Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...

In this remarkable book Michel Foucault, one of the most influential thinkers of recent times, calls us to look critically at specific historical events in order to uncover new layers of significance.

In conjunction with the growing feminist literature on pregnancy and visualization, this paper uses Foucault’s The Birth of the Clinic to demonstrate how the effort to make the interior of the pregnant body visible in medical discourse was a crucial part of the development of the modern medical gaze. In doing so I develop two concurrent arguments. First, I argue that the pathological corpse of the Clinic can conceptually serve as a double for the pregnant body as (...) it emerged in modern medicine in the 20th century. At the same time I use the insights of the Clinic to illustrate changes in pregnancy from early modernity to the 20th century. In early modernity, the pregnant body was understood in terms of generation, as a tree that bears fruit; by the 19th century, the pregnant body was a machine that reproduced the species. This transition can be seen in the overlap of pathology and pregnancy in early modernity, an overlap that continued throughout the 19 century and is inadvertently reinforced through the practice of ultrasound. (shrink)

This article presents results from an empirical investigation of the role and importance of ethics in the daily work of Danish oncologyphysicians and Danish molecular biologists. The study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.We found that oncology physicians (...) consider ethical evaluation as part of their daily work. They discuss how to treat patients in groups and they have interdisciplinary seminars. In contrast, molecular biologists employed at the university do not think that basic research causes significant ethical problems, they do not talk about ethics in their daily work and they do not want to prioritise seminars on ethics. Molecular biologists employed in a private biopharmaceutical company do not think that basic research causes significant ethical problems, but the private company prioritises ethical evaluation. If the company behaves unethical, they will be punished by the consumers and by the investors in the last end. In general, oncology physicians working in the clinic experience a closer relationship between their daily work and ethical problems concerning human beings than molecular biologists conducting basic research. (shrink)

BackgroundThis study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups.MethodThis study is based on 12 semi-structured interviews with (...) three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.ResultsIn this sample, the authors found that oncology physicians and molecular biologists employed in a private biopharmaceutical company have the specific principle of beneficence in mind in their daily work. Both groups are motivated to help sick patients. According to the study, molecular biologists explicitly consider nonmaleficence in relation to the environment, the researchers' own health, and animal models; and only implicitly in relation to patients or human subjects. In contrast, considerations of nonmaleficence by oncology physicians relate to patients or human subjects. Physicians and molecular biologists both consider the principle of respect for autonomy as a negative obligation in the sense that informed consent of patients should be respected. However, in contrast to molecular biologists, physicians experience the principle of respect for autonomy as a positive obligation as the physician, in dialogue with the patient, offers a medical prognosis based upon the patients wishes and ideas, mutual understanding, and respect. Finally, this study discloses utilitarian characteristics in the overall conception of justice as conceived by oncology physicians and molecular biologists from the private biopharmaceutical company. Molecular biologists employed at a public university are, in this study, concerned with allocation, however, they do not propose a specific theory of justice.ConclusionThis study demonstrates that each of the four bioethical principles of the American bioethicists Tom L. Beauchamp & James F. Childress – respect for autonomy, beneficence, nonmaleficence and justice – are reflected in the daily work of physicians and molecular biologists in Denmark. Consequently, these principles are applicable in the Danish biomedical setting. (shrink)

The Lacanian concept of fantasy is an essential locus for the conception of subjectivity and reality in the work of Slavoj Žižek, particularly in his initial English texts from 1989–2002. Whilst looked at creatively in its various guises and extended beyond clinical applications in his vast oeuvre – e.g. toward the exploration of the social, in terms of ideological fantasy foremost, to fuller elaborations in The Plague of Fantasies and beyond – the conceptual heritage is in need of fleshing out (...) within contemporary scholarship. To this end, and as part of a larger project currently underway, in the following we will trace the somewhat staggered development of the concept of fantasy in Lacan's initial meetings held at le Centre hospitalier Sainte-Anne between 1953 and 1961 where 'fantasy' as subjective component was truly born. Ultimately, the understanding of this trajectory and the changing significations involved in conceptual evolution can broaden our insight into Lacan's theoretical methodology as well as their insistence on retaining the category of subject in the philosophical tradition. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

This paper offers an account of the role of the concept of space in Foucault's The Birth of the Clinic, and, particularly, of the challenge it poses for conventional philosophical accounts of space and time. The question of the relation between conceptual, bodily, and institutional spaces is also treated.

It is commonly assumed that there are differences in physicians’ and caregivers’ ethical attitudes towards clinical situations. The assumption is that the difference is driven by different values, views and judgements in specific situations. At Aalborg University Hospital, Denmark, we aimed to investigate these assumptions by conducting a large quantitative study. The study design, based on the Factorial Survey Method, was a carefully constructed survey with 50 questions designed to test which factors influenced the respondents’ ethical reasoning. The factors were (...) clustered into three categories of ethical reasoning and values. The categories were formulated in terms of easily recognizable ethical positions: consequential ethics, deontological ethics and relational ethics. Based on 2129 respondents, we found significant support for the assumption of differences between physicians and caregivers. The group of caregivers favoured the relational ethics view in clinical ethical situations, and the group of ph... (shrink)

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence into bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of (...) bioethics. Thirdly, the meta‐ethical distinction between ‘is’ and ‘ought’ created a ‘natural’ border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence‐based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared. (shrink)

_Vi gennemførte i 2016 et omfattende empirisk studie på Aalborg Universitetshospital med henblik på at afdække de forskellige sundhedsprofessioners etiske holdninger. Hensigten var at afdække eventuelle forskelle mellem professionerne samt at få begrebsliggjort de etiske tankemønstre, der er tilstede i den kliniske praksis. Vi fandt i den indledende dataanalyse, at vi med signifikans kunne vise, at plejegruppen i højere grad bruger nærhedsetiske og omsorgsetiske vurderinger, til forskel fra lægegruppen, der er mere pligtetisk funderet__. Undersøgelsen blev sat op ved brug af (...) vignetmetoden, der giver mulighed for at indsamle kvantitative data, der er velegnede til en statistisk analyse, men som samtidig også muliggør en kvalitativ undersøgelse ved en efterfølgende hermeneutisk analyse af udvalgte besvarelser. I denne artikel studerer vi undersøgelsens resultater inden for sygeplejegruppen alene med det formål at uddrage, hvad deres vurderinger kommer an på, og at diskutere, hvordan disse faktorer indbyrdes forholder sig til hinanden og skaber sammenhæng. Med udgangspunkt i dette finder vi frem til, hvordan sygeplejerskernes etiske holdninger som helhed formes af de særlige værdier, som den nærhedsetiske profil understøtter, men som videre også giver et mere fleksibelt og nuanceret billede af sygeplejeetikken._ _Nøgleord:_ sygeplejeetik, vignetmetoden, hermeneutik, patientperspektiv, klinisk praksis _ _ _English title: _Factors that influence nurses' attitude to "good clinical practice" - a qualitative analysis of data from an empirical study at Aalborg University Hospital In 2016, we conducted a comprehensive empirical study at Aalborg University Hospital in order to uncover the ethical attitudes of various health professions. The intention was to uncover any differences between professions as well as to conceptualize the ethical thought patterns present in clinical practice. We found in the preliminary data analysis that we could show with significance that the group of care givers uses relational ethics and care ethics assessments to a greater extent as opposed to the more duty ethics based group of physicians. The study was set up using the vignette method, which allows for the collection of quantitative data suitable for statistical analysis, but which also allows for a qualitative study by a subsequent hermeneutical analysis of selected answers. In this article we study the results of the study within the nursing group solely for the purpose of extracting what their assessments depend on and discussing how these factors relate to each other and create some form of moral coherence. Based on this we find how nurses' ethical attitudes are shaped by the particular values ​​that the relational ethical profile supports, but also how this profile is modified and flexible to the conditions of clinical settings and situations. In the end our interpretation provides us with a more nuanced picture of nursing ethics than a single theoretical perspective or a set of guidelines provide. _Keywords:_ nursing ethics, the vignette method, hermeneutics, patient perspective, clinical practice. (shrink)

The prospect of using genome technologies to modify the human germline has raised profound moral disagreement but also emphasizes the need for wide-ranging discussion and a well-informed policy response. The Hinxton Group brought together scientists, ethicists, policymakers, and journal editors for an international, interdisciplinary meeting on this subject. This consensus statement formulated by the group calls for support of genome editing research and the development of a scientific roadmap for safety and efficacy; recognizes the ethical challenges involved in clinical reproductive (...) applications of genome editing but, importantly, rejects the idea that human reproductive germline modification is necessarily morally unacceptable; and highlights the importance of meaningful engagement in discussions of genome editing and the development of regulation and oversight mechanisms to govern future uses of such technologies. (shrink)

The Italian debate about the role of clinical ethics and ethics consultation has brought about the need to create a working group of Healthcare Ethics Consultation. The group began to take shape an...

The year 2013 may someday be seen as the year a new profession was born. Clinical ethics consultation has been practiced in different ways for roughly 30 years, originally initiated by a group of h...

ABSTRACTSince its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence into bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of (...) bioethics. Thirdly, the meta‐ethical distinction between ‘is’ and ‘ought’ created a ‘natural’ border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence‐based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared. (shrink)

As a feminist updating of Foucauldian analysis, the article makes the point that ‘the lesbian’ was not significantly exposed or seriously interpellated by Danish official discourse until the political debate on new reproductive technologies and reprogenetics accelerated at the end of the 20th century. In the 1990s, the debate thus constructed ‘the lesbian’ not only as an ‘unnatural mother’, but also as heiress to the monstrous figure of the ‘mad scientist’ whose tampering with the embryo had stirred the political mind (...) in the previous decade. Deeply worried by developments in biotechnology, many politicians felt they should protect the embryo from this sinister scientist, and, subsequently, the innocent child from the monstrous lesbian. Hence, a majority of MPs voted for excluding lesbians and single women from access to assisted reproduction in medical clinics. (shrink)

As obstetric medicine has become more sophisticated, so Caesarean section (CS) has become safer. It is now seen as equally safe or, in some circumstances, safer than vaginal birth. Under the new National Institute for Clinical Excellence (NICE) guidelines on CS that were published in November 2011, requests for CS are to be given more weight. Women requesting CS can no longer be seen as compromising their control over birth. Rather, they are merely exercising their power, with the (...) new guidelines offering them an increasing role in the decision-making process regarding how they give birth. However, these new guidelines also present new problems, bringing the rights of patients and obstetricians into conflict. In order to mediate these tensions, a virtue-based approach to obstetric ethics is needed as a supplement to the rule- and right-based guidance provided by NICE. (shrink)

Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization (...) of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs. (shrink)

This article discusses the function, development and maintenance of meaning and the importance of meaning-making from different perspectives, as it is based on a collaboration between professionals from health science and psychology. The aim is to discuss how meaning-making processes can be employed in the health context to enhance individuals’ well-being. Starting point is a description of the common basis of the understanding of meaning-making. Afterwards brief examples from the different professional areas will show how meaning-making can improve health care (...) practice. We will focus on the processual nature of meaning-making, its existential layers, as well as the ways in which meaning-making is at play in everyday activities and limit situations, such as illness or suicidality. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Background Changes in policies and practices related to repeat cesareans and home birth in the U.S. have been influenced by different interpretations of the risk of poor outcomes. Methods This article examines two cases—vaginal birth after cesarean (VBAC) and home birth to illustrate how an emphasis on relative over absolute risk has been used to characterize outcomes associated with these practices. The case studies will rely on reviews of the research literature and examination of data on (...) class='Hi'>birth trends and outcomes. Results Childbirth involves some unique challenges in assessing health risks, specifically the issues of: (1) timing of risks (lowering health risk in a current birth can increase it in subsequent births); (2) the potential weighing of risks to the mother’s versus the infant’s health; (3) the fact that birth is a condition of health and many of the feared outcomes (for example, symptomatic uterine rupture) involve very low absolute risk of occurrence; and (4) a malpractice environment that seizes upon those rare poor outcomes in highly publicized lawsuits that receive widespread attention in the clinical community. In the cases of VBAC and home birth, the result has been considerable emphasis on relative risks, typically an adjusted odds ratio, with little consideration of absolute risks. Conclusion Assessments of the safety of interventions in childbirth should involve careful consideration and communication of the multiple dimensions of risk, particularly a balancing of relative and absolute risks of poor health outcomes. (shrink)

IVF/PGS procedures require that all embryos produced for potential implantation be screened for genetic abnormalities: only embryos free of genetic defects may be implanted or cryogenically preserved for future implantation. In this paper, I argue that the standard practice of the reproductive technology clinic, according to which all abnormal embryos must be discarded, unjustly imposes certain biases and discriminatory social values upon persons for whom it may not be a significant concern that their offspring would be disabled. The “standard” (...) practice both reflects a bias against disability and imposes this bias upon those who seek reproductive assistance from RTCs. I argue, therefore, that insofar as consenting to the destruction of any abnormal embryos as a condition of IVF treatment, RTCs threaten the autonomy of women seeking medical assistance to overcome infertility. Finally, I examine recent empirical findings which suggest that genetic screening and destruction of abnormal embryos does not actually aid the overall objective of IVF, which is live birth, and may actually hinder it. (shrink)

Meier et al. describe a pilot study that developed METHAD, an AI-based Medical Ethics Advisor tool that draws on the principlism approach and was tested using text-book cases and clinical et...

This article presents the case of a mother who is planning a home birth with a midwife with the shared knowledge that the fetus would have congenital anomalies of unknown severity. We discuss the right of women to choose home birth, the caregivers’ duty to the infant, and the careproviders’ dilemma about how to respond to this request. The ethical duties of concerned careproviders are explored and reframed as professional obligations to the mother, infant, and their profession at (...) large. Recommendations are offered based on this case in order to clarify the considerations surrounding not only home birth of a fetus with anticipated anomalies, but also to address the ethical obligations of caregivers who must navigate the unique tension between respecting the mother’s wishes and the duty of the careproviders to deliver optimal care. (shrink)

Within the caring science paradigm, variations of a method of interpretation inspired by the French philosopher Paul Ricoeur's theory of interpretation are used. This method consists of several levels of interpretation: a naïve reading, a structural analysis, and a critical analysis and discussion. Within this paradigm, the aim of this article is to present and discuss a means of creating distance in the interpretation and the text structure by using narration in a poetic language linked to the meaning of the (...) text. Ricoeur's ‘Hermeneutical function of distanciation’ will be introduced, and this concept of distanciation will be illustrated with reference to narrations from a study of patient's life experiences living with chronic illness and home mechanical ventilation in Denmark. Distanciation in the interpretation objectifies the text, and narration in a poetic language creates a particular kind of mediation in the interpretation. That narration represents an interpreted understanding of the whole, which facilitates an appropriate and evocative presentation of the interpreted data. This way of objectifying the text through narration can contribute yet another perspective to Ricoeur's rich and varied theory of interpretation. (shrink)

Bioethical research has tended to focus on theoretical discussion of the principles on which the analysis of ethical issues in biomedicine should be based. But this discussion often seems remote from biomedical practice where researchers and physicians confront ethical problems. On the other hand, published empirical research on the ethical reasoning of health care professionals offer only descriptions of how physicians and nurses actually reason ethically. The question remains whether these descriptions have any normative implications for nurses and physicians? In (...) this article, we illustrate an approach that integrates empirical research into the formulation of normative ethical principles using the moral-philosophical method of Wide Reflective Equilibrium (WRE). The research method discussed in this article was developed in connection with the project ‘Bioethics in Theory and Practice’. The purpose of this project is to investigate ethical reasoning in biomedical practice in Denmark empirically. In this article, we take the research method as our point of departure, but we exclusively discuss the theoretical framework of the method, not its empirical results. We argue that the descriptive phenomenological hermeneutical method developed by Lindseth and Norberg (2004) and Pedersen (1999) can be combined with the theory of WRE to arrive at a decision procedure and thus a foundation for the formulation of normative ethical principles. This could provide health care professionals and biomedical researchers with normative principles about how to analyse, reason and act in ethically difficult situations in their practice. We also show how to use existing bioethical principles as inspiration for interpreting the empirical findings of qualitative studies. This may help researchers design their own empirical studies in the field of ethics. (shrink)

This book uses an incidence approach to look at the economic repercussions of birth defects. The authors investigate eighteen of the most clinically significant birth defects affecting 35,000 newborns each year in our country. Their assessments suggest that the annual cost of these eighteen birth defects, together, is more than eight billion dollars . The authors describe in detail their methodology and data sources while providing thorough accounts of each of the eighteen birth defects. Waitzman, Scheffler, (...) and Romano break new ground by using reports from the California Birth Defects Monitoring Program in order to provide cost estimates. They illustrate to the reader how cost estimates of specific birth defects can be used to justify prevention interventions and strategies. In chapter seven, they provide an important example, showing cost-benefit analysis of a program of folate supplementation of food to prevent neutral tube defects. Contents: List of Tables; Preface; Acknowledgements; Introduction; The Application of Cost-of-Illness Methodology To Birth Defects; The Direct Medical Costs of Birth Defects; Nonmedical Direct Costs of Birth Defects: Developmental Services and Special Education; The Indirect Costs of Birth Defects; Premature Mortality and Heightened Morbidity; An Assessment of Total Costs and Policy Implications; Description of Birth Defects; Description of Major Data Sources; Index. (shrink)

This article presents results from a qualitative empirical investigation of how Danish oncology physicians and Danish molecular biologists experience the principle of respect for autonomy in their daily work.

Home births continue to constitute only a small percentage of all deliveries in the United States, in part because of concerns about their safety. While the literature is decidedly mixed in regard to the degree of risk, there are several studies that report that home birth may at times entail a small absolute increase in perinatal risks in circumstances that cannot always be anticipated prior to the onset of labor. While the definition of “small” will vary between individuals, and (...) publications vary in the level of risk they ascribe to birth at home, studies with the least methodological flaws and with adequate power often cite an excess death rate in the range of one per thousand.Home birth is, in that regard, but one example of patients’ choices and plans that sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. Our intention in this opinion piece is not to advocate for or against home birth. Rather, we recognize that home birth is but one example of a patient choice that might differ from what a provider feels is in a woman’s best interests.In this article we will discuss ethical considerations in such circumstances using home birth as an example. We consider in this article how the ethical principles of respect for autonomy and non-maleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals’ evaluation of patient choices. We also consider how in some circumstances, the value and safety added by a physician’s participation may outweigh a potentially small increment in absolute risk that might result from a patient’s decision to deliver at home because of a perceived physician endorsement.We recognize, however, that doctors and midwives participating in choices they have not recommended, or may even believe will lead to or increase risk for adverse outcomes, presents dilemmas and raises important questions. When does respect for patient choice and autonomy become support for poor decision making? When is participation not respectful but enabling? Finally we discuss the role and responsibility of organized medicine in making all births as safe as possible. (shrink)

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the (...) Scottish and English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)

Research suggests that some fathers and birth partners can experience post-traumatic stress disorder after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale (...) for use with birth partners. The City Birth Trauma Scale is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria, symptoms of re-experiencing, avoidance, negative cognitions and mood, and hyperarousal, as well as duration of symptoms, significant distress or impairment, and exclusion criteria or other causes. A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale had good reliability and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: general symptoms and birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale provides a promising measure of PTSD following childbirth that can be used in research and clinical practice. (shrink)

The assumption in current U.S. mainstream medicine is that birthing requires hospitalization. In fact, while the American College of Obstetricians and Gynecologists supports the right of every birthing person to make a medically informed decision about their delivery, they do not recommend home birth owing to data indicating greater neonatal morbidity and mortality. In this article, we examine the evidence surrounding home birth in the United States and its current limitations, as well as the ethical considerations around (...) class='Hi'>birth setting. (shrink)

The presence of stigmatizing language in the electronic health record (EHR) has been used to measure implicit biases that underlie health inequities. The purpose of this study was to identify the presence of stigmatizing language in the clinical notes of pregnant people during the birth admission. We conducted a qualitative analysis on N = 1117 birth admission EHR notes from two urban hospitals in 2017. We identified stigmatizing language categories, such as Disapproval (39.3%), Questioning patient credibility (37.7%), Difficult (...) patient (21.3%), Stereotyping (1.6%), and Unilateral decisions (1.6%) in 61 notes (5.4%). We also defined a new stigmatizing language category indicating Power/privilege. This was present in 37 notes (3.3%) and signaled approval of social status, upholding a hierarchy of bias. The stigmatizing language was most frequently identified in birth admission triage notes (16%) and least frequently in social work initial assessments (13.7%). We found that clinicians from various disciplines recorded stigmatizing language in the medical records of birthing people. This language was used to question birthing people's credibility and convey disapproval of decision‐making abilities for themselves or their newborns. We reported a Power/privilege language bias in the inconsistent documentation of traits considered favorable for patient outcomes (e.g., employment status). Future work on stigmatizing language may inform tailored interventions to improve perinatal outcomes for all birthing people and their families. (shrink)

This article aims to analyse a possible manner of approaching the birth of intersexual children. We start out by summing up what intersexuality is and how it is faced in the dominant clinical practice. We then argue against this paradigm, in favour of a postponement of genital surgery. In the second part of this paper, we take into consideration the general question of whether only two existing sexes are to be recognized, arguing in favour of an expansion of sex (...) categories. In the third part, we illustrate the reasons supporting provisional sex attribution: the child’s best interest and respect for their developing moral autonomy. This position aims to increase the child’s well-being and self-determination, limiting parents’ freedom to take decisions on behalf of others, in particular, those decisions concerning basic aspects of their children’s personal identity. (shrink)

Following the Second Summit on Human Gene Editing in Hong Kong in 2018, where the birth of two girls with germline genome editing was revealed, the need for a responsible pathway to the clinical application of human germline genome editing has been repeatedly emphasised. This paper aims to contribute to the ongoing discussion on research ethics issues in germline genome editing by exploring key issues related to the initial applications of CRISPR in reproductive medicine. Following an overview of the (...) current discussion on bringing germline genome editing into clinical practice, we outline the specific challenges associated with such interventions and the features that distinguish them from conventional clinical testing of new medical treatments. We then review proposed ethical requirements for initial heritable genome editing, such as the absence of reasonable alternatives, the existence of sufficient and reliable preclinical data, appropriate informed consent, requirements related to safety, and long-term follow-up. (shrink)

This volume addresses the interdependencies between visual technologies and epistemology with regard to our perception of the medical body. It explores the relationships between the imagination, the body, and concrete forms of visual representations: Ranging from the Renaissance paradigm of anatomy, to Foucault's "birth of the clinic" and the institutionalised construction of a "medical gaze"; from "visual" archives of madness, psychiatric art collections, the politicisation and economisation of the body, to the post-human in mass media representations. Contributions to (...) this volume investigate medical bodies as historical, technological, and political constructs, constituted where knowledge formation and visual cultures intersect. Contributors are: Axel Fliethmann, Michael Hau, Birgit Lang, Carolyn Lau, Heikki Lempa, Stefanie Lenk, Joanna Madloch, Barry Murnane, Jill Redner, Claudia Stein, Elizabeth Stephens, Corinna Wagner, and Christiane Weller. (shrink)

Despite advances in feminism, the "law of the father" remains the dominant model of Western psychological and cultural analysis, and the law of the mother continues to exist as an underdeveloped and marginal concept. In her radical rereading of the Greek myth, _Oresteia_, Amber Jacobs hopes to rectify the occlusion of the mother and reinforce her role as an active agent in the laws that determine and reinforce our cultural organization. According to Greek myth, Metis, Athena's mother, was Zeus's first (...) wife. Zeus swallowed Metis to prevent her from bearing children who would overthrow him. Nevertheless, Metis bore Zeus a child-Athena-who sprang forth fully formed from his head. In Aeschylus's _Oresteia_, Athena's motherless status functions as a crucial justification for absolving Orestes of the crime of matricide. In his defense of Orestes, Zeus argues that the father is more important than the mother, using Athena's "motherless" birth as an example. Conducting a close reading of critical works on Aeschylus's text, Jacobs reveals that psychoanalytic theorists have unwittingly reproduced the denial of Metis in their own critiques. This repression, which can be found in the work of Sigmund Freud and Melanie Klein as well as in the work of more contemporary theorists such as André Green and Luce Irigaray, has resulted in both an incomplete analysis of Oresteia and an inability to account for the fantasies and unconscious processes that fall outside the oedipal/patricidal paradigm. By bringing the story of Athena's mother, Metis, to the forefront, Jacobs challenges the primacy of the Oedipus myth in Western culture and psychoanalysis and introduces a bold new theory of matricide and maternal law. She finds that the Metis myth exists in cryptic forms within Aeschylus's text, uncovering what she terms the "latent content of the Oresteian myth," and argues that the occlusion of the law of the mother is proof of the patriarchal structures underlying our contemporary social and psychic realities. Jacobs's work not only provides new insight into the Oresteian trilogy but also advances a postpatriarchal model of the symbolic order that has strong ramifications for psychoanalysis, feminism, and theories of representation, as well as for clinical practice and epistemology. (shrink)

In The Birth of the Clinic, The Order of Things, and Discipline and Punish, Foucault writes a "history of the present" by showing the connections between the archaeology of knowledge and criticism. In the first, he is fundamentally concerned with the changes in human perception evident at the end of the eighteenth century and the relation of these changes to the fundamental structures of experience. Underlying the history of medicine is the moral and political attempt to link the (...) development of science with the development of bourgeois freedom. In The Order of Things, he cites archaeology as a method of uncovering the fundamental paradigms of cultures and their systems of thought. Finally, in Discipline and Punish, he considers discourse a domain of power relations and thus establishes a link between knowledge and power. A "history of the present" is a self-conscious field of power relations and political struggle. (shrink)