Issues in Law & Medicine

The American College of Obstetricians and Gynecologists (ACOG) released a Committee Opinion in November 2007 titled "The Limits of Conscientious Refusal in Reproductive Medicine." This document, claiming to speak on behalf of the entire profession of Obstetrics and Gynecology, proposed that conscience rights of healthcare professionals have limits with regard to certain aspects of patient care. Despite calls for revision from many within the profession, this document was reaffirmed in 2016, unchanged. This document provides a detailed analysis of the ethical flaws in ACOG Committee Opinion 385...

Fetal tissue research refers to research using several types of tissue, including but not limited to samples obtained from aborted fetuses, cell lines derived from aborted fetuses, and in rarer cases, living previable neonates who have survived an abortion attempt. The ethical questions surrounding each type of tissue procurement are not identical, but do share similarities. This guideline on fetal tissue research discusses the moral status of the human fetus, the state of ethics for medical research on vulnerable subjects, aspects of medical research using human fetal tissue, and the necessity of including fetuses as a protected class under vulnerable populations in research...

Considerable controversy exists about the effects of medication abortion on the incidence of preterm birth (PTB). Medication abortion of various types continues to be touted as a safe alternative to surgical abortion, and without increased risk for PTB. There is a paucity of evidence regarding medication abortion and PTB, but available papers are reviewed here. There is moderate-quality evidence that medication abortions which require surgical completion increase PTB rates more than surgical abortion alone.

A complex biological and psychological series of events commence at fertilization and continue through parturition between the preborn human organism and his or her mother, which extends far beyond the physical connection between an adult patient and contained tissue. This guideline reviews evidence in support of various aspects of this bond and its implications for care of the maternal patient.

Adult stem cells dominate worldwide stem cell clinical trials. We investigated factors that may explain levels of stem cell research across different countries. Stem cell trials from clinicaltrials.gov were counted and categorized based on the country, the type of stem cell used, and whether that type is ethically controversial. The trial data were compared with characteristics of the countries such as population and GDP. We looked at the general ethical position of the countries by ranking their favorability toward abortion via their legislation...

Many people worldwide, particularly those with disabilities and the elderly, suffered greatly not only as a result of the Covid-19 pandemic but also as a result of the lockdowns. In this article we set out widely-accepted ethical criteria for assessing when coercive public health measures are justified. We then review the empirical evidence, not least concerning the benefits and costs of the lockdowns, and conclude that lockdowns as instituted in the UK (and, presumptively, in many other jurisdictions) appeared to breach those criteria...

Can sexual activity, alcohol and drug use, violent video games, pornography and other activities, including use of social media, damage adolescent minds? Early high-risk behaviors appear to have significant harmful effects on the brain's development. Evidence suggests that the hormones and neural patterns triggered may lead to addictive, and other high-risk behaviors, social withdrawal, and depression. Compounding these concerns are the immature decision-making processes during adolescence. Fortunately, parents can positively impact the brain development of adolescents as they assist in decision-making, provide structure to the adolescent's environment, and monitor the adolescent's activities...

Chemical abortions, otherwise known as "medication-induced" abortions, were approved by the FDA in September 2000, and now account for over 50% of abortions in the United States. Women are being encouraged to order and carry out their own abortion, without in-person supervision by health care professionals, contributing to increased risks of complications. This paper describes the use of synthetic chemicals to induce abortion and the complications faced by women who obtain care in a medical setting, including hemorrhage and incomplete abortions that may require surgical intervention...

Crucial to the fight against sex trafficking1 is understanding the experiences of victims and survivors. Survivor surveys have illuminated key areas to address, but a clear gap in the research is in the reproductive, gynecological, and procreative health issues of victims and survivors. This article opens the door to research and dialogue by publishing the findings of a pilot survivor survey focused on survivors' sexual and reproductive health. The retrospective survey offers preliminary findings for a larger national study underway in 2023 that will enable healthcare providers, service providers and other first responders to identify and better meet the unique needs of victims and survivors of human trafficking in this area...

The Freedom of Access to Clinic Entrances Act of 1994 is no longer a valid exercise of federal jurisdiction under the Fourteenth Amendment, in light of Dobbs v. Jackson Women's Health Organization, nor ever was under the Commerce Clause, properly understood, per United States v. Morrison.

The research review, "Three Decades of Research: The Case for Comprehensive Sex Education," by Goldfarb and Lieberman (2021), purports to show "strong support" for the effectiveness of school-based comprehensive sex education (CSE) at producing many benefits beyond its original goals of preventing teen pregnancy and STDs. We reviewed the evidence the study cites in support of these claims, item by item, and found that 1) 80% of the sources cited as supporting evidence for CSE are not studies of CSE programs and 2) of the few cited studies of actual CSE programs, roughly 90% do not meet recommended scientific standards for evidence of program effectiveness...

Self-managed abortion has been particularly prominent in recent discussions of abortion, with the rise of telemedicine abortion during the COVID-19 pandemic and the reality of self-managed illegal abortion in pro-life states following the overturning of Roe v. Wade . There has likewise been much political concern about misinformation and fake news circulated in the media. This article highlights how misinformation and poor quality studies have been used to make implausible claims regarding the safety of telemedicine and the number of deaths from unsafe abortion where abortion is illegal...

Unprecedented efforts are made to research and develop technologies that are directly connected to the brain and allow us to access, monitor, investigate, assess, manipulate or stimulate neural processes. This exciting development holds many valuable prospects in the medical context and in other fields of daily life such as entertainment, security or criminal justice. However, it also raises major concerns among ethicists and human rights advocates, who argue that fundamental interests are put at risk as these neurotechnologies result in a growing accessibility and influenceability of the mind...

The case of Alta Fixsler, where a judge ruled that withdrawing life sustaining care was in her best interest rather than transferring her to Israel, as her parents wanted, is the latest in a series of controversial paediatric best interest decisions. Using this case, as well as some other recent cases, I argue that the UK exhibits a high degree of medico-legal paternalism in best interest decisions, even though paternalism seems to be ubiquitously negatively perceived in medical ethics. Firstly, I explain what I mean by medico-legal paternalism and defend my claim that this phenomenon is present in the UK...

Hormonal contraceptives are widely used for birth control and therapeutic purposes. The mechanism of action proposed for these compounds can be found in several scientific journals published to date. The present work consists in a scoping review of a convenience sample of papers regarding the mechanisms of action of each of the three main classes of hormonal contraceptives available. Different parameters and biological consequences associated with their use were also reviewed. Based on these data, we evaluated the probability of embryo loss due to the use of hormonal contraceptives...

The selective termination of one or more fetuses in higher order multiple pregnancies began in the 1980s in response to the increased rate of multiples arising from assisted reproductive technology (ART). Multifetal Pregnancy Reduction (MFPR) was justified by improving outcomes for the remaining offspring and their mother, and while the evidence suggests prematurity and the morbidity associated with it are reduced, there is a cost in increased miscarriage and mortality. As perinatal care has advanced, the margins of improvement have narrowed and hence the cost/benefit ratio...

Mentors are instrumental in the professional and personal growth of healthcare professionals. However, there is often reluctance to serve as a mentor due to a variety of perceived barriers. Attendees will be encouraged and empowered to engage in mentoring relationships that provide both the mentor and the mentee with a rewarding experience. This reflection will define mentoring, discuss mentoring competencies, and describe the mentoring process.

The first thousand days of life, composing the 270 days of pregnancy and the first two years (730 days) of life, is at once a critical and vulnerable time for human development. It is a time in which the human person is to a large extent "embodied," becoming the integrated mind-brain-body-spirit that defines every human being. This embodiment is set in motion at fertilization and continues with the unfolding development of the embryo. By six weeks in utero, the brain is forming via ongoing neurogenesis, neuronal migration, synaptogenesis, and myelination...

In line with the Oath of Hippocrates, the American Medical Association (AMA) code of ethics states that the duty to advocate for the patient is paramount. However, many instances in healthcare expose a discrepancy between the needs of society and the needs of individual patients. Given that society is merely a collection of individuals, one's personal physician is uniquely qualified to devise solutions that can resolve that conflict. This essay will discuss the potential overreach of public health interventions and solutions that ethically serve societal interests to help physicians maintain their duty to individual patients' health and confidentiality...

OBJECTIVE: Clinicians should encourage and promote paternal involvement even in prenatal care, as this early engagement has far-reaching, positive implications on a child's life. SUMMARY: Men are not superfluous to the abortion process. In fact, a father's roles and responsibilities start before the act leading to conception and continue through the pregnancy, birth, and through their children's lives. This paper seeks to review evidence that these roles play an important part in a child's overall development...