Courtney S. Campbell

Hospice and Physician-Assisted Death: Collaboration, Compliance, and Complicity

Although the overwhelming majority of terminally ill patients in Oregon who seek a physicians aid in dying are enrolled in hospice programs, hospices do not take a major role in this practice. An examination of fifty-five Oregon hospices reveals that both legal and moral questions prevent hospices from collaborating fully with physician-assisted death.

Marks of the Body: Embodiment and Diminishment

The images and ideologies of embodiment embedded in contemporary biomedical ethics stress the ways that the body is experienced as “other” and alien to ourselves. The enterprise of modern medicine, for example, presupposes in part the Cartesian understanding of the body as machine, infinitely malleable and manipulable to mechanical interventions, experimental testing, and technological repair ([13], p. 30). The technical skills of the physician as mechanic are critical to “salvaging” body “parts” or the body as a whole, even at the expense of minimal dialogue with the voice of the person.

Dignity, Death, and Dilemmas: A Study of Washington Hospices and Physician-Assisted Death

The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patients death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.

Theology, religious traditions, and bioethics.

The social and medical ethos within which bioethics emerged in the late 1960s and early 1970s was constituted in part by religious questions and religious thinkers. However, this identifiably religious influence on bioethics subsequently seemed to decline. How has this diminished impact come about, and what significance, if any, does it hold for the ways we now do bioethics? What difference, finally, do religious perspectives make for bioethics? These were the overarching questions that led the Hastings Center to initiate a research project on the relation of Religion and Bioethics, culminating in this special supplement to the Hastings Center Report.

The bodily incorporation of mechanical devices: Ethical and religious issues (part 1)

A substantial portion of the developed world’s population is increasingly dependent on machines to make their way in the everyday world. For certain privileged groups, computers, cell phones, PDAs, Blackberries, and IPODs, all permitting the faster processing of information, are commonplace. In these populations, even exercise can be automated as persons try to achieve good physical fitness by riding stationary bikes, running on treadmills, and working out on cross-trainers that send information about performance and heart rate. Still, these examples of everyday human interaction with a mechanized world presuppose an ability to differentiate between ourselves in our organic and bounded embodiedness and the “other” we encounter as an external mechanical artifact of technology. This boundary, which, in actuality, has been permeable for several centuries, may be dissolving further as new mechanical devices are introduced in biomedicine and incorporated in the body. The terrain of contemporary medicine is, in fact, permeated with innovative technologies to restore, repair, rehabilitate, and, in rare cases, enhance our physical and psychological capacities. Consider recent examples about the devices used to assist a soldier who has lost a limb in the war in Iraq and a quadriplegic who was enabled to have neural control over external devices. Sgt. David Sterling lost his right hand and forearm from an IED in Iraq, and now wears a myoelectric forearm (which cost

Sounds of Silence: The Latter-Day Saints and Medical Ethics

85,000). This forearm not only allows him to have use of an artificial hand, but also to snap on “kitchen devices, work tools, [and a] separate hand that help him write, play golf, shoot pool, even cast a fishing rod.” 1 Although not organically part of his body, the myoelectric device has now been incorporated to become one of his two arms. Even more recent research has focused on overcoming loss of motor control by patients through an electronic brain implant or neuroprosthesis. In July 2006, a report in Nature described the success of researchers at Brown University in implanting an electrode array into the brain of quadriplegic patient Matthew Nagle. Nagle, who had been deprived of control over his nervous system for three years following a violent assault, was able to control a computer cursor, open e-mail, control a television, and move objects with a robotic arm.2

Embodiment and Ethics: A Latter-Day Saint Perspective

Although The Church of Jesus Christ of Latter-day Saints (LDS) has a long tradition of reflection on questions of practical ethics, it was not until the mid-1970s that formalized ecclesiastical policy was proposed and adopted on ethical issues arising out of the intersection of religious convictions, medical practice, and applied biomedical technology. First promulgated in 1974 as “Attitudes of the Church of Jesus Christ of Latter-day Saints Toward Certain Medical Problems” [5] and subsequently incorporated in 1976 into the Church’s authoritative General Handbook of Instructions (hereafter Instructions), these initial documents addressed such “problems” as abortion, artificial insemination, contraception, cremation, experimentation, hypnosis, organ transplants, prolongation of life and the right to die, sterility tests, and sterilization. The conclusions presented in these short statements of general policy often did not identify or elaborate underlying theological rationales or ethical principles, or indicate, with some exceptions, as in the case of abortion, how binding these positions were on the practical conduct of Latter-day Saints.

Spirituality in Health-Care Reform

This essay will examine the perspectives of the Latter-day Saint (LDS) tradition on issues in biomedical ethics through the organizing theme of embodiment. This is a necessary feature for understanding the relationship of religious convictions and ethical values in this faith community because the tradition offers a distinctive interpretation of the existential and ethical significance of the human body. The tradition has rejected the philosophical and religious gnosticism of the body as a prison or tomb of the soul, the Cartesian dualism of mind and body, and the organic reductionism of modern science. The LDS theology of the body instead invokes themes of the body as temple or tabernacle, as teacher, and as gift. These theological perspectives are expressed in various ethical positions and moral practices relevant to health and medicine.

Ecclesiology and Ethics: An LDS Response

Much of the discussion about health-care reform has focused on questions of political and economic policies. By contrast, this article contends that this dispute involves deeper questions of meaning regarding the kinds of values, including spiritual values, that we wish to be present in health care. Communities of religious believers have a civic duty of responsibility and a theological duty of stewardship for health-care institutions. Such communities bring to the health-care debate spiritual meaning embedded in themes of humility, justice, and mercy. These virtues provide a moral test of the soundness of reform proposals.

Physicians of No Value

An awakening of moral consciousness regarding the ethical implications of medicine and science has characterized the Latter-day Saint (LDS) church during the preceding biennium. The ecclesiastical leadership was conferred in June 1994 upon Howard W. Hunter, through a process of apostolic succession, following the death of the late President Ezra Taft Benson. In his short ministry thus far, Hunter has emphasized an ethic of compassion and love and the renewal of worship through rituals in LDS temples. While this change in leadership does not hold out the prospects of direct influence on LDS medical ethics, there has emerged in various settings a new ecclesiastical focus on collective, rather than personal, political witness on matters of life and death. Moreover, the ecclesiastical context is central to two recent studies that offer the most comprehensive scholarship to date on medical ethics in the LDS community. This essay will begin with a brief overview of the relation between ecclesiology and ethics in the Latter-day Saint church to better situate the significance of these recent developments.