Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we are guided (...) less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. (shrink)

This paper is essentially concerned with defending the idea of a universal right to adequate health care coverage. It will argue for the existence of a human right grounded in Catholic social thought. At the outset, a statement of clarification is needed. This paper does not pretend to offer the panacea for all ills relating to health care provision. Rather, it is an inquiry into the kinds of value that should inform decision making relating to health policy. A universal right (...) to adequate health care cannot be established without questioning the underlying values that inform the debate and bring them firmly to the level of deliberative consciousness. It is these value concerns that structure the dynamic of health care provision and the general provision of wider resources in society. (shrink)

This article uses diary data from the most recent Australian Bureau of Statistics Time Use Survey to compare by gender total child care time calculated in the measurements of main activity, main or secondary activity, and total time spent in the company of children. It also offers an innovative gender comparison of relative time spent in the activities that constitute child care, child care as double activity, and time with children in sole charge. These measures give a fuller picture of (...) total time commitment to children and how men and women spend that time than has been available in previous time use analyses. The results indicate that compared to fathering, mothering involves not only more overall time commitment but more multitasking, more physical labor, a more rigid timetable, more time alone with children, and more overall responsibility for managing care. These gender differences in the quantity and nature of care apply even when women work full-time. (shrink)

In 2005, President George Bush read John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History. After his experiences of 9/11 and Hurricane Katrina, Bush began the first White...

This paper provides an overview of the application of canon law to the administration of Catholic heahh care in the United States. It is divided into four sections. The first section provides a context for the role of canon law in the life of the Church. The second section considers the fundamental question of juridic personality in the Church. The third section delineates the predominant forms of organization that have hitherto been the main Church related institutions providing health care. The (...) fourth section considers the validity of the McGrath "independence" thesis conceming the continuing applicability of canon law to incorporated health care structures under U.S. civil law. The paper concludes with some practical considerations conceming the relationship between canon law and corporate structures. (shrink)

The public responsibilities of nonprofit hospitals have been contested since the advent of the 1969 community benefit standard. The distance between the standard's legal language and its implementation has grown so large that the Internal Revenue Service issued a new reporting form for 2008 that is modeled on the Catholic Health Association's guidelines for its member hospitals. This article analyzes the appearance of an emerging moral consensus about community benefits to argue against a strict charity care mandate and in favor (...) of directing efficient care delivery and healthy community initiatives to underserved populations. The analysis turns on three moral conceptions of community benefits, the social contract model of hospital critics and the common good and covenantal models of Catholic and Jewish hospitals. (shrink)

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why (...) we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ’it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

As resources in health care are scarce, managers and clinicians must make difficult choices about what to fund and what not to fund. At the level of a regional health authority, limited approaches to aid decision makers in shifting resources across major service portfolios exist. A participatory action research project was conducted in the Calgary Health Region. Through five phases of action, including observation of senior management meetings, as well as two sets of one-on-one interviews and two focus groups, an (...) approach to priority setting at the macro level within the health region was developed and implemented. The resulting macro level approach builds on the program budgeting and marginal analysis (PBMA) framework. Using a multi-disciplinary expert panel, about $45M (CAN) was released for the 2002/03 fiscal year and made available for re-allocation to service growth areas and the deficit. Important qualitative themes from the managers and clinicians informed both process development and refinement. The approach developed here not only facilitated re-allocation of resources, but also drew in both clinicians and managers to work together on this challenging task. The approach is pragmatic, transparent and evidence based, and should have application elsewhere. (shrink)

Using interviews with activists and Lisa Sowle Cahill's concept of participatory discourse, this article examines how the Greater Boston Interfaith Organization (GBIO) built solidarity for the 2006 Massachusetts health care reform law. The analysis explores the morally formative connections between GBIO's activist strategies and its public liturgy for reform. The solidarity generated through this interfaith coalition's activities and religious arguments contrasts with two standard types of policy discourse, economics and liberalism. Arguments for health care reform based on economic efficiency or (...) positive rights are hampered by the lack of solidarity in U.S. political culture. GBIO's congregation-based organizing offers a performative model of public argumentation for religious groups committed to achieving affordable, quality health care for all Americans. (shrink)

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, (...) digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care. (shrink)

This book is an exploration and defense of the coherence of classical theism’s doctrine of divine aseity in the face of the challenge posed by Platonism with respect to abstract objects. A synoptic work in analytic philosophy of religion, the book engages discussions in philosophy of mathematics, philosophy of language, metaphysics, and metaontology. It addresses absolute creationism, non-Platonic realism, fictionalism, neutralism, and alternative logics and semantics, among other topics. The book offers a helpful taxonomy of the wide range of options (...) available to the classical theist for dealing with the challenge of Platonism. It probes in detail the diverse views on the reality of abstract objects and their compatibility with classical theism. It contains a most thorough discussion, rooted in careful exegesis, of the biblical and patristic basis of the doctrine of divine aseity. Finally, it challenges the influential Quinean metaontological theses concerning the way in which we make ontological commitments. (shrink)

Although recent scholarship in diverse professional areas shows an ongoing interest in the application of agape - the New Testament's term for the highest order of self-giving love - no published work has made an in-depth exploration of agape in relation to journalism. This article explores what agape can contribute to media theory and practice. After explaining what distinguishes agape from other concepts of altruism and how agape can complement other approaches to compassion or minimizing harm, the analysis turns to (...) three questions raised by applying agape to mainstream journalism: (a) Does agape have a place for self-interest? (b) What does agape imply for notions of journalistic neutrality? (c) Can agape speak to journalists who don't accept its religious roots? Agape provides a test case for the application of religiously based ethical perspectives to journalism. (shrink)

This paper draws on data from Work and Care During COVID-19, an online survey of Australians during pandemic lockdown in May 2020. It focuses on how subsamples of lesbian, gay, and bisexual mothers and fathers in couples and single mothers subjectively experienced unpaid work and care during lockdown compared with heterosexual mothers and fathers in couples, and with partnered mothers, respectively. During the pandemic, nonheterosexual fathers’ subjective reports were less negative than those of their heterosexual counterparts, but differences between heterosexual (...) and lesbian/bisexual mothers were more mixed. Unlike their partnered counterparts, more single mothers reported feeling satisfied than before with their balance of paid and unpaid work and how they spent their time overall during the pandemic, perhaps because they avoided partnership conflicts and particularly benefited from relaxed commuting and child care deadlines. (shrink)

USING QUALITATIVE INTERVIEWS AT CATHOLIC AND JEWISH HOSPITAL organizations, this essay contrasts the market-driven reforms of consumer-directed health care and physician entrepreneurship with the mission-driven structures of religious nonprofits. A structural analysis of values in health care makes a convoluted system more transparent. It also demonstrates the limitations of market reforms to the extent that they erode organizational structures of solidarity, which are needed to pool risks, shift costs, and maintain safety nets in a complex and expensive health economy.

As a graduate student in Linguistics at UMass/Amherst in the 1980s, I was fortunate to be exposed to a number of new developments bearing on the relationship between formal semantics and pragmatics. In the 1970s under the influence of Cresswell, Lewis, Montague, and Partee, enormous progress in semantics was made possible by narrowing the focus of the field mainly to the consideration of the conventional, truth conditional content of an indicative utterance, calculated compositionally as a function of the semantic contributions (...) of its parts and its syntactic structure. Context was typically relegated to the background, in the form of indices of evaluation, though occasionally popping out for more serious consideration, as in the work of Kaplan, Karttunen, and Stalnaker. But eventually the nature of the rigorous formal enterprise itself, confronted with phenomena like Geach’s donkey sentences, presupposition projection, and the context-dependence of tense and aspect, forced the field into a more careful, thorough reconsideration of the relationship between context and content. Hence were born the dynamic theories of interpretation, beginning with Hans Kamp (1981) and Irene Heim (1982), who were both at UMass during my stay there, Heim completing her dissertation and Kamp on the faculty in Philosophy. Such frameworks posit a dynamic interchange between content and context, each dependent on the other, even in the course of interpreting a single utterance. Mats Rooth was also a graduate student at UMass at that time, and wrote his influential dissertation (1985) proposing an alternative semantics for the interpretation of prosodic focus, inter alia shedding light on how focus contributes to the contextual domain restriction of various operators. (shrink)

Stakeholder theory, as a method of management based on morals and behavior, must be grounded by a theory of ethics. However, traditional ethics of justice and rights cannot completely ground the theory. Following and expanding on the work of Wicks, Gilbert, and Freeman (1994), we believe that feminist ethics, invoking principles of caring, provides the missing element that allows moral theory to ground the stakeholder approach to management. Examples are given to support the suggested general principle for making business decisions (...) under feminist moral theory. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

For many philosophers, bad-history wrongdoers are primarily interesting because of what their cases might tell us about the interaction of moral responsibility and history. However, philosophers focusing on blameworthiness have overlooked important questions about blame itself. These bad-history cases are complicated because blame and sympathy are both fitting. When we are careful to consider the rich natures of those two reactions, we see that they conflict in several important ways. We should see bad-history cases as cases about whether and how (...) we should blame, rather than as cases giving us ready insight into the nature of moral responsibility. (shrink)

Moral distress is a concept used to date in clinical literature to describe the experience of staff in circumstances in which they are prevented from delivering the kind of bedside care they believe is expected of them, professionally and ethically. Our research objective was to determine if this concept has relevance in terms of key health care managerial functions, such as priority setting and resource allocation. We conducted interviews and focus groups with mid- and senior-level managers in two British Columbia (...) (Canada) health authorities. Transcripts were analyzed qualitatively using constant comparison to identify key themes related to moral distress. Both mid- and senior-level managers appear to experience moral distress, with both similarities and differences in how their experiences manifest. Several examples of this concept were identified including the obligation to communicate or ‘sell’ organizational decisions or policies with which a manager personally may disagree and situations where scarce resources compel managers to place staff in situations where they meet with predictable and potentially avoidable risks. Given that moral distress appears to be a relevant issue for at least some health care managers, further research is warranted into its exact nature, prevalence, and possible organizational and personal responses. (shrink)

In the last decade, the humanities have been shrinking in number of students, percent of faculty, and in number of degrees awarded. Humanities students also earn lower salaries than their STEM-prepared peers. At the same time, the health humanities have been in ascendance over the last fifteen years. The number of majors, minors and certificates has increased 266% in that time frame, attracting large numbers of students and preparing future patients, lay caregivers, and health care providers to interact with a (...) complicated and dehumanized medical system. In 1982, British philosopher and educator Stephen Toulmin declared that medicine saved philosophy from irrelevance and possibly extinction. I propose that the health humanities can serve a similar function to stave off the decline of the broader humanities. The health humanities can model an applied approach for the broader humanities to attract student interest; develop students’ capacity for critical reading, writing and reflection about health and medicine in society, practice, and their own lives and inoculate all students against the influence of medicine, whether through preparing pre-health students to navigate the hidden medical curriculum or preparing future patients to navigate the health care system. (shrink)

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why (...) we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ‘it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

This paper considers the possibility that nonrelativistic quantum mechanics tells us that Nature cares about time reversal. In a classical world we have a fundamentally reversible world that appears irreversible at higher levels, e.g., the thermodynamic level. But in a quantum world we see, if I am correct, a fundamentally irreversible world that appears reversible at higher levels, e.g., the level of classical mechanics. I consider two related symmetries, time reversal invariance and what I call ‘Wigner reversal invariance.’ Violation of (...) the first is interesting, for not only would it fly in the face of the usual story about temporal symmetry, but it also appears to imply (as I’ll explain) that time is ‘handed’, or as some have misleadingly said in the literature, ‘anisotropic’. Violation of the second is, as I hope to show, even more interesting. The paper also contains a discussion of two mostly neglected topics: what it means to say time is handed and what warrants such an attribution to time. (shrink)

We review Potts' influential book on the semantics of conventional implicature , offering an explication of his technical apparatus and drawing out the proposal's implications, focusing on the class of CIs he calls supplements. While we applaud many facets of this work, we argue that careful considerations of the pragmatics of CIs will be required in order to yield an empirically and explanatorily adequate account.

In this paper data from a Tanzanian horticultural population are used to assess whether mother’s kin network size predicts several measures of children’s health and well-being, and whether any kin effects are modified by household socioeconomic status. This hypothesis is further tested with a questionnaire on maternal attitudes towards kin. Results show small associations between measures of maternal kin network size and child mortality and children’s growth performance. Together these results suggest that kin positively influence child health, but the effects (...) are small and it is unlikely that the high prevalence of undernutrition observed in this setting is influenced by the availability of kin. (shrink)

Collecting and deploying poverty-related data is an important starting point for leveraging data regarding social determinants of health in precision medicine. However, we must rethink how we collect and deploy such data. Current modes of collection yield imprecise data that is unsuited for research. Better data can be collected by cross-referencing other sources such as employers and public benefit programs, and by incentivizing and encouraging patients and providers to provide more accurate information. Data thus collected can be used to provide (...) appropriate individual-level clinical and non-clinical care, and to systematically determine what share of social resources healthcare should consume. (shrink)

The practice of psychology in rural areas offers unique challenges for psychologists as they try to provide optimal care, often with a minimum of resources. Psychologists are frequently required to be creative and flexible in order to provide effective services to a wide range of clients. However, these unique challenges often confront psychologists with ethical dilemmas and problems for which their urban-based training has not prepared them. The author examines how certain characteristics of rural communities may lead to specific ethical (...) dilemmas. By being a part of a small community, psychologists will inevitably face multiple relationship dilemmas. Confidentiality is harder to maintain in a small town, particularly with its informal information-sharing network. To provide services to meet community needs, with a limited number of referral options, psychologists typically need to be generalists. This may lead to concerns about scope of practice, training, and experience with diverse populations. Psychologists also face other competency issues, such as a lack of supervision and consultation resources. Other concerns addressed include the psychologist's visibility in the community, having clients know about the psychologist's personal life, and the blurring of professional and personal roles. Suggestions are made for coping with each of these ethical issues, although more quantitative research and discussion are needed on the practice of psychology in rural areas. (shrink)

This article analyzes the origins of the “responsible corporate officer” doctrine: the trial of Joseph Dotterweich. That doctrine holds that an officer may be personally liable for the criminal act of a subordinate if the officer was, in some indefinite way, able to prevent the violation. Applying this doctrine, the prosecution of Dotterweich entailed strict liability for a strict liability offense. The underlying offenses—the interstate sale of one misbranded and adulterated drug and one misbranded drug—were said to be strict liability (...) offenses. And then, with respect to Dotterweich as the corporation’s general manager, the government argued that he was strictly liable because he stood in “responsible relation” to the company’s acts. The government never tried to prove that the company, Buffalo Pharmacal, was negligent, nor did it try to prove that Dotterweich was negligent in his supervision of the employees of Buffalo Pharmacal. The prosecutor and judge were candid about this theory throughout the trial, although the judge conceded that it seemed bizarre and unfair. The defense lawyer repeatedly sought to inject what became known throughout the trial as the “question of good faith,” but was circumvented at almost every turn. What would thus seem to be the crux of any criminal trial—the personal fault of the defendant—was carefully shorn from the jury’s consideration. The government’s theory was so at odds with intuitive notions of liability and blame that, as one probes into the case, and looks at the language used in the government’s appellate briefs, imputations of moral fault inevitably crept in. Yet the government was not entitled to make such accusations, as it had pruned moral considerations from the trial. The article argues that the responsible corporate officer doctrine can never enjoy a secure place in our legal system. First, the doctrine is at a minimum in tension with, and often in direct opposition to, basic principles of the criminal law; and second, the doctrine fails, when followed to its logical conclusions, to accord with basic notions of fair play. The article concludes that the responsible corporate officer doctrine is either unnecessary, in cases in which the evidence establishes personal fault, or unjust, in cases in which it creates liability in the absence of personal fault through the unspecified notion of “responsibility.” The Dotterweich case illustrates what is contemplated by the latter possibility, and why it is problematic in any judicial system that purports, in the words of the Model Penal Code, “to safeguard conduct that is without fault from condemnation as criminal.”. (shrink)

While the natural world may scare us, more frightening beasts arise when we neglect our calling to care for creation and “play god” via technology. From King Kong, Frankenstein, and Godzilla to recent films like The Babadook, The Shape of Water and Us, the most enduring monsters provoke humility, evoke empathy, and prompt us to love rather than fear. These holy terrors can offer an encounter with what Rudolf Otto famously called the mysterium tremendum.

A case study is presented of the American Psychological Association (APA), as a health care organization that promotes human welfare. APA includes policies on human welfare in its Ethical Principles of Psychologists and even lists the advancement of psychology "as a means of promoting human welfare" on its letterhead. Nevertheless, APA has other policies and activities based on military and weapons work that appear to conflict with its promotion of human welfare. Although military work in and of itself may not (...) necessarily be problematic, work that contributes to people purposely being harmed or killed should be squared with the association's ethical guidelines. The results presented here show that this may not be the case: There currently appears to be little justification in the Ethical Principles for work intended to harm people. APA's active lobbying, research, and development for the military are documented here, in relation to an analysis of the Ethical Principles. APA's uncritical support for Operation Desert Storm is examined specifically, with regard to weapons technology and therapeutic treatment of U.S. soldiers on the battlefield. This one-sided support for victims of the war is not in keeping with a Hippocratic health care ethic to treat patients needing care, and to do so with neutrality and impartiality. Similarities to a historical example of nationalistic mental health ethics are discussed, with a review of the development of the German Institute for Psychological Research and Psychotherapy and of the German Society for Psychology in the Nazi wartime effort and the Holocaust. The results here show similar deficiencies in APA's ethical standards, not the least of which is that the code applies to individual members but not to APA policies, committees, or activities. This article concludes with suggested criteria for the Ethical Principles that would at least (a) recognize the ambiguities in systematically developing and using weapons to hurt people and (b) provide an initial rationale of potential justifications. (shrink)

Bioethicists, like many other academics, have a tendency to try to make things general and simpler by eliminating context. Particulars, such as race, economic class, and gender, often seem to be lost in this ocean of generality and abstraction. But in losing them, we are neglecting the analysis of serious moral problems and, with it, the possibility of offering some kind of solution to such problems. This article argues that particulars do matter very much. We will focus ourattention here on (...) gender. We will argue that ignoring questions of gender when evaluating genetic technologies is seriously problematic because it might lead to further injustices against women. Proceeding with a noncontextual understanding of genetic technologies will likely disregard the unjust ways in which the health care system treats women, as well as the ways in which genetic technologies impose extra burdens on them. (shrink)

Chinese medicine (CM) is one ofseveral ancient systems of medical care basedupon a different worldview than the prevailingbiomedical model; it employs its own language,systems of logic, and criteria forunderstanding health and diagnosing illness.Medicinal herbs play a central role in the CMsystem of practice and knowledgeable CMpractitioners have extensive clinicalexperience using them. However, the establishedscientific and regulatory organizations thatrely upon biomedical understandings ofpathology do not accept the definitions formedicinal herb quality used by CMpractitioners. Furthermore, local medicinalherb growers within the upper Midwest (...) are in aposition to grow many herbs, but are unclearabout the demand for and desired qualities ofthe medicinal herbs they produce. Given thissituation, the Medicinal Herb Network wasfounded as a partnership effort of small-scalemedicinal herb growers and practitioners of CMto develop more appropriate standards ofmedicinal herb quality and to encourage locallygrown, high quality medicinal herbs consistentwith these standards. An overview of CM servesas grounding from which to articulate thedilemmas experienced by CM practitioners ofperceiving medicinal herb quality andintegrating knowledge across divergent medicalsystems. A Network initiative designed toovercome these dilemmas illustrates thepossibility of developing a lexicon of qualitydescriptors for medicinal herbs using Chinesemedical theory, while drawing from descriptivesensory analysis procedures currently practicedby a sub-group of food scientists. (shrink)

While I may have misunderstood certain points in Craig's Molinist theodicy, a careful reading of my article will show that Craig is incorrect in his claim that I have failed to evaluate his proposal on the basis of its asserted standard: plausibility. The heart of my argument is that Craig's theodicy is implausible because it fails to provide a credible explanation of the culpability of all non-believers. In this rejoinder I try to show (1) why an evidentialist (...) exoneration of reflective disbelievers (in Christ) also applies, contra Craig, to the unevangelized; and (2) that an evidentialist account of reflective disbelief is more plausible than Craig's sinful-resistance account. (shrink)

Craig, Barry M The combination of 'the eyes of the blind shall be opened' in Isaiah 35:5 and the psalm's 'the Lord gives sight to the blind' seems to be preparing the way for an account of the restoration of sight in the gospel, but its focus is instead on restoring hearing and speech. In this story, which is shared with Matthew, as with the raising of the young girl told also by Matthew and Luke, Mark alone reports the (...) Lord's command in Aramaic. In this case the Lord's word is transmitted in Greek transliteration as Ephphatha, but correctly it should be Ethphathach. The mispronunciation perhaps points to a particular fascination with the Lord's own words in Mark's Greek-speaking circles, and also to the attribution of magical power to such words that may then be borrowed in magical folk-medicine; think similarly of the conjectured origin of Hocus pocus in Hoc est Corpus from Mass in Latin. However, the Aramaic word is richly connected to the mission of Jesus. In the first reading, the Hebrew has two synonymous verbs in verse 5 for opening, respectively applied to the eyes of the blind and the ears of the deaf. The first is not common and is always said of eyes, except in Isaiah 42:20, where it is used of ears. The second verb is common and refers to the opening of eyes and ears and mouths, but also to the untying of cords and to setting free. This is clear in the Syriac Peshitta's use of a single verb for both Hebrew verbs in Isaiah and the word Mark reports Jesus using, where it is applicable both to opening the man's ears to hear and to freeing his tongue to speak clearly. The Septuagint's version of Isaiah has 'will hear' instead of the Hebrew's second verb, 'will be opened', while the added translation in Mark matches only the Septuagint's translation of Isaiah's first verb. That Greek verb is fitting only for the ears, not for the tongue, so that the man's becoming able to speak clearly seems to be merely a consequence of the miraculous opening of his ears. Reading both passages via the Syriac, and reading them in parallel as the Lectionary has us do today, reveals the gospel encounter to be more than simply a story of a healing: the episode points to Christ's redeeming mission as being one of liberating, the scene becoming a fulfilment of Isaiah's prophetic passage in a demonstration of Christ's mission in the flesh and in the life of an actual person. Furthermore, Mark's transmission of the Aramaic commands Ethphathach and Kum in 5:41, together sum up Christ's twofold work: to redeem and raise those doomed to die. Both stories show this at work in the here and now of people's lives and not merely as a future hope for the end of time. If our mission as Church is to continue Christ's work, then it is likewise to be carried out among people in our own time. Thus the historical impetus to establish such works as schools, since education sets free from ignorance, and hospitals, since curing the sick frees them from ills or caring for them brings relief in time of suffering. But we should not think only in such institutional modes; not every parish can or should establish a school or hospital or hospice, or other such major works, but the question remains for each: What does this community do to proclaim Christ's saving mission in the lives of real people both near and far? (shrink)

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. (...) Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice. (shrink)

A review of medical ethics literature relating to the importance of the participation of patients in decision-making introduces the role of rights-based mediation as a voluntary process now being developed innovatively in America. This is discussed in relation to the theory of communicative ethics and moral personhood. References are then made to the work of medical ethics committees and the role of mediation within these. Finally it is suggested that mediation is part of an eirenic ethic already being used informally (...) in good patient care, and that there is a case for developing it further. (shrink)

The decline of empathy among health professional students, highlighted in the literature on health education, is a concern for medical educators. The evidence suggests that empathy decline is likely to stem more from structural problems in the healthcare system rather than from individual deficits of empathy. In this paper, we argue that a focus on direct empathy development is not effective and possibly detrimental to justice-oriented aims. Drawing on critical and narrative theory, we propose an interpersonal approach to enhance empathic (...) capacities that is centered on constructive and transformative interactions which integrates the participatory arts and involves both patients and health professional students. We describe and evaluate a program where patients and students create collaborative, original songs. Interviews and a focus group revealed interactional processes summarized in four themes: reciprocal relationships, interactions in the community, joint goal, and varied collaboration. There was a significant enhancement of positive attitudes about care post-program amongst health professional students. The interpersonal approach may be a preliminary framework for the medical humanities to shift away from a focus on direct empathy development and further towards participatory, co-creative, and justice-oriented approaches to enhance health and thereby empathic capabilities. (shrink)

Social, legal and health-care changes have created an increasing need for ethical review within end-of-life care. Multiprofessional clinical ethics committees (CECs) are increasingly supporting decision-making in hospitals and hospices. This paper reports findings from an analysis of formal summaries from CEC meetings, of one UK hospice, spanning four years. Using qualitative content analysis, five themes were identified: timeliness of decision-making, holistic care, contextual openness, values diversity and consensual understanding. The elements of an engaged clinical ethics in a hospice context is (...) not generally acknowledged nor its elements articulated. Findings from this study have the potential to explain some of the most challenging ethical problems and to contribute to their resolution. It may also guide future deliberation and raise CEC members' awareness of the recurrent issues and values of their CEC practice. (shrink)

The institutional review board Is charged with assessing the risks and benefits of research projects Involving human subjects. Ethical considerations and federal regulations require that an IRB, in part, must find that the potential risks of participation are proportional to the potential benefits and to the Importance of the knowledge that may be learned before the IRB can approve the voluntary assumption of risk by a research participant. Adequate assessment of the risks and benefits requires careful scrutiny of the study (...) design In relation to the study objectives. (shrink)

We illustrate the crucial role played by decoherence (consistency of quantum histories) in extracting consistent quantum probabilities for alternative histories in quantum cosmology. Specifically, within a Wheeler-DeWitt quantization of a flat Friedmann-Robertson-Walker cosmological model sourced with a free massless scalar field, we calculate the probability that the universe is singular in the sense that it assumes zero volume. Classical solutions of this model are a disjoint set of expanding and contracting singular branches. A naive assessment of the behavior of quantum (...) states which are superpositions of expanding and contracting universes suggests that a “quantum bounce” is possible i.e. that the wave function of the universe may remain peaked on a non-singular classical solution throughout its history. However, a more careful consistent histories analysis shows that for arbitrary states in the physical Hilbert space the probability of this Wheeler-DeWitt quantum universe encountering the big bang/crunch singularity is equal to unity. A quantum Wheeler-DeWitt universe is inevitably singular, and a “quantum bounce” is thus not possible in these models. (shrink)