Conscience, Caricatures, and Catholic Identities.

Catholic health care is often viewed as antithetical to secular conceptions of autonomy. This view can engender calls to protect "choice" in Catholic facilities. However, this view is built on a fundamental misunderstanding of the Ethical and Religious Directives for Catholic Health Care Services (ERDs). This commentary, which responds to "Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience," by Abram Brummett et al., seeks to demonstrate the nuance of the ERDs as well as to address some of the challenges various Catholic identities have when interpreting and living out the ERDs so that all patients receive high-quality, compassionate care. By highlighting the Church's desire to protect all people at every stage, I hope to dispel the caricatures that often result from misunderstandings by Catholics and non-Catholics alike.

Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience.

"Conscientious provision" refers to situations in which clinicians wish to provide legal and professionally accepted treatments prohibited within their (usually Catholic) health care institutions. It mirrors "conscientious objection," which refers to situations in which clinicians refuse to provide legal and professionally accepted treatments offered within their (usually secular) health care institutions. Conscientious provision is not protected by law, but conscientious objection is. In practice, this asymmetry privileges conservative religious or moral values (usually associated with objection) over secular moral values (usually associated with provision). In this article, we first argue for a legal right to one kind of conscientious provision: referral for procedures prohibited at Catholic hospitals. We then argue that a premise in that argument-the principle of comparably trivial institutional burdens-justifies legal protections for some additional forms of conscientious provision that include, for example, writing prescriptions for contraception or medical abortions. However, this principle cannot justify legal protections for other forms of conscientious provision, for instance, the right to perform surgical abortions or gender-affirming hysterectomies at Catholic hospitals.

Holy Medicine: Patron Saints of Wounds Due to Animal Bites.

The cult of saints in Western Europe developed during the late period of antiquity and the early Middle Ages. Their importance to European society was undeniable; holy medicine was the only hope for people, because there were no doctors. The number of saints had increased over the years, and people sought medical help from them through prayer and other religious practices. Some of the saints became "specialized" in treating various wounds and dermatologic diseases. During our research, we tried to determine whether the cult of saints led to the develop-ment of hospitals that treated skin diseases, as discovered in the Hospital Brother of Saint Anthony. A large number of saints who were patrons of wounds and skin diseases were collected in three studies. In the first report, we presented a great number of saints who were patrons to treat animal bites. The second report presented patron saints of wounds, ulcers, burns, and frostbites; and the third report decsribed saints who treated contagious diseases (such as ergotism, leprosy, and scabies). The phenomenon of holy medicine is part of the history of dermatology and is important due to "specializations," which refer to an understanding of skin diseases and the methods of treating various wounds and dermatologic diseases.

Faith and Health in Israel, Türkiye and the USA.

This issue of JORH focuses upon faith and health within three nations that have contributed a great deal in terms of religion and health research during this century-namely Israel, Türkiye and the USA.

Ethical Issues in the Care of Patients Whose Personal, Religious, or Cultural Beliefs Impact Clinical Management Strategies.

Ethical principles regarding respect for patient autonomy in medical decision-making and the impact of religion, culture, and other issues on clinical care have been extensively reviewed in the medical literature. At the same time, despite physicians having an understanding of the underlying ethical principles in clinical decision-making, challenges arise when managing complicated clinical problems for which medical treatment is available, but not acceptable to the patient. For example, many anesthesiologists are challenged when caring for one of Jehohah's Witnesses who refuses to receive blood or blood products despite the potential consequences of doing so.

The Opioid Epidemic and Faith-Based Responses in Southern Appalachia, USA: An Exploration of Factors for Successful Cross-Sector Collaboration.

This study aimed to identify factors for successful cross-sector collaboration with faith-based responses to the opioid epidemic in southern Appalachia. In-depth interviews were conducted with representatives from organizations responding to the opioid epidemic (N = 25) and persons who have experienced opioid dependency (N = 11). Stakeholders perceived that collaboration is hindered by stigma, poor communication, and conflicting medical and spiritual approaches to opioid dependency. Collaborations are facilitated by cultivating compassion and trust, sharing information along relational lines, and discerning shared commitments while respecting different approaches. The study concludes with theoretical and practical implications for both religious leaders and potential cross-sector collaborators.

Catholic religious agency during the Covid-19 emergency: the issue of vaccines.

The Catholic Church's reflection on and assessment of the Covid-19 pandemic has developed in several areas. Inspired by the tradition of its social teaching, specifically by the values of the dignity of the human person, justice, solidarity, and the common good, a strong sense of responsibility-on the part of all to prevent the spread of the pandemic and care for the affected sick-was called for. This resulted in a series of interventions and documents on the various medical and spiritual issues involved, particularly concerning the vaccines again Covid-19. In this short article, I draw out these insights from the official and universal reference point of the Catholic Church (i.e., Vatican sources in their various expressions and expertise). Interventions from other religions have also played a significant role during the Covid-19 pandemic as exemplified by the close relationship between certain religious actors and the World Health Organization. However, these alternative viewpoints, while important in and of themselves, do not find a suitable place within this work, which focuses on the Catholic Church's perspective.

Road To Deceased Donor Transplantation in Egypt.

In Egypt, there is presently a growing need to have a deceased donor transplant program. Egypt conducted its first kidney transplant from a living donor in 1976 and a first partial liver transplant in 2001. Since 2009, the Egyptian Health Authorities Combat Transplant Tourism in concordance with ethics codes and the Declaration of Istanbul Custodian Group has been in place. The Egyptian Transplantation Law of 2011 mentions that organs could be procured from deceased donors based on a will and on family consent. This law has had many critics, including religious authorities who have stressed that organs cannot be taken from a person with brain death because, in their view, life ends with death of all organs. Many intensivists disagree over the definition of death. In addition, the media has communicated contradicting and sometimes misleading health care information. Mummification is rooted in pharos practice and linked to religious beliefs. The ancient Egyptians believed that, by burying the deceased with their organs, they may rejoin with them in the afterlife. Since 2019, the transplant community in Egypt has started collaborations with international transplant organizations and campaigns with doctors and celebrities to donate their organs after death, which have stressed that a deceased donor program could help against end-stage organ mortality. In November 2022, after communications with politicians, President Abdelfattah El Sisi directed the government to establish a regional center for organ transplantation, which aimed to be the biggest in the Middle East and North Africa region. The new center will be part of a new medical city that would replace Nasser Medical Institution in Cairo, Egypt. The Ministry of Health issued an official form to be signed by a person before his death, accepting use of organs, to give hope and support to other patients in need.

Evolution of the Concept of Death.

The definition of death remains unresolved. To define death, one has to define the characteristics of a living person and to confirm whether an individual with brain death fulfils any of these characteristics. Although the concept of irreversible cessation of brain function is clear, controversy remains on the treatment of individuals with brain death and beating hearts. An individual with brain death but a beating heart is not breathing on his own and is dependent on medications and machines to maintain respiration, heartbeat, and blood pressure. Muslim scholars remain divided over the issue of whether death also means irreversible cessation of brain function. Questions remain on when it is permissible to remove vital organs for organ transplant. Groups have advocated for uniformity in law and medical practice on the definition of brain death.

Organ Donation in Syria.

The first living donor kidney transplant in Syria was performed 44 years ago; by the end of 2022, 6265 renal transplants had been performed in Syria. Kidney, bone marrow, cornea, and stem cells are the only organs or tissues that can be transplanted in Syria. Although 3 heart transplants from deceased donors were performed in the late 1980s, cardiac transplant activities have since discontinued. In 2003, national Syrian legislation was enacted authorizing the use of organs from living unrelated and deceased donors. This important law was preceded by another big stride: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the law was enacted, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to <2% in 2007. Rates plateaued through 2010, before the political crisis started in 2011. Forty-four years after the first successful kidney transplant in Syria, patients needing an organ transplant rely on living donors only. Moreover, 20 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be factors inhibiting initiation of a deceased donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.

The Scientist, the Therapist, and the Conspiracy Theorist: Three Responses to the COVID-19 Pandemic Within the Ultra-orthodox Jewish Revival Movement in Israel.

This article examines the responses of three rabbis to the Coronavirus (COVID-19) pandemic in Israel and the distinctive approach and strategy expressed by each of them: (1) rational-scientific, (2) emotional support, (3) resistance and distrust. The first two rabbis maintain that they trust the medical institutions and the government, whereas the third rabbi evinces distrust, expressed through conspiracy theories. These different approaches can be explained by their dispositions prior to the pandemic, which were exacerbated by the Coronavirus. Hence, COVID-19 served as more of a reflecting phenomenon than an agent of change. Analyzing the dispositions of the three rabbis can show us how they are related to two significant forces of the twentieth and twenty-first centuries-science (rational-scientific and resistance and distrust) and psychology (emotional support). Psychological discourse has been used to promote public health. On the other hand, the scientific discourse has been used to promote adherence to government and health ministry directives, as well as to oppose those directives.

Assessing the Variability in Interpretation of the Catholic Directives Pertaining to Reproductive Health Services: An Exploratory Qualitative Study of Two Hospitals on the American East Coast.

The ethics in Catholic hospitals are guided by the Ethical and Religious Directives for Catholic Health Care Services, which provide direction on many topics, including family planning. Previous research has demonstrated there is variability in the availability of prohibited family planning services at Catholic hospitals. This study aims to research a potential source of variability in interpretation and application of the directives through interviewing ethics committee members. Participants were recruited from two different hospitals on the east coast with a total sample size of eight. Ethics committee members were asked questions regarding their personal approach to ethics, their hospital's approach to ethics, and the permissibility of specific family planning methods at their hospital. Most ethics committee members stated that the Catholic faith and/or directives were important in their hospitals' approach to ethics. Most participants stated that they had instances in which their personal approach to ethics conflicted with their hospital's approach, citing women's health and end-of-life care as common causes of conflict. All but one ethics committee member stated that hormonal contraception was forbidden under the directives; however, many members stated that this was either a gray area or permissible under certain circumstances. Reproductive health issues rarely came before the ethics committee at either site with one participant referring to them as "black and white issues." This research suggests that ethics committee members did not see the directives governing family planning services to be ambiguous. However, given the low frequency in which these issues come to the attention of the ethics committee, it is difficult to determine whether the opinions expressed by our participants contribute to the variability between Catholic hospitals when it comes to reproductive healthcare provision. An interesting topic for future research would be interviewing executives at Catholic hospitals to determine where this variability arises.

Impact of Ramadan fasting on lipid profile, uric acid, and HbA1c in CKD: A systematic review and meta-analysis.

Studies have shown that fasting during Ramadan has different effects on circulating levels of several biochemical markers. This study aims to conduct a comprehensive evaluation of studies related to the effect of fasting in the holy month of Ramadan on lipid profile, uric acid, and HbA1c in CKD patients. Studies were systematically searched and collected from three databases (PubMed, Scopus, and Web of Science). After screening, the quality and risk of bias assessment of the selected articles were evaluated. Study heterogeneity was assessed using the Cochrane test and I² statistic. In case of any heterogeneity random effects model with the inverse-variance method was applied. All analyses were performed using STATA software version 16. Four observational studies were included in this study. The results of this meta-analysis were that cholesterol (Weighted mean differences (WMD):0.21 with 95% CI:-0.09-0.51 (P-value=:0.18)), LDL (WMD:0.06 with 95% CI -0.24-0.36 (P-value:0.69)), triglyceride (WMD:0.05 with 95% CI:-0.25-0.35 (P-value:0.73)) had not-significant increase. Uric acid (WMD: -0.11 with 95% CI: -0.42-0.21 (P-value:0.51)) and HbA1c (WMD: -0.22 with 95% CI: -0.79-0.36 (P-value: 0.46)) show a non-significant decrease. The results of the analyses did not report significant changes in the lipid profile, uric acid, and HbA1c in CKD patients after Ramadan fasting.

Nurses, Clergy, Chaplains, Parkinson's Disease, Workplace Religiosity, Women's Health and Family Issues.

This issue of JORH explores a broad range of topics looking at the professions of nursing, clergy and chaplains. This issue also concludes the series on Parkinson's disease (Part 2), and for the first time, JORH presents a collation of articles relating to workplace religiosity. Finally, this issue revisits the topics of women's health and family issues in relation to religiosity and spirituality.

Lived Religion in Religious Vaccine Exemptions.

This essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of religious vaccine exemptions. The author contends that broadening the meaning of religion by employing the concept of lived religion would promote a more inclusive and equitable implementation of religious vaccine exemptions.

Digitising diabetes education for a safer Ramadan: Design, delivery, and evaluation of massive open online courses in Ramadan-focused diabetes education.

AIMS: Ramadan-focused diabetes education is critical to facilitate safer Ramadan fasting amongst Muslim people living with diabetes. We present the design, delivery, and evaluation of two parallel massive open online courses (MOOCs) in Ramadan-focused diabetes education for people with diabetes and HCPs. METHODS: Two Ramadan-focused diabetes education MOOCs were developed and delivered for Ramadan 2023: one for HCPs in English, and another for people with diabetes in English, Arabic and Malay. A user-centred iterative design process was adopted, informed by user feedback from a 2022 pilot MOOC. Evaluation comprised a mixed-methods evaluation of pre- and post-course user surveys. RESULTS: The platform was utilised by people with diabetes and their family, friends and healthcare professionals. Overall, a total of 1531 users registered for the platform from 50 countries, 809 started a course with a 48% subsequent completion rate among course starters. Qualitative analysis showed users found the course a user-friendly and authoritative information source. In the HCP MOOC, users reported improved post-MOOC Ramadan awareness, associated diabetes knowledge and ability to assess and advise patients in relation to their diabetes during Ramadan (p<0.01). CONCLUSIONS: We demonstrate the potential of MOOCs to deliver culturally tailored, high-quality, scalable, multilingual Ramadan-focused diabetes education to HCPs and people with diabetes.