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This article examines some of the ethical challenges of prioritizing intensive care resources during the Covid-19 pandemic by comparing the Italian and United States contexts. After presenting an overview to the clinical, ethical, and public debates in Italy, the article will discuss the development of triage allocation protocols in United States hospitals. Resource allocation criteria underwent increased scrutiny and critique in both countries, which resulted in modified professional and expert guidance regarding healthcare ethics during times of emergency and resource scarcity., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Researchers increasingly recognize that the mind and culture interact at many levels to constitute our lived experience, yet we know relatively little about the extent to which culture shapes the way people appraise their experiences and the likelihood that a given experience will be reported. Experiences that involve claims regarding deities, extraordinary abilities, and/or psychopathology offer an important site for investigating the interplay of mind and culture at the population level. However, the difficulties inherent in comparing culture-laden experiences, exacerbated by the siloing of research on experiences based on discipline-specific theoretical constructs, have limited our ability to do so. We introduce the Inventory of Nonordinary Experiences (INOE), which allows researchers to compare experiences by separating the phenomenological features from how they are appraised and asking about both. It thereby offers a new means of investigating the potentially universal (etic) and culture-specific (emic) aspects of lived experiences. To ensure that the INOE survey items are understood as intended by English speakers in the US and Hindi speakers in India, and thus can serve as a basis for cross-cultural comparison, we used the Response Process Evaluation (RPE) method to collect evidence of item-level validity. Our inability to validate some items drawn from other surveys suggests that they are capturing a wider range of experiences than researchers intend. Wider use of the RPE method would increase the likelihood that survey results are due to the differences that researchers intend to measure., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Taves et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Religious leaders commonly provide assistance to people with mental illness, but little is known about clergy views regarding mental health etiology and appropriate treatment., Objective: To assess the views of religious leaders regarding the etiology and treatment of depression., Design, Setting, and Participants: This cross-sectional study used the National Survey of Religious Leaders, which is a nationally representative survey of leaders of religious congregations in the United States, with data collected from February 2019 to June 2020. Data were analyzed in September and October 2022., Main Outcomes and Measures: Views about causes of depression (chemical imbalance, genetic problem, traumatic experience, demon possession, lack of social support, lack of faith, and stressful circumstances) and appropriate treatments (seeing a mental health professional, taking prescribed medication, and addressing the situation through religious activity)., Results: The analytic sample was limited to congregations' primary leaders (N = 890), with a 70% cooperation rate. Clergy primarily endorsed situational etiologies of depression, with 93% (95% CI, 90%-96%) endorsing stressful circumstances, 82% (95% CI, 77%-87%) endorsing traumatic experiences, and 66% (95% CI, 59%-73%) endorsing lack of social support. Most clergy also endorsed a medical etiology, with 79% (95% CI, 74%-85%) endorsing chemical imbalance and 59% (95% CI, 52%-65%) endorsing genetics. A minority of clergy endorsed religious causes: lack of faith (29%; 95% CI, 22%-35%) or demon possession (16%; 95% CI, 10%-21%). Almost all of the religious leaders who responded to the survey would encourage someone with depressive symptoms to see a mental health professional (90%; 95% CI, 85%-94%), take prescribed medication (87%; 95% CI, 83%-91%), and address symptoms with religious activity (84%; 95% CI, 78%-89%). A small but nontrivial proportion endorsed a religious cause of depression without also endorsing chemical imbalance (8%; 95% CI, 5%-12%) or genetics (20%; 95% CI, 13%-27%) as a likely cause. A similar proportion would encourage someone exhibiting depressive symptoms to engage in religious treatment without also seeing a mental health professional (10%; 95% CI, 5%-14%) or taking prescribed medication (11%; 95% CI, 8%-15%)., Conclusions and Relevance: In this cross-sectional survey, the vast majority of clergy embrace a medical understanding of depression's etiology and treatment. When clergy employ a religious understanding, it most commonly supplements rather than replaces a medical view, although a nontrivial minority endorse only religious interpretations. This should encourage greater collaboration between medical professionals and clergy in addressing mental health needs.

This article reviews the current research literature concerning Black people in Western societies to better understand how they regulate their emotions when coping with racism, which coping strategies they use, and which strategies are functional for well-being. A systematic review of the literature was conducted, and 26 studies were identified on the basis of a comprehensive search of multiple databases and reference sections of relevant articles. Studies were quantitative and qualitative, and all articles located were from the United States or Canada. Findings demonstrate that Black people tend to cope with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly). Findings suggest gender differences in coping strategies. We also explore the relationship between coping with physical versus emotional pain and contrast functional versus dysfunctional coping approaches, underscoring the importance of encouraging personal empowerment to promote psychological well-being. Findings may help inform mental-health interventions. Limitations include the high number of American-based samples and exclusion of other Black ethnic and national groups, which is an important area for further exploration.

Child abuse and neglect are public health issues impacting communities throughout the United States. The broad adoption of electronic health records (EHR) in health care supports the development of machine learning-based models to help identify child abuse and neglect. Employing EHR data for child abuse and neglect detection raises several critical ethical considerations. This article applied a phenomenological approach to discuss and provide recommendations for key ethical issues related to machine learning-based risk models development and evaluation: (1) biases in the data; (2) clinical documentation system design issues; (3) lack of centralized evidence base for child abuse and neglect; (4) lack of "gold standard "in assessment and diagnosis of child abuse and neglect; (5) challenges in evaluation of risk prediction performance; (6) challenges in testing predictive models in practice; and (7) challenges in presentation of machine learning-based prediction to clinicians and patients. We provide recommended solutions to each of the 7 ethical challenges and identify several areas for further policy and research., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

More than 1 billion people worldwide report no religious affiliation. These religious "nones" represent the world's third largest religion-related identity group and are a diverse group, with some having previous religious identification and others never identifying as religious. We examined how 3 forms of religious identification-current, former, and never-influence a range of cognitions, emotions, and behavior. Three studies using nationally representative samples of religious Western (United States), secular Western (Netherlands, New Zealand) and Eastern (Hong Kong) cultures showed evidence of a religious residue effect : Formerly religious individuals (i.e., religious "dones") differed from never religious and currently religious individuals in cognitive, emotional, and behavioral processes. Study 1 ( n = 3,071) offered initial cross-cultural evidence, which was extended in a preregistered replication study that also included measures of charitable contribution (Study 2; n = 1,626). Study 3 ( N = 31,604) found that individuals who deidentified were still relatively likely to engage in prosocial behavior (e.g., volunteering) after leaving religion. This research has broad implications for understanding changing global trends in religious identification and their consequences for psychology and behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: The purpose of this study was to examine whether extended use of a variety of screen-based devices, in addition to television, was associated with poor dietary habits and other health-related characteristics and behaviors among US adults. The recent phenomenon of binge-watching was also explored., Methods: A survey to assess screen time across multiple devices, dietary habits, sleep duration and quality, perceived stress, self-rated health, physical activity, and body mass index, was administered to a sample of US adults using the Qualtrics platform and distributed via Amazon Mechanical Turk (MTurk). Participants were adults 18 years of age and older, English speakers, current US residents, and owners of a television and at least one other device with a screen. Three different screen time categories (heavy, moderate, and light) were created for total screen time, and separately for screen time by type of screen, based on distribution tertiles. Kruskal-Wallis tests were conducted to examine differences in dietary habits and health-related characteristics between screen time categories., Results: Aggregate screen time across all devices totaled 17.5 h per day for heavy users. Heavy users reported the least healthful dietary patterns and the poorest health-related characteristics - including self-rated health - compared to moderate and light users. Moreover, unique dietary habits emerged when examining dietary patterns by type of screen separately, such that heavy users of TV and smartphone displayed the least healthful dietary patterns compared to heavy users of TV-connected devices, laptop, and tablet. Binge-watching was also significantly associated with less healthy dietary patterns, including frequency of fast-food consumption as well as eating family meals in front of a television, and perceived stress., Conclusions: The present study found that poorer dietary choices, as well as other negative health-related impacts, occurred more often as the viewing time of a variety of different screen-based devices increased in a sample of US adults. Future research is needed to better understand what factors among different screen-based devices might affect health behaviors and in turn health-related outcomes. Research is also required to better understand how binge-watching behavior contributes impacts health-related behaviors and characteristics.

Moral injury is closely associated with posttraumatic stress disorder (PTSD) and characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different between moral injury and PTSD. A sample of 26 U.S. military veterans (two females: 28-55 years old) were investigated to determine how subjective appraisals of morally injurious events measured by Moral Injury Event Scale (MIES) and PTSD symptoms are differentially related to spontaneous fluctuations indexed by amplitude of low frequency fluctuation (ALFF) as well as functional connectivity during resting-state functional magnetic resonance imaging scanning. ALFF in the left inferior parietal lobule (L-IPL) was positively associated with MIES subscores of transgressions, negatively associated with subscores of betrayals, and not related with PTSD symptoms. Moreover, functional connectivity between the L-IPL and bilateral precuneus was positively related with PTSD symptoms and negatively related with MIES total scores. Our results provide the first evidence that morally injurious events and PTSD symptoms have dissociable neural underpinnings, and behaviorally distinct subcomponents of morally injurious events are different in neural responses. The findings increase our knowledge of the neural distinctions between moral injury and PTSD and may contribute to developing nosology and interventions for military veterans afflicted by moral injury., (© 2019 Wiley Periodicals, Inc.)

Background:: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70% completion rate. There are little data on the time at which ACD are completed in relation to when the resident was admitted to the nursing home facility., Objective:: To explore the success of advanced care planning at a large, rural long-term care (LTC) facility., Methods:: A descriptive approach, using a retrospective chart review, of 167 residents was used to examine resident completion of health-care system documents, legal documents, predisposing factors (resident demographics and psychosocial characteristics), and the actual process of ACP as defined by the rural LTC facility., Results:: This nursing home utilizes a document entitled resident preference for life-sustaining treatment (RPLST). For residents who do not have formal prepared advance directive documents, the RPLST serves to define resident and family choices for resuscitation and implementation of fluids, nutrition, medications, and antibiotics. The most striking finding was the completion rate of the RPLST within 100 days of being admitted to the nursing home., Conclusion:: Documentation of end-of-life preferences within 10 days of admission was achieved through the incorporation of RPLST during the resident admission process.

While cochlear implantation is now considered routine in many parts of the world, the debate over how to ethically implement this technology continues. One's stance on implantation often hinges on one's understanding of deafness. On one end of the spectrum are those who see cochlear implants as a much needed cure for an otherwise intractable disability. On the other end of the spectrum are those who view the Deaf as members of a thriving culture and see the cochlear implant as an attempt to eliminate this culture. Rather than take a stance in this debate, we will argue that the informed consent process for cochlear implantation must include access to Deaf perspectives. Deaf individuals know best what it is like to be a member of the Deaf community; the reasonable person would put significant weight on the testimony of Deaf individuals when considering whether to undergo cochlear implantation. The reasonable person standard determines what information careproviders must present as part of the informed consent process; thus, informed consent for cochlear implantation requires access to the testimony of Deaf individuals., (Copyright 2015 The Journal of Clinical Ethics. All rights reserved.)

Evangelical megachurches across the United States provide a subculture for core and committed members who immerse themselves in these communities of faith. This article argues that American evangelical megachurches fail to mitigate "the narcissism epidemic" in the dominant secular culture. Using object relations theory, I discuss splitting as a psychological foundation for narcissism, and I employ Heinz Kohut's self-psychology to analyze idealized, mirroring, and twinning self-objects in evangelical megachurches. Finally, given Kohut's categories for a mature narcissism, I find that Evangelicals achieve creativity, empathy, transience, humor, and wisdom, in part, but their ideological frameworks, organizational characteristics, and beliefs challenge a transformation to mature narcissism.

A sharp and personal polemical style characterized psychology as a new human science in American universities at the turn of the 20th century. When the experimental pursuit of truth about the mind produced quarreling rather than clarity, psychologists experienced a crisis of confidence. One solution was rhetorical: the use of a disclaimer that all current knowledge was rudimentary and a call for further research to end contention. The wording established a public tone of modesty and fostered collegiality. Scientific disagreements and underlying personal tensions remained, but conventional phrases promising future resolution of disputes contributed to a language of good manners and thereby facilitated debate. Nonetheless, the verbal formula of deferred hopes also made uncertainty seem normative. Confessions of tentativeness helped lay a historical foundation for routine investigation in psychology, but emphasis on incompleteness as an explanation of discord also made experimentation seem perpetual and truth elusive.

This article considers the stigmatized deaths in Jonestown, Guyana, in 1978, in which more than 900 Americans died of mass murder and suicide, and how this led to the disenfranchisement of grief. It examines the rituals of exclusion by which bodies were handled and describes the experiences of Jonestown survivors. It then looks at the ways in which grief has been enfranchised through a memorial website that posts names, photographs, and eulogies of those who died. This website serves as the primary place for relatives to visit, since the names themselves have become signs of absent bodies.

In this article, Erik Erikson's and subsequent researchers' ideas on generativity are applied to "the clerical abuse crisis," in which 111 U.S. Roman Catholic bishops protected priests rather than safeguard children. The goal was to discover what psychological dispositions led bishops to act in the manner they did. A case is made that pre-existing tendencies coupled with an all-male, celibate environment and formation indoctrination led to deficits in psychological development, moral judgment and leadership capacity, revealing an Episcopal subculture characterized by pseudo-speciation and authoritism.

This article discusses the relation between empirical and normative approaches in bioethics. The issue of dwarf tossing, while admittedly unusual, is chosen as a point of departure because it challenges the reader to look with fresh eyes upon several central bioethical themes, including human dignity, autonomy, and the protection of vulnerable people. After an overview of current approaches to the integration of empirical and normative ethics, we consider five ways that the empirical and normative can be brought together to speak to the problem of dwarf tossing: prescriptive applied ethics, theoretical ethics, critical applied ethics, particularist ethics and integrated empirical ethics. We defend a position of critical applied ethics that allows for a two-way relation between empirical and normative theories. Against efforts fully to integrate the normative and the empirical into one synthesis, we propose that the two should stand in tension and relation to one another. The approach we endorse acknowledges that a social practice can and should be judged both by the gathering of empirical data and by normative ethics. Critical applied ethics uses a five stage process that includes: (a) determination of the problem, (b) description of the problem, (c) empirical study of effects and alternatives, (d) normative weighing and (e) evaluation of the effects of a decision. In each stage, we explore the perspective from both the empirical (sociological) and the normative ethical point of view. We conclude by applying our five-stage critical applied ethics to the example of dwarf tossing.

The public responsibilities of nonprofit hospitals have been contested since the advent of the 1969 community benefit standard. The distance between the standard's legal language and its implementation has grown so large that the Internal Revenue Service issued a new reporting form for 2008 that is modeled on the Catholic Health Association's guidelines for its member hospitals. This article analyzes the appearance of an emerging moral consensus about community benefits to argue against a strict charity care mandate and in favor of directing efficient care delivery and healthy community initiatives to underserved populations. The analysis turns on three moral conceptions of community benefits, the social contract model of hospital critics and the common good and covenantal models of Catholic and Jewish hospitals.

The professional identity of the chaplain in Dutch health care institutions is in need of a new theoretical underpinning. The continued employment of the "spiritual caregiver," as the professional is called in the Netherlands, may be at stake. In former days, she or he was primarily a religious office holder fulfilling ecclesiastical functions. Against the background of secularization and individualization of religions and worldviews, the spiritual caregiver now turns more and more into an existential counselor, focusing on the search for meaning and life-orientation of all the clients/patients/residents, irrespective of their religion or philosophy of life. This brings along the need for a conceptualization of spiritual care. What is the spiritual caregiver's particular contribution to care and treatment, compared to that of, for instance, psychotherapists and social workers? What are the specific aims, methods, and key images of the profession? This brief communication sketches the specific context in which the Dutch spiritual caregiver has to work and the identity dilemmas he or she faces.

The concept of the cell has been based on metaphor since its inception, and the history of cell theory has continued to rely on metaphor and analogy. In the nineteenth century, cells were most popularly conceived either as building stones or elementary autonomous organisms from which larger organisms are composed. With advances in physiology and the rise of modern biochemistry in the early twentieth century, the chemical factory or laboratory became the dominant metaphor for this biological unit. Today in the twenty-first century, the metaphorical imagery has become a reality, with cells acting as chemical factories for the synthesis of commercially valuable bio-products. The history of the cell shows how metaphors act as conceptual tools, with particular strengths for facilitating different sorts of questions and experimental techniques.

The troubling public, moral and legal issues surrounding questions of death and dying need a new focus on the virtues of compassion and respectfulness, on a better understanding of a person as someone who has deep emotional, spiritual, and social aspects and needs, and whose body is more than "physical machine," but is "lived body" which gives persons the capacity to act in the world and to feel and suffer deeply. Western medicine needs to re-humanize death; physicians need to see themselves as "assisting" persons in dealing with health, life and death in the context of being able to assert their values and beliefs and to realize their goals. Western medicine's concepts of 'benefit' and 'harm,' are too narrow, as is their fight to 'preserve life' at all costs. Finally, the present approach to death and dying, except for the Hospice movement, neglects the patient's emotional, psychological, social, and existential suffering.

Using autobiographical narratives, this article explores the experience and role of childhood immigration in the ongoing construction of self-identity. A variety of border-crossings are considered in the child's journey from cultural marginalization to acculturation into American society. Continuing feelings of displacement and loss into adulthood-common tropes in adult narratives-are then examined, as are immigrants' efforts to creatively address aspects of a hybrid identity, e.g., via "return trips" to the homeland or through the deployment of a double vision in the interest of social and political inclusiveness.

In the United States, controversy has raged about ethical public policies toward some potential sources of human stem cells for research, particularly human embryos left over from in vitro fertilization (IVF) or created through somatic cell nuclear transfer. This article critically examines the ethical and policy issues, particularly as they have emerged in the reports and recommendations of two presidentially appointed advisory bodies: The National Bioethics Advisory Commission (NBAC) and the President's Council on Bioethics (PCB).

Feminist analysis of cultural mythology surrounding organ donation offers a critical perspective on current U.S. transplant policy. My argument is three-pronged. First, I argue that organ donation is appropriately understood as a sacrifice. Structurally, donation accords both to general and to specifically Christian archetypes of sacrifice. The characterization of donation as sacrifice resonates in the cultural psyche even though it is absent in public rhetoric. Second, I characterize widespread feminist concerns about the over-glorification of sacrifice. These concerns provide a helpful framework for considering whether the sacrifice of organ donation is over-glorified in our culture. Third, I consider several specific aspects of organ recruitment and organ allocation. Each demonstrates an over-glorification of sacrifice that leads to a dangerous "routinization" of sacrifice. None of these excesses are addressable without due attention to the symbolic import of organ donation and transplantation. I close by suggesting lessons my analysis offers to Christian churches who support donation, to the discourse of bioethics, and to the general public.

Should chaplaincy be scientific? The answer is a resounding yes! Science is not the enemy of chaplaincy any more than it is the enemy of theology. It is necessary and therapeutically vital that chaplains strive to base their theory and practice on appropriate and well-researched evidence. The substantial question, however, is: What actually constitutes acceptable evidence, who decides and why?

Traditional informed consent often promotes passive acquiescence rather than active exercise of autonomy. A more natural biologically based model of autonomy is needed, a model that both recognizes the biological roots and therapeutic benefits of active confident choices among real alternatives, and offers substantive guidelines for promoting patient autonomy. A biological model of patient autonomy explains the value of information to patients, outlines the circumstances under which patients make effective choices, and suggests complementary roles for patients and professional caregivers.

The author asserts that physicians have two fundamental duties: they must balance the interests and wishes of the patient with the welfare of the health care system in which they practice. In fact, many physicians actually act in accordance with this dual approach, but they sense an inconsistency between their behaviors and their ideals, which focus on the patient only. The author explains why, as a consequence of this more complex role, medicine must stop viewing the case manager as the unavoidable but unwanted child within the family of medicine and must incorporate case management within the very identity of the physician. Finally, the author explains in detail that when the physician practices according to the dual-stewardship model just described, at least three beneficial consequences will emerge. First, the abysmal quality of end-of-life care in the United States may improve. Second, restraints on funding for last-chance or experimental treatments may, surprisingly, advance patients' interests. Third, an admission that much is not known about many mental illnesses and an acknowledgment that the money spent in treatment often yields limited results may encourage the health system to resist providing unproven treatments. This admission should also lead to more scientific knowledge and more effective approaches to these bewildering problems. In conclusion, the author states that it is not just the physician who must redefine himself in the new world of medicine. Administrators of managed care organizations must face the challenge of redirecting their traditional commitments to stockholders and boards of directors toward the patient-centered values of the physician.

Health care institutions, including Roman Catholic institutions, are in a time of crisis. This crisis may provide an important opportunity to reinvigorate Roman Catholic health care. The current health care crisis offers Roman Catholic health care institutions a special opportunity to rethink their fundamental commitments and to plan for the future. The author argues that what Catholic health care institutions must first do is articulate the nature of their identity and their commitments. By a renewed commitment to the praxis of health care on their own distinctive terms, Roman Catholic health care institutions may reestablish a vision of human nature and human service in an increasingly secular society. Health care could then reclaim its place as a powerful setting for the expression of Roman Catholic faith, life and witness.

In November 1998 biologists announced that they had discovered a way to isolate and preserve human stem cells. Since stem cells are capable of developing into any kind of human tissue or organ, this was a great scientific coup. Researchers envision using the cells to replace damaged organs and to restore tissue destroyed by, for example, Parkinson's disease, diabetes, or even Alzheimer's. But, since stem cells are taken from aborted embryonic and fetal tissue or "leftover" in vitro embryos, their use raises large ethical issues. The National Institutes of Health (NIH) recently decided to fund research employing, not stem cells, but "cell lines" derived from them. The NIH has essentially made an ethical determination, finding sufficient "distance" between cell lines and abortion. Can Catholic universities sponsoring biological research agree with this finding? Probably not. In Catholic teaching, the concept of "complicity" would likely preclude such research. However, Catholic teaching would probably allow research done with stem cells obtained from postpartum placental tissue and from adult bone marrow and tissue. These cells, which lack the pluripotency of embryonic and fetal stem cells, are nevertheless scientifically promising and do not involve the destruction of human life.

This article examines the evolution of state and federal legislation and court opinions in the 1990s concerning treatment abatement and assisted suicide. The recent Supreme Court decision on assisted suicide is summarized, and its rejection of a recognized constitutional right to assisted suicide is explored. Additionally, surveys of the opinions of nurses, physicians, and the public regarding the permissibility of assisted suicide are evaluated. The contradictions between public opinion and some federal and state legislation are highlighted and discussed.

This article argues that although there may exist morally valid reasons to justify assisted suicide in some cases, establishing state or national policies legalizing assisted suicide is morally unjustified. Five arguments are examined that support the position against legalization: consequentialist arguments, arguments about who could legitimately choose assisted suicide and when it could be chosen, the incompatability of assisted suicide policy and authentic self-determination; the probable lack of efficacy of assisted suicide in a managed care environment, and the effects of assisted suicide on the profession and practice of nursing. The article ends with a discussion of alternatives to assisted suicide legislation that might accomplish in large part what is sought by such legislation.

Although theology is often seen as impractical speculation on unimportant matters, it serves as a necessary foundation--and provides valuable guidance--for chaplains who must provide pastoral care to persons with dementia and their families. Theology can help us "to see things as God sees them." Among the theological doctrines found in the Hebrew-Christian scriptures and traditions that are particularly helpful are the following: human creation "in the image of God"; human nature as a psychophysical unity; the dependence of all persons upon God's mercy; the centrality of community; and God's judgment of personal worth by standards very different from those of "the world." A model for applying these concepts and some thoughts of the importance of chaplains are offered.

This paper explores ways in which Chinese healing practices have undergone acculturation in the United States since the early 1970s. Reacting to what is perceived as biomedicine's focus on the physiological, those who describe themselves as favoring a holistic orientation often use the language of "energy blockage" to explain illness, whether thought of as "physical," "emotional," or "spiritual." Acupuncture in particular has been appropriated as one modality with which to "unblock" such conditions, leading to its being used by some practitioners in conjunction with more psychotherapeutic approaches which include valuing the verbalizing of feelings. Some non-Chinese practitioners in the United States, returning to older Chinese texts to develop "an American acupuncture," are reinserting diagnoses eliminated from Traditional Chinese Medicine (TCM) by the People's Republic of China as "superstition." The assumption has been that many such diagnostic categories refer to psychological or spiritual conditions, and therefore may be useful in those American contexts which favor this orientation. Among these categories are those drawn from traditions of demonology in Chinese medicine. What was once a religious category in China turns psychological in the American setting. At the same time, many who use these terms have, since the late 1960s, increasingly conflated the psychological and the religious, the latter being reframed as "spiritual." Thus, this indigenization of Chinese practices is a complex synthesis which can be described as simultaneously medical, psychotherapeutic, and religious.

The argument that human life should be fully protected once conception is complete has been challenged by the claim that at that time such life is not genuinely individuated in the morally required sense. This essay analyzes the "conception versus individuation" exchange and directs attention to the communal contexts within which the relevant arguments and counter-arguments arise.

Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection.

We examined the effects of stereotyping on impression formation when encountering people dressed to represent a religious faith. We used stimulus photographs of eight male and female models dressed casually and a second photograph of one male and one female model in religious attire that was placed beside the control photos of models dressed causally. From each set of photographs, subjects selected a photo of the person with whom they would associate the various positive personality traits suggested by our stimulus questions. Subjects were students from a U.S. Catholic school, a U.S. public school, and a Malaysian Muslim school. All the subjects attributed more of the positive traits to photos of the models who were religiously attired than to photos of those who were casually dressed, but subjects from U.S. schools attributed more of the positive traits to the photos of religiously dressed models than did the subjects from the Malaysian school.

This essay analyzes the principle of double effect and, to a lesser extent, the distinction between killing and letting die in the context of the Pittsburgh protocol for managing patients who may become non-heart-beating donors or sources of organs for transplantation. It notes several ambiguities and unresolved issues in the Pittsburgh protocol but concludes that neither the principle of double effect nor the distinction between killing and letting die (with the prohibition of the former and the allowance of the latter under some circumstances) erects insurmountable obstacles to the implementation of the protocol. Nevertheless, the requirement of the principle of double effect that the intended good effects outweigh the unintended side effects necessitates careful attention to the probable overall impact of the proposed policy on organ procurement, particularly because public mistrust plays such a significant role in limiting the number of organ donations.

In several US states, the legalisation of euthanasia has become a question for voters to decide in public referenda. This democratic approach in politics is consistent with notions of personal autonomy in medicine, but the right of choice does not mean all choices are morally equal. A presumption against the taking of human life is embedded in the formative moral traditions of society; human life does not have absolute value, but we do and should impose a strict burden of justification for exceptions to the presumption, as exemplified by the moral criteria invoked to justify self-defence, capital punishment, or just war. These criteria can illuminate whether another exception should be carved out for doctor-assisted suicide or active euthanasia. It does not seem, in the United States at any rate, that all possible alternatives to affirm the control and dignity of the dying patient and to relieve pain and suffering, short of taking life, have been exhausted. Moreover, the procedural safeguards built into many proposals for legalised euthanasia would likely be undone by the sorry state of the US health care system, with its lack of universal access to care, chronic cost-containment ills, a litigious climate, and socioeconomic barriers to care. There remains, however, common ground in the quest for humane care of the dying.