Tag: reproductive rights

Blog Posts (6)

November 22, 2016

Seeing Red, Feeling Blue: Fordham Historians Discuss the 2016 Election

Following the 2016 election this month, a panel of historians at Fordham University discussed the results and President-Elect Trump through the lenses of different historical perspectives on November 22, 2016. The panelists discussed several issues including, but not limited to, Latino/hispanic votes, immigration, fascism and the “alt-right,” mistrust of the United States government, misogyny, white … More Seeing Red, Feeling Blue: Fordham Historians Discuss the 2016 Election
October 20, 2016

The Ethics of Crisis Pregnancy Centers

"Pregnant? Scared? Need Help?" read signs along major thoroughfares in the southern United States. Many Americans have seen signs like these, often simultaneously advertising free pregnancy and sexually transmitted infection (STI) testing. Unless experiencing a unplanned pregnancy, most people pass by these signs without a second thought. However, for some of our most vulnerable patients, the establishments posting these advertisements - known as crisis pregnancy centers - represent a significant ethical difficulty in reproductive healthcare. Although these organizations are almost exclusively run by community volunteers, they represent themselves as healthcare workers by wearing lab coats and scrubs, providing lab testing and ultrasounds, and setting up offices that look like medical clinics. This would be problematic in itself from a legal perspective but the political and religious perspectives of these organizations provides serious ethical questions as well. Far from unbiased, crisis pregnancy centers (CPCs) are usually religiously affiliated organizations with a hard right agenda of preventing abortion at any cost. Medical evidence and scientific fact are not considered in this equation so clients of CPCs are often told that abortion causes breast cancer, infertility, psychiatric disorders (such as the entirely fictitious post-abortion syndrome), and even, in one case, kidney failure and subsequent dialysis. Furthermore, results of testing done at CPCs are frequently fabricated or ignored - clients are given falsely negative pregnancy test results or incorrect dating ultrasounds to prevent those considering an abortion from pursuing other care. CPC clients are usually unaware that these organizations do not employ trained medical providers or that they have a political agenda. However, the intent is clearly to strongly imply to CPC clients that they are being given information by medical personnel. As such, it seems fair to evaluate CPCs using principles of medical ethics, such as the four basic principles of beneficence, nonmaleficence, autonomy, and justice.

There is no question that the principle of autonomy is violated at these centers egregiously - purposefully providing misleading or false information takes away a person's ability to make informed decisions. However, the other three principles come into play with CPCs as well. Since there are rarely real medical providers at these centers, patients with serious health issues may be given advice that is, at best, suboptimal and, at worst, dangerous, arguably violating the principle of nonmaleficence. When a patient is told they are not pregnant when they are, they will not be able to seek timely prenatal care and are potentially put at risk for complications of pregnancy. When a non-expert performs an ultrasound and provides inaccurate results, fetal abnormalities, ectopic pregnancies, and other concerns go unrecognized. One center in Texas was documented telling a patient with a history of transposition of the great vessels that pregnancy was likely uncomplicated for her and would require “occasional monitoring,” rather than the extensive cardiologic and obstetric care that she would need throughout her pregnancy. These scenarios are not uncommon at CPCs and clearly have the potential to cause harm to patients seen in their offices. The principle of justice should also be considered in the case of CPCs as well – most situate themselves in areas of low socioeconomic status and target low income people as primary clients. These are generally the patients who can least afford access to healthcare and typically have lower levels of education, making them the least able to afford to care for an additional child and most vulnerable to the tactics of CPCs. It is hardly just when vulnerable patients, frequently people of color, are targeted to receive radically different healthcare and information than those with greater financial means, who would be less likely to be looking for low cost services.

Beneficence is the only principle of the four that could be debated depending on one's political and ethical leanings. A more pro-life leaning position might argue that the beneficence attributable to the fetus by potentially preventing an abortion should be considered with the discussion surrounding CPCs. This, of course, is predicated on the assumption that CPCs help to prevent abortions at all, which has yet to be adequately studied, although many CPCs tout the numbers of supposedly prevented abortions on promotional materials. Conversely, a pro-choice argument would be more concerned with the pregnant person, the potential benefits and risks of continuing a pregnancy and abortion, and the beneficence attributable to them. Overall, the patient should be able to determine for themselves what beneficence is for them and whether the patient should be treated as a patient. Regardless of stance, any ethical analysis would involve weighing multiple factors to determine whether or not a particular practice should be considered ethical. Looking at the complete picture surrounding CPCs and considering the violations of nonbeneficence, autonomy, and justice as previously outlined, it is not difficult to conclude that the practices of CPCs are not ethical and should not be endorsed by mainstream medical providers.

Although the ethical violations are clear, the course of action with regard to CPCs is not. These centers tend to fall into a legal gray area, as they are not officially bound by rules regarding medical practitioners and generally fall under non-commercial and/or speech stipulations when it comes to false advertisement litigation. Complicating the issue further is the fact that not every CPC operates this way – some centers follow strict guidelines regarding usage of scientific evidence and disclosure of non-medical personnel status, usually in states that regulate these centers. There is also no question that there is a need for services in populations targeted by CPCs and that, if operated appropriately, they could be a force for good in low income communities. Thus, although it’s difficult to universally condemn the practice, advocacy for regulation of CPCs, especially those who receive state funding, seems key. As medical practitioners, it is important to be aware of the existence of CPCs and their ethical problems. Furthermore, one of the best things we can do for our patients is make sure they do not fall prey to such predatory practices by advocating for laws that plainly identify CPCs as non-medical practices and/or require fact-based counseling, particularly in those centers that receive state and federal funding. Regardless of personal feelings on abortion, honest and ethical practices with patients should be an issue that all medical practitioners can agree with. 

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 20, 2016

The Ethics of Crisis Pregnancy Centers

"Pregnant? Scared? Need Help?" read signs along major thoroughfares in the southern United States. Many Americans have seen signs like these, often simultaneously advertising free pregnancy and sexually transmitted infection (STI) testing. Unless experiencing a unplanned pregnancy, most people pass by these signs without a second thought. However, for some of our most vulnerable patients, the establishments posting these advertisements - known as crisis pregnancy centers - represent a significant ethical difficulty in reproductive healthcare. Although these organizations are almost exclusively run by community volunteers, they represent themselves as healthcare workers by wearing lab coats and scrubs, providing lab testing and ultrasounds, and setting up offices that look like medical clinics. This would be problematic in itself from a legal perspective but the political and religious perspectives of these organizations provides serious ethical questions as well. Far from unbiased, crisis pregnancy centers (CPCs) are usually religiously affiliated organizations with a hard right agenda of preventing abortion at any cost. Medical evidence and scientific fact are not considered in this equation so clients of CPCs are often told that abortion causes breast cancer, infertility, psychiatric disorders (such as the entirely fictitious post-abortion syndrome), and even, in one case, kidney failure and subsequent dialysis. Furthermore, results of testing done at CPCs are frequently fabricated or ignored - clients are given falsely negative pregnancy test results or incorrect dating ultrasounds to prevent those considering an abortion from pursuing other care. CPC clients are usually unaware that these organizations do not employ trained medical providers or that they have a political agenda. However, the intent is clearly to strongly imply to CPC clients that they are being given information by medical personnel. As such, it seems fair to evaluate CPCs using principles of medical ethics, such as the four basic principles of beneficence, nonmaleficence, autonomy, and justice.

There is no question that the principle of autonomy is violated at these centers egregiously - purposefully providing misleading or false information takes away a person's ability to make informed decisions. However, the other three principles come into play with CPCs as well. Since there are rarely real medical providers at these centers, patients with serious health issues may be given advice that is, at best, suboptimal and, at worst, dangerous, arguably violating the principle of nonmaleficence. When a patient is told they are not pregnant when they are, they will not be able to seek timely prenatal care and are potentially put at risk for complications of pregnancy. When a non-expert performs an ultrasound and provides inaccurate results, fetal abnormalities, ectopic pregnancies, and other concerns go unrecognized. One center in Texas was documented telling a patient with a history of transposition of the great vessels that pregnancy was likely uncomplicated for her and would require “occasional monitoring,” rather than the extensive cardiologic and obstetric care that she would need throughout her pregnancy. These scenarios are not uncommon at CPCs and clearly have the potential to cause harm to patients seen in their offices. The principle of justice should also be considered in the case of CPCs as well – most situate themselves in areas of low socioeconomic status and target low income people as primary clients. These are generally the patients who can least afford access to healthcare and typically have lower levels of education, making them the least able to afford to care for an additional child and most vulnerable to the tactics of CPCs. It is hardly just when vulnerable patients, frequently people of color, are targeted to receive radically different healthcare and information than those with greater financial means, who would be less likely to be looking for low cost services.

Beneficence is the only principle of the four that could be debated depending on one's political and ethical leanings. A more pro-life leaning position might argue that the beneficence attributable to the fetus by potentially preventing an abortion should be considered with the discussion surrounding CPCs. This, of course, is predicated on the assumption that CPCs help to prevent abortions at all, which has yet to be adequately studied, although many CPCs tout the numbers of supposedly prevented abortions on promotional materials. Conversely, a pro-choice argument would be more concerned with the pregnant person, the potential benefits and risks of continuing a pregnancy and abortion, and the beneficence attributable to them. Overall, the patient should be able to determine for themselves what beneficence is for them and whether the patient should be treated as a patient. Regardless of stance, any ethical analysis would involve weighing multiple factors to determine whether or not a particular practice should be considered ethical. Looking at the complete picture surrounding CPCs and considering the violations of nonbeneficence, autonomy, and justice as previously outlined, it is not difficult to conclude that the practices of CPCs are not ethical and should not be endorsed by mainstream medical providers.

Although the ethical violations are clear, the course of action with regard to CPCs is not. These centers tend to fall into a legal gray area, as they are not officially bound by rules regarding medical practitioners and generally fall under non-commercial and/or speech stipulations when it comes to false advertisement litigation. Complicating the issue further is the fact that not every CPC operates this way – some centers follow strict guidelines regarding usage of scientific evidence and disclosure of non-medical personnel status, usually in states that regulate these centers. There is also no question that there is a need for services in populations targeted by CPCs and that, if operated appropriately, they could be a force for good in low income communities. Thus, although it’s difficult to universally condemn the practice, advocacy for regulation of CPCs, especially those who receive state funding, seems key. As medical practitioners, it is important to be aware of the existence of CPCs and their ethical problems. Furthermore, one of the best things we can do for our patients is make sure they do not fall prey to such predatory practices by advocating for laws that plainly identify CPCs as non-medical practices and/or require fact-based counseling, particularly in those centers that receive state and federal funding. Regardless of personal feelings on abortion, honest and ethical practices with patients should be an issue that all medical practitioners can agree with. 

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 25, 2016

More on the Male Pill: Social Reasons Why It Is Good for Women and Men

In my previous blog , I discussed how the lack of male contraception reduces men’s reproductive autonomy and burdens women with the health-related and financial consequences of being the one responsible for contraception. In this blog, I want to explore some of the social burdens women face when contracepting, especially those that men do not and would not face when using contraception.

Women face the social burdens of contraception, which include medicalization of one’s reproductive health, the stress and worry about the possibility of an unintended pregnancy, social repercussions of one’s contraceptive decisions, and possible moral reproach for contraceptive failures. While men could potentially face some of these social burdens, several of them are specific to women. For example, since pregnancy occurs in a woman’s body, she will physically embody the stigma and shame of an unintended pregnancy whereas the man will not carry any physical reminder of it.

Another burden unique to women is the double-bind they face regarding contraceptive use. Women who use contraceptive may be seen as violating the feminine norm of chastity. Yet, if single women do not use contraception, they risk an unintended pregnancy, which is associated with irresponsibility and trying to “trap” a man.

Since men are not held to the norm of chastity, but rather are frequently lauded for sexual promiscuity, they are not socially penalized for engaging in sexual activity and using contraception. Thus, the development of male contraceptives could help women avoid this no-win situation while empowering men to control their reproduction.

The need for male contraceptives is often looked overlooked because contraception is often conflated with women, thereby marginalizing and even ignoring men. For instance, unmet need for contraception is generally calculated using only women’s information: their fertility intentions and their contraceptive use. Excluding men from questions about unmet contraceptive needs fails to recognize their role in and responsibility for contraception both in their personal relationships and on the social level. It moreover fails to acknowledge that men may also have unmet contraceptive needs.

One study in Western Africa that interviewed both women and men regarding unmet contraceptive need found that between 15 – 23% of husbands had unmet contraceptive need even though their wives did not. These men were not interested in having children, at least at that time, but the dearth of reversible male contraceptives limited their options for controlling their reproduction since their partner did not have unmet contraceptive need and was consequently not using female or shared methods (and the male condom is frequently considered a shared method).

One of the benefits of female LARCs is that the woman’s partner does not need to be involved in or even know about their use. This is a good option for women if they and their partner disagree about contraceptive use. Unfortunately, men have no alternative available to them that they can use without their partner’s involvement or knowledge, which raises justice concerns and highlights men’s diminished reproductive autonomy.

 

 


 [LC1]Hyperlink to my previous blog.

August 25, 2016

More on the Male Pill: Social Reasons Why It Is Good for Women and Men

In my previous blog , I discussed how the lack of male contraception reduces men’s reproductive autonomy and burdens women with the health-related and financial consequences of being the one responsible for contraception. In this blog, I want to explore some of the social burdens women face when contracepting, especially those that men do not and would not face when using contraception.

Women face the social burdens of contraception, which include medicalization of one’s reproductive health, the stress and worry about the possibility of an unintended pregnancy, social repercussions of one’s contraceptive decisions, and possible moral reproach for contraceptive failures. While men could potentially face some of these social burdens, several of them are specific to women. For example, since pregnancy occurs in a woman’s body, she will physically embody the stigma and shame of an unintended pregnancy whereas the man will not carry any physical reminder of it.

Another burden unique to women is the double-bind they face regarding contraceptive use. Women who use contraceptive may be seen as violating the feminine norm of chastity. Yet, if single women do not use contraception, they risk an unintended pregnancy, which is associated with irresponsibility and trying to “trap” a man.

Since men are not held to the norm of chastity, but rather are frequently lauded for sexual promiscuity, they are not socially penalized for engaging in sexual activity and using contraception. Thus, the development of male contraceptives could help women avoid this no-win situation while empowering men to control their reproduction.

The need for male contraceptives is often looked overlooked because contraception is often conflated with women, thereby marginalizing and even ignoring men. For instance, unmet need for contraception is generally calculated using only women’s information: their fertility intentions and their contraceptive use. Excluding men from questions about unmet contraceptive needs fails to recognize their role in and responsibility for contraception both in their personal relationships and on the social level. It moreover fails to acknowledge that men may also have unmet contraceptive needs.

One study in Western Africa that interviewed both women and men regarding unmet contraceptive need found that between 15 – 23% of husbands had unmet contraceptive need even though their wives did not. These men were not interested in having children, at least at that time, but the dearth of reversible male contraceptives limited their options for controlling their reproduction since their partner did not have unmet contraceptive need and was consequently not using female or shared methods (and the male condom is frequently considered a shared method).

One of the benefits of female LARCs is that the woman’s partner does not need to be involved in or even know about their use. This is a good option for women if they and their partner disagree about contraceptive use. Unfortunately, men have no alternative available to them that they can use without their partner’s involvement or knowledge, which raises justice concerns and highlights men’s diminished reproductive autonomy.

 

 


 [LC1]Hyperlink to my previous blog.

August 15, 2016

Why We Need a Male Pill: Enhancing Men’s Reproductive Autonomy and Unburdening Women’s Contraceptive Responsibility

One of the key tenets of reproductive autonomy is being able to control if, when, and with whom one reproduces. Men’s reproductive autonomy is inhibited by the lack of good contraceptive options available to them. Whereas women have 11 types of contraceptives—including barrier, hormonal, permanent, and long-acting reversible—men only have two types—the male condom, a barrier method, and vasectomy, a permanent method. It is not just the number of methods that is problematic; it is also the lack of long-acting reversible contraceptives (LARCs). Many men want to maintain their future fertility, thus ruling out vasectomy, but do not want to rely on condoms, especially if they are in a long-term monogamous relationship. While part of the reason some men do not like condoms is because they can decrease sexual sensation, another reason is that the failure rate for actual use is so high: 17%. Female LARCs, in contrast, have much lower failure rates for actual use, which enhances their reproductive autonomy because they are equipped with effective methods to enact their reproductive desires (i.e. avoiding pregnancy).

The lack of male LARCS causes some men to rely upon their female partner to contraceptive since she has more and better contraceptive options. Yet this dependence on his partner may also comprise his reproductive autonomy because he has to trust that she is consistently and correctly using female methods. If she does become pregnant, he has no recourse and, in many settings, is legally responsible for any offspring, including financial and even social obligations to the child.

Placing the majority of contraceptive responsibility on women due to the lack of male methods is not just bad for men; it is also bad for women. Women have to shoulder the health-related side effects of contraception, which tend to have more serious side effects than male methods because they include hormonal methods. Not surprisingly then, the most common reason for nonuse of modern contraceptives among women with an unmet need is health concerns and side effects. Additionally, side effects are the most cited reason why women discontinue contraceptives and most forms of contraception have discontinuation rates near 50% after one year of use. The fact that women continue to use a particular method does not mean she is happy with it; she (and her partner) may simply see it as their best option among poor choices.

In addition to the health related side effects of contraception, there are also the financial burdens of contraception. In the US, although the Affordable Care Act requires health insurance companies to cover female contraceptives, not all women are aware of this and very few women realize that certain forms of contraceptive, such as IUDs and tubal ligation, are covered. Even if the cost of contraception is covered, women still have to invest the time to acquire contraception: all methods except the female condom and the sponge require at least one health care provider visit and hormonal methods require an ongoing prescription. In the global South, women may face difficulty affording contraception, especially if their government does not prioritize reproductive health services.

News (2)

February 13, 2013 1:40 pm

Africa: Women's Silent Killer - Rights Missing From Sexual and Reproductive Health Policies Worldwide (All Africa)

According to human rights organizations, including Amnesty International, there are often catastrophic consequences when women and girls lack effective health services and related information. In many countries, a lack of autonomy and decision-making power usually amounts to a further disadvantage for women and girls.

May 21, 2012 4:50 pm

Column: Where are the doctors? (USA Today)

Since the choice to terminate an unwanted pregnancy was established by the U.S. Supreme Court in 1973 inRoe v. Wade, almost one in three women have had abortions. The legality of contraception was established even earlier, in 1965, in Griswold v. Connecticut, and tens of millions of women use some form of artificial contraception. But there is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion and contraception, mainly by intruding on the relationship between doctor and patient.