Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain’s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through (...) protection of moral freedoms and patients’ rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied. (shrink)

Protein misfolding is a topic that is of primary interest both in biology and medicine because of its impact on fundamental processes and disease. In this review, we revisit the concept of protein misfolding and discuss how the field has evolved from the study of globular folded proteins to focusing mainly on intrinsically unstructured and often disordered regions. We argue that this shift of paradigm reflects the more recent realisation that misfolding may not only be an adverse event, as originally (...) considered, but also may fulfil a basic biological need to compartmentalise the cell with transient reversible granules. We nevertheless provide examples in which structure is an important component of a much more complex aggregation behaviour that involves both structured and unstructured regions of a protein. We thus suggest that a more comprehensive evaluation of the mechanisms that lead to aggregation might be necessary. (shrink)

In recent years, researchers in the “psychedelic renaissance” have been reinvestigating the therapeutic potential of psychedelic compounds for conditions like post-traumatic stress disorder, clinical anxiety/depression, and addiction. Each of these has treatment-resistant cases, sometimes decades in the making, but studies employing psychedelics to address them are yielding impressive results. Given the evolving legal situation around these substances as well as corporate investment in them, their availability and appeal promise to increase. The question facing Christians is: How do these developments impact (...) the theological significance of psychedelics as a broader phenomenon? This paper argues that since the population standing to benefit from these treatments is likely to include Christians, a thoughtful and rigorous response is necessary. The inquiry proceeds by analyzing some of the pertinent research, showing the insufficiency of previous Christian responses, and considering some hurdles and objections before issuing a call to theologize on this timely and important cultural moment. (shrink)

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

As medical science continues its rapid advances, questions are raised that have more to do with theology than with technology: Where is God when I am hurt or suffering? What role does God play in my healing? "Pain Seeking Understanding" examines how believers and nonbelievers alike wrestle with questions of faith when confronted with pain and suffering that medicine alone cannot treat. Margaret Mohrmann and Mark Hanson call upon fellow experts in the fields of medicine, ethics, theology, and pastoral (...) care to help them weave the complex story of faith and science working together to ease suffering -- and to help broaden our understanding of God's role in suffering and healing. (shrink)

Resumen En el presente artículo se abordará la medicina espiritual de San Gregorio de Nisa como un aporte para los retos de una Iglesia en salida. Para ello se partirá de una aproximación a la Iglesia en salida misionera, para luego abordar al Niseno y examinar en sus textos la importancia de la medicina en su reflexión especulativa, mística y pastoral, así como para la comprensión de su quehacer teológico como medicina espiritual. Finalmente, se recogerán algunos aportes para los (...) desafíos de una Iglesia en salida.This article will analyze the approach to the spiritual medicine of Saint Gregory of Nyssa, like a contribution for the challenges of an outgoing Church. For this purpose, it will start with an approach to the Church in a missionary outing, to then approach Gregory’s life and examined in his texts the importance of medicine and his speculative, mystical and pastoral reflection, as well as for the understanding of its theological work as spiritual medicine. Finally, some contributions will be collected for the challenges of an outgoing Church. (shrink)

In this profoundly theological reflection on illness, healing, and the doctor-patient relationship, pediatrician Margaret Mohrmann bridges the sometimes disparate worlds of medicine and faith, of high technology and ultimate concern. Drawing on her two decades of experience treating children who suffer from disease and dysfunction, Mohrmann movingly reveals the temptations of idolatry that beset our understanding of health and life, the intrinsic connectedness underlying all medical encounters, and the difficulties and riches of using scripture as a moral resource. In clear, (...) accessible language Mohrmann emphasizes the importance of interpreting the lives of the suffering as meaningful and ongoing stories - stories that require all of us to respond in healing ways. Uncovering insights from such diverse sources as the apostle Paul, Alasdair MacIntyre and Flannery O'Connor, she suggests that what is required for a truly human life is not the absence of pain, but the presence of others. Both pastoral and prophetic, Medicine as Ministry is a challenge to rethink the purposes of health care - and to better discern the human condition. (shrink)

Through the centuries, women from all over the world remain vulnerable to their social status. In some developed countries the situation has improved, but there are many countries where it is still unbearable. United Nations Educational, Scientific and Cultural Organization aims to assist in this regard by addressing ethical issues pertaining to medicine, life sciences and related technologies as applied to human beings with consideration of women's social, legal and environmental dimensions. Yet pastoral counsellors on ground level are confronted (...) with the need for assistance to women who suffer because of this exploitation. Therefore, the aim of this article is to focus on biblical principles that can serve as anchors to guide women regarding their human vulnerability and personal integrity when they experience suffering and hardship. The challenge facing the pastoral counsellor is to guide women to accept the reality of their situation within a certain framework, to adequately deal with this and, in spite of overwhelming emotions, continue to grow in personal integrity and healing. (shrink)

This paper employs Foucault’s concept of “governmentality” to examine critically the efforts by medical humanists to reform the medical case. I argue that these reform efforts contribute to the individualizing dimensions of medical power through the development of a “pastoral” technique that medicine has taken over from religious authority. Clinical experiences at this NEH Institute also revealed a juridical dimension of the medical case that treats a patient’s statements as suspect and in need of corroboration by evidence provided by (...) the patient’s body. The combination of these pastoral and juridical dimensions of the case contributes to the normalizing power of modern medicine, and medical humanists need to be aware of their own contribution to this form of power as they reform the case. (shrink)

The Church, as an institution, has pioneered ground-breaking interventions, although some of these interventions were also a vehicle for imperial colonisation. Through its missionary activities, the Church has exercised such a form of power over its flock. This article intends to analyse the extent of the knowledge that pastors in Thulamela Municipality, Limpopo Province, have concerning HIV/AIDS and the prejudices associated with the illness. The article applies a qualitative approach in ascertaining the extent of such knowledge as well as the (...) pastoral approaches utilised. In this qualitative phenomenological study, the authors explored the knowledge of these pastors regarding HIV/AIDS. A semi-structured interview guide was used to direct the collection of data. Following thematic analysis, the knowledge of pastors regarding HIV/AIDS emerged as the theme of the study. The findings revealed that difficulties relating to providing pastoral care to people living with HIV/AIDS (PLWH) were exacerbated by a lack of knowledge and limited training offered to pastors. The article will further argue that there is a need for a partnership between the churches and public health services.Contribution: This article strives to expose biblical discourse exhibited by pastors because of a lack of theological formation and to suggest a way forward in collaborating the church as a religious institution and public health institution for combating HIV/AIDS. (shrink)

Pierre Viret (1511–1571), one of the leaders of the Calvinist Reformation, claims that the natural theology of his Instruction Chrestienne (1564) dedicated to the Faculty of Medicine of Montpellier, is a spiritual medicine. This paper shows that such spiritual medicine amounts to a specific expression of Calvinist pastoralism. Viret's natural theology uses natural-historical data as moral examples, thus transforming them into the material fit for his pastoral cure. This cure consists in exhorting his audience to bear the trials of (...) divine Providence by meditating on their own sinful state: such medicine asserts the limits of human reason. (shrink)

Contributing Authors Include Otis Rice, Erich Lindemann, Paul Tillich And Many Others.

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1917 edition. Excerpt:... (6) Columns for Discount on Purchases and Discount on Notes on the same side of the Cash Book; (c) Columns for Discount on Sales and Cash Sales on the debit side of the Cash Book; (d) Departmental columns in the Sales Book and in the Purchase Book. (...) Controlling Accounts.--The addition of special columns in books of original entry makes possible the keeping of Controlling Accounts. The most common examples of such accounts are Accounts Receivable account and Accounts Payable account. These summary accounts, respectively, displace individual customers' and creditors' accounts in the Ledger. The customers' accounts are then segregated in another book called the Sales Ledger or Customers' Ledger, while the creditors' accounts are kept in the Purchase or Creditors' Ledger. The original Ledger, now much reduced in size, is called the General Ledger. The Trial Balance now refers to the accounts in the General Ledger. It is evident that the task of taking a Trial Balance is greatly simplified because so many fewer accounts are involved. A Schedule of Accounts Receivable is then prepared, consisting of the balances found in the Sales Ledger, and its total must agree with the balance of the Accounts Receivable account shown in the Trial Balance. A similar Schedule of Accounts Payable, made up of all the balances in the Purchase Ledger, is prepared, and it must agree with the balance of the Accounts Payable account of the General Ledger." The Balance Sheet.--In the more elementary part of the text, the student learned how to prepare a Statement of Assets and Liabilities for the purpose of disclosing the net capital of an enterprise. In the present chapter he was shown how to prepare a similar statement, the Balance Sheet. For all practical... (shrink)

Digital technology, including artificial intelligence, is having a dramatic impact on the professions of medicine, law, journalism, finance, and others. Some suggest that clergy will also be affected. We describe recent progress in designing artificially intelligent systems, suggesting that this is possible, perhaps even likely. We investigate ways in which technology currently is affecting ministry and outline some plausible scenarios in which digital systems could supplement or supplant clergy in some areas, specifically preaching and pastoral care. We also raise (...) some theological issues raised by the use of digital systems in ministry. (shrink)

The New Charter for Health Care Workers is a revision and updating of the earlier 1994 edition, also produced by the Pontifical Council for Health Care Workers. The work is divided into three major sections: "Procreating," "Living," and "Dying," each of which lays out authoritative teachings in medical ethics grounded in the traditional resources of the Church.

In Morals and Medicine a leading Protestant theologian comes to grips with the problems of conscience raised by new advances in medical science and technology. They arise as issues at the start or making of a life, in preserving its health, and in facing its death. They are the problems of Everyman: some are new problems of conscience, such as artificial insemination; some are old problems in new dimensions, such as euthanasia. Modern medicine provides such a high degree of control (...) over health and vital processes that men must inevitably shoulder the burden of intelligent decision, and shoulder it as rationally as possible. Thus far, only Roman Catholic moralists have worked out a coherent ethics of medical care. Morals and Medicine is a new and independent analysis of the morals of life and death, striking out along the line of the values of personality rather than of mere physiological life itself. It offers a modern and at the same time Christian concept of right and wrong for all who are involved: the patient, the doctor and nurse, the pastor, and the family and friends. Originally published in 1954. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Contending that concern over the ethical dimensions of these and other like issues are no longer just in the domain of those involved in medical practice, the ...

In a single convenient resource, this book organizes and presents clearly the documents of the Catholic church pertaining to medical ethics.

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries[5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when moral theology became recog (...) nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ([8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics[ll]. (shrink)

Religion constitutes an important element in every society as regards coping with the demands as well as vicissitudes of life. Mental health issues are becoming a recurrent decimal in societies overwhelmed by stress and other social factors. This paper examines how the presence of religious beliefs affects how some Christians respond to cases that have to do mental health. At the same time, it surveys how a near absence of religious attitude, that is, clinical medicine approach to mental health issues (...) betters the state of those suffering from these psychopathologies. This work sees participatory partnership approach as an effective means of correcting unhealthy biases that prevent a better understanding of mental health care. Sociological theory of structural functionalism will be used in assessing how religion can reinvent itself in areas that are associated with mental health. Ethnographic methodology through quantitative analysis of administered questionnaire is used as a research tool for this research. Three persons were also interviewed. The research findings show that religion is a crucial agent of socialization that can change how religious beliefs impact on mental health and there is need for medical professionals to collaborate with pastoral agents. (shrink)

Background and aimsFew Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, at least (...) 10% of all chaplains currently working in Polish hospitals.ResultsOf the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy—as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics.ConclusionsIn order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains. (shrink)

The approach to mental health and well‐being taken here illustrates the complementary perspectives approach and assumes that there are useful and intersecting contributions from science (including medicine) and from religion and spirituality. What counts as poor mental well‐being depends on the interaction of relatively objective criteria with culturally contingent value judgments. I then discuss theological perspectives on depression, including a consideration of sources of hope and tolerance of dysphoria, and argue that depression can be part of a spiritual journey. I (...) then look at the relationship between psychosis and religion, including the work of Isabel Clarke, arguing that a spiritual approach to psychosis can complement a medical approach. Finally, I present a pastoral case study illustrating the interface between neurological and spiritual aspects of the sense of presence. A religious perspective can challenge and complement current assumptions about mental health in a potentially fruitful way. (shrink)

Section VIII of Toward a Social Ethos covers the areas of healing and medicine, new technologies including the internet, faith and science, human sciences and pastoral care, the natural world and ecological crisis. This article comments on the text in the light of wider Orthodox thinking on these areas (where it exists) and earlier statements on use of the world and environment from the Churches of Constantinople, Antioch and Moscow.

Polanyi broke through the notion that science has a distinct methodology and epistemology which sets it apart from the other cultural disciplines (law, medicine, music). When it came time to address the issues of how Christianity functions, however, Polanyi unfortunately lapsed into romantic notions based upon his own ill-informed and marginal participation in the religious enterprise. By way of addressing this deficiency, my study puts forward seven theses designed to demonstrate that everything which Polanyi put forward regarding the transmission of (...) a scientific heritage through a successive series of apprenticeships can be seen as functioning within the religious enterprise as well. Then, when it comes to the role of masters in pursuing lines of inquiry which sometimes lead to self-transforming acts of discovery, such feats can be understood as defining the function of creative theologians and pastors who both exhibit and transform the tradition in which they dwell. In conclusion, my inquiry will attempt to show that, when Polanyi’s own inadequate assessment of religion is set aside, one comes to a proper understanding as to how religious pedagogy actually functions within the Christian enterprise. (shrink)

This article offers a critique and reformulation of the concept of empathy as it is currently used in the context of medicine and medical care. My argument is three pronged. First, that the instrumentalised notion of empathy that has been common within medicine erases the term’s rich epistemological history as a special form of understanding, even a vehicle of social inquiry, and has instead substituted an account unsustainably structured according to the polarisations of modernity. I suggest that understanding empathy by (...) examining its origins within the phenomenological tradition, as a mode of intersubjective understanding, offers a different and profitable approach. Secondly, I argue that the appropriation of empathy in medicine means that, ironically, empathy can function as a technique of pastoral power, in which virtue, knowledge and authority remain with the doctor. And thirdly, empathy is in danger of being resourced as a substitute for equity and funding within health systems. I conclude however with hope for the productive possibilities for empathy. (shrink)

Narratives are ever-present in medicine and care: patients, relatives, doctors, nurses and pastoral workers tell quite different stories. The present volume examines the question of the significance of narratives for the ethical judgement in medicine and care and illustrates what theological reflection can contribute to the current discussion about the ethics of medicine and care. The focus of the volume is on the theological discussion on the ethical issues of medicine and care which is enriched by contributions from literary (...) studies, philosophy, nursing science and the ethics of medicine and care. (shrink)

Niger is regularly affected by food insecurity, mainly due to the high sensitivity of its agricultural sector to climate variability. Despite the support from multiple development institutions and households’ willingness to address food security, hunger and malnutrition continue to challenge many vulnerable households. This study aims to analyze household livelihood strategies toward food security and assess factors determining their resilience. To address the issue, cluster analysis and the principal component analysis were used to identify the different livelihood strategies and to (...) construct a resilience index, respectively. Regression analysis was used to identify the most significant factors determining households’ resilience. The results indicate there were six different household types—pastoralist-extensive agriculturalists, farmers, agro-pastoralists, public service employees, entrepreneurs and wage employees—however, the majority of households obtained their livelihood from both agriculture and livestock (agro-pastoral systems). The principal component analysis highlighted that the pastoralist-extensive agriculturalists are the most resilient followed by public service employees, while households focused on wage labor are the least resilient, followed by entrepreneurs. In terms of gender, the study reveals that households headed by men are more resilient than those headed by women. However, the resilience components including income and food access, assets and adaptive capacity are the most correlated with the households’ resilience to food insecurity. Furthermore, the regression analysis results reveal that the household size, crop production, farming experience, livestock size and number of coping strategies are the most significant factors determining household resilience to food insecurity. Consequently, to face the challenges of climate change and food security, rational investments in agriculture are necessary to transit rural household land-use practices to climate-smart agriculture. (shrink)

The interdisciplinary book series Studies in Spiritual Care (SCC) publishes international research ranging from studies on specific aspects of Spiritual Care to programmatic contributions to the self-understanding of this new practice and research area. The series is of interest to professionals working in the field as well as to students, researchers, and scholars from the fields of medicine, pastoral care, psychotherapy, and social work.

On the basis of experiences in pastoral hospital care, the relationship between disease, sin, and guilt in the life of patients is explored. Against the disregard of this subject in medicine, and even in most of pastoral care, it is argued that patients' interest requires that their hidden or manifest questions be addressed, rather than their being exposed to efforts at “helping” through mere attempts at “debt clearance.” Only by openly confronting sin and guilt can the patient be (...) taken seriously in his role as subject of his disease. Theological and anthropological background considerations revealing the essence of sin as a disruption or even destruction of the Divine gift of life in its realization through a lived relationship to God and other humans are offered as evidence for this claim. (shrink)

Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government has put ambitious plans in place, which are part of the National Development Plan to ward 2030. In the midst of this we find the individual person and their family and community (...) staggering under the suffering caused by disease, poverty, crime and violence. There is a more than 70% chance that this person and their family and community are trying to make sense of this within a spiritual framework and that they belong to a faith-based community. This article explores the valuable contribution of spirituality, spiritual and pastoral work, the faith-based community and faith-based organisations to holistic people-centred healthcare in South Africa. (shrink)

This book offers a unique and comprehensive outline of the ethos, the bioethics and the sexual ethics of the renowned anatomist and founder of modern geology, Niels Stensen. It tells the story of a student who is forced to defend himself against his professor who tries to plagiarize his first discovery, the “Ductus Stenonis”: the first performance test for the young researcher. The focal points are questions of bioethics, especially with regard to human reproduction, sexual ethics, the beginning of life (...) and the ensoulment of the embryo, together with frontiers of pastoral care. The book delineates Stensen’s ethos as well as its medico-ethical and theological implications and reception by researchers and physicians from the 17th century until today, and asks about his lasting significance. Despite dating back more than 300 years, Stensen’s character and his work offer up surprisingly topical answers to current questions on the nature of professional ethics in medical science and practice. Furthermore, “Ethos, Bioethics, and Sexual Ethics in Work and Reception of the Anatomist Niels Stensen : Circulation of Love” is the first academic book on bioethics and sexual ethics with a foreword by the Prefect of the Congregation for the Doctrine of the Faith. A fascinating book for bioethicists, physicians, members of health professions, scientists, and theologians. (shrink)

While many western countries now have large Muslim communities, relatively little scholarly attention is given to the attitudes of Muslims regarding end-of-life issues. Meanwhile, we receive strong and significant signals from physicians and pastoral care teams on the difficulty of discussing pain treatment with Muslim patients. With this study of Islamic views on pain control and palliative sedation in English Sunni e-fatwas we wish to make a contribution from the field of religious studies to a better understanding of how (...) Muslim patients balance their personal needs for pain treatment with the Islamic normative background. Using Broeckaert’s conceptual framework on treatment decisions in advanced disease, we conducted an in-depth analysis of English Sunni e-fatwas on pain control and palliative sedation. The e-fatwas were selected using Bunt’s typology of Cyber Islamic Environments and Tyan’s definition of a fatwa. We found that references to the use of sedative medication to reduce the consciousness of the patient for pain treatment were very scarce in the texts we analysed. Although the idea of patiently enduring pain is present in the e-fatwas, it does not dominate the discussion, since the alleviation of pain is equally encouraged. When the pain medication used is addictive, alters the patient’s state of consciousness or contains alcohol making it problematic from an Islamic normative point of view, the use of this type of medication can be permitted on the basis of a principle in Islamic jurisprudence: necessity permits breaking the law. The possible danger of death after the administration of high doses of pain medicine is countered based on the intention of the treating physician: he or she aims to alleviate the pain and not kill the patient. The study of English Sunni e-fatwas on pain and symptom control indicates the absence of an insurmountable ethical problem connected to the use of heavy pain medication. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment of it in favor of (...) basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Virtues, Obligations, and the Prophetic VisionRoy Branson (bio)Ethics at its best is only bad poetry—that is, it seeks to help us see whatwe see every day but fail to see rightly...If ethicists had talent, they might be poets,but in the absence of talent, they try tomake their clanking conceptual anddiscursive chains do the work of art.—Stanley HauerwasThe speaker was so severely bent over that his congenitally deformed back had (...) to be supported. He was a young Ph.D. in history. We were some 50 physicians, lawyers, health care administrators, and ethicists studying the ethics of organ transplants. Before he arrived, the conference had discussed different understandings of equal access and the nuances of federal policies governing organ transplant distribution. 1 In his lecture, our guest matter-of-factly described his own condition. He then pointed out that not only in ancient civilization but in American history as well, the disabled had been killed just because they were disabled. Indeed, even now, he said, they were not being allowed to live.In the question and answer session, he was immediately challenged by nationally prominent transplant surgeons. He responded by asking the surgeons: If two people could avoid death and anticipate significantly prolonged life from receiving an organ transplant and the only difference between them was that one was disabled and the other not, who would receive the life-saving transplant? The surgeons’ initial, spirited defense of excluding the significantly disabled person died down as they began to realize that, as far as they were concerned anyway, they might not have allowed the lecturer to live. They were stunned by the realization that they had not felt the disabled were fully persons. In the silences between their sentences, the participants sensed that they had passed beyond the discussion of economic, medical, and legal terms to glimpse new horizons of responsibility. [End Page 361]The conference was experiencing the truth of William F. May’s claim that moral quandaries must be placed within “a fresh and liberating vision of the world;” within “metaphysical horizons” (May 1983, pp. 15, 19).Pastoral VirtuesIn the late sixties, André Hellegers, the dynamic physician and Catholic layman who founded the Kennedy Institute of Ethics and who claimed that he had invented the word bioethics, focused bioethics elsewhere—on virtue. “As the caring branches of medicine were gradually pushed aside by the curing ones,” Hellegers said, “there seemed to be less use for the Christian virtues.” We must, he declared, “recapture the Christian virtues of care” (cited in McCormick 1985, p. 111). In a subsequent essay on the conceptual foundation of bioethics, Hellegers, writing with Albert Jonsen, did not invoke the word pastor, but he did argue that the codes drawn up for the ethical practice of medicine were, among other things, guides for the cure of physicians’ souls (Jonsen and Hellegers 1976, pp. 35–36).In 1969, at the same time that André Hellegers was in the process of establishing the Kennedy Institute, Edmund Pellegrino, then a medical school dean, led in the founding of humanities programs within American medical schools. Pellegrino, like Hellegers, a physician and Catholic layman, also focused on virtue. Obligations are not irrelevant for Pellegrino, but in biomedical ethics “one starts always with one’s commitment to be a certain kind of person and then approaches clinical quandaries, conflicts of values, and patient interests as a good person ought” (Pellegrino 1988, p. 123). Pellegrino knows that the classical and Christian tradition of Aristotle and Aquinas, a tradition with which he identifies, is concerned with the whole gamut of ethics. But for Pellegrino, that tradition teaches that “no matter to what depths a society may fall, virtuous persons will always be the beacons that light the way back to moral sensitivity” (p. 123). He freely acknowledges that “a virtue-based ethics is inherently elitist, in the best sense, because its adherents demand more of themselves than does the prevailing morality” (p. 123).Hellegers and Pellegrino added to the need of physicians acquiring professional skills their responsibility to become the embodiment of the moral ideal in the patient-physician relationship by caring for the patient... (shrink)

MIRÓ M, GASTALDO D, NELSON S and GALLEGO G. Nursing Inquiry 2012; 19: 270–280 Spanish nursing under Franco: reinvention, modernization and repression (1956–1976)This article examines Spanish nursing during a critical 20‐year period (1956–76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state‐run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS–Ayudante Técnico Sanitario (...) (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women’s Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid‐twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first‐year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender‐related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women’s branch of the ruling Falangist Party in mid‐twentieth century Spain. (shrink)

Respect for personal autonomy and authenticity is a very important principle in late modern political and applied ethics. In the context of medicine and nursing, for example, a great deal of ethical research is devoted to this principle, both theoretical and empirical, raising many hotly debated questions, both conceptual – on the concepts of autonomy and authenticity – practical – on the application of the principle of respect for autonomy and authenticity – and methodological – on using empirical methods in (...) ethical research. In the present contribution I present two of the results of my doctoral research concerning personal autonomy and authenticity in the practice of personal pastoral care, using empirical methods.The first consists of a formulation of the goals of pastoral care as they were found in the cases analysed, the second of the different forms of personal autonomy and authenticity that were identified. Our primary aim is to argue for the importance of a) conducting empirical research into what is actually morally relevant and not just at the surface, and of b) assigning a privileged position in empirical ethical research to practices and the tacit knowing of advanced, reflective practitioners. (shrink)

Abstract: This essay consists of some clarifying remarks on the doctrine of double effect (DDE). After providing a contemporary formulation of the doctrine we put special emphasis on the distinction between those aspects of an action plan that are intended and those that are merely foreseen (the I/F distinction). Making use of this distinction is often made difficult in practice because salient aspects of the action plan exhibit a felt “closeness” to one another that is difficult if not impossible to (...) articulate with the precision we might like. The essay goes on to examine an especially adroit criticism of DDE best articulated by J.J. Thomson. We conclude with a brand new double effect case (new to the philosophical literature anyway) taken from medicine and Roman Catholic pastoral ministry. (shrink)