Topic: Women's Reproductive Rights
January 28, 2016 | Posted By Claire Horner, JD, MA

Gestational surrogacy contracts have been in the news again recently as a gestational surrogate reports that the intended father, having discovered that she is expecting triplets, is demanding that she undergo selective reduction to abort one of the fetuses.  Situations such as these, while often not reported, are not necessarily uncommon.  In 2013, a gestational carrier was offered $10,000 to abort when a second trimester ultrasound discovered congenital heart and brain abnormalities.  Despite a well-established Constitutional right to privacy that includes a pregnant woman’s right to procure – or refuse – an abortion, surrogacy contracts routinely include provisions that not only prohibit a surrogate from having an abortion unless there is a medical need, but also give the intended parents sole discretion to determine whether the surrogate should abort where there is evidence of a physical abnormality or other issue.  Such provisions have not been tested in court, but would almost certainly be unenforceable based on the surrogate’s Constitutionally-protected right to reproductive autonomy.


In India, where there is an estimated $400 million surrogate tourism industry, women agree to be surrogates in exchange for $5,000-7,000, which is far more than they could make otherwise.  In many clinics, surrogates live in dormitories for the duration of the pregnancy and their food and medical care is provided by the clinic.  There are also reports that some clinics have policies against pregnancies of 3 or more fetuses – meaning that selective reduction may occur as a matter of course to reduce the number of fetuses to 2 or 1.  If this is in fact happening, are the surrogates (or even the intended parents) aware of what is happening?  Are they given a voice in the medical care and treatments they receive?  Or are the decisions made by the intended parents or the clinic, and simply imposed on the surrogate?


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 24, 2015 | Posted By Paul Burcher, MD, PhD

I was surprised to read recently in the New York Times that a woman has undergone a cesarean section despite her refusal to consent to the procedure.  While the details of the case are not entirely clear in the article, so I do not want what follows to be understood as a specific comment on this case, my surprise arises because I thought the ethics of refusal of consent were not in dispute.  The American College of Obstetrics and Gynecology has taken a clear position of this: it is not justifiable to perform surgery on a patient with decisional capacity without her consent. ACOG’s committee opinion, “Maternal Decision Making, Ethics, and the Law,” strongly discourages even attempting to seek a court order for treatment when a pregnant woman refuses cesarean section, and concludes with a statement that:

Pregnant women's autonomous decisions should be respected. Concerns about the impact of maternal decisions on fetal well-being should be discussed in the context of medical evidence and   understood within the context of each woman's broad social network, cultural beliefs, and values. In the absence of extraordinary circumstances, circumstances that, in fact, the Committee on Ethicscannot currently imagine, judicial authority should not   be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman's autonomy. 

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 6, 2015 | Posted By Claire Horner, JD, MA

A Catholic hospital came under fire recently for stating that it would not permit doctors to perform a tubal ligation during a c-section scheduled for October.  According to news reports (including anarticle written by the patient herself), the pregnant patient has a brain tumor, and her doctor have advised her that another pregnancy could be life-threatening.  Her doctor has recommended that she have a tubal ligation at the time of her c-section.  While my knowledge about this hospital, this case, and the participants is limited to what has been reported in the media, it raises an interesting question: in our pluralistic society, where conscientious objection is respected while maintaining a patient’s right to a certain standard of care, is it ethical to allow a religiously-affiliated health care institution to refuse to provide certain treatments it finds morally objectionable?

As background, the Catholic Church has historically been outspoken on bioethical issues and has a strong and robust bioethical teaching.  Catholic hospitals are governed by the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a document promulgated by the United States Conference of Catholic Bishops (USCCB) that clearly articulates the bioethical policies that must be followed in a health care institution based on the Church’s moral teachings.  It explains the Church’s teaching against direct sterilization as a method of birth control based on the principle of double effect.  “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.  Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.” (Directive 53).  In other words, if the sterilization procedure directly treats a pathology, it is licit; if it is used as a form of birth control to prevent a pregnancy, even if that pregnancy would be life-threatening, it is not licit.

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 14, 2015 | Posted By Lisa Campo-Engelstein, PhD

In some countries where there is a strong preference for sons due to cultural and religious reasons, women sometimes choose to have an abortion after learning the sex of the fetus they carry is female, which is often referred to as sex selection abortion. For example, sex selection abortion is common in India and has increased significantly in the couple of last decades, especially for pregnancies following a firstborn daughter. The prevalence of sex selection abortion is also common in China, often referred to as the “missing girls of China” phenomenon, and is due to a similar cultural preference for sons as well as the One Child Policy.

Given the strong pressure women are under to have sons, is ethical for them to have sex selection abortions? Some point out that it may not be women’s authentic choice that is leading them to abort female fetuses but rather familial pressure from their husband and other family members as well as broader social pressure. In these situations, paternalistic approaches may be more justifiable in order to protect women from oppressive social forces that may coerce them into having sex selection abortion. From a justice perspective, outlawing sex selection abortion sends the message that sex discrimination is wrong, seeks to protect female fetuses, and attempts to ensure a balanced birth ratio between females and males.

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 28, 2015 | Posted By Valerye Milleson, PhD

This month’s blog is going to be a bit of a rant. I don’t generally consider myself a rant-y person, but some of the commentary surrounding the recent FDA approval of the sexual desire disorder drug Addyi has proven too much for my delicate constitution.

First, what I am NOT doing: I am NOT denying the existence of hypoactive sexual desire disorder (HSDD), or that for women who are so afflicted it can cause serious distress or otherwise negative consequences. I am NOT challenging the notion that HSDD is a medical problem that warrants seeking a medical treatment or medical solution. I am NOT arguing against pharmaceuticals in general, or here specifically, as a potentially viable medical treatment for HSDD. I am NOT saying all pharmaceuticals should have absolutely no risks or side effects, or should be required to produce overly substantial benefits for it to be appropriate for them to be FDA-approved and released to the market. I am NOT calling into question the claims that there are very real sex and gender disparities in medicine, human medicalization, and medical treatment. And I am NOT disputing the value of empowering women with greater control over their own bodies and their own healthcare.

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 23, 2015 | Posted By Lisa Campo-Engelstein, PhD

Planned Parenthood recently made national news because an anti-abortion group released an undercover video showing two people posing as fetal tissue recruiters interviewing Dr. Deborah Nucatola, the senior director of medical services of Planned Parenthood. The interview was cropped down into an eight minute clip in which Dr. Nucatola seems to be suggesting that Planned Parenthood sells fetal tissue for profit. Planned Parenthood has responded to the video saying that it is heavily edited and that they do not sell fetal tissue. They do, however, donate fetal tissue with women’s explicit consent and they sometimes receive a small amount of money – in the video Dr. Nucatola says it is typically between $30-100 – that covers transportation of the fetal tissue.

This story made national news because the idea of selling fetal tissue for profit without women’s consent is horrifying. Yet, once we uncover the facts here, this story is much less troubling than it originally seems. One concern the undercover video raises is of selling fetal tissue. It is illegal in the US to sell human and fetal organs and tissue. However, it is not only legal, but also laudable to altruistically donate organs and tissue. Because there is such a strong need for organs and tissue for patients waiting for transportation and for scientific research, there are various campaigns to get people to sign up to be cadaveric organ donors, to donate blood, and to be live kidney donors.  In the US, organ donation is opt-in only, meaning it is completely voluntary and people are under no ethical obligation to donate. Likewise, women who have abortions are under no ethical obligation to donate fetal tissue and typically the fetal tissue is discarded. Women who choose to donate fetal tissue for scientific research are acting altruistically because there are choosing to further scientific research, which could help others in the future.

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 29, 2015 | Posted By Lisa Campo-Engelstein, PhD
Apple recently announced that they will update their health app, HealthKit, to include reproductive health. Many were critical of the original app because although it can track a wide range of health indicators, such as BMI, sleep, sodium intake, number of falls, etc., it neglected reproductive health. Specifically, it is problematic that the app includes some obscure health indicators, like selenium intake, but not menstrual cycle, which affects half of the population. While there are other apps that are specifically geared toward women's reproductive health, it is troubling that an iPhone app that comes standard with the phone would exclude something so central to women's health as menstruation. Some believe that the omission of reproductive health from HealthKit is due to the fact that the tech world, including Apple, is dominated by men.  

The new the updated app is a huge improvement because it includes a variety of reproductive health indicators like menstruation, basal body temperature, and spotting. The broad range of reproductive health indicators helps women keep track of their reproductive health in general and specifically for women looking to prevent pregnancy and for women looking to achieve pregnancy. This is an important addition because too often reproductive health is overlooked or not considered part of "real" healthcare. The addition of the reproductive health category in HealthKit technology not only acknowledges the reproductive health issues specific to many women, but also normalizes them.

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 10, 2015 | Posted By Wayne Shelton, PhD

The history of America from the beginning was a struggle of opposing ideological perspectives over the role of the state’s power vis-à-vis the consciences of individual citizens. The 17th century Puritans in the Massachusetts Bay Colony basically transported to America the same kind of religious, state intrusion into the lives of individuals they were trying to escape in England by requiring citizens to subscribe to the official state religion. Fortunately, there were courageous individuals there at the time, like Roger Williams (1603-1683), who strongly resisted such requirements. Williams, prior to coming to America, had been educated at Cambridge and worked for Lord Chief Justice Edward Coke. (1552-1634)  Coke was the famous English jurist whose work provided much of the foundations of the Anglo-American legal system, and who famously “declared the king to be subject to the law, and the laws of Parliament to be void if in violation of "common right and reason”.  No doubt Williams’ prior education and influences from Coke, and from others like Francis Bacon (1561-1626) who taught him the way of learning through experiment and observation, helped temper his strong theological commitments in relation to his views about the proper relationship between the authority of the state and religion, and the extent to which the state could have control over the consciences of free individuals, what Williams called “soul liberty”. Williams himself did not have theological quarrels with the Puritans; however, he did not believe religious conviction could be coerced. It was on this moral and political basis, that Williams founded Rhode Island, the first state ever to have a constitution guaranteeing expansive freedom of conscience to individual citizens. Fortunately, the thinking of Williams became the mindset of the key founders, particularly Jefferson (1743-1826) and Madison (1751-1836), of the American constitutional system. (For a full account of Roger Williams’ life and influence, see the wonderful book, Roger Williams and the Creation of the American Soul: Church, State, and the Birth of Liberty by John M. Barry)

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 18, 2015 | Posted By Lisa Campo-Engelstein, PhD

The story about the UK passing a law to allowa reproductive technology called mitochondrial donation, what has been informally known as three person or three parent embryos, recently dominated the news.Part of the reason this story received so much attention is because the idea of a child with more than two biological parents sounds really scary, even Frankensteinish.While new medical technologies often raise ethical concerns, it is imperative to understand the science behind these technologies in order to accurately assess the likelihood and degree of potential harms caused by these technologies. In the case of three parent embryos, once we understand the science, this technology is not as threatening as it may initially appear.

The UK will only allow mitochondrial donations in cases where women could pass along mitochondrial diseases to their children. There are various types of mitochondrial diseases, which affect approximately one in 8,500 people and can lead to serious and fatal conditions. The mitochondria are located in the cytoplasm of the cell and serve as the cell powerhouses. Mitochondria have their own set of DNA with the 37 genes and a mitochondrial disease occurs when there is a mutation in the mitochondrial DNA. Mitochondrial donation allows women who are at risk for passing along mitochondrial diseases to the children to avoid doing so by using the mitochondria of a donor. There are two ways this can be done. In the first way, known asmaternal spindle transfer technique, the nucleus from the donor egg is removed and replaced with the nucleus from the intended mother's egg. The resultant eggwill carry the nucleus with all the genetic information from the intended mother, but will also contain the healthy mitochondrial DNA from the donor egg.The second way, known as pronuclear transfer, removes the nucleus from a donor embryo and replaces it with the nucleus of an embryo that contains the genetic material from intended mother and father. Here again,the resultant embryo contains the genetic material from the intended parents, but avoids inheriting mitochondrial diseases because donor mitochondria is used. 

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, 2015 | Posted By Lisa Campo-Engelstein, PhD

Although life-saving, cancer treatments (e.g. radiation, chemotherapy, and surgery) can also lead to infertility in both women and men. Established reproductive technologies for women and men like gamete freezing and embryo freezing allow cancer patients to preserve their fertility in case they want to become biological parents in the future. 

Unfortunately, patients are frequently not adequately informed and sometimes not informed at all about fertility preservation. Some oncologists don’t consider fertility preservation to be an important issue, as they are more focused on saving the patients’ lives and see fertility preservation as a secondary consideration. Research has shown that even when oncologists refer their patients for fertility preservation they often do so based on social factors (they are more likely to refer wealthy, white, heterosexual, married patients) rather than purely on medical indications. Even when health care providers discuss fertility preservation with patients, many patients say that once they heard the word “cancer” as a diagnosis, they didn’t absorb much else from their initial conversation with their provider. 

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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