Volume 20, Issue 4, May 2020, Page 8-10.

In this paper I will show how the medical image, presented to the patient by the physician, participates in medicine's cold culture of abstraction, objectification and mandated normativity. I begin by giving a brief account of the use of anatomical imaging since the Renaissance to show how images have historically functioned in contrast to how they are currently used in medical practice. Next, I examine how contemporary medical imaging techniques participate in a kind of knowledge production that objectifies the human (...) body. Finally, I elucidate how physicians ought to place the medical image within the context of the lived body so as to create a healing relationship with the patient. In all this I hope to show that the medical image, far from a piece of objective data, testifies to the interplay of particular beliefs, practices and doctrines contemporary medicine holds dear. To best treat her patient, the physician must appreciate the influence of these images and appropriately place them within the context of the patient's lived experience. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery (...) can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

Women’s pain remains underappreciated, undertheorized, and undertreated in both medicine and theology. The ascetic practices of women in pain, however, can help Christians understand and navigate their own pain and suffering, particularly because they are experienced in the context of chronic illness and disability. In what follows, I argue that Christians would do better to view the pain that accompanies disability and chronic illness as a potential resource for spiritual practice rather than an example of sin or evil. I begin (...) with a brief overview of the most common theological explanations for the relationship between disability and sin within contemporary Christian writings on disability. What is often neglected in these conversations is the acknowledgment of pain in the disability experience. Likewise, discussions of evil often attempt to explain the existence of pain and suffering, but rarely address the practical realities of pain. As a way to begin to remedy the lack of attention to the experience of chronic pain for those living with illness and disability, I consider what it would mean to live faithfully with pain by examining the lives of three holy women who provide examples of what it means to interpret, manage, and share their pain within the body of Christ. (shrink)

Christians have an obligation to attend to the voices of persons who are crying out that their dignity and very lives are in jeopardy when physician-assisted suicide becomes legalized. The following essay begins with an account of the concept of “disability moral psychology,” which elucidates the unique ways persons with disabilities perceive the world, based on their phenomenological experience. The author then explores the disability critique of PAS and the shared social conditions of persons who are chronically disabled and terminally (...) ill. Finally, the author positions the disability critique within Christian moral deliberations on PAS to unearth its significance for Christian ethics. To bear witness to a compassionate God, theological and ethical judgments concerning PAS must seek perspectives from persons who claim that their dignity and even their lives are in jeopardy by the practice. (shrink)

This book uses insights from disability studies to understand in a deeper way the ethical implications that genetic technologies pose for Christian thought. Theologians have been debating genetic engineering for decades, but what has been missing from many theological debates is a deep concern for persons with genetic disabilities. In this ambitious and stimulating book, Devan Stahl argues that engagement with metaphysics and a theology of nature is crucial for Christians to evaluate both genetic science and the moral use (...) of genetic technologies, such as human genetic engineering, gene therapy, genetic screenings, preimplantation genetic diagnosis, and gene editing. Using theological notions of creation ex nihilo and natural law alongside insights from disability studies, the book seeks to recast the debate concerning genetic well-being. Following the work of Stanley Hauerwas, Stahl proposes the church as the locus for reimagining disability in a way that will significantly influence the debates concerning genetic therapies. Stahl's project in "genethics" proceeds with an acute awareness of her own liberal Protestant tradition's early embrace of the eugenics movement in the name of scientific and medical advancement, and it constructively engages the Catholic tradition's metaphysical approach to questions in bioethics to surpass limitations to Protestant thinking on natural law. Christianity has all too frequently been complicit in excluding, degrading, and marginalizing people with disabilities, but the new Christian metaphysics developed here by way of disability perspectives provides normative, theological guidance on the use of genetic technologies today. As Stahl shows in her study, only by heeding the voices of people with disabilities can Christians remain faithful to the call to find Christ in "the least of these" and from there draw close to God. This book will be of interest to scholars in Christian ethics, bioethics, moral theology, and practical theology. (shrink)

Over one hundred years after Max Weber delivered his lecture “Science as a Vocation,” his description of the work of the physician in a disenchanted world still resonates. As a chronically ill patient who interacts with physicians frequently, I struggle with reconciling my understanding of my ill body with how my physician makes sense of my illness. My diagnosis created an existential crisis that caused me to search for meaning in my embodied experience, but I soon learned there is little (...) room for such a search within modern biomedicine. Instead, I turned to fine art to help me make sense of my ill body and its purpose in my life. With the aid of my printmaker sister, Darian Goldin Stahl, I have transformed the magnetic resonance images of my body into works of art, which help to re-enchant my body and give purpose to my illness. (shrink)

Disability theology has been a small but growing field over the past thirty years. This paper reviews the current methods used in the discipline and proposes ways to move the field forward. Two intersections between disability studies and Christian theological ethics are explored in particular: bioethics and critical theory. Bioethics helps to address the material health and wellbeing concerns of people with disabilities and the discriminatory attitudes about disability that stem from the medical field. Critical theory on the other hand, (...) examines disability through cultural productions that shape our ableist imaginary. Critical theory offers resources for countering or “disciplining” our imaginations. Both bioethics and critical theory offer unique entry points into disability, but each also contains limitations that reveal why disability theology must continue to engage multiple methods and discourses. (shrink)

Examines the promises and perils of bioenhancement technologies for those most vulnerable to health disparities: persons with disabilities, racial and ethnic minorities, and women.

For centuries, philosophers and theologians debated the meaning of monstrous births. This article describes the debates that took place in the early modern period concerning the origins of monstrous births and examines how they might be relevant to our understanding of disability today. I begin with the central questions that accompanied the birth of conjoined twins in the early 17th century as well as the theological origins of those questions. I then show the shifts that occurred in philosophical debate in (...) the 18th century, which reveal the changing understanding of God’s interaction with creation, as well as the burgeoning medical responses to monstrous births. By reexamining these earlier debates, I claim some of the earlier questions posed by philosophers and theologians have been neglected but remain relevant in bioethics debates concerning how best to consider and treat newborns with certain disabilities. (shrink)

Ableist attitudes and structures regarding disability are increasingly recognized across all sectors of healthcare delivery. After Dobbs, novel questions arose in the USA concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. As a case study, we examine the Louisiana’s Department of Public Health August 1st Emergency Declaration, “List of Conditions that shall deem an Unborn Child ‘Medically Futile.’” We raise a number of medical, ethical, and public health concerns that lead us to argue (...) the declaration should be rescinded. The ethically objectionable declaration provides valuable lessons concerning how to uphold both reproductive and disability justice in a post-Dobbs landscape. (shrink)

The author argues that genetic technologies can never be fully sepa­rated from their eugenic ends. Because of this, the Church’s sexual ethic must be integrated with its social teaching to respond faithfully to ethical issues that arise with the use of genetic technologies. The author discusses, first, the Catholic opposition to eugenics from the turn of the twentieth century to the official papal condemnation of eugenics in 1930; next, the Church’s reaction to advances in DNA research in the 1950s and (...) 60s; and finally, the shift from optimism to caution from the 1970s on, as new genetic technologies emerged in embryonic stem cell research, genetic counseling, and gene therapy. The author explores both the sources on which the Church has drawn in responding to genetic advances and the social issues that should prove fruitful for con­templation in the future. (shrink)

For many persons with chronic illness and disability, medical images can come to represent their stigmatized “otherness.” A growing group of artists, however, are transforming their medical images into works of visual art, which better represent their lived experience and challenge viewers to see disability and illness differently. Although few of these artists are self-professed Christians, they challenge the Church to live into the communion to which it has been called. Using a method of correlation, Christian ethicists can find within (...) this art the potential for: creative resistance to modern deployments of biopower, a celebration of divine poiesis, opportunities for communion, and prophetic challenges to the cult of normalcy. Disability art encourages a new ethic of communion in which embodied vulnerabilities are shared, celebrated, and reoriented toward the ground of being. (shrink)

The human intestinal ecosystem, previously called the gut microflora is now known as the Human Gut Microbiota. Microbiome research has emphasized the potential role of this ecosystem in human homeostasis, offering unexpected opportunities in therapeutics, far beyond digestive diseases. It has also highlighted ethical, social and commercial concerns related to the gut microbiota. As diet factors are accepted to be the major regulator of the gut microbiota, the modulation of its composition, either by antibiotics or by food intake, should be (...) regarded as a fascinating tool for improving the human health. Scientists, the food industry, consumers and policymakers alike are involved in this new field of nutrition. Defining how knowledge about the HGM is being translated into public perception has never been addressed before. This raises the question of metaphors associated with the HGM, and how they could be used to improve public understanding, and to influence individual decision-making on healthcare policy. This article suggests that a meeting of stakeholders from the social sciences, basic research and the food industry, taking an epistemological approach to the HGM, is needed to foster close, innovative partnerships that will help shape public perception and enable novel behavioural interventions that would benefit public health. (shrink)

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...

The rapid development of COVID-19 vaccines in 2020 involved an unprecedented clinical research initiative. The case here involves a Phase I clinical trial of “second-generation” COVID-19 vaccines d...

De l'épistémologie à la politique, le rationalisme critique de Karl Popper se présente comme une solution théorique à la difficulté que rencontra Kant du lien entre philosophie théorique et philosophie pratique. Ce qui est en jeu ici, c'est la façon particulière que l'oeuvre de Popper a de montrer qu'une théorie de la connaissance peut servir de fondement théorique à une théorie politique et à une théorie de la société sans, pour autant, tomber dans le positivisme ou le scientisme.

Volume 20, Issue 10, October 2020, Page 82-83.

Volume 20, Issue 4, May 2020, Page 111-113.

Volume 20, Issue 4, May 2020, Page 102-103.

Volume 20, Issue 5, June 2020, Page 31-33.

ABSTRACT Controlled human infection (CHI) models have been developed for numerous pathogens in order to better understand disease processes and accelerate drug and vaccine testing. In the past, some researchers conducted highly controversial CHIs with vulnerable populations, including children. Ethical frameworks for CHIs now recommend vulnerable populations be excluded because they cannot consent to high risk research. In this paper we argue that CHI studies span a wide spectrum of benefit and risk, and that some CHI studies may involve minimal (...) risk. The categorical exclusion of children from CHIs therefore departs from the standard approach to evaluating research risks, as international regulations and ethical guidance for pediatric research generally permit non‐beneficial research with low risks. The paradigm in research ethics has also shifted from focusing on protecting vulnerable participants to recognizing that inclusion can be important as a matter of justice, providing new reasons to question this default exclusion of children from CHIs. Recognizing that pediatric CHIs can raise complex ethical issues and are easy to sensationalize in ways that may threaten the public’s trust in research and sponsor institutions, we conclude by describing additional complexities that must be addressed before pediatric CHIs beyond licensed vaccine studies might be ethically acceptable. (shrink)

Volume 20, Issue 10, October 2020, Page 90-91.

For many rare diseases, the availability of effective interventions is limited or non-existent. In this context, clinical research evaluating emerging interventions may be the only potentially “the...

Review of Paul Copan, Is God a Moral Monster? Making Sense of the Old Testament God, (Grand Rapids: Baker, 2011).

When the Neo- or "New Atheist" publishing frenzy climaxed with Richard Dawkins' The God Delusion, Daniel C. Dennett's Breaking the Spell, Sam Harris's The End of Faith, Christopher Hitchens' god is not Great and subsequent titles; New Atheists repeatedly denounced the Bible as dangerously false, suppressive to scientific inquiry, and as inculcating and promoting problematic, contemptible, even abhorrent moral values. The Genesis 1-11 and 19 Creation, Noah, and Lot narratives persist among the New Atheists' favorite targets. Heretofore there has been (...) no systematic examination of New Atheist treatments of Genesis generally or Genesis 1-11 and 19 particularly. This article scrutinizes leading New Atheist interpretations of Genesis 1-11 and 19 articulated by Richard Dawkins, Daniel C. Dennett, Sam Harris, and Christopher Hitchens. Part one documents these New Atheist renderings of Genesis 1-11 and 19 through the entire corpus of their published books. Part two synthesizes, applies, and extends relevant Genesis 1-11 and 19 scholarship to appraise and respond to the most serious New Atheist allegations, concluding that a more rigorous analysis of Genesis 1-11 and 19 nullifies and potentially reverses New Atheist criticisms. (shrink)

Background Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. Methods We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of agreement (...) among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item’s mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. Results Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. Conclusions Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research. (shrink)

Members of the Student Clinical Ethics Committee discussed the ethical and legal issues arising in a case referred for consideration – the family of a very elderly non-English speaking Asian lady did not want her to be informed that she had incurable lymphoma. The case study summarises the reflections of the Committee and focusses on: the role of cultural norms in healthcare decision making; the extent to which the views of the family about what is best for the patient should (...) be respected, whether the patient should have been informed of her terminal diagnosis and the role of the clinician in navigating complex family dynamics. (shrink)

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...) distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

Members of the Student Clinical Ethics Committee discussed whether tube feeding should be instigated for a man who had indicated through his actions that he may be refusing it, although his family stated that he would have wanted to be kept alive in such a situation. The Committee considered the key issues of capacity and best interests, which in this case were confounded by lack of clarity about whether the patient’s actions amounted to a valid refusal of life sustaining treatment, (...) and if his previous views still pertained to his current, yet unforeseen, circumstances. As the discussion progressed, it became apparent that some members were reluctant to accept that non-insertion of clinically assisted feeding could ever be in a patient’s best interests. (shrink)

Members of the Student Clinical Ethics Committee discussed the ethical issues arising in a case referred for consideration – a homeless man presenting to the emergency department of a busy London hospital with recent self-reported suicide attempts. Should he be admitted overnight in order to address a short-term shelter problem? The case study summarises the reflections of the Committee and focusses on the doctor’s duty of care and patient responsibility, benefits of admission and resource considerations.