This book summarizes the contributions at an April 2016 conference held at Albany Medical College, Reproductive Ethics: New Challenges and Conversations. Reproductive ethics does not suffer from a lack of challenging issues, yet a few "hot button" issues such as abortion and surrogacy seem to attract most of the attention, while other issues and dilemmas remain relatively underdeveloped in bioethics literature. The goal of this book is to explore and expand the range of topics addressed in reproductive ethics. This is (...) a multi-disciplinary book bringing together philosophers, clinicians, sociologists, anthropologists, and other scholars whose research or clinical interests touch reproductive issues. The results of this compilation are a comprehensive and unique discussion of the evolving issues in the rapidly changing field. The majority of the popular reproductive ethics anthologies were published at least 10 years ago. The field of reproductive ethics would benefit from a new anthology that addresses some of the perennial dilemmas in reproductive ethics (e.g. abortion, sex selection) from updated perspectives and that also covers new technologies that have emerged only in the last few years, such as social egg freezing. (shrink)

Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women’s inequality. (...) While these advancements and technologies can benefit women, I argue medicine is not the best tool to ‘cure’ social problems and should not be co-opted as an agent of social change. Systemic social changes, not just technomedical approaches, are needed to address the root of gender inequality, which is social in nature, not medical. (shrink)

According to Petersen, ‘the individualization argument against NMEF [nonmedical egg freezing]’ states: ‘it is morally wrong to let individuals use technology X [NMEF] – in order to try to handle a problem that is social in nature – if the use of X [NMEF] will somehow work against a social solution to a social problem P [gender inequality in the labor market]’. While there may be individuals making individualisation argument against NMEF, I do not read the scholars he discusses—Karey Harwood,1 (...) 2 Lynn Morgan, Janelle Taylor3 and Angel Petrapanagos4—as making this argument. These scholars agree with the premise of the individualisation argument that NMEF ‘is an individualistic and morally problematic solution to the social problems that women face’, but this does not mean that they agree with the conclusion ‘women should not use NMEF’. In fact, several admit that NMEF can be a good choice for some women; Petropanagos, for example, states ‘individual women may benefit from egg freezing to satisfy their reproductive desires’.4 In this commentary, I argue that Petersen incorrectly reduces these scholars’ positions to the individualisation argument by neglecting three pertinent factors: their feminist orientation, their multifaceted critiques of NMEF and how the rapidly advancing field of reproductive medicine informs their ethical analysis. While Petersen …. (shrink)

(2011). An Obscure Rider Obstructing Science: The Conflation of Parthenotes with Embryos in the Dickey–Wicker Amendment. The American Journal of Bioethics: Vol. 11, No. 3, pp. 20-28.

In 2012, two major professional societies representing Europe and the United States released influential statements that would propel a commercial market for social egg freezing, in which women bank their oocytes for later use in order to avoid compromised fertility that comes with age. While the European Society of Human Reproduction and Embryology condoned SEF based on reproductive autonomy and justice, the American Society for Reproductive Medicine discouraged SEF based on insufficient data and concerns about false hope. In this article, (...) we map the contexts and discursive moves by which the biomedicalization of SEF proceeded since 2012. We compare professional bioethical arguments that made the case to approve SEF in Europe with news and popular media discourse that formed and shaped the commercial marketization of SEF in the United States despite the recommendation of the ASRM. While a statist pronatalist perspective informed the former, a distinctly private labor market recruitment strategy utilizing a Lean In efficiency model of feminism buttressed the latter. (shrink)

A 16-year-old adolescent who identifies as transgender wishes to consider fertility preservation prior to the use of gender-affirming hormones. The adolescent’s parents are divorced, and one parent supports fertility preservation while the other does not. This case explores the minor’s future reproductive autonomy and parental decision making in a field where there is limited evidence of known harms and benefits to the use of fertility preservation in the transgender population and about future potential regret from lack of consideration of fertility (...) preservation during the prime window of opportunity. This case is created from a composite of cases seen at multiple institutions. (shrink)

The article “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose,” Marshall et al. (2024) highlights the critical issue of care after an opioid overdose. “Revive and Re...

In assessing the ethics of fetal therapy trials, we agree with Hendriks et al. that we should not just consider biomedical benefits, but also psychosocial benefits. Specifically, we argue th...

We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This orientation, combined with (...) a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training. (shrink)

We appreciate Fritz’s thoughtful analysis of the asymmetry between legal protections for negative and positive conscience claims and are particularly interested in further exploring the conc...

Modern contraceptives—especially long-acting, reversible contraceptives, or LARCs—are typically seen as a boon for humanity and for women, the majority of their users, in particular. But the disparity between the number and types of female and male LARCs is problematic for at least two reasons: first, because it forces women to assume most of the financial and health-related responsibilities of contraception, and second, because men’s reproductive autonomy is diminished by it. In order to understand how to change our current contraceptive arrangement, (...) I want to look at some of the historical and contemporary factors that contribute to this disparity, especially gender norms that associate women with reproduction .. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such harm. (...) My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

New York defines rape as forced penile vaginal penetration, which means only women can be rape victims. Given this definition, rape should always be considered a type of hate crime and thus eligible for sentencing enhancement because the perpetrators target victims based on their group membership. Such a narrow definition of rape is problematic because it fails to acknowledge oral and anal rape and overlooks the fact that men can also be raped. I argue that regardless of the type of (...) sexual assault that occurs, rape should be considered a hate crime when the rapist chooses the victim based on gender, gender identity, and/or sexual orientation and the rape reinforces the patriarchal and heteronormative hegemony. (shrink)

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such harm. (...) My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

Contraception works by preventing fertilization of an egg or preventing implantation of a fertilized embryo. For those who believe pregnancy begins at implantation, contraceptives preventing implantation are not abortifacient. However, for those who assert that pregnancy begins at fertilization, any agent causing the intentional loss of an embryo, even prior to implantation, is abortifacient, both morally and for lack of a different term to describe the postfertilization, preimplantation loss. In the debate on this topic, much of the discourse on both (...) sides wrongly focuses on the opposing side's perceived ignorance in denying scientifically proven definitions rather than on the substance of the conflict. Indeed, both sides accuse the other of prioritizing its “subjective” views over “objective” facts. In this essay, we unpack the scientific, cultural, and religious factors that underlie this debate. We argue that the only way to move forward is to clarify our terminology and engage with the substance of the argument, rather than merely the rhetoric. (shrink)

In Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care, Jill B. Delston uses a feminist lens to examine the overwhelmingly common gynecological practice of declining to write prescriptions for oral contraceptives unless a woman agrees to an annual Pap smear, which is used to detect precancerous changes, as well as cancer of the cervix. Employing a comprehensive evaluation of the medical literature, Delston methodically builds a strong argument that these measures not only do not follow evidence-based medical guidelines, but (...) they also carry a significant potential of harm to the patient. Furthermore, cervical cancer prevention has absolutely nothing to do with... (shrink)

A necessary component to reproductive autonomy is being trusted to make reproductive decisions. In the case of contraception, however, women are considered both trustworthy and untrustworthy. Women are held responsible for contraception and because responsibility usually stems from trust, it appears that women are trusted with contraception. Yet myriad laws and forms of surveillance and normalization surrounding contraception make women seem untrustworthy. Relying on Amy Mullin’s conception of trust that we trust those who we assume believe in the same social (...) norms we do, I argue that this tension results from two competing social norms. One norm governing contraception is that people should be self-sacrificing, a norm with which most women align due to traditional gender roles. However, there is a norm that women are irrational in general as well as in contraceptive matters and consequently should not be trusted to use contraception. In order to combat both these norms, I make concrete recommendations for increasing knowledge of contraception, normalizing its use, and trusting both women and men with it. (shrink)

Melanie was 29-years-old, married, and hoping to start a family when she discovered a lump in her pelvis. She was diagnosed with non-Hodgkin lymphoma. But one of her biggest fears upon learning of her diagnosis was the possibility of loosing her ability to have children. When Melanie asked her oncologist and radiation oncologist about the risk cancer treatment posed to her fertility, they told her it was small, as only one ovary would be destroyed during the radiation. Deciding to ask (...) for another opinion, she sought out a reproductive endocrinologist, who told her, contrary to what her oncologists had said, that women like her typically did have problems conceiving after radiation treatment on their pelvis. One of the hardest parts of dealing with her dual diagnosis, Melanie later recalled, was the unknown: “I didn't know if my treatment would definitely render me infertile.”. (shrink)

In the last two decades, genital transplants have emerged as another type of quality‐of‐life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality and reproduction to show (...) how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of “normal” male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms—regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure— has engendered various types of genital transplants, but not clitoris transplantation. (shrink)

In this paper, we recommend expanding infertility insurance mandates to people who may become infertile because of cancer treatments. Such an expansion would ensure cancer patients can receive fertility preservation technology (FPT) prior to commencing treatment. We base our proposal for extending coverage to cancer patients on the infertility mandate in Massachusetts because it is one of the most inclusive. While we use Massachusetts as a model, our arguments and analysis of possible routes to coverage can be applied to all (...) states' seeking inclusive coverage for infertility treatment. Furthermore, our proposal can also be applied to people with other diseases who may be rendered infertile by treatment. (shrink)

This book is the second collection of essays on reproductive ethics from Drs. Campo-Engelstein and Burcher. This volume is unique in that it is both timely and includes several essays on new technologies, while also being a comprehensive review of most of the major questions in the field, from racial disparities in reproductive healthcare to gene editing and the possibility of the creation of a transhuman species. The scholars writing these essays are pre-eminent in their fields, and their (...) backgrounds are quite varied, including philosophers, anthropologists, physicians, and professors of law. Reproductive ethics remains an underdeveloped area of bioethics despite the recent technological breakthroughs that carry both great promise and potential threats. Building on the first volume of work from a conference held just over one year ago, this new collection of essays from a conference held April 2017 continues this discussion as well as provides ethical insights and reviews of these emerging technologies. The ethical questions swirling around human reproduction are both old and new, but the conference presentations, and the essays derived from them, focus on new ways of appreciating old arguments such as the ethics of abortion, as well as new ways of seeing new technologies such as CRISPR and mitochondrial transfer. (shrink)

In the United States, single individuals and LGBTQ couples who wish to conceive biological children are considered to be “socially infertile” due to their relationship status. Due to the high cost of infertility treatments and inadequate insurance coverage, the socially infertile has minimal access to assisted reproductive technology. Under the current medical definitions of infertility, even in states with infertility insurance mandates, only heterosexual couples with physiological infertility are covered for ART. It is well documented that infertility interferes with many (...) aspects of the human experience and reduces the quality of life for involuntarily childless individuals regardless of whether the infertility is physiologically or socially based. Physiological infertility was initially considered to be a private issue before being recognized as a medical diagnosis and has since legitimized heterosexual couples’ access to ARTs. The medical diagnosis of infertility not only affirms that their intention to conceive biological children is justifiable but also confirms that it is a condition that can and should be treated with current medical interventions. Expanding the current definition of infertility to include social infertility will elevate it to a treatable medical condition, justifying the use of ART for such individuals and potentially alleviating the negative impacts of infertility. Thus, states with infertility insurance mandates should provide the same infertility coverage to socially infertile individuals as physiologically infertile heterosexual couples. (shrink)

In their article, De Bie et al. (2023) provide a scoping review of the ethical and socio-legal issues arising from research into, and the potential, maybe even likely deployment of, artificial womb...

The antiabortion movement is increasingly using ostensibly scientific measurements such as ‘fetal heartbeat’ and ‘fetal pain’ to provide ‘objective’ evidence of the moral status of fetuses. However, there is little knowledge on how clinicians conceptualise and operationalise the moral status of fetuses. We interviewed obstetrician/gynaecologists and neonatologists on this topic since their practice regularly includes clinical management of entities of the same gestational age. Contrary to our expectations, there was consensus among clinicians about conceptions of moral status regardless of specialty. (...) First, clinicians tended to take a gradualist approach to moral status during pregnancy as they developed and viewed viability, the ability to live outside of the uterus, as morally significant. Second, in contrast to ‘fetal pain’ laws and philosophical discussions about the ethical salience of sentience, the clinicians in our study did not consider the ability to feel pain as a morally relevant factor in moral status determinations. Third, during previability and perviability, clinicians viewed moral status as a personal value decision, which should be made by pregnant people and parents of neonates. (shrink)

Assuming a relational understanding of the self, I argue that empathy is necessary for individual and cultural recovery from rape. However, gender affects our ability to listen with empathy to rape survivors. For women, the existence of cultural memories discourages empathy either by engendering fear of their own future rape or by provoking sympathy rather than empathy. For men, the lack of cultural memories makes rape what Arendt calls an "unreality," thus diminishing the possibility for empathy. Although empathetic listeningpresents gender (...) specific challenges for both women and men, it should not be abandoned as a strategy for trauma recovery. I make two broad suggestions for promoting empathy. First, we need to teach empathy for victims and survivors. Second, we need to discredit problematic gender norms, which buttress rape culture and sexual violence. (shrink)

A dominant cultural narrative within Costa Rica describes Costa Ricans not only as different from their Central American neighbours, but it also exalts them as better: specifically, as more white, peaceful, egalitarian and democratic. This notion of Costa Rican exceptionalism played a key role in the creation of their health care system, which is based on the four core principles of equity, universality, solidarity and obligation. While the political justification and design of the current health care system does, in part, (...) realize this ideal, we argue that the narrative of Costa Rican exceptionalism prevents the full actualization of these principles by marginalizing and excluding disadvantaged groups, especially indigenous and black citizens and the substantial Nicaraguan minority. We offer three suggestions to mitigate the self-undermining effects of the dominant national narrative: 1) encouragement and development of counternarratives; 2) support of an emerging field of Costa Rican bioethics; and 3) decoupling health and national successes. (shrink)

Ovarian tissue transplantation is an experimental procedure that can be used to treat both infertility and premature menopause. Working within the current legal framework in the USA, I examine whether ovarian tissue should be legally treated like gametes or organs in the case of ovarian tissue transplantation between two women. One option is to base classification upon its intended use: ovarian tissue used to treat infertility would be classified like gametes, and ovarian tissue used to treat premature menopause would be (...) classified like organs. In the end, however, I argue that this approach will not work because it engenders too many legal, cultural and logistical concerns and that, at least for the near future, we should treat ovarian tissue like gametes. (shrink)

Until quite recently human reproduction was considered an entirely natural process, and the ethics of reproduction were governed more by cultural mores and religious strictures than by any serious philosophical or empirical inquiry. However, more recently reproductive ethics has exploded as a field for several reasons. At a cultural level, many things taken for granted a generation ago, including the increasing medicalization of birth and the heteronormative two-parent nuclear family, have been challenged, and new possibilities have arisen from these now (...) contested ideas. It is important to remember that the explosion of reproductive ethics is as much from new thinking as it is from new technologies, and, at least in regard to reproductive possibilities for the LGBTQ community, it may well be fair to say that it is our new thinking that then led to new technological explorations. (shrink)

One winter morning, the two of us—both postdoctoral fellows in medical humanities and bioethics—gathered with a handful of reproductive science graduate students in the lab to watch a demonstration on making alginate beads. Due to their three-dimensional nature, the beads are capable of holding ovarian follicles—the beads act as though they were a small ovary. The scientists in the lab have managed to mature the follicles maintained in the beads into eggs, fertilize these eggs, and produce the birth of live (...) mice. This research was begun in an effort to develop a means of gathering ovarian follicles from young human cancer patients before they commence cancer treatment that may result in their infertility, thus .. (shrink)

When one thinks about organ transplantation, the organs that usually come to mind are the heart, or possibly the kidney, the most commonly transplanted organ (UNOS 2008). Transplantations are generally regarded as necessary to the life of the person receiving the transplant or to physiologically improving that life: the transplant is seen as making the recipient “whole” once more (Lederer 2008). While many have commented on the various ethical issues brought forth by the clinical practice of organ transplantation, here we (...) are concerned with the idea of becoming whole from organ transplantation. The idea of wholeness that a transplant renders can extend beyond the physiological to the individual, the familial, and .. (shrink)

Given recent legal developments in the United States, now is a critical time to draw attention to how ‘conscientious objection’ is sometimes used by health care providers to discriminate against the LGBTQ community. We review legal developments from 2019 and present several cases where health care providers used conscientious objection in ways that discriminate against the LGBTQ community, resulting in damaged trust by this underserved population. We then discuss two important conceptual points in this debate. The first involves the interpretation (...) of discrimination (provider versus patient-centered views), and we argue for a patient-centered view; the second involves the use of the people versus procedure distinction to reach a compromise between LGBTQ individuals and the clinicians who do not want to treat them. We argue the distinction is problematic when applied to treatment of the LGBTQ population. (shrink)

Medical students’ concerns during clinical clerkships may not always be addressed with mentors who work under significant time constraints. This study examined 3rd year students’ survey responses regarding patient encounters to elucidate what may be hidden aspects of their learning environment. We analyzed results to an 18-item survey completed during a required ethics and professionalism course in third-year medicine clerkships over a period of 18 months. The survey covered types of concerns elicited by patient encounters, interactions with mentors about concerns, (...) perceptions of mentors, and level of moral distress. We also examined results of a 7-item evaluation of small group discussions during the study period. 1210 surveys and 195 evaluations constituted the study samples. Students’ concerns related primarily to ethics (36.4%, n = 441) and quality of care (34.5%, n = 418). Concerns had not been raised with a mentor in 535 (44.2%) instances. Students experienced moral distress in connection with 35.4% (n = 324) of cases; this was particularly common when a concern applied to a mentor. Higher levels of moral distress were associated with a lower likelihood of wishing to emulate the mentor (r = -0.27, p <.001). Two thirds of students, 66.9% (n = 107), stated that small group discussions where concerns were discussed lowered their stress levels. We suggest that clinical mentors be made aware of students’ learning needs and that structured discussions be available for students to articulate concerns with peers and facilitators in efforts to uncover elements of the hidden curriculum with the goal of optimizing students’ well-being, learning and professional development. (shrink)

This paper discusses the ethical issues related to hemicorporectomy surgery, a radical procedure that removes the lower half of the body in order to prolong life. The literature on hemicorporectomy (HC), also called translumbar amputation, has been nearly silent on the ethical considerations relevant to this rare procedure. We explore five aspects of the complex landscape of hemicorporectomy to illustrate the broader ethical questions related to this extraordinary procedure: benefits, risks, informed consent, resource allocation and justice, and loss and the (...) lived body. (shrink)

We report on the case of a 2-year-old female, the youngest person ever to undergo ovarian tissue cryopreservation (OTC). This patient was diagnosed with a rare form of sickle cell disease, which required a bone-marrow transplant, and late effects included high risk of future infertility or complete sterility. Ethical concerns are raised, as the patient's mother made the decision for OTC on the patient's behalf with the intention that this would secure the option of biological childbearing in the future. Based (...) on Beauchamp and Childress's principlism approach of respect for autonomy, nonmaleficence, beneficence, and justice, pursing OTC was ethically justified. (shrink)

Fertility preservation has become more common for various populations, including oncology patients, transgender individuals, and women who are concerned about age-related infertility. Little attention has been paid to fertility preservation for patients with differences/disorders of sex development (DSD). Our goal in this article is to address specific ethical considerations that are unique to this patient population. To this end, we present a hypothetical DSD case. We then explore ethical considerations related to patient’s age, risk of cancer, concern about genetic transmission (...) of a DSD condition to children, co-occurring gender dysphoria, and access to experimental fertility preservation procedures. Given the limitations of current technologies, we recommend offering fertility preservation to individuals living with DSD using an informed decision-making approach that instills realistic expectations and minimizes the potential for false hope. Finally, we conclude with practical recommendations for this case based on the ethical considerations. (shrink)