Michael P. Moreland

The Charlie Gard case: British and American approaches to court resolution of disputes over medical decisions

The Charlie Gard case: British and American approaches to court resolution of disputes over medical decisions

Circulatory arrest in a brain-dead organ donor: is the use of cardiac compression permissible?

Care of the brain-dead patient is common in intensive care practice. Aggressive donor management is advocated to increase supply of viable organs. Significant controversy exists over cardiac resuscitation in patients determined dead by cardiac criteria. The issue, till now, has not been addressed in brain dead patients. We discuss a case of cardiac resuscitation of a brain-dead donor to ensure organ donation. This case allows us to examine the use of brain death criteria to declare death, the controversy regarding cardiac resuscitation in organ donor patients, and the standards for use of cardiac resuscitation in the organ donor declared dead by brain death criteria. The consent process for organ donation in brain dead patients should address the possibility of subsequent cardiac arrest.

The Catholic Tradition on the Due Use of Medical Remedies: The Charlie Gard Case:

The widely publicized British case of Charlie Gard became an international cause célèbre when the treating physicians petitioned the British courts to prevent the parents from taking their dying child to America where a physician held out promise of an unproven experimental therapy. The case became more sensationalized when the press reported that Pope Francis had intervened in the case against the position of the Vatican’s Academy for Life on the appropriate response to a patient with a lethal genetic disorder for which there was no known treatment. A review of the centuries-long teaching of Catholic moral theology on care of the dying demonstrates that the pastoral concern of Pope Francis for the grieving parents did not signal a change in church teaching on the care of the dying patient or reveal a disagreement between Pope Francis and the Academy for Life’s position on the appropriate care of Charlie Gard.

Dispute between physicians and family on surgical treatment for an infant with ultra short gut syndrome: the perspective of an Ethics Committee

Medical treatments exist on a continuum from experimental procedures to those that are of proven efficacy and well within the standard of care [1]. The ethical aspects for use of non-established medical treatments differ significantly from those that apply in treatments of proven efficacy [2]. Although imposing heroic suffering on oneself in the hope of advancement of science is ethically acceptable, the same does not hold for imposing suffering on others [3]. In particular there are limits to which children may be subjected to unproven medications or procedures [4]. The insistence on increased scrutiny by the physician on behalf of the patient undergoing unproven treatment highlights the continuing significance of the Nuremberg Code for medical practice [5]. The Code provides norms for undertaking a proposed treatment regimen. First and foremost, the physician must obtain the free, voluntary consent of the patient—or in the case of a minor—of the parent before utilizing a proposed treatment. Although consent of the patient or proxy is a necessary prerequisite to begin a procedure, it is not a sufficient basis to continue an intervention. As Francis Moore, the distinguished Surgeon-in-Chief at Boston’s Brigham & Women’s Hospital noted in a now classic essay on desperate cases, “There must be a rationale on which the desperately ill patient may be offered not merely pain, suffering, and costs but also a true hope of prolonged [disease free] survival” [6]. Under that imperative a physician has an on-going duty to exercise independent judgment on the safety and efficiency of the intervention. Does the advancement in treatments for short bowel syndrome now achieve this goal? A recent case highlights the conflicts that arise from differing assessments of what is achievable or desirable from a clinician and parent perspective.

Universalism and Particularism in Bioethics: Lessons from Theological Ethics

Abstract In response to Paul Rabinow’s essay, “Prosperity, Amelioration, Flourishing: From a Logic of Practical Judgment to Reconstruction,” this essay argues that bioethical debate on a range of issues is beset by apparent incommensurability. The origin of bioethics in religious ethics offers a provocative historical and normative basis from which to better understand the character of bioethical argument. The essay then surveys three contemporary figures in religious ethics (Stanley Hauerwas, Richard McCormick, and James Gustafson) who provide a typology of approaches in bioethics ranging from particularism to non-particularism.