Hot Topics: Reproductive Ethics

Blog Posts (105)

May 22, 2018

The Land of the Gagged and the Home of the Complicit: Domestic Abortion Gag Rule is Unethical

by Craig Klugman, Ph.D.

On his fourth day in office, Trump reinstated the Mexico City Rule. The MCR was originally declared by Ronald Reagan in 1984 to prohibit U.S.…

May 11, 2018

What Do International Adoptive Parents Owe their Children’s Birthparents?

by Ann Mongoven, Ph.D. MPH

Another Mother’s Day is here.   Another candle is lit to honor the unknown birthparents of my Chinese-American daughter, adopted as an infant and now a young woman.…

May 11, 2018

BioethicsTV (May 7-11): #ChicagoMed, #GreysAnatomy

by Craig Klugman, Ph.D.

Chicago Med (Season 3; Episode 19): Maternal-Fetal Conflict; Grey’s Anatomy (Season 14; Episode 23): Personal Disclosures of Illness

As the traditional television season comes to a close, many medical dramas have steered away from ethical dilemmas in medical care to heighten the drama among their characters in order to provide strong cliff hangers for the season finale.

March 28, 2018

Fertility Meltdown

by Craig Klugman, Ph.D.

Earlier this month, two fertility clinics reported problems with their cold storage equipment that led to the thawing and destruction of frozen embryos and eggs slated for people’s future reproductive options.…

March 22, 2018

BioethicsTV (March 19-23): The Good Doctor, The Resident, Chicago Med

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 17): Cost of healthcare, stealing identities, dating patients; The Resident (Season 1; Episode 8): Patient Dumping; Chicago Med (Season 3; Episode 12): Pedophilia; Cherry-picking; ECMO; teenage pregnancy

The Good Doctor (Season 1; Episode 17): Cost of healthcare, stealing identities, dating patients

In the first storyline,  a patient, “Lucy,” comes to the ER with a post-op infection: She never filled her antibiotic prescription.…

January 16, 2018

Black Women are Dying in Disproportionate Numbers During and After Giving Birth and not even Celebrity Serena Williams is Safe

by Keisha Ray, Ph.D.

In a previous blog I wrote about racial disparities in health and health care in which black patients fare much worse than white patients, including worse health outcomes.…

October 24, 2017

When the Government Prevents a Teen from Receiving an Abortion

by Craig Klugman, Ph.D.

Update: The U.S. Court of Appeals in D.C. full panel ordered the government to arrange for Doe to receive her abortion.

August 4, 2017

The Age of Designed Babies Arrives

by Craig Klugman, Ph.D.

In the film Gattaca, a couple desiring to have a child visits their neighborhood geneticist:

Geneticist: You have specified hazel eyes, dark hair and fair skin.

August 2, 2017

Sterilization for Prisoners Is Not New and Shows That Studying History is Essential

by Craig Klugman, Ph.D.

In 1927, Supreme Court Justice Oliver Wendell Holmes ruled that Carrie Buck and her baby could be sterilized because of a perception that they were “mental defectives.” In the 20th century, 32 states had federally funded programs that sterilized “undesirable” populations.…

June 22, 2017

Fertility preservation for transgender individuals

The field of oncofertility emerged to preserve the fertility of cancer patients whose treatment might render them as infertile or sterile. Today, the field of fertility preservation has expanded to other patient populations whose medical treatment may affect their fertility. One such population is transgender individuals undergoing gender affirming treatments. Although research on transgender individuals is limited overall and in particular regarding issues surrounding reproduction, transgender individuals are interested in biological reproduction. Because various gender affirming treatments will permanently affect their fertility, such as hormonal treatment and surgical removal of the gonads, it is important for transgender individuals to be offered fertility preservation before they start these treatments.

There are, however, some factors that may make fertility preservation difficult or less attractive of an option for transgender individuals. Healthcare professionals offering fertility preservation should be aware of these factors so they can help mitigate them. Here I will discuss two of them.

First, undergoing fertility preservation treatment can be stressful for both transgender and cisgender people, but there are some unique challenges for transgender individuals. Individuals with gender dysphoria may find it particularly difficult to undergo procedures involving anatomy that is discordant with their identity. For example, transgender women who are asked to retrieve sperm via masturbation may find this request exacerbates their gender dysphoria and may not be possible to do. Transgender men who are asked to undergo vaginal ultrasounds may find this psychologically traumatic. In recognizing how fertility preservation treatment can be particularly difficult for transgender individuals, healthcare professionals should be prepared to find ways to alleviate these difficulties, such as by offering surgical methods of sperm retrieval for transgender women and sedating transgender men during vaginal ultrasounds.

Second, the gametes retrieved and frozen will not match the gender identity of transgender patients (i.e. a transgender woman will bank sperm and a transgender man will bank eggs). This discordance may not matter for some transgender individuals, but it could affect others. At least one older study found that having frozen discordant gametes made it difficult for some transgender individuals to move forward with their lives in their gender identity. More research is needed in this area to understand if and how this discordance affects transgender individuals today. Healthcare professionals should be aware of this potential discordance between gender identity and frozen gametes, but it should not be a reason to deny fertility preservation to transgender patients.

In addition to the two factors I have discussed here, there are other factors at play in fertility preservation for transgender individuals. Fertility preservation is becoming more common for transgender individuals undergoing gender affirming treatment and consequently healthcare professionals treating these individuals should be aware of some of the unique challenges this patient population faces. For more information on this topic, check out the “Proceedings of the Working Group Session on Fertility Preservation for Individuals with Gender and Sex Diversity.”

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.  

 

View More Blog Entries

Published Articles (32)

AJOB Primary Research: Volume 8 Issue 4 - Dec 2017

“Will they be good enough parents?”: Ethical dilemmas, views, and decisions among assisted reproductive technology (ART) providers Robert Klitzman

AJOB Primary Research: Volume 8 Issue 4 - Dec 2017

Counseling parents at risk of delivery of an extremely premature infant: Differing strategies Marlyse F. Haward, Annie Janvier, John M. Lorenz & Baruch Fischhoff

AJOB Primary Research: Volume 8 Issue 2 - Apr 2017

Adolescent oncofertility discussions: Recommendations from a systematic literature review Dorit Barlevy, Bernice S. Elger, Tenzin Wangmo & Vardit Ravitsky

AJOB Primary Research: Volume 8 Issue 1 - Feb 2017

Morals or markets? Regulating assisted reproductive technologies as morality or economic policies in the states Erin Heidt-Forsythe

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

A Framework for Unrestricted Prenatal Whole-Genome Sequencing: Respecting and Enhancing the Autonomy of Prospective Parents Stephanie C. Chen & David T. Wasserman

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

Modern Pregnancies and (Im)Perfect Babies Stephanie A. Kraft

American Journal of Bioethics: Volume 16 Issue 12 - Dec 2016

Does Lack of “Genetic-Relative Family Health History” Represent a Potentially Avoidable Health Disparity for Adoptees? Thomas May, Kimberly A. Strong, Kaija L. Zusevics, Jessica Jeruzal, Michael H. Farrell, Alison LaPean Kirschner, Arthur R. Derse, James P. Evans & Harold D. Grotevant

American Journal of Bioethics: Volume 16 Issue 5 - May 2016

The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic Lisa H. Harris, Neil S. Silverman & Mary Faith Marshall

American Journal of Bioethics: Volume 16 Issue 2 - Feb 2016

Fetal Risks, Relative Risks, and Relatives' Risks Howard Minkoff & Mary Faith Marshall

American Journal of Bioethics: Volume 16 Issue 2 - Feb 2016

Restricting Choices of Childbearing Women Bela Fishbeyn

View More Articles

News (728)

May 3, 2018 4:36 pm

Iowa lawmakers pass the nation's most restrictive abortion ban -- as soon as a fetal heartbeat is detected (CNN)

The Republican-led legislature in Iowa has passed a bill that, if signed into law, will become the nation’s most restrictive abortion ban: It forbids doctors from performing the procedure after a fetal heartbeat is detected. In many cases, that can happen as early as six weeks into a pregnancy, before many women even know they’re expecting.

December 26, 2017 9:00 am

NIH Lifts Ban On Research That Could Make Deadly Viruses Even Worse (NPR)

Scientists could soon resume controversial experiments on germs with the potential to cause pandemics, as government officials have decided to finally lift an unusual three-year moratorium on federal funding for the work. The research involves three viruses — influenza, SARS, and MERS — that could kill millions if they mutated in a way that let the germs spread quickly among people.

November 23, 2017 9:00 am

Childbirth is killing black women in the US, and here's why (CNN)

Each year in the United States, about 700 to 1,200 women die from pregnancy or childbirth complications, and black women like Saba are about three to four times more likely to die of pregnancy or delivery complications than white women.

November 6, 2017 9:00 am

She signed up to be a surrogate mother — and unwittingly gave away her own child (Washington Post)

A DNA test would soon reveal the truth: One of the “twins” was actually Allen and Jasper’s biological son. Despite using condoms, they had apparently conceived the child after becoming pregnant with the Lius’ baby, in what is believed to be an extremely rare case of superfetation. The condition — in which an already pregnant woman conceives another child — is so rare that alleged cases are usually treated with skepticism. In a widely publicized 2009 case of a pregnant Arkansas woman becoming pregnant “again,” Karen Boyle, a reproductive medicine specialist, told ABC News that there were only about 10 reported cases of superfetation in medical literature.

September 14, 2017 9:00 am

Senate panel seeks middle ground on human fetal tissue research and abortion (Science)

The Senate Appropriations Committee, in a bill that boosts NIH funding by $2 billion, to $36.1 billion, ordered the biomedical research agency to launch a pilot study to determine whether banking tissue from stillbirths and spontaneous abortions, or miscarriages, could serve all of the needs of biomedical researchers.

August 31, 2017 9:00 am

Nepal outlaws menstruation huts, but what will take their place? (CNN)

On August 9, Nepal’s Parliament passed a bill that would criminalize the banishment of women during menstruation. Once the bill goes into effect, set for August 2018, anyone who forces a woman into a menstrual hut will be sentenced to three months in prison or fined US $30.

August 22, 2017 9:00 am

China’s embrace of embryo selection raises thorny questions (Nature)

Early experiments are beginning to show how genome-editing technologies such as CRISPR might one day fix disease-causing mutations before embryos are implanted. But refining the techniques and getting regulatory approval will take years. PGD has already helped thousands of couples. And whereas the expansion of PGD around the world has generally been slow, in China, it is starting to explode.

June 20, 2017 10:54 am

Legionnaires' cases among newborns raise questions about water births (CNN)

Cases of Legionnaires’ disease have been documented at hotels, gyms and even health care facilities, but a recent report from the Centers for Disease Control and Prevention finds that even newborns are being infected — after water births.

June 15, 2017 9:00 am

A fetus needs to defend itself against foreign bodies—so how does it avoid attacking its mother? (Science)

The immune system of a fetus developing in the womb faces a quandary: It has to prepare itself to attack dangerous pathogens after birth, by distinguishing its own cells from those of invaders. But until that time, it needs to avoid attacking the mother, whose cells are also “foreign.” A new study of fetal tissue has revealed one way the developing immune system keeps itself in check: by interrupting the production of a key weapon in the body’s arsenal against invaders.

April 6, 2017 9:00 am

Proposed SC bill would define 'person' at fertilization (WISTV)

South Carolina’s Lt. Gov. Kevin Bryant is fighting for the ‘right to life’ for unborn children, starting at fertilization. He sponsored the bill as a senator along with 18 other senators who also signed on as sponsors. In a standing room only meeting on Thursday morning, there was moving testimony on the bill from those both for and against it. If passed, the act would grant the same rights to the zygote or fertilized egg, as to the adult.

View More News Items