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J C Fletcher

Publications and source records attributed to J C Fletcher.

At least 73 records · Page 4Linked to original sources
PubMed1992

Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues.

Following the diagnosis of a genetic anomaly, some couples choose to have a legal abortion. However, following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management. To avoid this situation, we have added fetal intracardiac potassium chloride injection to cause fetal cardiac arrest before induction of labor. The ethical issues surrounding such a practice are complex. We support this practice for three reasons: 1) The women's decision for abortion is protected because this practice assures her right for non-interference; 2) potential psychological harm to the patient and other family members is avoided; and 3) the potential for coercive intervention by other health care personnel is eliminated. At least three objections can be raised: 1) All abortions are unjust; 2) newborns and second-trimester fetuses at similar weights with identical defects should be managed in like fashion; and 3) the patient is not entitled to death of the fetus, only to evacuation of the uterine contents. On balance, we believe that our approach is justifiable ethically as it reduces the burden of conflict between the wishes of the patient and those of the neonatal care givers. It should be introduced only in situations in which the likelihood of civil or criminal liability or unwarranted medical intervention is high.

Abortion, Eugenic↗
PubMed1991

Attitudes on the ethics of abortion, sex selection, and selective pregnancy termination among health care professionals, ethicists, and clergy likely to encounter such situations.

The ethical attitudes of health care providers toward abortion, sex selection, and selective termination of normal and anomalous fetuses in singleton or multiple pregnancies were evaluated by questionnaires distributed to members of the American Society of Human Genetics, the International Fetal Medicine and Surgery Society, the Society of Perinatal Obstetricians, ethicists, and clergy. Demographic characteristics of respondents exhibited a preponderance of men (76%), age greater than 40 (68%), and of United States residents (82%). Seventy-nine percent of respondents were in the medical profession. Approximately half of the respondents were Protestant, the rest being evenly distributed among Catholic, Jewish, and other religions. Acceptance of abortion for social indication varied by religion and gestational age but not by religious conviction, age, country, or gender of respondent. First-trimester abortion of a normal singleton pregnancy was considered more acceptable than selective termination of normal fetuses in multifetal gestations. Sex selection was considered unethical by most respondents. Selective termination was deemed ethically appropriate in quadruplets or multifetal gestations of more than five fetuses and in multiple pregnancies bearing one anomalous fetus. In the latter situation, acceptance increased with the severity of fetal anomalies and decreased from the first to the third trimester. The medical specialty of respondents was the only independent factor strongly associated with acceptance of selective termination by trimester, indication, and number of fetuses. Acceptance of selective termination among health care professionals appears to reflect not only perceptions of procedure-related risks and benefits in the index pregnancy but also individual training and religious beliefs.

Abortion, Induced↗
PubMed1990

Selective termination: clinical experience and residual risks.

Assisted reproductive technologies have aided thousands of couples, but complications have resulted in multifetal pregnancies creating a bitter irony for infertility patients. In an effort to increase the rate of intact survival, we have successfully performed transabdominal first-trimester selective termination procedures on 22 pregnancies including one octuplet, five quintuplet, twelve quadruplet, and four triplet gestations. There have been eight sets of twins, and two singletons delivered, seven twin pregnancies are ongoing, and one early and four late losses of pregnancies. With experience we now counsel as to a high likelihood of a technically successful procedure, but we still have concerns for late losses. We have tried to balance the arguments about the direct harms of performing selective termination and the obstetric risks of not performing selective termination. We believe that selective termination should not be considered a "social" procedure. Our data do not yet make clear whether one, two, or three is the optimal number of embryos to leave. Therefore, on the basis of both current obstetric risk factors and ethical reasoning we will continue to support our protocol of optimally leaving twins.

Abortion, Induced↗
PubMed1990

Evolution of ethical debate about human gene therapy.

Ethical issues generally evolve through four stages: threshold, open conflict, extended debate, and adaptation. The history of the ethical debate on human gene therapy is examined. The threshold was the Nirenberg appeal in 1967. The open conflict centered around two early controversial cases: those of Rogers and Cline. The extended debate has lasted from 1980 to the present, but now adaptation, i.e., a public policy, for somatic cell gene therapy is emerging.

Ethical Analysis↗
PubMed1990

Controversies in research ethics affecting the future of human gene therapy.

A critical analysis is undertaken of the ethical debate on two general classes of research activities that bear on the future of human gene therapy: (i) the human fetus and (ii) the preimplantation human embryo after in vitro fertilization (IVF). The conclusion is that the hope of human gene therapy and of other clinical applications of the human genome initiative is in danger because of the obstacles to research in reproductive biology and human genetics in the federal sector.

Aborted Fetus↗
PubMed1990

Fetal tissue transplantation research and federal policy: a growing wall of separation.

The federal moratorium on fetal tissue transplantation research is creating an ever growing wall of separation between public and private research. This federal policy is based on undocumented psychological assumptions about what motivates women to have abortions, neglects to consider the suffering that could be prevented by allowing such research, disregards the fact that other forms of fetal research are performed at federal expense, infringes on the scientific freedom of federally employed scientists and compromises the federal government's ability to control the quality of research. Efforts must be made to legally dismantle this wall before it further impedes the goals of medical research.

Aborted Fetus↗
PubMed1990

Medical geneticists confront ethical dilemmas: cross-cultural comparisons among 18 nations.

To provide a basis for international discussion of ethical problems, we studied responses of medical geneticists in 18 countries to questionnaires about 14 clinical cases and five screening situations. Of 1,053 asked to participate, 677 (64%) responded. There was greater than or equal to 75% consensus on five cases involving (1) disclosure of (1) conflicting diagnostic findings, (2) disclosure of ambiguous results, (3) disclosure of controversial interpretations, (4) protection of mother's confidentiality in cases of false paternity, and (5) nondirective counseling about 45,X and XYY syndrome. A majority (51%-60%) would disclose the diagnosis to relatives at risk for Huntington disease or hemophilia A, against the patient's wishes; would disclose which parent carries a translocation causing Down syndrome; and would disclose XY genotype in a female. As reproductive options for patients with disorders not diagnosable prenatally, 84% would discuss artificial insemination by a donor, 66% would discuss in vitro fertilization with donor egg, and 46% would discuss surrogate motherhood. In all, 85% would perform prenatal diagnosis for (or would refer) parents who refuse abortion, 75% for maternal anxiety, and 42% for selection of fetal sex. Screening questions showed that 72% believed that workplace screening should be voluntary and that results should be confidential.

Confidentiality↗
PubMed1989

Ethical problems in prenatal diagnosis: a cross-cultural survey of medical geneticists in 18 nations.

In order to provide a basis for international discussion of ethics among geneticists, we surveyed the responses of medical geneticists to a questionnaire describing 14 hypothetical cases that posed ethical dilemmas. The cases were selected through discussions with leading geneticists in 12 nations, as representative of the most difficult problems of moral choice experienced in practice. Six cases involved indications for prenatal diagnosis or disclosure of information. All medical geneticists in each of 18 nations were included. Of 1053 asked to participate, 677 (64 per cent) responded. A large majority (83 per cent) would perform prenatal diagnosis for parents who oppose abortion but request the service. A smaller majority (63 per cent) would do so for maternal anxiety, and a minority (25 per cent) would perform for sex selection in the absence of X-linked disease. Most would disclose conflicting controversial, or ambiguous test results, and two-thirds would disclose colleagues' differences of opinion.

Beneficence↗
PubMed1989

Moral reasoning among medical geneticists in eighteen nations.

We surveyed the approaches of 661 geneticists in 18 nations to 14 clinical cases and asked them to give their ethical reasons for choosing these approaches. Patient autonomy was the dominant value in clinical decision-making, with 59% of responses, followed by non-maleficence (20%), beneficence (11%) and justice (5%). In all, 39% described the consequences of their actions, 26% mentioned conflicts of interest between different parties and 72% placed patient welfare above the welfare of others. The U.S., Canada, Sweden, and U.K. led in responses favoring autonomy. There were substantial international differences in moral reasoning. Gender differences in responses reflected women's greater attention to relationships and supported feminist ethical theories.

Asia↗
PubMed1989

Decisions to forego life-sustaining treatment.

Decisions not to start or to stop life-sustaining technologies raise the most frequent ethical problems in clinical and long-term care settings in the United States. At the University of Virginia Hospitals, 66% of the requests for ethics consultation concern decisions to forego treatment. The decision is especially hard in cases when death is the only alternative to starting or stopping treatment that is costly in pain and suffering as well as resources. The author presents five maxims, fitting five common dilemmas, to help guide the physician in making such decisions.

Disclosure↗