Respect for patients’ self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients’ capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of endof-life care, I present a growing body of evidence (...) that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of endof-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients’ satisfaction. (shrink)

Farrell, Marie T Review(s) of: How to read a graveyard: Journeys in the company of the dead, by Peter Stanford (London: Bloomsbury, 2013), pp.263, $32.95.

Farrell, Marie T Review of: Jesus and the dreaming: Discovering an Australian spirituality through Aboriginal-Christian dialogue, by Frank Fletcher, MSC, ed. Fabian Byers, pp. 344, paperback $24.95.

Farrell, Marie T Review(s) of: The first thing to do is live: Essays sacred and secular, by Adrian Lyons SJ (Melbourne: David Lovell Publishing, 2013), pp. 136, pb $27.95.

Ever since its nascent days, psychoanalysis has enjoyed an uneasy coexistence with religion. However, in recent decades, many analysts have been more interested in the healing potential of both psychoanalytic and religious experience and have explored how their respective narrative underpinnings may be remarkably similar. In _Toward Mutual Recognition_, Marie T. Hoffman takes just such an approach. Coming from a Christian perspective, she suggests that the current relational turn in psychoanalysis has been influenced by numerous theorists - analysts and philosophers (...) alike - who were themselves shaped by an embedded Christian narrative. As a result, the redemptive concepts of incarnation, crucifixion, and resurrection - central to the tenets of Christianity - can be traced to relational theories, emerging analogously in the transformative process of mutual recognition in the concepts of identification, surrender, and gratitude, a trilogy which she develops as forming the "path of recognition." Each movement on this path of recognition is given thought-provoking, in-depth attention. Chapters dedicated to theoretical perspectives utilize the thinking of Benjamin, Hegel, and Ricoeur. In her historical perspectives, she explores the personal and professional histories of analysts such as Sullivan, Fairbairn, Winnicott, Erikson, Kohut, and Ferenczi, among others, who were influenced by the Christian narrative. Uniting it all together is the clinical perspective offered in the compelling extended case history of Mandy, a young lady whose treatment embodies and exemplifies each of the steps along the path of growth in both the psychoanalytic and Christian senses. Throughout, a relational sensibility is deployed as a cooperative counterpart to the Christian narrative, working both as a consilient dialogue and a vehicle for further integrative exploration. As a result, the specter of psychoanalysis and religion as mutually exclusive gives way to the hope and redemption offered by their mutual recognition. (shrink)

The Hebrew Scriptures reveal that for the Hebrews the physical body was fundamental. In thinking of human existence they did not isolate mental processes from sense reactions and bodily feelings. The word "heart" was often used instead of a personal pronoun. In Judges 19, "Comfort thy heart with a morsel of bread" means "Give yourself comfort." In Exodus 33:14, "My face will go with thee," means "I will go with thee." The word ruah, or spirit, denoting breath or wind, referred (...) to anyone who by physical energy and mental alertness was full of life. In many cases the word "heart" was used to bring together the feelings, motives, intentions, and other aspects of an individual as a whole. The word "heart" referred to psychic activity, not merely to a physical organ. (shrink)

Historically, treatment for pain relief has varied according to the social status of the sufferer. A similar tendency to make arbitrary distinctions affecting pain relief was found in an ethnographic study of animal research laboratories. The administration of pain-relieving drugs for animals in laboratories differed from standard practice for humans and, perhaps, for companion animals. Although anesthesia was used routinely for surgical procedures, its administration was sometimes haphazard. Analgesics, however, were rarely used. Most researchers had never thought about using analgesics (...) and did not consider the subject worthy of serious attention. Scientists interviewed for this study agreed readily that animals are capable offeeling pain, but such assertions were muted by an overriding view of lab animals as creatures existing solely for the purposes of research. As a result, it was the exceptional scientist who was able to focus on anything about the animal's subjective experience that might lie outside the boundaries of the research protocol. (shrink)

This paper examines contemporary Catholic higher education and its unique role in preparing graduates, who have been grounded in natural moral law, to respond to the bioethical questions of the day. The importance of the commitment by both administration and faculty to articulating and embracing the mission of Catholic higher education as they prepare graduates for a culture of relativism is presented. Curricular objectives, content, and teaching strategies are provided which address the most relevant bioethical dilemmas of the day. The (...) importance of an integrated approach to examining these dilemmas, as well as a grounding in core content in philosophy and theology for all graduates, regardless of discipline of concentration, are presented. The interjection of government mandates into the void of bioethical resolutions is examined in relationship to the rights of conscience. The paper concludes with examples of best practices, showing the role of Catholic higher education as uniquely suited to advance the common good. National Catholic Bioethics Quarterly 11.4 (Winter 2011): 705–734. (shrink)

Polycentric leadership is a growing issue in the global missions movement. The focus of this article is to help readers understand polycentrism broadly and examine what it means for those seeking to lead fruitfully in God’s mission. Examples will be provided to illustrate what polycentric leadership can look like. Biblical and theological convictions that shape leaders who work out of this paradigm will be examined. The reality of tension points experienced by people who desire to lead from this paradigm will (...) be explored, as well as practical strategies and insights for those who have to navigate these tensions in their missional journeys. Through bringing together these different threads, the goal is for this article is to provide both academic insights and practical assistance for anyone who cares deeply about God’s work around the world and desires to lead fruitfully in a polycentric mission context. (shrink)

The protein Po has long been proposed to be responsible for the compact nature of peripheral myelin through interactions of both its extracellular and cytoplasmic domains. Recent studies support such a role for Po's extracellular region while more precise mapping of its adhesive domains are ongoing. As Po is a member of the immunoglobulin gene superfamily and perhaps bears the closest similarity to the ancestral molecule of this whole family, these studies may also have more general implications for adhesive interactions. (...) In addition, although long believed to be purely an inert, structural molecule, Po has been reported to promote neurite outgrowth, which suggests a more dynamic role for this interesting molecule. (shrink)

Evidence suggests that the nurse’s role as an advocate for patients and for the professional right to conscience is being eroded because of a lack of conscience protections in the Patient Affordable Care Act and because of a faulty understanding in general of the separation of church and state. While the main task of the principle of separation of church and state is to secure religious liberty, the principle is increasingly interpreted in a secularist way to mean that religion must (...) be confined to the home and church and that people of conscience may not object to immoral practices in the workplace or public square. If nurses must risk their jobs to advocate for their patients, patient care will suffer. National Catholic Bioethics Quarterly 14.1 : 47–52. (shrink)

St. Augustine of Hippo wrote the ’De Trinitate’ to explain to critics of the Nicene Creed how the Christian doctrine of the divinity and coequality of Father, Son, and Holy Spirit is present in Scripture. He also wanted to convince philosophers that Christ is the Wisdom they sought. Augustine’s third purpose was to correlate the biblical truth that all human persons are created to image God, a Trinity, a communion of love, with the first two Commandments of the Old and (...) New Testaments. Augustine succeeded in showing the need for combining faith and reason for a greater understanding of Scripture as well as for a greater understanding of the true nature and destiny of human persons. Augustine emphasized the scriptural revelation of God as Father, Son, and Holy Spirit, and used reason to convince philosophers that the one and three-Personed God is philosophically and logically defensible. He concluded that the likeness of human persons to Christ and to the Trinity is accomplished not onl. (shrink)