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1.
JENNIFER A. PARKS 《Bioethics》2010,24(7):333-340
This essay will focus on the moral issues relating to surrogacy in the global context, and will critique the liberal arguments that have been offered in support of it. Liberal arguments hold sway concerning reproductive arrangements made between commissioning couples from wealthy nations and the surrogates from socioeconomically weak backgrounds that they hire to do their reproductive labor. My argument in this paper is motivated by a concern for controlling harms by putting the practice of globalized commercial surrogacy into the context of care ethics. As I will argue, the unstable situations into which children of global surrogacy arrangements are born is symbolic of the crisis of care that the practice raises. Using the Baby Manji case as my touch point, I will suggest that liberalism cannot address the harms experienced by Manji and children like her who are created through the global practice of assisted reproductive technology. I will argue that, if commissioning couples consider their proposed surrogacy contracts from a care ethics point of view, they will begin to think relationally about their actions, considering the practice from an ethical lens, not just an economic or contractual one. 相似文献
2.
ANNE DONCHIN 《Bioethics》2010,24(7):323-332
Reproductive tourism is a manifestation of a larger, more inclusive trend toward globalization of capitalist cultural and material economies. This paper discusses the development of cross‐border assisted reproduction within the globalized economy, transnational and local structural processes that influence the trade, social relations intersecting it, and implications for the healthcare systems affected. I focus on prevailing gender structures embedded in the cross‐border trade and their intersection with other social and economic structures that reflect and impact globalization. I apply a social connection model of responsibility for unjust outcomes and consider strategies to counter structural injustices embedded in this industry. The concluding section discusses policy reforms and proposals for collaborative action to preclude further injustices and extend full human rights to all. 相似文献
3.
Surgery is an increasingly common and expensive mode of medical intervention. The ethical dimensions of the surgeon‐patient relationship, including respect for personal autonomy and informed consent, are much discussed; but broader equity issues have not received the same attention. This paper extends the understanding of surgical ethics by considering the nature of evidence in surgery and its relationship to a just provision of healthcare for individuals and their populations. 相似文献
4.
Evie S. Kendal 《The Yale journal of biology and medicine》2022,95(3):371
Artificial wombs are already in development that have the potential to radically alter how we perceive the developing fetus and the role of pregnancy in society. That this technology would allow greater visibility of gestation than ever before also highlights the risk that artificial wombs will be used to further restrict women’s reproductive liberty and access to abortion. This article uses Paul Lauritzen’s theory of “visual bioethics” to explore the ethical significance of images of the developing fetus and how artificial wombs might best be visually designed and integrated into society. 相似文献
5.
The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions. 相似文献
6.
Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity – namely, healthier social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high‐income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non‐clinical health research and its contribution to advancing global justice. 相似文献
7.
Infertility is an unpredictable but widespread condition. While high‐income countries grapple with when, or how to cover the costs of assisted reproductive technology (ART), such as in‐vitro fertilisation (IVF), these services are generally only available to wealthy persons at private facilities in low‐ and middle‐income countries (LMICs). Although the principle of non‐interference with normal individual reproductive rights is robust, whether it is also the responsibility of collective society to provide the means (when ART applies) to achieve pregnancy, is controversial. Recently, a low‐cost model was developed at a South African public institution. The target population for this model was “helpless and marginalised, childless couples”, but a new threat has arisen, namely, infertile couples who could conceivably afford private care. In the allocation of this scarce resource, we argue for a prioritarian response that first addresses the worst‐off, in order to even out unequal access imposed by sharp differences in income. 相似文献
8.
TIMOTHY F. MURPHY 《Bioethics》2013,27(4):224-232
Sex selection of children by pre‐conception and post‐conception techniques remains morally controversial and even illegal in some jurisdictions. Among other things, some critics fear that sex selection will distort the sex ratio, making opposite‐sex relationships more difficult to secure, while other critics worry that sex selection will tilt some nations toward military aggression. The human sex ratio varies depending on how one estimates it; there is certainly no one‐to‐one correspondence between males and females either at birth or across the human lifespan. Complications about who qualifies as ‘male’ and ‘female’ complicate judgments about the ratio even further. Even a judiciously estimated sex ratio does not have, however, the kind of normative status that requires society to refrain from antenatal sex selection. Some societies exhibit lopsided sex ratios as a consequence of social policies and practices, and pragmatic estimates of social needs are a better guide to what the sex ratio should be, as against looking to ‘nature’. The natural sex ratio cannot be a sound moral basis for prohibiting parents from selecting the sex of their children, since it ultimately lacks any normative meaning for social choices. 相似文献
9.
辅助生殖技术（assisted reproduction technique,ART）的飞速发展给社会带来了复杂伦理难题。因此,在ART全过程中加强伦理管理并对其后果进行评价,具有深刻的内涵价值和深远的社会意义。只有发挥生殖医学伦理委员会作为一个工作机构的职能,在医患人群中加强ART技术基本原理及相关伦理原则的宣传教育,强化医学伦理的监督机制,落实充分的知情同意等措施,才能促使医患人群都能够自觉遵守优良的医学伦理道德规范,保证人类辅助生殖技术的健康发展,使ART发挥积极的、革命性的意义。 相似文献
10.
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. 相似文献
11.
EDUARDO RIVERA-LÓPEZ 《Bioethics》2006,20(6):319-325
In a recent paper published in this journal, Thomas S. Petersen makes a qualified defense of what he calls ‘the Claim from Adoption’, according to which, ‘instead of expending resources on bringing new children [in developed countries] into the world using reproductive technology and caring for these children, we ought to devote these resources to the adoption and care of existing destitute children’. My purpose in this paper is not to discuss Petersen’s argument in favor of that claim. Rather, I want to show that, even if the Claim from Adoption might be, other things being equal, true, it is not true all things considered. What is, all things considered, true is a much more complex set of statements, including a general prima facie obligation to adopt, as well as an obligation by the state of developed countries to discourage procreation and promote adoption of destitute children. 相似文献
12.
Ana Nordberg Timo Minssen Oliver Feeney Iñigo de Miguel Beriain Lucia Galvagni Kirmo Wartiovaara 《Bioethics》2020,34(1):16-32
Potential applications of genome editing in assisted reproductive technology (ART) raise a vast array of strong opinions, emotional reactions and divergent perceptions. Acknowledging the need for caution and respecting such reactions, we observe that at least some are based on either a misunderstanding of the science or misconceptions about the content and flexibility of the existing legal frameworks. Combining medical, legal and ethical expertise, we present and discuss regulatory responses at the national, European and international levels. The discussion has an EU starting point and is meant as a contribution to the general international regulatory debate. Overall, this paper concludes that gene editing technologies should not be regulated autonomously. Rather, potential uses should be regulated under general, existing frameworks and where applicable by reference to sufficiently equivalent technologies and techniques already subject to specific regulation. To be clear, we do not argue for the hasty introduction of gene editing as a reproductive treatment option in the immediate future. We call for caution with regard to overreaching moratoria and prohibitions that will also affect basic research. We recommend flexible regulations that allow for further responsible research into the potential development of the technology. We call for an open and inclusive debate and argue that scientific communication should claim a more prominent role to counter the danger of widespread misinformation. A high level of transparency and accuracy should guide scientific communication while simultaneously global-scale responsibility and governance should be fostered by promoting cross-disciplinary thinking and multi-level stakeholder involvement in legal and regulatory processes. 相似文献
13.
This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non‐domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision‐making on whether and to what extent to allocate resources to non‐domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny. 相似文献
14.
Aureliano Lopes da Silva Junior Mônica Fortuna Pontes Anna Paula Uziel 《Developing world bioethics》2023,23(2):122-137
This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction technologies (ART), particularly the surrogacy. For that purpose, we interviewed: 1) a lesbian woman who had her daughter through her partner's pregnancy, using ART with anonymous donor semen; 2) a gay man who, together with his partner, used a surrogacy service under contract via a specialised offshore agency; 3) a woman who was a surrogate, in Brazil, for her sister-in-law and brother who lived abroad and, from abroad, sent an embryo fertilised for surrogacy; 4) a woman who resorted to her sister-in-law in order to be a mother by surrogacy, with ovules from the woman herself fertilised with semen from her husband; and 5) the sister-in-law mentioned in 4), who acted as surrogate for her brother and his wife. These interviews made it possible to think about the discursive construction of the legitimacy of such parenthoods, as it is produced by access to, and manipulation and circulation of, reproductive technologies and persons. This biomedical management of bodies sets up a material and discursive circuit that, in turn, produces a complex web of personal, normative, legal, professional and market relationships, particularly with a view to construction of a parenthood anchored in a notion of biologically-constituted origin. In this respect, biological, affective and social bonds merge to produce a precise placement of who is the father and/or who is the mother, as well as who are the important others and how they are linked to the child in a broader web of parenthood. 相似文献
15.
Both conservation biology and macroecology are synthetic, and macroecological research consistently has informed the theory and practice of biological conservation. Explicit integration of the macroecology of human systems and natural systems has been rare, but can advance the incorporation of social justice, environmental justice and environmental equity into conservation biology and participatory conservation (inclusion in decision‐making of those who are affected by, or can affect, that decision). The basis of this strong link is the focus of macroecology on the relations of a given biota to environmental patterns and processes, and these patterns and processes can affect humans differentially. Macroecological integration of social justice and conservation generally requires spatial and temporal representation of all variables at resolutions and extents that allow meaningful analyses. This requirement may facilitate clarity about social metrics and norms. To illustrate, we examine applications of macroecology to analysis of the effects of climate change on social justice and biological conservation; relations among climate, violence among humans and conservation; and the response of the spread of disease to social and ecological factors. We believe that macroecology is a means of providing transparent inferences that can inform conservation, health and social policies. 相似文献
16.
Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs. 相似文献
17.
Gammeltoft T 《Culture, medicine and psychiatry》2002,26(3):313-338
Despite the increasing use ofreproductive technologies the world over,anthropological studies have paid remarkablylimited attention to the ethical dilemmasinvolved in people's choices of suchtechnologies. Against this background, theauthor analyzes moral perceptions of inducedabortion among unmarried young adults in urbanNorth Vietnam. While the ethical aspects ofabortion are shrouded in silence in public lifein Vietnam, the young people participating inthe study expressed strong moral scepticismtowards the practice of abortion, even whileundergoing it themselves. Through the analysisof young people's experiences and perceptions,the paper demonstrates how moral ideas are tiedto particular social situations and structuredby larger socio-political circumstances. It isargued that moral notions which are dominant ina society's public sphere may not berepresentative of the moral sentiments that arelived in practice and felt in private. 相似文献
18.
Sanja Medenica Eliana Garaleji&#x; Dihan Abazovi&#x; Zoran Bukumiri&#x; Stavroula A. Paschou Biljana Arsi&#x; Sneana Vujo&#x;evi&#x; Biljana Me&#x;o Milo&#x;
arkovi&#x; 《Journal of Medical Biochemistry》2023,42(1):27
BackgroundHigher levels of thyroid autoantibodies in follicular fluid (FF) of thyroid autoimmunity (TAI) positive women are strongly correlated with serum levels and may have effect on the post-implantation embryo development. Literature highlights that levothyroxine (LT4) treatment may attenuate the risk of adverse pregnancy outcomes. The aim of the study was to estimate the pregnancy and newborn outcomes in women with FF thyroid autoantibodies undergoing assisted reproductive technology (ART).MethodsThe study population included 24 women with confirmed clinical pregnancy, 8 TAI positive and 16 TAI negative women. LT4 supplementation was applied in 20.8% patients, TAI positive.ResultsPregnancy outcomes were: twin pregnancy rate 41.7%, early miscarriage rate 8.3%, late miscarriage rate 4.2%, preterm birth rate 16.7%, term birth rate 70.8%, live birth rate 96.0%. There was significant difference in serum and in FF TgAbs (p< 0.001)between the groups according to TAI, while serum fT3 was lower in the group with TAI (p = 0.047). Serum P4 was higher in LT4 treated group (p = 0.005), with TAI, and newborns in this group had higher birth weight (p = 0.001) and height (p = 0.008). Maternal complications occurred in 23.8% of patients. No congenital malformations in newborns were noted.ConclusionsThyroid autoantibodies present in FF may have an effect on the post-implantation embryo development, but have no effect on further course of pregnancy. The special benefit of LT4 treatment for successful ART outcome was demonstrated for newborn anthropometric parameters. 相似文献
19.
Molecular insights into the causes of male infertility 总被引：6，自引：0，他引：6
Polani B. Seshagiri 《Journal of biosciences》2001,26(4):429-435
Infertility is a reproductive health problem that affects many couples in the human population. About 13–18% of couple suffers from it and approximately one-half of all cases can be traced to either partner. Regardless of whether it is primary or secondary infertility, affected couples suffer from enormous emotional and psychological trauma and it can constitute a major life crisis in the social context. Many cases of idiopathic infertility have a genetic or molecular basis. The knowledge of the molecular genetics of male infertility is developing rapidly, new “spermatogenic genes” are being discovered and molecular diagnostic approaches (DNA chips) established. This will immensely help diagnostic and therapeutic approaches to alleviate human infertility. The present review provides an overview of the causes of human infertility, particularly the molecular basis of male infertility and its implications for clinical practice. 相似文献
20.
Giraldo AM Lynn JW Godke RA Bondioli KR 《Molecular reproduction and development》2006,73(10):1230-1238
Few studies have characterized donor cell lines in terms of proliferative capacity and chromosomal stability. Abnormal phosphorylation patterns of the histones during metaphase could lead to abnormal chromosome segregation and extensive chromosome loss during mitosis. Suboptimal culture conditions may lead to abnormal histone H3 phosphorylation patterns, ultimately inducing missegregation and loss of chromosomes. The objective of the present study was to determine proliferative characteristics, chromosomal stability, and level of histone phosphorylation in cell lines established by explants and enzymatic dissociation. Proliferative characteristics, percentage of aneuploid cells, and relative levels of phosphorylated histone H3 (ser10) were determined at different population doublings (PD) by cell counting, karyotyping, and flow cytometry, respectively. The level of aneuploidies was high and remained elevated throughout the study independent of the technique used to establish the primary culture. Some cell lines had up to 50% of aneuploid cells during early passages. Multinucleated cells and abnormal spindle configurations were observed after prolonged time in culture (60 and 41%, respectively). An increase in the relative level of phosphorylated histone occurred after extended time in culture (55.7 during early passages vs. 102.6 at late passages). These data demonstrate the importance of determining chromosome content and the selection of healthy cell lines to decrease the percentage of aneuploid reconstructed embryos and increase the efficiency of nuclear transfer (NT). 相似文献