David Jones

In this article we explore the underpinnings of what we view as a recent "backlash" in English law, a judicial reaction against considering children's and young people's expressions of their own feelings about treatment as their "true" wishes. We use this case law as a springboard to conceptual discussion, rooted in (a) empirical psychological work on child development and (b) three key philosophical ideas: rationality, autonomy and identity. Using these three concepts, we explore different understandings of our central theme, true wishes. These different conceptual interpretations, we argue, help to elucidate important clinical questions in the area of children's informed consent to treatment. For example, how much should a child's own wishes count in making medical decisions? Does it make a difference if the child or young person is undergoing psychiatric treatment?—if in some sense her wishes are abnormal, not "true" expressions of what she really wants? If the child's wishes do not count, why not? If they do matter but count for less, how much less? We conclude by advocating functional tests of a young person's true wishes, applicable on a case-by-case basis, rather than a black-and-white distinction between "incompetent" children and "competent" adults.

Slippery slope arguments have been important in the euthanasia debate for at least half a century. In 1957 the Cambridge legal scholar Glanville Williams wrote a controversial book, The Sanctity of Life and the Criminal Law, in which he presented the decriminalizing of euthanasia as a modern liberal proposal taking its rightful place alongside proposals to decriminalize contraception, sterilization, abortion, and attempted suicide (all of which the book also advocated).1 Opposition to these reforms was in turn presented as exclusively religious and particularly Roman Catholic. Thus Williams asserted that "euthanasia can be condemned only according to religious opinion" (1957, p. 312).The following year, in ..

It has become common, in both popular and scholarly discourse, to appeal to ‘delayed animation’ as an argument for abortion (DAAA). Augustine and Aquinas seemingly held that the rational soul was infused midway in pregnancy, and therefore did not regard early abortion as homicide. The authority of these thinkers is thus cited by some contemporary Christians as a reason to tolerate or, for proportionate reasons, to promote first-trimester abortion and embryo experimentation. The present essay is an exercise in aetiology. It examines the origins of DAAA. Distinctions are drawn between different forms of DAAA in historical context, premises, and conclusions. Some forms raise important anthropological questions, though these arguments are not indefeasible. The most popular forms of DAAA, which are typically framed as appeals to precedent, are the weakest, in that there is little precedent for DAAA before 1950. The argument is in fact a novelty in the tradition

The term ‘dignity’ is used in a variety of ways but always to attribute or recognize some status in the person. The present paper concerns not the status itself but the virtue of acknowledging that status. This virtue, which Thomas Aquinas calls ‘observantia’, concerns how dignity is honoured, respected, or observed. By analogy with justice observantia can be thought of both as a general virtue and as a special virtue. As a general virtue observantia refers to that respect for human dignity that is implicit in all acts of justice. As a special virtue it concerns the specific way we show esteem for people. Healthcare represents a challenge to observantia because those in need of healthcare are doubly restricted in expressing their dignity in action: in the first place by their ill health, and in the second place by the conditions required by healthcare. To be understood properly, especially in the context of healthcare, the..

A recent online article in the Journal of Medical Ethics, which received wide media coverage, raised the possibility that children are being ‘subjected to torture’ due to the ‘fervent or fundamentalist views’ of their parents. However, the quality of argument in that article was inadequate to sustain such a radical thesis. There was no engagement with the perspectives of different religious traditions about end-of-life care. Instead the authors invoked practices such as male infant circumcision which are wholly irrelevant to the end-of-life theme. There were serious failings in relation to core principles of social and epidemiological research practice: the study based its conclusion on a sample of only six cases and failed to consider even the more obvious confounding features. Rather than demonizing the religious beliefs of parents there should be recognition of the need for mutual respect, dialogue based on an ‘expert–expert relationship’ and collaboration based on ‘shared understanding’

There is an apparent gap between public policy on embryo research in the United Kingdom and its ostensible justification. The rationale is respect for the “special status” of the embryo, but the policy actively promotes research in which embryos are destroyed. Richard Harries argues that this is consistent because, the “special status” of the human embryo is less than the absolute status of persons. However, this intermediate moral status does no evident work in decisions relating to the human embryo. Rather, public policy seems to be based on a different account of “special status”: that developed by Mary Warnock. According to this, the embryo has no inherent status and the language of “special status” serves rather to accommodate the feelings of those who object to embryo research. This “emotivist” account is highly problematic, not so much for its attitude to the embryo as for its subversion of public moral reasoning

This article examines the account of the relationship between sin and suffering provided by J. L. A. Garcia in “Sin and Suffering in a Catholic Understanding of Medical Ethics,” in this issue. Garcia draws on the (Roman) Catholic tradition and particularly on the thought of Thomas Aquinas, who remains an important resource for Catholic theology. Nevertheless, his interpretation of Thomas is open to criticism, both in terms of omissions and in terms of positive claims. Garcia includes those elements of Thomas that are purely philosophical, such as natural law and acquired virtue, but neglects the theological and infused virtues, the gifts and fruits of the Holy Spirit, and the beatitudes. These omissions distort his account of the Christian life so that he underplays both the radical problem posed by sin (and suffering), and the radical character of the ultimate solution: redemption in Christ through the grace of the Holy Spirit

The diagnosis of death by neurological criteria (colloquially known as ‘brain death’) is accepted in some form in law and medical practice throughout the world, and has been endorsed in principle by the Catholic Church. However, the rationale for this acceptance has been challenged by the accumulation of evidence of integrated vital activity in bodies diagnosed dead by neurological criteria. This paper sets out 10 different Catholic responses to the current crisis of confidence and assesses them in relation to a Catholic understanding of philosophical anthropology. Having considered each of these responses, none is found to provide good grounds for the moral certainty about death needed for current transplant practice to be ethically acceptable. Unless adequate grounds for the use of neurological criteria can be restored, current transplantation practice will have become what Pope John Paul II called a ‘furtive, but no less serious and real, form of euthanasia’

Rev. Kevin Flannery, SJ, has helpfully drawn attention to some key sources for magisterial teaching on “vital conflicts,” where interventions to save a mother’s life would involve or lead to the death of her unborn child. However, former responsa by the Holy Office on this topic from 1884 to 1902 need to be interpreted carefully and understood in relation to the context of the time. Recent teaching has indeed clarified that the condemnation of direct abortion is de fide. Nevertheless, in the last forty years, the magisterium has, de facto, tolerated debate among faithful Catholic scholars over the ethics of craniotomy. Appeal to former magisterial teaching is not sufficient to settle this contemporary debate over what constitutes direct abortion. National Catholic Bioethics Quarterly 14.1 : 81–104.

There has been little considered reflection by Catholic theologians on the concepts of gender identity, gender dysphoria and gender transition. Seeking inspiration in the Scriptures, some Catholic thinkers have interpreted the first three chapters of Genesis and especially the text ‘male and female he created them’ (Gen. 1:27) as requiring all human beings to live in the gender role congruent with their biological sex, and have viewed the biology of sex as self-evident. This article argues that these chapters constitute an appropriate locus for reflection on theological anthropology but that they need to be taken together with other texts and especially with the explicit teaching of Jesus Christ. In the Gospel according to Matthew, the one occasion in which Jesus invokes this passage from Genesis is when he draws attention to exceptional examples in nature and, in a striking phrase, states that some ‘have made themselves eunuchs for the sake of the kingdom of heaven’ (Matt. 19:12). If the Genesis text is interpreted in the light of the words of Christ, the binary division of the sexes, while ordained by God and the basis for a vocation to marry and procreate, admits of exceptions both natural and supernatural.