What should the management of incest pregnancies be? An ethical view presented via three cases.

Incest is a taboo and a neglected social problem. Especially in the adolescent population, which is a very sensitive period of development, it becomes harder for the patients to share their secret with either legal or health authorities. Sometimes pregnancy becomes the only vehicle to uncover this secret. There is a contradiction whether their pregnancies should continue or not. Some authors believe abortion is the best choice for the victim to pull herself together, whereas others advocate that it is just another trauma that will not solve the problem but merely hide it. In this report, three paternal incest cases and their pregnancies will be presented. The aim is not only to discuss the different points of view regarding the management of these pregnancies but also to make the clinicians think about the different choices before making a decision.

The case for re-thinking incest laws.

The recent case of German siblings Patrick Stübing (age 30 years) and his sister Susan Karolewski (age 22 years) has reignited debate over the criminalisation of sexual intercourse among consanguine descendants. The primary justification for criminalising incest is the purported increased risk of genetic disabilities among offspring, but is criminalising sexual intercourse an empirically sound and proportionate response to this increased risk? To answer this question we must consider the specifics of the harm in question (eg, is it a harm to the child or a societal harm) and the magnitude of the harms of the intervention. The example of incest law has important implications for liberal societies. If we can justify imprisoning consenting adults for choosing partners who will increase the risk of having children with disabilities, then we set a troubling precedent for all couples who may pass on genetic disorders to their children.

Réflexions sur les fondements éthiques de l'acte clinique / Reflections on the ethical bases for the clinical act

Dans le domaine de la prise en charge psychothérapeutique la réflexion éthique est aujourd’hui reléguée à un second plan par le discours de l’efficacité et de l’évaluation. Or cette réflexion reste essentielle même si on peut considérer qu’elle a parfois été réduite à une rhétorique. Partant de la description d’un suivi psychothérapeutique référé à la psychanalyse, les auteurs proposent une démarche de recherche susceptible de mettre en évidence de manière rigoureuse la dimension éthique des actes cliniques. Dans une situation d’inceste la catégorie éthique de l’intime apparaît comme une valeur fondant l’ensemble de l’attitude du clinicien, ce qui interroge la validité d’une approche strictement évaluatrice et qui donc ne prendrait pas en compte cette dimension de l’acte clinique.

No domínio do tratamento psicoterápico a reflexão ética é hoje relegada a um segundo plano pelo discurso da eficácia e da avaliação. Esta reflexão ainda é essencial mesmo quando é possível considerar que por vezes foi reduzida a uma retórica. Partindo da descrição de um acompanhamento psicoterápico com base psicanalítica, os autores propõem um procedimento de pesquisa capaz de evidenciar de modo rigoroso a dimensão ética dos atos clínicos. Em uma situação de incesto, a categoria ética do íntimo aparece como um valor básico do conjunto da atitude do clínico, o que questiona a validade de uma abordagem estritamente avaliativa e que, apesar de tudo, não consideraria esta dimensão do ato clínico.

In the domain of psychotherapeutic treatment, any discussion of ethics today is given less importance than the discourse of effectiveness and evaluation. But a discussion of ethics is necessary when one realizes that it has at times been reduced to mere rhetoric. Based on the description of a psychoanalytically-based psychotherapeutic process, the author proposes a research procedure that is able to clearly highlight the ethical dimension of clinical acts. In a situation of incest, the category of the ethics of the intimate appears as a basic value in the overall attitude in clinical work. This questions the validity od a strictly evaluative approach which, in spite of everything, might fail to consider this dimension of the clinical act.

Familiarity breeds: incest and the Ptolemaic Dynasty.

This paper examines the problem of Ptolemaic incest from a variety of cross-disciplinary perspectives. Specifically, it seeks to establish the following: that there is little in the ancient record to support the common claim that the Ptolemies suffered extensively from the deleterious genetic effects of inbreeding; that the various theories so far put forward as explanations for Ptolemaic incest offer at best only a partial rationale for this dynastic practice; that the most compelling rationale for Ptolemaic incest is to be found in complex, and perhaps unconscious, symbolic motivations analogous to those observed by anthropologists in other cultures; and finally, that, for the Ptolemies, incest was, like the "truphê" for which they were so notorious, a dynastic signature which highlighted their singularity and above all, their power.

Incest, gamete donation by siblings and the importance of the genetic link.

Recently, several requests have emerged in which women wished to be impregnated with donor eggs fertilized with spermatozoa of their brother. An important argument advanced against such applications is that it is a kind of incest. Four definitions of incest are reviewed in this article to evaluate the acceptability of these demands. The first three (sexual intercourse, reproduction with gametes of first-degree relatives and symbolic incest) do not apply to the cases. However, when the sister and her brother intend to raise the child as social mother and father, these requests should be considered as "intentional incest". If the brother only functions as an uncle, the request of the woman resembles the currently accepted practice of oocyte donation from sister to sister. In that case, the wish to receive gametes from a first-degree relative is motivated by the wish to establish as far as possible a genetic link with the child.