A diagnosis of fetal abnormality presents parents with a difficult – even tragic – moral dilemma. Where this diagnosis is made in the context of surrogate motherhood there is an added difficulty, namely that it is not obvious who should be involved in making decisions about abortion, for the person who would normally have the right to decide – the pregnant woman – does not intend to raise the child. This raises the question: To what extent, if at all, (...) should the intended parents be involved in decision-making? In commercial surrogacy it is thought that as part of the contractual agreement the intended parents acquire the right to make this decision. By contrast, in altruistic surrogacy the pregnant woman retains the right to make these decisions, but the intended parents are free to decide not to adopt the child. We argue that both these strategies are morally unsound, and that the problems encountered serve to highlight more fundamental defects within the commercial and altruistic models, as well as in the legal and institutional frameworks that support them. We argue in favour of the professional model, which acknowledges the rights and responsibilities of both parties and provides a legal and institutional framework that supports good decision-making. In particular, the professional model acknowledges the surrogate's right to decide whether to undergo an abortion, and the intended parents' obligation to accept legal custody of the child. While not solving all the problems that arise in surrogacy, the model provides a framework that supports good decision-making. (shrink)
Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not cause such (...) harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)
The diagnosis of Fetal Alcohol Spectrum Disorders is embedded in a matrix of biological, social and ethical processes, making it an important topic for crossdisciplinary social and ethical research. This article reviews different branches of research relevant to understanding how FASD is identified and defined and outlines a framework for future social and ethical research in this area. We outline the character of scientific research into FASD, epidemiological discrepancies between reported patterns of maternal alcohol consumption during pregnancy and the (...) incidence of FASD, and the social and ethical considerations that may impact on who is, and is not, diagnosed. We highlight what further research investigating FASD diagnostic processes, as well as the multi-generational impacts of FASD, is needed. Important research priorities are to: 1) enumerate the variety of stakeholders involved in seeking FASD diagnoses; 2) understand the experiences and perspectives of mothers from different backgrounds who have consumed alcohol during pregnancy and their affected children; and 3) collect health histories of maternal alcohol consumption in families to determine the effect of FASD at sub-cultural and cultural levels. (shrink)
When surgery is performed on pregnant women forthe sake of the fetus (MFS or maternal fetalsurgery), it is often discussed in terms of thefetus alone. This usage exemplifies whatphilosophers call the fallacy of abstraction: considering a concept as if it were separablefrom another concept whose meaning isessentially related to it. In light of theirpotential separability, research on pregnantwomen raises the possibility of conflictsbetween the interests of the woman and those ofthe fetus. Such research should meet therequirement of equipoise, i.e., a (...) state ofgenuine uncertainty about the risks andbenefits of alternative interventions ornoninterventions. While illustrating thefallacy of abstraction in discussions of MFS,we review the rationale for explicitacknowledgment of the essential tie betweenfetus and pregnant woman. Next we examinewhether it is possible to meet the requirementof equipoise in research on MFS, focusing on afetal condition called myelomeningocele. Weshow how issues related to equipoise innonpregnant populations appear also in debatesregarding MFS. We also examine evidence insupport of claims that the requirement ofequipoise has been satisfied with respect to``the fetal patient'' while considering risks andbenefits to gestating women only marginally ornot at all. After delineating challenges andpossibilities for equipoise in MFS research, weconclude with a suggestion for avoiding thefallacy of abstraction and achieving equipoiseso that research on MFS may be ethicallyconducted. (shrink)
This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as (...) a criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)
Infant facial characteristics may affect discriminative parental solicitude because they convey information about the health of the offspring. We examined the effect of Fetal Alcohol Syndrome (FAS) infant facial characteristics on hypothetical adoption preferences, ratings of attractiveness, and ratings of health. As expected, potential parents were more likely to adopt “normal” infants, and they rated the FAS infants as less attractive and less healthy. Cuteness/attractiveness was the best predictor of adoption likelihood.
Since the introduction of ultrasound technology in the 1960s as a tool to visibly articulate the interiors of the pregnant body, feminist scholars across disciplines have provided extensive critique regarding the visual culture of fetal imagery. Central to this discourse is the position that fetal images occupy- as products of a visualizing technology that at once penetrates and severs pregnant and fetal bodies. This visual excision, feminist scholars describe, has led not only to an erasure of the (...) female body from fetal images but also to an erasure of the pregnant body in social, political, and biomedical discourses. Vital to feminist scholarship is, thereby, an engagement with fetal images in ways that reinscribe the pregnant body onto fetal images and into political discourses pertaining to reproductive rights. In this paper, similar to the feminist aim, I am interested in engaging with fetal images as way to gain agency for pregnant women and their bodies. The critical question that I ask is: Can we conceive of medical technology in an embodied way -one that interacts organically, dynamically, and through multisensory dimensions with pregnant bodies? In attempting to answer this question, I turn to Bruno Latour and Gilles Deleuze’s articulations of how bodies and machines interact to produce visual fact. (shrink)
Both the medical model and the social model of disability have substantial drawbacks for the project of creating better lives for people with disabilities; the first denies the value of difference and the effects of discrimination, and the second denies any place for prevention and cure. Using fictional and non-fictional parental narratives of Fetal Alcohol Syndrome, this article argues that a third model–a morphological model of disability–can best help us think about respectfully and effectively intervening in disability.
The history of the fetal alcohol syndrome provides a microcosm in which to explore the larger ramifications of historical citations in biomedical publications. Though some historical references such as Biblical writings may hint at a rudimentary understanding of the relationship between maternal drinking and fetal development, no definitive case can be made for an understanding of FAS dating back hundreds of years. Authors who claim an impressive history for FAS misrepresent that history. The modern history of FAS raises (...) a question concerning citations of original discoveries. The first paper describing ethanol-induced damage to the fetus appeared in 1968 yet most researchers cite one of two papers from 1973. Both ancient citations and modern references to original discoveries pose difficult questions for the scientist. Both dilemmas may be solved by a better reading of the literature and a more judicious wording when writing about history. (shrink)
Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such as (...) home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. (shrink)
At many slaughterhouses, if a pregnant cow is killed, then medical companies pay to harvest the fetus's blood. When you communicate the details of this process to people, many of them are disgusted. I submit that those who are repulsed thereby acquire a reason to believe that this practice is morally wrong. However, it is controversial to maintain that disgust can provide moral guidance. So, I develop a theory of disgust’s moral salience that fits with the empirical work that’s been (...) done on it, and I apply it to the collection of bovine fetal blood. I conclude by suggesting how this theory may be of use in animal ethics generally. (shrink)
Fetal surgery has been practised for some decades now. However, it remains a highly complex area, both medically and ethically. This paper shows how the routine use of ultrasound has been a catalyst for fetal surgery, in creating new needs and new incentives for intervention. Some of the needs met by fetal surgery are those of parents and clinicians who experience stress while waiting for the birth of a fetus with known anomalies. The paper suggests that the (...) role of technology and visualisation techniques in creating and meeting such new needs is ethically problematic. It then addresses the idea that fetal surgery should be restricted to interventions that are life-saving for the fetus, arguing that this restriction is unduly paternalistic. Fetal surgery poses challenges for an autonomy-based system of ethics. However, it is risky to circumvent these challenges by restricting the choices open to pregnant women, even when these choices appear excessively altruistic. (shrink)
Infertility affects 15 per cent of the world's couples. Research at Edinburgh University has been directed at transplanting fetal ovarian tissue into infertile women, thus enabling them to bear children. Fetal ovary transplantation (FOT) has generated substantial controversy; in fact, one ethicist deemed the procedure 'so grotesque as to be unbelievable' (1). Some have suggested that fetal eggs may harbour unknown chromosomal abnormalities: however, there is no evidence that these eggs possess a higher incidence of genetic anomaly (...) than ova found in a healthy adult female. There is also concern that fetal egg children will be psychologically harmed by the knowledge of their special conceptual status. It will be demonstrated that special conceptual status in and of itself does not determine developmental success. Rather, psychological well-being is dependent upon how the family and child cope with the unique challenges inherent in FOT. Lastly, though considering FOT a legitimate method of family building, given the global population crisis the wisdom of procreational rights will be challenged. Inherent to this challenge is a re-evaluation of the treatment of infertility as a significant disease necessitating remedy. (shrink)
This essay concerns what people should do in conflict situations when a doubt of fact bears on settling whether an alternative under consideration is legitimate or not. Its principal audience are those who believe that abortion can be legitimate when not having an abortion gives rise to serious harms that can be avoided by having one, but who are concerned that fetuses might feel pain when being aborted, and who believe that causing unnecessary pain should be avoided when doing so (...) would not pose an undue burden. The essay remains neutral on the substantive questions of the moral status of the unborn and the morality of abortion. The question of fetal pain has taken center stage in the last few years in the .. (shrink)
In the debate over fetal tissue use, an analogy is often drawn between removing organs from the body of a person who has been murdered to use for transplantation, and collecting tissue from an aborted fetus to use for the same purpose. The murder victim analogy is taken by its proponents to show that even if abortion is the moral equivalent of murder, there is still no good reason to refrain from using the fetal tissue, since as a (...) society we do not see any problem about using organs from murder victims. However, I argue that the analogy between murder victims and aborted fetuses does not hold -- the two situations are not the same in all morally relevant respects. Thus the murder victim analogy does not provide an argument in favour of fetal tissue transplant. In conclusion, I point to some of the potential pitfalls of using analogies in ethical argument. (shrink)
In her ground-breaking 1971 article, “A Defense of Abortion,” Judith Jarvis Thomson argues that even if one grants to the prolifer her most important premise—that the fetus is a person—the prolifer’s conclusion, the intrinsic wrongness of abortion, does not follow. However, in her 1995 article, “Abortion: Whose Right?,” Thomson employs Rawlsian liberalism to argue that even though the prolifer’s view of fetal personhood is not unreasonable, the prochoice advocate is not unreasonable in rejecting it. Thus, because we should err (...) on the side of liberty, the right to abortion is vindicated. In this article, I argue that Thomson’s latter reliance on Rawlsian thinking suggests a way of re-reading her earlier essay that casts doubt on whether she really grants the dominant prolife account of unborn human life. (shrink)
Ethical controversy over transplantation of human fetal tissue has arisen because the source of tissue is induced abortions. Opposition to such transplants has been based on various arguments, including the following: rightful informed consent cannot be obtained for use of fetal tissue from induced abortions, and fetal tissue transplantation might result in an increase in the number of abortions. These arguments were not accepted by the National Institutes of Health (NIH) Human Fetal Tissue Transplantation Research Panel. (...) The majority opinion of the panel stated that abortion and fetal tissue use are entirely separate issues, and that tissue use is ethically acceptable because it can be morally insulated from the issue of abortion. In support of this view, panel members and others have replied to the arguments put forward by opponents of fetal tissue use. However, replies to the two arguments mentioned above have been unsatisfactory, and the shortcomings of those replies are identified herein. Examination of the arguments pro and con suggests that fetal tissue use cannot be completely insulated from the issue of abortion. Thus, in seeking an ethical justification for fetal tissue transplantation we must consider reasons other than those put forward by the NIH panel. In this paper it is argued that whatever wrong is involved in using fetal tissue from induced abortions must be balanced against the benefits for patients, and it is on this basis that fetal tissue transplantation can be ethically justified. (shrink)
In this essay, some of the signatories to “Medical Intervention in Cases of Maternal–Fetal Vital Conflicts: A Statement of Consensus” respond to “The Placenta as an Organ of the Fetus: A Response to the Statement of Consensus on Maternal–Fetal Conflict,” both recently published in this journal. The response examines Bringman and Shabanowitz’s claims and assumptions about the morally relevant pathologic condition in some cases of peripartum cardiomyopathy complicated by a subsequent pregnancy, the moral status of a normally functioning (...) placenta, and the use of the principle of double effect in these cases. The signatories’ response sets out to demonstrate how Bringman and Shabanowitz do not engage the essential points of the statement of consensus and how their argument is premised on false assumptions. National Catholic Bioethics Quarterly 15.2 : 241–250. (shrink)
Using qualitative methods, we observed a series of fetal pig dissection sessions in a high school biology course and interviewed 17 students in the class.The students' responses to dissection varied considerably. Most felt that dissection was a positive experience, but a substantial minority viewed it primarily in negative terms. Almost all the students had some ambivalence about aspects of the fetal pig lab and believed that alternatives should be provided for students who object to the practice. We argue (...) that dissection remains a viable educational tool but should be an optional rather than compulsory component of the curriculum. (shrink)
In this commentary we discuss the possibility of subcortical consciousness and its implications for fetal anesthesia and analgesia. We review the neural development of structural and functional elements that may participate in conscious representation, with a particular focus on the experience of pain. (Published Online May 1 2007).
Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status (...) of the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)
Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as ‘keepsake’ ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by (...) governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed. (shrink)
Since 1994, when the first fetal imaging boutique appeared in Texas, many sites have been established around the country for parents to receive nonmedical fetal imaging using three- and four-dimensional ultrasound machines. These businesses boast the benefits they offer to parental-fetal bonding, but the medical community objects to the use of ultrasound machines for nonmedical purposes. In this article, I present the statements released by the medical community, highlighting the alarmist strategies used to paint boutique ultrasounds as (...) bad science and elevate the medical use of ultrasounds. Through a close reading of the statements, it is shown that the medical community's primary concern is not the health of the fetus or the woman but rather their place as the sole users of fetal ultrasounds. This detailed analysis reveals a medical community fearful that its authority is being usurped and is therefore responding with statements meant to denigrate boutique fetal ultrasounds. (shrink)
This essay critiques feminist treatments of maternal-fetal "relationality" that unwittingly replicate features of Western individualism (for example, the Cartesian division between the asocial body and the social-cognitive person, or the conflation of social and biological birth). I argue for a more reflexive perspective on relationality that would acknowledge how we produce persons through our actions and rhetoric. Personhood and relationality can be better analyzed as dynamic, negotiated qualities realized through social practice.
A scientist at Edinburgh University announced in 1994 that he had removed ovaries from, mouse fetuses and transplanted them, to adult mice. The ovaries released eggs, and conceptions occurred. Although this was not the first such attempt with mice, the study attracted attention because the researcher suggested, that fetal to adult ovarian transplants were a theoretical possibility for humans. If aborted, fetuses were used, as egg sources in assisted conception, a new entity would arise: the never-born genetic mother. Using (...) eggs from aborted fetuses for conception would lead to quixotic and novel family ties. Its use would echo surrogate gestational motherhood, in which a child has both a genetic mother who contributed her egg and a gestational mother who contributed her uterus for gestation and childbirth. With fetal egg use, however, the child's genetic mother would be a never-born fetus without sentience or known, physiology. (shrink)
This essay considers the ways in which the various contexts – abortion, prenatal diagnosis, fetal research, and the use of fetuses in transplantation – shape the American debate on the moral standing of the fetus. This discussion gives rise to several philosophical debates on the status of the preimplantation embryo, particularly the debate over when the preimplantation embryo becomes individuated. How that question is resolved has critical ethical and policy implications.
Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, (...) in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation. (shrink)
Sham surgery is a controversial and rarely used component of randomised clinical trials evaluating surgical interventions. The recent use of sham surgery in trials evaluating efficacy of intracerebral fetal tissue grafts in Parkinson’s disease has highlighted the ethical concerns associated with sham surgery controls. Macklin, and Dekkers and Boer argue vigorously against use of sham surgery controls. Macklin presents a broad argument against sham surgery controls while Dekkers and Boer present a narrower argument that sham surgery is unnecessary in (...) the specific setting of fetal tissue engraftment for Parkinson’s disease. I defend sham surgery controls against both these criticisms. Appropriate clinical trial design, sometimes including sham surgery, is needed to ensure that false positive trial results do not occur and endanger public safety. Results of a completed trial of fetal tissue grafting for Parkinson’s disease are used to illustrate the potential benefits of, and problems associated with, sham surgery controls. Sham surgery controls, however, should be employed only when absolutely necessary. I suggest criteria for appropriate use of sham surgery controls. (shrink)
Stigma can influence the prevention and identification of fetal alcohol spectrum disorder, a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies. We propose a descriptive model of stigma in FASD and note current knowledge gaps; discuss the ethical (...) implications of stigma based on two distinct criteria ; and describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD. (shrink)
A recent statement of consensus held that the principle of double effect would allow the induction of a previable fetus in order to eliminate a grave and present danger to the life of a mother suffering from peripartum cardiomyopathy. The author responds to this declaration, points out some limitations preventing it from being a vehicle for broader agreement, and offers an alternative, namely, medical induction of labor in cases of maternal–fetal vital conflict can be justified if the fetus has (...) at least a fair chance of survival. This support of induction in cases of periviability considers the interests of both fetus and mother and, unlike the earlier consensus statement, can be defended by those who hold that one’s moral intention includes both the ultimate and proximate ends, or the immediate consequences of one’s act. (shrink)
In early 2010, the Nebraska state legislature passed a new abortion restricting law asserting a new, compelling state interest in preventing fetal pain. In this article, we review existing constitutional abortion doctrine and note difficulties presented by persistent legal attention to a socially derived viability construct. We then offer a substantive biological, ethical, and legal critique of the new fetal pain rationale.
Deborah is a thirty-three-year-old who presented to labor and delivery at thirty-seven weeks gestation with complaints of contractions. Upon arrival, she explained that her fetus, Nathan, had been diagnosed with a “lethal” condition by her primary obstetrician. At twenty-two weeks gestation, an amniocentesis confirmed trisomy 13, a chromosomal abnormality leading to miscarriage or stillbirth in nearly one-half of affected pregnancies. During the admission process, Deborah voices the worry that due to Nathan's brain and heart structure, vaginal delivery could be traumatic (...) and cause him to suffer. Deborah wishes for him to have as painless and as dignified a death as possible; cesarean section, she feels, will achieve this. Yet with her history of three prior vaginal deliveries, normally progressing labor, and poor fetal prognosis that is unlikely to improve with cesarean delivery, there is no maternal or fetal indication for a cesarean section. Should the obstetrician proceed with a cesarean delivery despite knowing that it would expose the mother to surgical risks with little or no corresponding fetal or neonatal benefit? (shrink)
Khalafzai, Rida Usman Harms of alcohol consumption are not limited to the consumer. For women, it poses a significant threat to their unborn child. This article discusses one type of alcohol-related harm to the fetus: the fetal alcohol spectrum disorders (FASD).
Genetics holds the key to understanding normal human biology and possibly many of the major causes of human disease and impairment. Research into human developmental genetics seems, therefore, to be both necessary and justified. However, such research requires the use of embryonic and fetal tissue obtained from spontaneous abortions and elective termination of pregnancy. This paper examines the arguments in favour of using tissue from elective terminations and the evolution of regulatory frameworks for this research. The paper argues that (...) the recent statutory and regulatory reforms in the UK have not properly addressed the issue of ethically obtaining postimplantation human embryos for research. It is argued that the recent reforms have left the Polkinghorne guidelines untouched but that these are now unequal to the task. A practical suggestion for reform of the approach to the informing and consent of potential donors is offered. (shrink)
Proceedings of a one day symposium for medical professionals with an interest in, or with a responsibility for, the development of ante-natal screening, fetal medicine and the provision of termination of pregnancy, held on 26 September 1996 at the Royal Society of Medicine, London. The objectives of the symposium were: to provide an occasion for the discussion of the clinical and ethical issues involved in screening for fetal abnormality and in providing the options of continuing the pregnancy or (...) abortion; to clarify good practice in respect of late abortion for fetal abnormality; to discuss the problems of providing a service sympathetic to women. (Author). (shrink)
This article presents an overview ofregulations, guidelines and societal debates ineight member states of the EC about a)embryonic and fetal tissue transplantation(EFTT), and b) the use of human embryonic stemcells (hES cells) for research into celltherapy, including `therapeutic' cloning. Thereappears to be a broad acceptance of EFTT inthese countries. In most countries guidance hasbeen developed. There is a `strong' consensusabout some of the central conditions for `goodclinical practice' regarding EFTT.International differences concern, amongstothers, some of the informed consent issuesinvolved, and (...) the questions whether anintermediary organisation is necessary, whetherthe methods of abortion may be influenced bythe possible use of EFT, and whether EFTTshould only be used for the experimentaltreatment of rare disorders. The potential useof hES cells for research into cell therapy hasgiven a new impetus to the debate about (human)embryo research. The therapeutic prospects withregard to the retrieval and research use of hEScells appear to function as a catalyst for theintroduction of less restrictive regulationsconcerning research with spare embryos, atleast in some European countries. It remains tobe seen whether the prospect of treatingpatients suffering from serious disorders withtransplants produced by therapeutic cloningwill decrease the societal and moral resistanceto allowing the generation of embryos for`instrumental' use. (shrink)
Corporate fetal protection policies are designed to protect unborn children from exposure to harmful substances in the workplace. In recent years, a number of corporations have instituted fetal protection policies which excluded all fertile female employees from jobs which exposed them to hazardous substances. Critics argued that these policies discriminated against women, and several lawsuits were filed.The United States Supreme Court recently decided a case involving the fetal protection policy of Johnson Controls, Inc. This article will analyze (...) the impact of the Supreme Court decision from a legal and ethical perspective. Practical guidelines for policies which protect the unborn and comply with the law will also be addressed. (shrink)
Despite some clinical promise, using fetal transplants for degenerative and traumatic brain injury remains controversial and a number of issues need further attention. This response reexamines a number of questions. Issues addressed include: temporal factors relating to neural grafting, the role of behavioral experience in graft outcome, and the relationship of rebuilding of neural circuitry to functional recovery. Also discussed are organization and type of transplanted tissue, the of transplant viability, and whether transplants are really needed to obtain functional (...) recovery after brain damage. (shrink)
In addition to the scientific and medical issues surrounding the use of fetal tissue transplants, the ethical implications should be considered. Two major ethical issues are relevant. The first of these is whether this experimental procedure can be justified on the basis of potential benefit to the patient. The second is whether the use of tissue obtained from intentionally aborted fetuses can be justified in the context of historical and existing guidelines for the protection of human subjects. The separation (...) of ethical decisions from medical practice and scientific research is necessary to prevent the exploitation of innocent human life. (shrink)
The use of human fetal tissue for scientific research has enormous potential but is subject to government legislation. In the United Kingdom the Polkinghorne Committee's guidelines were accepted by the Department of Health in 1990. These guidelines set out to protect women undergoing termination of pregnancy from exploitation but in so doing may significantly restrict potential research. Although the committee took evidence from a wide variety of experts they did not seek the views of the general public. We asked (...) 108 women about to have a therapeutic abortion; 167 women who had had a pregnancy terminated in the past, and 419 women who had never had an abortion, their views on research using human fetal tissue. Regardless of their past experiences the women were overwhelmingly in favour of research using fetal tissue (94 per cent). They made little distinction between basic research and research with obvious clinical relevance and supported the concept of using transplanted fetal tissue for the treatment of adult disease such as Parkinsonism. Women about to undergo an abortion were significantly more likely (p < 0.001) to approve of all types of research including that aimed at improving methods of abortion and research using live fetuses in utero. (shrink)
The procurement of fetal tissue for transplantation may promise great benefit to those suffering from various pathologies, e.g., neural disorders, diabetes, renal problems, and radiation sickness. However, debates about the use of fetal tissue have proceeded without much attention to ethical theory and application. Two broad moral questions are addressed here, the first formal, the second substantive: Is there a framework from other moral paradigms to assist in ethical debates about the transplantation of fetal tissue? Does the (...) use of fetal tissue entail cooperation in abortion? To answer these questions I develop a theoretical framework by combining the paradigm of just-war reasoning with canons governing the use of cadaverous tissue. The kinds of safeguards provided by this paradigm allow fetal tissue to be procured without the taint of association with abortion. Central to solving the problem of cooperation is the distinction between intending and foreseeing a moral misdeed. Fetal researchers may foresee fetal death in elective abortions without intending such deaths to occur. Thus, even those who object unequivocally to elective abortion may condone the procurement of fetal tissue, if sufficient reason exists. Keywords: fetal tissue, casuistry, prima facie duties, just-war tenets, complicity CiteULike Connotea Del.icio.us What's this? (shrink)
Objective Standards of care regarding obstetric management of life-threatening anomalies are not defined. It is hypothesised that physicians' management of these pregnancies is variable and influenced by demographic factors. Design A questionnaire was mailed to members of the Society of Maternal–Fetal Medicine with valid US addresses assessing obstetric management of both ‘uniformly lethal’ (eg, anencephaly, renal agenesis) and ‘uniformly severe, commonly lethal’ (eg, trisomy 13 and 18) anomalies. Respondents were asked to answer as if not limited by state/institutional restrictions. (...) Fisher's exact or χ2 tests were used as appropriate and correction made for multiple comparisons in analyses that were not prespecified. Results The response rate was 36% (732/2038). Nearly 100% of respondents discuss termination for both uniformly and commonly lethal anomalies. In continuing pregnancies, with patient request for obstetric non-intervention 99% of providers would comply for either uniformly or commonly lethal anomalies. The majority ‘encourage’ such management, but some were non-directive or discouraged this management. In continuing pregnancies, with patient request for full obstetric intervention the majority of respondents was willing to comply for both uniformly (71%) and commonly (82%) lethal anomalies. While most practitioners ‘discouraged’ full intervention, some were non-directive or encouraged this management. Demographics and severity of anomaly influenced counselling. Conclusion Discrepancies exist regarding the management of life-threatening fetal anomalies. Patients may be offered different options based on practitioner demographics. The majority of physicians comply with patient wishes. Differences were noted when comparing the management of lethal with that of severe commonly lethal anomalies, suggesting that practitioners make a distinction when counselling patients. (shrink)
Several conceptual and methodological challenges must be solved in order to create knowledge that can be useful to pregnant women, their families, and any clinicians who serve them: (1) going beyond nominal and ordinal hypotheses and presenting estimates of conditional probabilities; (2) focusing on clearly defined outcomes; (3) modeling the relationship of fetal growth and length of gestation; (4) understanding the process of fetal growth even though most of our data is cross-sectional; (5) estimating the independent effects of (...) genetics, race, ethnicity, maternal risk behaviors, medical prenatal care, and socioeconomic status on fetal growth and length of gestation; and (6) estimating the independent effects of maternal pre-pregnancy weight, weight gain during pregnancy, and nutrition on fetal growth and length of gestation. (shrink)
This essay examines three tendencies nurtured in the practices of reproductive technology – tendencies with profoundly disturbing implications for us as individuals and as social beings. They are: 1) the increasing subjectification of the fetus (that is, the increasing tendency to posit a fetal subject), 2) the increasing objectification of the gestating woman, leading to her representation as interchangeable object rather than unique subject, and 3) the increasing tendency to conceive of the fetus and the mother as social, medical, (...) and legal antagonists. Considering the construction of fetus, mother, and the fetal/maternal relation in earlier (Western) historical periods, a contemporary work of literature, a government report, and the popular press, I argue that as the fetus is increasingly being understood as a subject, the mother is increasingly being reduced to an antagonist, an obstacle to fetal health, and an object. The essay concludes by offering some tentative conclusions about the general process of fetal subjectification in the United States and Europe. (shrink)