Currents in contemporary bioethics: waiving informed consent to prenatal screening and diagnosis? Problems with paradoxical negotiation in surrogacy contracts

Recently, an agonizing twist intersecting predictive genetic tests and surrogacy contracts made news headlines in Canada. The intended parents, a couple from British Columbia, instructed the surrogate mother with whom they were working to undergo First Trimester Screening and Chorionic Villi Sampling (CVS), which revealed the fetus likely had Down syndrome. The parents directed the surrogate to terminate the fetus or they would abdicate their parental claim upon birth. This story raised numerous legal and ethical questions relating to the transferability of decision making for prenatal screening, diagnostic tests, and the connected decision of termination when additional interested parties – the intended parents – are involved in the medical decision-making relationship. First, although the surrogate is the patient, what are the implications when the intended parents' wishes influence or even dictate the relationship between her and her obstetrician and genetic counselor? Second, if the intended parents' level of authority reaches explicit demands, may the intended parents ethically and legally require the surrogate to waive her right to informed consent for prenatal screening and diagnosis?

Post-abortion syndrome: creating an affliction

The contention that abortion harms women constitutes a new strategy employed by the pro-life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post-abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of trauma are only selectively investigated. We argue that there is no such thing as post-abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites.

Parental consent for abortion and the judicial bypass option in Arkansas: effects and correlates

CONTEXT

In 2005, Arkansas changed its parental notification requirement for minors seeking an abortion to a parental consent law, under which a minor can obtain an abortion without consent after obtaining a judicial waiver.

METHODS

Using state health department data on 7,463 abortions among 15-19-year-olds over the period 2001-2007, an analysis of abortion and second-trimester abortion rates among Arkansas minors relative to rates among older teenagers evaluated the influence of the 2005 change in the law. Linear and logistic regression analyses estimated the changes in rates among different age-groups, and assessed the likelihood of minors' using the bypass procedure or having a second-trimester abortion.

RESULTS

No association was found between the change in the law and either the abortion rate or the second-trimester abortion rate among minors in the state. Ten percent of all abortions among minors were obtained through the judicial bypass procedure, and minors aged 15 or younger who had an abortion were less likely than those aged 17 to get a waiver (odds ratio, 0.2). Minors who used the bypass option were less likely than those who obtained parental consent to have a second-trimester abortion (0.5), and they terminated the pregnancy 1.1 weeks earlier, on average, than did minors who had gotten such consent.

CONCLUSIONS

States that convert a parental notification statute to a parental consent statute are unlikely to experience a decrease in abortions among minors.

[Conscientious objection of health personnel in the recent Organic Law 2/2010, about sexual and reproductive health and voluntary interruption of pregnancy]

The main goal of the paper is to analyse and evaluate the recent Organic Law 2/2010, and its prescriptions referring to the conscientious objection of health personnel in relation to the voluntary interruption of pregnancy. The paper starts studying conscientious objection: its raison d'être, its delimitation, its recognition by the Spanish regulation. Further on, the paper focuses on the article 19.2° of the Organic Law 2/2010, underlining on the one hand the positive aspects (such as the formal requirements for the objection), and on the other hand the negative ones (such as suspicion over objectors).

Legal protection of informed consent of minors

One of the pillars of healthcare provision is respect for the autonomy of the patient's wishes, which is given substance by the process of obtaining informed consent. Minors deserve special protection, entitled to basic rights and increasingly autonomous as they develop. In certain situations, minors are deemed matures and able to consent to treatment without the involvement of a parent or guardian. The assessment of competence would be based on the child's functional ability, not on age or outcome of the decision. This manuscript includes a brief analysis of legal perspectives on informed consent of minors, and minors' capacities to make medical decisions. Remaining questions of how to evaluate capacity and balance parental and minor autonomy are explored. Considerations on informed consent in different situations as refusing treatment and termination of pregnancy by female children are analyzed.

[Scientific evidence on the legalization of abortion in Mexico City]

BACKGROUND

On April 24 2007, abortion before 12 weeks became legal in Mexico City. The arguments for this decision were: diminish the maternal morbidity and mortality, avoid a "severe health problem" and accomplish the women's physical, mental and social well being.

OBJECTIVE

To analyze the scientific evidences that support or reject this arguments.

MATERIAL AND METHOD

Retrospective study realized by bibliographic search of electronic data basis and Internet portals of interested groups.

RESULTS

Mexico is considered by the World Health Organization, one of the countries in the world with low maternal mortality rates (<100/100,000 live births). The main causes are: preeclampsia-eclampsia, pregnancy related hemorrhage, complications of pregnancy, delivery and puerperium, and other causes (92.2 to 93.1%). In 2007, the Health Services of Mexico City reported 11 deaths (0.03% of the total maternal deaths) associated with "non-spontaneous abortion". In the hospitals of the Mexican Institute of Social Security, maternal deaths as consequence of induced abortions were, approximately, three every year. The evidences used as arguments in favor of abortion come from studies performed in Sub-Saharan African countries, which do not apply to Mexico.

DISCUSSION

The scientific evidences show that induced abortion has important psychological sequels in women, a higher frequency of illegal drug abuse, alcoholism, child abuse, low birth weight in the following pregnancy, greater risk of subsequent miscarriage and greater mortality rate.

CONCLUSIONS

There are no scientific evidences to support the arguments used for the legal approval of abortion in Mexico City.

Do men have rights in abortion? The Greek view

AIM

We have examined from a legal perspective the father's role in the decision to abort a pregnancy in western society. Furthermore, we have taken a closer look into the inadequacies the Greek legal framework on this issue, from a legal and social point of view.

METHODS

Literature in the Greek and English language.

RESULTS

One of abortion's many victims is the father of the child. In most European countries and the United States of America, the law does not give any rights to the father on the issue of an abortion. Quite simply, men have no legal rights when it comes to abortion. Legally, an abortion is a private matter between a woman and her doctor, even if she is married. Greece was one of the last countries in Europe to legalize abortion after a long debate in Parliament and the publication of numerous declarations by women's rights organizations. However, despite the liberalization of abortion, which followed the ratification of L 1609/86, the legal framework in which abortions are carried out is not entirely satisfactory. One of the areas that require clarification is the role of father. L 1609/86 does not specify men's rights in abortion. Post-abortion counseling services are dealing with an increasing number of men coming forward, grieving their aborted children.

CONCLUSION

A more careful approach is required and a possible review of the law on abortion may be useful. Counselling for women and their male partners should be offered by state organisations. Clarity of thinking, sympathy and understanding are prerequisites in order for a solution respecting the personality of both the woman and her male partner to be reached.

Limits of state intervention in sex-selective abortion: the case of China

Sex-selective abortion is the major direct cause of the severe imbalance in the sex ratio at birth - contributing to the phenomenon of over 100 million 'missing' females worldwide and 40 million in China alone. Internationally as well as in China, moral condemnation and legal prohibition constitute the mainstream and official position on sex-selective abortion. This paper characterises the dominant Chinese approach to the issue as state-centred and coercion-oriented. Drawing upon case study material, the paper discusses eight major problems arising from coercive state intervention in sex-selective abortion: neglect of reproductive liberty and reproductive rights; the hidden dangers of state power; inconsistency with existing abortion policies; practical ineffectiveness; underestimating the costs and resistance involved; simplifying and misrepresenting the key issues; the lack of sufficient public discussion; and ignoring the moral and political principles established by traditional Chinese thought. To avoid a solution that is worse than the problem itself, alternative social programmes that are focused on women, community-oriented and voluntary in nature need to be developed.

Politics, religion and gender equality in contemporary Mexico: women's sexuality and reproductive rights in a contested secular state

This article explores the complexities of the interaction between politics, religion and gender equality in contemporary Mexico, by analysing recent developments in public debate, legal changes and implementation of government policies in two areas: 1) the inclusion of emergency contraception in public health services in 2004; and 2) the decriminalisation of abortion in Mexico City in 2008, which was followed by a massive campaign to re-criminalise abortion in the federal states. Three main findings emerge from our analysis: first, that women's sexual and reproductive autonomy has become an issue of intense public debate that is being addressed by both state-public policy and society; second, that the gradual democratisation of the Mexican political system and society is forcing the Catholic Church to play by the rules of democracy; and third, that the character and nature of the Mexican (secular) state has become an arena of intense struggle within which traditional political boundaries and ideologies are being reconfigured.

Chimeras, moral status, and public policy: implications of the abortion debate for public policy on human/nonhuman chimera research

Researchers are increasingly interested in creating chimeras by transplanting human embryonic stem cells (hESCs) into animals early in development. One concern is that such research could confer upon an animal the moral status of a normal human adult but then impermissibly fail to accord it the protections it merits in virtue of its enhanced moral status. Understanding the public policy implications of this ethical conclusion, though, is complicated by the fact that claims about moral status cannot play an unfettered role in public policy. Arguments like those employed in the abortion debate for the conclusion that abortion should be legally permissible even if abortion is not morally permissible also support, to a more limited degree, a liberal policy on hESC research involving the creation of chimeras.

Female feticide in India

Women are murdered all over the world. But in India a most brutal form of killing females takes place regularly, even before they have the opportunity to be born. Female feticide--the selective abortion of female fetuses--is killing upwards of one million females in India annually with far-ranging and tragic consequences. In some areas, the sex ratio of females to males has dropped to less than 8000:1000. Females not only face inequality in this culture, they are even denied the right to be born. Why do so many families selectively abort baby daughters? In a word: economics. Aborting female fetuses is both practical and socially acceptable in India. Female feticide is driven by many factors, but primarily by the prospect of having to pay a dowry to the future bridegroom of a daughter. While sons offer security to their families in old age and can perform the rites for the souls of deceased parents and ancestors, daughters are perceived as a social and economic burden. Prenatal sex detection technologies have been misused, allowing the selective abortions of female offspring to proliferate. Legally, however, female feticide is a penal offence. Although female infanticide has long been committed in India, feticide is a relatively new practice, emerging concurrently with the advent of technological advancements in prenatal sex determination on a large scale in the 1990s. While abortion is legal in India, it is a crime to abort a pregnancy solely because the fetus is female. Strict laws and penalties are in place for violators. These laws, however, have not stemmed the tide of this abhorrent practice. This article will discuss the socio-legal conundrum female feticide presents, as well as the consequences of having too few women in Indian society.

Between the town and the mountain: abortion and the politics of life in Edith Wharton's "Summer"

In the early twentieth century, American laws focused on women's reproductive capacities and were coalescing into the ethical and moral frameworks that subtend American reproductive politics today. Edith Wharton published her 1917 novel, Summer, at a time when anti-abortion sentiment was widespread in American culture. Through a reading of Summer, the article provides a theoretical and historical framework for understanding this new American obsession with the judicial regulation of women's reproductive options. In particular, I situate the novel's presentation of abortion within the tension between the carefully defined laws of North Dormer, the town in which the majority of the story takes place, and the lawlessness of the Mountain, a place that looms throughout the story as the protagonist's birthplace and a location of utmost abjection. The novel's profound insight is that power does not function unilaterally and individually but through and on the population. Furthermore, Wharton leaps ahead by recognizing that life is not simply that which lives but that which is recognized and embraced by the law. This realization, one that Wharton must have come to terms with through her painful work with World War I refugees, shapes Charity's character and her understanding not only of how reproduction is regulated but also of how living within this regulation and control generates the norm and offers the only possibility for a liveable and legible life.