Background Past studies emphasized the possible cultural influence on attitudes regarding reprogenetics and reproductive risks among medical students who are taken to be “future physicians.” These studies were crafted in order to enhance the knowledge and expand the boundaries of cultural competence. Yet such studies were focused on MS from relatively marginalized cultures, namely either from non-Western developing countries or minority groups in developed countries. The current study sheds light on possible cultural influences of the dominant culture on medical (...) students in two developed countries, potentially with different dominant cultures regarding reprogenetics and reproductive risks: Israel and Croatia. Methods Quantitative-statistical analyses were employed, based on anonymous questionnaires completed by 150 first year medical students in Israel and Croatia. The questionnaires pertained to the knowledge and attitudes regarding genetics, reproduction and reproductive risks. These questionnaires were completed before the students were engaged in learning about these topics as part of the curriculum in their medical school. Results Substantial differences were revealed between the two groups of medical students. Israeli medical students were less tolerant regarding reproductive risks and more knowledgeable about genetics and reproductive risks than Croatian medical students. For example, while nearly all Israeli medical students disagreed with the idea that “Screening for reproductive risks in prospective parents is wrong,” less than 40% of their Croatian counterparts shared a similar stance. Similarly, all Israeli medical students correctly observed that “A carrier of a recessive genetic disease actually has the disease” was wrong, as opposed to only 82% of Croatian students. Conclusions By linking applicable theoretical literature to these findings, we suggest that they may reflect the hidden influence of the dominant culture in each country, disguised as part of the “culture of medicine.” Acknowledging and learning about such influence of the dominant culture, may be an important addition to the training of medical students in cultural competence, and specifically their cultural awareness. Such an acknowledgement may also pave the road to drawing the attention of existing physicians regarding a less known yet an important aspect of their cultural competence, insofar as the cultural awareness component is concerned. (shrink)

In 2006, the Centers for Disease Control and Prevention launched an initiative to address the health of women of childbearing age in the United States—a preconception care campaign to improve fetal and maternal health in the country by targeting interventions on parents, and largely women, before conception occurs. In The Zero Trimester: Pre-Pregnancy Care and the Politics of Reproductive Risk, sociologist Miranda Waggoner uses this campaign as an entry point to address the emergence and widespread acceptance of preconception (...) care and its political consequences in the United States. Throughout the book, Waggoner interrogates how preconception care extends assumptions that the onus for children’s health falls... (shrink)

In 2006, the Centers for Disease Control and Prevention launched an initiative to address the health of women of childbearing age in the United States—a preconception care campaign to improve fetal and maternal health in the country by targeting interventions on parents, and largely women, before conception occurs. In The Zero Trimester: Pre-Pregnancy Care and the Politics of Reproductive Risk, sociologist Miranda Waggoner uses this campaign as an entry point to address the emergence and widespread acceptance of preconception (...) care and its political consequences in the United States. Throughout the book, Waggoner interrogates how preconception care extends assumptions that the onus for children’s health falls... (shrink)

The aim of this paper is to analyze the process of risk communication in the context of assisted reproduction in Latvia. The paper is based on a qualitative methodology and two types of data: media analysis and 30 semi-structured interviews (11 patients, 4 egg donors, 15 experts). The study explores a broad definition of risk communication and explores three types of risks: health, psychosocial, and moral. We ask (1), who is involved in risk communication, (2), how risks (...) are discussed using different channels of communication, and (3), what ethical problems arise during this process. In the process of analysis, we identified four types of information channels and two strategies of risk communication used by patients, as well as several ethical problems. In our view, the analysis of risk communication practices is significant to improve patient/physician relationship, as well as better meet patients' needs for comprehensive risk information. (shrink)

Brazil is the biggest market for pesticides in the world. In the registration process, a pesticide must be authorized by the Institute of the Environment, Health Surveillance Agency and Ministry of Agriculture. Evaluations follow a package of toxicological studies submitted by the companies and also based on the Brazilian law regarding pesticides. We confronted data produced by private laboratories, submitted to the Institute of the Environment for registration, with data obtained from scientific databases, corresponding to mutagenicity, carcinogenicity and teratogenicity of (...) pesticides. All studies submitted by the companies were carried out by private laboratories. From 247 pesticide formulations analyzed, none showed positive results for mutagenicity, carcinogenicity or teratogenicity. From 574 articles in the scientific literature, 84% published by public laboratories showed positive results, while 79% of those showing negative results came from private laboratories. There is an ethical concern about a conflict of interest between public/independent laboratories and private laboratories that produce data for registering pesticides. We demonstrated that there is a clear contradiction between public and private laboratories. Brazilian regulatory authorities have approved the registration of pesticides based almost exclusively on the monographs provided by the pesticide industry, because the use of scientific articles or information from the independent literature is strongly belittled by the industry. Pesticide companies argue that scientific articles cannot be trusted. Also, according to the industry, pesticide registration cannot be refused based on results from scientific articles. Thus, the registration of pesticides with mutagenic, carcinogenic and teratogenic risks has been approved in Brazil. (shrink)

Introducción: El embarazo, aborto, las infecciones de transmisión sexual incluido el Virus de Inmuno Deficiencia Humana, se han convertido en problemas sanitarios de mayor vulnerabilidad en jóvenes. Objetivo: Describir las conductas de riesgo y prevalencia de problemas sexuales y reproductivos de estudiantes universitarios. Método: Investigación descriptiva, el universo estuvo constituido por alumnos de dos grupos de segundo semestre; el grupo de estudio conformado por la totalidad de estudiantes de la Facultad de Salud Pública ; y el control seleccionado mediante una (...) muestra aleatoria de estudiantes del resto de las facultades, se realizó esta selección con el propósito de valorar la homogeneidad de las variables entre los grupos. Resultados: Existe homogeneidad en la mayoría de conductas de riesgo y problemas sexuales en los grupos, en consecuencia estas variables no están influenciadas por la pertenencia a la Facultad de Salud Pública. Se evidencian conductas de riesgo como: inicio temprano de relaciones sexuales, múltiples parejas, infidelidad, relaciones sexuales ligadas al consumo de sustancias, dificultades con el uso de métodos anticonceptivos o de protección; se encontró prevalencia de problemas como: experiencia de embarazos, la mayoría no planeados, abortos inducidos y presencia de infecciones de transmisión sexual. Conclusiones: Existe vulnerabilidad en la salud sexual y reproductiva de los jóvenes universitarios independientemente de la formación que reciben, por tanto, emerge la necesidad de buscar alternativas integrales de promoción, prevención y educación sexual integral. Introduction: Pregnancy, abortion, sexually transmitted infections including Human Immunodeficiency Virus, have become a health problem of more vulnerable in young people. Objective: To describe risk behaviors and prevalence of sexual and reproductive problems of university. Method: Descriptive study, the universe consisted of students from two groups of second semester; the study group is conformed by students of the Public Health Faculty ; and control selected by a random sample of students from other faculties, in order to assess the homogeneity of the variables between groups. Results: Homogeneity exists in most risk behaviors and sexual problems in groups, therefore these variables are not influenced by membership in the Public Health Faculty. Risk behaviors as evidence: early initiation of sexual activity, multiple partners, infidelity, sexual relationship linked to substance consumption, which prevails alcohol, together with the non-use or inappropriate use of contraception or protection; experience of pregnancy, most unplanned, induced abortions and the presence of sexually transmitted infections: prevalence of problems as found. Conclusions: There is vulnerability in sexual and reproductive health of young students regardless of their training, thus emerges the need to find alternatives comprehensive promotion, prevention and comprehensive sex education. (shrink)

Research protocols must have a reasonable balance of risks and anticipated benefits to be ethically and legally acceptable. This article explores three characteristics of research on reproductive genetic technologies that complicate the assessment of the risk-benefit ratio for such research. First, a number of different people may be affected by a research protocol, raising the question of who should be considered to be the subject of reproductive genetic research. Second, such research could involve a wide range of (...) possible harms and benefits, making the evaluation and comparison of those harms and benefits a challenging task. Finally, the risk-benefit ratio for this type of research is difficult to estimate because such research can have unpredictable, long-term implications. The article aims to facilitate the assessment of risk-benefit ratios in research on reproductive genetic technologies by proposing and defending some guidelines for dealing with each of these complicating factors. (shrink)

In ‘in vitro eugenics’ (IVE), I outlined a theoretical use of a technology of artificial gametogenesis, wherein repeated iterations of the derivation of gametes from embryonic stem cells, followed by the fusion of gametes to create new embryos, from which new stem cells could be derived, would allow researchers to create multiple generations of human embryos in the laboratory and also to produce ‘enhanced’ human beings with desired traits. As a number of commentators observed, my purpose in publishing this paper (...) was to provoke ethical discussion of a largely unremarked upon technological possibility and surrounding issues. Even if this was, as Murphy observes archly, to aim ‘low’, discussion of IVE is valuable for three reasons. First, it may render us better prepared should IVE become practical. I noted of my original discussion that it was speculative and several of the respondents suggest that IVE is even less likely to come about than I allowed there. Nevertheless, second, discussion of IVE is valuable for what it reveals about the ethics of new reproductive technologies (NRTs) more generally and, third, about the ethics of genetic human enhancement in particular. The responses to my paper demonstrate this nicely by (a) illustrating the selective way in which arguments about risk are mobilised in debates about NRTs and (b) highlighting the tension between any obligation of ‘procreative beneficence’ and a concern for genetic relatedness. Even if IVE should never be pursued, then, discussion of this possibility may help us better understand the ethics of other NRTs and means of genetic human enhancement. (shrink)

This article discusses the new reproductive technology of egg freezing in the context of existing literature on gender, medicalization, and infertility. What is unique about this technology is its use by women who are not currently infertile but who may anticipate a future diagnosis. This circumstance gives rise to a new ontological category of “anticipated infertility.” The author draws on participant observation and a qualitative analysis of scientific, mainstream, and marketing literature to identify and compare the representation of two (...) different candidates for egg freezing: women with cancer and healthy young women. Although both populations experience anticipated infertility, their dichotomous portrayals as appropriate candidates are demonstrative of gender norms linking women to motherhood. Egg freezing is a concise illustration of how the medicalization of women’s bodies and bodily processes masks a host of cultural anxieties about aging, illness, reproduction, and risk. (shrink)

The advances in treatment of HIV and the introduction of polymerase chain reaction assay for the virus now make it acceptable for HIV discordant couples where the male partner is seropositive to attempt to conceive through artificial insemination by husband or via in vitro fertilisation. With undetectable viral load and washed sperm, there is minimal risk of transmission of HIV to the female partner, children, other patients, or staff. We describe the development of a programme of AIH for HIV (...) discordant couples and the reasoning behind offering such a programme. (shrink)

The advances in treatment of HIV and the introduction of polymerase chain reaction assay for the virus now make it acceptable for HIV discordant couples where the male partner is seropositive to attempt to conceive through artificial insemination by husband (AIH) or via in vitro fertilisation. With undetectable viral load and washed sperm, there is minimal risk of transmission of HIV to the female partner, children, other patients, or staff. We describe the development of a programme of AIH for (...) HIV discordant couples and the reasoning behind offering such a programme. (shrink)

Reproduction, a basic property of biological life, entails costs for an organism, ultimately detectable as reduction in survival prospects. Telomeres are an excellent candidate biomarker for explaining these reproductive costs, because their shortening correlates with increased mortality risk. For similar reasons, telomeres are perceived as biomarkers of individual “quality.” The relationship between reproduction and telomere dynamics is reviewed, emphasizing that cost and quality perspectives, commonly presented in isolation, should be integrated. While a majority of correlative studies have confirmed (...) the relationship between telomere dynamics and various reproductive outputs, only limited experimental support exists showing that reproduction causes telomeres to shorten. A shift of focus to experimental manipulations of reproductive effort/telomere dynamics is crucial. However, the observation of survival reduction in response to these manipulations is essential for establishing telomeres as genuine biomarkers, allowing to unravel trade‐offs related to reproduction. (shrink)

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers strong (...) counter-arguments to this view that enable us to think in terms of universal standards. (shrink)

As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research (...) in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (shrink)

Reproductive genetic technologies allow parents to decide whether their future children will have or lack certain genetic predispositions. A popular model that has been proposed for regulating access to RGTs is the ‘genetic supermarket’. In the genetic supermarket, parents are free to make decisions about which genes to select for their children with little state interference. One possible consequence of the genetic supermarket is that collective action problems will arise: if rational individuals use the genetic supermarket in isolation from (...) one another, this may have a negative effect on society as a whole, including future generations. In this article we argue that RGTs targeting height, innate immunity, and certain cognitive traits could lead to collective action problems. We then discuss whether this risk could in principle justify state intervention in the genetic supermarket. We argue that there is a plausible prima facie case for the view that such state intervention would be justified and respond to a number of arguments that might be adduced against that view. (shrink)

Zika infection in pregnant women is associated with an elevated probability of giving birth to a child with microcephaly and multiple other disabilities. Public health messaging on Zika prevention has predominantly targeted women who know they are pregnant or intend to become pregnant, but not teenage females for whom unintended pregnancy is more likely. Vulnerabilities among this population to reproductive risks associated with Zika are further amplified by restrictive abortion laws in several Zika-impacted states. Key to prevention is enhanced, (...) targeted public health messaging centered on teens nationally and particularly in certain high-risk regions. (shrink)

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; necessity; (...) and custom, we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

Having children is probably as old as the first successful organism. It is often done thoughtlessly. This book is an argument for giving procreating some serious thought, and a theory of how, when, and why procreation may be permissible.Rivka Weinberg begins with an analysis of the kind of act procreativity is and why we might be justifiably motivated to engage in it. She then proceeds to argue that, by virtue of our ownership and control of the hazardous material that is (...) our gametes, we are parentally responsible for the risks we take with our gametes and for the persons that develop when we engage in activity that allows our gametes to unite with others and develop into persons. Further argument establishes that when done respectfully, and in cases where the child's chances of leading a life of human flourishing are high, procreation may be permissible. Along the way, Weinberg argues that the non-identity problem is a curiously common mistake. Arguments intending to show that procreation is impermissible because life is bad for people and imposed on them without their consent are shown to have serious flaws. Yet because they leave us with lingering concerns, Weinberg argues that although procreation is permissible under certain conditions, it is not only a welfare risk but also a moral risk. Still, it is a risk that is often permissible for us to take and impose, given our high level of legitimate interest in procreativity. In order to ascertain when the procreative risk is permissible to impose, contractualist principles are proposed to fairly attend to the interests prospective parents have in procreating and the interests future people have in a life of human flourishing. The principles are assessed on their own merits and in comparison with rival principles. They are then applied to a wide variety of procreative cases. (shrink)

When things go wrong with assisted reproduction we should look at what’s best for everyone in the particular circumstancesA RTBs, as we must now call them, are becoming more and more frequent. In the recent United Kingdom case Mr and Mrs A, a “white” couple, gave birth to twins described as “black”. The mix up apparently occurred because a Mr and Mrs B, a “black” couple, were being treated in the same clinic and Mrs A’s eggs were fertilised with Mr (...) B’s sperm. Mr and Mrs A love the twins and wish to keep them and the facts seem to be that Mrs A is the genetic mother of the twins but her partner is not the genetic father. Under English law, in assisted reproduction, the woman who gives birth to the child is the legal mother and this is true also in cases of surrogacy. I think there is no doubt in this case that English law has taken the right path and that it would be unconscionable to contemplate taking a child away from the woman who had undergone the risks and pains of pregnancy and childbirth and the bonding process that goes along with that when she wishes to keep the child particularly when there is no substantial and pressing evidence that she would be an unsafe parent. I argued this in my book The Value of Life4 and I think it is still true. So in this case justice, morality, and decency are served by confirming Mr and Mrs A as the parents of the children. Since in English law there is some ambiguity over paternity and how that is to be assigned and since Mr A is apparently not the genetic father, I think it is important …. (shrink)

This paper explores one aspect of the social implications of new reproductive technologies, namely, the impact such technologies have on our understandings of family structures and our expectations of children. In particular it considers whether the possibilities afforded by such technologies result in a more contractual and commodified understanding of children. To do this the paper outlines the possibilities afforded by NRTs and their commodificatory tendencies; second, it explores the commodification debate using the somewhat parallel example of commodification of (...) organs; and third, in light of these debates the link between the commodification of body parts and persons is addressed. It will argue that there is a prime facie connection between body parts and persons and thus, although needing to be balanced with other ethically relevant factors, commodification remains an issue of ethical concern. Accordingly we should only be supporting potentially commodifying practices when there are ethically pressing reasons to do so (such as in organ transplantation). Moreover given this link between body part and persons we should attempt to lessen commodifying attitudes and thus should resist the increasing use of practices which regard children as having choose-able parts. (shrink)

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses (...) of reproductive technologies and third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. (shrink)

Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the ‘in and out’ situation of CBRC in (...) Canada, we conducted an ethnographic study taking a ‘critically applied ethics’ approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants’ perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of ‘reproductive outsourcing’ that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders. (shrink)

Definition of the problem The present article focuses on the current international ethical debate on “responsible implementation” of expanded carrier screening to public healthcare systems. Expanded carrier screening is a novel genetic test which aims to provide information to couples about whether both partners carry a genetic variation for the same recessively inherited condition. It was introduced to the market by commercial laboratories in the U.S. in 2010; since about 2015, however, international debates have emerged on how and why to (...) offer the screening as a public health service. Arguments It is shown that, initially, enhancement of couples’ reproductive autonomy, not prevention of recessive disorders, has been established as the ethically well-founded aim and guiding principle of responsible implementation. Recently, however, in 2019, three well-known Dutch bioethicists argued that this aim has been embraced without much reflection and should therefore be replaced with the guiding principle of “responsible parenthood”. According to the latter, autonomous reproductive decision-making of couples or women is morally acceptable solely when carrier screening is done only during pregnancy. Before pregnancy, by contrast, couples are held to have a moral duty to take preventive measures if their future children are at risk of being affected by one of the “worst” recessive conditions. In the present paper, both of these conflicting ethical framings of expanded carrier screening are critically examined. Conclusions While the aim of reproductive autonomy also has problematic aspects, the notion of “responsible parenthood” is much more objectionable since it challenges voluntary participation in carrier screening, argues for directive genetic counseling, limits reproductive self-determination of women and couples, and introduces dubious concepts to the debate. (shrink)

In recent years, as newborn screening has expanded to include conditions for which treatment is questionable, new rationales for screening have proliferated. One such rationale is the potential reproductive benefit to parents from the detection of a genetic condition or carrier status in infants. An unanticipated consequence of invoking knowledge of reproductive risk as a major benefit of screening has been to open newborn screening to the charge that it constitutes state‐sanctioned eugenics. Thus, an endeavor that had (...) been viewed as the converse of state programs of selective breeding has come to be seen in some quarters as yet another of its incarnations. The result has been serious and self‐inflected harm to the reputation of newborn screening programs. (shrink)

We conducted the largest multiple-iteration retelling study to date (12,840 participants and 19,086 retellings) with two different studies that test how emotional appraisals are transmitted across retellings. We use a novel Bayesian model that tracks changes across retellings. Study 1 examines the preservation of appraisals of happy and sad stories and finds that retellings preserve the story’s degree of happiness and sadness even when length shrinks and aspects of story coherence and rationalisation deteriorate. Study 2 compared the transmission of appraisals (...) of happiness and sadness with embarrassment, disgust, and risk. Appraisals of happiness, sadness, and also embarrassment showed high appraisal preservation, while disgust and risk were not well preserved. We conclude that participants in our studies encoded happy and sad stories by encapsulating the events and details into an overall emotional appraisal of the story and that this processing strategy might also apply to stories involving other emotions like embarrassment. The emotional appraisal played a key role in retelling by helping to guide the selection, invention, and ordering of the story elements. Hence, we posit that emotion appraisals can operate as anchors for remembering and retelling stories, thus playing an important role in narrative communication. (shrink)

In their article “Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?” Bayefsky and Berkman briefly mention that: “[s]ome are...

The emergence of new forms of reproductive technology raise an increasingly complex array of social and ethical issues. Nevertheless, this paper focuses on commonplace reproductive technologies used during labor and birth such as ultrasound, fetal monitoring, episiotomy, epidurals, labor induction, amniotomy, and cesarean section. This paper maintains that social pressures increase women’s perceived need to such reproductive technologies and thus undermine women’s capacity to choose an elective cesarean or avoid an emergency cesarean. Routine, normalized use of technology (...) interferes with the possibility of choosing use of technology where best suited through misdirecting laboring women to use technological resources whenever possible. This normalized use of technology decreases risk tolerance and increases dependence on technology for reassurance, which bears significant implications for self-trust and self-confidence. My account encourages women’s cultivation of autonomy as a capacity interconnected with our own attitudes and those of other persons; and as a function of cultivating trust and confidence in one’s body. (shrink)

The contingent cultural, epistemological and ontological status of biology is highlighted by changes in attitudes towards reproductive politics in the history of feminist movements. Consider, for example, the American, British, and numerous European instances of feminist sympathy for eugenics at the turn of the century. This amounted to a specific formation of the role, in late nineteenth and early twentieth century feminisms, of concepts of biological risk and defence, which were transformed into the justificatory language of rights claims. (...) In this context, one can ask how reproductive politics are to be fitted into the paradoxical relationship between biopolitics and thanatopolitics discussed by Michel Foucault and more recently by Roberto Esposito. In this context, “reproductive life,” can be thought of arising at the intersection of thanapolitics and biopolitics as these relate to women’s bodies. Revisiting Foucault and Esposito in the light of reproductive politics also allows a reconsideration of the paradoxical feminist aims involved in defending individual rights by reference to overall biopolitical interest and futurity. (shrink)

In this paper I will discuss three areas in which advances in human reproductive technology could occur, their uses and abuses, and their effects on society. First is the potential to drastically increase the success rate and availability of in vitro fertilization and embryo freezing. Second is the ability to perform biopsies on embryos prior to the onset of pregnancy. Finally, I will consider the adding or altering of genes in embryos, commonly referred to as genetic engineering.As new (...) class='Hi'>reproductive technologies pass from experimental models into the potential for medical utilization, I believe that it will be important for lawmakers everywhere to avoid the impulse to outlaw procedures that a society believes to be unnatural at a first glance. Rather, I would hope that they can respond thoughtfully with legislation that serves two purposes — to protect the rights of couples to overcome infertility or to reduce the risk of genetic disease in their children-to-be, and more importantly, to protect children-to-be from the abuses that could result from some of the practices that I will discuss. (shrink)

This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. (...) This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. (shrink)

ABSTRACT This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and (...) rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. (shrink)

With an increasing number of ways to ‘assist’ reproduction, some bioethicists have started to wonder what it takes to become a genetic parent. It is widely agreed that sharing genes is not enough to substantiate the parent–offspring relation, but what is? Without a better understanding of the concept of reproduction, our thinking about parent–offspring relations and the ethical issues surrounding them risk being unprincipled. Here, I address that problem by offering a principled account of reproduction—the Overlap, Development and Persistence (...) account—which I believe best captures the meaning of ‘genetic parenthood’. (shrink)

BackgroundCurrent preimplantation genetic testing (PGT) technologies enable embryo genotyping across the whole genome. This has led to the development of polygenic risk scoring of human embryos (PGT-P). Recent implementation of PGT-P, including screening for intelligence, has been extensively covered by media reports, raising major controversy. Considering the increasing demand for assisted reproduction, we evaluated how information about PGT-P is communicated in press media and explored the diversity of ethical themes present in the public debate.MethodsLexisNexis Academic database and Google News (...) were searched to identify articles about polygenic embryo screening. This led to 535 news articles. 59 original articles met the inclusion criteria. Inductive content analysis was used to analyse these articles.Results8.8% of articles gave embryo polygenic scoring a positive portrayal, while 36.8% expressed a negative attitude. 54.4% were neutral, mostly highlighting limited practical value of the technology in in vitro fertilization settings. We identified five main ethical themes that are also present in academic literature and the broader debate on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice and societal readiness.ConclusionsImplementation of embryo polygenic profiling engenders a need for specific recommendations. Current media analysis discloses important ethical themes to consider when creating future guidelines for PGT-P. (shrink)

In vitro gametogenesis (IVG) is believed to be the next big breakthrough in reproductive medicine. The prima facie acceptance of this possible future technology is notable when compared to the general prohibition on human reproductive cloning. After all, if safety is the main reason for not allowing reproductive cloning, one might expect a similar conclusion for the reproductive application of IVG, since both technologies hold considerable and comparable risks. However, safety concerns may be overcome, and are (...) presumably not the sole reason why cloning is being condemned. We therefore assess the non‐safety arguments against reproductive cloning, yet most of these can also be held against IVG. The few arguments that cannot be used against IVG are defective. We conclude from this that it will be hard to defend a ban on reproductive cloning while accepting the reproductive use of IVG. (shrink)

Tendencies and efforts have shifted from genome description, DNA mapping, and DNA sequencing to active and profound re-programming, repairing life on genetic and molecular levels in some parts of contemporary life science research. Mirroring and materializing this atmosphere, various life engineering technologies have been used and established in many areas of life sciences in the last decades. A contemporary progressive example of one such technology is DNA editing. Novel developments related to reproductive technologies, particularly embryo editing, prenatal human life (...) engineering, and germline engineering need to be analyzed against the broader social and structural background. The crucial analytical scope for this paper is a specific field: the life-editing technologies used in reproductive medicine and performed experimentally on viable human embryos, particularly CRISPR/cas9 technology. This text argues that germline editing technologies, as a representative part of contemporary biomedicine, are merging ideas of treatment and enhancement to avoid future risks. Using this specific life manipulation of embryos and gametes, the text analyzes these processes within the concept of power over life—biopower and the specific governing rationality that imagines, classifies, and governs contemporary societies. The text specifically focuses on the potential to create, define, and manage future risks and uncertainties related to prenatal life. (shrink)

In “Sex selection and regulated hatred”1 John Harris launches a vehement critique of the Human Fertilisation and Embryology Authority’s recent report Sex Selection: options for regulation, raising several issues that merit discussion.He begins by complaining about the recommendation that because of the theoretical risk associated with the use of flow cytometry as a method of sperm sorting, its use should be restricted for the moment to cases in which a clear medical benefit is to be gained from its use. (...) Harris objects that in this recommendation “an absurdly high standard of caution is employed”, since a theoretical risk is associated with almost all medical procedures. This objection is misplaced: as paragraph 142 of the report indicates, the phrase “theoretical risk” is to be understood here in the light of the earlier discussion of the risks arising from the fact that flow cytometry exposes sperm to laser energy, a procedure which is known to be liable to damage DNA. Since the application of flow cytometry to humans is a new procedure, the risk of human genetic defects caused this way is still only “theoretical”; nonetheless it is serious enough to warrant caution—hence the recommendation that at present flow cytometry should be available only when its use brings clear medical benefits. The HFEA has recently been criticised by some for not being cautious enough when permitting the use of intracytoplasmic sperm injection even though in that case there are clear medical benefits from its use. It is extraordinary that Harris should now criticise the HFEA for not throwing caution to the winds concerning flow cytometry.Harris’ next point concerns the justification for this suggestion that preimplantation sex selection should be available only where it is undertaken for medical reasons. The obvious way to justify this would appear …. (shrink)

Penelope Deutscher reconsiders the role of procreation in Foucault's thought, especially its proximity to risk, mortality, and death. Foucault's Futures brings together his work on sexuality and biopolitics to provide new insights into the conflicted political status of reproductive conduct and what it means for feminism and critical theory.

This article discusses section 156 of the Criminal Justice and Public Order Act 1994 which prohibits the use of eggs from aborted female foetuses for the purposes of reproduction. I argue that the pre-legislative debates focus only on the biological relationship between the aborted foetus and any ensuing child and foreclose the possibility of useful discussion about the potential merits of such technology. Kristeva's theory of abjection has been used in order to elucidate the strength of feeling about the use (...) of eggs from the expelled foetus. I suggest that the ‘yuk’ factor stems from the potential for the blurring of the boundaries between life and death. In addition, I suggest that the stress placed on the biological link means that the foetus is ascribed special properties not given to live donors. Woman's very crucial role in reproductive technologies is therefore erased. The article argues that there are very good reasons why the debate on the subject should remain open. At present women donors have to undergo highly intrusive procedures in order to give eggs and the process is not without its health risks. The use of eggs from aborted foetuses certainly raises important consent issues but these could be addressed by placing women at the centre of the decision making process, starting with the recognition that it is women and not foetuses who have the remit and responsibility for giving consent for the use of their genetic material. Moreover, there should be an acknowledgement that women are perfectly capable of making informed decisions about donation and of considering the potential implications of participating in egg donation. (shrink)

The advantages and risks of a number of new genome modifying procedures seeking to create healthy or enhanced individuals, such as Maternal Spindle Transfer, Pronuclear Transfer, Cytoplasmic Transfer and Genome Editing, are currently being assessed from an ethical perspective, by national and international policy organizations. One important aspect being examined concerns the effects of these procedures on different kinds of identity. In other words, whether or not a procedure only modifies the qualities or properties of an existing human being, meaning (...) that merely the qualitative identity of this single individual is affected, or whether a procedure results in the creation of a new individual, meaning that a numerically distinct human being would have come into existence. In this article, the different identity arguments proposed, so far, are presented with respect to these novel reproductive procedures. An alternative view is then developed using the Origin Essentialism argument to indicate that any cha... (shrink)

Concerns about exploitation pervade the literature on commercial cross-border reproductive care, particularly egg selling and surrogacy. But what constitutes exploitation, and what moral weight does it have? I consider the relationship between vulnerability, limited choice, consent, and mutually advantageous exploitation. To elucidate the difference between limited choice and consent, I draw on an account of relational autonomy. In the absence of a normative principle of fair distribution, it is unclear whether the providers of reproductive goods and services are (...) treated fairly in such contracts, and therefore whether they have been exploited. I finish with some pragmatic recommendations for minimizing risks and empowering egg sellers and surrogates. (shrink)

This study analyzes 435 oocyte donor recruitment advertisements to assess whether entities recruiting donors of oocytes to be used for in vitro fertilization (IVF) procedures include a disclosure of risks associated with the donation process in their advertisements. Such disclosure is required by the self-regulatory guidelines of the American Society for Reproductive Medicine (ASRM) and by law in California for advertisements placed in the state. We find very low rates of risk disclosure across entity types and regulatory regimes, (...) although risk disclosure is more common in advertisements placed by entities subject to ASRM's self-regulatory guidelines. Advertisements placed in California are more likely to include risk disclosure, but disclosure rates are still quite low. California-based entities advertising outside the state are more likely to include risk disclosure than non-California entities, suggesting that California's law may have a modest “halo effect.” Our results suggest that there is a significant ethical and policy problem with the status quo in light of the known and unknown risks of oocyte donation and the importance of risk disclosure to informed consent in the context of oocyte donation. (shrink)

In vitro fertilization using donated oocytes has proven to be an effective treatment option for many prospective parents struggling with infertility, and the usage of donated oocytes in assisted reproduction has increased markedly since the technique was first successfully used in 1984. Data published by the Centers for Disease Control and Prevention on the use of assisted reproductive technologies in the United States indicate that approximately 12% of all ART cycles in the country now use donated oocytes. The increased (...) use of oocyte donation in the United States has prompted discussion regarding risks associated with the process and how best to ensure the safety of oocyte donors.Physical risks associated with oocyte donation include bleeding, infection, ovarian hyperstimulation syndrome and a potential, although unconfirmed, increased risk of developing various forms of cancer, such as uterine, colon, breast, ovarian, and endometrial cancers. (shrink)

This target article presents an integrated evolutionary model of the development of attachment and human reproductive strategies. It is argued that sex differences in attachment emerge in middle childhood, have adaptive significance in both children and adults, and are part of sex-specific life history strategies. Early psychosocial stress and insecure attachment act as cues of environmental risk, and tend to switch development towards reproductive strategies favoring current reproduction and higher mating effort. However, due to sex differences in (...) life history trade-offs between mating and parenting, insecure males tend to adopt avoidant strategies, whereas insecure females tend to adopt anxious/ambivalent strategies, which maximize investment from kin and mates. Females are expected to shift to avoidant patterns when environmental risk is more severe. Avoidant and ambivalent attachment patterns also have different adaptive values for boys and girls, in the context of same-sex competition in the peer group: in particular, the competitive and aggressive traits related to avoidant attachment can be favored as a status-seeking strategy for males. Finally, adrenarche is proposed as the endocrine mechanism underlying the reorganization of attachment in middle childhood, and the implications for the relationship between attachment and sexual development are explored. Sex differences in the development of attachment can be fruitfully integrated within the broader framework of adaptive plasticity in life history strategies, thus contributing to a coherent evolutionary theory of human development. (shrink)