Tag: gestational age

Bioethics Blogs

What We Do When We Resuscitate Extremely Preterm Infants

by Jeremy R. Garrett, Brian S. Carter & John D. Lantos

This editorial is made available on bioethics.net. The editorial along with the target article and open peer commentary is available via tandfonline.com

Neonatal intensive care is one of the most successful medical innovations of the last half century. Every year, in the United States alone, nearly 500,000 babies are born prematurely. Before neonatal intensive care, most of those babies died, and those who survived often suffered significant life-limiting impairments. Today, most preemies survive without impairments.

In spite of this success, neonatal intensive care unit (NICU) care has always been viewed as ethically problematic. The objections to this care have taken different forms at different times.

Economists questioned whether neonatal intensive care was cost-effective. Careful studies showed that it was more cost-effective than any other form of intensive care, and even more cost-effective than many modalities of preventive care (including, for example, Pap smears).

Some parents claimed that doctors were not honestly informing them of the potential long-term sequelae of NICU care, and that, if honestly informed, many parents would choose palliative care. Careful studies showed that these parents were unusual. Most parents want more intensive care than even doctors and nurses think is appropriate, and they want it even when informed that survivors might be left with significant disabilities.

Bioethicists and doctors argued that neonatologists were playing God, that premature babies were not full-fledged persons, and that saving disabled babies was like an ill-conceived military mission. Each of these attempts to undermine the commitment made by parents, doctors, and society to saving preemies has been met with hard questions and strong rebuttals.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Preeclampsia: Study Highlights Need for More Effective Treatment, Prevention

Thinkstock

It’s well known that preeclampsia, a condition characterized by a progressive rise in a pregnant woman’s blood pressure and appearance of protein in the urine, can have negative, even life-threatening impacts on the health of both mother and baby. Now, NIH-funded researchers have documented that preeclampsia is also taking a very high toll on our nation’s economic well-being. In fact, their calculations show that, in 2012 alone, preeclampsia-related care cost the U.S. health care system more than $2 billion.

These findings are especially noteworthy because preeclampsia rates in the United States have been steadily rising over the past 30 years, fueled in part by increases in average maternal age and weight. This highlights the urgent need for more research to develop new and more effective strategies to protect the health of all mothers and their babies.

The causes of preeclampsia remain somewhat mysterious, though recent data suggest a role for proteins produced by the placenta. Because preeclampsia affects a pregnant woman’s vascular system, her unborn child can be deprived of needed oxygen and nutrients. In mild cases, the condition can often be managed with careful monitoring and blood pressure medications. But if the symptoms become severe and potentially life-threatening to either mother or child, the only answer is to induce early delivery, which carries its own health risks and high health care costs.

In the study reported in the American Journal of Obstetrics & Gynecology, a team led by Anupam Jena at Harvard Medical School, Boston, set out for the first time to quantify those costs up to a year after delivery.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Very Early Embryo & Its Moral Signifiance

by Andrew J. Prunty

As technology and biological research continue to develop in the twenty-first century, it is necessary to address and further define the ethical considerations of embryonic research and the appropriate rights that may limit the extent of human research on zygotes, blastocysts, and fetal scientific advancement. Because the area of harvesting embryonic stem cells remains significantly undefined, both legally and morally, there are vastly different opinions between researchers and bioethicists, mainly because of ethical limitations, on the rights that should be granted to cells with the potential to develop into human beings and the consequences of neglecting significant scientific research or advancement.

Current laws in the United States differ at the federal and state level, but there is no consistency in recognizing human embryos as humans, or affording them the same legal rights granted to a child; in fact, legal precedent actually detracts certain rights from developing embryos, favoring a human’s ability to destroy a potential human being (i.e. Roe v. Wade[i]) or the categorization of embryos as property (i.e. Davis v. Davis[ii], A.Z. v. B.Z.[iii], Marriage of Dahl[iv], or Reber v. Reiss[v]). These case law samples suggest the courts’ inability to reach a conclusion as to what is the status of an embryo.

The debate is not only circumscribed to matters of research, but to fundamental controversial and intertwined issues of bioethics such as: when life begins, embryonic stem cells, fetal rights, abortion, et cetera. All these topics are contentious and when one topic arises, they begin to comingle.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Contraception and Reproductive Ethics: Constitutional Right vs. Right for the Country

Sophia Yin won the Reproductive Ethics category for our 2016 Bioethics Essay contest.  Our panel of judges thought Sophia’s essay presented a rigorous and clarifying analysis of a contentious and ongoing debate about reproductive rights.  We are pleased to publish Sophia’s essay, below. — The Editors

by Sophia Yin

Though the male condom seems almost ubiquitous in current American society, female contraceptive methods constantly seem to be the subject of controversy. While debates in the twentieth century centered on the legalization of contraception, the discussion now is over who should be required to pay for contraception. This question of funding may seem less pressing than the question of legality, however, ability to pay is directly tied to access: women who cannot afford contraception cannot freely use it. Though many supporters frame their case in terms of an infringement of women’s rights, this argument is inherently weak. Women should have open access to contraception regardless of whether they have the right to it. The issue of women’s access to contraception is most often viewed through a legal lens, but it should be discussed in terms of its benefits to public health.

Supporters of access to contraception argue that women have a right to contraception. This argument is based upon the rulings of Griswold v. Connecticut, in which the Supreme Court ruled that states cannot outlaw the use of contraception by married couples because of “the zone of privacy created by several fundamental constitutional guarantees.” Though the ruling did not directly state that women had a right to contraception, it did create a right to privacy in reproductive matters for married couples, which allowed them the freedom to decide, without state interference, whether they would like to use contraception.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Everyday violence, mobility and access to antenatal care by Nicole Ferreira

I met Libby on a cold winter morning at the clinic. She was a short woman with a strong voice and slow walk. Libby was 35 years old and taken by surprise at being pregnant again. She had one child, a son who was already 17 and whose presence filled the two hour conversation as Libby returned to stories of him. I walked with her to my car to get my flask of tea for us to share. I got the flask and we decided to stay outside to talk in the fresh air despite my concern for the quality of the audio recording. We sipped tea while she described how she had prepared to come to the clinic for her appointment on August 6th 2015. The sun only rose after 7:30 that winter day. She had left her house at 5:30am to get to the clinic, and had walked nearly two kilometres from her home in Lavender Hill (an area notorious in Cape Town for gang violence) to Retreat MOU in the dark. It took about twenty minutes.

The time I woke up it was half past four so I told myself ‘just another few minutes’ and then the alarm went off quarter to five, put on the kettle, wash my face, wash my private parts, finish breakfast cornflakes on the stoep[1], see what people is walking around, brush my hair, brush my teeth, then I came here twenty past five, half past went out of the house and came here… When I looked up it was quarter to six… my sister actually asked if she can walk me, and I said no it’s fine, I will just pray.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Are Babies Born via ART More Likely to Have Birth Defects?

June 21, 2016

(Medscape) – The authors studied the frequency of birth defects among liveborn infants in three states over a 10-year period and evaluated the impact of ART use. Various linked databases were used for data collection. The prevalence of chromosomal (chromosomes 13, 18, and 21) and nonchromosomal birth defects of specific organ systems were compared. Maternal age, race, education, parity, history of diabetes, hypertension, smoking status, plurality of pregnancy, infant sex, birth weight, and gestational age at delivery were adjusted for during the analysis. Subgroup analysis was carried out for types of ART procedures.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals, August 2015 by Aaron Seaman

In addition to special issues highlighted earlier this month on Somatosphere — Limn (on “Ebola’s Ecologies“), the Annals of Anthropological Practice (on “Community Health Workers and Social Change: Global and Local Perspectives“), and Social Theory & Health (entitled “Theorising Health Inequalities” — the month provided, as always, a bevy of good reading, including a special section of Social Studies of Science on the ontological turn (see below). Enjoy!

American Ethnologist

Biomedicine, the whiteness of sleep, and the wages of spatiotemporal normativity in the United States
Matthew Wolf-Meyer

The racialization of individuals in the contemporary United States is increasingly accomplished through institutional actors, including scientists and physicians. As genetic health risks, chronic disease treatments, and pharmaceuticals come to define Americans’ understanding of themselves, a fundamental shift is occurring in the way medicine is practiced and its role in the production of subjectivity. Underlying these changes is an expectation of orderly bodies—of “white” bodies that exemplify social and cultural norms of biology and behavior. Fundamental to U.S. medical ideas of normativity is that the white heteronormative subject is the standard against which disorderly and nonwhite subjects are to be judged. I explore these ideas through the history and contemporary world of sleep: the clinical production and interpretation of related scientific data, advertising use of images of sleep-disordered patients who have been “cured,” and experiences of nonwhite Americans within mainstream sleep medicine.

The doctor’s political body: Doctor–patient interactions and sociopolitical belonging in Venezuelan state clinics
Amy Cooper

Patients of Venezuelan state clinics ascribe meanings to doctor–patient interactions that reverberate beyond the immediacy of the clinical encounter to shape political subjectivities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Sale of Fetal Tissue

TUESDAYS WITH ROSEMARY AND MYRA

Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post.

The Sale of Fetal Tissue

M:  Rosemary, you know all the hub-bub about the video of the executive from Planned Parenthood being caught on tape talking about the sale of fetal tissue to two people posing as employees of a company looking to procure fetal tissue for research purposes. It’s been all over the Internet…

R:  I do know about it. It’s gone viral!

M:  It certainly has, and it has provided fodder for those hoping to be nominated by one of the parties for the 2016 presidential election. The video has been proven to be an example of “hit and run” journalism, but that doesn’t negate the ethical question that underpins it, i.e., “Is it acceptable to sell fetal tissue?” And that’s what I want to talk about.

R:  And I want to ask is there any difference in fetal tissue and other human tissue, all of which gets “sold.”

M:  THAT’S THE QUESTION!

R:  Of course, there is something special about fetal tissue, but does that mean that it can’t be used for research. It’s not the same kind of tissue that comes off your elbow…

M:  Why not?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Considering best care for extremely premature babies

A couple of weeks ago I was invited to attend a lecture given by Dr. Mark Mercurio of Yale University on making ethical decisions regarding the treatment of neonatal babies. Dr. Mercurio’s talk focused on the topic of aggressive treatment of extremely premature infants (22 – 25 week gestational age). Although I have devoted much of my time to researching beginning of life issues (predominantly issues focusing on the baby in-utero and the mother), I have only recently started focusing my attention more on ethical issues regarding neonatal topics. Dr. Mercurio’s presentation was extremely thoughtful and brought up some interesting and practical points for consideration; I thought I would share three that stood out to me with all of you this week.

1. Whether treatment is impermissible, permissible, or obligatory should be determined by two factors: prognosis and feasibility.

I appreciated this point because it recognizes that treatment needs to be both appropriate and actually possible. It is important to remember that the baby is the patient, and what is done in the form of treatment should be just that: treatment. Experimentation should not be presented as treatment if it is not known to actually provide treatment to the patient. While there is a time and place for developing experimental treatments, this must be presented as experimental and monitored closely to avoid any unethical conduct, any illegal conduct, or any harm to the patient.

2. Gestational age should not be the only factor used to decide whether or not to treat a premature infant.

Although gestational age seems like a decisive line to use to determine treatment, it is not the best indicator of how a baby will respond.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Abortion Wars: Arizona Mandates Unscientific “Truths”

by Craig Klugman, Ph.D.

The Arizona legislature has apparently gone through medical school and graduated. They have passed a new law of the land. A person in Arizona is no longer permitted to buy health insurance on the health exchange if the plan provides coverage for abortion (except for the cases of rape, incest, or when the mother’s life is in danger).

A second provision of the law is what has troubled most people. The law now requires that a physician tell his or her patient that a medically induced abortion can be reversed. When having a medicated abortion, a woman takes mifepristone (RU-486) and several days later, a dose of misprostol. The new law requires women be told that the abortion can be reversed if she has a shot of progesterone after the first pill.

A 2012 study in the Annals of Pharmacotherapy by George Delgado claimed the he reversed abortions in 4 out of 6 women who received progesterone. He also claims that this technique is not commonly known. The article is presented as “a series of cases” rather than as a research study. The article also neglects to mention that if the first drug is taken but not the second, abortion occurs only 40 percent of the time. In Arizona, Dr. Allan Sawyer is a Glendale, AZ OB-GYN who testified that he reversed an abortion using this procedure, once. The reason that this technique is not commonly known, is because there is no technique.

This is not the first time doctors have been forced to lie in the name of stopping abortions.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.