Oncofertility is one of the 9 NIH Roadmap Initiatives, federal grants intended to explore previously intractable questions, and it describes a new field that exists in the liminal space between cancer treatment and its sequelae, IVF clinics and their yearning, and basic research in cell growth, biomaterials, and reproductive science and its tempting promises. Cancer diagnoses, which were once thought universally fatal, now often entail management of a chronic disease. Yet the therapies are rigorous, must start immediately, and in many (...) cases result in premature failure of the body's reproductive ability. In women, this loss is especially poignant; unlike the routine storage of sperm, which is done in men and boys facing similar treatment decisions, freezing oocytes in anticipation of fertility loss is not possible in most cases, and creating an embryo within days of diagnosis raises significant moral, social and medical challenges. Oncofertility is the study of how to harvest ovarian tissue in women facing cancer to preserve their gametes for future use with IVF, thus allowing the decisions about childbearing to be deferred and reproductive choices to be preserved. The research endeavor uses the capacity of the ovarian follicle to produce eggs in vitro . Developing the human follicle to ovulate successfully outside the body is scientifically difficult and ethically challenging. Infertility is linked to long-standing religious and moral traditions, and is intertwined with deeply contentious social narratives about women, families, illness and birth. Is the research morally permissible? Perhaps imperative if understood as a repair from iatrogenic harms? How are considerations of justice central to the work? How will vulnerable subjects be protected? What are the moral implications of the work for women, children and families? What are the implications for society if women could store ovarian tissue as a way of stopping the biological clock? What are the moral possibilities and challenges if eggs can be produced in large quantities from a stored ovarian tissue? (shrink)
The field of bioethics is by definition based on the presupposition that questioning, arguing, interruption, and response are the means by which we evaluate the truth claims of medicine and healthcare policy. The field began with the premise that another voice, one of at least critique, if not dissension, was just what was needed in any arena in which hegemonic expertise held sway. The field of the humanities is similarly based on the idea that both the literary and cultural canonare (...) acknowledged, taught, and honored. In situ in the clinic, on national boards, or in the literature, when a philosopher perceives a unanimity, she begins to be uneasy and begins to do the very thing she is trained for: to raise the questions of definition, method, data, motive, and goal. (shrink)
: The controversy about research on human embryonic stem cells both divides and defines us, raising fundamental ethical and religious questions about the nature of the self and the limits of science. This article uses Jewish sources to articulate fundamental concerns about the forbiddenness of knowledge in general and of knowledge thought of as magical creation. Alchemy, and the turning of elements into gold and into substances for longevity, and magic used for the creation of living beings was at stake (...) in various Talmudic texts. Since contemporary discourse calls regenerative science magical, and makes claims about its restorative power, careful reflection on when magic is forbidden and when it is responsible allows a novel understanding of ethical questions in stem cell research. (shrink)
This essay will address the ethical issues that have emerged in the first considerations of the newly emerging stem cell technology. Many of us in the field of bioethics were deliberating related issues as we first learned of the new science and confronted the ethical issues it raised. In this essay, I will draw on the work of colleagues who were asked to reflect on early stages of the research (members of the IRBs, the Geron Ethicist Advisory Board, and the (...) National Bioethics Advisory Commission) as the field debated the issues of consent, moral status, use of animal tissues, abortion, use of fetal tissue, and the nature and goals of entrepreneurial research. In this new capacity, ethicists weighed the problem of privacy, the role of justice considerations, and the issues of the marketplace in science. At this point, it is clear that far more issues remain unresolved than are settled, that there is largely unexplored territory ahead, and that the single most important task that faces us as a field is a steady call for ongoing conversation and public debate. (shrink)
Jewish ethics provides resources not only for exotic cases, but also for the practical necessities of everyday business practice, such as sustaining non-profit health care. Non-profit health care presents tough choices for justice because it is motivated by community compassion but must meet the pressures of the marketplace. Feminist ethics offers an "ethics of care" to guide our actions in such conflicts. This article argues that an ethics derived from both ferrlinism and Jewish sources calls for a different approach, one (...) which is rooted in the history of business practice, in the history of women's leadership in this health care, and in the Jewish legal teaching (halacha) that seeks a balance between competing moral appeals in the marketplace. (shrink)
In the move to critique managed care, the essential principles that first made it a reasonable alternative to fee-for-service medicine can easily be lost. Careful reflection on the history of early grassroots movements that created managed care, and on selected textual narratives of the founders of the managed care organizations at their inception, offers us insight into which of the critical premises and goals of that effort might be reclaimed as we analyze the current managed care environment.