Hot Topics: Reproductive Medicine

Blog Posts (73)

May 16, 2016

Taking a ride down the slippery slope

Did you know: we can now make sperm from embryonic stem cells (in mice).  Not only can we create this sperm, but we can use it to successfully fertilize an egg and develop into a fully grown mouse.  And what is the role of bioethics in this scientific discovery, according to the article?  A brief mention of theoretical ethical issues relegated to the end of the news article that no one reads far enough to see, anyway.

 

Scientific advancements in reproduction have occurred at an unbelievable rate.  We not only have the ability to create sperm, but we can also create an embryo using three genetic donors, choose or reject embryos based on their genetic traits, such as sex, and correct genetic defects by essentially cutting and pasting healthy DNA sequences over defective ones.  Conversely, using such technology, we also have the potential to clone human beings, choose or reject embryos based on traits such as hair color or athletic ability, and irreversibly alter a germ cell line, potentially leading to unknown negative effects in later generations.

 

While breakthroughs in reproductive technologies have the potential to address issues as important and varied as male infertility, uterine factor infertility, mitochondrial disease, genetic defects and disease, and even artificial gestation, one wonders whether anyone is stopping to ask: to what end?  How will we use this technology?  What are the short- and long-term effects?  How might this technology be misused?  And, my personal favorite, when will we start to regulate how and when we tinker with biology at a genetic level?

 

Despite the promise of treatment or eradication of genetic diseases using this technology, there is still a persistent and very realistic fear that this technology will be misused.  Even worse, the misuse may become so common as to be considered acceptable, particularly in our profit-driven fertility industry.  Will the desire to prevent Huntington’s disease also lead to the desire to enhance intelligence?  Can we really resist the urge to create so-called designer babies, and should we accept that while some may win the genetic lottery, others will be able to afford to stack the deck?

 

Bioethicists are sometimes viewed as obstructionists on the path of progress, unnecessarily blocking scientists from discovering all that can be accomplished through science and medicine. (For an excellent rebuttal, read here).  But the very purpose of the vast and diverse field of bioethics is to identify and acknowledge the normative implications of scientific advances and engage in a dialogue that directly addresses the “should” in a world of “could.”  Hence, the age-old question that is often asked but rarely answered: just because we can do it, does it mean we should?

 

In the world of reproductive technologies and germline manipulation, perhaps the answer, sometimes, is no.

 

 

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 9, 2016

Bad Moms, Blameless Dads: Examining How the Media Portrays Age-Related Preconception Harm

As I discussed in a previous blog, the blame for fetal harm is generally directed at women. Some of my colleagues and I, including AMBI faculty member Zubin Master, were interested in examining how fetal harm, and more specifically age-related preconception harm, is portrayed in the media. Our findings were published earlier this year in the American Journal of Bioethics Empirical Bioethics.

Given the significant social change that many people today are delaying childbearing in comparison to previous generations, it is relevant to examine the media portrayal of older parental age and risk to future offspring. Furthermore, there is clear evidence that older parental age carries certain risks to offspring: older age in women and men leads to an increased risk of having children with autism and Down syndrome and older paternal age has also been linked to higher rates of children with schizophrenia. Many people get most of their scientific news from the media, so it is important to examine the accuracy and biases of the information.

Our results indicate that reproduction is still largely seen as the domain of women, rather than of couples or of men. We rarely found articles discussing reproduction as it relates to both women and men as the majority of articles were maternally focused. Even among the articles that were paternally focused, they almost always discussed maternal harm as well. However, the reverse – maternally focused articles containing discussions of paternal harm – were almost nonexistent. This pattern suggests that men alone are never seen as solely responsible for fetal harms, but rather that this responsibility is always shared with women.

Responsibility and blame typically go hand-in-hand and not surprisingly articles were four times more likely to blame women for fetal harms than men. The infrequency of paternal blame suggests that authors either do not recognize men’s contribution to harm due to ignorance or denial, or do not want to hold men responsible for harm. Even when men’s contribution to harm was acknowledged, the authors were more likely to absolve men from responsibility for harm by presenting reassuring information, such as the overall risk of fetal harm is quite low, in conjunction with factual information stating that older paternal age can increase risks to future children. The same sort of reassurance was not seen for women.

Although reproductive blame and responsibility is still typically assigned to women, newspapers are increasingly discussing the relationship between paternal age and preconception harm: no articles discussed this relationship in the 1970s or 1980s, 20% discussed it in the 1990s, and nearly 40% discussed it between 2000 and 2012. The increase in articles on paternal harm in the 2000s may be due to the increase in scientific data showing the connection between paternal age and harm, the growing body of social science literature on male reproduction, the rising medicalization of men’s sexuality and reproduction, as well as changes in social norms that make discussions of paternal role and responsibility in reproduction more commonplace.

However, despite the fact that newspapers are actually acknowledging and discussing paternal age and preconception harm, the primary focus of newspaper articles regarding preconception harm remains concentrated on women and articles are more likely to blame women than men for any harm. In short, our analysis of age-related preconception harm reflects the broader gendered social patterns regarding reproduction that tend to minimize, and even ignore, men’s role in and responsibility for reproduction.

 

 

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 27, 2016

The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic

by Lisa H. Harris, Neil S. Silverman, and Mary Faith Marshall

The inequalities of outcome are, by and large, biological reflections of social fault lines (Paul Farmer)

Three paradoxes characterize the Zika virus pandemic and clinical and policy responses to it:

  1. Zika virus has been shown to cause severe developmental anomalies in the fetuses of infected women.
April 26, 2016

BioEthicsTV: A night of consent issues on ChicagoMed

by Craig Klugman, Ph.D.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus.…

April 6, 2016

Paternalists at the Gate: Those With Privilege Fight to Keep It

by Craig Klugman, Ph.D.

One of the main concepts that most medical ethics instructors teach to their students is that of autonomy—self governance.…

April 6, 2016

BIOETHICSTV: Chicago Med-BIID, post mortem egg retrieval, scope of practice and forgiveness

by Craig Klugman, Ph.D.

This week on Chicago Med brought 3 new ethical issues as well as the unsatisfying resolution to a story arc.…

April 1, 2016

The ethics of Indiana HB 1337: Outlawing abortion based on race, sex, and disability

In March, the Indiana legislature passed and the Indiana governor signed into law HB 1337, a bill that bans abortions for women seeking them based solely on certain characteristics of the fetus, such as race, sex, and disability. Specifically, the bill:

 “Prohibits a person from performing an abortion if the person knows that the pregnant woman is seeking the abortion solely because of: (1) the race, color, national origin, ancestry, or sex of the fetus; or (2) a diagnosis or potential diagnosis of the fetus having Down syndrome or any other disability. Provides for disciplinary sanctions and civil liability for wrongful death if a person knowingly or intentionally performs a sex selective abortion or an abortion conducted because of a diagnosis or potential diagnosis of Down syndrome or any other disability.”

As I have discussed in a previous blog, sex selection is a frequent occurrence in certain countries, such as India and China, where there is a strong preference for sons. Yet, there is little to no evidence that sex selection abortion is commonplace in the US. Abortion based on the race of the fetus is similarly rare in the US. While the purpose of any law is to prohibit actions it deems unethical or contrary to social norms, regardless of their frequency, due to limited time and resources, it makes sense to focus on bills that address common occurrences or things that are so morally repugnant that the state must take a stand. The main motivating factor for this bill does not seem to be avoiding discrimination based on sex and race, but rather trying to undermine legal access to abortion. Indiana is one of only five states that does not have a hate crime law and it recently rejected another attempt to pass hate crime legislation. It seems odd, and even contradictory, that Indiana is so worried about discrimination against fetuses, but not against legal persons.

The provision outlawing abortion due to disability is also troubling. Women and their families are often faced with very difficult decisions if they find out a fetus they are carrying has a disability and they should have the autonomous right to make decisions that are best for themselves and their families. This bill does allow women carrying fetuses with lethal abnormalities to abort, but they first have to receive materials about perinatal hospice care and complete documentation stating that they received such materials. The knowledge that the fetus has a lethal abnormality is devastating to many women and the idea of carrying the pregnancy to term is often psychologically distressing for them. Requiring them to be counseled about perinatal hospice care seems unnecessary and insensitive. Good physicians already ensure that their patients are adequately informed about their options and this seems to be a form of directive, morally laden counseling that will just make women feel guilty, rather than expanding their choices.

Another aspect of this bill that is quite problematic is that it “Provides that a miscarried or aborted fetus must be interred or cremated by a facility having possession of the remains.” For most abortions, the fetal remains are disposed of with other medical waste. This law, however, requires that the fetal remains are buried or cremated. This is clearly an attempt to elevate the status of the fetus and give it equal rights to legal persons.

This law means that Indiana now has some of the most restrictive abortion laws in the country. While many antiabortion supporters are in favor of this law, it is worth noting that some antiabortion legislators think this bill goes too far. They are concerned that this bill lacks compassion and demeans women. I agree with these concerns and am troubled by the passage of this law for the reasons I have outlined here.

 

 

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 24, 2016

A Few Thoughts On Abortion and Valuing Human Life

Who could be against life? Ancient natural law theory in the Catholic tradition tells us that human beings desire to live, and that life is good, therefore humans have an obligation to live and not kill other human beings. This ancient wisdom has been instilled into western ways of moral thinking. So, who could not be prolife in terms of how we place value on all individual human life?

Who could be against human freedom? Individual human beings should be free to live peacefully in accordance with their own values and life goals. This is a basic tenet of democracy that has shaped moral and political thinking in the West for the past four centuries. So, who could not be against the exercise of free choice, especially about something so basic as having control over our bodies?

The two value perspectives contained in the prior two paragraphs, all things equal, are eminently reasonable and most ethically unproblematic. These two value positions represent two fundamental principles of ethics—the intrinsic value of all individual human lives and the right of free individuals to govern their own lives and bodies—that guide us in living an ethical life and making ethical decisions. It is when these fundamental principles come into direct conflict that a serious, a near irresolvable, ethical conflict arises. There is no greater direct conflict of these two ethical principles than right of women to have an abortion. It is commonly assumed that one is either on one side of this moral abyss or the other and the twain shall never meet. It seems to me one of the central tasks of ethical reflection on this issue is to find as much meaningful middle ground as possible. In this brief blog I’ll offer a few ideas in this regard, which advocates on either extreme will likely find unsatisfactory.

 

Once a fetus reaches full term and emerges at birth into the world as a separate human being, there is no question about its full moral standing—from my perspective this would include babies with the most serious birth defects, including anencephaly. Some bioethicists believe that a being must have interests to have full moral standing. Since babies with anencephaly, if they survive a short time after birth, have no brain, no capacity to experience pain or pleasure, and no future life, they have no interests. The latter may be true descriptions of babies with this disorder, but they are unequivocally individual human beings. And there is no reason, as the law currently supports, to justify killing or euthanizing the lives of these babies in my view. So can’t the same be said of a fetus from the moment of conception?

It is true that a human embryo is a biologically a distinct form of individual human life and because of that fact has moral worth and deserves respect. But there is a basic aspect of fetal life even after viability and prior to birth that is inescapable: the fetus is dependent on the mother for its life and is part of the woman’s body. There is no protecting the fetus prior to birth without controlling the bodies of pregnant women. At the same time, at the very least, abortion as I am defining my terms is morally concerning and even problematic. I realize many of my pro-choice friends will find that conclusion concerning, but it is simply a consequence of recognizing the moral humanity of fetal life. So the key question then becomes who should make this moral or ethical decision and how should abortion services be regulated under the law?

A moderate position that seeks to preserve as many values as possible in this conflict, it seems to me, will recognize elective abortion as a moral issue but will reject the notion that it should be restricted as a service under the law. For if the law seeks to protect fetal life by restricting abortions, ipso facto, it also seeks to restrict the liberty of the woman to control her body as she so desires. The idea of requiring a woman to keep an unwanted pregnancy is an assault to her dignity as free human being. We cannot pretend to live in a free society where men and women have equal moral worth if we do not extend full moral autonomy to both men and women equally.

I conclude abortion is a moral issue and like many moral issues they are decisions that individual free human people should make and should not be the business of government to regulate. But it is not trivial to recognize abortion as a moral issue. We should not only talk, but also act, like all human life as value. We can provide adequate healthcare to all people, which should include family planning, prenatal, and birth control services for woman. We should provide more day care for parents, particularly single parents and other support services to make having children easier.

In short we can be a society that acts like it values all human life, of which fetal life is a part. But the ethical position of valuing all human life in terms of ascribing full moral standing to individual human beings cannot extend individual fetal life if we are to full value women as autonomous human beings.

 

 

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 15, 2016

Should providers offer oncofertility to patients with a poor prognosis?

Whereas quality of life issues for cancer patients used to minimized, and sometimes even ignored, today there is more of a focus on cancer patients’ quality of life post-cancer. One such quality of life issue is oncofertility, which is fertility preservation for cancer patients. In many places, oncofertility is, or is becoming, the standard of care for cancer patients. But should it be offered to all patients? What about patients who have a very bad prognosis?

 Fertility preservation for patients with a poor prognosis raises a host of ethical issues. Providers may worry that discussing fertility preservation will give patients false hope about their prognosis. In other words, these patients may feel their providers deceived them by mentioning fertility preservation, leading them to believe that their prognosis is not as bad as they originally thought.

Yet, at the same time, pursuing fertility preservation may be a source of hope and happiness for patients during difficult times. It may furnish them with mental and physical strength, making them even more motivated to survive for the sake of their potential future children. Additionally, these patients, and their families, may feel a degree of inner peace knowing that part of their lives will continue on in the reproductive material even if they are never used.

Nevertheless, some may argue that, despite any personal and emotional benefits they may experience, offering patients with a poor prognosis fertility preservation options is an unjust allocation of resources. From a utilitarian perspective, it does not make sense to devote resources to patients who will likely not benefit from them. Put differently, resources should be allocated to those who have a high probability of a positive outcome, which means individuals with a poor prognosis should be placed lower on the priority list for receiving fertility preservation resources than individuals with a good prognosis.

On the other hand, if we take a deontological (duty-based, individual rights) approach, providers have a duty to care for their patients. Not offering fertility preservation to all of their patients, including those with a poor prognosis, may be seen as diminishing patient autonomy. According to this view, providers should be more concerned with the needs and rights of their individual patients than with social justice (i.e., fair allocation of resources).

For more on this topic, see my book chapter “Addressing the Three Most Frequently Asked Questions of a Bioethicist in an Oncofertility Setting” in Oncofertility Medical Practice, edited by T.K. Woodruff and C. Gracia.

 

 

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 8, 2016

Zika: An opportunity to improve pre-conception care.

by Andrea L. Kalfoglou, Ph.D.

The Zika virus is spreading rapidly throughout parts of South and Central America. Public health officials are concerned because there is a correlation between the emergence of the Zika virus and a dramatic increase in number of babies born in Brazil with a severe birth defect called microcephaly.…

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Published Articles (25)

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

American Journal of Bioethics: Volume 15 Issue 11 - Nov 2015

Sleepwalking Into Infertility: The Need for a Public Health Approach Toward Advanced Maternal Age Marie-Eve Lemoine & Vardit Ravitsky

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Ritual Male Infant Circumcision and Human Rights Allan J. Jacobs & Kavita Shah Arora

American Journal of Bioethics: Volume 14 Issue 7 - Jul 2014

Therapeutic, Prophylactic, Untoward, and Contraceptive Effects of Combined Oral Contraceptives: Catholic Teaching, Natural Law, and the Principle of Double Effect When Deciding to Prescribe and Use Murray Joseph Casey & Todd A. Salzman

American Journal of Bioethics: Volume 14 Issue 5 - May 2014

Transnational Gestational Surrogacy: Does It Have to Be Exploitative? Jeffrey Kirby

American Journal of Bioethics: Volume 13 Issue 10 - Oct 2013

Gender Eugenics? The Ethics of PGD for Intersex Conditions Robert Sparrow

American Journal of Bioethics: Volume 13 Issue 10 - Oct 2013

Critically Appraising Prenatal Genetic Diagnosis to Prevent Disorders of Sexual Development: An Opportunity Missed Laurence B. McCullough

American Journal of Bioethics: Volume 13 Issue 5 - May 2013

The Right to Know Your Genetic Parents: From Open-Identity Gamete Donation to Routine Paternity Testing An Ravelingien & Guido Pennings

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News (698)

May 9, 2016 8:54 am

Why this lab-grown human embryo has reignited an old ethical debate (Science)

It’s easy to obey a rule when you don’t have the means to break it. For decades, many countries have permitted human embryos to be studied in the laboratory only up to 14 days after their creation by in vitro fertilization. But—as far as anyone knows—no researcher has ever come close to the limit. The point of implantation, when the embryo attaches to the uterus about 7 days after fertilization, has been an almost insurmountable barrier for researchers culturing human embryos.

May 6, 2016 8:37 am

Can A Hospital Tell A Doctor To Stop Talking About Abortion? (NPR)

One of the country’s most outspoken abortion providers has filed a civil rights complaint against the hospital where she works, saying that it has wrongly banned her from giving media interviews.

April 28, 2016 9:53 am

Taking Sperm From the Dead (The Atlantic)

Post-mortem sperm extraction gives widows the chance to have children with the recently departed.

April 1, 2016 11:41 am

WHO sees scientific consensus on Zika as cause for disorders

Researchers around the world are now convinced the Zika virus can cause the birth defect microcephaly as well as Guillain-Barre syndrome, a rare neurological disorder that can result in paralysis, the World Health Organization said on Thursday. The statement represented the U.N. health agency’s strongest language to date on the connection between the mosquito-borne virus and the two maladies.

March 31, 2016 8:37 am

F.D.A. Eases Requirements on Abortion Pill Label

The Food and Drug Administration stepped into the politics of abortion on Wednesday, relaxing the requirements for taking a medication that induces abortion, a move that is expected to expand access to the procedure.

March 4, 2016 1:31 pm

Zika Kills Cells Key to Fetal Brain Development, Study Says

The Zika virus destroys cells that give rise to the brain cortex in the developing fetus, scientists reported on Friday. The finding, published in the journal Cell Stem Cell, may help explain how the virus might cause microcephaly, or unusually small heads, in infants whose mothers are infected during pregnancy.

March 2, 2016 12:34 pm

First Uterus Transplant in the US Gives 26-year-old Woman Chance at Pregnancy

Surgeons at the Cleveland Clinic have performed the nation’s first uterus transplant, offering a 26-year-old infertile woman a chance at getting pregnant.

March 1, 2016 2:48 pm

All Surrogacy is Exploitation – The World Should Follow Sweden’s Ban

That something is not quite right about surrogacy has been evident for some time. Ever since the commercial surrogacy industry kicked off in the late 1970s, it has been awash with scandals, exploitation and abuse. From the infamous “Baby M” case – in which the mother changed her mind and was forced, in tears, to hand over her baby – to the Japanese billionaire who ordered 16 children from different Thai clinics. There has been a total commodification of human life: click; choose race and eye colour; pay, then have your child delivered.

February 18, 2016 1:38 pm

Pope suggests women threatened by Zika virus could use contraception

Abortion “is an evil in and of itself, but it is not a religious evil at its root, no? It’s a human evil,” he said. “On the other hand, avoiding pregnancy is not an absolute evil. In certain cases, as in this one (Zika), such as the one I mentioned of Blessed Paul VI, it was clear.”

February 10, 2016 5:54 pm

Catholic group urges pope to allow contraception to fight Zika

A Roman Catholic group appealed to Pope Francis on Wednesday to allow Church members to “follow their conscience” and use contraception or to let women have abortions to protect themselves against the Zika virus.

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