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J C Fletcher

Publications and source records attributed to J C Fletcher.

At least 91 records · Page 5Linked to original sources
PubMed1988

Ethics and medical genetics in the United States: a national survey.

The approaches of 295 medical geneticists in the United States to 14 clinical problems and 3 screening situations that required a moral choice are summarized. These data are part of a survey of 682 geneticists in 19 nations. Of 490 U.S. geneticists asked to participate, 295 (60%) returned anonymous detailed questionnaires. There was strong (greater than 75%) consensus that preserving the mother's confidentiality overrides disclosure of true paternity; that conflicting test results, new/controversial interpretations of results, and ambiguous/artifactual results should be disclosed; that artificial insemination by donor, adoption, taking chances, contraception, sterilization, and in-vitro fertilization with a donor egg should be presented as reproductive options to carriers of disorders not diagnosable prenatally; that prenatal diagnosis should be performed for patients who refuse abortion and for maternal anxiety in the absence of medical indications; that screening in the workplace should be voluntary. There was no consensus about disclosure of a diagnosis of Huntington disease or hemophilia A to relatives at risk, against the patient's wishes, or about disclosure of parental translocations. Geneticists in the U.S. differed from 18 other nations in presenting surrogate motherhood as an option (67%); willingness to perform prenatal diagnosis for sex selection or refer (62%); and disclosure of XY genotype in a female (62%). Men were more likely than women to say that they would give directive counseling. Women were more likely than men to say that they would perform prenatal diagnosis for maternal anxiety or for sex selection.

Confidentiality↗
PubMed1988

Medical genetics.

Explore the source record for details and available documents.

Attitude↗
PubMed1988

Selective first-trimester termination in octuplet and quadruplet pregnancies: clinical and ethical issues.

The induction of grand multiple gestations is a known complication of infertility treatments. The obstetric outcome in such cases has been very poor. We have evaluated, counseled, and performed first-trimester selective terminations for four patients, all treated with human menopausal gonadotropin, one with octuplets and three with quadruplets. In all cases, the gestations were reduced to twins. In two of the four cases, the pregnancy continued to near term without problem and resulted in the delivery of healthy twins. In the third case, pregnancy continued without problems for eight weeks, at which time renal agenesis was identified in one of the twins. In the fourth case, preterm labor five weeks later could not be stopped. Significant ethical issues must be addressed. We argue that selective termination in appropriate circumstances (eg, when the ability to carry the pregnancy to viability is very small) is ethically justified because it meets the criterion of least harm and most potential good.

Abortion, Induced↗
PubMed1988

Attitudes of genetic counselors: a multinational survey.

Of 1,053 medical geneticists in 18 nations 677 (64%) returned questionnaires on their views on the importance of seven goals of genetic counseling, the appropriateness of five directive/nondirective approaches to counseling, and their choices of action in four situations involving directive/nondirective counseling. The majority (92%-94%) regarded nondirective approaches as appropriate; their views on both goals and approaches were similar to those reported in an earlier survey of 205 genetic counselors in the United States. In clinical situations involving presentation of reproductive options to carriers of disorders not diagnosable prenatally, 74%-85% would present contraception, sterilization, taking one's chances, artificial insemination donor (AID), or adoption as options even if not asked; 66% would present in vitro fertilization (IVF) with a donor egg; and 46% (67% in the United States) would present surrogate motherhood. In regard to three situations involving fetuses with low-burden disorders (Turner syndrome, XYY, and a possible small neural tube defect), 84%-88% would counsel nondirectively. Stepwise logistic regression analyses on professional and personal background variables showed that gender was related, cross-nationally, to self-reported directiveness in counseling, with men more likely than women to regard directive approaches as appropriate, more likely to give advice about fetuses with low-burden disorders, and more likely to present either IVF with donor egg or surrogate motherhood as options. Social and ethical implications of this widespread acceptance of nondirective counseling are discussed.

Allied Health Personnel↗
PubMed1987

A comparison of Ektaspeed and Ultraspeed films using manual and automatic processing solutions.

Kodak's Ektaspeed (E) dental film is twice as fast as Ultraspeed (D) film and thereby significantly reduces radiation exposure to the patient. The film quality of the E film and D film was compared following processing with two manual and two automatic processing techniques. E-speed film processed manually or automatically produces diagnostically acceptable radiographs, with film densities within the recommended density limits commonly used in dentistry. High-contrast and low-contrast radiographs can be achieved by varying processing techniques.

Absorptiometry, Photon↗
PubMed1987

Ethical aspects of prenatal diagnosis: views of U.S. medical geneticists.

This article presents data from a study of 295 qualified medical geneticists in the United States. The study's objective was to determine the degree of consensus and variation among practicing medical geneticists about the major ethical problems of prenatal diagnosis. Based on the data presented, the argument has been made that most medical geneticists share a dominant moral approach on three major problems: abortion choices, controversial indications for fetal diagnosis, and problems in disclosure of ambiguous or disputed results. Ethical problems in selective termination in high-risk twin and multiple pregnancies need more study. A preliminary evaluation of the strengths and weaknesses of prevailing standards in prenatal diagnosis was also made. Three weaknesses were noted: neglect of the demands for fairness in access to and distribution of prenatal diagnosis in the United States, unpreparedness for society's growing concerns about developing trends in human genetics, and need for changes in non-directive counseling in order to appreciate the complexities that will accompany the introduction of proven new treatments for genetic disorders.

Attitude of Health Personnel↗
PubMed1987

Reasoning about illness in ill and healthy children and adolescents: cognitive and emotional developmental aspects.

Anxiety level, perception of control over illness, stage of cognitive development, and stage of reasoning about illness were examined in pediatric oncology, obese, and healthy children and adolescents. Among the groups, there were no mean differences with regard to any of these measures. Older participants in the higher stages of cognitive development were higher on stage of reasoning about illness in general and their own illness than were younger and less cognitively mature participants. In the pediatric oncology and obese groups, participants higher on perception of control over illness were higher on stage of reasoning about illness in general and their own illness, in particular, than those lower on perception of control. Anxiety level was not related to stage of reasoning about illness, but participants higher on anxiety were lower on perception of control over illness. Clinical implications of the findings are discussed.

Adolescent↗
PubMed1986

Primates and anencephalics as sources for pediatric organ transplants. Medical, legal, and ethical issues.

This article discusses some of the medical, legal, and ethical issues in using organs from primates and anencephalics to transplant to infants who will otherwise die. The use of primates is discouraging on ethical grounds due to scarcity of chimpanzees, the preferred species, and to the poor chance of survival. Anencephalic fetuses and newborns are promising sources of organs for pediatric transplants, provided that ethical and legal considerations are met. An argument is made, based on current practice in management of dying donors, that complies with the legal requirement to delay organ removal until after whole brain death; however, this approach requires the compensating step of gradual cooling of the body of the newly delivered anencephalic to save the organs from ischemia.

Anencephaly↗
PubMed1985

Pharmacologic suppression of the fetal adrenal gland in utero. Attempted prevention of abnormal external genital masculinization in suspected congenital adrenal hyperplasia.

21-Hydroxylase deficiency results in congenital adrenal hyperplasia and leads to masculinization of the external genitalia of affected females. This complication could be avoided if fetal adrenal gland function were suppressed. A woman with mild 21-hydroxylase deficiency whose previous female child had classic congenital adrenal hyperplasia with masculinization was given dexamethasone beginning at the tenth week of gestation. Maternal estriol and cortisol values indicated rapid and sustained fetal and maternal adrenal gland suppression. At 39 weeks' gestation, the patient was spontaneously delivered of a female neonate with normal external genitalia. Postnatal tests indicated the infant was a single heterozygote for 21-hydroxylase deficiency. This study demonstrates prolonged suppression of the fetal adrenal gland with dexamethasone and suggests it might prevent abnormal masculinization in fetuses with severe congenital adrenal hyperplasia.

Adrenal Cortex↗
PubMed1985

Ethical issues in and beyond prospective clinical trials of human gene therapy.

As the potential for the first human trials of somatic cell gene therapy nears, two ethical issues are examined: problems of moral choice for members of institutional review boards who consider the first protocols, for parents, and for the clinical researchers, and the special protections that may be required for the infants and children to be involved, and ethical objections to somatic cell therapy made by those concerned about a putative inevitable progression of genetic knowledge from therapy to mass genetic engineering in human reproduction. The author's viewpoint is that a consensus exists on the required moral approach to somatic cell therapy, but that no moral approach yet exists for experiments beyond this level, especially in the germline cells of human beings.

Beneficence↗