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Given recent legal developments in the United States, now is a critical time to draw attention to how 'conscientious objection' is sometimes used by health care providers to discriminate against the LGBTQ community. We review legal developments from 2019 and present several cases where health care providers used conscientious objection in ways that discriminate against the LGBTQ community, resulting in damaged trust by this underserved population. We then discuss two important conceptual points in this debate. The first involves the interpretation of discrimination (provider versus patient-centered views), and we argue for a patient-centered view; the second involves the use of the people versus procedure distinction to reach a compromise between LGBTQ individuals and the clinicians who do not want to treat them. We argue the distinction is problematic when applied to treatment of the LGBTQ population.

We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This orientation, combined with a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training.

Contraception works by preventing fertilization of an egg or preventing implantation of a fertilized embryo. For those who believe pregnancy begins at implantation, contraceptives preventing implantation are not abortifacient. However, for those who assert that pregnancy begins at fertilization, any agent causing the intentional loss of an embryo, even prior to implantation, is abortifacient, both morally and for lack of a different term to describe the postfertilization, preimplantation loss. In the debate on this topic, much of the discourse on both sides wrongly focuses on the opposing side's perceived ignorance in denying scientifically proven definitions rather than on the substance of the conflict. Indeed, both sides accuse the other of prioritizing its "subjective" views over "objective" facts. In this essay, we unpack the scientific, cultural, and religious factors that underlie this debate. We argue that the only way to move forward is to clarify our terminology and engage with the substance of the argument, rather than merely the rhetoric.

We appreciate Fritz’s (2021) thoughtful analysis of the asymmetry between legal protections for negative and positive conscience claims and are particularly interested in further exploring the conc...

The antiabortion movement is increasingly using ostensibly scientific measurements such as ‘fetal heartbeat’ and ‘fetal pain’ to provide ‘objective’ evidence of the moral status of fetuses. However, there is little knowledge on how clinicians conceptualise and operationalise the moral status of fetuses. We interviewed obstetrician/gynaecologists and neonatologists on this topic since their practice regularly includes clinical management of entities of the same gestational age. Contrary to our expectations, there was consensus among clinicians about conceptions of moral status regardless of specialty. First, clinicians tended to take a gradualist approach to moral status during pregnancy as they developed and viewed viability, the ability to live outside of the uterus, as morally significant. Second, in contrast to ‘fetal pain’ laws and philosophical discussions about the ethical salience of sentience, the clinicians in our study did not consider the ability to feel pain as a morally relevant factor in moral status determinations. Third, during previability and perviability, clinicians viewed moral status as a personal value decision, which should be made by pregnant people and parents of neonates.

Lynch syndrome (LS) is a genetic cancer syndrome that puts affected individuals at a significantly higher risk of developing multiple cancers. Participants (n = 57) were recruited through social media. Data were collected through online surveys and phone interviews; the interview data (n = 55) were analyzed to identify provider terminations and the factors that motivated these decisions. Results indicate that individuals with LS terminated their patient–provider relationships due to lack of provider LS knowledge, poor interactions, or a combination of both factors. Findings from this study suggest a need for better interactions between LS patients and providers and increased knowledge of LS-specific care.

According to Petersen, ‘the individualization argument against NMEF [nonmedical egg freezing]’ states: ‘it is morally wrong to let individuals use technology X [NMEF] – in order to try to handle a problem that is social in nature – if the use of X [NMEF] will somehow work against a social solution to a social problem P [gender inequality in the labor market]’. While there may be individuals making individualisation argument against NMEF, I do not read the scholars he discusses—Karey Harwood,1 2 Lynn Morgan, Janelle Taylor3 and Angel Petrapanagos4—as making this argument. These scholars agree with the premise of the individualisation argument that NMEF ‘is an individualistic and morally problematic solution to the social problems that women face’ (p. 4), but this does not mean that they agree with the conclusion ‘women should not use NMEF’ (p. 4). In fact, several admit that NMEF can be a good choice for some women; Petropanagos, for example, states ‘individual women may benefit from egg freezing to satisfy their reproductive desires’.4 In this commentary, I argue that Petersen incorrectly reduces these scholars’ positions to the individualisation argument by neglecting three pertinent factors: their feminist orientation, their multifaceted critiques of NMEF and how the rapidly advancing field of reproductive medicine informs their ethical analysis. While Petersen …

In 2012, the American Society for Reproductive Medicine (ASRM) lifted the experimental label on oocyte preservation, but cautioned against women using it to avoid age-related infertility, known as social egg freezing (SEF). In 2014, Facebook and Apple announced that they would offer SEF as a workplace benefit. Within the context of a rapidly growing market for SEF, we were interested in how these two decisions affected media discussions, given that such discourse can strongly influence public perceptions and behaviors. We used a content analysis methodology to code 138 articles published in U.S. newspapers and magazines between 2012 and 2015. Focusing on a financial concern over the cost of SEF and the lack of insurance for SEF, we found that media portrayals of SEF pivot away from the ethical principle of nonmaleficence centered in the ASRM decision to discourage SEF. Instead, they highlight an issue of justice that can be remedied through the offer of SEF as a workplace benefit. Overall, media portrayals of SEF paint a simplistic and rosy picture that more options, especially more reproductive and economic options, automatically enhance women's autonomy.

In “Transgender Children and the Right to Transition,” Maura Priest (2019) cogently defends the rights of transgender children to access puberty-blocking treatment (PBT) even if their parents or gu...

Expedited partner therapy is an ethical and effective treatment for sexually transmitted infection, provided patients are reliable messengers to partners.

Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women’s inequality. While these advancements and technologies can benefit women, I argue medicine is not the best tool to ‘cure’ social problems and should not be co-opted as an agent of social change. Systemic social changes, not just technomedical approaches, are needed to address the root of gender inequality, which is social in nature, not medical.

Background: Although much is known scientifically about maternally and paternally mediated fetal harms, there has been little research examining how these harms are portrayed in the media. The objective of this study was to examine how maternal and paternal age-related harm is portrayed in contemporary U.S. newspapers.Methods: A content analysis was undertaken of 64 newspaper articles after systematic searching and selection of articles based on inclusion criteria. A coding framework was developed and used to analyze articles for tone. The text of the articles was analyzed for one or more of eight tones, which were correlated with the main article focus and gender of author. Results: Most articles were maternally focused, and only 6% of articles were equally focused on both women and men. Most U.S. newspaper articles focused on maternal age-related harms, and negative tones were often used to describe older parents, especially for women. In contrast, paternal age-related harms were less likely to ...

Dans cet article, nous mettons en évidence trois façons dont les brevets sur les gènes pourraient nuire à la recherche scientifique. Premièrement, les lois relatives aux brevets sur les gènes risquent d’exacerber la culture du secret omniprésente en science. Deuxièmement, sans un accès à toutes les étiologies génétiques, les brevets sur les gènes peuvent limiter la capacité des chercheurs à étudier les maladies poly ou multigénétiques. Troisièmement, les brevets sur les gènes pourraient aboutir à un « maquis de brevets »., In this paper, we point out three possible ways gene patents could impede scientific research. First, gene patent laws might exacerbate the culture of secrecy ubiquitous in science. Second, gene patents may limit researchers’ ability to study poly or multigenic diseases without access to all genetic etiologies. Third, gene patents could result in a “patent thicket”., Commentaire / Commentary

We report on the case of a 2-year-old female, the youngest person ever to undergo ovarian tissue cryopreservation (OTC). This patient was diagnosed with a rare form of sickle cell disease, which required a bone-marrow transplant, and late effects included high risk of future infertility or complete sterility. Ethical concerns are raised, as the patient's mother made the decision for OTC on the patient's behalf with the intention that this would secure the option of biological childbearing in the future. Based on Beauchamp and Childress's principlism approach of respect for autonomy, nonmaleficence, beneficence, and justice, pursing OTC was ethically justified.

A more just sharing of the responsibility for contraception can only be achieved through the development of male birth control methods and reconceptualizing responsibility for contraception as shared between men and women.

A dominant cultural narrative within Costa Rica describes Costa Ricans not only as different from their Central American neighbours, but it also exalts them as better: specifically, as more white, peaceful, egalitarian and democratic. This notion of Costa Rican exceptionalism played a key role in the creation of their health care system, which is based on the four core principles of equity, universality, solidarity and obligation. While the political justification and design of the current health care system does, in part, realize this ideal, we argue that the narrative of Costa Rican exceptionalism prevents the full actualization of these principles by marginalizing and excluding disadvantaged groups, especially indigenous and black citizens and the substantial Nicaraguan minority. We offer three suggestions to mitigate the self-undermining effects of the dominant national narrative: 1) encouragement and development of counternarratives; 2) support of an emerging field of Costa Rican bioethics; and 3) decoupling health and national successes.

Scholars have shown that organ transplantation may transform ideas about one's body, with recipients feeling that they are receiving not just a body part but also a part of the donor's identity. This article focuses on a different way in which organ transplantation shapes recipient identity: the idea of becoming whole. We present the case studies of two women separated by a century (one in 1902 and the other in 2004) who sought ovarian transplantation, and examine how ovarian transplantation can engender a sense of wholeness on the individual, the familial, and the cultural levels, due to its ability to enable a recipient to naturally conceive and experience pregnancy.

Melanie was 29-years-old, married, and hoping to start a family when she discovered a lump in her pelvis. She was diagnosed with non-Hodgkin lymphoma. But one of her biggest fears upon learning of her diagnosis was the possibility of loosing her ability to have children. When Melanie asked her oncologist and radiation oncologist about the risk cancer treatment posed to her fertility, they told her it was small, as only one ovary would be destroyed during the radiation. Deciding to ask for another opinion, she sought out a reproductive endocrinologist, who told her, contrary to what her oncologists had said, that women like her typically did have problems conceiving after radiation treatment on their pelvis. One of the hardest parts of dealing with her dual diagnosis, Melanie later recalled, was the unknown: “I didn't know if my treatment would definitely render me infertile.”

An individual's right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient's DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts-especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event-are common to all situations (Brown et al. in Am J Bioeth 13(3):3-12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual's reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail.

One winter morning, the two of us--both postdoctoral fellows in medical humanities and bioethics--gathered with a handful of reproductive science graduate students in the lab to watch a demonstration on making alginate beads. Due to their three-dimensional nature, the beads are capable of holding ovarian follicles--the beads act as though they were a small ovary. The scientists in the lab have managed to mature the follicles maintained in the beads into eggs, fertilize these eggs, and produce the birth of live mice. This research was begun in an effort to develop a means of gathering ovarian follicles from young human cancer patients before they commence cancer treatment that may result in their infertility, thus preserving parts of their ovaries for later use in in vitro fertilization. But the point of this paper is what else happened that day in the lab. The graduate students and the fellows began talking about the inability of the lab to extend the experiment to see if human ovarian follicles are similarly capable of maturing into eggs that would be fertilizable. As the recipient of a grant from the National Institutes of Health, the lab must abide by the Dickey-Wicker Amendment, which bans federal funding for research involving human embryos and parthenotes. A parthenote is an egg that begins dividing as though it were fertilized even though fertilization has not occurred. Eggs can be induced to develop into parthenotes (a process known as parthenogenesis) in the absence of sperm by several different chemical and mechanical stimuli that mimic fertilization. The lab scientists understood the prohibition of federal funding for embryos, but they were frustrated that parthenotes were lumped in with embryos, especially given their scientific differences, because the ability to use human parthenotes would significantly improve their understanding of egg maturation in humans. We were surprised to learn about the ban on parthenote research, and somewhat chagrined to recognize how little we knew about the Dickey-Wicker Amendment. Our discussion with the scientists of why a parthenote was legally and ethically equated to an embryo in the Dickey-Wicker Amendment began the first of several joint research projects. (1) Many have noted the importance of multidisciplinary work, and here we describe how such work--well, worked. We also show how our postdoctoral fellowships could be used as a model for the postgraduate training of others in medical humanities and bioethics. But first, a bit about our backgrounds, because our multidisciplinary work is not just about being embedded with scientists, but also about coming at medical humanities and bioethics from different disciplines. Lisa approaches her work from a philosophical background, with careful attention to power dynamics that can lead to health care inequities and injustices. Sarah comes at her work from a historical perspective, looking at how an issue developed in order to contextualize ethical issues and frame questions being asked today. Yet given that we both work in the broader field of medical humanities and bioethics, our work by its very nature is multidisciplinary. Furthermore, we are both interested in reproductive health and how the issues brought forward and the questions being asked are influenced by and influence the larger culture. We learn from each other the importance of historic contextualization and philosophical inquiry, and we join our work with the work in the lab. By being embedded in the lab, we can both learn more about reproductive science and enable scientists in the lab to think about their work away from the bench. We discuss the differences between the scientific process and the historical and ethical research processes, as well as the similarities among the disciplines. We learn about the science of ovaries, ovarian follicles, eggs, embryos, and parthenogenesis, which furthers our ability to carefully analyze the intricacies of reproductive technologies. …

This paper discusses the ethical issues related to hemicorporectomy surgery, a radical procedure that removes the lower half of the body in order to prolong life. The literature on hemicorporectomy (HC), also called translumbar amputation, has been nearly silent on the ethical considerations relevant to this rare procedure. We explore five aspects of the complex landscape of hemicorporectomy to illustrate the broader ethical questions related to this extraordinary procedure: benefits, risks, informed consent, resource allocation and justice, and loss and the lived body.

Modern contraceptives - especially long-acting reversible contraceptives or LARCs are typically seen as a boon for humanity and for women the majority of their users in particular. But the disparity between the number and types of female and male LARCs is problematic for at least two reasons: first because it forces women to assume most of the responsibilities of contraception and second because mens reproductive autonomy is diminished by it. In order to understand how to change the current contraceptive arrangement the author looks at some of the historical and contemporary factors that contribute to this disparity especially gender norms that associate women with reproduction and distance men from it. The author suggests that more resources need to be devoted to developing male LARCs and also emphasizes the importance for health care professionals to involve men more fully in reproductive health care in order for male LARCs to succeed.

Ovarian tissue transplantation is an experimental procedure that can be used to treat both infertility and premature menopause. Working within the current legal framework in the USA, I examine whether ovarian tissue should be legally treated like gametes or organs in the case of ovarian tissue transplantation between two women. One option is to base classification upon its intended use: ovarian tissue used to treat infertility would be classified like gametes, and ovarian tissue used to treat premature menopause would be classified like organs. In the end, however, I argue that this approach will not work because it engenders too many legal, cultural and logistical concerns and that, at least for the near future, we should treat ovarian tissue like gametes.

Testicular tissue cryopreservation (TTCP) is a neglected to– pic in the fields of fertility preservation and bioethics not only because reproduction is usually associated with women and girls, but ...

We wrote our article, “An Obscure Rider Obstructing Science: The Conflation of Parthenotes with Embryos in the Dickey-Wicker Amendment,” out of concern for the practical effects of the Dickey-Wicke...

Dans cet article, je décris quelques-unes des raisons pour lesquelles les « previvors » de BRCA (c-a-d. « survivants d ’ u n e prédisposition au cancer ») sont différents des previvors avec d’autres cancers héréditaires. J’examine comment l’absence d’une norme de soins pour le risque de cancer du sein chez les femmes ayant une mutation BRCA, associée à un large éventail de pénétration génétique et une mortalité plus faible, rend le BRCA différent des autres cancers héréditaires qui ont des directives claires et établies. En plus de ces différences médicales, des facteurs sociaux tels que la prééminence culturelle du cancer du sein et la signification sociale des seins ont engendré une identité prédictive individuelle plus complexe et une réponse culturelle aux femmes ayant une mutation BRCA., In this paper, I outline some of the reasons why BRCA “previvors” (i.e., “survivors of a predisposition to cancer”) are different from previvors with other hereditary cancers. I examine how the absence of a standard of care for breast cancer risk for women with a BRCA mutation, coupled with a broad range of genetic penetrance and lower mortality, makes BRCA different than other hereditary cancers that have clear and established guidelines. In addition to these medical differences, social factors like the cultural prominence of breast cancer and the social significance of breasts have engendered a more complicated individual previvor identity for and cultural response to women with a BRCA mutation., Commentaire / Commentary

While sexual and gender minorities are at increased risk for poor health outcomes, there is limited data regarding patient-provider interactions. In this study, we explored the perspectives of LGBTQ patients and their encounters with physicians in order to improve our understanding of patient-physician experiences. Using purposive selection of self-identified LGBTQ patients, we performed fourteen in-depth semi-structured interviews on topics of sexual orientation and gender identity, as well as their perceived role in the patient-provider relationship. Coding using a modified grounded theory approach was performed to generate themes. We identified three major themes that demonstrate the complexity of LGBTQ patient experiences. The first, Lacking trust, identifies mistrust and loss of the physician-patient relationship resulting from physicians’ poor or judgmental communication, or from physicians making assumptions about gender, using incorrect pronouns, and not recognizing heterogeneity within the transgender community. A second theme, Being vulnerable, describes the challenges and fears related to comfort of patients with disclosing their sexual orientation and/or gender identity. A final theme, Navigating discrimination, outlines racial or ethnic discrimination which creates an additional burden on top of illness and stigmatized identity. Our results reveal the complex needs of individuals with multiple stigmatized identities when developing relationships with providers. By using an intersectional perspective that appreciates the plurality of patients’ identities, providers can help to improve their relationships with LGBTQ patients. Incorporating intersectional training for medical students and residents could greatly benefit both LGBTQ patients and their physicians., Bien que les minorités sexuelles et de genre courent un risque accru de problèmes de santé, on dispose de peu de données sur les interactions patient-prestataire de soins. Dans cette étude, nous avons exploré les perspectives des patients LGBTQ et leurs rencontres avec les médecins afin d’améliorer notre compréhension des expériences patient-médecin. À l’aide d’une sélection ciblée de patients LGBTQ auto-identifiés, nous avons réalisé quatorze entrevues semi-structurées en profondeur sur des sujets comme l’orientation sexuelle et l’identité de genre, ainsi que leur rôle perçu dans la relation patient-fournisseur. Un codage utilisant une approche modifiée de la théorie ancrée a été effectuée pour générer des thèmes. Nous avons identifié trois grands thèmes qui démontrent la complexité des expériences vécues par les patients LGBTQ. La première, le manque de confiance, identifie la méfiance et la perte de la relation médecin-patient résultant d’une mauvaise communication des médecins ou d’un jugement porté sur eux, ou du fait que les médecins font des suppositions sur le genre, utilisent des pronoms incorrects et ne reconnaissent pas l’hétérogénéité dans la communauté transgenre. Un deuxième thème, être vulnérable, décrit les défis et les craintes liés au réconfort des patients face à la divulgation de leur orientation sexuelle ou de leur identité de genre. Un dernier thème, la discrimination sélective, met en relief la discrimination raciale ou ethnique qui crée un fardeau supplémentaire en plus de la maladie et de l’identité stigmatisée. Nos résultats révèlent les besoins complexes des personnes aux multiples identités stigmatisées lorsqu’il s’agit d’établir des relations avec les prestataires. En utilisant une perspective intersectionnelle qui tient compte de la pluralité des identités des patients, les prestataires peuvent aider à améliorer leurs relations avec les patients LGBTQ. L’intégration d’une formation intersectionnelle pour les étudiants en médecine et les résidents pourrait grandement profiter aux patients LGBTQ et à leurs médecins.