We appreciate Paul Hoaken's comments. Classic philosophical conceptions of autonomy present the rational, dispassionate individual as the ideal decision-maker. Many current ethical perspectives recognize and validate the role that emotional, relational and spiritual factors play in autonomous decision-making. We argue that Protestant ideas have played an important role in promoting this broader understanding of autonomy. We did not mean to imply that other traditions and viewpoints, including those advocated by humanists, have not also played an important role, or that acceptance of Protestant beliefs is a necessary prerequisite for the moral life.

With regards to Lynette Sutherland's concerns, we have used the word casuistry in a descriptive manner to refer to a form of moral reasoning that is case-based and is historically associated with the Catholic Church. Our use of the term reflects its current use in the bioethics literature,^1,2 and was not meant to carry a negative connotation.

Merril Pauls Emergency Physician Queen Elizabeth II Health Sciences Centre Dalhousie University Halifax, NS Roger Hutchinson Principal and Professor of Church and Society Toronto School of Theology University of Toronto Toronto, Ont.