1
|
Jackson C, Snyder J, Crooks VA, Lavergne MR. Exploring isolation, self-directed care and extensive follow-up: factors heightening the health and safety risks of bariatric surgery abroad among Canadian medical tourists. Int J Qual Stud Health Well-being 2019; 14:1613874. [PMID: 31084487 PMCID: PMC6522967 DOI: 10.1080/17482631.2019.1613874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: This article explores first-hand accounts of Canadian bariatric patients’ experiences of seeking and obtaining weight loss surgery abroad through the practice of medical tourism. While researchers have identified many of the challenges and associated health and safety risks imposed on patients by engaging in medical tourism generally, little is known about the specific challenges experienced by Canadians seeking bariatric surgery abroad.Method: To better understand these challenges, we conducted thematic analysis on interviews conducted with 20 former Canadian bariatric tourists.Results: Our analysis illuminated three key challenges Canadians face in obtaining bariatric care: (1) stigma and isolation from friends, family and medical professionals; (2) self-directed navigation of domestic and destination health care systems; and (3) challenges with obtaining adequate follow-up care in Canada.Conclusions: While these challenges identified by participants may occur in other forms of medical tourism, it appears that these challenges are occurring simultaneously in cases of bariatric tourism by Canadians. These challenges appear to work in conjunction to heighten the health and safety risks potential Canadian bariatric tourists may be exposed to. Unless structural changes occur to increase domestic availability of bariatric surgery, Canadians are likely to continue seeking this care abroad.
Collapse
Affiliation(s)
- Carly Jackson
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Jeremy Snyder
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Valorie A Crooks
- b Department of Geography , Simon Fraser University , Burnaby , British Columbia , Canada
| | - M Ruth Lavergne
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| |
Collapse
|
2
|
Kool EM, Bos AME, van der Graaf R, Fauser BCJM, Bredenoord AL. Ethics of oocyte banking for third-party assisted reproduction: a systematic review. Hum Reprod Update 2018; 24:615-635. [DOI: 10.1093/humupd/dmy016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- E M Kool
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
| |
Collapse
|
3
|
Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites. Fertil Steril 2017; 108:183-191. [PMID: 28579417 DOI: 10.1016/j.fertnstert.2017.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess geographical distribution and practice characteristics of fertility clinics inclusive of lesbian, gay, bisexual, and transgender (LGBT) patients. DESIGN Cross-sectional analysis. SETTING Not applicable. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Prevalence and geographical distribution of fertility clinic websites with LGBT-specific content, indicated by keywords and home page cues specific to the LGBT patient population. Assessment of relationship between LGBT-specific content and clinic characteristics, including U.S. region, clinic size, private versus academic setting, and state-mandated fertility insurance coverage. RESULT(S) Of 379 websites analyzed, 201 (53%) contained LGBT content. Clinics with the highest proportion of LGBT website content were in the Northeast (59/82, 72%) and West (63/96, 66%), while the lowest proportion was in the Midwest (29/74, 39%) and South (50/127, 39%). Most frequently used terms included lesbian (72%), LGBT/LGBTQ (69%), and gay (68%), while less used terms included trans/transgender (32%) and bisexual (15%). Larger clinic size was associated with LGBT-specific website content (odds ratio, 4.42; 95% confidence interval, 2.07-9.67). Practice type and state-mandated fertility insurance coverage were not associated with a clinic website having LGBT content. CONCLUSION(S) Over half of Society for Assisted Reproductive Technology member fertility clinics included LGBT content on their websites, yet those in the Midwest and South were significantly less likely to do so. Predictive factors for having LGBT website content included location in northeastern and western regions and increasing clinic size. Further studies are needed to evaluate whether inclusion of LGBT content on clinic websites impacts use of reproductive services by the LGBT patient population.
Collapse
|
4
|
Abstract
Since inception, the use of assisted reproductive technologies (ART) has been accompanied by ethical, legal, and societal controversies. Guidelines have been developed to address many of these concerns; however, the rapid evolution of ART requires their frequent re-evaluation. We review the literature on ethical and legal aspects of ART, highlighting some of the most visible and challenging topics. Of specific interest are: reporting of ART procedures and outcomes; accessibility to ART procedures; issues related to fertility preservation, preimplantation genetic testing, gamete and embryo donation, and reproductive outcomes after embryo transfer. Improvements in ART reporting are needed nationally and worldwide. Reporting should include outcomes that enable patients to make informed decisions. Improving access to ART and optimizing long-term reproductive outcomes, while taking into account the legal and ethical consequences, are challenges that need to be addressed by the entire community of individuals involved in ART with the assistance of bioethicists, legal counselors, and members of society in general.
Collapse
Affiliation(s)
- Laura Londra
- Department of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology and Infertility, Lutherville, MD, USA
| | - Edward Wallach
- Department of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology and Infertility, Lutherville, MD, USA
| | - Yulian Zhao
- Department of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology and Infertility, Lutherville, MD, USA.
| |
Collapse
|
5
|
Brezina PR, Zhao Y. The ethical, legal, and social issues impacted by modern assisted reproductive technologies. Obstet Gynecol Int 2012; 2012:686253. [PMID: 22272208 PMCID: PMC3261493 DOI: 10.1155/2012/686253] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 11/25/2011] [Indexed: 11/30/2022] Open
Abstract
Background. While assisted reproductive technology (ART), including in vitro fertilization has given hope to millions of couples suffering from infertility, it has also introduced countless ethical, legal, and social challenges. The objective of this paper is to identify the aspects of ART that are most relevant to present-day society and discuss the multiple ethical, legal, and social challenges inherent to this technology. Scope of Review. This paper evaluates some of the most visible and challenging topics in the field of ART and outlines the ethical, legal, and social challenges they introduce. Major Conclusions. ART has resulted in a tectonic shift in the way physicians and the general population perceive infertility and ethics. In the coming years, advancing technology is likely to exacerbate ethical, legal, and social concerns associated with ART. ART is directly challenging society to reevaluate the way in which human life, social justice and equality, and claims to genetic offspring are viewed. Furthermore, these issues will force legal systems to modify existing laws to accommodate the unique challenges created by ART. Society has a responsibility to ensure that the advances achieved through ART are implemented in a socially responsible manner.
Collapse
Affiliation(s)
- Paul R. Brezina
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Phipps 264 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | | |
Collapse
|
6
|
Murphy TF. Dignity, marriage and embryo adoption: a look at Dignitas Personae. Reprod Biomed Online 2011; 23:860-8. [PMID: 22023731 DOI: 10.1016/j.rbmo.2011.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/07/2011] [Accepted: 06/07/2011] [Indexed: 11/18/2022]
Abstract
The Catholic Church's 2008 Dignitas Personae discusses the moral implications of respecting the dignity of all human beings, regardless of the stage of development. In that text, the Vatican's Congregation for the Doctrine of the Faith argues that respect for this dignity is incompatible with the conception of embryos outside marriage as well as assisted reproduction treatments and certain kinds of human embryonic research. Not only that, but the Congregation also rejects efforts at embryo adoption. As a matter of secular moral philosophy, this view of dignity is disputable and this article shows how an alternate view of dignity--one that depends on interests as against status--serves as a better foundation for decisions about ways in which to help people have children. This view of dignity is entirely compatible with a wide array of assisted reproduction treatments and research and is compatible with the conception of embryos for single parents or opposite-sex couples looking to have children. Using its notion of human dignity, the Congregation makes a case against embryo adoption, but that case is unconvincing given the permissible exercise of individual conscience and the presumptive importance of rescuing human lives where they can be rescued.
Collapse
Affiliation(s)
- Timothy F Murphy
- University of Illinois College of Medicine, Department of Medical Education, 808 South Wood Street, Chicago, IL 60612-7309, United States.
| |
Collapse
|
7
|
Walsh APH, Omar AB, Collins GS, Murray GU, Walsh DJ, Salma U, Sills ES. Application of EU tissue and cell directive screening protocols to anonymous oocyte donors in western Ukraine: data from an Irish IVF programme. J OBSTET GYNAECOL 2011; 30:613-6. [PMID: 20701513 DOI: 10.3109/01443615.2010.497875] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anonymous oocyte donation in the EU proceeds only after rigorous screening designed to ensure gamete safety. If anonymous donor gametes originating from outside EU territory are used by EU patients, donor testing must conform to the same standards as if gamete procurement had occurred in the EU. In Ireland, IVF recipients can be matched to anonymous donors in the Ukraine (a non-EU country). This investigation describes the evolution of anonymous oocyte donor screening methods during this period and associated results. Data were reviewed for all participants in an anonymous donor oocyte IVF programme from 2006 to 2009, when testing consistent with contemporary EU screening requirements was performed on all Ukrainian oocyte donors. HIV and hepatitis tests were aggregated from 314 anonymous oocyte donors and 265 recipients. The results included 5,524 Ukrainian women who were interviewed and 314 of these entered the programme (5.7% accession rate). Mean age of anonymous oocyte donors was 27.9 years; all had achieved at least one delivery. No case of hepatitis or HIV was detected at initial screening or at oocyte procurement. This is the first study of HIV and hepatitis incidence specifically among Ukrainian oocyte donors. We find anonymous oocyte donors to be a low-risk group, despite a high background HIV rate. Following full disclosure of the donation process, most Ukrainian women wishing to volunteer as anonymous oocyte donors do not participate. Current EU screening requirements appear adequate to maintain patient safety in the context of anonymous donor oocyte IVF.
Collapse
Affiliation(s)
- A P H Walsh
- Division of Reproductive Endocrinology and Infertility, Sims IVF/Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Benagiano G, Carrara S, Filippi V. Sex and reproduction: an evolving relationship. Hum Reprod Update 2010; 16:96-107. [PMID: 19729373 DOI: 10.1093/humupd/dmp028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although sexual activity has, until very recently, been essential to reproduction, this did not preclude the non-reproductive importance of sexual relationships and non-conceptive copulations. Technological advances, however, now allow for both sex without reproduction and reproduction without sex. This review summarizes social and ethical commentaries on the new relationship between sex and reproduction. METHODS For each main area discussed, a systematic search was made using (depending on the subject) PubMed, Medline, ScienceDirect, classic books, Google and/or religious websites. The search focused on publications between 1975 and 2009, although some materials from the first part of the 20th century were also utilized. RESULTS The classic picture of sex for reproduction and bonding between mating partners is increasingly being replaced by reproduction separate from sexual activity. Although not every advance in assisted reproduction produced, per se, a further separation from sexual intercourse, these two fundamental human activities are today increasingly carried out independently, as reproduction is possible, not only without sex, but even through the intervention of more than two partners. The possibility of reproduction with only one or even no gametes, although highly controversial and not yet feasible, is nonetheless being investigated. CONCLUSIONS Technological advances in the field of reproductive biology have enabled couples considered infertile to conceive and have healthy babies, causing a revolution in culture and customs. Today the independence of sex and reproduction is established and in the future human reproduction may move even further away from the sexual act, an option definitely unacceptable to some ethicists.
Collapse
Affiliation(s)
- Giuseppe Benagiano
- Department of Obstetrics and Gynaecology, Sapienza University, Rome, Italy.
| | | | | |
Collapse
|