Material appearing below is thought to be of particular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary but not the sole source of such material. In general, abstracts\u27 are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. C. Laforet, M.D. , 2000 Washington St., Newton Lower Falls, MA. 02162.

Catholic Physicians\u27 Guild

English

Material appearing below is thought to be of particular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary, but not the sole source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D., 2000 Washington St., Newton Lower Falls, MA 02162

epublications@Marquette

The Linacre QuarterlyVolume 48 | Number 3 Article 178-1-1981Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1981) "Current Literature," The Linacre Quarterly: Vol. 48: No. 3, Article 17.Available at: http://epublications.marquette.edu/lnq/vol48/iss3/17includes the goods of prolonging life and combatt ing of natural death. Theoretical issu es aside, I fear Veatch 's position will be read by industrialized cou ntries as further justification fo r ex pending every more resources in the area of extending li fe and defeating death - for the benefit of the affluent. In his conclud ing state-ment, Veatch acknowledges that an allocation of resources question is invo lved , an d that in a sequal to this paper he intends to defen d the distribut ional principle that m edical resources should go first to those least well off. Such a discussion, for me, would give an entirely di fferen t perspective to his natural death paper. I wish the sequel had been included here or that he had reserved an ent ire section at least to sketch the m ai n lines of such a thesis. Two arti cl es concentrate on eutha nasia - John Ladd's "Positive and Negative Euthanasia" and Michael D. Bayles's "Eu thanasia and the Quali ty of Life." Both cover what is by now well-trodden ground. They seem to be in basic agreem en t on major issues. For exa mple, both contend that t here is no moral difference between killing and permi tt ing a patient to die by ceasing li fe-prolo nging treat-ment . Adequate representation of t he opposite view would have added to the usefulness of this book . Overall, I do not recommend Medical Treatment of the Dying. For better balance and general coverage of issues in this area, for useful organization of the material with introductions and bibliographies for each sect ion , I recommend the paperback Ethical Issues in Death and Dying, edited by Beauchamp and Pe rlin (Prentice- Hall, 197 8). - R. J. Connelly , Ph .D. Division of Humanities and Fine Arts Incarnate Word College Current Literature Material appearing below ·is thought to be of par-ticular interes t to Linac re Quarte rly readers because of its m oral, religiou s. or philosophic content. The medical literature constitutes the p rimary. but not the sale so urce of such material. In general. abstracts are intended to refleel the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet. M.D .• 2000 Washington St .• Newton Lower Falls. MA 02 162) Position statement on medical partici-pation in capital punishment. Am J Psychiat 137:1487 Nov 1980. The American Psychiatric Associa-tion "strongly opposes any participa-tion by psychiatrists in capital punish-ment, that is, in activities leading directly or indirectly to the death of a condemned person as a legitimate medical procedure." Koryagin A: Unwilling patients. Lance t 821-82411 April 1981. In the Soviet Union the diagnosis of psychopathy may often be based on August, 1981 political criteria, and dissenters may be committed to mental institutions for punitive purposes. These individuals receive no psychiatric treatment while institutionalized. (Cf. Chapman article following. ) Siegler M: A physician's perspective on a right to health care. JAMA 244:1591-15963 Oct 1980. The claim of a right to health care is, in the first place, ambiguous. Con-fusing a right to health care with a right to health may result in an inappropriate emphasis on heal th care 287 rather than on health itself as a desid-eratum. In addition, insistence on a right to health care would diminish the freedom of choice that currently exists in the doctor-patient relationship, and would substitute a narrow contractual model of medicine. Most important, however, establishing a right to health care would impinge severely on the liberty of the patient. Bulger RJ: Narcissus, Pogo, and Lew Thomas' wager. JAMA 245:1450-1454 10 April 1981. The fundamental values of modern society are being undermined by nar-cissism. In medicine this is manifest by the tendency to consider good health as the single greatest blessing rather than as one of several. This results in a destruction of individual and family responsi bility and the transfer of same to society and to the helping profes-sions . Furthermore, morality has become a matter of majority vote, and all taboos are to be extirpated. How-ever, societal narcissism is the last step before mass cynicism and pessimism, and Lew Thomas' wager offers a more optimistic alternative. Donnai P, Charles N, Harris R : Atti-tudes of patients after "genetic" termination of pregnancy_ Brit Med J 282:621-62221 Feb 1981. Based on a study of 12 women who had undergone abortion for "genetic" reasons, it would seem that "persistent adverse psychological and social reac-tions" are more common in this group than in those undergoing abortion for "social" indications. Chapman CB: The importance of being ethical. Perspect Bioi & Med 24:422-439 Spring 1981. Law and medicine are the critical professions if the term "profession" is considered as a form of covenant in which society grants definite privileges to specially competent groups in return for a professional ethic that is 288 centered on the interests of the person being served. However, codes of pro-fessional ethics through the ages have consistently focused on the needs of the profession rather than on those of the patient or client. It is necessary to persuade members of the critical pro-fessions (about 1 percent of our total population) of the need to be truly ethical and not to confuse codes of etiquette with norms of ethical behavior. This is crucial for our times because otherwise the only morality becomes legality, a~ in a collectivist totalitarian society in which the only ethical obligation is that exacted by the state. Stone AA: The right to refuse treat-ment. Why psychiatrists should and can make it work_ Arch Gen Psychiat 38:358-362 March 1981. The right to refuse treatment is included in the legal doctrine of informed consent. This right may be overcome, however, if the patient is incompetent. Numerous legal opinions have been offered to deal with the contradictions that may arise. Ideally it should be possible for psychiatrists rather than neutral arbiters to make treatment decisions for their patients. Maddison, F_, Pelling, M., Webster, C. (eds.): Linacre Studies: Essays on the Life and Work of Thomas Linacre, c. 1460-1524. Clarendon Press: Oxford 1977. Readers of Linacre Quarterly migh t be interested in this collection of 12 essays dealing with various aspects of the career of Thomas Linacre. Altman DG: Statistics and ethics in medical research. Brit Med J 281: 1182-1184 1 Nov 1980. In the first of eight articles dealing wi th statistics and ethics, the au thor contends that research that is statis-tically substandard is unethical be-cause it involves misuse of patients, misuse of resources, and the possibility of publishing misleading results. Linacre Quarterly 

Current Literature

The Linacre QuarterlyVolume 49 | Number 2 Article 125-1-1982Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1982) "Current Literature," The Linacre Quarterly: Vol. 49: No. 2, Article 12.Available at: http://epublications.marquette.edu/lnq/vol49/iss2/12{J Current Literature Material appearing below is thought to be of par-ticular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary, but not the sole source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D., 2000 Washington St., Newton Lower Falls, MA 02162) Mahler DM, Veatch RM, Sidel VW: Ethical issues in informed consent: research on medical cost contain· ment. JAMA 247:481-485 22/29 Jan 1982. Restriction of medical services by the decision to con tain medical costs involves social and political considera· tions. Research is required, however, in order to assess the effect of such cost containment efforts. Such research necessarily raises difficult questions of informed consent on the part of each affected patient. These difficulties might be resolved in part by a greater reliance on retrospective studies, resorting to clinical decision· making models based on already avail· able data, and emphasizing the role of the primary care physician in maxi· mizing patient autonomy. Kreutzer EW, Rutherford RB, Lehman RAW: Diagnosis of brain death by common carotid artery velocity waveform analysis. Arch Neurol 39:136-139 March 1982. Demonstrating the cessation of cer· ebral blood flow is a desirable con· firmatory study when establishing the diagnosis of brain death . Arteriog· raphy and similar approaches have proven reliable but unwieldy. Com· mon carotid artery velocity waveform analysis is a simpler method of obtain· ing such data. Sheldon M: Truth telling in medicine. JAMA 247:651-6545 Feb 1982. Prescinding from the philosophic issue of just what "the truth" is, truth telling in medicine nevertheless con· May, 1982 tinues to raise vexing questions. Approaches range from that of Bok, who would insist on direct truth tell· ing in almost all circumstances, to that of Henderson /Ellin, whose fiduciary model would permit the element of harm to modify what is told the patient. Slavin LA, O'Malley JE, Coocher GP, Foster DJ: Communication of the cancer diagnosis to pediatric patients: impact on long·term adjustment. Am J Psychiat 139:179.183 Feb 1982. This stu dy supports the hypothesis "that early knowledge of the cancer diagnosis is related to good psycho· social adjustment among long·term survivors of childhood malignancies." Muyskens JL: Nurses' collective responsibility and the strike weapon. J Med & Phi/os 7:101·112 Feb 1982. In addi tion to the nurse's du ties as an individual health professional toward the individual patient, there are also collective duties toward the profession itself. These include main· taining and improving standards of nursing, maintaining conditions of employment that are conducive to to quality nursing care, contributing to the development of community and national health needs, and making the most efficient use of nursing resources. In order to meet these collective duties it may be necessary to resort to strike action which, within certain contexts, is a moral action. 191 (Editorial): Genetic counselling and the prevention of Huntington's chorea. Lancel p. 147 16 Jan 1982. Huntington's chorea is perhaps the most devastating genetic disorder of adult life. Its prevalence would fall precipitously, however, if procreation were avoided or limited by those at high risk. This would involve inform· ing those family members at risk, which raises two important questions. First, is the aim of genetic counseling to help the individual family or society at large? Second, how can a valid deci· sion be made when there is no objec· tive evidence of the effect of such counseling? But with respect to the latter, there is accumulating evidence th a t n on· directive counseling does indeed result in a reduction of family size. As for directive counseling, firm data are not yet available. Wolf CR, Robinson B: Brain death: a review. Military Med 146:246·248 Apr 1981. The diagnosis of brain death is reviewed from the aspects of the neurologic examination, clinical pre· requisites (such as the absence of Are You Moving? hypothermia or of drug ingestion), electroencephalographic findings, and determination of cerebral blood flow. Abramson NS, Meisel A, Safar P: Informed consent in resuscitation research. JAMA 246:2828·2830 18 Dec 1981. Currently established legal require· ments involving informed consent impede research on emergency resusci· tation. These regulations must be mod· ified in order to permit such necessary research. McNeil BJ, Weichselbaum R, Pauker SG: Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. New Engl J Med 305: 982·987 22 Oct 1981. For patients with laryngeal cancer, radiation therapy preserves voice func· tion but offers a lower survival than laryngectomy, which has a higher sur· vival but which destroys normal voice function. An analysis of the attitudes or normal volunteers indicates that approximately 20 percent would choose radiation therapy in this sit· uation. If the next issue of this journal should be delivered to a differ-ent address, please advise AT ONCE. The return postage and cost of remailing this publication is becoming more and more costly. Your cooperation in keeping us up-to-date with your address will be most helpful. EDITOR'S NOTE: In the article entitled "On Attitudes Toward Death and the Cost of Dying" in the February, 1982 issue, the 11th line from the bottom of page 51 should have read, "Hospice care is not inexpensive." We apologize for this error. 192 Linacre Quarterly .' 

Material appearing below is thought to be of particular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary, but not the sole source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D., 2000 Washington St., Newton Lower Falls, MA. 02162.

The Linacre QuarterlyVolume 47 | Number 4 Article 1611-1-1980Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1980) "Current Literature," The Linacre Quarterly: Vol. 47: No. 4, Article 16.Available at: http://epublications.marquette.edu/lnq/vol47/iss4/16(Coincidentally, . a similar statement is to be found in the preface to Macquarrie's work above: "We have followed no party line, but have tried to bring together in this volume some of the most significant thinking that is currently going on about Christian ethics.") There is a w ealth (or at least a welter) of information in The Concise Dictionary, but the "fundamentals of ethics" do not really stand out. This is unfortunate, especially since the work seems designed for persons other than professional eth ic ians, at least if the bibliographies are any indication. Apparently as a convenience to English·speaking persons , foreign titles are not included in the bibliographies even though most of the 30 or so authors are German-speaking and even though professional ethicians whose native language is English must have a facility with other m odern languages (German, for example). Some major entries (e.g., " Norm") have no bibliography, and when a name is used in other entries (e.g., "Biblical Ethics") there is no reference in the bibliography. Nor is every bibliographical reference accurate: in the bibliography appended to "Celibacy," R. Francoeur's book Eve's New Rib becomes Eve's Spare Rib! There are other inaccuracies as well. For example , in the same entry on "Celibacy," this is said: " .. . by the R eformation a theoretically celibate clergy was taken for granted in the West. This was reaffirmed at Trent, and again in the Decree on Priestly Formation of Vatican II. A flurry of encyclicals in the same sense, before and since, is perhaps the clearest indication that change will even· tually come about" (p. 40). The fact is, there has been no "flurry of encyclicals" in any sense, and it is certainly misleading to suggest this as an indication (let alone "the clearest") that things will change. There is an abundance of typo· graphical errors, a few instances of lines being left out and other lines repeated, some awkward translations and, most notably, major omissions for a work of this type. In brief, the publication of this Dictionary is not one of Seabury 's better edi torial decisions. - Dennis J. Doherty, Dr. theol. Marquette University Current Literature Mat erial appearing below is thought to be of par· ticular interest to Linacre Quarterly readers because of its moral, religious, or philosophic co ntellt . Th e m ed ical literature constitutes the primary. but 1I0t the so le source of such material. In general. abstracts are intended to ref"/ec t the substance or th e original article. Contributions and comments from readers are invited. (E. G. Laforet. M. D. , 2000 Washingt o n St., Newtoll Lower Falls, MA 02162) Pruitt RD: On science and ethics. Mayo Clin Proc 1978; 53:684-685. Andre Cournand has advocated the "Code of Science" as the most appro-priate ethical basis for modern society. But despite his assertion that the ethic of science "should provide a basis for going beyond the competing ideologies and religions of our day ," its tenets are 378 curiously similar to those embodied in some of the world's great religions. Nev· ertheless, demonstrating these paralle ls between the Ethic of Devel opmen t and the Judeo·Christian ethic demeans neither. In fact , "science in its role as the 20th century Messiah may give to those teachings a power for dispersion and general acceptance that they would not otherwise achieve." Linacre Quarterly Callahan D: Contemporary biomedical ethics. New Eng J Med 302: 1228· 123329 May 1980. The past decade has been marked by vigorous activity in the field of bio· medical ethics. The time has now come for a rethinking of its role, methodology, and relation to other disciplines. In addition to working more closely with people in medicine, biomedical ethicians must also begin a more earnest dialogue with those in law and the social sciences. Green MB, Wikler D: Brain death and personal identity. Phil & Public Affairs 9:105·133 Winter 1980. A continued capacity for mental life is what makes life valuable. Per· sonal identity is a crucial component of this capacity. "For the position we hold here is not simply that a mindless future life would be of no value to us, but that such a life , whatever else might be true of it, could not be ours. " Chapman CB: On the definition and teaching of the medical ethic. New Eng J Med 301:630-634 20 Sept 1979. Although the relation between the medical profession and patients is one of social covenant, this remains an unwritten ethic. Organizational articu-lations of medical ethics neglect this crucial aspect and instead represent guild rules which are codes of conduct and etiquette relating only to intra· professional matters. This is not suffi-cient for modern medicine and a true expression of the covenant between the profession and society is needed. Osmond H: God and the doctor. New Eng J Med 302:555-558 6 March 1980. Aesculapian authority has long been part of medicine and has been fostered not only by physicians but also by patients. However, its unre-stricted application poses serious prob-lems. The sick-role is not well under· November, 1980 stood by health-care professionals and needs to be studied more intensively. Aesculapian authority, as a powerful modality, is open to abuse and its nature and limitations require examin-ation. Alexander E Jr: A 'truth in mending' act. JAMA 243:1239-1240 28 March 1980. Patients who have industrial acci-dents or injuries involved in litigation may request the physician to lie explicitly for their benefit or to co-operate in a fraud by remaining silent. This may be encouraged by govern-ment or by employers. Physicians, too, by over-using diagnostic studies that are paid for by third parties, may encourage this behavior. Without con· stant attention, truthfulness and integ-rity may erode. Physicians should resist such corruption by refusing to participate in such fraud. Lewis TL T: Legal abortion in England and Wales 1968-78. Brit Med J 295-2962 Feb 1980. Since the Abortion Act of 1967 there have been 1,325 legal abortions in England and Wales. Hoff C: Immoral and moral uses of animals. New Eng J Med 302:115-11810 Jan 1980. Although animal experimentation in general is morally defensible , certain strictures obtain. For example, if sub-stantial benefits cannot be expected to accrue, painful experiments are not justifiable. On the other hand, animals may be employed in painful and dan-gerous experiments when vital benefit is anticipated. Reiser SJ: Words as scalpels: transmit-ting evidence in the clinical dia-logue. Ann Int Med 92:837-842 June 1980. The perspective of medical history is brought to bear on the difficult problem of how or whether to inform 379 the patient about the presence of a ser-ious disease_ In the past there has been a tendency to suppress unpleasant medical information, but recent trends favor full disclosure_ This would appear to be the appropriate stance, but prob-lems persist with both the method and timing of conveying such information. Norberg A, Norberg B, Gippert H, Bexell G: Ethical conflicts in long-term care of the aged: nutritional problems and the patient-care worker relationship. Brit Med J 377-3789 Feb 1980. The dying geriatric patient who requires infusions or tu be- feeding for support poses a dilemma for the care professionals. Often infusions or tube-feeding are undertaken for their bene-fit rather than for that of the patient. In general, it may be preferable to allow such a patient a painless death 380 from dehydration rather than to pro-long pain and discomfort by resorting to infusions or tube-feeding. Rubenstein HS: Allergists who alarm the public : a problem in medical ethics. JAMA 243:793-794 22-29 Feb 1980. Some allergists, for whatever rea-son, "have a long tradition of alarming their patients." This is particularly so in the case of bee stings. Death from such events is extremely uncommon and not readily predictable. Despite this, we now witness an expensive and "frantic race for venom vaccine and rush immunization programs for a disease with an almost zero mortality and for which people at risk have not been identified." This results in a grave disservice to countless trusting patients who are not at risk from bee stings but who are victims of alarmist propa-ganda. Linacre Quarterly 

The Linacre QuarterlyVolume 47 | Number 1 Article 152-1-1980Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1980) "Current Literature," The Linacre Quarterly: Vol. 47: No. 1, Article 15.Available at: http://epublications.marquette.edu/lnq/vol47/iss1/15Current Literature Material appearing below is thought to be of par-ticular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary , but not the sale source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. C. Laforet, M.D., 2000 Washington St., Newton Lower Falls, MA 02162) Pollock WF: "Cognitive" and "sapi· ent" - which death is the real death? Am J Surg 136:3·7 July 1978. Difficulty in reaching a consensus on the definition of death has posed serious problems. Legal definitions may vary from state to state. The situ· ation is compounded by the escalating cost of medical care. The criteria pro· posed in 1968 by the Harvard Ad Hoc Committee on the definition of brain death represented an early attempt to clarify the situation, but in the Karen Ann Quinlan case the court ruled that these criteria had not been met. The issue is further beclouded in the mat· ter of abortion, as exemplified by the Edeline case. "Common sense de· mands that these criteria of 'life ' and of 'death' must be based on medical fin dings." Furthermore, legislatures must eventually address the need to define in law the circumstances under which a fetus acquires the legal rights of a "person." lVIurphy EA: Eugenics: an ethical anal· ysis. Mayo Clin Proc 53:655·664 Oct 1978. It is difficult to devise a rational and responsible eugenic policy. Public support for clinical genetics is getting closer, however, and there is therefore a need to address the ethical considera· tions that this will entail. Kaste lVI, Hillbom lVI, Palo J: Diagnosis and management of brain death. Brit Med J 1:525·527 24 Feb 1979. The first nation to accept the de fin· February, 1980 ition of brain death for legal purposes was Finland. In 37 cases of brain death reviewed since 1975, clinical criteria were satisfactory in 21; confirmatory studies, including electroencephalogra· phy and cerebral angiography, were needed in the remainder. The main concern in the diagnosis of brain death is to distinguish it from drug intoxica· tion. In general, the criteria for brain death as delineated in the Finnish code are reliable and suitable for routine use. Ryan lVI : Aspects of ethics (1). Brit Med J 2:585·5868 Sep 1979. Although the health services of the UK and USSR are similar in many respects, the role of the physician in each society is quite different. In Brit· ain, for example, physicians still see themselves as members of a "free and learned profession" while their Rus· sian counterparts have lost this image completely. Soviet physicians are bas· ically technicians who lack an effective power base. How this has developed is difficult to determine, but much is due to the pervasive influence of the Com· munist Party. In the Soviet Union it is compulsory to take a professional oath upon completion of medical studies. This is similar in many aspects to the Hippocratic Oath. However, it avers the primacy of the state over the indio vidual patient when these interests conflict, and the interests of the state "are articulated by individuals and agencies that may persuade and coerce to a degree that is hard to imagine if one lives in a pluralistic Ii beral democ· racy. " 95 Nelson LJ, Mills J: Ethics and research involving celibate religious groups. Clin _Research 26:322-329 Oct 1978. Celibate religious groups, prepon-derantly Catholic, have been used in research projects of three types: 1) studies of conditions associated with sexuality; 2) studies of conditions associated with life style; and 3) stud-ies of a sociopsychologic nature. Canon law does not prohibit participa-tion in such investigations. However, ethical problems arise in connection with the research use of celibates. These include the areas of confiden-tiality and privacy, informed consent, autonomy of consent, satisfactory jus-tification for the use of such a popula-tion, and conflicts between religion and science. Novack DH, Plumer R, Smith RL, Ochitill H, Morrow GR, Bennett JM: Changes in physicians' atti-tudes toward telling the cancer pa-tient. JAMA 241:897·900 2 Mar 1979. In 1961 a questionnaire study indi-cated that 90 per cent of physicians preferred not to tell a cancer patient the diagnosis. A similar survey in 1977 showed that 97 per cent of physicians favored informing the patient. The rea-sons for this reversal of attitude are multiple and incompletely evaluated at present. 96 Silber T J: Placebo therapy: the ethical dimension. JAMA 242:245·246 20 July 1979. The use of placebo therapy in medi-cine poses ethical difficulties. In the utilitarian view it may be morally justi-fied if it proves effective, but in the de ontological view it may be unethical because of the deceit involved in the act itself. However, placebo therapy may imply a special form of symbolic communication that renders it ethical. But in any event such therapy must be part of a careful clinical plan aiming at health. "Thus, placebo therapy is accepted as moral when it enhances physician· patient communication, and it is accompanied by active efforts to achieve health. Conversely, placebo therapy is viewed as immoral if it dim· inishes or replaces patient-physician communication and there is no gen· uine pursuit of health." Stevenson I, Greyson B: Near·death experiences: relevance to the ques· tion of survival after death. JAMA 242:265·26720 July 1979. There is increasing interest in the phenomenon of near-death experience. The tendency of popular writings is to adduce from them strong s\;pport for man's survival after death, while scien-tific studies generally fail to concede this possibility. However, persistence in the latter attitude may preclude "appropriate inquiries that could clar-ify the many questions with which near-death experiences abound." Linacre Quarterly 

Material appearing below is thought to be of particular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary, but not the sole source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D., 2000 Washington St., Newton Lower Falls, MA. 02162

The Linacre QuarterlyVolume 48 | Number 1 Article 192-1-1981Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1981) "Current Literature," The Linacre Quarterly: Vol. 48: No. 1, Article 19.Available at: http://epublications.marquette.edu/lnq/vol48/iss1/19Current Literature Material appearing below is thought to be o{ par-ticular interest to Linacre Quarterly readers because o{ its moral, re ligious, o r philosophic co ntent . Th e medical literature constitutes th e primary, but no t th e sole source of such mat erial. In general, abstracts are intended to reflect lh e substance o{ the original article. Contributions and co mm ents {rom readers are invited. (E. G. Lafore t, M.D., 2000 Washingt o n St., Newton Lower Falls, MA 02162) Norberg A, Norberg B, Bexell G: Ethical problems in feeding patients with advanced dementia, Brit Med J 281:847-84827 Sep 1980. Eventually, aged patients with advanced dementia reach a terminal state at which spoon feeding is no longer feasible. In Sweden there has been increasing reluctance to institute tube feeding or infusion in this situa-tion. This causes significant anxiety in the personnel who are caring for such patients. A double·binding condition results which may foster distancing and scape-goating. An effort should be made to reduce the pressure of such double-binding. Weiss RJ: The use and abuse of decep-tion. Am J Public Health 70:1097-1098 Oct 1980. The use of deception in research raises two questions, one about the morality of such deception and another about the value of the infor-mation so obtained. In the author's view, "Deception in research may have serious consequences for the trust that is so essential to the relationship between patient and physician, while yielding little if anything in return." Renaud M: The ethics of consumer protection research. Am J Public Health 70:1098-1099 Oct 1980. Weiss's absolutist position rejecting the use of deception in research (uide supra) ignores the fact that ethical issues cannot be discussed in the abstract since they are inevitably linked to specific societal milieux. Consequently the use of deception in February, 1981 research should not be rejected out of hand but should be permitted as part of the methodology of science, pro-vided no one is harmed and valid answers to socially important ques· tions can be obtained. Curran WJ, Casscells W: The ethics of medical participation in capital punishment by intravenous drug injection. New Eng/ J Med 302:226-230 24 Jan 1980. Some states have now legislated a method of execution that involves the injection of a lethal drug by medically trained personnel. Such state-ordered medical participation in capital punish-ment is a threat to the tradi tional ethic of the physician and " a corruption and exploitation of the healing profession's role in society." As such it should be formally condemned by the medical profession in the United States. Kola ta GB: Prenatal diagnosis of neural tube defects. Science 209:1216·121812 Sep 1980. It is now medically feasi ble to diag-nose neural tu be defects prenatally. Ho wever, efforts to implement a screening program based on this tech-nology raise questions about access to such testing, abortion, and the quality of life of affected children. Bayley C, McCormick RA: Steriliza-tion: the dilemma of Catholic hos-pitals. America 143:222-225 18 Oct 1980. "If reputable theologians believe that direct sterilization cannot be absolutely excluded morally. then one 95 has to question whether the hospital is pursuing the true overall good of the patient if it adopts a policy that is based on an absolutist moral position. This is not to suggest that Catholic health care facilities ought to adopt a laissez·faire attitude or policy." (Editorial): In cancer, honesty is here to stay. Lancet 2:245 2 Aug 1980. Although the past two decades have witnessed a growing tendency for physicians to inform their patients of a diagnosis of cancer, questions remain about the extent of such disclosure. Societal expectations and pragmatic aspects of treatment both favor dis· closure. "The change in attitude is here to stay and we should start to train our students so that they will be able to help their patients without some of the anxieties still experienced by an older generation of doctors." Paris JJ: Court intervention and the diminution of patients' rights: the case of Brother Joseph Fox. New Engl J Med 303:876-878 9 Oct 1980. As evidenced by the case of Brother Fox, the intrusion of the judiciary in the area of medical decisions about prolongation of life for incompetent patients results in grave injustice for the patient and for the family and associates. National Center Plans Forum The National Center for Health Care Technology , in collaboration with the National Heart, Lung, and Blood Institute, is conducting a technical assessment forum to address the economic, ethical, legal , and social issues related to coronary artery bypass surgery on April 21-23, 1981 at the Shera· ton Washington Hotel, Washington, D.C. Among the issues to be addressed are costs, organization and use of resources , ethical and legal considerations, and quality of life. This conference will draw upon information presented and conclusions reached at the previous consensus development conference on medical and scientific aspects held on December 3-5, 1980 by the National Heart, Lung, and Blood Institute in conjunction with the Center. Presentations and critiques will be given by cardiologists, cardiac surgeons, economists, ethicists, health planners, lawyers, and behavioral and social scientists. The Center was authorized by Congress in 1978 to conduct and support assessments of medical technology; its mission is to evaluate the medical, economic, ethical, legal, and social implications of health care technologies. This meeting is open to the pu blic ; there is no registration fee. The Cen-ter encourages attendance by health professionals and interested private citizens. For technical information For administrative information, please contact: Michael Eliastam, M.D. Special Assistant to the Director National Center for Health Care Technology Parklawn Building, Room 17 A-29 5600 Fishers Lane Rockville , MD 20857 (301) 443-4097 96 please contact: Elaine Kokiko Executive Vice President Moshman Associates, Inc. 6400 Goldsboro Road Washington, D.C. 20034 (301) 229-3000 Linacre Quarterly 

The Linacre QuarterlyVolume 47 | Number 2 Article 185-1-1980Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1980) "Current Literature," The Linacre Quarterly: Vol. 47: No. 2, Article 18.Available at: http://epublications.marquette.edu/lnq/vol47/iss2/18Current Literature Material appearing below is thought to be o f par-ticular int erest to Linacre Qu arte rly readers because of its moral, religiou s, or philosophic con ten t. The medical literature constitutes the primary, but no t th e sole source of such material. In general, abstracts are intended to re fle c t the substance of the original article. Contributions and comments fro m readers are invited. (E. G. Lafore t, M.D., 2000 Wa shingto n St., Newto n L ower Falls, MA 02162) Gellhorn A: Violations of human rights: torture and the medical pro-fession. N Engi J Med 1978; 299: 358-359. The incidence of torture as an in-strument of repression has been in-creasing world-wide, and medical stud-ies have now documented not only the physical but also the psychological effects. The medical profession has been involved in the treatment of tor-ture victims to a great extent. Unfor-tunately, there is also evidence of com-plicity by some physicians in the appli-cation of torture. Holmes C: Bioethical decision making: an approach to improve the proc-ess. Med Care 1979; 17 :1131-1138. There are deficiencies in the current system of making bioethical decisions, including limited input by the general public. The process might be improved by a two-step approach involving (1) the use of branching logic "to sep-arate the bioethical dilemmas into a series of independent, sequential deci-sion points along a decision-making tree" and (2) the use of explicit cri-teria "to deci de whether each individ-ual componen t is ethical or technical in natu re." Langham P: Parental consen t: its justi-fication and limitations. Clin R e-search 1979; 27:349-358. Parents have generally been in-vested with a right to determine treat-ment of their children. The special par-ent-chil d relationship from which this is thought to deri ve, howeve r, is due to confusion between ownership and par-May, 1980 enthood. Under ordinary conditions parents satisfy the conditions of prox-imity and expertise needed to care for their child. In illness, however, it is the physician who most satisfies these con-ditions and it is he who should have the major role in medical decision-making for the child. "Any restrictions on the physician's control will come not from an overriding right of the parents, but either from the fact that nonme dical considerations are in-volved or from a desire for checks and balances." Lo B, Jonsen AR: Ethical decisions in the care of a patient terminally ill with metastatic cancer. Ann lnt Med 1980; 92:107-11l. Refusal of treatment, euthanasia, and therapeutic side-effects posed dif-ficult ethical pro blems in the manage-ment of a patient with metastatic can-cer. Appropriate decision-making re-quires a thorough appreciation of the medical aspects, a consideration of treatment alternatives, and a consider-ation of the ethical dimension of each therapeutic option. This process may be complicated by psychological fac-tors such as stress, misunderstanding, and premature termination of the deli berative mechanism. Curran WJ, Casscells W: The ethics of medical participation in capital punishment by intravenous drug injection . N Engl J Med 1980; 302:226·230. Death by injection of a lethal drug has been adopted by four states as a new means of capital punishment. This 191 raises serious ethical questions about the participation by physicians in such judicial executions. Throughout his-tory, however, explicit and traditional codes of medical ethics have opposed such a perversion of the healer's role. The proposed new method of capital punishment "presents the most serious an d intimate challenge in modern American history to active medical participation in state-ordered killing of human beings" and should be formally condemned by the medical profession in the United States. Byrne P A, O'Reilly S, Quay PM: Brain death - an opposing viewpoint. JAMA 1979; 242:1985-1990. Legislation defining death on the basis of brain-related cri teria equates the irreversible cessation of total brain function with the death of the human person. This is due in part to the am-bivalences of "death." Irreversible or not, cessation of total brain function is not synonymous with total destruc-tion of the brain or with the death of the individual. It is therefore morally unacceptable to most Orthodox Jews and Christians to harvest vital organs or otherwise treat patients as though they were already dead on the basis of these criteria. (For an editorial re-sponse see Veatch RM: Defining death : the role of brain function. JAMA 1979; 242:2001-2002.) Reiman AS: Michigan's sensible "living wilL" N Engi J Med 1979; 300: 1270-127l. Therapeutic decisions in hopeless cases have been traditionally difficult, and the intrusion of conflicting legal opinions has produced massive con-fusion. A bill filed in the Michigan leg-islature would obviat.e many of the problems by deferring to the decision of a proxy nominated in advance by the patient. Holden C: Ethics in social science re-search. Science 1979; 206:537-540. Social science researchers are begin-ning to chafe under the regulations 192 concerning privacy , consent, decep-tion, and harm that have long been applied to biomedical investigators. There are two schools of thought con-cerning ethical aspects of social science as well as of biomedical research. Con-sequentialism (or utilitarianism) main-tains that the ethical propriety of an act can be judged by its consequences; the nonconsequentialist (or deontolog-ical) position, on the other hand, insists on absolute moral values. Deception has traditionally played an important role in social science re-search and the deontological approach would question its morality. Silber TJ: Placebo therapy: the ethical dimension. JAMA 1979; 242: 245-246. Since placebo therapy involves de-ception, its morality may be viewed from two traditional aspects. The con-sequentialistic approach would permit it if the results were acceptable; the deontologic approach would condemn it since it involves the immoral act of deception. A decision regarding the ethics of placebo therapy may also be reached by "building down" or by "building up." The former involves the general condemnation of placebo ther-apy on deontological grounds and then proceeds to define strict limitations in situations where there is no alterna-tive. The latter begins by acknowledg-ing that the use of placebos is a decep-tion, but builds up from that by indi-cating that there is a fine line between deceit and deception and that, in a given situation, effectiveness may pro-vide justification. The matter, how-ever, remains controversial. "When placebo therapy is given, it needs to be part of a careful clinical plan moving actively in the direction of health. Thus, placebo therapy is accepted as moral when it enhances physician-patient communication, and is accom-panied by active efforts to achieve health. Conversely, placebo therapy is viewed as immoral if it diminishes or replaces patient-physician communica-tion and there is no genuine pursuit of health. " Linacre Quarterly 

The Linacre QuarterlyVolume 49 | Number 1 Article 152-1-1982Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1982) "Current Literature," The Linacre Quarterly: Vol. 49: No. 1, Article 15.Available at: http://epublications.marquette.edu/lnq/vol49/iss1/15/" philosophically, which Father McKeever seems unable to do. The inevitably sterile consequentialism implied or stated in contemporary attempts at proportional ism escapes him. In his conclusion he assumes that defending proportional ism (which he does not purport to do, in this essay at least) is not directly contrary to the explicit teaching of the Church because, as he says, there is no explicit teaching on it. While he admits that magisterial language implies a position contrary to propor-tionalism , he says that magisterial statements are not on the level of infallibility . He does not mention the excellent arguments raised by Ford, Grisez, and others on behalf of the infallibility of the ordinary magisterium in moral matters, and notably conception. Moreover, he seems unaware of the fundamental ambiguity involved in the proportionalists' use of the term antic or premoral evil. The bishops were not well served by this essay. The concluding chapter strengthens the book. Among many cogent points and several distinctive contributions, Rev. Benedict Ashley, a.p., shows that Church teaching on the inseparability of the unitive and procreative meaning of inter-course involves a corollary: the inseparability of the value of sexual pleasure con-sidered as a positive human good. He finds that the inseparability of pleasure from marital love is so lidly founded in Scripture and tradition, and he thinks it is potentially definable by the magisterium. His grasp of contemporary objections to Church teaching is outstanding and his general perspective for their refutation is good. Father Ashley cites three major priorities in the Church's teaching on sexuality and seven major points of consensus among most Catholic theologians. The themes of analysis, dialog, and pastoral care, common to all contributors in this book, are particularly well expressed in this essay. - Robert E. Joyce, Ph.D. St. John's University, Collegeville, Minn. Current Literature Material appearing below is thought to be of par-ticular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content . The medical literature constitutes the primary, but not the sale source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D., 2000 Washington St., Newton Lower Falls, MA 02162) Gustafson JM: Nature, sin, and cov-enant: three bases for sexual ethics. Perspect Bioi & Med 24:483-497 Spring 1981. In Western society rapid revisions are occurring in prescriptive sexual ethics. Such revisions, however, must take into account three fundamental bases in human nature and experience. These are our nature as humans, the concept of sin, and the social or coven-antal aspect of human experience. February, 1982 Karasu TB: The ethics of psychother-apy. Am J Psychiat 137:1502-1512 Dec 1980. In today's social milieu, psychiatry faces intensified questioning and review from within and without the pro fession with respect to ethical tenets. Problem areas include dual allegiance of the psychiatrist, homo-sexuality, confidentiality, and thera-pist-patient sex. "Ethical dilemmas in psychotherapy are not entirely 95 solu ble; ultimately, the therapist, guided by his or her profession as a group, will be able to find answers to the complex problems that inevitably arise. " Riga PJ: Philip Becker: another mile· stone. America 143:8·9 12 July 1980. . In a decision based on the quality-of-life argument, the courts have decided that an institutionalized Mon- · goloid child with a congenital heart defect need not undergo recom-mended corrective cardiac surgery. Daues VF: More on Philip Becker. America 143:211 11 Oct 1980. A response to the Riga article (uide supra). Brett AS: Hidden ethical issues in clin· ical decision analysis. New En~! J Med 305: 1150·1152 5 Nov 1981. Although clinical decision analysis is a useful and valid technique, its seeming objectivity may disguise important ethical issues that can be resolved only if it is kept in mind "that the ultimate concrete reality of a medical event derives from its interac-tion with individuals rather than statis-tically manipulated populations, and that medical decisions involve human beings - both doctors and patients -with unique attitudes and values." Howe EG: Medical ethics - Are they different for the military physician? Milit Med 146:837·841 Dec 1981. The practice of medicine in a mil-itary setting might appear to pose ethical problems that differ from those encountered in civilian life. For example, the military physician may encounter a conflict between his duty to an individual patient and his obliga-tion to the military. However, civilian medical practice is replete with similar conflicts. In other contexts, there may be apparent conflicts between the mil itary and society and between the military and medicine itself. However, there do not seem to be sufficient dif-96 ferences between medicine and mili-tary medicine to warrant the develop-ment of a separate body of ethical considerations. Nevertheless, greater atten tion should be given to bioethical problems in the context of military medicine. Seven sky RL: Religion and illness: an outline of their relationship. South Med J 74:745·750 June 1981. For the sick or dying patient, reli-gion may serve three functions. First, it may offer a means of understanding illness and mortality without denying their reality. Second, it may afford a practical means of coping with these problems. And, third, it may confer hope in the face of death. Fletcher JC: The fetus as patient: ethical issues. JAMA 246:772·773 14 Aug 1981. The growing ability to treat congen-ital defects in the fetus raises at least four complex ethical issues. First, there may be a conflict between the interests of the fetus and those of the parents. Second, there may be a con-flict between undertaking fetal ther-apy and considering parental choice about abortion. Third, fetal research as such may pose ethical problems. And , finally, there may be difficulties with the social and economic priority assigned to fetal research. Halleck SL: The ethics of antiandro· gen therapy. Am J Psy chiat 138:642·643 May 1981. Antiandrogen treatment is cur-rently available for sex deviates whose behavior may have societal implica-. tions. Such biological treatment poses both advantages and risks to society, as well as to the individual. Long-term studies are necessary to determine whether the benefits outweigh the risks. Furthermore, the issue of informed consent to such therapy is extremely complicated. There is there-fore a pressing need to develop ethical guidelines for this use of an tiandrogen drugs. Linacre Quarterly 

The Linacre QuarterlyVolume 49 | Number 4 Article 1811-1-1982Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1982) "Current Literature," The Linacre Quarterly: Vol. 49: No. 4, Article 18.Available at: http://epublications.marquette.edu/lnq/vol49/iss4/18( Current Literature Material appearing below · is thought to be of par-ticular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary, but not the sole source of such material. In general, abstracts are intended to reflect the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D., 2000 Washington St. , Newton Lower Falls, MA 02162) Weiss BD: Confidentiality expecta-tions of patients, physicians, and medical students. JAMA 247:2695-269721 May 1982. Patients' expectations regarding the handling of confidential medical information are stricter than those of physicians or of medical students. Even neophyte medical students with· out any clinical experience tended to assume the attitude of physicians in this regard. Knowledge of patients' expectations should improve the atti· tude and practice of physicians in the area of privileged information. Szasz TS: The psychiatric will: a new mechanism for protecting persons against "psychosis" and psychiatry. Am Psychologist 37:762-770 July 1982. A psychiatric patient who refuses treatment generates a conflict between his individual freedom and his need for treatment. This problem may be resolved by the psychiatric will , an instrument analogous to the living will. By writing a psychiatric will a person could indicate, while sane and rational , to what extent (if any) he would desire psychiatric intervention should he become mentally disabled . Thomas S: Ethics of a predictive test for Huntington's chorea. Brit Med J 284:1383-13858 May 1982. The lack at present of an ideal pre· dictive test for Huntington's chorea has produced an ethical dilemma for November, 1982 the medical profession. One group has tended to advise against procreation by potential transmitters of the disease until such time as a reliable predictive test becomes available. A second group would withhold any future test from applicants until improved therapy or cure is developed for the full-blown disease. The problem requires con-tinuing informed discussion. Lasagna L: Murder most foul. The Sciences (NY Acad Sci) 22 : 7-8 Aug-Sept 1982. In a well-publicized case , a newborn with Down's syndrome died in an English hospital and the consultant pediatrician was charged with, and later acquitted of, murder. Nourish-ment and antibiotics had been with· held, and depressant drugs adminis-tered. The verdict was not in keeping with British legal tradition and "its implications for the ethical fabric of British medicine and law are chilling." Margolin G: Ethical and legal consider-ations in marital and family ther-apy. Am Psychologist 37 :788-801 July 1982. The ethical standards of the Amer-ican Psychological Association dealing with marital and family therapy are insufficient as guidelines. Issues that relate to the responsibility of the therapist, confidentiality, and informed consent, ambiguous to begin with, become ex tremely complex when multiple family members are 377 involved. In addition to ethical aspects, clinical and legal considera-tions - sometimes in direct conflict with the former - must be addressed. Dunea G: Death by judiciary order. Brit Med J 284:1462-146315 May 1982_ Th e increasing and troublesome intrusion of lawyers and law into the practice of medicine is well exempli-fied by the proliferating legal require-ments that surround care of terminally ill or mechanically sustained patients. Care of defective newborns poses similar difficulties. Bulmer M: Are pseudo-patient studies justified? J Med Ethics 8:65-71 June 1982_ Useful information may sometimes be obtained by studies in which an investigator masquerades as a patient. Such an approach , however, involves issues of deception, privacy, freedom, human dignity, and risk to the investi-gator . On the other hand, this approach may be vital in monitoring patient care or in obtaining informa-tion available in no other way. The ethical problems involved in this type of research "are likely to defy defin-itive solution and remain dilemmas requiring the exercise of moral choice." 378 Favazza AR: Modern Christian healing of mental illness_ Am J Psychiat 139: 728-735 June 1982. Christianity has a long but fluctuat-ing tradition of healing mental illness by religious practices. Currently there is a resurgence of interest in such heal-ing not only by Fundamentalists but also by middle-class conservative Chris-tians. Psychotherapists should under-stand and respect such beliefs in their patients if they hope to provide effec-tive treatment. Brody H: The lie that heals: the ethics of giving placebos_ Ann lnt Med 97:112-118 July 1982. The ethics of administering pla-cebos has been questioned by some because of the assumption that decep-tion was necessarily involved. How-ever, successful placebo therapy does not require lying. Recent research on placebos suggests a re-evaluation of the strictures sometimes applied to this mode of treatment. The placebo effect, in fact , is an integral part of the doctor-patient relationship and "clin-icians turn to alternative, non-deceptive ways to elicit positive placebo responses in all patient encounters at the same time that they apply the most appropriate medical tech-nology." Linacre Quarterly 

The Linacre QuarterlyVolume 48 | Number 4 Article 1611-1-1981Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1981) "Current Literature," The Linacre Quarterly: Vol. 48: No. 4, Article 16.Available at: http://epublications.marquette.edu/lnq/vol48/iss4/16Current Literature Material appearing below ·is thought to be of par-ticular interest to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary , but not the sole source of such material. In general, abstracts are intended to reflect the substance of the origin, -l article_ Contributions and comments from reade.-s are invited_ (E. G_ Laforet, M.D_, 2000 Washington St., Newton Lower Falls, MA 021 62) McCormick RA: The Fox case_ JAMA 244:2165-2166 14 Nov 1980_ The court decision in the case of Brother Fox reaffirmed the primacy of the courts in deciding whether or not cessation of mechanical support for a comatose patient is appropriate_ This decision, however, is too far-reaching and, in fact, may threaten the rights of the individual it is designed to protect. Since this decision is, by its nature, extremely complex, the courts are not uniquely qualified to render such a judgment. Furthermore, the societal interests invoked by the court are no more susceptible to protection by the court than by family and physician_ Finally, despite its protestations, the legal process is, by its nature, far from expeditious_ Paris JJ: Brother Fox, the courts and death with dignity. America 143:282-285 8 Nov 1980_ The court ruling in the case of Brother Fox is predicated on its con-cern for the sanctity of life in in-stances where, in fact, the patient is dead. In arrogating to itself the right to render decisions about the continu-ation of life-support measures in coma-tose patients, the court has stated that such decisions "must reside with the judicial process and the judicial proc-ess alone_" In so declaring, the court stipulates that the right to decline extraordinary treatment rests not with the patient but rather requires "a mini-mum of four to six physicians, five attorneys and one judge_" This is costly, unnecessary, and painful, and "represents a rejection of the tradi-380 tional Catholic teachJlg that the incompetent, chronically vegetative, senile or comatose need not be sub-jected to useless treatment." Ingelfinger FJ: Arrogance. New Eng/ J Med 303:1507·1511 25 Dec 1980_ In the context of medical practice, "arrogance" may be considered to include three issues_ First, the hubris of the bioscientist; but this is much the same as with any group, and pos-sibly somewhat less_ Second, authori-tarianism and paternalism; these cer-tainly exist, but to some degree are necessary to good medical care_ Third, lack of empathy; this is all too com-mon and is fostered by technologic medicine_ "Efficient medical practice, I fear, may not be empathic medical practice, and it fosters, if not arro-gance, at least the appearance of arrogance_ " Furlong FW: Determinism and free will: review of the literature. Am J Psychiat 138:435-439 April 1981. In the 19th century the traditional view of man as a responsible agent capable of making choices persisted, and in psychiatry the main problem was to explain the apparent lack of responsi bili ty seen · in the "insane_" However, Freud and others challenged the traditional view and determinism has become a basic tenet of modern psychiatry_ But the existential view that freedom and choice are exper-ienced as genuine phenomena has not been adequately dealt with by current theories of mental functioning. Linacre Quarterly 

The Linacre QuarterlyVolume 49 | Number 3 Article 198-1-1982Current LiteratureCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCatholic Physicians' Guild (1982) "Current Literature," The Linacre Quarterly: Vol. 49: No. 3, Article 19.Available at: http://epublications.marquette.edu/lnq/vol49/iss3/19Current Literature Material appearing below ' is thought to be of par-ticular interes t to Linacre Quarterly readers because of its moral, religious, or philosophic content. The medical literature constitutes the primary, but not the sale source of such material. In general, abstracts are intended to reflec t the substance of the original article. Contributions and comments from readers are invited. (E. G. Laforet, M.D. , 2000 Washington St., Newton Lower Falls, MA 02162) Kincaid Smith P: Ethics and in-vitro fertilisation_ (editorial) Brit Med J 284: 1287 1 May 1982_ In-vitro fertiliza tion is an estab-lished technique. Ethical issues are polari ze d in two directions - the Roman Catholic view, which holds it to be immoral, and the alternative view that ethics is independent of reli-gious dogma and a matter for reasoned debate_ Reasoned debate, in fact, can dispose of all objections to the prac-tice of in-vitro fertilization as long as the long-term aspects are avoided. If the latter are considered, there remain unanswered socio-economic (alloca-tion of scarce medical resources) and legal problems_ Sider RC, Clements C: Psychiatry's contribution to medical ethics edu-cation_ Am J Psychiat 139 :498-501 April 1982_ Growing interest in bioethics and in the examination of psychiatry 's role in medicine are important trends for psychiatry . In general, however, psychiatry has failed to appreciate and to act upon its potential in the area of bioethics. The issue of informed con-sent is an example of an area in which ps yc hiatric insights are extremely important. Daniels N: Equity of access to health care : some conceptual and ethical issues. Health & Socie ty 60 :51-81 1982_ Any discussion of equity of access to health care is complicated by lack of agreement on basic conceptual issu es, but these must be addressed 288 be fore proceeding to the ethical aspects involved. As for the latter, there are important issues of distribu-tive justice which transcend such argu-ments as the cost-effec tiveness of pre-ventive measures as opposed to acu te therapeu tic services_ A further aspect is that considerations of justice may challenge the traditional view that the physician may act as "the unrestrained agent" of his patient. "The remaining task. _ . is to show the level at which constraints should be imposed so as to disturb as little as possible what is val-uable in the traditional view of physi-cian responsibility." Miles SH, Cranford R, Schultz AL: The do-not-resuscitate order in a teach-ing hospital: considerations and a suggested policy_ Ann Int Med 96:660-664 May 1982_ The availability of modem resusci-tative technology has resulted in the need to establish broad policy prin-ciples. Those developed by the authors are presented_ Such codification has resulted in improved consideration for and communication with both patient and family. van Eys J: Should doctors play God? Perspect Bioi & Med 25 :481-485 Spring 1982_ This query is usually posed in such a context that a negative answer is anticipated. However, the concept of "play" is extremely complex. Play is not the same as playacting. "Through playing God the doctor tries to under-stand God_ Through playing God doc-tors will learn the limits of their power. Only through playing God will they learn to accept God." Linacre Quarterly 

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