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Topic: Fertility
March 20, 2014 | Posted By Lisa Campo-Engelstein, PhD

While assisted reproductive technologies (ART) are common in most “developed” countries (the global North), in the global South (“developing” countries), ART is generally not available for a variety of reasons, most of which center around money. These resource-poor countries typically lack both qualified health-care professionals and facilities necessary for ART. Although some countries do have ART centers, the cost of ART is prohibitive for all but the extremely wealthy. Indeed, infertility is usually seen as a treatable problem only for the upper class primarily because the poor cannot afford basic health care let alone expensive treatment like ART. The fact that the majority of people in the global South cannot afford basic health care, which is typically seen as the top priority in health-care allocation, is another reason why ART are not readily available in the global South. Most public and private health-care funding goes toward primary care and not treatments that are often seen as elective and cosmetic, like ART.

Yet, infertility can be considered a health problem according to the World Health Organization's broad definition of health – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Infertility in the global South can have severe and interrelated social, economic, and health-related consequences for women. This is still the case when the woman is physiologically fertile but her partner has male factor infertility; she is the one who is generally blamed for the couple’s inability to have a biological child.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

November 21, 2013 | Posted By Lisa Campo-Engelstein, PhD

As I’ve mentioned in a previous blogs, men only have 2 contraceptive options—male condom and vasectomy—and neither are long-acting reversible contraceptives. If more male contraceptives were developed, would men use them? Some empirical research shows many men would, especially young, urban, and educated men. Yet, skeptics say men don’t value pregnancy prevention to the same degree that women do so they won’t be motivated to use male contraception. Another common reason given for why men wouldn’t use male contraceptives is the fear that these contraceptives will emasculate them. Here I will discuss three social beliefs that contribute to this fear. 

First, many men believe that testosterone is a crucial factor in what makes them men. Though certain levels of testosterone in the body do result in what are usually classified as masculine characteristics, such as more body hair, more muscle tone, deeper voice, aggressive behavior, and stronger sex drive, the category ‘men’ is not just a biological one, it is also a social one. There are many cultural beliefs about what it means to belong to the category ‘men,’ one of which is that men have an uncontrollable libido. Most men want and feel pressured to adhere to these dominant conceptions of masculinity so that they are considered “real” men. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

Testicular tissue cryopreservation is a neglected topic in the fields of fertility preservation and bioethics not only because reproduction is usually associated with women and girls, but also because sperm banking is an established, easy, and cheap method that works for the majority of male cancer patients. However, norms surrounding fatherhood are changing, with more men interested in active fatherhood, and consequently fertility preservation is becoming and will continue to become increasingly important to male cancer patients.

When compared to the number of studies demonstrating the importance of fertility to female cancer patients, the literature focusing on male cancer patients’ perspectives on fertility is minimal. However, there are more researchers examining the latter topic today than in the past. Contemporary research on gendered perspectives on fertility preservation reveals a shift over time: although older studies generally found that female cancer patients value their fertility

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 9, 2013 | Posted By Marleen Eijkholt, PhD

Sarah is 10 years old and has cancer. She has lymphoblastic lymphoma, an aggressive form of non-Hodgkin lymphoma. News reports suggest that her parents and Sarah herself, decided to stop chemo treatment. “Sarah’s father said she begged her parents to stop the chemotherapy and they agreed after a great deal of prayer”. Sarah and her family are Amish. Reports note that they refused chemobecause the side effects made Sarah horribly sick, and that she was worried about losing her fertility. They decided to use a doctor who would attempt to treat the cancer with natural medicines, like herbs and vitamins. 

Over the last couple of days, their court battle has been outlined in the media. The hospital, where Sarah had been treated with chemotherapy, had applied for limited guardianship.  Guardianship would allow them to ‘force’ chemo therapy on her, particularly as they estimated her chance of long-term survival around 85% after treatment. Initially, this guardianship request was refused on grounds that it was the parents’ right to end treatment, while on appeal the judge ruled her best-interest had to be reconsidered. However, the most recent judgment reasoned that the parents were concerned and informed, that they have a right to decide about treatment for their child, that there was no guarantee for success of the chemo, and that guardianship & treatment would go against the girl’s wishes as it could cause her infertility. Guardianship was refused; Sarah’s health is governed by her parents.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

August 23, 2013 | Posted By Lisa Campo-Engelstein, PhD

Unlike organs, the U.S. allows gametes to be purchased. Given this dichotomy between the legal treatment of gametes and the legal treatment of organs, the question then arises: how should we legally classify ovaries, which can be used to treat both reproductive conditions (infertility) and non-reproductive conditions (premature menopause)?  

I believe ovarian tissue should be aligned with gametes rather than organs. I recognize that this leads to concerns about the sale of ovarian tissue (e.g., price, access, limitations, etc.). However, ovarian tissue like gametes and unlike other types of transplant, can lead to pregnancy, a socially and ethically important difference. The potential to create a new life is significant because new life often engenders new relationships and legal responsibilities. Whereas organ donors, both living and cadaveric, can remain anonymous, gamete donors typically cannot, at least not fully anonymous. Gamete donors are generally required to provide personal information on a variety of topics, such as physical characteristics, family medical history, religion, personal achievements, and personality traits. Potential recipients (and fertility centers) are usually the only ones who have access to this personal information. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

July 25, 2013 | Posted By Benita Zahn, MS

The law in the United States is clear that once a person has completed their prison sentence and parole they are free to go on and live their lives. The state does not have continued control over them. While some might argue that for sex offenders and regulations regarding where they may live impinges on this, that narrow issue is not the focus of this paper. I will argue that castration, chemical or physical, is antithetical to our society. 

The eighth amendment prohibits cruel and unusual punishment. Mutilation would be considered cruel and unusual punishment and castration clearly falls under that banner. It involves a surgical procedure to remove the testicles or in women, the removal of their ovaries. One need to look no further than to realize physical castration to control sexual predators should not be permitted.    

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

June 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

One of the major concerns with human egg donation is that there is no federal or systematic oversight. The UK has the Human Fertilisation and Embryology Authority (HFEA) that regulates the use of gametes and embryos for fertility treatment and research. In contrast, the US is the “Wild West” when it comes to reproductive medicine as we lack any real regulation in this field (there are soft policy guidelines from various medical and scientific organizations but these don’t have teeth). 

Without any oversight, many concerns are raised about the screening of donors. For example, women can donate at multiple centers without any of the other centers knowing. There are no good studies on the effects of donating eggs numerous times, but many believe it could be detrimental to women’s health. Another problem with women donating to multiple centers is that if their eggs are to be used for research purposes, it could lead to less diversity in the research sample. If their eggs are being used for reproductive purposes, then there is a greater chance of creating many half-siblings. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

May 22, 2013 | Posted By Benita Zahn, MS

In their 2012 article "Preserving the Right to Future Children: An ethical Case Analysis" the authors apply a principalist approach to the ethical analysis of a mother’s decision to allow her 2 year old daughter, Daisy, to undergo OTC to preserve her fertility following stem cell transplant to treat her severe Sickle Cell disease.

While this approach gives one clear parameters to make ethical decisions by identifying issues of autonomy, non-maleficence, beneficence and justice, it does not adequately provide for the contextual issues surrounding such an emotionally charged decision and thus may miss crucial points.  A narrative ethics approach would better identify the contextual issues and create an environment for those issues to be factored into the decision. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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