Medical professionals often deny patients who inject opioids a second or third heart valve replacement, even if such a surgery is medically indicated. However, such a position is not well defended. As this paper demonstrates, the ethical literature on the topic too often fails to develop and apply an ethical lens to analyse the issue of multiple valve replacements. This paper addresses this lacuna by analysing the case of Mr Walsh, a composite case which protects the identity of any one (...) patient, through the principlist approach of Beauchamp and Childress. It argues that the hospital should offer Mr Walsh, a second valve replacement because the procedure is: medically indicated, autonomously requested, non-maleficent, beneficent and does not violate a formal account of justice. The paper concludes with clinical ethical guidelines for valve surgery for patients with opioid use disorder. (shrink)

The field of medical ethics, such as the discipline of ethics in general, has traditionally focused on moral dilemmas and quandaries at the expense of ‘everyday’ moral issues. The methodologies, norms and principles of the field reflect this. Although the principle of double effect works well in adjudicating the provision of life-shortening medications to relieve pain, it fails to guide the vast majority of mundane moral decisions that providers make daily.This article contends that exemplarist medical ethics provides action guidance on (...) everyday medical ethical issues. Further, it offers an ethical methodology that is not tethered to a comprehensive doctrine of the good.The paper develops an account of, and draws on Zagzebski’s exemplarist moral theory. It then describes how medical providers can morally deliberate by appealing to exemplars. I contend there are three modes of exemplarist action guidance: dialogue, emulation and substituted judgement. It demonstrates how each of these modes guides moral deliberation regarding quotidian medical ethical issues. The article then turns to a moral exemplar of medical practice, Dr. Jim O’Connell, who Tracy Kidder profiles in his 2023 book, Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People. The advantages and challenges of this approach are delineated before a brief conclusion. (shrink)

Catholic end-of-life ethics does not contain a principle that prohibits the excessive use of medical treatment for declining and dying patients. This article fills this lacuna by exploring and developing the principle of unreasonable means. Unreasonable means are present when the burdens to the patient and community far outpace the benefits to the patient and when the use of such means directly or indirectly limits another patient’s access to ordinary means. Unreasonable means reinforce the redistribution of limited medical resources from (...) the poor to the wealthy and from the global south to the global north. The principle of unreasonable means guides individual patients and medical proxies to preferentially opt for the morally ordinary medical needs of others before the patient’s own extraordinary medical needs. The principle underscores the need for patients and proxies to incorporate justice and the common good into end-of-life decisions. (shrink)

In this book Daly attempts to forge a new ethical approach to issues of social structures, an area of thought deficient in traditional Catholic ethics. Daly argues that the concept of the structures of virtue and vice provide the best ethical lens with which to scrutinize the effects of social structures on personal character and the well-being of the community. His argument relies on two premises: First, he considers the nexus between structures and individual moral agency - arguing that Catholic (...) ethics has failed to account for these realities adequately. The second premise concerns virtue theory, once again emphasizing the importance of accounting for the individual when approaching societal ethics. With the establishment of these premises, Daly furthers the book's ultimate goal: the development of ethical concepts capable of scrutinizing social structures regarding how they shape personal moral character, as well as how they causally impact the well-being of people and groups. Drawing on the works of Thomas Aquinas as well as social theories such as critical realism, Daly fills a lacuna in Catholic ethics that addresses the structure-agency problem that has plagued this field of study. (shrink)