Hot Topics: Reproductive Medicine

Blog Posts (93)

March 22, 2017

Texas Considers Letting Doctors Lie to Patients

by Craig Klugman, Ph.D.

The Texas Senate just passed a new bill (SB 25) that would shield doctors from a lawsuit if a baby is born with a disability even if the doctor knew of the concern and chose not to tell the parents.…

March 2, 2017

The ethics of conscientious objection: Caring for patients and supporting providers

Although conscientious objection arises in various areas of medicine, notably end-of-life issues (e.g. physician assisted death), it is ubiquitous in all aspects of reproductive medicine and women’s health care. Indeed, it is discussed extensively in the academic bioethics literature, clinical practice, healthcare law and policy (e.g. the Hobby Lobby Supreme Court case), and in the popular press. Part of the reason conscientious objection is so commonplace in reproductive medicine and women’s healthcare is because of the controversial nature of abortion and emergency contraception.

The topic of conscientious objection forces us to confront the boundaries of professional obligations and individual rights. Which should be prioritized when they conflict? The common stance of most professional medical organizations is that providers have an obligation to refer if they oppose a practice/prescription based on personal beliefs (e.g. providers should provide a referral if a patient requests an abortion and they oppose abortion due to philosophical or religious reasons), but not if they believe the practice/prescription doesn’t align with standard of care (e.g. providers don’t have to provide a referral if a patient requests antibiotics for the common cold).

The position of most medical organizations on conscious objection raises some concerns. First, there are logistical and feasibility concerns. While it may be easier to uphold providers’ conscientious objection in densely populated areas, in rural areas where there may only be one provider, thereby making it difficult to find someone to refer patients to. It is burdensome for patients to travel far away to receive medical care that they could receive locally if the provider did not have a conscientious objection.  

Second, there are concerns about violating the beliefs of individual providers. Some providers may believe that a certain medical practice/prescription, such as abortion, is so evil that even making a referral violates their religious or philosophical beliefs by making them an “accomplice” in what they see an immoral act. However, it may be difficult for patients to know where to go to receive care if they don’t have a referral. Furthermore, providers who intentionally withhold information about medically appropriate care (e.g. not mentioning that abortion is an accepted standard of care option for a woman carrying a fetus with a lethal abnormality) can be seen as violating the principles of nonmaleficence and informed consent.

Although there are some concerns with the position of most medical organizations on conscientious objection, ultimately it does its best to protect the interests of both patients and providers. One of the main goals of medicine is to care for patients according to the accepted medical standard of care. When providers have a conscience objection to a particular standard of care, they still have an obligation to their particular patients to ensure the patients receive the care that they need. Referring their patients to another provider safeguards the health of the patients while preventing the provider from having to participate in care that violates deeply held beliefs.

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 9, 2017

Crossing the Line: When Doctors’ Beliefs Endanger Patients’ Autonomy and Health

by Craig M. Klugman, Ph.D.

In 2016 the Illinois legislature passed and Governor Bruce Rauner signed into law Public Act 099-690 (SB 1564), an amendment to the Health Care Right of Conscience Act.…

January 2, 2017

The Year in Bioethics That Was - 2016

by Craig Klugman, Ph.D.

Happy New Year. As has become a tradition at the bioethics.net blogs, the ending of one year and beginning of another is a time for reflection, for reviewing the year that has passed and planning for the year to come.…

December 28, 2016

Modern Pregnancies and (Im)Perfect Babies

by Stephanie A. Kraft, JD

The modern experience of pregnancy is distinctly “not your mother’s pregnancy”. Ever-expanding options for carrier, prenatal, and newborn screening offer today’s pregnant women countless choices when it comes to genetic testing—choices that were unheard of, even unfathomable, just a generation ago.…

December 9, 2016

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask


One of the first questions a newly married straight couple often gets from well-meaning friends and family is “when are you going to start trying?” For those of you who are wondering what this question is getting at, it is asking them if they are going to start to try to get pregnant. It is interesting to analyze the language used here. People typically talk about “trying” without ever specifying what they are in fact trying to do. Part of the reason for this may be because people assume the meaning is obvious from the context, such as “they’ve been trying for six months but haven’t gotten pregnant yet.” Another reason probably has to do with our societal discomfort talking about sex.

We use general and vague terms to imply that we are talking about sex, but often don’t feel comfortable out right discussing it. For example, the birth control pill is generally just referred to as “the pill.” There is still shame and stigma surrounding sex, particularly for women and sexual minorities, so it may be easier and safer for a woman to talk about being on “the pill,” even though everyone knows what she is referring to, than to overtly announce that she is using contraception.

Even though we as a society may not feel comfortable explicitly discussing sex, we still feel that it is our business. From a legal perspective, look at how carefully reproductive medicine is regulated. For instance, certain reproductive procedures (e.g. abortion and sterilization) can require waiting mandatory periods – something that is not common in other areas of nonelective medicine. In the social realm, family, friends, and even strangers feel they have the right to comment on a pregnant woman’s behavior, such as by telling her what she should and should not eat or drink.

Returning to the topic of “trying,” family, friends, and again even strangers often have no qualms about asking women about whether they are trying to conceive. This is especially the case for straight women who are recently married and women who are perceived as being near or at the end of their “biological clock.”

Asking women whether they are “trying” is problematic on many levels. First, it assumes that all women want to become pregnant with genetically related children. While this may be true for many women, it is not true for all women. There is already enough social pressure on women in our pronatalist society to have biological children so people should avoid adding to this pressure. Second, asking people if they are “trying” is just a euphemism for asking them if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, which is usually not considered an appropriate topic, especially among strangers. It is typically seen as impolite to discuss sex under certain circumstances or with certain people and discussing reproductive sex (that is, sex for which one of the purposes is reproduction) should not be treated differently.

To summarize, if you don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, then don’t ask them if they are “trying” to conceive.

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.

December 8, 2016

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask them if they are “trying” to conceive

 

One of the first questions a newly married straight couple often gets from well-meaning friends and family is “when are you going to start trying?” For those of you who are wondering what this question is getting at, it is asking them if they are going to start to try to get pregnant. It is interesting to analyze the language used here. People typically talk about “trying” without ever specifying what they are in fact trying to do. Part of the reason for this may be because people assume the meaning is obvious from the context, such as “they’ve been trying for six months but haven’t gotten pregnant yet.” Another reason probably has to do with our societal discomfort talking about sex.


We use general and vague terms to imply that we are talking about sex, but often don’t feel comfortable out right discussing it. For example, the birth control pill is generally just referred to as “the pill.” There is still shame and stigma surrounding sex, particularly for women and sexual minorities, so it may be easier and safer for a woman to talk about being on “the pill,” even though everyone knows what she is referring to, than to overtly announce that she is using contraception.


Even though we as a society may not feel comfortable explicitly discussing sex, we still feel that it is our business. From a legal perspective, look at how carefully reproductive medicine is regulated. For instance, certain reproductive procedures (e.g. abortion and sterilization) can require waiting mandatory periods – something that is not common in other areas of nonelective medicine. In the social realm, family, friends, and even strangers feel they have the right to comment on a pregnant woman’s behavior, such as by telling her what she should and should not eat or drink.


Returning to the topic of “trying,” family, friends, and again even strangers often have no qualms about asking women about whether they are trying to conceive. This is especially the case for straight women who are recently married and women who are perceived as being near or at the end of their “biological clock.”


Asking women whether they are “trying” is problematic on many levels. First, it assumes that all women want to become pregnant with genetically related children. While this may be true for many women, it is not true for all women. There is already enough social pressure on women in our pronatalist society to have biological children so people should avoid adding to this pressure. Second, asking people if they are “trying” is just a euphemism for asking them if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, which is usually not considered an appropriate topic, especially among strangers. It is typically seen as impolite to discuss sex under certain circumstances or with certain people and discussing reproductive sex (that is, sex for which one of the purposes is reproduction) should not be treated differently.


To summarize, if you don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, then don’t ask them if they are “trying” to conceive.

 

 

 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.


November 9, 2016

Bioethics faces a rocky but navigable road

by Arthur Caplan, Ph.D.

Academic bioethics has never been popular with Republicans.  Libertarians dislike academic bioethics because it seems too elitist and anti-free market. …

November 9, 2016

President Trump & A Republican Congress: What Might It Mean?

by Craig Klugman, Ph.D.

In a 2000 episode of The Simpsons, a flash forward shows Lisa being elected the first heterosexual female U.S.…

November 3, 2016

Why we should recognize social infertility: the exclusion of lesbian and gay couples and single individuals from definitions of infertility

The diagnosis of infertility is an anomaly among medical conditions because it requires two people, whereas almost all other medical conditions require just one person. For instance, if I break my leg, my diagnosis and treatment does not include or depend upon anyone else within my web of relationships. In contrast, when physicians are assessing a patient for infertility, they inquire about the person’s presumed heterosexual partner. This is because the majority of medical definitions of infertility rely upon heterosexual activity as a prerequisite to determine if an individual is infertile. For example, the World Health Organization (WHO) defines infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” 

One significant problem with this definition is that it cannot account for lesbian and gay couples and single heterosexual individuals. Lesbian and gay cisgender couples are not having sexual intercourse (i.e. vaginal penile sex), so they are automatically excluded from definitions of infertility. Single heterosexual individuals may be having intercourse, but it may not be “regular,” which we can presume to mean on a consistent basis, and they may not be having unprotected intercourse.  

Yet, lesbian and gay couples and single individuals, regardless of their sexual orientation, are all infertile in a sense because they are not able to sexually reproduce via intercourse. Some in the bioethics literature have used the term “social infertility” to refer to individuals who are unable to reproduce due to factors associated with their partner. This can include individuals in same-sex couples who are not able to engage in intercourse and individuals who do not have a partner and thus are not able to engage in intercourse. 

In recognizing social infertility, the WHO recently changed their definition of infertility to include lesbian and gay couples and single individuals. Unfortunately, insurance companies in the United States do not tend to recognize social infertility. For example, a lesbian couple in New Jersey is suing their insurance company because it will not cover infertility treatment for them. Between the two women, they have had six miscarriages, which shows they are not just socially infertile, but there are also physiological components to their infertility. However, their insurance company is stating that they have not demonstrated that they are infertile because they have not been having heterosexual intercourse. 

The idea of requiring lesbian and gay individuals to prove their infertility by engaging in vaginal penile intercourse is ridiculous, especially given that modern medicine has various ways of assessing an individual’s fertility (e.g. hormonal tests, ovarian reserve, sperm motility, etc.). We need a broader definition of infertility that does not depend upon an individual’s relationship, or lack thereof, with others. The new WHO definition is a step in the right direction to recognize social infertility as well as the fact that lesbian and gay couples and single individuals can experience physiological infertility on top of social infertility.

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.