Persons who identity as LGBTQ+ should be treated with respect, compassion, and sensitivity. Under the guise of helping such persons, legislation is surreptitiously appearing in several countries seeking to ban so-called conversion therapy. While the definition of the term remains concerningly vague, the terms of enforcement for alleged offences tend to be precisely delineated, often including provisions that curtail Christian catechesis, teaching, and preaching in the areas of human dignity and sexuality. These problematic and repressive initiatives can prevent access to (...) any psychotherapy that is not strictly gender-affirming. This article reviews and assesses conversion therapy in support of a judicious approach to the practice, accurately understood. It reviews past abuses and misunderstandings while considering the merits of conversion therapy and related therapeutic and pastoral approaches. Concerns about gender-affirming interventions are considered, especially for youth and teenagers, and efficacy claims around conversion therapies and related psychotherapies are also discussed. (shrink)

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, (...) and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed. (shrink)

The difference between partially and completely eliminating an individual’s state of consciousness through the use of pharmacological agents seems particularly significant in the final phases of dying. Remediating pain and suffering by means of palliative sedation and the complete shutting down of consciousness raises ethical and spiritual concerns about categorically precluding participation in one’s own death. Given that, at the end of life, suffering almost invariably imposes itself on us in some form, we are challenged to reflect on how our (...) dying process should appropriately incorporate and take cognizance of that suffering, even as we acknowledge the value and importance of palliative steps to remediate the suffering. (shrink)