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PubMed1989

Infertility and bioethical issues of the new reproductive technologies.

The scientific breakthroughs resulting in the delivery of Louise Brown in 1978 have opened the floodgates for an ongoing bioethical discussion about medically assisted reproduction. The majority in our society has accepted in vitro fertilization as an ethically justifiable procedure for infertile couples. The concern persists, however, that new reproductive technology has started us on the course of a slippery slope with potentially dire consequences for the so-created children, the traditional family, and, indeed, for society as a whole. The moral status of the embryo is the central issue in debates about such reproductive developments as the "spare" embryo, embryo freezing, embryo donation, embryo research and micromanipulation. Conflicts of interests between the adult's desire to become a parent and the welfare of the offspring are at the root of moral objections raised against manipulation of human reproduction. Extracorporal conception with the possibility for various gamete donors has also brought the long-practiced procedure of artificial insemination by donor and the potential consequences for the child into the discussion. Surrogate mothering and surrogate gestational mothering force us to redefine the age old dictum mater certa est and can render the child a helpless pawn in parental, emotional, and legal strife. Over the ages, society has through firmly established values exerted control over reproduction and acceptance of the new member in the community. Sex without reproduction was a severe blow to the highly regarded societal belief in parenting as the epitomy of life goals. Reproduction without sex through various technically feasible collaborative means further jolts fundamental traditional values and mandates their re-evaluation. Ethical belief systems are by nature highly charged and fiercely defended. Thus, in a pluralistic society, a consensus on the question "What ought to be done of all that can be done with new reproductive technologies?" is probably unachievable. Heated controversies between interest groups constitute an additional psychological burden complicating the ethical ambiguities for some infertile couples who have to decide about using noncoital conception. The interdisciplinary group report by the ethics committee of the American Fertility Society published in the "Ethical Considerations of the New Reproductive Technologies" constitutes a wide framework of guidelines for rational consideration. It will, one hopes, help to formulate needed regulations because some segments of our society as well as many scientists and physicians in the field believe that not all that potentially can be done ought to be done.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethics, Medical↗
PubMed1979

Bioethical issues in family planning.

Contraception and elective abortion are two of the controversial ethical issues with which social workers must deal. Since policies regarding these issues have recently been established by the courts, the author presents a review of the relevant decisions. The policy questions stemming from a related family planning issue, namely, selective abortion because of genetic defects, are also discussed.

Abortion, Legal↗
PubMed1986

Bioethical issues in perinatology--is the future now?

The rapid progress of the science of perinatology has produced a broad range of capabilities in our approach to the fetus. Advances in diagnostic methodology, both invasive and noninvasive, enable early identification and potentially, early correction, of a multitude of disorders. The laboratory correlates of this progress have kept pace, with possibilities in the areas of fetal surgery and genetic manipulation which seemed fantasy only a few years ago. Important moral issues which had been deferred because of our physical limitations must now be addressed. As instigators of the scientific stampede, perinatologists must assume a major role in the ethical inquiry as well.

Bioethics↗
PubMed2000

Reporting by physicians of impaired drivers and potentially impaired drivers. The Committee on Bioethical Issues of the Medical Society of the State of New York.

Physicians routinely care for patients whose ability to operate a motor vehicle is compromised by a physical or cognitive condition. Physician management of this health information has ethical and legal implications. These concerns have been insufficiently addressed by professional organizations and public agencies. The legal status in the United States and Canada of reporting of impaired drivers is reviewed. The American Medical Association's position is detailed. Finally, the Bioethics Committee of the Medical Society of the State of New York proposes elements for an ethically defensible public response to this problem.

Age Factors↗
PubMed2002

[Bioethical issues in pediatric cochlear implants].

The use of cochlear implants can modify significantly the way in which deaf children relate with the outside world through psychological, linguistic and cognitive changes. The main question about this subject is the ethical controversy with regards to who has the right to make such a decision for a young child. We present the children evaluated at our hospital in order to assess the cochlear implant option. That population was of 37 implanted children, 10 children waiting for surgery and 21 rejected children. We describe and analyze from the bioethical bases and methodology the problems found: decision of no implant in children of hearing parents, the deaf culture point of view, the mature minor doctrine, teenagers, social and cultural problems, multihandicapped children and responsibility of the implants team.

Bioethics↗
PubMed1990

Contemporary bioethical issues in critical care.

The critical care nurse confronts ethical dilemmas in practice on a regular basis. Problems concerning treatment issues, allocation of resources, and collegial disputes are common. Knowledge of available resources can assist the nurse in dealing with these dilemmas.

Adult↗
PubMed1995

HIV+/AIDS related bioethical issues in Japan.

Annual and cumulative incidences of HIV+ and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV+ or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each of the following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV+ and AIDS patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical consideration.

AIDS Serodiagnosis↗
PubMed1979

Bioethical issues and the moral matrix of U.S. health care.

Solutions to ethical-moral issues will be influenced by the growth of medical technology, by the escalating cost of medical care, and by the involvement of public entities in health care delivery. The major areas of concern that will be affected by these factors are care of the dying, genetics, euthanasia, sterilization, behavior control, reproductive interventions, abortion, informed consent, and distributive justice.

Abortion, Legal↗
PubMed2000

Bioethical issues related to continuous renal replacement therapy in intensive care patients.

OBJECTIVE: To examine the ethical approach of intensivists and nephrologists to continuous renal replacement therapy (CRRT). DESIGN: A questionnaire. SETTING: The First International Course on Critical Care Nephrology. PARTICIPANTS: The participants in the course (around 500). RESULTS: Most participants think that establishing ethical criteria for managing CRRT is a medical task, as clinicians have adequate criteria for defining futility. However, many responders would grant the request of starting futile CRRT or would maintain it if requested by the family. Only 55% believe that informed consent is necessary for initiating CRRT; one out of four would start or maintain unwanted life-saving CRRT. In case of lack of equipment, the majority would select the patients, excluding the worst one or on a "first-come, first-served" basis. Withholding and withdrawing are regarded differently by most responders. Again, most think that every vital support should be withdrawn when futile, but practical and psychological aspects still influence the final decision. Responders think that ethics critical care committees can help in the management of ethical problems in ICU. CONCLUSIONS: Our results show that several ethical questions are still unsolved and that practical and psychological aspects of the treatment process can be stronger than bioethical principles.

Attitude of Health Personnel↗
PubMed2002

Attitudes to bioethical issues: a case study of a screening project.

Commonly expressed in theoretical discussions about ethical problems in the context of epidemiology and screening is the need for more data. A study was carried out involving 21 explorative interviews with participant and nonparticipant mothers in a neonatal research screening project in progress in Sweden, ABIS (All Babies in Southeast Sweden). The respondents were asked, by way of open-ended questions, to give their opinions about certain ethical issues: informed consent; reasons for joining/declining; surrogate decision; the collection, analysis and storage of written and "live" material (biobanks); intervention etc. The ethical implications mentioned in the literature mostly concern the risk of creating distress and anxiety (anxiety and possible stigmatisation in respect of positive or false-positive results, worry about material collected and stored, distress caused by blood sampling procedures, etc.). Our results do not support the idea that the risks are substantial. The respondents rather indicate an attitude of benevolence--they are positive both to the current research on children, to the material they contribute (both written material and "biomaterial"), to possible results and intervention plans. On the other hand the participants expressed concern about the storage of material and the right to be informed of any screening/project results. Further studies in this field are needed and would be of help in theoretical discussion, the work of ethical committees and the designing of, for example, screening and research projects.

Anxiety↗
PubMed2000

Disclosure and prevention of medical errors. Committee on Bioethical Issues of the Medical Society of the State of New York.

Medical errors occur and are sometimes unavoidable. Physicians generally, but not always, have ethical and moral obligations to disclose their errors to the patient. Because common medical errors can be expected, physicians are obligated to work within health systems toward reducing systems flaws that promote errors. However, the obligations of physicians to disclose errors made by others are less clear. This article discusses the professional ethics involved in disclosing and preventing medical errors.

Ethics, Medical↗