulses. They refashion their sense of human flourishing, their vision of women’s social role, the (...) value they place on education, career, and economic well-being, and their understanding of reproductive responsibility. This de-Christianization is not sufficiently appreciated in a nominally still “Christian culture.” Such blindness reflects an inability to distinguish Christian commitments from moral commitments, which, although framed in terms that are compatible with Christian meanings, are equally open to meanings affirming the idolatry informing secular humanism. De-Christianization is not the same as de-moralization. This essay explores the way in which the new moral norms about sexuality, about education and career opportunities for women, authority within marriage, the role of this-worldly well-being and human suffering all contribute to our culture’s complacency in view of abortion. The underlying concern is to illustrate how a morality (even a morality of human sympathy and solidarity) that is not anchored in a genuine Tradition-affirming Christian conduct of life leads away from Christ, and how only a return to that conduct can heal our “culture of death.”. (shrink)

Belgium's policy of not permitting Catholic hospitals to refuse euthanasia services rests on ethical presuppositions concerning the secular justification of political power which reveal the paradoxical character of European liberalism: In endorsing freedom as a value (rather than as a side constraint), liberalism prioritizes first-order intentions, thus discouraging lasting moral commitments and the authority of moral communities in supporting such commitments. The state itself is thus transformed into a moral community of its own. Alternative policies (such as an explicit moral (...) diversification of public healthcare or the greater tolerance for Christian institutions in the Netherlands) are shown to be incompatible with Europe's liberal concern with securing social and material freedom resources, as well as the concern with equality of opportunity, as embodied in the European Union's anti-discrimination labor law. The essay's argument for the preferability of a libertarian solution closes with the challenge that only if the provision of public healthcare can be shown to be rationally indispensable for a morally justified polity, could the exposed incoherence of modern European liberalism be generously discounted. (shrink)

Corinna Delkeskamp-Hayes; Bioethics for Thresholders: A Brief Introduction, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 3.

Corinna Delkeskamp-Hayes; Sin and Disease in a Post-Christian Culture: An Introduction, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume.

(2005). Between Morality and Repentance: Recapturing “Sin” for Bioethics. Christian Bioethics: Vol. 11, No. 2, pp. 93-132.

Schmidt and Egler's critique of Christianity's exclusivist claim to truth rests on two suppositions: (a) that inter-religious pastoral care for dying patients requires a respect for their cultural backgrounds which necessitates accepting the equal validity of their respective (non-Christian) religions, and (b) that exclusivism is incompatible with the Christian love-of-neighbor commandment. In opposition to this critique, (a) the authors' own “pluralist” understanding of Christianity is refuted on two levels. First, it leads to inconsistencies in the authors' own (and very adequate) (...) understanding of pastoral care, especially with regard to their notion of intolerance, and second, it is irreconcilable with explicit New and Old Testament claims to absoluteness. In addition, (b) the authors' understanding of the way in which “exclusivism” justifies intolerance and missionary violence is shown to rest, first, on a secularized reduction of Christianity, i.e., of Christians' own “religious identity” as well as of the Christian way of “helping those in need,” and second, on a merely theoretical (rather than also practical) view of Christians' commitment to God. As a corollary to that refutation, a reconsideration of the truly Christian sources of obedience and charity is recommended. (shrink)

Corinna Delkeskamp-Hayes; Christian Credentials for Roman Catholic Health Care: Medicine versus the Healing Mission of the Church, Christian bioethics: Non-Ecum.

This essay questions the way in which continental Western Christians welcome political implementation (i.e., integration into the publicly funded welfare network and collaboration with heterodox Christians, members of other religions, or irreligious humanitarians) when offering their diaconic services. Among the theological assumptions underlying such reliance from outside the Church, this essay takes special issue with the idea that Christianity's “ethical” commitment to charity can be separated from its spiritual (e.g., liturgical, ascetical, missionary) concerns. Such separation suggests prioritizing charity recipients’ needs (...) over against the framing character of charity providers’ Christian love. On the philosophical level, this same separation refashions Christian philanthropy in terms of a secularly construed “human dignity.” This dignity, even though nominally endorsed by the welfare bureaucracy, is however shown to get repudiated by the objectifying and depersonalizing implications of publicly funded social services. On the theological level, the potentially anti-Christian implications of secularly implemented “diakonia” are pointed out. The scriptural bases usually invoked for the prioritizing of needs are exposed as unfit to offer the hoped-for justification. As a result, only, and at most, a very limited, reserved, and watchful material cooperation with the secular state and with those outside the Church is recommended for Christian “diakonia.”. (shrink)

This essay takes a Traditional Christian, that is, Orthodox look at the integration of psychotherapy into pastoral counseling, as endorsed by many Western mainline Christianities. It examines how the Christian pastor can guide his sheep through the bioethical problems they encounter in their pursuit of salvation. The first part explores whether the turn to psychology and psychotherapy can be welcomed as a return to the Traditional therapeutic understanding of theology and of the Church as a spiritual hospital for fallen souls. (...) The second part examines two typical ways in which non-Orthodox Christianities embrace psychotherapy in pastoral counseling, as directed to unburdening parishioners from their doubts about bioethical decision making in the context of a Christian life. This part highlights the theological assumptions (about the pastor, his care, and the notion of God informing both) framing that embrace and shows them to be incompatible with the Traditional commitment to man's Divine vocation. The turn to psychotherapy here, rather than inaugurating a return to the therapeutic spirit of Traditional theology, offers a secularized substitute. The third part investigates the possibility of a Traditional Christian way of practicing psychotherapy along with its significance for Orthodox pastoral care in bioethical counseling. Here it becomes clear that, even beyond incompatible theological assumptions, already psychotherapy's endorsement of a predominantly discursive approach to healing is alien to Traditional pastoral care. (shrink)

The Convention on Human Rights and Biomedicine confuses respect for a person's right to self-determination with concern about protecting human beings generally. In a legal document, this mixture of deontological with utilitarian considerations undermines what it should preserve: respect for human dignity as the foundation of modern rights-based democracies. Falling prey to the ambiguity of freedom, the Convention blurs the dividing line between morality and the law. The document should be remedied through distinguishing fundamental rights from social 'rights', persons as (...) entitled to the right to self-determination from born humans as entitled to the right to life and from members of the human species as entitled to the morally respo-nsible care of voting majorities. For the cultivating of the required responsibility, the conditions for an adequate public debate should be secured. (shrink)

logical failure or contradiction by a fact. Intuition alone can decide between two competing theories agreeing with the facts. (ibid. ...

The rise of progressive education -- John Dewey -- Other pioneers in the progressive education movement -- The progressive education movement during the first half of the twentieth century -- The fifties -- The sixties and seventies -- A nation at risk (1983) -- The eighties and nineties -- No child left behind -- Maria Montessori -- Teacher education programs -- Middle schools -- Choice -- Education of the gifted and talented -- Progressive education today -- The future of progressive (...) education. (shrink)

This introduction to Christian Bioethics 15/2 focuses on the challenges which secular moral reconstruction and secular political implementation presents for Christian diakonia. It summarises the various Roman Catholic, Protestant, and Orthodox ways in which Christians’ loving service to the world have been integrated either into the secular state's provision of social welfare or into the Church's liturgical life by the authors of this issue. This summary centres on questions concerning the political nature of Christian charity, its role within the church, (...) the implication of public funding for the integrity of the Christian service, the relationship between love and justice, and the impact of different kinds of feminism on Christian diaconic work. (shrink)

Can proposing a policy of equal access to health care be justified on Christian grounds? The notion of a “Christian justification” with regard to Christians' political activity is explored in relation to the New Testament texts. The less demanding policy of granting “rights to (basic) health care,” the meaning of Jesus' healing activities, early Christian welfare schemes, and Christian grounds for the ascription of “rights” are each discussed. As a result, with some stretching of the neighbor-love and missionary imperatives it (...) is proposed that a basic health care policy can be legitimized. With regard to equal access to health care, however, all attempts to derive an equalizing imperative from the spiritual “equality among humans” or by way of the “love your neighbor as yourself” imperative are shown to fail. Particular attention is given to whether “attending to the least of my brothers' needs” obliges Christians to satisfy those needs optimally, as well as to the personal involvement aspect of the love-commandment in its simultaneously spiritual and temporal orientations. (shrink)

This introduction supplies further bearing points for the conceptual map, which the introduction to the previous issue on European bioethics (2008/1) had provided for sorting out the various dimension in which the essays collected in these issues resemble and differ from each other. Special attention is devoted to communication, as diverse Christianities attend to different purposes, problems, and opportunities for normatively engaging (persuading, influencing, ruling, opposing, and converting) their surrounding secularized cultures. These differences reflect incompatible ways of conceiving Christ's acts (...) of healing, as these provide a model for His disciples' bioethics. These differences also reflect diversely rationalist and noetic epistemologies. The subtext concerns the haunting question about the enduring sustainability of a specifically Christian bioethics in Europe. As Schotsmans opts for a Roman Catholicism that is not recognized as such by his Magisterium, as Muller transforms Protestantism into a religiously nonhostile laicity, as Messer and Silva da Barbosa hope for the prophetic impact of communal “cities on the hill,” and as the Orthodox pursue the conversion of Western Europe in Greek, Russian, and Rumanian, ongoing Divine miracles present the most realistic hope. (shrink)

This introduction discusses the various respects in which the turn to psychotherapy and psychology in pastoral counseling touches on issues of bioethics (as the content of such counseling) and medical morality (insofar as the spiritual dimension addressed in pastoral care impacts the medical condition of those cared for, and the various kinds of psychotherapy relate to the therapy offered by medicine). A short characterization of each essay contained in this issue of Christian Bioethics highlights the major subjects on which these (...) essays agree and disagree. These subjects concern the significance of psychotherapy and psychology for (1) reaching out to parishioners who are estranged from the church, (2) criticizing religion as a whole, and (3) remedying certain distortions for which pastoral care and counseling have been criticized in some Christianities. Problems that arise from the incompatibilities between different sorts of theological and psychological accounts of human flourishing and their suggested solutions are considered. The introduction, then, concludes by briefly discussing the different understandings of tradition and church that inform the various post- and extra-Enlightenment positions adopted by the authors. (shrink)

Unlike (especially) the various Protestantisms, Orthodox Christianity recognizes no fundamentally different problems in the development and (future) application of human germ line genetic engineering (HGGE) than those raised by more traditional medicine. The particular challenges which frame the life of a traditional Christian arise not only in view of “groundbreaking” technological progress and its attendant increase in human power over nature, but permeate already his most simple daily routines. The diverse post-traditional Christianities have ceased confronting such liturgical–ascetical challenges. The quite (...) appropriately pious desire, among those committed to such Christianities, for some restraint in the face of such increase of power therefore gets refocused onto substitute concerns. The new challenge then arises to establish the universal validity of the moral norms underlying such concerns in order to ground the desired prohibition. The discussions of several such norms offered in this issue of Christian Bioethics illustrate the embarrassment presented by the unavailability of either theological or rational foundations needed for such a project. The attempt to prove that there is something in principle morally wrong about HGGE is thus not only unnecessary for the Christian conduct of life (and presents a distraction), but also doomed to fail. (shrink)

Does a non-ecumenical journal on Christian bioethics make sense? Taking issue with Stanley Hauerwas' critique of Ramsey, the author argues (l) interdenominational exchange should not be construed as contest, and (2) the attempt on the part of Christians to address secular issues in secular terms should not be mistrusted or viewed as a contamination hazard. Instead (I) an awareness of human limits should render adherents of different traditions willing to learn from each other and (2) one should see in the (...) love-of-neighbor principle an obligation to serve the world. Addressing the communication problem, the author recommends different language levels for intra-group and ever more encompassing inter-group exchanges. (shrink)

A comprehensive introduction to the theory of knowledge, this work explores what it is to be a rational, sentient human being.