Heuser, Eller and Byrne provide important descriptive ethics data about how physicians counsel women on the clinical management of pregnancies complicated by severe fetal anomalies. The authors present an account of what such counselling ought to be based on, the ethical concept of the fetus as a patient and the professional responsibility model of obstetric ethics. When there is certainty about the diagnosis and either a very high probability of either death as the outcome of the anomaly or survival with (...) severe and irreversible deficit of cognitive developmental capacity as a result of the anomaly diagnosed, the pregnant woman should be offered the alternatives of aggressive and non-aggressive obstetric management and induced abortion before viability. It is also ethically permissible to offer feticide followed by termination of pregnancy after viability in such cases. This ethically justified approach will reduce the variation in the actual practices of specialists in maternal–fetal medicine described by Heuser, Eller and Byrne. (shrink)

Many accounts of the morality of abortion assume that early fetuses must all have or lack moral status in virtue of developmental features that they share. Our actual attitudes toward early fetuses don’t reflect this all-or-nothing assumption: early fetuses can elicit feelings of joy, love, indifference, or distress. If we start with the assumption that our attitudes toward fetuses reflect a real difference in their moral status, then we need an account of fetal moral status that can explain that difference. (...) I argue that we can have or lack relational obligations to early fetuses in light of our own activities or choices, independent of the fetus’s own features or properties. Those relational obligations make the early fetus morally considerable to the persons who stand in a moral relation to it. Pregnant persons (and other participants in the procreative process) can come to have relational obligations to an early fetus just in virtue of their own decision to create a person, either by intentionally getting pregnant or by deciding to continue a pregnancy. That decision not only makes it appropriate for them to care about the fetus, but it also generates obligations to the fetus that they didn’t have before that decision. (shrink)

Background There is longstanding consensus on the need to include pregnant women in research. The goal of clinical research is to find highly regulated, carefully controlled, morally responsible ways to generate evidence about how to effectively and safely prevent illness or treat sick people. This manuscripts present a conceptual analysis of the ethicality of clinical trials in 3 scenarios: where the pregnant is involved in clinical trials as a participant during pregnancy for data that addresses pregnancy complications, (...) where the pregnant woman consents to clinical trial participation for an unborn baby that has complications, to generate data on complications at this stage of life, and where the mother may consent for participation of their newborn child in clinical trials. Methods Conceptual analysis. Findings Investigators often choose to exclude pregnant women and newborns from research, even where there is possibility for them to benefit from the study intervention. Objections include vulnerability of pregnant women, altered pharmacokinetics and risk of adverse effects, with a need to balance potential maternal and fetal risks and benefits of research participation. While the objections may be valid, not performing research magnifies what should be a carefully controlled risk during research, pushing this risk into the clinical setting, and subsequently posing a challenge to clinicians who are faced with making treatment decisions for pregnant patients with limited evidence of efficacy and safety. The potential benefits of fair inclusion in clinical trials outweigh the potential risks. Conclusion Research involving pregnant women is necessary to provide women with effective treatment during pregnancy, to promote fetal safety, and to reduce avoidable harm from suboptimal care and to provide pregnant women, their fetuses and newborns. (shrink)

Background There is longstanding consensus on the need to include pregnant women in research. The goal of clinical research is to find highly regulated, carefully controlled, morally responsible ways to generate evidence about how to effectively and safely prevent illness or treat sick people. This manuscripts present a conceptual analysis of the ethicality of clinical trials in 3 scenarios: where the pregnant is involved in clinical trials as a participant during pregnancy for data that addresses pregnancy complications, (...) where the pregnant woman consents to clinical trial participation for an unborn baby that has complications, to generate data on complications at this stage of life, and where the mother may consent for participation of their newborn child in clinical trials. Methods Conceptual analysis. Findings Investigators often choose to exclude pregnant women and newborns from research, even where there is possibility for them to benefit from the study intervention. Objections include vulnerability of pregnant women, altered pharmacokinetics and risk of adverse effects, with a need to balance potential maternal and fetal risks and benefits of research participation. While the objections may be valid, not performing research magnifies what should be a carefully controlled risk during research, pushing this risk into the clinical setting, and subsequently posing a challenge to clinicians who are faced with making treatment decisions for pregnant patients with limited evidence of efficacy and safety. The potential benefits of fair inclusion in clinical trials outweigh the potential risks. Conclusion Research involving pregnant women is necessary to provide women with effective treatment during pregnancy, to promote fetal safety, and to reduce avoidable harm from suboptimal care and to provide pregnant women, their fetuses and newborns. (shrink)

There is longstanding consensus on the need to include pregnant women in research. The goal of clinical research is to find highly regulated, carefully controlled, morally responsible ways to generate evidence...

A difficult task for politicians who want to fight injustice without doing wrong themselves is identifying where it is permissible to vote for and/or promote so-called “imperfect laws” which somewhat improve existing unjust legal situations but leave closely related injustices intact. One approach is to seek a “selective ban” on some injustices which are politically preventable. This approach is acceptable at least in principle, unlike the approach of “regulation”—i.e., permitting or instructing others to do, or prepare to do, the unjust (...) act in specified ways. The latter necessarily involves us in formal cooperation with evil: wrongly intending that others choose wrongly; for example, that abortion doctors deliberately prepare for abortion, albeit in ways that make an abortion less risky or less likely. In relation to parental consent or parental notification, and to pregnancy counselling and provision of information to pregnant women, while there may be ways of requiring these without complicity in others’ wrongful choices, this is at least more difficult than is often recognised. There can also be problems of principle in seeking consensus with fellow-legislators who may positively intend and even promote the continuation of remaining injustices even as they collaborate with more consistent reformers in passing laws which mitigate injustice overall. (shrink)

The aim of the study was verifying, whether speech development is conditioned by a preterm birth, multiple pregnancy or pregnancy complicated with TTTS. We examined 52 preterm children, 15 of which were born after a single pregnancy and 42 after a multiple pregnancy. 23 children came from a pregnancy complicated by TTTS. The average age of the subjects was 32.5 months. The research methods used in our study were as follows: analysis of medical documentation, a (...) structured clinical interview and psychological conversation. Speech development of a child was assessed using BSID-III. An analysis of the results we obtained showed that there was a lower level of EC in the TTTS children in comparison to multiple-birth children without TTTS and single-birth children. We also found statistically significant relations between the EC scores and gender, age at the time of testing, disability, gestational age, birth weight. (shrink)

Survival after solid-organ transplantation has improved significantly, and many contemporary transplant recipients are of childbearing potential. There are limited data to guide decision-making surrounding pregnancy after transplantation, variations in clinical practice, and significant knowledge gaps, all of which raise significant ethical issues. Post-transplant pregnancy is associated with an increased risk of maternal and fetal complications. Shared decision-making is a central aspect of patient counselling but is complicated by significant knowledge gaps. Stakeholder interests can be in conflict; exploring (...) these tensions can help patients to evaluate their options and inform their deliberations. We argue that uniform, evidence-based recommendations for pregnancy after solid organ transplantation are needed. Conducting research, including patient-engaged studies, in this area should be priority for the transplant community. (shrink)

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential (...) for pregnancy.MethodsA literature review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

Settler colonialism has contributed to disproportionate health disparities for Indigenous women, however their health experiences during pregnancy are understudied. The first author used qualitative description methodology to conduct life-course semi-structured interviews with 31 women who were members of a state-recognized Gulf Coast Indigenous tribe in the United States. Participants most often described these types of pregnancy experiences: How and From Who Learned About Pregnancy and Birth; Experiences with Miscarriage; Complications During Pregnancy; Working During Pregnancy (...) and Lack of Post-Partum or Maternity Leave and Generational Changes in Pregnancy. We discuss research implications and areas of future research based on participants' experiences. (shrink)

Shifting laws and regulations increasingly displace the centrality of women's health concerns in the provision of abortion services. This is exemplified by the growing presence of deceptive Crisis Pregnancy Centers alongside new informed consent laws designed to dissuade women from seeking abortions. Litigation on informed consent is further complicated in the clinical context due to the increased mobilization of facts – such as the gestational age or sonogram of the fetus – delivered with the intent to dissuade women from (...) accessing abortion. In other words, factual information utilized for ideological purpose. To preserve a woman's autonomy and decision-making capacity, there must be a concerted effort on the part of legislators and courts to place a woman's health at the center of abortion law and policy. (shrink)

Starting from first person experience, I argue that early miscarriage may invoke a sense of loss that is enigmatic and ambiguous, often times complicated by the fact that the topic of miscarriage is culturally silenced. Understanding the frequency of such occurrences of early pregnancy loss (in terms of the “miscarriage iceberg”) adds to the existential need to conceptualize such losses as they bleed into life at its very emergence. The prevalent cultural discourse on loss, even when it deals with (...) ambiguity, is focused upon individuation and personhood, which may complicate the grieving process in the case of early pregnancy loss.In searching for alternative epistemologies to address early pregnancy loss and its consequent grief, I propose the following conceptual pathways to elucidate the nature of this loss. First, early pregnancy loss may be understood in terms of the dissipation of a pregnant constellation, thereby putting less emphasis on losing a “being” but rather a sense of participation. This clarifies the kind of loss involved but does not yet completely explain what kind of relationality is lost. Secondly, the grief involved in early pregnancy loss benefits from the Freudian-inspired theories of Pauline Boss and Judith Butler, who emphasize that grief entails absence and presence (Boss, The myth of closure: ambiguous loss in a time of pandemic and change. W.W. Norton & Company, New York, 2021) as well as a deep loss of identity given the loss of relational ties that inform identity (Butler, Stud Gender Sexuality 4(1):9–37, 2003). This deepens the account of grief but does not precisely address the loss of mere emergent relationality. Thirdly, following Gilbert Simondon’s theory on ontogenesis (Simondon, The genesis of the individual. In Crary J, Kwinter S (eds) Incorporations. Zone Books, New York, 297–319, 1992), pregnancy loss involves losing a bridge to a pre-individual relationality, due to which the formerly pregnant body cannot easily leap “back” into former forms of individuation nor leap forward into a socially recognized altered collectivity. This account is able to clarify the kind of relational loss involved in early pregnancy loss. (shrink)

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the (...) previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness. (shrink)

Males are selectively afflicted with the neurodevelopmental and psychiatric disorders of childhood, a broad and virtually ubiquitous phenomenon that has not received proper attention in the biological study of sex differences. The previous literature has alluded to psychosocial differences, genetic factors and elements pertaining to male “complexity” and relative immaturity, but these are not deemed an adequate explanation for selective male affliction. The structure of sex differences in neurodevelopmental disorders is hypothesized to contain these elements: Males are more frequently afflicted, (...) females more severely; disorders arising in females are largely mediated by the genotype; in males, by a genotype by environment interaction; complications of pregnancy and delivery occur more frequently with male births; such complications are decisive and influence subsequent development. We hypothesize that there is something about the male fetus that evokes an inhospitable uterine environment. This “evocative principle” is hypothesized to relate to the relative antigenicity of the male fetus, which may induce a state of maternal immunoreactivity, leading either directly or indirectly to fetal damage. The immunoreactive theory thus constructed is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders. Although the theory is necessarily speculative, it is heuristic and hypotheses derived from it are proposed; some are confirmed in the existing literature and by the authors' research. (shrink)

Khalafzai, Rida Usman; Hameed, Imran Obstetric fistula is the most devastating complication of parturition. The impact of this ailment extends beyond physical morbidity, with immense social repercussions for the women who suffer from it.

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature (...) and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)

Adenosine transport in cultured human umbilical vein endothelial cells (HUVEC) was characterized and shown to be mediated by a single facilitated diffusion mechanism. Initial rates of adenosine influx at 22 degrees C were saturable [apparent Michaelis constant, 69 +/- 10 mu M; maximum velocity (V-max), 600 +/- 70 pmol.10(6) cells(-1).s(-1)] and inhibited by nitrobenzylthioinosine (NBMPR). Formycin B had an unusually high affinity [inhibitory constant K-i), 18 +/- 4.3 mu M], whereas inosine had a low affinity (K-i, 440 +/- 68 mu (...) M) and nucleobases were without effect on adenosine influx. The number of transporters (1.2 x 10(6) sites/cell) was estimated by NBMPR equilibrium binding (apparent dissociation constant, 0.11 +/- 0.01 nM; maximum binding, 2.0 +/- 0.15 pmol/10(6) cells). In addition, we compared these endothelial cells with those obtained from cords from pregnancies complicated by diabetes (HUVEC-D), since embriopathy may occur in these conditions. HUVEC-D exhibited a 2.3-fold reduction in both the V-max for adenosine influx and the maximum number of NBMPR binding sites (260 +/- 40 pmol.10(6) cells(-1).s(-1) and 0.86 +/- 0.08 pmol/10(6) cells, respectively). However, the turnover number for each nucleoside transporter in normal and diabetic HUVEC was similar (approximate to 300 adenosine molecules/s). Adenosine metabolism at 10 mu M in HUVEC-D was modified compared with normal cells. Intracellular phosphorylation (> 90%) was the predominant pathway in normal HUVEC, whereas in HUVEC-D, substantial levels of adenine and adenosine were detected. The present results demonstrate therefore the downregulation of the NBMPR-sensitive nucleoside transporter and changes in adenosine metabolism in HUVEC from diabetic pregnancies. (shrink)

Despite increasing recognition of the ways in which ethical and social values play a role in science (Kitcher 2001; Longino 1990, 2002), scientists are often still reluctant to acknowledge or discuss ethical and social values at stake in their research. Even when research is closely connected to developing public policy, it is generally held that it should be empirical data, and not the values of scientists, that inform policy. According to this view, scientists need not, and should not, endorse non-epistemic (...) values related to their research, as doing so may bias their assessment of what the evidence is. As a result, debates over science-based policy tend to be construed solely as empirical discussions to be .. (shrink)

Is the “act itself” of separating a pregnant woman and her previable child neither good nor bad morally, considered in the abstract? Recently, Maureen Condic and Donna Harrison have argued that such separation is justified to protect the mother’s life and that it does not constitute an abortion as the aim is not to kill the child. In our article on maternal–fetal conflicts, we agree there need be no such aim to kill (supplementing aims such as to remove). However, we (...) argue that to understand “abortion” as performed only where the death of the child is intended is to define the term too narrowly. Respect for the mother, the fetus, and the bond between them goes well beyond avoiding any such aim. We distinguish between legitimate maternal treatments simply aimed at treating or removing a damaged part of the woman and illegitimate treatments that focus harmfully on the fetal body and its presence within the mother’s body. In obstetrics as elsewhere, not all side effects for one subject of intervention can be outweighed by intended benefits for another. Certain side effects of certain intended interventions are morally conclusive. (shrink)

Trafficking and persistence of fetal microchimeric cells (fMCs) and circulating extracellular vesicles (EVs) have been observed in animals and humans, but their consequences in the maternal body and their mechanistic contributions to maternal physiology and pathophysiology are not yet fully defined. Fetal cells and EVs may help remodel maternal organs after pregnancy‐associated changes, but the cell types and EV cargos reaching the mother in preterm pregnancies after exposure to various risk factors can be distinct from term pregnancies. As preterm (...) delivery‐associated maternal complications are rising, revisiting this topic and formulating scientific questions for future research to reduce the risk of maternal morbidities are timely. Epidemiological studies report maternal cardiovascular risk as one of the major complications after preterm delivery. This paper suggests a potential link between fMCs and circulating EVs and adverse maternal cardiovascular outcomes post‐pregnancies, the underlying mechanisms, consequences, and methods for and how this link might be assessed. (shrink)

When a woman or girl finds herself pregnant, is it morally permissible for her to end that pregnancy? One dominant tradition says “no”; its close cousin says “rarely” - exceptions may be made where the burdens on the individual girl or woman are exceptionally dire, or, for some, when the pregnancy results from rape. On both views, though, there is an enormous presumption against aborting, for abortion involves the destruction of something we have no right to destroy. Those (...) who reject this claim, it is said, do so by denying the dignity of early human life - and imperiling their own. I think these views are deeply flawed. They are, I believe, based on a problematic conception of how we should value early human life; more than that, they are based on a profoundly misleading view of gestation and a deontically crude picture of morality. I believe that early abortion is fully permissible, widely decent, and, indeed, can be honorable. This is not, though, because I regard burgeoning human life as “mere tissue”: on the contrary, I think it has a value worthy of special respect. It is, rather, because I believe that the right way to value early human life, and the right way to value what is involved in and at stake with its development, lead to a view that regards abortion as both morally sober and morally permissible. Abortion at later stages of pregnancy becomes, for reasons I shall outline, multiply more complicated; but it is early abortions - say, abortions in the first half of pregnancy - that are most at stake for women. (shrink)

Reproductive coercion encompasses a collection of pregnancy promoting and pregnancy avoiding behaviours. Coercion may vary in severity and be perpetrated by intimate partners or others. Research is complicated by the inclusion of behaviours that do not necessarily involve an intention to influence reproduction, such as contraceptive sabotage. These behaviours are the most common, but are not always included in survey instruments. This may explain why the prevalence of reproductive coercion varies widely. Prevalence also varies when coerced abortion is (...) included in survey instruments. When it is, it seems roughly comparable in prevalence to coercion intended to impregnate. The extent and nature of coerced abortion can also be derived from studies that explore the reasons why women access abortion, the relationship between abortion and intimate partner violence, and online blogs and forums. This narrative review of reproductive coercion examines the evidence and attempts to comprehend why coerced abortion has been neglected. (shrink)

The pregnancy rate among teenagers has increased overall in the past years in most industrial countries, especially in urban population. The aim of our study was to estimate the incidence of adolescent deliveries in Szczecin population and to analyze problems associated with maternity in teenagers (adolescent childbearing).The study population consists of 90 teenagers, the control group contains 2707 adult women delivered between Jan. 1, 2000 and Dec. 31, 2000 at two Obstetrics Clinics of Pomeranian Academy of Medicine and Municipal (...) Hospital in Szczecin. Data on outcomes for children of adolescents were obtained from hospital documentation and anonymous questionnaires. Findings show that newborns of adolescents suffer many negative complications and problems and that pregnancy in adolescents is a clear risk for abnormal outcomes. Special programs for pregnancy prevention and intervention in adolescents should be prepared. (shrink)

Psychologists providing services to pregnant individuals using substances face a number of complicated ethical dilemmas, however guidance in this area is sparse. This article presents the ethical and legal issues that may arise in working with this population within the framework of the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct (2017). The recommendations made are designed to assist psychologists with understanding factors that contribute to substance use during pregnancy, navigating punitive policies and liability risk, (...) and methods to increase access to care for this vulnerable group. (shrink)

Although there are those who understand that the debates about the morality of the interruption of pregnancy are newly born, when analyzing some passages of the classical sources, the antiquity of such discussions is revealed. Likewise, as the legal, political and moral conclusions in such respects are often based on a metaphysical, anthropological, theological or biological position, it is necessary to enter these fields in order to fully explore the different edges of such a complicated object. In this way, (...) this work aims to show the terminological pitfalls that the words embryon and kyema generate for the understanding of Aristotelian embryology, which is the basis for understanding his position on abortion, as well as the scholastic debates that use this as a source. We aspire to analyze the various appearances of both terms in various works of Aristotle - fundamentally De generatione animalium and De partibus animalium - and show how there is no criterion to distinguish them in most contexts. (shrink)

Prenatal genetic analysis complicates problems of decision-making during pregnancy. After a brief summary of the new situation the article resumes the argumentation within the German feminist and the German church debate. The author proposes some activities for churches and theological arguments to support women's reproductive rights as well as the ebryos' right to live.

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

Whole genome sequencing is quickly becoming more affordable and accessible, with the prospect of personal genome sequencing for under $1,000 now widely said to be in sight. The ethical issues raised by the use of this technology in the research context have received some significant attention, but little has been written on its use in the clinical context, and most of this analysis has been futuristic forecasting. This is problematic, given the speed with which whole genome sequencing technology is likely (...) to be incorporated into clinical care. This paper explores one particular subset of these issues: the implications of adopting this technology in the prenatal context without a good understanding of when and how it is useful. Prenatal whole genome sequencing differs from current prenatal genetic testing practice in a number of ethically relevant ways. Most notably, whole genome sequencing would radically increase the volume and scope of available prenatal genetic data. The wealth of new data could enhance reproductive decision‐making, promoting parents' freedom to make well‐informed reproductive decisions. We argue, however, that there is potential for prenatal whole genome sequencing to alter clinical practice in undesirable ways, especially in the short term. We are concerned that the technology could (1) change the norms and expectations of pregnancy in ways that complicate parental autonomy and informed decision‐making, (2) exacerbate the deleterious role that genetic determinism plays in child rearing, and (3) undermine children's future autonomy by removing the option of not knowing their genetic information without appropriate justification. (shrink)

It has been argued that Thomson's defense of abortion, if successful, implies that abortion is permissible only until the point of viability. After that point, if one wanted to end a pregnancy, one must do so by birthing the fetus through induction or cesarean. In this paper, I argue that Thomson's defense of abortion does, in fact, imply that abortion after the point of viability is sometimes permissible. To show this, I point out that the process of birthing a (...) fetus makes use of the body of the pregnant person in significant ways. Indeed, the body of the pregnant person is as much a part of this process as it is a part of the process of carrying a fetus during pregnancy. Thus, just as it is sometimes morally permissible to choose to have an abortion rather than continue a pregnancy, it is sometimes morally permissible to choose to have an abortion rather than undergo an induction or cesarean. Those who support Thomson's defense of abortion, then, have reason not to support the view that induction or cesarean are the only permissible procedures for ending an unwanted pregnancy with a viable fetus. I then use this discussion to suggest that autonomy rights are more complicated than initially thought. Given the extent to which the body is involved in detaching the fetus, it is not merely that one has a right to detach a fetus, but also a right to actualize one's reasonable preferences over the method of detachment. (shrink)

Black women are 3–4 times more likely to die from a pregnancy‐related complication and twice as likely to experience severe maternal morbidity when compared to white women in the United States. The risks for pregnancy‐related maternal mortality are well documented, yet Black women's experiences of life‐threatening morbidity are essentially absent in the nursing literature. The purpose of this interpretive phenomenological study was to understand the experiences of Black women who developed severe maternal morbidity. Face‐to‐face, one‐to‐one, in‐depth conversational interviews (...) were conducted with nine Black women who experienced life‐threatening complications during childbirth or postpartum. Five essential themes emerged (1) I Only Know What I Know; (2) How You Cared for Me; (3) Race Matters; (4) Faced with Uncertainty; and (5) Still Healing. These themes illuminate the complexity of Black women's subjective interpretations of severe maternal morbidity, and reveal ways in which racism, not race, places Black women at risk for poor maternal health outcomes. The author envisions greater equity for Black mothers entrusted to nursing care, guided by nursing theories informed by these study findings. (shrink)

I argue that miscarriage, referred to by poet Susan Stewart as “the event that was nothing,” is a liminal event along four distinct and inter-related dimensions: parenthood, procreation, death, and induced abortion. It is because of this liminality that miscarriage has been both poorly addressed in our society, and enrolled in larger debates over women's reproduction and responsibility for reproduction, both conceptually and legally. If miscarriage’s liminality were better understood, if miscarriage itself were better theorized, perhaps it would not so (...) easily be enrolled in these other debates to the detriment of women who miscarry, and their families. However, its very liminality and the fact that it is enrolled in these debates sheds light on the complicated network of concepts within which miscarriage lies. (OPEN ACCESS AT URL). (shrink)

In 2004, prenatal risk assessment (PRA) was implemented as a routine offer in Denmark, in order to give all pregnant women an informed choice about whether to undergo prenatal testing. PRA is a non-invasive intervention performed in the first trimester of pregnancy and measures the risk of a fetus having Down's syndrome or other chromosomal disorders. The risk figure provides the basis for action, i.e. the decision about whether or not to undergo invasive fetal testing via the maternal route (...) (amniocentesis or chorionic villus sampling), which, however, involves the risk of inducing a miscarriage. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, this paper investigates how ideals such as autonomy and non-directiveness are practised in processes of decision-making. We view such ideals as forming social practice rather than neutral instruments to reach a certain goal. Focusing on one couple's trajectory through the clinical practices of PRA and the process through which a decision is reached, we call into question the assumption that more choice and more objective information is a source of empowerment and control. We make evident how decisions are made through a complicated process of meaning-making, which emerges through the relationship between professionals, the clinical setting and the social life of the couples. In the face of complex risk knowledge, PRA users are reluctant to make choices and seek to re-install authority in the health professionals. However, when assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the fetus. It is argued that PRA performs a form of government that works not through compulsion or persuasion but through choice. An ethic of a shared responsibility for PRA and its outcome between pregnant women and health professionals would be more in agreement with how decisions are actually made. (shrink)

Disagreements about abortion are often assumed to reduce to disagreements about fetal personhood (and mindedness). If one believes a fetus is a person (or has a mind), then they are “pro-life.” If one believes a fetus is not a person (or is not minded), they are “pro-choice.” The issue, however, is much more complicated. Not only is it not dichotomous—most everyone believes that abortion is permissible in some circumstances (e.g. to save the mother’s life) and not others (e.g. at nine (...) months of a planned pregnancy)—but scholars on both sides of the issue (e.g. Don Marquis and Judith Thomson) have convincingly argued that fetal personhood (and mindedness) are irrelevant to the debate. To determine the extent to which they are right, this article will define “personhood,” its relationship to mindedness, and explore what science has revealed about the mind before exploring the relevance of both to questions of abortion’s morality and legality. In general, this article does not endorse a particular answer to these questions, but the article should enhance the reader’s ability to develop their own answers in a much more informed way. (shrink)

The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of whether (...) they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard‐of‐care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions.One of the best examples of the conflict between evidence‐based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability. (shrink)

The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of whether (...) they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard-of-care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions. One of the best examples of the conflict between evidence-based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability. (shrink)

In this open peer commentary, we concur with the three target articles’ analysis and positions on abortion in the special issue on Roe v. Wade as the exercise of reproductive liberty essential for the bioethical commitment to patient autonomy and self-determination. Our proposed OPC augments that analysis by explicating more fully the concept crucial to Roe of fetal personhood. We explain that the development and use of predictive reproductive technologies over the fifty years since Roe has changed the literal image, (...) and thereby the epistemological landscape, through which a prospective parent comes to know the fetus. The logic of Roe required a legal and ethical denial of fetal personhood to prioritize maternal autonomy over claims to fetal moral personhood. Our claim is that such a denial may be more complicated today. The fetal person genetic testing and reproductive imaging now presents to prospective parents has become an increasingly individualized, distinct medicalized picture of a developing person with which a parent can either identify or differentiate. In contrast, the fetal person of Roe was an abstract and vague figure stripped of most human particulars, a pregnancy rather than the specific individualized human entity reproductive technology now presents as a person to prospective parents. We discuss the implications of this shift and call for a more capacious analysis of reproductive ethics that works towards both reproductive and disability justice. (shrink)

Obstetric ultrasound has become a significant tool in obstetric practice, however, it has been argued that its increasing use may have adverse implications for women’s reproductive freedom. This study aimed to explore Australian obstetricians’ experiences and views of the use of obstetric ultrasound both in relation to clinical management of complicated pregnancy, and in situations where maternal and fetal health interests conflict.

On April 13, 2010, Nebraska enacted a new state ban on abortion in the Pain-Capable Unborn Child Protection Act that ha caught the attention of many on both sides of the abortion debate, and has inspired other states to attempt similar measures. The statute requires the referring or abortion-providing physician to make a “determination of the probable postfertilization age of the unborn child” and makes it illegal to induce or attempt to perform or induce an abortion upon a woman when (...) the “probable postfertilization age” of the fetus is “twenty or more weeks” unless the doctor determines in “reasonable medical judgment she has a condition which so complicates her medical condition as to necessitate the abortion of her pregnancy to avert her death or to avert serious risk of substantial and irreversible physical impairment of a major bodily function or it is necessary to preserve the life of an unborn child.”. (shrink)

Background Factors that could potentially act as facilitators and barriers to successful recruitment strategies in perinatal clinical trials are not well documented. The objective was to assess lay persons’ understanding of the informed consent for randomized clinical trial in emergency obstetric and newborn care. Methods This was a qualitative study conducted among survivors of severe obstetric complications who were attending the post-natal clinic of Kawempe National Referral Hospital, Uganda, 6–8 weeks after surviving severe obstetric complications during pregnancy (...) or childbirth. The study that involved 18 in-depth interviews was conducted from June 1, 2019 to July 6, 2019. The issues explored included perceptions of the purpose and necessity to conduct such research how research-related information would be disclosed, and what could be the potential benefits and risks of participation. The data was analyzed by thematic analysis. Results Respondents felt that research was necessary to investigate the cause, prevention or complications of an illness, especially as much was known about some pregnancy and newborn complications. Most believed that the emergency contexts affects whether and what prospective participants may understand if information about research was disclosed. Whereas they did not see the value of procedures like randomization, they felt that if these and any other procedures necessary should be done transparently and fairly. The decisions to participate would significantly be influenced by possibility of risk to the unborn baby or the newborn. Solidarity was an important influence on decision-making. Conclusions Respondents valued participation in RCTs in emergency obstetric and newborn care. However, they expressed concerns and valued openness, transparency and accountability with regard to how clinical trials information is disclosed and the decision-making process for clinical trial participation. While autonomy and solidarity are contradictory values, they complement each other during decision-making for informed consent. (shrink)

Drawing on in-depth interviews with thirty-six lesbians, this article offers a feminist qualitative analysis of lesbian conception practices. The article examines the ways lesbian actors negotiate biomedical discourse in ways that reveal the co-constitutiveness of nature and culture, bodies and technologies, and biomedical and subjective knowledge. The article offers the concept of hybrid technologies, which are described as lesbian pragmatic negotiations of shifting control loci of technoscience. The author argues that lesbians' pathways to pregnancy are characterized by a negotiation (...) of discursive elements from alternative health discourses and biomedical knowledge, of various forms of technology, and of what is often termed the authoritative, objective, and scientific with the subjugated, subjective, and the embodied. In doing so these actors complicate through multiple agencies what is often interpreted as a totalizing force of biomedicalization. (shrink)

Feminist scholarship has demonstrated the importance of sustained critical engagement with ultrasound visualizations of pregnant women’s bodies. In response to portrayals of these images as “objective” forms of knowledge about the fetus, it has drawn attention to the social practices through which the meanings of ultrasound are produced. This article makes a novel contribution to this project by addressing an empirical context that has been neglected in the existing feminist literature concerning ultrasound, namely, its use during pregnancies that women decide (...) to terminate. Drawing on semi-structured interviews with women concerning their experiences of abortion in England, I explore how the meanings of having an ultrasound prior to terminating a pregnancy are discursively constructed. I argue that women’s accounts complicate dominant representations of ultrasound and that in so doing, they multiply the subject positions available to pregnant women. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journey to WellnessRoberta PriceI should preface this by saying that as a child and early teen years I was lean, well within my weight range for my height of 5’3”. I was physically active as a snow skier, swimmer, hiker and biker. I started running in high school until I got pregnant at the age of 17 in 1988, but even then, my family and I had a gym (...) membership and I worked out with a trainer until my belly got too big and complications from pre–eclampsia forced me to bed rest the last four weeks of my pregnancy. I gained about 80 pounds, mostly water, during this time. Post pregnancy, I lost all my weight and resumed my active lifestyle of walking etc. It wasn’t until I got married in 1990 that I found my weight creeping up on me, slowly, every year. I was still active with three kids and a husband by then, but bad eating habits and cheap carbohydrates were not my friend.My efforts to return to leanness started a few years ago, about 2006. At that point, I weighed at least 200 pounds and I was not happy. Everyone knows the best way to lose weight is to exercise and watch what you eat, so I start daily walks. While walking I started having problems with my legs going numb to the point that I could not feel my feet hit the ground. At first I thought this feeling was due to a pinched nerve as a result of a single–vehicle car accident I was in earlier that year. Some days my legs would not bother me while walking and other days only a few steps would bring on the numbness. Also, I was susceptible to feelings of panic and a racing heart beat. My doctor at the time never once mentioned my weight being an issue. The nurse would write my weight on the chart, I would cringe as I waited for the lecture from my doctor about my weight to start. It never did. It was a strange, sort of “non–issue” with him as I had three kids so I was fat from that. My physician just said, “Lose the weight, I have no idea what is causing the numbness in your legs.”Fast forward to 2011, I am now under the care of a chiropractor in hopes of relieving the numbness that is happening all too frequently now. An ultrasound of my veins showed good blood flow so that ruled out a circulation issue. The chiropractor prescribed physical therapy to help ease my lower back pain hoping that would relieve the nerves I thought were pinched. I was prescribed high blood pressure medication by my doctor, with adverse side effects such as a nagging cough that would not go away—no matter how much cough medicine I consumed. It was during these sessions with my physical therapist that I was able to lose 10 pounds.There is a lot of self–talk in the life of an overweight or obese person. Everyday I woke up, knowing I had to lose weight. Every single time I looked in any mirror or saw any photo (which I was careful to be the photographer and not a subject as denial had become my best and worst friend). It was the subject of many a late night conversation with my husband, whom by the way, at his worst weight was 30 pounds over his preferred height to weight ratio. Not a single doctor I saw previous to this offered any hope for weight loss other than to shove a piece of paper at me telling me to eat these “healthy foods” listed. Since I was the family chef and chief purchaser of food, I was buying and eating vegetables, fruit, whole grains, and attempting to cut down on the processed foods—although, we were heavy eaters of potatoes, pastas, bagels, pizzas and other high carbohydrate foods. Over the years, [End Page 112] the most weight I had lost “counting calories” or portioning out “slow carbs” over “fast carbs” only afforded me a 15 pound loss, to be gained... (shrink)

We present the case of a 36-year-old woman who has experienced three lost pregnancies; during the most recent loss, a full term pregnancy, she almost died from complications of placental abruption. She is now completing the 34th week of gestation and is experiencing symptoms similar to those under which she lost the previous pregnancy. Despite a lack of specific medical indications, the patient and her husband firmly but politely request that the attending obstetrician/perinatologist perform an immediate cesarean (...) section in order to alleviate the couple’s anxiety about possibly never having a family. Discussing the case are an experienced perinatologist, a neonatologist, a regional perinatal center coordinator, and a clinical ethicist. (shrink)

The complex world of motherhood is here unveiled. Covering issues ranging from whether we should occasionally lie to our children, to the unexpected challenges and complications of being a mother, _Motherhood - Philosophy for Everyone_ offers insightful, serious but often humorous essays that can be enjoyed by everyone - including husbands and fathers. Considers salient philosophical issues relating to pregnancy, birth, babycare, and raising a child Chapters include "The Days and Nights of a New Mother: Existentialism in the (...) Nursery", "The Media Proudly Presents: Lessons' from Celebrity Moms", and "The Off Button: Thought Experiments and Child Control" Contains work from diverse academic perspectives, including economics, psychology, education, English, sociology, women's studies, and theological studies, as well as from nurses and stay-at-home mothers Includes a foreword by Judith Warner, the New York Times columnist and author of _Perfect Madness: Motherhood in the Age of Anxiety_. (shrink)