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Topic: Reproductive Medicine
July 29, 2014 | Posted By Lisa Campo-Engelstein, PhD

The goal of the Bill & Miranda Gates Foundation Family Planning program is “to bring access to high-quality contraceptive information, services, and supplies to an additional 120 million women and girls in the poorest countries by 2020 without coercion or discrimination, with the longer-term goal of universal access to voluntary family planning.”  This is an extremely important endeavor and I'm glad that this program is devoting so many resources to achieving its goal. 

MicroCHIPS, a company based in Lexington Massachusetts, is one of the companies/organizations working with the Bill & Melinda Gates Foundation Family Planning program. They are developing a contraceptive chip that can be implanted under a women's skin. The chip, just 20 x 20 x 7 millimetres, would deliver daily dose hormones and could last up to 16 years. The chip will be controlled by remote control so that if a woman decides she wants to become pregnant, she can deactivate the chip. When she wants to resume contraceptive use, she can reactivate the chip.

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 16, 2014 | Posted By Lisa Campo-Engelstein, PhD

In a recent blog, I asserted that assisted reproductive technology (ART) should be a higher priority for the global South because of the severe health, social, and economic effects infertility can have on women there. The most common response to this claim is that resources should first be devoted to treating and preventing life-threatening conditions, such as malaria and HIV/AIDS, rather than conditions that are perceived as merely social and/or psychological. The same response is often used when people suggest that ART should receive higher priority in the global North. Whereas many global North countries provide national health coverage for ART, the US does not. However, there has been movement toward coverage for ART in the US in the last couple of decades and currently 14 states require health insurance companies to cover ART (though there is a wide range of what is covered and under what circumstances). Unfortunately, oncofertility (fertility preservation for cancer patients) is not covered in any of these state laws.

While I understand the argument that limited healthcare resources should be dedicated to the most "pressing" conditions, it is also important to recognize the potential side effects of choosing not to provide coverage for oncofertility and other types of ART. One concern with the lack of coverage for ART is that it reinforces socioeconomic inequalities. The primary users of ART are white, educated, middle- and upper-class not because this group is the most likely to be infertile, but because they are the most likely to be able to afford the high cost of ART out-of-pocket expenses. Cancer patients from lower socioeconomic backgrounds are unlikely to have the large amount of disposable funds (the average cost for one cycle of IVF is around $12,400) for fertility preservation treatment. While “traditional” infertility patients can save their money over a period of time in order to be able to afford ART, cancer patients need to preserve their fertility before their cancer treatment commences and thus they need to be able to immediately provide the cash for fertility preservation treatment in order for it to occur. 

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 29, 2014 | Posted By Marleen Eijkholt, PhD

Imagine you or your partner want to take your placenta home after birth. You feel that the placenta is part of your (partner’s) body and you should be allowed to take it home.  Maybe to eat it: ‘I ate my wife's placenta raw in a smoothie and cooked in a taco’ (Guardian 30 April 2014) or to bury it for cultural reasons, as protection of the soul and the newborn (LA times 31 December 2013). In Oregon you are legally allowed to take it home. In some hospitals elsewhere, you are not. Imagine that due to circumstances, you end up in a hospital that prohibits you from obtaining the placenta. What’s next?

Requests to take placentas home after birth are increasing. Human placentophagy is on the rise. Kim Kardashian spoke about it in her soap series not too long ago.  Newspapers are full of stories about placentas, their use and ability, and significant amounts of websites discuss the pros and cons of bringing placentas home. Different sources report on the alleged benefits of eating your placenta and other reasons to take it home. The public exposure to this ‘appetite’, its context and the rise in requests, raise concerns about prohibitive practices. Prohibitive policies are likely to come under increased scrutiny. My question in this context: What about eating placentas, what about policies prohibiting this?

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.

April 21, 2014 | Posted By Lisa Campo-Engelstein, PhD

Abortion is a contentious issue and one that gets a lot of attention by politicians and in the media. These debates on the ethics of abortion often take place on the abstract, theoretical level and fail to account for the empirical information on who seeks out abortions and why (all of the information presented here comes from the Guttmacher Institute).

Half of all pregnancies in the United States are an intended. 40% of these unintended pregnancies end in abortion and 22% of intended pregnancies also end in abortion. Over half of all women had been using some form of contraception during the month in which they became pregnant. However, many of these women (or their partners) were incorrectly or inconsistently using contraception.  Just under half of women who had an unintentional pregnancy were not using contraception for one of the following reasons: 33% perceived themselves to be at low risk for pregnancy, 32% had concerns about contraceptive methods, 26% had unexpected sex, and 1% had been forced to have sex.

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.

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.

February 24, 2014 | Posted By Lisa Campo-Engelstein, PhD

There is a cultural perception that women are very likely to cause fetal harm, reflected in limitations on women’s participation in clinical trials and certain jobs, public service announcements telling women not to drink alcohol while pregnant, and extensive media coverage of ‘‘crack babies.’’ The long history of the medical realm treating women’s bodies as weak, permeable, and inherently diseased contributes to the worry that women’s bodies will ‘‘infect’’ fetuses. Men’s bodies, in contrast, are as seen as stable, bound, and healthy; therefore, they are not a risk to fetuses. However, this belief is scientifically inaccurate. Men’s behaviors and characteristics can cause paternal-fetal harm. For instance, paternal smoking and drinking can result in an increased chance of birth defects and low birth weight. Paternal use of illegal drugs (such as cocaine, hashish, opium, and heroin) can also lead to fetal health problems because of abnormal sperm. Additionally, older paternal age has been associated with a higher risk of children with autism, Down syndrome, and schizophrenia.  

Despite these scientific facts, there is little public and academic discussion of men and fetal harm, which implies that men do not (or cannot) cause such harm. The cultural narrative that men are not causally or ethically responsible for fetal harm has been reified in law, policy, medicine, and the media.  Even the language we use to discuss reproduction and childcare minimizes the role men play in reproduction. The verb “to father” is synonymous with ‘‘to sire’’ and refers to impregnating a woman, that is, the one time event of fertilization. In contrast, “to mother” refers to constant caregiving and nurturing. 

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.

January 23, 2014 | Posted By Lisa Campo-Engelstein, PhD
When we think about organ transplantation, the organs that usually come to mind are the heart, or possibly the kidney, the most commonly transplanted organ. Transplantations are generally regarded as necessary to the life of the person receiving the transplant or to physiologically improving that life: the transplant is seen as making the recipient “whole” once more. The idea of wholeness that a transplant renders can extend beyond the physiological to the individual, the familial, and the cultural; this can be seen dramatically in the case of ovarian transplantation. The donor ovary, and with it the potential of restored fertility and the hope of pregnancy and thus motherhood, is a surgical means to make her whole.

Stephanie Yarber entered menopause for no apparent reason at age 14. Her identical twin sister, Melanie Morgan, maintained her fertility and donated eggs to Yarber. However, after at least two failed IVF cycles in her early 20s,Yarber was broke. Through her research on infertility treatment, she stumbled across Dr. Sherman Silber’s work on testicle transplants and discovered that his practice focused on infertility problems in both men and women. Thinking that a similar gonadal transplant could be possible in women, Yarber called Silber to ask if he thought an ovary transplant was “a crazy idea.” Silber, who had been considering the possibility of an ovarian transplant since the testicle transplant, jumped at the opportunity to try this procedure, telling Yarber “I’ve been waiting for your call for 30 years.”
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.
December 20, 2013 | Posted By Lisa Campo-Engelstein, PhD

There are many celebrities who make the news because they have used a gestational surrogate to have their children, including Sarah Jessica Parker, Guiliana Rancic, Elizabeth Banks, Nicole Kidman, Ricki Martin, Neil Patrick Harris, and Elton John. From the little information provided about their surrogacy arrangements, it seems like most of the celebrities partner with surrogates who live in the US. What is almost never mentioned in these articles is the legality and enforceability of surrogacy contracts, which can vary dramatically from state to state. Each state has to determine how they want to regulate surrogacy because there is no federal legislation, though there was a push for it following the infamous Baby M case. 

Surrogacy laws can be categorized into three categories. The first category is comprised of laws that permit surrogacy contracts by outlining the criteria for the contracts to be lawful and enforceable. For example, surrogacy laws in Florida require that the intended couple must be over 18 years old and married, the intended mother must be incapable of gestating a pregnancy without physical risk to herself or the fetus, and at least one of the intended parents must be biologically related to any resulting child. These requirements have to be fulfilled in order for any surrogacy contract to be legal and enforceable.

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.

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

Some physicians will write prescriptions in advance for young women so they can have immediate access to emergency contraception if the need arises. In order to be most effective, emergency contraception should be used within a few days of unprotected sex. Writing prescriptions for emergency contraception in advance makes it easier for women to take it right away and can reduce barriers they may face in trying to access it when they are under time pressure. My goal in this blog is to discuss some of the ethical issues raised by physicians writing preventive prescriptions for emergency contraception.

Some are concerned that the practice of physicians writing prescriptions in advance for emergency contraception will condone, and even encourage, young women’s sexual activity, especially premarital and "promiscuous" sexual activity. As with nonemergency forms of contraception and the HPV vaccine, some believe preventive measures against the risks involved with sexual activity are a tacit endorsement of sexual activity. On a related note, even if people did not oppose young women's sexual activity, they may still be concerned that writing prescriptions in advance for emergency contraception will discourage young women from using nonemergency contraception.  

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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