The Power of Proximity: Toward an Ethic of Accompaniment in Surgical Care.

Although the field of surgical ethics focuses primarily on informed consent, surgical decision-making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment. The ethic of accompaniment is born from a theological tradition that has motivated work to improve health outcomes in those at the margins through its emphasis on listening, solidarity against systemic drivers of disease, and proximity to individuals and communities. Through a review of surgical ethics and exploration of a central patient case, we argue for applying an ethic of accompaniment to the care of surgical patients and their communities.

Building Caregiver Resiliency in Global Health: Embodying the Catholic Social Tradition in the Face of COVID-19.

For international healthcare NGOs, the impact of the COVID-19 pandemic has been significant. Healthcare workers in both LMICs and high-income countries have described the impact of the pandemic as traumatic. This article focuses on one initiative designed to address this impact: CMMB's Building Resiliency program. This article provides an overview of the structure and content of program, situating it within the landscape of global mental healthcare disparities and caregiver trauma. Designed to address caregiver mental health in Peru, Haiti, Kenya, South Sudan, and Zambia, the program sought to offset global mental healthcare disparities by bringing needed psycho-social-spiritual support to CMMB staff. It was intentionally shaped by the commitments of Catholic social thought-particularly to the well-being, dignity, and integral human development of CMMB staff members, to envisaging new forms of solidarity, and to prioritizing subsidiarity and participation. Theories of post-traumatic growth provided the theoretical framework for three remotely delivered seminar series, which made space for staff members to share their stories with their colleagues, to build community, to foster creativity and hope, and to intentionally integrate faith and spirituality into both personal self-care as well as the common life of the organization. Thus, this was designed equally to build the organizational resiliency that is the fruit of Catholic social thought. For attending to caregivers' mental health and well-being is crucial not only for the success of medical missions but for embodying and witnessing the Catholic commitment to the human dignity and the integral development of those who do the work of our organizations.

From the Anticipatory Corpse to the Participatory Body.

Jeffrey Bishop's The Anticipatory Corpse demonstrates how death is present in and cloaked by contemporary practices of end-of-life care. A key to Bishop's argument is that for modern medicine the cadaver has become epistemologically normative and that a metaphysics shorn of formal and final causes now shapes contemporary healthcare practices. The essays of this symposium laud and interrogate Bishop's argument in three ways. First, they raise critical methodological challenges from the perspectives of human rights, Charles Taylor's concept of social imaginaries, and economics. Second, they demonstrate the analytical power of his argument by detailing how it might be extended to additional issues beyond simply end-of-life care and how it might be brought into conversation with sociology. Third, they engage the constructive turn Bishop takes at the end of the book. Bishop himself also updates readers on the reception of The Anticipatory Corpse, as well as the way his thinking has evolved over the past 5 years since its publication. He also engages the questions, challenges, and openings provided by our authors.

Treatment of asthma exacerbations with the human-powered nebuliser: a randomised parallel-group clinical trial.

BACKGROUND: Nebulisers aid the treatment of respiratory diseases, including asthma, but they require electricity and are often cost-prohibitive for low- and middle-income countries. AIMS: The aim of this study was to compare a low-cost, human-powered nebuliser compressor with an electric nebuliser compressor for the treatment of mild to moderate asthma exacerbations in adults and children. METHODS: This was a non-blinded, parallel-group, equivalence study, with 110 subjects between 6 and 65 years of age, conducted in the emergency department of a district hospital in Ilopango, El Salvador. Participants were assigned by random allocation to receive a 2.5-mg dose of salbutamol from the experimental human-powered nebuliser or the electric nebuliser control. All assigned participants completed treatment and were included in analysis. The study was not blinded as this was clinically unfeasible; however, data analysis was blinded. RESULTS: The mean improvement in peak flow of the experimental and control groups was 37.5 (95% confidence interval (CI) 26.7-48.2) l/min and 38.7 (95% CI, 26.1-51.3) l/min, respectively, with a mean difference of 1.3 (95% CI, -15.1 to 17.7) l/min. The mean improvement in percent-expected peak flow for the experimental and control groups was 12.3% (95% CI, 9.1-15.5%) and 13.8% (95% CI, 9.8-17.9%), respectively, with a mean difference of 1.5% (95% CI, -3.6 to 6.6%). CONCLUSIONS: The human-powered nebuliser compressor is equivalent to a standard nebuliser compressor for the treatment of mild-to-moderate asthma. (Funded by the Opus Dean's Fund, Marquette University College of Engineering; ClinicalTrials.gov NCT01795742.).

Docile bodies: transnational research ethics as biopolitics.

This essay explores the claim that bioethics has become a mode of biopolitics. It seeks to illuminate one of the myriad of ways that bioethics joins other institutionalized discursive practices in the task of producing, organizing, and managing the bodies-of policing and controlling populations-in order to empower larger institutional agents. The focus of this analysis is the contemporary practice of transnational biomedical research. The analysis is catalyzed by the enormous transformation in the political economy of transnational research that has occurred over the past three decades and the accompanying increase in the numbers of human bodies now subjected to research. This essay uses the work of Michel Foucault, particularly his notion of docile bodies, to analyze these changes. Two loci from the bioethics literature are explored-one treating research in the United States and one treating research in developing countries. In the latter, we see a novel dynamic of the new biopolitics: the ways in which bioethics helps to create docile political bodies that will police themselves and who will, in turn, facilitate the production of docile human bodies for research.

Practicing the Order of Widows: a new call for an old vocation.

This essay argues for a renewed institution of an ancient Christian practice, the Order of Widows. Drawing on the Roman Catholic tradition's recent writings on the elderly, particularly the 1998 document from the Pontifical Council for the Laity entitled "The Dignity of Older People and their Mission in the Church and in the World," I argue that we find within the Roman Catholic tradition advocacy for a renewed understanding of the vocation of the elderly within the Church. Building on this, I then trace in the broadest of outlines some elements of what a renewal of the Order of Widows might look like. In doing so, it becomes clear how this new ecclesial practice addresses health issues of older women (devaluation, marginalization, loss of voice, impoverishment, debilitation, loneliness, isolation, and euthanasia). More importantly, such a practice moves beyond principles to demonstrate a concrete alternative. As such it would provide a powerful witness to the very culture the Church seeks to transform.

Respect: or, how respect for persons became respect for autonomy.

This article provides an intellectual archeology of how the term "respect" has functioned in the field of bioethics. I argue that over time the function of the term has shifted, with a significant turning point occurring in 1979. Prior to 1979, the term "respect" connoted primarily the notion of "respect for persons" which functioned as an umbrella which conferred protection to autonomous persons and those with compromised autonomy. But in 1979, with the First Edition of Principles of Biomedical Ethics by Beauchamp and Childress, and the report of the Ethical Advisory Board (EAB) of the (then) Department of Health, Education, and Welfare entitled Research on In Vitro Fertilization, usage shifts from "respect for persons" to "respect for autonomy." Two results: 1) those with compromised autonomy are no longer protected by the canons of "respect" but rather the less overriding canons of beneficence; and 2) the term "respect" functions increasingly as a rhetorical device in public bioethics discourse.