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Biomedical subjects

M B Mahowald

Publications and source records attributed to M B Mahowald.

At least 19 recordsLinked to original sources
PubMed2001

Maternal-fetal surgery: the fallacy of abstraction and the problem of equipoise.

When surgery is performed on pregnant women for the sake of the fetus (MFS or maternal fetal surgery). it is often discussed in terms of the fetus alone. This usage exemplifies what philosophers call the fallacy of abstraction: considering a concept as if it were separable from another concept whose meaning is essentially related to it. In light of their potential separability, research on pregnant women raises the possibility of conflicts between the interests of the woman and those of the fetus. Such research should meet the requirement of equipoise. i.e., a state of genuine uncertainty about the risks and benefits of alternative interventions or noninterventions. While illustrating the fallacy of abstraction in discussions of MFS, we review the rationale for explicit acknowledgment of the essential tie between fetus and pregnant woman. Next we examine whether it is possible to meet the requirement of equipoise in research on MFS, focusing on a fetal condition called myelomeningocele. We show how issues related to equipoise in nonpregnant populations appear also in debates regarding MFS. We also examine evidence in support of claims that the requirement of equipoise has been satisfied with respect to "the fetal patient" while considering risks and benefits to gestating women only marginally or not at all. After delineating challenges and possibilities for equipoise in MFS research, we conclude with a suggestion for avoiding the fallacy of abstraction and achieving equipoise so that research on MFS may be ethically conducted.

Empirical Research↗
PubMed1999

Honoring gender-based patient requests for obstetricians: ethical imperative or employment discrimination?

Patient requests for a female or male obstetrician are fairly common and are routinely respected when a physician of the desired gender (usually female) is available. We examine whether compliance with such gender-based requests is legal, based on accepted standards for employment discrimination and five reported cases of gender-based employment policies in nursing. (There are no reported cases of such policies with regard to physicians.) Legally, we argue, compliance with such requests is permissible but not obligatory. We then consider whether compliance with such requests is ethical, based on considerations of justice as fairness, distinguishing between individual justice claims and social justice claims. We conclude that hospitals and physicians should honor those gender-based patient requests that are based on the individual patient's history or psyche, but they should not honor those that are based on gender generalizations.

Adult↗
PubMed1998

Genetic counseling: clinical and ethical challenges.

After explaining the origin, nature, and goals of genetic counseling, we consider the impact of the Human Genome Project on its practice. In light of the availability of presymptomatic tests for late-onset disorders and the possibility of preventive behavior or treatment, we examine the apparent conflict between nondirectiveness and directiveness in genetic counseling. We discuss views of genetic counselors, medical geneticists, and counselees on specific issues, and document gender differences in attitudes toward genetic ties to offspring. Because genetic discrimination and unequal access to genetic services are likely to increase with advances in genetics, we conclude that efforts of genetic counselors to adhere to the principle of justice or equity in their practice cannot be successful without governmental and public support, as well as support from researchers and colleagues in health care.

Ethics, Medical↗
PubMed1997

Genes or gestation? Attitudes of women and men about biologic ties to children.

In light of the different reproductive roles of men and women, our objective was to ascertain whether men and women attach different significance to genetic, as distinct from gestational, ties to offspring. Surveys returned by 106 men and women of reproductive age in the general clinic waiting area of the University of Chicago Health Service showed that 71.1% of women and 62.9% of men would seek medical assistance if necessary to have a biologically related child. When women were asked whether they would choose the genetic tie or the gestational tie if both were not possible, 48.6% chose the genetic tie, and 51.4% chose the gestational tie. When men were asked which relationship they preferred for their partner, 73.5% chose the genetic tie, and 26.5% chose the gestational tie. Neither marital status nor experience of child-birth (for oneself or one's partner) were predictive of preferences. Our data suggest that gender differences as well as individual differences need to be addressed in counseling individuals and couples.

Adult↗
PubMed1996

Neural fetal tissue transplants: old and new issues.

Neural fetal tissue transplantation offers promise as a treatment for devastating neurologic conditions such as Parkinson's disease. Two types of issues arise from this procedure: those associated with the use of fetuses, and those associated with the use of neural tissue. The former issues have been examined in many forums; the latter have not. This paper reviews issues and arguments raised by the use of fetal tissue in general, but focuses on the implications of the use of neural tissue for basic concepts of personhood and personal identity.

Aborted Fetus↗
PubMed1996

The new genetics and women.

The U.S. Human Genome Project (HGP) is a federally funded effort to produce a detailed genetic and physical map of all human chromosomes. Because of their central role in reproduction and caregiving, women are likely to be affected differently, and more significantly, by the information the HGP generates. It is important to identify inequities that may emerge from gender differences and to consider ways in which they may be avoided, reduced, or overcome. Although this type of analysis is one of the goals of the Ethical, Legal, and Social Issues Program of the National Center for Human Genome Research, few studies have focused explicitly on the impact of the HGP on women. This article describes the potential impact of the "new genetics" on women. Identification of gender differences as they affect both research and clinical practice and the psychosocial, legal, and ethical implications of the HGP should evoke and inform public discussion and policies that may be generated by these issues.

Caregivers↗
PubMed1994

So many ways to think. An overview of approaches to ethical issues in geriatrics.

This article provides an overview of ways to think about ethical issues in geriatrics. Principle-based approaches include deontology, utilitarianism, virtue theory, and natural law. Case-based approaches include casuistry, care, and narrative ethics. Pragmatism and feminism are methods that mesh case-based with principle-based considerations. Each of these approaches is explained and critiqued in relation to specific cases in geriatrics. The author concludes that clinical ethical decisions are optimized by considering, but not necessarily following, all of the available approaches to ethical dilemmas.

Aged↗
PubMed1992

To be or not be a woman: anorexia nervosa, normative gender roles, and feminism.

This paper reviews the characteristics of anorexia nervosa described in the DSM-III-R, relates them to normative gender roles and adolescent development, and critiques those roles on feminist grounds. Two apparently contradictory explanations for the irrational pursuit of thinness are considered: a) the anorexic thus attempts to conform to a socially defined feminine ideal; b) the anorexic thus attempts to avoid the appearance and consequences of mature womanhood. I propose that both explanations are applicable, together emplifying the ambiguity that Simone de Beauvoir considers characteristic of female experience. Because both explanations suggest a gender identity disorder, I question the fact that the DSM-III-R fails to indicate this linkage. I argue further that therapeutic considerations require efforts to alter the socialization factors that are implicative in anorexia nervosa.

Anorexia Nervosa↗