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1.
Am J Law Med ; 45(2-3): 130-170, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722626

RESUMO

In many areas of innovation, the United States is a leader, but this characterization does not apply to the United States' position in assisted reproductive technology innovation and clinical use. This article uses a political science concept, the idea of the "democratic deficit" to examine the lack of American public discourse on innovations in ART. In doing so, the article focuses on America's missing public consultation in health care innovation. This missing discourse is significant, as political and ethical considerations may impact regulatory decisions. Thus, to the extent that these considerations are influencing the decisions of federal agency employees, namely those who work within the U.S. Food and Drug Administration, the public is unable to participate in the decision-making process. This lack of a public discourse undermines the goals of the administrative state, which include democratic participation, transparency, and accountability. The United Kingdom, on the other hand, has had a markedly divergent experience with assisted reproductive technology innovation. Instead of ignoring the various ethical, social, and legal issues surrounding assisted reproductive technology innovation, the United Kingdom engaged in a five-strand public consultation on the topic of mitochondrial transfer, a form of assisted reproductive technology that uses genetic modification in order to prevent disease transmission. This article argues that after a multi-decade standstill in terms of the public discourse related to ethical issues associated with assisted reproductive technology and germline modification, it is time for the United States to institute a more democratic inquiry into the scientific, ethical, and social implications of new forms of assisted reproductive technology and ultimately, forthcoming medical innovations that involve genetic modification.


Assuntos
Democracia , Invenções/legislação & jurisprudência , Formulação de Políticas , Técnicas de Reprodução Assistida/legislação & jurisprudência , Participação da Comunidade , Governo Federal , Fertilização In Vitro/ética , Fertilização In Vitro/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Humanos , Invenções/ética , Técnicas de Reprodução Assistida/ética , Responsabilidade Social , Participação dos Interessados , Governo Estadual , Inquéritos e Questionários , Reino Unido , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência
2.
Health Care Anal ; 27(2): 61-76, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30848407

RESUMO

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation (IVF). One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable.


Assuntos
Fertilização In Vitro/ética , Política de Saúde , Infertilidade/terapia , Obesidade , Medicina Baseada em Evidências , Feminino , Fertilização In Vitro/métodos , Humanos
3.
Fertil Steril ; 111(4): 664-670, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30871766

RESUMO

This Ethics Committee report outlines the interests, obligations, and rights of all parties involved in gamete and embryo donation: both males and females who choose to provide gametes or embryos for use by others, recipients of donated gametes and embryos, individuals born as a result of gamete or embryo donation, and the programs that provide donated gametes and embryos to patients. This document replaces the document "Interests, obligations, and rights of the donor in gamete donation," last published in 2014.


Assuntos
Destinação do Embrião/ética , Células Germinativas , Obrigações Morais , Direitos Sexuais e Reprodutivos/ética , Doadores de Tecidos/ética , Conflito de Interesses , Comissão de Ética , Prova Pericial , Feminino , Fertilização In Vitro/ética , Humanos , Masculino , Doação de Oócitos/ética , Gravidez , Sêmen
7.
J Assist Reprod Genet ; 36(3): 383-393, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30554395

RESUMO

The purpose of the paper is to explore novel means to overcome the controversial ban in the USA against mitochondrial replacement therapy, a form of IVF, with the added step of replacing a woman's diseased mutated mitochondria with a donor's healthy mitochondria to prevent debilitating and often fatal mitochondrial diseases. Long proven effective in non-human species, MRT recently performed in Mexico resulted in the birth of a healthy baby boy. We explore the ethics of the ban, the concerns over hereditability of mitochondrial disease and its mathematical basis, the overlooked role of Mitochondrial Eve, the financial burden of mitochondrial diseases for taxpayers, and a woman's reproductive rights. We examine applicable court cases, particularly protection of autonomy within the reproductive rights assured by Roe v Wade. We examine the consequences of misinterpreting MRT as genetic engineering in the congressional funding prohibitions causing the MRT ban by the FDA. Allowing MRT to take place in the USA would ensure a high standard of reproductive medicine and safety for afflicted women wishing to have genetically related children, concurrently alleviating the significant financial burden of mitochondrial diseases on its taxpayers. Since MRT does not modify any genome, it falls outside the "heritable genetic modification" terminology of concern to Congress and the FDA. Correcting this terminology, the IOM's conclusion that MRT is ethical, the continuing normalcy of the first MRT recipient, and increasing public awareness of the promising benefits might be all that is required to modify the FDA's position on MRT.


Assuntos
Fertilização In Vitro , Doenças Mitocondriais/terapia , Terapia de Substituição Mitocondrial , Fertilização In Vitro/ética , Fertilização In Vitro/legislação & jurisprudência , Fertilização In Vitro/tendências , Edição de Genes/legislação & jurisprudência , Humanos , Mitocôndrias/genética , Doenças Mitocondriais/genética , Terapia de Substituição Mitocondrial/ética , Terapia de Substituição Mitocondrial/legislação & jurisprudência , Terapia de Substituição Mitocondrial/tendências , Estados Unidos
8.
Afr J Reprod Health ; 22(3): 51-58, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30381932

RESUMO

The need to formulate practice guidelines and ethical framework to guide the practice of assisted conception in Nigeria has been highlighted severally. The Association for Fertility and Reproductive Health (AFRH) ethics committee is charged with the objective of producing ethical guidelines that would govern the practice of assisted conception in Nigeria. This study was a survey of attendees at the AFRH international conference that held in Abuja in September 2017. The aim of the study was to generate empirical data that would form the drafting of ethical practice guidelines in Nigeria. Ninety-seven (50%) of the respondents were of the view that performing IVF for unmarried couples was ethical while about 70 (36%) were of the contrary opinion. Respondents were equally divided (45.26% versus 44.21%) on the ethical standing of performing IVF for single ladies. About 128 (70.33%) of respondents agree that egg donors should be paid more in compensation besides reimbursement for personal expenditure incurred during the process of egg donation and that they should be an upper age limit for clients requesting ART with donor eggs. Several unethical practices ongoing in Nigeria were highlighted including inadequate provision of information and counselling and exploitation of egg donors. Majority agreed on the need for a regulatory framework to govern the practice of ART in Nigeria. The diverse range of views and ethical issues concerning ART practice in Nigeria obtained from this study demonstrates the need to recognise the local context in Nigeria when applying universal principles of ethics.


Assuntos
Fertilização In Vitro/ética , Infertilidade Feminina/terapia , Doação de Oócitos/ética , Guias de Prática Clínica como Assunto , Serviços de Saúde Reprodutiva/ética , Técnicas de Reprodução Assistida/ética , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Inquéritos e Questionários
9.
Medicina (Kaunas) ; 54(5)2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30366459

RESUMO

Oocyte freezing for 'social reasons' refers to women of reproductive age who are aiming to prolong, protect and secure their fertility. The term emerged to describe application of the highly promising technique, namely vitrification on oocytes retrieved through controlled ovarian stimulation (COS) from women intending to preserve their fertility for social reasons. These women opt to cryopreserve their oocytes at a point in their life when they need to postpone childbearing on the grounds of so called 'social' reasons. These reasons may include a highly driven career, absence of an adequate partner, financial instability, or personal reasons that make them feel unprepared for motherhood. This is a sensitive and multifaceted issue that entails medical, bioethical and socio-psychological components. The latest trend and the apparent increase noted on oocyte freezing for 'social reasons' has prompted our team of fertility specialists, embryologists, obstetricians, gynecologists and psychologists to proceed with a thorough, critical and all-inclusive comprehensive analysis. The wide range of findings of this analysis involve concerns of embryology and epigenetics that shape decisions made in the IVF laboratory, issues regarding obstetric and perinatal concerns on the pregnancy concluding from these oocytes and the respective delivery management and neonatal data, to the social and bioethical impact of this trend's application. This literature review refers to matters rising from the moment the 'idea' of this option is 'birthed' in a woman's thoughts, to proceeding and executing it clinically, up until the point of the pediatric follow up of the children born. We aim to shed light to the controversial issue of oocyte freezing, while objectively exhibit all aspects regarding this complex matter, as well as to respectfully approach how could the prospect of our future expectations be shaped from the impact of its application.


Assuntos
Criopreservação/ética , Fertilidade/ética , Fertilidade/fisiologia , Oócitos , Comportamento Reprodutivo/ética , Comportamento Reprodutivo/fisiologia , Vitrificação , Temas Bioéticos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/ética , Humanos , Idade Materna , Gravidez , Complicações na Gravidez , Comportamento Reprodutivo/psicologia , Fenômenos Reprodutivos Fisiológicos , Mães Substitutas
10.
Hastings Cent Rep ; 48(5): 3-4, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30311198

RESUMO

If you blinked you may have missed it. The Department of Health and Human Services published its strategic plan for the 2018-2022 fiscal years, which includes the statement that HHS accomplishes its mission through programs and initiatives that serve and protect "Americans at every stage of life, from conception." Of note, the "from conception" language is new and, depending on the direction President Trump's administration plans to go, could have profound implications for the regulation of reproductive services ranging from abortion to in vitro fertilization (IVF).


Assuntos
Aborto Legal , Fertilização In Vitro , Vida , Reprodução , Aborto Legal/ética , Aborto Legal/legislação & jurisprudência , Fertilização In Vitro/ética , Fertilização In Vitro/legislação & jurisprudência , Regulamentação Governamental , Humanos , Estados Unidos , United States Dept. of Health and Human Services , Direitos da Mulher
11.
J Bioeth Inq ; 15(3): 441-457, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29968019

RESUMO

Bioethical debates on the use of human embryos and oocytes for stem cell research have often been criticized for the lack of empirical insights into the perceptions and experiences of the women and couples who are asked to donate these tissues in the IVF clinic. Empirical studies that have investigated the attitudes of IVF patients and citizens on the (potential) donation of their embryos and oocytes have been scarce and have focused predominantly on the situation in Europe and Australia. This article examines the viewpoints on the donation of embryos for stem cell research among IVF patients and students in China. Research into the perceptions of patients is based on in-depth interviews with IVF patients and IVF clinicians. Research into the attitudes of students is based on a quantitative survey study (n=427). The empirical findings in this paper indicate that perceptions of the donation of human embryos for stem cell research in China are far more diverse and complex than has commonly been suggested. Claims that ethical concerns regarding the donation and use of embryos and oocytes for stem cell research are typical for Western societies but absent in China cannot be upheld. The article shows that research into the situated perceptions and cultural specificities of human tissue donation can play a crucial role in the deconstruction of politicized bioethical argumentation and the (often ill-informed) assumptions about "others" that underlie socio-ethical debates on the moral dilemmas of technology developments in the life sciences.


Assuntos
Atitude , Pesquisas com Embriões/ética , Fertilização In Vitro/ética , Pesquisa com Células-Tronco/ética , Estudantes , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , China , Cultura , Embrião de Mamíferos , Feminino , Fertilização In Vitro/métodos , Humanos , Masculino , Princípios Morais , Oócitos , Inquéritos e Questionários
12.
Monash Bioeth Rev ; 35(1-4): 24-35, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29804244

RESUMO

For most of human history children have been a byproduct of sex rather than a conscious choice by parents to create people with traits that they care about. As our understanding of genetics advances along with our ability to control reproduction and manipulate genes, prospective parents have stronger moral reasons to consider how their choices are likely to affect their children, and how their children are likely to affect other people. With the advent of cheap and effective contraception, and the emergence of new technologies for in vitro fertilization, embryo selection, and genetic engineering, it is becoming increasingly difficult to justify rolling the genetic dice by having children without thinking about the traits they will have. It is time to face up to the awesome responsibilities that accompany our reproductive choices.


Assuntos
Pesquisas com Embriões/ética , Eugenia (Ciência) , Engenharia Genética/ética , Comportamento Reprodutivo/ética , Feminino , Fertilização In Vitro/ética , Humanos , Pais/psicologia , Diagnóstico Pré-Implantação/ética , Diagnóstico Pré-Natal/ética
13.
Fertil Steril ; 109(4): 601-605, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29605404

RESUMO

This document discusses the ethical implications of informing offspring about their conception using gamete or embryo donation. It replaces the 2013 ASRM Ethics Committee document of the same name (Fertil Steril 2013;100:45-9).


Assuntos
Crianças Adultas , Destinação do Embrião/ética , Comissão de Ética/ética , Fertilização In Vitro/ética , Doação de Oócitos/ética , Direitos do Paciente/ética , Doadores de Tecidos/ética , Revelação da Verdade/ética , Acesso à Informação/ética , Humanos , Informações Pessoalmente Identificáveis/ética
14.
BMJ Case Rep ; 20182018 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-29437809

RESUMO

We discuss the case of a 50-year-old nulliparous woman who conceived after in vitro fertilisation. She had multiple medical comorbidities and presented an obstetric and medical challenge. She was carefully managed through pregnancy and had a successful outcome. In this report, we explore the medical complexity, as well as ethical and logistic issues involved.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Fertilização In Vitro , Gravidez em Diabéticas/terapia , Gravidez de Alto Risco , Cuidado Pré-Natal/métodos , Cesárea , Comorbidade , Feminino , Fertilização In Vitro/ética , Humanos , Recém-Nascido , Masculino , Idade Materna , Turismo Médico/ética , Pessoa de Meia-Idade , Obstetrícia/ética , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez , Ultrassonografia Pré-Natal
15.
J Genet Couns ; 27(4): 909-919, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29248993

RESUMO

Providers and patients are considering and pursuing PGD for ever-more conditions, but questions arise concerning how they make, view and experience these decisions, and what challenges they may face. Thirty-seven in-depth semi-structured interviews were conducted (with 27 IVF providers and 10 patients). Patients and providers struggled with challenges and dilemmas about whether to pursue PGD in specific cases, and how to decide. Respondents varied in how they viewed, experienced and made these choices, and for which conditions to pursue PGD (from lethal, childhood-onset conditions to milder, treatable, or adult-onset disorders). Several factors were involved, including differences in gene penetrance, predictability, and phenotypic expression, and disease severity, age of onset, treatability, stigma and degree of disability. Providers and patients face questions regarding possibilities of screening for more than one condition in one set of embryos, and limitations of PGD (e.g., inaccurate results). Characteristics of providers (e.g., amount of PGD experience, understandings of genetics, and use of genetic counselors), and of patients (e.g., related to broader moral and social attitudes) can also affect these decisions. These data, the first to examine several key questions concerning PGD, suggest that providers and patients confront several dilemmas. These findings have critical implications for future practice, guidelines, education and research.


Assuntos
Atitude do Pessoal de Saúde , Relações Médico-Paciente , Diagnóstico Pré-Implantação/ética , Diagnóstico Pré-Implantação/psicologia , Adulto , Criança , Confidencialidade , Tomada de Decisões , Feminino , Fertilização In Vitro/ética , Fertilização In Vitro/psicologia , Humanos , Masculino , Médicos/psicologia
16.
Minerva Endocrinol ; 43(1): 80-86, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28490169

RESUMO

Human reproduction has always generated more than its share of emotion that exceeds the life and death issues of medicine. For patients that are unable to conceive naturally, medical advances have greatly expanded treatment options. Assisted reproductive technology (ART) is a highly evolving, complex, and controversial field of medicine in which ethical principles play a large role in decision-making. The following highlights ethical considerations regarding ART, specifically in vitro fertilization (IVF), that practicing obstetricians and indeed all physicians may encounter. The aim was to encourage practitioners to consider these issues, and more, when developing guidelines for their own practice.


Assuntos
Técnicas de Reprodução Assistida/ética , Adulto , Feminino , Fertilização In Vitro/ética , Testes Genéticos , Humanos , Masculino , Gravidez
17.
J Med Ethics ; 44(12): 817-822, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29070706

RESUMO

Children created through mitochondrial replacement techniques (MRTs) are commonly presented as possessing 50% of their mother's nuclear DNA, 50% of their father's nuclear DNA and the mitochondrial DNA of an egg donor. This lab-engineered genetic composition has prompted two questions: Do children who are the product of an MRT procedure have three genetic parents? And, do MRT egg donors have parental responsibilities for the children created? In this paper, I address the second question and in doing so I also address the first one. First, I present a brief account of mitochondrial diseases and MRTs. Second, I examine how MRTs affect the numerical identity of eggs and zygotes. Third, I investigate two genetic accounts of parenthood and MRT egg donation. Fourth, I explore three causal accounts of parenthood and MRT egg donation. My conclusion is that, under the appropriate circumstances, MRT egg donors are parentally responsible for the children created under genetic accounts of parenthood and under causal accounts of parenthood.


Assuntos
Consentimento Livre e Esclarecido/ética , Doenças Mitocondriais/genética , Terapia de Substituição Mitocondrial/ética , Doadores de Tecidos/ética , Adulto , Temas Bioéticos , Criança , Feminino , Fertilização In Vitro/ética , Humanos , Doenças Mitocondriais/terapia , Pais , Pessoalidade , Gravidez , Técnicas de Reprodução Assistida , Responsabilidade Social
18.
Narrat Inq Bioeth ; 7(2): 151-156, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29056646

RESUMO

The authors of these stories describe tales of struggle with cancer and secondary infertility. Yet, they each have a different response to similar circumstances. Their stories touch on a lack of informed consent regarding infertility, spiritual discussions of the problem of evil, the need for improved collaboration among physicians to further care of the whole person, societal norms regarding reproduction and gender roles, the injustice of cancer in young people, and other topics. Of note, no stories mention prominent ethical concerns of in-vitro fertilization like how couples should deal with "extra" frozen embryos or concerns about the potential for commodification of children. This shows a disconnect between the concerns of bioethicists and the concerns of real patients facing actual problems. Both cancer patients and providers can learn something from these stories that directly apply to their lives.


Assuntos
Temas Bioéticos , Fertilidade/ética , Infertilidade , Narração , Neoplasias/complicações , Criança , Mercantilização , Criopreservação , Eticistas , Feminino , Fertilização In Vitro/ética , Humanos , Consentimento Livre e Esclarecido , Masculino , Princípios Morais , Normas Sociais , Espiritualidade
19.
Kennedy Inst Ethics J ; 27(3): 443-473, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28989168

RESUMO

In this paper I employ the case of "reciprocal IVF" (R-IVF)-in which a female-female couple uses in vitro fertilization to allow one woman to be the genetic mother and the other the gestational mother of their child(ren)-to illuminate the role sexual identity might productively play in bioethics. Bioethicists who have taken up this issue have largely focused on the moral permissibility and availability of the technology, and so defend R-IVF through analogy to commonly accepted different-sex uses of IVF. In this way, they position sexual identity as largely irrelevant to the primary bioethical questions raised by R-IVF. My approach diverges on these counts as I focus on the ethics of R-IVF through the lens of queer family values specifically. I ask what the practice of R-IVF as an option might mean for the queer community at large, and so view sexual identity as integral to a full bioethical evaluation of the practice.


Assuntos
Bioética , Fertilização In Vitro/ética , Minorias Sexuais e de Gênero , Feminino , Humanos , Princípios Morais
20.
Qual Health Res ; 27(10): 1529-1540, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28728530

RESUMO

Although in vitro fertilization (IVF) has offered hope to those struggling with infertility, it has also had some unintended consequences, including the fate of embryos that may be "surplus" to requirement following IVF treatment. The number of embryos in storage across the world is high, creating a dilemma for patients who need to make disposal decisions, as well as presenting an administrative and practical dilemma for clinics. Research has suggested that patients' views of the status of their embryo/s may affect their disposal decisions, and yet the nature of the links between views of the embryo and decisions to either donate or discard remain unclear. In this article, we engage in a discursive analysis of literature on disposal decisions. We discuss the range of ways in which embryos may be constructed, and demonstrate how these discourses make available or constrain particular action possibilities, and offer particular subject positions for patients. The analysis highlights the complexity of the relationship between embryo status and decision making, and may assist clinicians in supporting and guiding patients' decisions.


Assuntos
Destinação do Embrião/ética , Destinação do Embrião/normas , Fertilização In Vitro/ética , Fertilização In Vitro/normas , Adulto , Tomada de Decisões , Feminino , Humanos , Masculino
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