We often hear stories in the media about women (and it is usually women, not men) who are irresponsibly reproducing (e.g. teenage girls, older women, single women, women on welfare, women with addictions, etc.). While determining what counts as responsible reproduction is not always an easy task, one way to do so is by drawing on the principle of nonmaleficence (aka “do no harm”). John Arras and Jeffrey Blustein present this line of thinking in their discussion of what it means to responsibly reproduce: “If one can reasonably be expected to predict that, should a person decide to reproduce, the resulting child’s existence would fall below a certain threshold of acceptable well-being, the person can be blamed for reproducing irresponsibly.” Arras and Blustein enumerate a range of ideas of what counts as being below this threshold from least controversial to most controversial: child abuse and neglect, children born with severe medical conditions, “anything that parents do to lower a child’s potential” (e.g. drinking alcohol during pregnancy), and “parents who do not optimize their child’s potential for a good life” (e.g. genetic enhancement). Regardless of how this threshold is defined, the main idea here is that people should not reproduce if their potential children would be harmed. 

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.

One of the reasons pharmaceutical companies give for not pursuing male contraceptive research and development is that there is no market for it. However, recent empirical studies have shown that men are concerned about pregnancy prevention and are interested in using male contraceptives. For example, a survey of 9,000 men in 9 nine countries in 2005 revealed that 55% of men were willing to use male hormonal contraceptives, while only 21% were unwilling. Another study showed one third of men would use male contraception as their main form of contraception. Further evidence that there is indeed a market for male contraceptives is the fact that men are already responsible for contraception, as approximately 27% of heterosexual couples in western nations use a male-dependent form of contraception (condoms or vasectomy).

Despite this empirical evidence, however, there remains a strong cultural belief that men won’t use contraception because they don’t value the end of preventing pregnancy as much as women do. This cultural trope is usually presented as fact without much or any empirical backing in the lay literature and even in the academic literature. One explanation for this phenomenon is that reproductive prowess is an important component of masculinity. It’s true that fatherhood, especially biological fatherhood, is important to many men. However, the desire to be a father should not be conflated with a lack of reproductive responsibility or with the biological determinism to “spread one’s seed” and have as many children as possible mentality. 

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.

An article published this week documents the “criminalization of pregnancy” in the US over the last four decades. The main reason used to support the arrests of and forced interventions on pregnant women is that these women are causing fetal harm through their poor choices (e.g. using drugs, denying medical treatment, and engaging in risky behavior). The 413 cases described in this article highlight the common social belief that women cannot be trusted to make good decisions for their fetuses and that infringing upon these women’s rights is justified for the sake of the fetus. 

This social distrust toward pregnant women to prevent harm to their fetuses is found in various aspects of life. For example, warnings on alcoholic beverages caution only against pregnant women drinking. There is no similar warning for men seeking to become fathers even though alcohol use in men increases the chance of birth defects and low birth weight. Nor are there any warnings about all the other harms that occur due to alcohol consumption, harms that often cause more overall damage and affect more people, such as drunk driving and crime. Similarly, warnings on cigarettes only mention the harms women can cause to fetuses, even though secondhand smoke from male partners is also bad for fetuses and men who smoke are more likely to have children with birth defects and low birth weight. While such warnings are generally good and useful for the public, what I find problematic is that they ignore paternal fetal harm on only focus on maternal fetal harm.

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.

As I have written about before in this blog, although I fully support the requirement that insurance companies cover contraceptives without a co-pay, this new law will not solve many of the social and gender inequalities in the reproductive realm. In a previous blog, I discussed how this law conflates reproduction with women and ignores men. Here I want point out how there remains a social perception that women cannot be trusted with contraception and enumerate five factors that contribute to this perception. 

First is the high rate of unintended pregnancies—almost half of all pregnancies in the U.S. are unintended. According to some calculations, a woman can expect to have 1.42 unintended pregnancies by the time she reaches 45. Despite our recognition that no form of contraception is 100% effective, the existence of so many unintended pregnancies leads us to question women’s competence with 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.

During the recent election season, a handful of male Republican politicians made some now infamous comments about rape. The common theme in all these comments was implicitly or explicitly blaming and/or holding women responsible for rape (e.g. Missouri Rep. Todd Akin asserted that victims of “legitimate rape” rarely get pregnant) while ignoring or condoning men’s role in rape (e.g. Wisconsin state Rep. Roger Rivard stated that “some girls rape easy”). 

While these comments are problematic for a number of reasons, I want to point out how they are grounded in false and gendered views of biology. Specifically, these comments echo biological determinism: the belief that our biology determines our desires, characteristics, and actions. Because women have so few eggs (approximately 500 in total compared to the millions of sperm men produce daily), women need to be selective in who they choose to have sex with. They should limit sexual encounters to men who they think would make the best fathers; that is, men who would produce the best genetic offspring and who will be able to provide for the offspring. Moreover, since women will be responsible for childrearing, they should be careful to pick men who will make this investment worthwhile. Women’s passive sexual “nature”—i.e. their weak libido—is thought to aid them in making good choices about mates. In contrast, men have no reason to be selective. In fact, because they have so many sperm and because they are not responsible for childrearing, they have no constraints on whom to have sex with. If we accept there is a “biological” urge to procreate, then men are “naturally” inclined to have sex with as many women as they can.

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.

I just returned from the annual Oncofertility Consortium Conference and one of the ethical topics that came up was the possibility of disputes over frozen reproductive materials. Before undergoing life-saving cancer treatment, people may opt to freeze gametes, gonadal tissue, or embryos in order to preserve their fertility. If these people die or separate from their partners, a battle over what to do with the frozen reproductive materials can ensue. The best and easiest way to deal with disputes over reproductive material is to try to prevent them before they happen. In this blog, I discuss two ways to prevent such disputes. 

One way is to have the individual with cancer write an advance directive that clearly outlines what should be done with the reproductive material should the patient die. If the reproductive materials are gametes or gonadal tissue, then ultimately the decision of what to do with the reproductive material should be made by individual with cancer, as it is her/his genetic material. If the reproductive materials are embryos, then the individuals who contributed the gametes to create the embryos should come to an agreement about how the embryos should be handled under unfortunate circumstances (e.g. death of the genetic parents or separation of the couple). Many infertility clinics require all patients—both individuals and couples—to complete a document outlining how to handle reproductive materials in unfortunate circumstances and I think this should be standard practice for oncofertility patients as well. 

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.

Thanks to health care reform, beginning last month women with health insurance no longer have to pay for contraception. While I fully support this legislation, I think it has unintended negative consequences for both women and men. Specifically, I am concerned that this legislation, as well as the debate surrounding it, once again conflates reproduction with women, thereby ignoring men’s reproductive responsibility and autonomy.

This legislation is based on and buttresses our current heterosexual contraceptive arrangement in which women are largely held responsible for contraception, especially in monogamous relationships where couples are more likely to depend upon long-acting, reversible contraceptives (LARCs) or sterilization rather than barrier methods. Women today actively participate in all contraceptive methods except vasectomy, which only accounts for 9% of contraception use in the U.S. Part of the reason for this is due the disparity between the number and types of female and male contraceptives: there are eleven contraceptive options for women, including various types of LARCs, and only two for men—male condoms and vasectomy—neither of which are LARCs. Monogamous couples not ready for sterilization generally don’t delegate contraceptive responsibility to men because male condoms are not well-suited to their needs: they are not nearly as effective as female LARCs (16% versus under 3% failure rate for typical use) and they can interrupt and minimize pleasure during 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.

A recent New York Times article shares the story of Debra Demidon, who developed severe ovarian hyperstimulation syndrome (OHSS) after undergoing IVF. This potentially life-threatening condition caused her to gain more than 30 pounds of fluid and have trouble breathing, and ultimately landed her in the hospital for 5 days. OHSS is much more common in the US and UK than in Europe and Japan because the former countries rely on high-dose hormones for IVF where the latter countries use lose-dose hormones. Although rare, OHSS following high-dose hormone IVF is now one of the leading causes of maternal mortality in parts of the UK. OHSS is not the only adverse side effect of high-dose IVF for women; there are myriad other possible side effects including increased cancer risk, memory loss, and liver disorders.  Furthermore, there can also be increased risk for children born from high-dose IVF, such as low birth rate. 

Knowing these serious potential health-related outcomes, why is high-dose IVF the dominant and default method used in the US? The main reason is that high-dose IVF produces many more eggs (often 20-30 eggs and sometimes even more) than low-dose IVF produce (8-10 eggs). Given that most insurance companies do not cover infertility treatments (only 15 states have laws mandating insurance companies to cover infertility treatments and there are many exemptions and caveats), many people pay out of pocket for IVF. In order to save money – IVF costs $15,000 - $30,000 a cycle – people are often willing to increase their risks to themselves (choosing high-dose IVF or low-dose IVF) if it means they’re likely to generate more eggs. Individuals in time pressure situations who may only have one shot at gathering eggs, such as cancer patients wanting to preserve their fertility before undergoing treatments that will hopefully save their lives but may render them infertile, may also opt for high-dose IVF.  

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.

The Huffington Post recently published a blog by bioethicist and philosopher Rory E. Kraft, Jr. titled “Pregnancy as Harm?” As a friend and former colleague of Dr. Kraft, he and I have had numerous conversations about pregnancy as harm and we have presented on a conference panel together on this very topic. However, it seems—based in part on my students’ reactions and discussions I’ve had with people who don’t work in the field of reproduction—that most people find the idea of pregnancy as harm as counterintuitive or oxymoronic. 

Pregnancy is generally understood as a beautiful, special, and maybe even magical time in a woman’s life. And while it no doubt is for many women, it can simultaneously be harmful. For example, pregnancy can entail various nontrivial, though not life-threatening, discomforts, such as weight gain, back pain, edema, and morning sickness. Furthermore, pregnancy can lead to life threatening conditions, such as gestational diabetes and hypertension, and in many parts of the developing world pregnancy related complications are the leading cause of death for women in their prime. In addition to being painful, giving birth can also cause harms, like hemorrhaging, internal tearing, placental abruption, and nerve damage to the pelvic structures. In addition to physical harms, pregnancy and childbirth also have the potential to lead to mental health problems. Since being pregnant changes women’s hormone levels, it can affect women’s emotional well-being and their overall psychological balance. 

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.

Around 10% of all people diagnosed with cancer are in their reproductive or pre-reproductive years (under age 45). This means that, each year, approximately 133,000 women, men, and children who are diagnosed with cancer are at risk for infertility due to the very treatments (e.g. chemotherapy, radiation, and surgery) that can save their lives. Given improved survivorship rates, fertility concerns have emerged as an important quality of life issue to cancer survivors and their families. Oncofertility, a new and interdisciplinary field at the intersection of cancer and fertility, is working to address potential infertility as a result of cancer treatment. 

Although more cancer patients are being offered and are using fertility preservation technology (FTP), its cost and the lack of insurance coverage for it are often the major reasons given by oncologists for why they do not provide information on fertility preservation options to their patients. One method of ensuring people in their reproductive years or children who are diagnosed with cancer have access to and insurance coverage for FPT is to create a legal mandate requiring insurance companies to cover FTP for cancer patients. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.