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Topic: Women's Reproductive Rights
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.

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.
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.

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 12, 2013 | Posted By Wayne Shelton, PhD

I have probably done several hundred clinical ethics consultations since I began doing them in the early 90’s. Though I have had some second thoughts about some of the recommendations I have made, by and large, I have usually been confident that they represented viable moral options, given the range of limited, mostly bad options that were available.  Thus, I rarely if ever thought of myself as anything but fully supportive of the recommendations made in ethics consultation.  That is, until a few months ago when I heard about a case from another ethics consultant at another location where the right ethical recommendation seemed apparent, yet somewhat problematic. The case shows the almost boundless, and at times problematic, latitude of the negative right to refuse treatment and to be left alone, even when others may be negatively affected by the decision. I thought the general fact pattern of this case would be worth discussing in this forum. 

The case involved a 40 year-old woman with full capacity who was near full term with twins. She was showing signs of pre-eclampsia, a condition “when a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy.” (National Library of Medicine) When this condition occurs, it is important to get the babies out as soon as possible; otherwise, both the mother and babies would be at risk of dying. So labor was induced and she was being prepared for delivery. But given that she was having twins there was the possibility of excess bleeding from hemorrhaging and other complications, so the patient was informed that a blood transfusion might be necessary. As it turns out based on her religious beliefs she stated she did not wish to be transfused with blood products and that she understood the consequence: she could possibly die. Her babies would in all likelihood be saved. Should the fact that two babies will not have a mother be counted as ethical considerations against respecting her right to autonomy? Given our current ethical environment, a patient with capacity has a right to refuse any and all medical treatments and interventions. Are there ever countervailing reasons to not honor a patient’s autonomous wishes in such a situation? Let’s proceed with the general facts of this case, as it gets even more complex.

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 5, 2013 | Posted By John Kaplan, PhD

Usually when I write about stupidity in Congress I wait a couple of months before doing it again. However, I cannot help myself. This is low hanging fruit and I have to pick it. This is “truth is stranger than fiction” type of stuff. You cannot make this up. In this blog post I would like to introduce the readers to Representative Michael Clifton Burgess M.D., republican representative from Texas’ 26th Congressional District. Dr. Burgess was born in December 1950. I mention this only because it was the same month I was born. He graduated with a Bachelors of Science from North Texas State University. He graduated from medical school at The University of Texas Health Science Center at Houston. He completed his residency in Obstetrics and Gynecology from Parkland Memorial Hospital in Dallas. He also completed a Masters degree in Medical Management from the University of Texas at Dallas. Dr. Burgess is the founder and chair of the Congressional Health Care Caucus, albeit it’s only member. This all suggests the likelihood that Dr. Burgess is smart. His recent statements seem to refute that likelihood.

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 20, 2013 | Posted By Zubin Master, PhD

Last month, I covered in Part I of this blog the ethical debates surrounding the moral status of human embryos and the potential harms to women as egg providers for cloning research. I also described how the technique of research cloning (a.k.a. somatic cell nuclear transfer) works. For today’s blog post, I want to argue that bioethicists should not leave moral debates behind because the science of stem cell research has moved on in a different direction as it is likely to leave people uneasy and frustrated because no clear way to move forward has been resolved and the debate has almost ceased to continue.

Bioethical discourse surrounding the moral status of human embryos and payment of women for eggs became stagnant upon the discovery of induced pluripotent stem cells (iPSCs). iPSCs were heralded as free of ethical concern because this technique creates hESC-like cells without the creation and destruction of human embryos and it doesn’t require eggs from women. The technique aims to dedifferentiate specialized cells (e.g., skin cells) into a more pluripotent state prior to directing their differentiation into specific cell types needed for repair or regeneration. Even George W. Bush in his Eight State of the Union address stated that the iPSC breakthrough can expand the frontiers of medicine without destroying life. Although iPSCs may obviate ethical concerns surrounding moral status and harms to women, they haven’t served to replace hESC research. In fact, one study shows that hESCs and iPSCs are being used together which makes sense because hESC research serves as a control for iPSC research. In addition, there are also many other ethical challenges to iPSC research including moral complicity as well as research ethics issues including informed consent, privacy and withdrawal. I have argued along with Gillian Crozier that perhaps an ethical and political compromise in stem cell research is needed in order to permit stem cell research to be performed using eggs and embryos for a certain period until such time that non-egg and non-embryo sources for the derivation of stem cells can be used. But because iPSCs have received such hype, ethics discourse around research cloning and deriving hESCs has received far less attention in the past 4-5 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.

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.

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ABOUT BIOETHICS TODAY
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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