[The Best Interest of the Child in the Case of Surrogate Maternity]. / El Interés Superior del Menor en los Supuestos de Maternidad Subrogada.

This article claims to analyze the situation of children born by means of surrogate maternity contract since these babies are one of the most vulnerable parts of this agreement, so their rights and interests could be affected in many ways. In order to study that situation, in the first place, has been accomplished a brief analysis of the concept of the best interest of the child. Afterwards it is examined the possible violation of the best interest of the child in the cases that have already been examined by Doctrine and Jurisprudence, that is, first the case of registration of these children in the country of origin Civil Registry of the intentional parents, and, in second place, the case of maternity benefit for intentional mothers. The article concludes with a reflection about other situations in where the best interest of children can be affected , such as their right to know their biological origins or the cases of identity problems.

La protección del embarazo en el Departamento de Salud Valencia La Fe de 2010 a 2013 / Protection of pregnancy in the Department of Health La Fe, Valencia, 2010 to 2013

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The 2013 review of the Children's Health Insurance Program Reauthorization Act: a call to action.

In September 2013, Congress again will review the Children's Health Insurance Program Reauthorization Act of 2009. Fourteen states cover the fetus only (and not the pregnant woman) under the "unborn child" provision of the current law. That the Children's Health Insurance Program Reauthorization Act continues to make it possible for states to provide health insurance coverage to the fetus only has been critiqued for unnecessarily politicizing the law, dragging abortion and personhood debates into the matter of children's health insurance and creating unacceptable tensions between maternal and fetal health. Although the 2009 reauthorization attempted to remedy this issue by also providing coverage for the pregnant mother, it is imperative to review these changes and their effect before the 2013 reauthorization. To ensure optimum health care for both the fetus and the woman, we urge for removal of the "unborn child" pathway and promote coverage of both the fetus and the pregnant woman.

Why postnatal abortion throws the baby out with the bath water.

This paper articulates a careful and detailed objection to the moral permissibility of postnatal abortion. Giubilini and Minerva (2012) claim that if being unable to nurture one's newborn child without significant burdens to oneself, family or society, is a proper moral ground for the demand that the life of a fetus be terminated, then 'after-birth abortion should be considered a permissible option for women who would be damaged by [rearing the child or] giving up their newborns for adoption.' It will be shown that the permissibility of postnatal abortion does not follow from the argument's premises, in particular, the premise that the newborn is not a person in the morally relevant sense.

Ethical concerns for maternal surrogacy and reproductive tourism.

Reproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, eight such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.

Rights to safe motherhood and newborn health: ethical issues.

Worldwide, one woman dies every minute as a result of being pregnant. This statistic highlights the denial of women's rights to safe motherhood in many parts of the world, particularly in low-resource countries where 98% all maternal deaths occur. The majority of pregnant women die because they deliver unattended by a properly trained birth professional. According to the 1948 Universal Declaration of Human Rights, every woman has the right to a standard of living adequate for the health and well-being of herself and her family, including medical care. The principle of moral philosophy supporting women's rights to safe motherhood may be difficult to implement. Philanthropy is diverted by other competing needs, such as HIV prevention and treatment, or provision of urgent food supplies. Equity is denied because women's health is too often set as a low priority. Utilitarianism advocates that safe motherhood is an investment of societal shared interest.

Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach.

We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, women's health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality.

Women's autonomy and scheduled cesarean sections in Brazil: a cautionary tale.

BACKGROUND: In Brazil, one-fourth of all women deliver in the private sector, where the rate of cesarean deliveries is extremely high (70%). Most (64%) private sector cesareans are scheduled, although many women would have preferred a vaginal delivery. The question this study addresses is whether childbearing women were induced to accept the procedure by their physicians, and if so, how? METHODS: Three face-to-face structured interviews were conducted with 1,612 women (519 private sector and 1,093 public sector) early in pregnancy, approximately 1 month before their due date, and approximately 1 month postpartum. For all private sector patients having a scheduled cesarean section, women's self-reported reasons given for programming surgical delivery were classified into three groups according to obstetrical justification. RESULTS: After loss to follow-up (19.2% of private sector and 34.4% of public sector), our final sample included 1,136 women (419 private sector and 717 public sector). Compared with public sector participants in the final sample, on average, private sector participants were older by 3.4 years (28.7 vs 25.3 yr), had 0.4 fewer previous deliveries (0.6 vs 1.0), and had 3.4 more years of education (11.0 vs 7.6 yr). The final samples also differed slightly with respect to preference for vaginal delivery: 72.3 percent among those in the private sector and 79.6 percent in public sector. The cesarean section rate was 72 percent in the private sector and 31 percent in the public sector. Of the women with reports about the timing of the cesarean decision, 64.4 percent had a scheduled cesarean delivery in the private sector compared with 23.7 percent in the public sector. Many cesarean sections were scheduled for an "unjustified" medical reason, especially among women who, during pregnancy, had declared a preference for a vaginal delivery. Among 96 women in this latter group, the reason reported for the procedure was unjustified in 33 cases. On the other hand, more cesarean deliveries were scheduled for "no medical justification," including physician's or the woman's convenience, among women who preferred to deliver by cesarean (35/65). The incidence of real medical reasons for a scheduled cesarean section diagnosed before the onset of labor among private sector patients who had no previous cesarean birth and who wanted a vaginal delivery was 13 percent (31/243). CONCLUSIONS: The data suggest that doctors frequently persuaded their patients to accept a scheduled cesarean section for conditions that either did not exist or did not justify this procedure. The problem identified in this paper may extend well beyond Brazil and should be of concern to those with responsibility for ethical behavior in obstetrics.

Relational ethics: when mothers suffer from psychosis.

OBJECTIVE: The goal of this review is to aid clinicians with ethical issues arising in the treatment of women who suffer from psychosis. METHOD: This paper is a synthesis of the recent literature in adult and child psychiatry, ethics, law, and child welfare pertaining to the topic of maternal psychosis. Topics include: family planning, the care of pregnant women with schizophrenia, postpartum psychosis, child custody, involuntary treatment, confidentiality issues, and service fragmentation. CONCLUSION: Appreciation of the particularized circumstances of issues arising in the treatment of mothers who suffer from psychosis serve the clinician better than the dispassionate application of a principle-driven ethic.

Maternal brain death: medical, ethical and legal issues.

CASE PRESENTATION: We present the case of a pregnant woman who experienced a cerebral venous sinus thrombosis resulting in brain death at 13 weeks gestation. We discuss the management of the mother and foetus following this tragic event. We also discuss the complex medical, legal and ethical issues that arose following maternal brain death. The central question is whether continuing maternal organ supportive measures in an attempt to prolong gestation to attain foetal viability is appropriate, or whether it constitutes futile care. DISCUSSION: Successful maintenance of maternal brain somatic function to facilitate foetal maturation in utero has been reported. While the gestational age of the foetus is central to resolving this issue, there is no clear upper physiological limit to the prolongation of somatic function following brain death. Furthermore, medical experience regarding prolonged somatic support is limited. Finally, the legal rights conferred on the foetus may vary significantly depending on the jurisdiction in which the maternal brain death occurs and may have important implications. CONCLUSIONS: A consensus building approach, involving the family, is essential to resolving these potentially conflicting issues.

Is in-vitro fertilization for older women ethical? A personal perspective.

Fertility treatments raise a range of social and ethical issues regarding self-identity for family, sexual intimacy, and the interests and welfare of potential children. Eggs and sperm are combined to produce fertilized eggs. These eggs are then implanted as embryos and grow into viable fetuses, which are carried by the original mother or a surrogate mother. This artificial form of conception can challenge religious values and family structures. In-vitro fertilization (IVF) can be considered either as a medical miracle or playing with divinity. What obligation do medical professionals have to infertile women and to what extent? The bioethical dilemma of IVF use encompasses different moral issues for all involved in the process. Ethical issues address respect for personal autonomy, access and care, and the duty of the health care provider to be compassionate to persons whose actions and moral values may be different from their own. Health care providers need to impart empathy, understanding and sensitivity towards this unique type of patient population. The conflict for those treating patients who are trying to conceive by IVF includes respect for personal autonomy, nonmaleficence, justice, utility and the ethics of care. As a registered nurse in a postpartum hospital unit, I have seen antepartum and postpartum women involved with this new technology. I have worked with mothers and their partners as they experience different levels of anxiety and hope for the future. There is an underlying psychosocial connection with patients who undergo IVF treatments. The purpose of this article is to explore the ethical use of IVF on older women. Is this type of biotechnolgy being applied for the right reasons and for the best patient population?