This pastoral-theology-based reflection on hospital chaplaincy, set within the horizon of the pastoral situation of Germany in the post-secular (!) age, introduces the perspective of a consolation-oriented ministry, as this was developed by Ignatius of Loyola. Such a pastoral care for the sick, as integrated into the basic offices of the church, presents a graded model for action: while human accompaniment is offered to all, spiritual ministry is restricted, but realized in an ecumenically encompassing sense. Spiritual and ritual (...) care for members of other religions, while these members are to be addressed according to the principles laid down by Vatican II, is severely limited for reasons of identity and alterity. In all cases, however, Christianity is presented as “therapeutic religion”. (shrink)

A veteran nurse researcher and educator provides a spiritual perspective on the professional nurse's vocation of caring. Grounding each chapter in Scripture, O'Brien explores the Christian nurse's call to love as Jesus loved: without discrimination, reserve and, sometimes, reward.

This article has two purposes. The first is to show how one can know in a simple way what is an ordinary and obligatory means to care for a person with a serious illness. Using the information at hand, one must be able to answer yes to each of these three questions: “Is this the ordinary, usual, or valid way of treating this illness?” “Is it working?” “Is it within the capacity of the patient to undergo and of the (...) caregivers to administer?” The second purpose of the article is to show the moral validity of these questions, using a historical overview of theological and magisterial teaching and a systematic analysis and moral testing of the three questions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I (...) would be the acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

According to the literature, the family is now considered to be the most important resource for the care and support of a sick family member. Families are being increasingly invited and trained to play a utilitarian role, not just as family caregivers, but as healthcare agents. Healthcare institutions, based on neoliberal health policies, are encouraging them to perform increasingly complex and professionalized tasks. The burden associated with this expanded healthcare function, however, is significant (fatigue, emotional distress and exhaustion). (...) The aim of this article was to present French sociologist Jacques Donzelot's theoretical perspective on governing through the family. According to Donzelot, such a government is exercised through various power techniques, including the instrumentalization of the family role and the transfer to families of the responsibility for health care. This author describes how healthcare institutions call on the family to perform hospital and biomedical practices within the home. A spin‐off of neoliberalism, the practices of governing through families specifically target women, who are considered to be the pillar of the family. Donzelot's perspective is very relevant to nursing, but is still rarely mobilized in the discipline. His critical perspective allows for a re‐reading of relations of power and mechanisms of surveillance and control of families, issues that are often overlooked in nursing research. (shrink)

Recent years have witnessed a growing interest in the measurement of health status. One of the most well-known health status instruments is the Sickness Impact Profile (SIP). This paper examines the nature, development and testing of the SIP (and its UK equivalent the FLP). The practical merits of these instruments are explained, and some cautionary remarks are offered about their limitations.

In lieu of an abstract, here is a brief excerpt of the content:The Difficult Road to Deciding on CircumcisionAnonymous TwoAnonymous TwoWhen I got my results back from my noninvasive prenatal testing, NIPT and found out I was going to have a little boy, one of my first thoughts was, "I don't want to circumcise him," which sounds silly because I just found out the gender of my baby and my first thought is about his genitalia. The idea of growing and (...) carrying this perfect little baby for nine months and then hurting him was unthinkable to me. I simply did not want to hurt him. The idea of it made me feel sick. Anytime the subject came up, I would protectively put my hand over my belly. And I do admit there were a lot of times I wished I was having a girl so I didn't have to deal with the circumcision debate.There was a lot of conversation between myself and my husband about it. My husband was adamant about getting it done. He referred to uncircumcised penises as "snake penises" and said our son will be made fun of for being different. He said it would be easier for him to clean and when he's old, he won't have to worry about infection. I would counter with, "well what if he falls in love with a girl from a culture that doesn't circumcise? She will think his penis is weird." The more we talked about it, the more ridiculous it felt thinking that far in advance and all these hypothetical situations he might get in over his penis. My parents wanted it done for religious reasons, but that wasn't a factor for me. My mom kept saying it's in the Bible and it needs to be done. My boss is Jewish and she joked that I could just convert to Judaism and the choice would be taken away from me so I didn't have to stress over it. Everything I read on my mommy groups and sites like Reddit called male circumcision child abuse and stated how barbaric it was. Terms like "genital mutilation" were thrown around a lot, and I didn't want to be part of a group that was seemingly looked down upon by so many.I spent my whole pregnancy saying how much I did not want to circumcise my baby. About a week after he was born and we were starting to get settled, my husband started to call around trying to get him an appointment for circumcision. It was unusual to do it this way, as typically it's done when babies are still in the hospital. But the hospital wasn't doing circumcisions because it was elective, and they weren't doing elective procedures because of COVID. At his first doctor's appointment, I talked to our pediatrician about it. She is Indian and told me she didn't circumcise her boys and said that it was very normal in many parts of the world to not do it. I would watch her pull back the skin to check it for fibers and think, "Is it really that bad to keep it? It's just skin." Our pediatrician didn't do it, as she doesn't perform procedures in the office, and she gave us some names of doctors that were supposed to be doing it. My husband called them all and none of them were doing circumcisions either. Finally, my husband found a doctor, but he was booked out for almost a month and a half. With no other option, we made the appointment. I was not thrilled about it, and made my husband do all the calls and arrange it because I did not agree with it.What made me change my mind about circumcising him was I didn't want him to be different. My husband assured me this was the best choice and he was very concerned our son would be bullied for being different. I have a good friend that is a nurse in a long term care facility currently. I called her and asked if it was really that bad for old men to care... (shrink)

Through a focus on one child’s extended stay in a Pediatric Intensive Care Unit, I raise four general questions about pediatric medicine: How should physicians communicate with parents of very sick children? How should physicians involve parents of very sick children in treatment decisions? How should care be coordinated when a child is being treated by different medical teams with rotating personnel? Should the guidelines for making judgments of medical futility and discontinuation of treatment differ when (...) the patient is a child rather than an adult? (shrink)

After referring briefly to the fantasies regarding the origins of Christianity as elicited by the discovery of the Dead Sea Scrolls in 1947 (Dupont-Sommer, Allegro, Thiering), the purpose of the contribution is to put the Jesus movement into relief in the context of first-century Judaism. The identity of the Qumranites is argued to be Essene scribes. The identity, ideology and practices of the latter are compared with those of Jesus of Nazareth and the movement he elicited using the following rubrics: (...) (1) Jesus, the teacher of righteousness and the powers that be; (2) asceticism versus itinerary charismaticism; (3) caring versus lack of caring for the sick, poor and marginalised; (4) elitist priests and scribes versus lower-class peasants; (5) the interpretation of the law; (6) religious and daily practices (baptism, ritual meal, sacrifice, prayer, community of possessions, scribal activity); (7) religious views or ideology (kingdom of God, the new covenant, light and darkness, politics). The result is a picture of Jesus (with his focus on human suffering) in sharp relief versus Qumran and facets of the early church. (shrink)

The care of terminally ill patients can be physically, emotionally as well as psychologically exhausting. In the era where everyone is busy with his or her hectic daily schedule, caring for someone diagnosed with HIV on her or his deathbed can be a daunting challenge. Caring for someone dying of AIDS does not only challenge the physical being but rather leaves the carer emotionally drained. What was of concern to the author was to see the struggle that the caregiver (...) goes through whilst caring for the sufferer. More often than not, pastoral care and counselling concentrate mainly on the pain and the suffering of the sick person. In the process, pastoral care loses sight of the agony, the emotional strain and, above all, the trauma of the caregivers in their search for answers as they care for the infected. This scenario has prompted the author to look into the theology of caring with an emphasis on pastoral care of the carers with a view of alleviating their emotional burden in caring for the HIV patients. (shrink)

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a strange (...) way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it. (shrink)

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the (...) sick. However, there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the reso.. (shrink)

Buddhists, including the Bhutanese, value human life as rare and precious, and accept sickness, ageing and death as normal aspects of life. However, death and dying are subjects that evoke deep and disturbing emotions often characterised by denial related to high-tech medicalisation and its inspiring hope. Advanced medical interventions such as cardiopulmonary resuscitation are believed to interfere with the natural process of dying. However, some excessively pursue medical interventions in the hope of prolonging and preserving life, refusing its finitude. Healthcare (...) workers are faced with increasing instances of ethical and moral dilemmas exacerbated by inadequate training and lack of proper understanding of the socio-cultural context on end-of-life care and to facilitate good death in Bhutan. We discuss these ethical dilemmas in providing quality end-of-life care and good death against the backdrop of rapidly changing social values and expectations. (shrink)

The meaning of dignity in health care has been primarily explored using interviews and surveys with various patient groups, as well as with health care practitioners. Philosophical analysis of dignity is largely avoided, as the existing philosophical literature is complex, multifaceted and of unclear relevance to health care settings. The aim of this paper is to develop a straightforward philosophical concept of dignity which is then applied to existing qualitative research. In health care settings, a patient (...) has dignity when he or she is able to live in accordance with his or her standards and values. Accordingly, health care practitioners respect a patient's dignity when they refrain from transgressing the patient's standards and values, or refrain from forcing the patient to transgress his or her standards and values. This concept is shown to explain and illuminate most of the key qualitative findings. It therefore provides a more coherent and synthesised concept of dignity in health care. (shrink)

In thinking about how to expand insurance coverage, the issue that matters is whether insurance enables sick and high-risk people to get medical care. Over the course of three decades, market-oriented insurance reforms have shifted more costs of illness onto people who need and use medical care. By making the users of care pay for it , cost-sharing discourages sick people from getting care, even if they have insurance, and for people with low-incomes and (...) tight budgets, cost-sharing can effectively deny them access to care. Thus, covering or not covering sick people is the core issue of health insurance reform, both as a determinant of support and opposition to proposals, and as the proper yardstick for evaluating reform ideas. (shrink)

To properly comply with the Health Sector Act of 1992 a functioning competition should be introduced in the interests of the insured of the German Statutory Health Insurance, while still maintaining the principle of solidarity. This is a critical order-political aim, because the principles of solidarity and selfresponsibility as typically understood are functionally in contradiction. This paper analyzes the important measures of the Organizational Reform and concludes, that the principle of self-responsibility ought to obtain priority. Therefore, the German legislature ought (...) to focus on further competitively oriented reform steps. (shrink)

Background Conducting clinical trials with pre-term or sick infants is important if care for this population is to be underpinned by sound evidence. Yet, approaching the parents of these infants at such a difficult time raises challenges to obtaining valid informed consent for such research. In this study, we asked, What light does the analytical literature cast on an ethically defensible approach to obtaining informed consent in perinatal clinical trials? -/- Methods In a systematic search, we identified 30 (...) studies. We began our analysis by applying philosophical frameworks, which were then refined as concepts emerged from the analytical studies, to present a coherent picture of a broad literature. -/- Results Between them, the studies addressed four themes. The first three were the ethical basis for parental informed consent for neonatal and/or perinatal research, the validity of parental consent in this context, and the range of possible options in methods for gaining consent. The last was the issue of risk and the possibility of a double-standard or asymmetry in the current approaches to the requirement for consent for research and consent for clinical treatment. -/- Conclusions In addressing these issues, the analysed studies showed that, whilst there are a variety of possible defences for seeking parental ‘consent’ to neonatal and/or perinatal clinical trials, these are all consistent with the strongly and widely held view that it is important that parents do give (or decline) consent for such research. So far as the method of obtaining consent is concerned, none of the existing consent processes reviewed by the research is satisfactory, and there are philosophical reasons for supposing that at least some parents will fail to give valid consent in a neonatal context. Furthermore, in giving parental ‘consent’ in a perinatal context, parents are authorising infant participation, not giving ‘proxy consent’. Finally, there are reasons for giving weight to both parental ‘consent’ and the infant’s best interests in both research and clinical treatment. However, there are also reasons to treat these factors differently in the two contexts, and this may be partly due to the differing relevance of risk in each case. A significant gap is the lack of any detailed discussion of a process of emergency and/or urgent ‘assent’, in which parents assent or refuse their baby’s participation as best they can during the emergency and later give full consent to continuing participation and follow-up. (shrink)

This paper addresses how interactions between UK palliative care nursing staff and the bodies of the deceased they care for function as a mechanism to help them make sense of death in line with their work as carers. Through an analysis of postmortem care rituals, I will argue that nurses play an integral role in the ‘making of the dead’, and look at how this functions in relation to their role as carers of bodies in line with (...) associated states of personal wellbeing. Further to this, there is an argument to be made for the recognition of the nurse’s place in biomedical models as managers of the transient body; as the constructors of the well, sick, living and dead body. (shrink)

The paradox of the Aged Care Act 1997: the marginalisation of nursing discourse This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo‐reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo‐reform period and challenges the assertion that (...) the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever‐changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault. (shrink)

One of the best-known principles of halakha is that Shabbat is violated to save a life. Who does this saving and how do we know that a life is in danger? What categories of illness violate Shabbat and who decides? A historical-sociological analysis of the roles played by Jew, non-Jew, and physician according to the approach of “medical cosmology” can help us understand the differences in the approach of the Shulchan Aruch compared to later decisors (e.g., the Mishnah Berurah). Such (...) differences illuminate how premodern medical triage coexisted with a different halakhic understanding than that of the biomedical age. (shrink)

Not all actions that are legal are necessarily morally correct. However, there are few protections for providers who are pressured to comply with actions and procedures that infringe on their religious beliefs regarding human dignity. The right of health care providers to freely act on religious convictions and refrain from cooperating with morally reprehensible tasks is often eschewed in favor of political correctness or is branded as discrimination. Adequate safeguards are urgently needed for health care workers at all (...) levels to ensure that they can continue to care for the sick and most vulnerable members of the community without violating the dictates of their conscience. This article examines the free exercise of religion as it pertains to medical provider conscience protections. The author argues for conscience protection legislation with a right of action. (shrink)

The concepts of anxiety and despair together are central to Kierkegaard's conception of the self. He discusses these concepts principally in two works, The Concept of Anxiety and The Sickness Unto Death. Anxiety and despair each have a complex structure and are closely interrelated to one another. This thematic interconnection between anxiety and despair is doubled and made more difficult by the textual relationship between the two works and the fact that they have different pseudonymous "authors." Further, both these works (...) are very dense and bristle with problems of meaning and interpretation. Therefore, the dissertation is a careful articulation of the structure and relation between anxiety and despair through a close textual analysis of The Concept of Anxiety and The Sickness Unto Death. ;Kierkegaard understands anxiety to be both the attraction to and the repulsion from the nothingness of future possibilities. Thus, anxiety is not simply a psychological state, mood or feeling, but is an ontological structure essential to human being and is the mark of human freedom. Anxiety is that which psychology refers to in seeking an explanation to free human choices. Further, anxiety is an explanation of choice only in the sense that it explains the possibility of choice; it does not and can not explain the cause of this or that particular choice. ;Kierkegaard understands despair to be a not-willing-to-be-oneself. Like anxiety, despair is not simply a psychological state. Instead, it is the structure of one's being who has wrongfully used freedom. Since the self is capable of relating itself to itself in multiple ways, and since despair is the misrelation of oneself to oneself, despair has a multitude of forms. ;I argue that in Kierkegaard's writings, anxiety and despair are surely not different terms for the same mood or psychological state. Rather, anxiety is the mark of human freedom and the condition for the possibility of despair. Despair is the wrongful use of freedom through the failure to choose to be oneself. Finally, a cure for despair must include anxiety, that is, freedom's possibility. (shrink)

How can we provide the best care for the growing population of older adults, many of whom are either very frail or very sick? The traditional medical model of care is focused on treatment of single diseases. This can work well for pneumonia, cancer, or diabetes in younger patients. It does not, however, work as well for frail older adults who have accumulated multiple chronic conditions and disabilities. These elders often depend on family or paid caregivers to (...) provide assistance with taking medications, transportation, and other activities of daily living, such as dressing and bathing. A practitioner in the traditional medical model might prescribe medications that make sense in isolation but have harmful... (shrink)

In the early twenty-first century, we stand on the threshold of welcoming robots into domains of human activity that will expand their presence in our lives dramatically. One provocative new frontier in robotics, motivated by a convergence of demographic, economic, cultural, and institutional pressures, is the development of “carebots”—robots intended to assist or replace human caregivers in the practice of caring for vulnerable persons such as the elderly, young, sick, or disabled. I argue here that existing philosophical reflections on (...) the ethical implications of carebots neglect a critical dimension of the issue: namely, the potential moral value of caregiving practices for caregivers. This value, I argue, gives rise to considerations that must be weighed alongside consideration of the likely impact of carebots on care recipients. Focusing on the goods internal to caring practices, I then examine the potential impact of carebots on caregivers by means of three complementary ethical approaches: virtue ethics, care ethics, and the capabilities approach. Each of these, I argue, sheds new light on the contexts in which carebots might deprive potential caregivers of important moral goods central to caring practices, as well as those contexts in which carebots might help caregivers sustain or even enrich those practices, and their attendant goods. (shrink)

Christians have considered the care of the sick to be a form of ministry ever since the time of Jesus. As Christians prepare to commemorate the second millenium of the birth of the founder of their religion, they cannot help but notice that health care is changing more than it ever has in the last 2,000 years. Nor can they help but notice that these changes threaten the notion that health care can be practiced as a (...) genuine ministry in the twenty-first century. (shrink)

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by (...) double-effect reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick. (shrink)

In response to the articles by Eibach and Groenhut in this issue, I argue that there is a general connection between sickness and the entrance of sin into the world. There are times when there is a causal link between more specific sin and sickness, though often the patient is the one who has been sinned against. Illness can also expose sin in a patient's life. Integrating the reality of illness into the life history of a patient is a significant (...) pastoral care issue and can be done with humility and sensitivity if done in accordance with the teaching of Job and Ecclesiastes. These books argue that “under the sun” or this side of eternity, human beings can't grasp the coherence of life, including the “why” of illness. Rather, God provides His loving presence, through His people as a comfort to those suffering from illness. (shrink)

"The book is carefully organized and provides a clear, well-structured, and lucid expression of its theses." -- Dr. Marvin Fox, Department of Near Eastern and Judaic Studies, Brandeis University The Mishnah is the first canonical writing of Judaism after the Hebrew Scriptures of ancient Israel (the Old Testament) and the foundation of the two Talmuds and of all Judaism thereafter. According to eminent religion scholar Jacob Neusner, the key to understanding the Mishnah is to read it as philosophy, in accord (...) with the generally accepted understanding of philosophy in its time and place. In Judaism as Philosophy, Neusner studies a large sample of evidence, meticulously translated and carefully explained, and identifies the philosophical side of the Mishnah's system, method, and message alike. The philosophical tradition in which the Mishnah takes its place, Neusner explains, utilizes the Aristotelian method of hierarchical classification to demonstrate the proposition (important to Middle Platonism and profoundly expressed by Plotinus) that many things really form a single thing: many species, a single genus; many genera, an encompassing, well-crafted and cogent whole. Through the systematic and orderly hierarchical classification of the things of nature, the framers of the Mishnah illustrate the ultimate unity of all being emanating from the One on high. Arguing that the document's writers chose a legal form for a philosophical proposition, this book completely changes a centuries-old way of reading the Mishnah. Judaism emerges as a sustained demonstration of the unity of all being under one God. "What is the next phase in this ongoing history of the formation of Judaism in theclassical period[?]... The analysis of the philosophical character of the Mishnah places into perspective what I believe to be the character of the first phase, and therefore points toward the development of the second and third phases, of the Judaism of the Dual Torah. The entire characterization of the first phase of the Judaism of the Dual Torah, that is, the system attested by the Mishnah in particular, rests upon the results of this book and its two companions, on economics and politics respectively."--from the Preface. (shrink)

This book offers a long-overdue exploration of care at a pivotal moment in the history of health care.

Doctor and patient meet in a circle of feelings determined by suffering. Sensitivity to the suffering is an axis determining the nature of the doctor and patient relationship. The patient's experience of an illness is individual, private, and very often difficult to describe. But the possibility to understand the suffering of another person comes from the fact that suffering is a universal feeling. We propose to enter the world of patient's experience by writing a letter to a doctor, which would (...) reflect their experiences and expectations towards him. This was the task required for 120 students of the second year of medicine and dentistry education. (shrink)

In response to cancer, patients may be thrown into precarious processes of remaking their purpose, identity, and connections to the world around them. Thoughtful and thorough responses to these issues can be supported by person-centered phenomenological approaches to caring for patients. The importance of perspectives on illness offered by theoretical phenomenology will become apparent through the example of the experience of nausea, or perhaps more accurately put—chemo sickness. The focus here is on how chemo sickness alters one's way of relating (...) to the world. I will examine the phenomenon of nausea through the lens of the phenomenological concept of mood—an existential feeling that engenders a diffused tone permeating through one's world and shapes the envisioned possibilities on one's horizon. (shrink)

The notion of the value of life is often invoked in discussions regarding medical care for the sick and the dying. This theme has figured in arguments about medical ethics for decades, but many of the phrases associated with this concept have received little serious scrutiny. It is true that some philosophers have declared a few commonly used phrases such as “the sanctity of life,” “the infinite value of life,” and “the value of life itself” to be unclear (...) at best or misguided at worst. Their hasty dismissal of these phrases, however, is not the end of the story. I generally agree with this philosophical judgment but for reasons very different from those typically given by others. Moreover, the reasons I wish to .. (shrink)

As human beings we sometimes in one way or another become sick, and therefore go for treatment depending on our choice of treatment (religious perspective or Western medical treatment). Although African traditional religion is not against a Western medical way of treatment or healing process, its followers believe that there are some diseases that Western medicine cannot treat, and therefore need spiritual attention, as it is sometimes practiced in churches. This article discusses the African traditional view regarding disease, causes (...) of disease, how disease is diagnosed and treated, with a special focus on Ghana. The article also describes the role of the diviner or the African traditional priest or what others may term as ‘herbalists’. The advantages and disadvantages of the African traditional healing process are considered. The article concludes by discussing African traditional healing in the context of a contemporary health care discourse, as well as a proposal for dialogue between traditional healers, Western medical practitioners, the government of Ghana, and the governments of various countries where this issue may be applicable, to build a consensus in addressing health issues. (shrink)

We analyse solidarity as a mixture of social justice on the onehand and a set of cultural values and ascriptions on the otherhand. The latter defines the relevant sense of belonging togetherin a society. From a short analysis of the early stages of theDutch welfare state, we conclude that social responsibility wasoriginally based in religious and political associations. In theheyday of the welfare state, institutions such as sick funds,hospitals or nursing homes became financed collectively entirelyand became accessible to people (...) of all denominations. Solidaritywas transformed in a more general category, related to the statusof Dutch citizenship. Responsibility was transformed tocollective responsibility.Financial pressures on the Welfare State have resulted in adebate on choices in health care and in a number of systemreforms, so far relatively small. In the surrounding discourse,justice was linked to private responsibility. Both fromgovernment officials and from participants in the societaldebate, moralistic overtones could be heard concerning the threatof overburdening of the health care system by citizens.In this paper, we develop a concept of reflexive solidarity thatlinks elements of social justice to conceptualisations ofresponsibility that address policy makers and health careinstitutions as well as citizens, in their role of carereceivers. A short analysis of the phenomenon of personal budgetsin care services should prove that our concept of reflexivesolidarity is not empty. Linked to, but beyond the concept ofjustice, issues of social responsibility can be addressed withoutmoralistic overtones. (shrink)

This paper explores the relationship between temporal continuity in nursing and temporal features of sickness. It is based on phenomenological and hermeneutical philosophy, empirical studies of sickness time, and the nursing theories of Nightingale, of Benner and of Benner and Wrubel. In the first part, temporal continuity is defined as distinct from interpersonal continuity. Tensions between temporal continuity and discontinuity are discussed in the contexts of care management, of conceptualisations of disease and of time itself. Temporal limitations to the (...) methodological concept of situation are discussed. The main part of this paper explores nurses' possibilities to relate to their patients' time, and how temporal features of sickness may warrant temporal continuity of nursing. Three temporal characteristics of sickness are discussed: the immediacy of patients' suffering, the basic continuity of life through sickness and health care, and the indeterminism and precariousness of sickness. The timing of nursing acts is discussed. The paper explores how sickness is both part of the continuity of life, and threatens this continuity. It concludes that this tension is implicitly recognised in the temporal continuity of nursing, which allows for discontinuous and continuous aspects of sickness time. Nurses accordingly perceive the sick person's time at several levels of temporality, and distinguish highly complex temporal processes in their patients' trajectory. Temporal continuity provides the time, flexibility, and closeness for nurses to perceive and act into time dimensions of individual sickness. The paper shows that temporal continuity of nursing is grounded in temporal characteristics of severe sickness. It suggests that temporal continuity is an important theoretical concept in nursing. (shrink)

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the (...) sick. However, there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the resources available to successfully manage them is effective palliative care. However, this could hasten death in this vulnerable population and hence, while ethically and medically justifiable, is not without social risk. (shrink)

Hume’s Critique of Religion is a valuable and rewarding contribution to Hume scholarship. The atheistic interpretation that the authors defend is well supported and convincingly argued. Although Gaskin’s Hume’s Philosophy of Religion is (rightly) highly regarded, I believe that Bailey and O’Brien provide a more compelling and convincing interpretation. Their account is, in particular, much stronger in respect of the historical background and contextual considerations that they draw on to support of their interpretation. These historical advances are achieved without weakening (...) the care and attention that is given to Hume’s philosophical arguments. Students and more advanced scholars alike will find this study highly illuminating and instructive. It deserves to be widely read and carefully considered. -/- . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Bear Man's Greatness:On the Moral-Theological Message of a Recent Document of the Congregation for the Doctrine of the Faith, Samaritanus Bonus1Andrzej KucinskiBackground and ObjectiveWhen, in 1582, Camillus de Lellis, the later-canonized founder of the Order of Camillians, the "servants of the sick," had the inspiration to found a society of men who would serve the sick for religious motives,2 the revolutionary nature of such a decision (...) was clear. An unprecedented hope broke into the world of the hopelessly marginalized, who did not have sufficient means to be cared for at home, and therefore had to go to hospitals, where they were often assisted only by untrained caregivers, who did so under obligation because they were either criminals or compelled by economic need to perform such menial service. This hope consisted in the message that the love of God urges the voluntary and sacrificial service of dedication to the sick, and especially to those who will not recover from their illness. However, this service should be holistic, because the welfare of the needy encompasses all the dimensions of the human person: the body and the soul, but also the spirit.The letter of the Congregation for the Doctrine of the Faith (CDF) Samaritanus Bonus, dated July 14, 2020—the liturgical day of commemoration of Camillus of Lellis—on the care of persons in the critical and [End Page 753] terminal phases of life, seeks to promote the same concern for comprehensive service to the sick out of respect for the divinely anchored dignity of the human person. The letter suggests that it is this dignity, and therefore the incomparable greatness of each human being, that makes it necessary, contrary to any logic of efficiency and a cost–benefit calculation, to persevere at the side of the (terminally) ill until their natural death.This article aims to highlight some (in the author's opinion) central elements of this letter, and to comment on them specifically against the background of the magisterial positions underlying the document. For this purpose, I will often quote Robert Spaemann, the German philosopher who died in 2018 and whose ethical views appear in parts as well suited to illuminate from the ethical point of view the foundations of thought of the universal Church magisterium with regard to the relevant topics and to prepare these foundations for a scientific discussion. However, it is explicitly not the aim here to engage in such a discussion or to analyze the already existing relevant contributions. Rather, it is to deepen the current Church teaching in certain aspects on the basis of this new document. In this sense, contributions from the press conference on its presentation on September 22, 2020, will also be drawn upon. After the exploration of what one could understand as "core" of the letter according to a certain reading of the document, some concretizations follow under the guiding perspective of the "Catholic" approach to the terminally ill.The Core of the DocumentThe structure of Samaritanus Bonus will be briefly described: An introduction, in which above all the need for magisterial intervention is justified, is followed by chapter 1, on the comprehensive character of the care which is always possible for persons in critical states, according to the principle that "the judgement that an illness is incurable cannot mean that care has come at an end" (8).3 Chapter 2 then further explicates the grounds of Christian hope in the face of approaching death, starting from the mystery of the Crucified, with special reference to those who stay around him at the moment of the Passion. Chapter 3 recalls the positive meaning of human life as an expression of inalienable human dignity and as the source of certain imperatives in dealing with it. A clear reference to the proclamation [End Page 754] of Pope Francis is made in chapter 4, which explains some "cultural obstacles" to the recognition of the "sacred value of every human life." Finally, chapter 5 (the longest) addresses individual bioethical, medical-ethical, legal, pastoral, and educational issues related to care at critical stages of life.In substance, the doctrine set forth in the new document... (shrink)

Challenging previous interpretations of Levinas that gloss over his use of the feminine or show how he overlooks questions raised by feminists, Claire Elise Katz explores the powerful and productive links between the feminine and religion in Levinas’s work. Rather than viewing the feminine as a metaphor with no significance for women or as a means to reinforce traditional stereotypes, Katz goes beyond questions of sexual difference to reach a more profound understanding of the role of the feminine in Levinas’s (...) conception of ethical responsibility. She combines feminist interpretations of Levinas with interpretations that focus on his Jewish writings to reveal that the feminine provides an important bridge between his philosophy and his Judaism. Katz’s reading of Levinas’s conception of the feminine against the backdrop of discussions of women of the Hebrew bible points to important shifts in contemporary philosophy toward the creation of life and care for the other. (shrink)

In recent years society has come to expect more from the “socially-responsible” company and the global HIV/AIDS pandemic in particular has resulted in some critics saying that the “Big Pharma” companies have not been living up to their social responsibilities. Corporate social responsibility can be understood as the socio-economic product of the organizational division of labor in complex modern society. Global poverty and poor health conditions are in the main the responsibilities of the world’s national governments and international governmental organizations, (...) which possess society’s mandate and appropriate organizational capabilities. Private enterprises have neither the societal mandate nor the organizational capabilities to feed the poor or provide health care to the sick intheir home countries or in the developing world. Nevertheless, private enterprises do have responsibilities to society that can be categorized as what they must do, what they ought do, and what they can do. (shrink)