2013 Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University...

2013 Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University Press, Cambridge

nowadays, there is a divide between the moral values of clinicians and those of their patients

religious traditions should have a voice but not a veto clinicians are bound by their own moral

convictions, professional ethics, often by mission statements of the healthcare institutions where they work, and by law

there are patients who are often very much misinformed about what their own tradition teaches about a particular moral issue.

there are even times when so-called „religious“ position masks psychological pathology

Jehovah´s witness bioethicsMuramoto, O., (2008) Jehovah´s witness bioethics. in Singer, P.A., Viens, A.M., (eds.) The cambridge Textbooksof bioethics. Cambridge University press, Cambridge. pp. 416-423)

religion founded in the late nineteenth century in Pennsylvania, USA

the current JWs do not consider themselves as a Christian denomination there are fundamental differences in theology

from traditional christian faiths cca 6,5 milions of baptized followers the religious life of JWs is centered around

five religious meeting every week and door-to-door preaching („field activity“)

Jehovah´s witness bioethicsMuramoto, O., (2008) Jehovah´s witness bioethics. in Singer, P.A., Viens, A.M., (eds.) The cambridge Textbook of bioethics. Cambridge University press, Cambridge. pp. 416-423)

each JW is required to report monthly the time spent for preaching activity and the amount of literature distributed


the following are strictly prohibited: participation in politics and the military association with other religions celebrations of holidays and birthdays pledging allegiance to a national flag singing a national anthem smoking medical use of certain blood products


JWs also must shun excommunicated („disfellowshipped“) members including those who willfully accepted forbidden blood products, and opposing former members („apostates“)


this world is currently in the „Last Days“ awaiting imminent Armageddon or cataclysmic destruction of the present system

the Last Days started in 1914 and WTS (Watchtower Bible and Tract Society) has predicted different years as the starting year of Armageddon, including 1918, 1920, 1925 and 1975

in 1995 they finally abandoned the previous practice of predicting specific years

nonetheless, Armageddon is still imminent in the near future, a literal destruction of this system is inevitable, and only the faithful JWs will survive and live forever in paradise on earth.


JWs do not believe in immortal souls instead, their future hope is their physical

survival of Armageddon to enter paradise on earth or, if they die before Armageddon arrives,

ressurection in fresh bodies since entry into paradise depends on conduct

in this world, the most important concern is to work hard to fulfill Jehovah´s requirements, which include strict adherence to teachings of the WTS and dedication to preaching activity


violations of the religious rules are one of the worst offences, which disqualify JWs from survival in paradise

many JWs even postpone childbearing until after Armageddon (WTS,1998)


the refusal of blood products the doctrine had not existed until 1945 1951: the doctrine was firmly established based on

three biblical passages (Gen 9,4; Lev 17,12; Acts 15,28.39)

various medical and surgical procedures that take out blood and return it to circulation, such as heart-lung machine and hemodilution were also prohibited

in the 1960s and 1970s the WTS gradually introduced exceptions to the rules, allowing use of serum and hemophiliac clotting factors


1981: autologous blood

could not be used hemodilution was

objectionable


hemodialysis, heart-lung machine and intraoperative salvage were acceptable

all plasma fraction were now permitted

2000: the WTS announced, that hemoglobin

products were now permissible, retracting their long-standing prohibition against the medical use of human or animal hemoglobin, a policy that had been restated as currently as 1998.


another change involves transfusion of autologous blood. Prior to 2000, the WTS prohibited transfusion of

autologous blood that had been removed from a JW´s circulatory system.

As of 2000, the WTS permits JWs to accept autologous transfusionsof blood so long as the collection and re-infusion is part of what its policy calls „current therapy“

the only difference between now permitted hemodilution and still prohibited autologous transfusion is whether the infused blood is collected intraoperatively or preoperatively


2004 prohibition of the whole blood and „primary“

components red blood cells, white blood cells, platelets and

plasma whereas „fractions“ derived from the primary

components are now all acceptable however, such a distinction between „primary“

component and „fractions“ is not universally defined for example, red blood cells are still prohibited, but

hemoglobin (98 % of dry weight) is now permitted


2004 the removal and return of own blood for „current

therapy“ is permitted, but the same procedure for future therapy is prohibited

transplantations, including bone marrow transplantations are accepted. Apparently, the WTS is not concerned about the fact

that bone marrow contain numerous immature as well as some mature blood cells

JWs are unable to articulate why one is acceptable and the other unacceptable, other than saying „the Society (WTS) said so.“


the fundamental moral principe is to respect autonomous wishes of the individual person, but not necessarily her religion

it is critical to maintain an open-minded attitude and discuss the patient´s personal conviction rather than obediently following the guidlines published by WTS


JW patients show many different reactions, f.e.: to decline every possible treatment that has

anything to do with blood, even if some of them are recently permitted by WTS

to leave their decisions to the congregational officials. Many JW patients call in special elders of their congregations or „the hospital liaison committee“


other JW patients are willing to accept some of the prohibited blood products based on theor own interpretation f.e. some JWs may know that platelets are, in

fact, a very small fraction, much smaller than permitted albumin, and may conscientiously accept it.

others may have been sceptical about the blood policy all along. Such JWs might be willing to accept prohibited products under strict confidentiality


in an emergency when there is no current advance directive avilable and the patient cannot express her own wishes, it is legally defensible to use whatever is necessary to stabilize the patient´s life-threatening condition first based on implicit consent while the Canadian court ruled that the „no-blood

card“ carried by exsanguinating and unconscious JW could not be overridden even in emergency, this ruling has been criticized because the card was signed but not dated nor witnessed


in recent years, the WTS is using more formal advance directive forms in addition to the „no-blood card“

if a valid and adequately executed advance directive is made available, it is legally indefensible to override it even in an emergency.

"Parents may be free to become martyrs themselves.

But it does not follow that they are free in identical circumstances to make martyrs of their children before they have reached the age of full and legal discretion when they can make that decision for themselves."

Prince v. Massachusetts, 321 US 158 (1944), at 170

Mallete Case http://www.humanehealthcare.com/Article.asp?art_id=300

June 1979: After a head-on automobile collision that killed her husband, Georgette Malette, aged 57 years, was rushed by ambulance to a hospital in Kirkland Lake, Ont., where Dr. David Shulman attended her in the emergency department.

She had severe facial lacerations, multiple fractures of facial bones and a constant stream of blood from nose and mouth.

She appeared to be in shock, was semiconscious and was unresponsive to verbal stimuli; although she was groaning, she uttered no coherent sounds.

Since she was suffering from incipient shock secondary to blood loss, Dr. Shulman administered glucose and Ringer's lactate solutions intravenously.

Mallete Case

At that time, a nurse called his attention to a card that she had found in the patient's purse.

The undated card, which was signed by Mrs. Malette, read across the top, "No Blood Transfusion." It declared that the holder was a Jehovah's Witness and that "no blood or blood products be administered to me under any circumstances."

Mallete Case

The patient was examined by an orthopedic surgeon, who agreed with Dr. Shulman that it was vital to maintain her blood volume to prevent irreversible shock.

However, the bleeding could not be controlled. As she was being transferred to the radiology

department, her condition deteriorated. When her systolic blood pressure dropped markedly (below 50 mm Hg) and her breathing became increasingly distressed, Dr. Shulman concluded that blood transfusions were necessary to preserve her life.

He accordingly proceeded to transfuse Mrs. Malette, the Medical Alert card notwithstanding.

Mallete Case

While Mrs. Malette was being transfused, her daughter (also a Jehovah's Witness) arrived at the hospital. She objected strenuously to the treatment and demanded that it be withdrawn.

Dr. Shulman refused to comply. Aside from his clinical opinion that the transfusions were a vital part of treatment in a life-threatening situation, his position was that he would call a halt only if the patient herself gave an explicit instruction to that effect. As he explained, for all he knew the patient might have abandoned her faith before the accident, might have signed the card under family pressure or might accept blood if confronted with the likelihood that without a transfusion she would die.

In other words, he was not convinced that compliance with the Medical Alert card would be in accordance with the patient's wishes.

Mrs. Malette's condition improved overnight and the next day she was transferred by air ambulance to a Toronto hospital.

By then further transfusions were not needed, and she went on to recover from her injuries.

Mallete Case

Malette sued, alleging that the blood transfusions constituted negligence, assault and battery, and religious discrimination.

The trial court held that the Jehovah's Witness card validly restricted Shulman's right to treat Malette.

The harm lies in the fact that the patient did not consent to the treatment.

The Supreme Court of Ontario affirmed the trial court's judgment, concluding that Malette had informed the physician of her objection to blood transfusions in the only way she could. Absent some rationally founded doubt as to the card's validity, Malette's instructions stood.

Mallete Case

The trial court rendered a $20 000 judgement in favour of Mrs. Malette against Dr. Shulman.

The defendant appealed but to no avail; the Ontario Court of Appeal affirmed the trial-court ruling.

Mallete Case: Court of Appeal

In 1990 the Ontario Court of Appeal ruled that physicians must honour Medical Alert cards signed by Jehovah's Witnesses that forbid blood transfusion under any circumstances.

"The principal interest asserted by Mrs. Malette is in the freedom to reject, or refuse to consent to, intrusions on her bodily integrity."

Mallete Case: Court of Appeal

"The right to determine what shall be done with one's own body is a fundamental right in our society. The concepts inherent in this right are the bedrock upon which the principles of self-determination and autonomy are based."

In the hour when the Holy One Blessed Be He created the first man,He took him and let him pass before all of the trees of the garden of Eden,And said to him:See My works, how fine and excellent they are!Now all that I am going to create for you I have already created.Think about this and do not corrupt and desolate my world;For if you corrupt it, there will be no one to set it right after you.

Approximately 8th century.

Which Morality?

life becomes lifestyle and all morality a matter of choice

the orthodoxies of our time are that morality is a private affair, a matter of personal choice, and that the state must be morally neutral

the gradual transformation by which sin becomes immorality, immorality becomes deviance, deviance becomes choice and all choice becomes legitimate, is a profound redrawing of our moral landscape, and alters the way we see alternatives available to us.

(Sacks, J., (2005) The Persistence of Faith. Religion, Morality and Society in a Secular Age. Continuum, London, New York., p.17, 40, 50)

Which Morality?

society is not just agglomeration of individuals doing what they like so long as they do not harm others. society means a community of ideas; without

shared ideas on politics, morals, and ethics no society can exist

for society is not something that is kept together physically; it is held by invisible bounds of common though

if morality is a choice of individuals, it can not longer be though as a code of a society.

if morality is private, there is no logic in imposing it on society by legislation

"Reminder of the Origin"

it is now forever looked for in the depth, where formerly it was sought in the height

Judaism places our moral decisions into the context of a larger vision of the world and our goals within it.

Judaism thereby gives meaning to each of our moral efforts and provides motivation to meet our moral challenges

Genes do not make decisions. But we are free; we do choose; we do make decisions.

If the movements of the planets fail to obey Aristotle´s law of circular motion, that is not because they are disobedient but because Aristotle´s law is wrong.

But if human fail to obey te laws against murder, robbery or theft, that is not because there is something wrong with the laws but because there is something wrong with us.

Sacks, J., (2011) The Great Partnership. God, Science and the Search for Meaning. Hodder & Stoughton, London. p. 71

To be a Jew is to be beyond time

God´s word is eternal certain things do not change values and principles and laws are

constant to be a Jew is to be beyond time

A Jewish Approach

God created and therefore owns the entire universe, including each person´s body God acquired possession of the world and

apportioned it to humanity, but God always remains the master of the world (Artson. B.S. Our Covenantn with Stones: A Jewish Ecology of earth. in Judasim and Environmental Ethics (2001) Yaffe, M.D., (ed.) Lexington Books, Lnaham, p. 163)

A Jewish Approach

and we therefore do not have the right unnecessarily to destroy or dammage God´s property , including even God´s vegetation and inanimated property this obligation makes suicide an act of theft from

God, a violation of God´s prerogatives, and the trespass of the proper boundaries between God and human beings

(Dorff, E.N., (2003) Matters of Life and Death. A Jewish Approach to Modern Medical Ethics. The Jewish Publication Society, Philadelphia, PA, p. 179)

The God of Israel is the God of everyone, but the religion of Israel is not the religion of everyone.

Through you all the families of the earth shall be blessed - a sentiment that appears no less than five times in the book of Genesis.

Sacks, J., (2009) Future Tense. Hodder and Stoughton, London. p.95.

Judaism teaches that God grants a place in heaven to those whose religion is not the same as ours. (...)

Until we make theological space for the other, people will continue to hate in the name of the God of love, practise cruelty in the name of the God of compassion, wage war in the name of the God of peace, and murder in the name of the God of life.

Sacks, J., (2009) Future Tense. Hodder and Stoughton, London. p.111

If there is only one truth, and you have it, then others do not. They live in error, and to save them from that error you can claim religious justifcation for conquering, converting or even killing them. That has been the source of many crimes and much imperialism in the past and present, and that is why Judaism is a protest against empires.

Sacks, J., (2009) Future Tense. Hodder and Stoughton, London. p.170

Infertility

Happy are all who fear the Lord, who follow His ways… Your wife shall be like a fruitful vine within your house; your children, like olive saplings around your table…

children are an expression of God´s blessing

A Jewish Approach Deut 7, 12 - 14

As one infertile Jewish woman written, „Fertlitity, it seems, is an integral component of

the covenant. Is barrenness, then, next to godlessness? If you who are fertile have received a sacred blessing, have we who are not received a divine curse?“


A Jewish Perspective

people should, if at all possible, live in marital partnership and have children

if a couple cannot have children, the commandment to procreate no longer applies couples may consider adoption or use modern

technologies in an attemtp to overcome their infertility….

…but they are under no obligation to do so

A Jewish Perspective

IVF (AIH), GIFT, ZIFT are licit but there is no Jewish obligation to use any of

these new techniques because abortions are generally prohibited,

Jews should have only two, or at most three zygotes implanted for IVF or ZIFT and should use only two, or at most three, eggs for GIFT

if their attempts at having children with IVF succeed, Jews may discard the remaining embryos, because these embryos exist outside the uterus

AID: Arguments AgainstA Jewish Perspective

AID severs the link between the procreation of children and marriage

it would pave the way to a disastrous increase of promiscuity, as a wife, guilty of adultery, could always claim that a pregnancy which her husband did not, or was unable to, cause was brought about by AID, when in fact she had adulterous relations with another man so it is a type of adultery

diminution of the role of the father The generation of children would become arbitrary and

mechanical, robbed of those mystic and intimately human qualities which make man a partner with God in the creative propagation of the race

AID: Arguments AgainstA Jewish Perspective

children born through artifical insemination (AID), like adopted cildren, may feel and say that they would not be having such problems if their real fathers were there

if keeping in secrecy the secret of a woman´s donor insemination can

be revealed at any time in an angry moment relatives and friends who do not know about the DI

will quite innocently add to the man´s pain when they talk about whom the child resembles

AID: Arguments ForA Jewish Perspective

we do, after all, have many „blended“ families today where children are raised by one biological parent and one nonbiological parent

AID: Arguments ForA Jewish Perspective

the Jewish tradition always valued children

couples who use AID will undergo hardship that other couples need not endure

having and raising children is a demographic imperative for the Jewish community in our time


AID: Other IssuesA Jewish Perspective

couples considering DI often want to make sure that he is like them so that child will resemble them that, for some, is a racist attitude

the danger of a new eugenics it would be permissible to screen out, as sperm banks

usually do, donors with genetic disorders or other diseases like HIV, syphilis, hepatitis, gonorrhea and chlamydias, for those charactreristics of the donor are likely to affect the physical health of the child

but it would not be permissible to choose only those donors with outstanding mental or physical traits. That would be a step toward creating a master race.

Pragmatism Judaism

American school of pragmatism, its media and even its recent welfare legislation reforms would think of ourselves in utilitarian terms, with our worth being a function of what we can do for ourselves and others

American attitudes and laws thus permit suicide, especially when a person can no longer do anything useful for either herself or himself or for others

Judaism requires us to evaluate our lives in light of the ultimate value inherent in us because we were created in God´s image

Jewish ideology and law therefore strongly oppose commiting suicide or assisting others in doing so, for life is sacred regardless of its quality or usefulness

Judaisms

God created and therefore owns the entire universe, including each person´s body

and we therefore do not have the right unnecessarily to destroy or dammage God´s property , including even God´s vegetation and inanimated property this obligation makes suicide an act of theft from

God, a violation of God´s prerogatives, and the trespass of the proper boundaries between God and human beings

(Dorff, E.N., (2003) Matters of Life and Death. Judaismus to Modern Medical Ethics. The Jewish Publication Society, Philadelphia, PA, p. 179)

Judaisms

Even though Jewish law goes quite far in permitting terminally ill patients to die with whatever palliative care they need and without any other medical interference

it does not permit suicide or assisted suicide the tradition maintains a firm line between

legitimately withholding and withdrawing medical efforts on the one hand and illegitimately helping a person actively to take his or her life on the other

Judaisms

the value of life does not depend on the level of one´s abilities it derives from the image of God embedded in

us the tradition thus strongly affirms the divine

quality of the life of disabled people the Jewish tradition requires that we recognize

the divine aspect of people in the last stages of life, regardless of the quality of their lives

Environmental Ethics

our planet is not a mute „fact“, suitable only for measurement, testing, and objectification

full human relationship to the world is one n which the earth is loved and cultivated, a partner with Jews

our behavior allows the earth to fulfill its covenantal relationship, and our planet, in turn, provides humanity with further grounds for gratitude to God.

(Artson. B.S. Our Covenantn with Stones: A Jewish Ecology of earth. in Judasim and Environmental Ethics (2001) Yaffe, M.D., (ed.) Lexington Books, Lnaham, p. 168)

Alasdair MacIntyre once pointed out that there are two kinds of atheist: one who does not believe in God, and one for whom atheism itself is a kind of religion.

Of the latter, some of the greatest examples were lapsed, converted, or non-believing Jews - most famously Spinoza, Marx and Freud. Instead of merely denying the truths of Judaism, they set out to provide systematic alternatives. Each sought to show that we are not free. Man is a predictable animal. Our nature and character are subject to quasi-scientific laws. There

is a science of human behavior and there is a science of atoms. History, personal or collective, is a form of inevitability.

We are what we are because we could not be otherwise (Sacks, J., (2009) Genesis: The Book of Beginnings. Covenant and Coversation. Maggid Books

and The Orthodox Union. New Milford, USA, London, Jerusalem. p.70)

human beings are the crown of creation God´s vicegerents on earth

they have responsibilities including stewardship of other creatures, the environment and their own health

illness may be seen as a trial or even as a cleansing ordeal, but it is not viewed as a curse or punishment or an expression of Allah´s wrath

Hence, the patient is obliged to seek treatment and to avoid being fatalistic

life is sacred: every moment of life has a great value, even if it is a poor quality

prohibition against suicide or euthanasia

• if secular western bioethics can be described as rights, Islamic bioethics is based on duties and obligations

• abortion has been allowed after implantation and before ensoulment in cases in which there were adequate juridical or medical reasons.

• Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415

however, many Shias and some Sunnis have generally not permited abortion at any stage after implantation, even before ensoulment, unless the mother´s life is in danger

Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415

Islam

From a hadith we can learn that the embryo becomes a person at 120 days:

Islam

• On the authority of Abdullah bin Masud, who said : the messenger of Allah, and he is the truthful, the believed narrated to us :

"Verily the creation of each one of you is brought together in his mother's belly for forty days in the form of seed, then he is a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows the breath of life into him and who is commanded about four matters: to write down his means of livelihood, his life span, his actions, and whether happy or unhappy.

• (Sahih al-Bukhari and Muslim)

Islam

You can see that it is 40 day + 40 days + 40 days, when the soul enters the embryo a person is created with a purpose in life.

Islam

• In principle, the Qur'an condemns the killing of humans (except in the case of defense or as capital punishment), but it does not explicitly mention abortion. This leads Islamic theologians to take up different viewpoints: while the majority of early Islamic theologians permitted abortion up to day 40 of pregnancy or even up to day 120, many countries today interpret these precepts protecting unborn children more conservatively.

• Although there is no actual approval of abortion in the world of Islam, there is no strict, unanimous ban on it, either. Islam has not given any precise directions with regard to the issue of abortion.

• http://www.islamawareness.net/FamilyPlanning/Abortion/abortion3.html

full human life, with its attendant rights, begins only after the ensoulment of the fetus

some Muslim scholars agree that ensoulment occurs at about 120 days after conception, while other scholars hold that it occurs at about 40 days after conception

(Albar, M.A., (1995) When is the soul inspired? Contemporary Topics in Islamic Medicine. Ch.1.Jeddah: Saudi Arabia Publishing and Distributing House, pp.3-11

abortion after ensoulment is strictly forbidden by all islamic authorities, but the vast majority do make an exception to preserve the mother´s life

If a choice has to be made to save either the fetus or the mother, the the mother´s life would take precedence she is seen as a root, the fetus as an offshot

Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415

The Oath of a Muslim Physician

In the name of Allah, Most Gracious, Most Merciful.Praise be to Allah, the Sustainer of His Creation, the All-Knowing.Glory be to Him, the Eternal, the All-Pervading.O Allah, Thou art the only Healer,I serve none but Thee, and, as the instrument of Thy Will, I commit myself to Thee. I render this Oath in Thy Holy name and I undertake:

To be the instrument of Thy Will and Mercy, and, in all humbleness, to exercise justice, love and compassion for all Thy Creation;

To extend my hand of service to one and all, to the rich and to the poor, to friend and foe alike, regardless of race, religion or colour;

To hold human life as precious and sacred, and to protect and honour it at all times and under all circumstances in accordance with Thy Law;

To do my utmost to alleviate pain and misery, and to comfort and counsel human beings in sickness and in anxiety;

To respect the confidence and guard the secrets of all my patients;

The Oath of a Muslim Physician

To maintain the dignity of health care, and to honour the teachers, students, and members of my profession;

To strieve in the pursuit of knowledge in Thy name for the benefit of mankind, and to uphold human honour and dignity;

To acquire the courage to admit my mistakes, mend my ways and to forgive the wrongs of others;

To be ever-conscious of my duty to Allah and His Messenger (s.a.w) and to follow the precepts of Islam in private and in public.

O Allah grant me the strength, patience and dedication to adhere to this Oath at all times.

we are stewards, not owners, of our own bodies and we are accountable to God for the life that has been given to us the suicide is not allowed, because suicide is

outside the authority of the individual to take his or her life

life is not an absolute value

Natural law

life is the basic and necessary condition of other goods, and human beings have an innate desire to seek these goods such as sexual reproduction, social life and

knowledge

Ontological Personalism

as long as there is a living body, even if mental capacity is reduced or absent, there is still a person present

a human being is considered to be a person from conception to the death of the whole

some issues, such as matters concerning reproduction, are controversial even within catholic bioethics

the individual has a duty to promote his or her own health the person does not have the moral right to

take serious risks to health

but patients are obligated to use measures within their financial means; they are not obligated to reduce their family to poverty in an effort to stay alive

In 1956, the issue before society was the use of artificial insemination, either by the sperm of the husband or of a donor.

At the Naples meeting, Pius XII took occasion to oppose the use of artificial insemination in any form and formulated it in terms of reproduction being necessarily within the scope of conjugal love.

Jones, W.H., (2012) Personhood Revisited. Reproductive Technology, Bioethics, Religion and the Law. Langdon Street Press. Minneapolis, MN. p.121

Donum Vitae, 1987

Donum Vitae this document is the first external Vatican

statement after the clinical application of IVF and was intended to instruct the faithful about the licitness of the clinical application of IVF.

„Instruction Donum Vitae on Respect for Human Life in its Origin and on the Dignity of Procreation“ called IVF and related procedures „illicit“.

Unitive and Procreative Act

human love should be both love-giving (unitive) and life-giving (procreative)

Humanae Vitae 1968: this connection between unity and procreation

was deemed "inseparable" and a requirement in "each and every marriage act."

Catholic Approach

a person is a "unified totality", and thus is wrong to treat a person in a way that reduces that person either mere body or mere spirit.

reproductive techonology leads us to treat our bodies merely as a source of gametes, and that so treating our bodies is the first step to disembodying procreation altogether.

Stanovisko katolické církveHumanae vitae Encyklika Pavla VI.o správném řádu sdělování lidského životaz 25. července roku 1968 čl. 12 „Dva nerozlučné aspekty: spojení a početí života Učitelským úřadem vícekrát vyložená nauka se

zakládá na nerozlučném spojení dvojího významu manželského styku, který je Bohem chtěný a který člověk z vlastního popudu nemůže rozbít: je to význam spojivý a plodivý.

Manželský styk totiž svým vnitřním ustrojením hluboce spojuje manžely a uschopňuje je k početí nového života ve shodě se zákony, vepsanými do samotné bytosti muže a ženy. Sjednocuje oba tyto podstatné aspekty - aspekt spojení a početí. Je projevem vzájemné a pravé lásky a je zaměřen k význačnému povolání člověka k rodičovství. Domníváme se, že lidé naší doby jsou zvlášť schopni potvrdit hluboce rozumný a lidský charakter tohoto základního principu.“

Dignitas personae

In light of this principle, all techniques of heterologous artificial fertilization, as well as those techniques of homologous artificial fertilization which substitute for the conjugal act, are to be excluded.

On the other hand, techniques which act as an aid to the conjugal act and

its fertility are permitted.

Dignitas personae

Certainly, techniques aimed at removing obstacles to natural fertilization, as for example, hormonal treatments for infertility, surgery for endometriosis, unblocking of fallopian tubes or their surgical repair, are licit.

Dignitas personae

ICSI Just as in general with in vitro fertilization, of which it is a

variety, ICSI is intrinsically illicit: it causes a complete separation between procreation and the conjugal act.

zmražení embryí Cryopreservation is incompatible with the respect owed

to human embryos; it presupposes their production in vitro; it exposes them to the serious risk of death or physical harm, since a high percentage does not survive the process of freezing and thawing; it deprives them at least temporarily of maternal reception and gestation; it places them in a situation in which they are susceptible to further offense and manipulation

Dignitas personae

In this regard it needs to be stated that cryopreservation of oocytes for the purpose of being used in artificial procreation is to be considered morally unacceptable.

Dignitas personae

The proposal that these embryos could be put at the disposal of infertile couples as a treatment for infertility is not ethically acceptable for the same reasons which make artificial heterologous procreation illicit as well as any form of surrogate motherhood

H. Jones

The answer is that the pill is „unnatural“, therefore alien to God´s laws. But certainly prohibiting intercourse in a marriage blessed by true conjugal love is unnatural.

Jones, W.H., (2012) Personhood Revisited. Reproductive Technology, Bioethics, Religion and the Law. Langdon Street Press. Minneapolis, MN. p.79

Preparation for Death

The Sacrament of the Anointing of the Sick

The Sacrament of the Anointing of the Sick

viatikum

Catholicism

Role of suffering: Down through the centuries and generations it

has been seen that in suffering there is concealed a particular power that draws a person interiorly close to Christ, a special grace.

Pope John Paul II: Salvifici Doloris, 1984

We should relieve suffering when we can, and be with those who suffer, helping them to bear their suffering, when we can't. We should never deal with the problem of suffering by eliminating those who suffer.

catholic patients may appreciate various kinds of spiritual aid and support at the end of life, be it psychological support or the offering of Holy Communion, the Sacrament of Reconciliation, or the Sacrament of the Sick

it is appropriate to call a priest on behalf of Catholic patients when death is imminent

Ordinary and Extraordinary measures

ordinary means of preserving life are all medicines, treatments and operations which offer a reasonable hope of benefit for the patient and whih can be obtained and used without excessive expense, pain or other inconvenience

extraordinary means of preserving life mean all medicines, treatments, and operations, which cannot be obtained without excessive expense, pain or other inconvenience, or wghich, if used, would not offer a reasonable hope of benefit

(Markwell, J.H., Brown, B.F., Roman Catholic Bioethics in Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University Press, Cambridge. pp.436-441)

many different Christian denominations with a wide rangeof beliefs

origin in the Reformation of the 16th centuiry

there is no such thing like „protestant bioethics“

some Anglican churches are very close theologically to the Catholic Church

others have adopted different positions

Protestant influence on Western culture: principle of autonomy value of individual freedom

earthly authorities are fallible and believers should read and understand the scripture themselves

and many others

attention to social inequities (Salvation Army)

every person has been made in the image of God

there is a greater meaning or purpose in illness of which we may not be aware

conservative groups arae among the most active in pro-life movement

some liberal denominations are pro-choice some may object to IVF because of the

potential for embryo wastage many would consider this an option if they

were infertile

Buddhism

there is no central authority competent to pronounce on matters of doctrine or ethics

Buddhism

Buddhism emphasises the importance of death with an unclouded mind wherever possible, because it is believed hat this can lead to a better rebirth.

Some buddhists may therefore be unwilling to take pain-relieving drugs or strong sedatives, and even those who are not in a terminal condition might prefer to remain as alert as possible, rather than take analgesics that would impair their mental or sensory capacities.

Keown, D., End of Life: The Buddhist View. The Lancet 366 (2005): 952-55.

Buddhism

Death is an integral part of life, and by virtue of their belief in rebirth, Buddhist believe that death is an experience they will undergo many times.

Euthanasia is rejected by most buddhists as contrary to the First Precept, which prohibits intentional killing.


Buddhism

However, in this respect, Buddhism adheres to the principle of the middle way (majjhima patipada), and the prohibition on euthanasia does not imply a commitment to vitalism, namely the doctrine that life should be prolonged at all costs. The withdrawal of medical intervention when the end is nigh is accordingly not seen as immoral.


Palm Sunday

Initiatory Ceremony

Hierarchy

Corpus Domini

2013 Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University...

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Transcript of 2013 Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University...