TODAY: The Cost of Conscience

Today, Friday, March 2 at 4 p.m. in McKenna Hall Auditorium, Prof. O. Carter Snead of the Notre Dame Law School will deliver the Clarke Lecture in medical ethics, entitled "The Cost of Conscience." Reception to follow.

Carter Snead to deliver Clarke Lecture

Next Friday, March 2 at 4 p.m. in McKenna Hall Auditorium, Prof. O. Carter Snead of the Notre Dame Law School, and incoming Director of the Center, will deliver the Philip & Doris Clarke Family Lecture as part of our Annual Medical Ethics Conference. His lecture is entitled "The Cost of Conscience." Please join us! Reception to follow.

TODAY: Clarke Lecture in Medical Ethics

Today at 4 p.m., Thomas Cavanaugh will lecture on "Asclepius' Snake and Hippocrates' Oath: The Birth of a Medical Ethic" in McKenna Hall Auditorium as part of our annual medical ethics conference. Reception to follow. Free and open to the public.

TODAY: Schmitt Lecture with Dr. Carl Elliott

At 4 p.m. today in McKenna Hall, Dr. Carl Elliott will deliver the spring Schmitt Lecture, "A Clinical Trial, A Suicide, and the Strange Recent History of Anti-Psychotic Drugs." When a young man committed suicide in an industry-sponsored clinical trial of atypical antipsychotic drugs at the University of Minnesota in 2004, critics charged that he had been coerced into the study. They may be right, but the ethical problem is even larger. Today pharmaceutical companies are designing and analyzing clinical trials not to produce reliable scientific data, but to ensure that their own drugs look superior to the competition. These trials are published in peer-reviewed scientific journals and distributed by drug reps as a way of marketing the drugs. Which raises the question: when is it ethically justified to enroll human subjects in marketing studies?

A reception will follow after the lecture.

Attention Doctors: Annual Medical Ethics Conference

Notre Dame's 26th annual medical ethics conference is approaching. Organized by the Notre Dame Center for Ethics and Culture and the Alumni Association, the conference offers doctors an opportunity to discuss medical ethics cases they have faced in their own practice. This year's conference will be held at Notre Dame on March 18-20, 2011, and registration is open until March 7. The full schedule for the weekend is available here, and you can e-mail conference organizer Bryan Pilkington with any questions at Bryan.C.Pilkington.5@nd.edu.

Sign up for Bread of Life Dinner

The Notre Dame Center for Ethics and Culture invites undergraduate students to its Bread of Life dinner, Tuesday, Feb 22^nd at 6:00 p.m. in the South Dining Hall’s Oak Room. The evening will include a brief reflection on beginning-of-life ethical issues by Theology Professor Michael Baxter, in a talk entitled, "Ethics, Culture, and Life at Notre Dame: A View from the (true) Center", followed by a catered dinner and discussion, with a professor joining each table of students. We hope to attract students who may not be strongly committed to the Church's teachings on these issues, but who are open to exploring them. Space is limited. To RSVP, please e-mail your name, year, major, and a brief statement of why you would like to attend to ethics2@nd.edu.

Abuses of the Public by Psychiatry

Dr. Paul McHugh delivered a terrific lecture last night on the subject of "Abuses of the Public by Psychiatry," in honor of Notre Dame's Schmitt Fellows in the colleges of science and engineering. He recounted the rise of multiple personality disorder diagnoses, and the accompanying fad of repressed memories emerging in middle age of childhood sexual abuse. The phenomenon in psychiatry was at its peak in the late 1980's and early 1990's, and he said it affected over a million Americans, tearing apart families with false accusations. Dr. McHugh was careful to point out that child sexual abuse is a travesty and happens all too often, and that certainly in many cases such abuse is forgotten or repressed until the memories return later in life. The cases he dismissed as fabrications and inducements by psychiatrists to remember events that never happened are cases in which the memories were wildly improbable, such as remembering abuse as an infant. Psychiatrists have been recklessly irresponsible in encouraging this fad and creating discord in once harmonious families. He wrote a book on the subject, called Try to Remember: Psychiatry's Clash over Meaning, Memory and Mind.

His more devastating charge against psychiatry, however, is that it has gotten mired in an excessive concern for classification and description, embodied in the Diagnostic and Statistical Manual of Mental Disorders, which acts as a sort of field guide for psychiatry while failing to systematically explore the causes and cures for mental ill health. He believes psychiatry has hit a dead end as it prepares to publish the fifth edition of the DSM, and a reversal of course is needed.

Look for the video of Dr. McHugh's lecture on our homepage soon!

TODAY: Schmitt Lecture

Join us at 4 p.m. today in McKenna Hall Auditorium for this semester's Schmitt Lecture, "Abuses of the Public by Psychiatry," to be delivered by Dr. Paul McHugh of Johns Hopkins University.

Dr. McHugh was educated at Harvard College and Harvard Medical School with further training at the Peter Bent Brigham (now Brigham and Women’s) Hospital, Massachusetts General Hospital, the Institute of Psychiatry, University of London, and in the Division of Neuropsychiatry at Walter Reed Army Institute of Research.  After his training, he was eventually and successively Professor of Psychiatry at Cornell University School of Medicine, Clinical Director and Director of Residency Education at the New York Hospital Westchester Division; Professor and Chairman of the Department of Psychiatry at the Oregon Health Sciences Center.  He was Henry Phipps Professor and Director of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine and Psychiatrist-in-Chief at Johns Hopkins Hospital from 1975-2001.  The Johns Hopkins University School of Medicine named him University Distinguished Service Professor in 1998.  Dr. McHugh was elected to the Institute of Medicine, National Academy of Sciences in 1992.  In 2001, he was appointed by President Bush to the President’s Council on Bioethics and in 2002 by the United States Conference of Catholic Bishops to the National Review Board for the Protection of Children and Young People.

During his career, Dr. McHugh has pursued three interrelated aims: to create a model department of academic psychiatry by rendering explicit the conceptual structure of psychiatry and by demonstrating what this structure implies for patient care, education and research; to teach how the brain-mind problem is embedded in these concepts and how it affects the thought and actions of psychiatrists; and to investigate the “motivated” behaviors, such as hunger, thirst, sex, and sleep that are open in this era to multiple levels of analysis from molecular biology to social science.  With his expertise, Dr. McHugh will bring an intriguing set of questions to the conversation of the Schmitt Lecture Series.  Dr. McHugh’s most recent book is Try to Remember: Psychiatry's Clash over Meaning, Memory, and Mind.  It is an account of the recent legal and psychiatric struggle over the repressed memory movement, a struggle in which Dr. McHugh played a significant role.  It is also a plea for a more humane and well-grounded psychiatry. 

Dr. McHugh’s Fall 2010 Schmitt Lecture, set to explore the moral dimensions of psychiatry, promises to be an outstanding addition to the Schmitt Lecture Series.  The series honors the generosity of the Arthur J. Schmitt Foundation to the University of Notre Dame. It aims to provide occasions at which the Schmitt Fellows, graduate students in the Colleges of Science and Engineering, can join with other members of the Notre Dame community to reflect on the ethical, political and religious dimensions of the studies in which they are engaged.

Webinar: "Poor Prenatal Diagnosis of Lethal or Non-Lethal Conditions and Disability."

On Oct. 5 from 1:00 to 2:30 p.m., the diocesan Office of Family Life and the Notre Dame Center for Ethics and Culture will host a group viewing of a live webinar entitled "Poor Prenatal Diagnosis of Lethal or Non-Lethal Conditions and Disability." Presented by the National Catholic Partnership on Disability and the USCCB Secretariat for Pro Life Activities, the webinar will examine medical issues, Catholic Church teaching, pastoral care and family support, and provide the opportunity for live Q & A. The webinar will be held on Notre Dame's campus in 121 ITC (Information Technology Center), the building east of the reflecting pool in front of the Hesburgh Library.

25th Annual Clark Family Medical Ethics Conference

Twenty-five years ago, Notre Dame alumnus Dr. Philip Clarke organized the first Notre Dame Medical Ethics conference on the University of Notre Dame campus. Ever since, the Notre Dame Medical Ethics conference, co-sponsored by the Center and the Alumni Association, has been a fixture on the university calendar, bringing together alumni and non-alumni physicians, theologians, hospital chaplains, lawyers, and clergy members in stimulating discussion about the difficult ethical issues that confront the practice of medicine. To commemorate the conference's 25th anniversary, we invited everyone to the Eternal City and were joined by approximately one hundred doctors, nurses, lawyers, priests, medical students, philosophers, and theologians. The conference was held at the Pontifical University of the Holy Cross, located off the famous Piazza Navona.

Although the two-day conference itself took place on March 12-13th, most conference participants joined us in Rome for the entire week, taking the opportunity to see some of the city's magnificent sites. The week began with Mass at the Church of the Gesù, con-celebrated by Fr. Kevin Flannery, S.J. and Msgr. Charles Brown, with a buffet reception afterwards which provided an opportunity for conference participants and their families to meet one another. Throughout the week, participants had the opportunity to sign up for “insider tours” led by friends of the Center. Fr. Kevin Flannery, S.J., Professor of Philosophy at the Pontifical Gregorian University and the Center's 2006-2007 Remick Fellow, led a small group on a walking tour of famous Jesuit sites. Fr. Michael Sherwin, O.P., Associate Professor of Fundamental Moral Theology at the University of Fribourg and the Center's 2007-2008 Myser Fellow, took a group on a tour of some of Rome's famous Dominican sites. A lucky group of participants was able to attend a tour of the Vatican's Holy Offices, where the Congregation for the Doctrine of the Faith is located. This tour was led by Msgr. Charles Brown, a Notre Dame alumnus and priest of the Archdiocese of New York who has worked for the Congregation for the Doctrine of the Faith since 1994. We were also fortunate to have Professor David Mayernik from Notre Dame's School of Architecture give a tour of S. Andrea al Quirinale and S. Carlino alle Quattro Fontane, two churches that are fruitful points of comparison between the work of Borromini and Bernini. Aside from these “insider” tours, participants had opportunities to join tours of St. Peter's Basilica and of the excavations below St. Peter's Basilica where the tomb of St. Peter is located, both of which were led by well-known art historian, Elizabeth Lev.

The conference itself began on the morning of Friday, March 12th with the annual J. Philip Clarke Family Lecture in Medical Ethics. The Clarke lecturer this year was Fr. Michael Sherwin, O.P., who delivered his lecture entitled “Truth, Freedom, and Medicine: Toward a Renewed Anthropology of Healing.” The remaining sessions of the conference dealt with topics that allowed for reflection on the differences between European and North American approaches to bioethics. The topic of the second session of the conference was “Age-Based Rationing of Health Care: European, North American, and Asian Perspectives.” This session featured a panel discussion focusing on the ethical treatment of the elderly, paying particular attention to the thorny issues of age-based rationing and organ transplantation in the elderly.

The following session, “Casting Off the Cloak of Conscience: Can Modern Medicine Afford a Physician's Conscience?” dealt with conscience clauses. This topic was of particular interest to conference participants because of the Obama administration's proposal to repeal the “conscience” rule put in place by President Bush in the waning days of his administration. The topic for the last session of the day was “Ethical Dilemmas at the Beginning of Life: European and North American Developments.” Conference participants addressed the tough issues at the beginning of life for very sick or premature infants and gained familiarity with different regional guidelines for neonatal resuscitation and the controversial Groningen Protocol. Bright and early on Saturday morning, conference participants were confronted with the difficult topic of “Euthanasia and Physician-Assisted Suicide: European and North American Developments.” During this session, there was a panel discussion about the laws concerning euthanasia and physician-assisted suicides adopted in different European countries and in individual states of the U.S.

Conference participants then divided into small discussion groups for the sixth session of the conference, “The Doctor-Patient Relationship and the Physician's Larger Responsibilities.” Among the questions raised in this session included: “How does a physician balance his duty to his patient with his duty to the public?” and “Is it appropriate for a physician to offer unsolicited advice to a stranger?” Participants also had the opportunity to discuss the effects of “medical tourism” on developing questions, the phenomenon whereby physicians visit a developing country to volunteer medical services or practice medicine while on vacation in a developing country.

At the next session, “Obama's Struggle for Comprehensive Health Care Reform: What Can the United States Learn from the European Experience?” there was a panel discussion about President Obama's health care proposal. Conference participants also learned about different European health care plans and discussed their feasibility in the United States. At the final session of the day, participants once again broke into small discussion groups to discuss “The Significance of National Borders for Access to Health Care.” Here they discussed such questions as: “What is a country's obligations to provide medical care for non-citizens?” and “How do European countries ensure that citizens of other countries do not abuse the European Health Insurance Card, which is supposed to ensure that vacationers receive emergency care?”

We were fortunate to bring with us to Rome a large group of distinguished medical ethicists from around the world to serve as our consultants in medical ethics. We were especially honored that Fr. Wojciech Giertych, O.P., Theologian of the Papal Household, found the time in his busy schedule to join us for multiple sessions of our conference.

Our week in Rome was filled with good company, stimulating conversation, heartfelt prayer, beautiful sites and wonders, great wine, and delicious food. To say the least, much fun was had by all. We enormously indebted to Karen Chan, graduate assistant to the CEC, who with the assistance of Ruth Tarwacki from Anthony Travel, planned and coordinated this splendid international event.

24th Annual Clarke Family Medical Ethics Conference

On March 27th-29th, 2009, approximately one hundred doctors, nurses, medical students, medical ethicists, and Notre Dame undergraduates came together for our 24th annual Notre Dame Medical Ethics conference. As usual, the Notre Dame Alumni Association joined the Center in sponsoring the conference, which took place on campus at the Center for Continuing Education in McKenna Hall. The conference is designed to serve current and future medical professionals, providing them with an opportunity to join with others to reflect thoughtfully on the often complex ethical questions and problems that arise in medicine. Among medical ethics conferences, our conference is distinctive in encouraging theologically-informed discussions and in placing emphasis on small-group discussions of physician-submitted cases.

The first session of our conference dealt with challenges associated with finding a workable, accurate, medical definition of death. As the discussed cases made apparent, both which definition is chosen and who is deemed to have the authority to choose will have serious practical consequences for issues such as organ donation eligibility as well as treatment continuance and cessation. Two of the discussed cases also brought out some practical difficulties associated with applying the now widely-accepted brain-death criterion of death: for one class of persons—newborns—very rarely are physicians able to verify brain death.

On the first evening of the conference, we held our annual J. Philip Clarke Family lecture, a lecture open not only to our conference attendees but also to the Notre Dame, St. Mary’s, and greater South Bend communities. This year’s speaker was Edmund Pellegrino , M.D., Professor Emeritus of Medicine and Medical Ethics at the Center for Bioethics at Georgetown University Medical Center. This was Dr. Pellegrino’s third time giving the Clarke Lecture, and the title of his address was “A Moral Foundation for the Helping Professions: Medicine, Law, Ministry, and Teaching.”

Following the Clarke lecture, Dr. Pellegrino participated in a book signing for two recently-published books: The Philosophy of Medicine Reborn: A Pellegrino Reader, which was published in the Center’s book series, and Medical Ethics at Notre Dame: The J. Philip Clarke Family Lectures 1988-1999, a collection of the first twelve Clarke lectures with responses. During the third session, participants tackled problems of obtaining informed consent. Physicians discussed both what is required for full and proper informed consent and who is capable of giving true consent. They considered whether doctors are obligated to volunteer information about which hospitals and doctors can provide patients with the best treatment. The participants also discussed tough cases of consent to treatment involving minors and the very poor participating in medical research for pay.

For the fourth session of our conference, we welcomed Notre Dame Economics Professor Bill Evans, who gave detailed assessments of both the current state of the United States health care system and President Obama’s proposals for health care reform. At the request of several conference attendees, the slides from Prof. Evans’ lecture are available online at the Center’s website.

In the fifth session, “Medicine and Money,” participants considered problems that have arisen in the health care delivery system as hospitals, governments, and individuals have tried to deal with the realities of limited financial resources. One of the most provocative cases involved hospitals, including at least one Catholic facility, that have resorted to deporting indigent,
uninsured immigrants in an effort to balance their budgets.

On Saturday afternoon, participants had a choice of attending one of three panel discussions. The topics for these discussions were: the recent document from the Vatican’s Congregation for the Doctrine of the Faith, Dignitas Personae, a document on a series of recommended changes to resident duty hours that the ACGME (the organization that accredits medical schools in the U.S.) is now considering; and the appropriate response of health care professionals when they conflict with their colleagues on when and how to prescribe pain medication. dimensions of science and technology.

On Sunday morning, we had our usual “roundtable discussion,” a wrap-up session in which participants are invited to raise questions for all present to consider. These questions can be on topics discussed in previous conference sessions or on entirely new topics. Some of the most memorable discussions in this year’s roundtable were prompted by physicians seeking advice on how to handle some of the tough cases they had encountered in their own practices.

Practicing Medical Ethics, Think about the Hard Questions

The Practicing Medical Ethics course is our one-unit, day-long introduction into the interesting yet thorny field of medical ethics. The course is intended to familiarize students with some of the central issues in medical ethics and provide an opportunity for thoughtful and stimulating discussion about some of the hotly debated issues that dominate the public square.

When asked if doctors have an obligation to tell their patients the truth, the typical gut reaction is to answer this question affirmatively. This first session featured two cases that were contributed to the 2008 Medical Ethics Conference by a practicing physician. They bring to light the complications in the doctor-patient relationship, the complexity of human lives, and questions about the extent of a doctor’s obligation to tell the truth.

In the second session, students considered the implications of genetic testing and preimplantation genetic diagnosis (PGD). Currently, the abortion of fetuses that are afflicted with such maladies as Down Syndrome and Spina Bifida is accepted medical practice. Is the use of preimplantation genetic diagnosis to discard embryos that display certain predispositions different in any ethically relevant way? Is the use of PGD permissible to discard embryos that have the predisposition to develop afflictions that show up not at birth or early childhood, but much later in life?

What is the point of health care? Is health care a business or a profession? What are the obligations of a health care professional with respect to the sick at large and to his own home community? These are the questions that students faced in this third session, in which we asked them to reflect upon the nature of health care. The students also read an excerpt of The Rebirth of the Clinic by Daniel P. Sulmasy, O.F.M., M.D., Ph.D., the Clarke lecturer for the 2008 Medical Ethics Conference.

23rd Annual Clarke Family Medical Ethics Conference

On March 14-16, 2008, the Notre Dame Center for Ethics and Culture, in conjunction with the Notre Dame Alumni Association, hosted the 23rd annual Notre Dame Medical Ethics Conference. The aim of the conference is to allow for discussion regarding some of the complex issues that plague the practice of medicine, in a setting not only where participants can come to a deeper understanding of Catholic teaching on these issues, but where diverse viewpoints can be shared, heard, and appreciated.

The conference opened on Friday afternoon with the annual Clarke Lecture. This year, we were pleased to welcome as our Clarke Lecturer Daniel P. Sulmasy, O.F.M., M.D., Ph.D., a Franciscan friar, the Sisters of Charity Chair in Ethics at St. Vincent’s Manhattan, and Professor of Medicine and Director at the Bioethics Institute of New York Medical College. Dr. Sulmasy delivered his lecture on the topic, “Is Health Care a Spiritual Discipline?” In the first session on Saturday morning, participants discussed a range of cases that involve the concept of futility. A number of participants from Texas have suggested for a number of years that we devote a session to a discussion of the Texas Futile Treatment Law, and we included information about that law in our readings. After the break, participants gathered for a discussion of some of the recent initiatives in reforming the health care system. The topic of health care reform is a hot-button issue in the current political campaign and we invited David Betson, a distinguished economist at Notre Dame, and an expert on proposals for health care reform, to give us a brief presentation on the options now on the table from an economist’s point of view.

After lunch, we returned to our discussion group format to examine a series of cases that raise difficult ethical questions about disease-labeling and possible inappropriate uses of drugs. Participants addressed the question of whether “disease-mongering” is a serious problem in contemporary medicine.

In the final session on Saturday, participants were given a choice among three concurrent break-out sessions. The first session considered ethical issues raised by the merger of a public hospital and a Catholic hospital. Many of our participants have worked in situations where similar mergers have occurred and a lively discussion ensued on this matter. The second break-out session examined Church teaching on the provision of artificial nutrition and hydration.

The third session explored the new medical powers of genetic technologies and the ethical issues raised by them. Saturday concluded with Mass celebrated in Alumni Hall Chapel with Father Bresnahan presiding and Father Young concelebrating. On Sunday morning, participants concluded the conference with our traditional wrap-up session. At this session we put all of our consultants at the front of the room and had an open-mike free-for-all. Last year, at this session, there was an energetic discussion initiated by some medical students in attendance about forming a new medical student association devoted to the integrity of the patient and to a broadly Catholic approach to the vocation of medicine, especially with regard to life issues. There was a general sense that we should take some steps toward forming such an association. To that end, this year, we invited two-dozen current medical students to attend this year’s conference to discuss the formation of such an association. They arrived on Thursday night, before the conference, meeting on Friday morning to explore ideas about the association and then attended the remainder of the conference.

In addition to our many fine resource participants, we were especially fortunate this year to have three distinguished international specialists in medical ethics visiting the university and able to join us. Father Vladimir Littva from the Catholic University in Ružomberok, Slovakia and Father Grzegorz Holub from the University of Kraków were both visitors at the Nanovic Institute for European Studies during the spring semester and joined us as consultants. An old friend of the Center, Prof. Ruiping Fan from the City University of Hong Kong who gave the Clarke Lecture only a few years ago was a visiting Fulbright Scholar in the Notre Dame Center for Ethics and Culture and also served as one of our consultants. Prof. Fan is one of the leading specialists in the world on Confucian approaches to medical ethics.

Students Confront Contemporary Issues in Medical Ethics

The Practicing Medical Ethics course is our one-unit, day-long introduction into the interesting yet thorny field of medical ethics. The course is intended to familiarize students with some of the central issues in medical ethics and provide an opportunity for thoughtful and stimulating discussion about some of the hotly debated issues that dominate the public square.

In the first session this fall, students discussed the issues involved in the just distribution of medical resources. The first two cases asked whether alcoholics should be eligible for liver transplants and whether death-row inmates should be eligible for organ transplants. The third case came from recent headlines and dealt with the case of Dr. Anna Pou, who was accused of murdering nine patients at Memorial Medical Center in New Orleans in the aftermath of Hurricane Katrina, though a grand jury recently declined to indict her.

In this second session inspired by another recent tragedy, the Virginia Tech killings, students explored the issue of doctor-patient confidentiality. With the Virginia Tech tragedy, the question of how to balance doctor-patient confidentiality with public safety has resurfaced. The students read three different cases, two of which dealt with the issue of medical confidentiality and the university, and the third involving how much evidence is needed to constitute a “duty to warn.”

On August 1, 2007, the Vatican Congregation for the Doctrine of the Faith released a response to questions concerning artificial nutrition and hydration, thereby reiterating Pope John Paul II’s affirmation that artificial nutrition and hydration should be considered basic care. In the third session, the students discussed this highly controversial issue.

Undergraduates Wrestle with Medical Ethics for a Day

The Center’s annual medical ethics conference was the inspiration for this 1-unit Practicing Medical Ethics course, offered each semester to Notre Dame undergraduate students. Because the Practicing Medical Ethics course is only a one-day event, whereas the Conference is a three-day event, students focus on three of the issues discussed at the conference.
It is our hope that this sample of the complex field of medical ethics will encourage students to pursue these issues – and other issues in medical ethics – in greater depth.

The spring course, offered on April 14th, was divided into three main sessions:

Session I: The “Pillow Angel” Case. In the past year, much attention in the media has been given to the case of Ashley, otherwise known as the “Pillow Angel.” Her parents pursued several treatments in order to make Ashley, who is severely mentally and physically disabled, more comfortable and so that they could better care for her.

Session II: Seriously Ill Infants. Much debate around the world surrounds how we should care for seriously ill infants, particularly those who are fated to die shortly after birth, and what their moral status is. In this session, students discussed the permissibility of infant euthanasia, early induction, palliative care, and life support for infants not for their own benefit, but so their organs can be harvested.

Session III: Mandatory Vaccination and Testing. Mandatory HPV vaccination became a controversial issue earlier this year when Texas governor Rick Perry introduced an executive order requiring HPV vaccination for all girls entering the sixth grade. In this session, students discussed this and other similar cases concerning mandatory vaccination and testing and issues of public health.

We are forever indebted to the generosity of Dr. Paul Wright, a cardiologist from Youngstown, Ohio, for graciously funding this course. Additionally, we are grateful to the alumni physicians and faculty members who so generously gave of their time to teach this course: Dr. Mark Lindenmeyer, a lawyer and hospital administrator in the Cincinnati area; Rev. Jim Foster, CSC, MD, director of the Preprofessional Studies Department at Notre Dame; Dr. Tom Murphy, a clinical endocrinologist, and his wife, Dr. Laura David, an OB/GYN, both professors at Case Western Reserve School of Medicine in Cleveland, Ohio; Kevin McDonnell, the Edna and George McMahon Chair in Philosophy at Saint Mary’s College; Rudy Navari, Director of the Walther Cancer Research Center at the Notre Dame; Paul McCauley, who runs a free clinic in Maryland; Keri Oxley, a Notre Dame graduate and current medical student at Yale University; and Center director David Solomon.

22nd Annual Clarke Family Medical Ethics Conference

March 23rd to 25th, approximately 80 physicians, philosophers, hospital chaplains, and other medical professionals gathered here at Notre Dame for the 22nd Annual Philip and Doris Clarke Medical Ethics Conference. The aim of the conference is to allow for discussion regarding some of the complex issues that plague the practice of medicine, in a setting not only where participants can come to a deeper understanding of Catholic teaching on these issues, but where diverse viewpoints can be shared, heard, and appreciated.

The conference’s traditional format involves several small-group discussions of case studies provided by members of the conference audience and reflecting current issues in medical practice. In one session, participants discussed three cases where various considerations external to the narrowly medical features of a treatment situation (such as finances or religious commitments) raised ethical questions for the physician acting in the case. In the next session, participants discussed a range of cases concerning requests from patients for treatments that are based on what some might regard as medically irrelevant conditions. For example, one case involved the much-publicized “Pillow Angel” case and in another case, a mother sought human growth hormone treatment for her “undersized,” but medically healthy, son to avoid psychological damage. In another session, attendees examined a series of cases involving reproductive health. As always, the conference included a discussion of recent initiatives in health care reform. In our final session, participants chose among three concurrent break-out sessions. In the first, we considered ethical issues concerned with using body parts either in artistic displays or in religious settings. The second engaged the ethical issues surrounding vaccinations and HIV testing, and in the third, we returned to the ethical dilemmas raised by medical treatment at the end of life.

The only formal lecture of this conference is the annual J. Philip Clarke Family Lecture on Medical Ethics. This year, it was delivered by Margaret Monahan Hogan, the McNerny-Hanson Chair of Ethics, professor of philosophy and Executive Director of the Garavanta Center for Catholic Intellectual Life and American Culture at the University of Portland. Professor Hogan has been a leading figure in Catholic medical ethics for many years, and has contributed in diverse ways to contemporary discussions in the field.

In Professor Hogan’s lecture, “Bioethics and its Gordian Knot,” she posited that, abortion as an elective surgical procedure – what has sometimes been designated as abortion on demand – is similar to the legendary Gordian Knot, which only Alexander the Great could untie by his famous solution: cutting through it with his sword. Professor Hogan explained how this Gordian Knot of bioethics had been tied by a set of Supreme Court decisions, rendered as a seeming compromise to protect a rising consciousness of the rights of women to be free to develop their potential. The knot was then woven by bonds fashioned and tightened by a set of claims – liberty claims and equality claims, enunciated by a regent liberal philosophy and sustained by judicial decree. Finally, the knot has been reinforced by practices – practices by many in the medical profession and by many women who chose abortion. Professor Hogan suggested that the sundering of this Gordian Knot has found no easy Alexandrine solution to loosen its hold on the American culture. She concluded her lecture, hailed by many as one of the best Clarke lectures in the history of the series, with the following words: “Part of the task is the essential work of building the culture of life. To build this culture requires our engagement in the intellectual controversies – if we think we hold the truth, we ought to fear no pursuit of knowledge. To build this culture requires our participation in the deliberations of the democracy and in its political processes – Catholics have a right in the public square as citizens and an obligation to be in the public square as Catholics – the former is a guarantee of the first amendment and the latter the command of Christ that we ‘render to Caesar the things that are Caesar’s.’ To build that culture finally requires that we make abortion unthinkable because it is unnecessary.”

As always, we are grateful to the Notre Dame Alumni Association, and in particular to Mirella Riley, director of the Academic Division, and administrative assistant Janet Miller, for their assistance in coordinating this conference.

Practicing Medical Ethics One-Credit course

Each semester the Center organizes a one-day medical ethics course designed to give undergraduates considering a vocation in health care the opportunity to engage in conversation with physicians, philosophers and theologians familiar with medical ethics. This fall, on Saturday, October 28th, despite it being the day of an away game against the Naval Academy, almost 100 undergraduate students left their big screen TVs to meet together, using the small-group discussion format of our Medical Ethics Conference, to discuss real case studies that they might encounter in their future medical practices. This semester, the cases focused on three major themes: the scope of a physicians’ responsibility in a world of increasing globalization; suffering, dying and death; and the challenge of achieving social justice in light of limited resources.

As in past years, we are indebted to the generosity of Dr. Paul Wright, a cardiologist from Youngstown, Ohio, for so graciously funding this course. Additionally, we are grateful to the alumni physicians and faculty members who so generously give of their time to mentor Notre Dame’s undergraduate students: Dr. Mark Lindenmeyer, a lawyer and hospital administrator
in the Cincinnati area; Rev. Jim Foster, CSC, MD, director of the Preprofessional Studies Department at Notre Dame; Dr. Carol Lydiatt, a pediatric anesthesiologist, of Omaha, Nebraska; Dr. Tom Murphy, a clinical endocrinologist, and his wife, Dr. Laura David, an OB/GYN, both professors at Case Western Reserve School of Medicine in Cleveland, Ohio; Yuri Maricich, a medical student at the University of Washington; and Center director David Solomon.

On Thursday, October 26th, as part of his visit to campus for this course, Dr. Wright gave a moving talk to a wider audience, including members of the South Bend community, regarding his experience as a personal physician to Mother Teresa. He has written about his relationship with Blessed Mother Teresa in his book, Mother Teresa’s Prescription: Finding Happiness and
Peace in Service.

21st Annual Clarke Family Medical Ethics Conference

During a quiet spring break week, the time-honored favorite of physicians and scholars, the 21st Annual Philip and Doris Clarke Family Medical Ethics Conference, was held March 17th through 20th at Notre Dame. Philosophers, theologians and legal scholars mixed with Notre Dame students, alumni physicians and health-care workers to explore a variety of issues ranging from the familiar case of Terri Schiavo to recent scandals in medical research and ripped-from-the-headline stories of the challenges facing medical care in emergency and disaster conditions.

The conference, as always, primarily consisted of several small-group discussions of case studies provided by members of the conference audience and reflecting current issues in medical practice. To start off the weekend, on Friday afternoon, Center director David Solomon chaired a session entitled, “Doctor’s Duties in Disasters,” which featured the failures in medical care observed during Hurricane Katrina and the challenges posed by a possible avian flu pandemic. The results of the small-group discussions were then highlighted in a plenary discussion with a panel consisting of Dr. Mark Siegler, professor at the University of Chicago and Director of the MacLean Center for Clinical Medical Ethics, Gilbert Meilaender, the Phyllis & Richard Duesenberg Professor of Christian Ethics at Valparaiso University, Alyssa Brauweiler, and Christina Holmstrom, both Notre Dame undergraduate students. During the plenary discussion, participants noted the importance of hope and resourcefulness and the necessity of heroism in disaster cases. Differences in worldviews and in concepts of virtue, limited financial resources, and even the finitude of human life were all highlighted as challenges to ethical care-giving in disaster situations.

The conference continued on late Friday afternoon with the annual J. Philip Clarke Family Lecture on Medical Ethics, delivered by John Robinson, J.D., Ph.D., associate dean and associate professor of law at the Notre Dame Law School. Robinson’s lecture was entitled, “The Three Deaths of Terri Schiavo: Cultural, Medical and Legal.” In his lecture, Professor Robinson first recounted the facts and legal history of the Terri Schiavo case. He then brought this background into focus by emphasizing the near-impossible task assigned to judges in end-of-life cases. Judges, he claimed, must mix the subjective preferences of the patient or the patient’s family with objective legal or statutory standards to determine the appropriate legal outcome in each particular case. He noted, however, that judges are particularly suited to this task and he expressed confidence in judges’ ability to do it well. As he stated, “all normative institutions [including the judiciary] need time to adjust to the radical novelty of contemporary end-of-life medical care.” The Clarke Lecture was followed by a reception and dinner in McKenna Hall.

After the day’s hard work, many attendees attended a beautiful mass in Alumni Chapel concelebrated by Rev. James Bresnahan and Rev. John Young, followed by dinner in the private dining rooms of the Morris Inn. The closing banquet contained a touching tribute to Judy Gibson and Kathleen Sullivan, who are no longer coordinating the conference for the Alumni Association. Judy and Kathy have organized this conference for many years and their presence, guidance and wisdom will be greatly missed. The conference concluded with a final session on Sunday morning, where the participants discussed a variety of topics in a roundtable format, with panelists Margaret Hogan, Tris Englehardt, John Robinson, Jorge Garcia, Kevin McDonnell and David Solomon. Other ethics consultants in attendance at the conference and not already mentioned were Corinna Delkeskamp-Hayes, Mark Jensen (the Center graduate assistant who selected and put together the packet of readings), and Center associate director Daniel McInerny.

As always, we are grateful to the Notre Dame Alumni Association, and in particular to our new partners, Mirella Riley, newly-appointed director of the Academic Division, and administrative assistant Janet Miller, for their tremendous help in coordinating this year’s conference.

National Undergraduate Bioethics Conference (NUBEC)

The weekend of March 10-11 marked the beginning of spring break here at Notre Dame. But instead of heading for the beach, over 100 Notre Dame students and 150 students traveling from other schools gathered in McKenna Hall to discuss the future of bioethics at the 9th Annual National Undergraduate Bioethics Conference (NUBEC), hosted by a group of undergraduate students, the Notre Dame Forum on Biomedical Ethics (FBE), and led by the Center’s own undergraduate assistant and FBE president, Kate Wilson. For the last seven years, FBE has been actively involved in the national undergraduate conference, hosting it in 2001 and sending Notre Dame students with a demonstrated interest in ethics to the conference each year. In the last several years, however, Notre Dame students became disheartened by the secular emphasis in the field of the national conferences and felt that their opinions were dismissed, not on merit, but because being from Notre Dame carried a certain “moral tendency.” In April 2005, a group of Notre Dame students traveled to Philadelphia to successfully propose that Notre Dame once again host the annual conference with the goal of placing a decisive emphasis on the demand that bioethical decisions be oriented within a conception of the human person; a conception that is not adequately supplied by secular ethics.

The conference, entitled “Health Care in an Increasingly Health-Obsessed Culture,” attracted many prominent physicians and distinguished bioethicists from across the nation to discuss the increasing cultural and societal focus on medicine. Dr. Paul McHugh, the Henry Phipps Professor of Psychiatry at Johns Hopkins University, gave an electric keynote presentation on the disordered state of the field of professional bioethics and the hope for revival through the model represented by the President’s Council on Bioethics, of which he is a member. Eric Cohen, director of the Bioethics & American Democracy Program at the Ethics and Public Policy Center and editor of The New Atlantis, spoke about the “dilemma of old age,” end-of-life care, and the grave problems posed by the dissolution of the family. Deirdre McQuade, director of planning and information for the United States Conference of Catholic Bishops’ Secretariat for Pro-Life Activities, illuminated the “ethical lenses” prevalent in media in discussions of pregnancy, abortion, and stem cell research.

Dr. Carl Elliott, professor at the University of Minnesota’s Center for Bioethics, gave an energetic presentation about the “invention and marketing” of illness. Dr.William Hurlbut of Stanford University, and member of the President’s Council on Bioethics, spoke movingly on the “transformation of medicine” and the way the central idea of healing has been displaced by increasingly perverse ideas of freedom. Carter Snead, associate professor at the Notre Dame Law School, capped off the weekend with his fast-paced discussion of the role of the law in bioethics, the deep connection between the legal and the moral, and the “10 rules of engagement” that are fundamental to reforming the field of bioethics. Finally, at the closing banquet, Dr. Paul Wright spoke to a captivated audience of his years working with Mother Teresa and her “prescription” for life.

The variety of topics and perspectives, and the number of prominent figures from bioethics fields, combined to make the 9th Annual National Conference one of the best in years. While attracting these prominent professionals, the conference maintained its decided emphasis on undergraduate participation, presentation, and involved learning. Not only did several undergraduates present their papers, but they also served on panel discussions and led discussion groups, which all testified to the quality and professionalism of undergraduate work in bioethics. This conference was instrumental to increasing student awareness of and involvement in issues of bioethics.

Through the generous support of the Strake Foundation, the Pfizer Foundation, Mr. Thomas Abood of Minneapolis, MN, Mr. and Mrs. Thomas and Dorothy Gray of Dumfries, VA, and the Fighting Irish football fans who purchased food from the FBE concession stand, the entire conference was available to the Notre Dame community at no cost. Through the continued support of the Notre Dame Center for Ethics and Culture, the undergraduates of the Forum on Biomedical Ethics have big dreams for their organization. FBE was originally established to create a campus-wide forum for student discussion of biomedical ethics and to foster education and awareness of the scientific, religious, cultural, legal and economic implications of current issues in biomedical ethics. Hosting the national conference was certainly a successful step in achieving these goals. Next they intend to launch a website to serve as the hub for all undergraduate medical organizations on campus. With the collaboration of alumni in the medical field and “The Pathos Project” (recently begun by Notre Dame graduates currently in medical school, Yuri Maricich, Keri Oxley, and Phil Slonkowski), the website will provide essential readings in ethics, an online forum with a different topic each month, and resources for internships and graduate programs in the field.

Speaking Truthfully about Stem Cell Research and Human Cloning

There is at present no issue in biomedical ethics more fraught with misconceptions and exaggerated expectations than the field of stem cell research, especially research involving human embryos. To help us separate the facts from the fiction, the Center called upon Carter Snead, associate professor at the Notre Dame Law School, to deliver our semi-annual Schmitt Lecture, which was entitled: “Speaking Truthfully About Stem Cell Research and Human Cloning.” Professor Snead’s lecture was delivered on Wednesday afternoon, November 16, 2005, to a large crowd in the main auditorium of McKenna Hall at Notre Dame.

Professor Snead is uniquely qualified to discuss the moral, scientific and legal ramifications of stem cell research and human cloning. Before joining Notre Dame’s law faculty this year, Professor Snead was general counsel for President Bush’s Council on Bioethics. While serving on the Council, Professor Snead advised its members on the legal and public policy dimensions of numerous ethical questions arising from advances in biomedical science and biotechnology. He was the principal drafter of the Council’s 2004 report, “Reproduction and Responsibility: The Regulation of New Biotechnologies,” a comprehensive critical assessment of the governance (both public and private) of the activities at the intersection of assisted reproduction, human embryo research, and genetics.

In his energetic and engaging lecture, Professor Snead argued that, contrary to much popular rhetoric, science itself provides no answer to the moral question of whether it is licit to do research on human embryos or to clone human beings. He further claimed that the best moral argument for the maximal protection of the embryo was based on equality, claiming further that this was not a religious argument, but one accessible to all in the public debate.

The aim of the Schmitt Lecture Series—which in the past has featured such distinguished lights as Gilbert Meilaender, Mark Siegler, Paul Griffiths, Stanley Fish, Jean Bethke Elshtain, and Michael Baxter—is to provide an occasion to reflect on the ethical, political and religious dimensions of science and technology. It is difficult to imagine a topic which answers more directly to the charge of the Schmitt Lecture than the topic discussed by Professor Snead.

The lecture was well-attended by Notre Dame’s Schmitt Fellows, those graduate students in the Schools of Science and Engineering who are the principal recipients of the generosity of the Arthur J. Schmitt Foundation to the University of Notre Dame. It was for the sake of honoring that generosity that the Schmitt Lecture Series was founded.

A reception immediately followed the lecture in McKenna Hall, and then a special group of Center guests, including the Schmitt Fellows and a cross-section of Notre Dame faculty, convened at the Morris Inn for a dinner in honor of Professor Snead. After dessert, Professor Snead generously agreed to take more questions from the audience. In this lively question-and-answer period, we were especially pleased to see how many of those questions came from Schmitt Fellows, who found this topic deeply compelling. In the end, the day was a great success, and a fitting tribute to Arthur J. Schmitt’s desire to help form young persons in the fields of science and engineering not only as people of technical expertise, but also as moral leaders in their fields.