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Topic: Women's Reproductive Rights
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.

May 28, 2013 | Posted By Zubin Master, PhD

For Part I of this blog, I will highlight a new discovery where scientists have now been able to create cloned stem cells and I will review two ethical debates that were central to earlier discourse surrounding stem cell research: (1) the moral status of human embryos and (2) the potential physical and social harms to women as egg providers.

So finally research cloning (a.k.a. therapeutic cloning) has been achieved! The technique is called somatic cell nuclear transfer (SCNT) and now has been used to derive human embryonic stem cells (hESCs) (Tachibana et al.Cell 2013). Performing SCNT using human oocytes is an astonishing accomplishment and has significant ethical and clinical implications.

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.

April 16, 2013 | Posted By Lisa Campo-Engelstein, PhD

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.

March 7, 2013 | Posted By Lisa Campo-Engelstein, PhD

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.

January 29, 2013 | Posted By Lisa Campo-Engelstein, PhD

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.

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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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