Andrea Vicini

Cultivating the Inner Life of a Physician Through Written Reflection

All of us have an “inner life” that forms the core of who we are. It shapes and is shaped by our actions and experiences. During physician training, attention to residents’ inner life requires a focus on their beliefs and emotions as well as their ethical and spiritual development, topics often considered to be outside the realm of clinical training and practice. We suggest that written reflections, as part of medical residency curriculum, can allow residents to explore their inner lives. The depth and range of residents’ explorations show the value of adding brief, protected time for residents to explore their hopes, joys, struggles, and feelings, and to develop meaning from their experiences with patients.

Book Review: Christian Moral Theology in the Emerging Technoculture: From Posthuman Back to Human. By Brent WatersChristian Moral Theology in the Emerging Technoculture: From Posthuman Back to Human. By WatersBrent. Ashgate Science and Religion Series. Burlington, VT: Ashgate, 2014. Pp. 260.

participation of all for the sake of the common good, (2) enjoys the support of the broader population and (3) controls and limits violence in the face of a regime which uses violence with impunity to maintain power” (76). These tests would indeed be helpful in other contexts; in her final chapter on the Arab Spring, S. argues that it was precisely a lack of an appropriate legitimate authority that led to abortive revolutions in Egypt and elsewhere. S. also proposes a refinement to the criterion of “right intention”: not only is it necessary for a revolutionary to intend a just peace as her goal, but the intracommunal nature of a revolution requires that its proponents go even further, and intend reconciliation the final goal. S.’s chapter on restorative justice after revolution shows how this intention to reconcile with the enemy can be fulfilled post bellum. In addressing proportionality, S.’s focus on nonviolent means comes to the fore again. Reiterating that nonviolent means should be primary, she then argues that “(1) armed resistance should be graduated, beginning with those means that intend to incur no loss of life, (2) opportunity for negotiation should be offered regularly, and (3) armed resistance should escalate to forms that include loss of life only as is necessary to promote negotiation, and to decrease overall violence” (90). As an illustration of the “graduated” use of force, she notes that the South African resistance began by using sabotage before escalating to more lethal tactics. (S. contrasts this with the recent cases of Libya and Syria, where revolutionaries resorted to lethal tactics too quickly.) Perhaps controversially, S. also argues that limited use of armed resistance by a legitimate authority may reduce the overall violence of a revolution, because this provides a sign of hope, and assures the majority of the oppressed that they need not take up arms but can instead focus on nonviolent strategies. S.’s discussion of the “reasonable hope of success” criterion is an interesting one for a theological audience. Drawing on Charles Villa-Vicencio’s work, the Kairos Document and other South African sources, S. shows how both unity and justice on earth should be objects of Christian hope. But she also argues that it is the oppressed who are best positioned to say what is “reasonable” hope and assess the sacrifices that it may require. Overall, S.’s interweaving of traditional sources with contemporary examples makes for engaging reading that would not be out of reach for advanced undergraduates. A “just revolution” involves complex moral questions and S. is to be commended for approaching them with both nuance and clarity.

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McLaughlin makes an important contribution to the field of eco-theological ethics by engaging the main voices in eco-theological discourse and by offering a constructive and creative approach. With his volume, he achieves three goals. In the first part of the book, he delineates a novel taxonomy of four paradigms of nonhuman theological ethics. In particular, he explores the tensions between “anthropocentrism” and “cosmocentrism” as well as those between the teleological terms of “conservation” and “transfiguration.” These four terms define specific and paradigmatic theological approaches in eco-theological ethics. Here, McL.’s approach is “critically analytic.” While for anthropocentrism only the human world has value, in cosmocentrism the nonhuman world possesses intrinsic value. Moreover, conservation is advocated by those aiming at preserving the current natural order, while transfiguration is stressed by those who propose to depart from the current state of affairs and aim at promoting an eschatological vision. Second, by engaging these four paradigms, McL. articulates a new paradigm called “cosmocentric transfiguration,” which he frames in conversation with Jürgen Moltmann and Andrew Linzey who are accurately discussed in the second part of the volume. Cosmocentric transfiguration means that the entire cosmos shares in the eschatological hope of a harmonious participation in God’s triune life that entails the end of suffering, predation, and death. Finally, in his third part, McL. shows how cosmocentric transfiguration shapes an ethic based upon a tension between preservation (i.e., the sustaining of nature, which requires suffering, predation, and death) and protest (i.e., the personal witness against suffering, predation, and death through nonviolent living). Readers, scholars, and students interested in enriching their theological expertise in addressing ecological themes and concerns will enjoy McL.’s critical analysis and creative theological proposal.

Book Review: Preservation and Protest: Theological Foundations for an Eco-Eschatological Ethics. By Ryan Patrick McLaughlinPreservation and Protest: Theological Foundations for an Eco-Eschatological Ethics. By McLaughlinRyan Patrick. Emerging Scholars. Minneapolis: Fortress, 2014. Pp. xiii + 460.

Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients’ illness experiences. This project examines physicians’ written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients’ lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.

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(26) may raise questions for some. Yet, here B. rightly seeks to challenge the common view that economic life is value free or value neutral in moral terms. Others may pose questions about the metaphysical positions of Deleuze that appear to conceive of “being as desire” (42). B. acknowledges that many in the modern West would struggle with Deleuze’s perspective that “reality is constituted by desire” rather than “being” (42). B. does, however, offer a critique of “failed” understandings of Christianity by Deleuze and Foucault. Other readers might also raise questions about Deleuze’s well-knownMarxist materialist metaphysical views (44). In places, the more technical philosophical treatment of the work of Deleuze and Foucault makes for dense reading. Yet, careful readers will discover that their efforts are well repaid. This well-written and carefully argued work should be welcomed by all who are interested in the complex moral questions about economic life in our time. B.’s engaging theological and moral analysis also presents a wise and inspiring spiritual vision. The divine economy and B.’s focus on “what God is doing here and now to heal desire” (210) along with fostering Christian works of mercy, simplicity, solidarity, and the reordering of life “in accord with the common good and the universal destination of material goods” (211) point to a way forward in these challenging times.

Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents’ Reflections About Communication

Ted Nordhaus and Michael Shellenberger begin their book Break Through by referring to the historic speech by Martin Luther King “I have a dream.”1 They highlight its strength, its focus on what is positive and desirable, its ability to point us toward the future with a contagious hope and with a strong longing for freedom and justice. I profoundly love that speech. I read it often. I dream it too. It always moves me to tears. I used it in teaching and in homilies. I turn to it to nourish my hope in a better future. Such a future can come. We can play a significant role in making it happen, sooner than later, here and now.

Book Review: Hippocratic, Religious, and Secular Medical Ethics: The Points of ConflictHippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. By VeatchRobert M.. Washington: Georgetown University, 2012. Pp. xiii + 242.

People living in the small Republic of Kiribati—the I-Kiribati—strikingly experience one of the many consequences of the current environmental crisis: gradually and progressively, the Pacific islands in which they live will be submerged by the water level increase caused by global warming. They will be forced to relocate elsewhere. They will join the many others who will be displaced people because of environmental global changes.1

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In the past few years, a variety of alarming narratives, global concerns addressed locally, and new biotechnological developments have shaped contemporary bioethical discourse. This note identifies (1) five of these narratives that come from other disciplines: history, journalism, surgery, literature, and personal experience; (2) original voices, particularly from Asia and Africa, that shape the innovations emerging in todays global theological bioethics; and (3) three biotechnological developments—neurosciences, oncofertility, and synthetic biology—that call for our attention. Throughout each section, one can see that an interdisciplinary approach could sustain conversations and generate transformative practices.