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  • 1
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 23 April 2014, Vol.40(4), p.242
    Description: Bioconservative commentators argue that parents should not take steps to modify the genetics of their children even in the name of enhancement because of the damage they predict for values, identities and relationships. Some commentators have even said that adults should not modify themselves through genetic interventions. One commentator worries that genetic modifications chosen by adults for themselves will undermine moral agency, lead to less valuable experiences and fracture people's sense of self. These worries are not justified, however, since the effects of modification will not undo moral agency as such. Adults can still have valuable experiences, even if some prior choices no longer seem meaningful. Changes at the genetic level will not always, either, alienate people from their own sense of self. On the contrary, genetic modifications can help amplify choice, enrich lives and consolidate identities. Ultimately, there is no moral requirement that people value their contingent genetic endowment to the exclusion of changes important to them in their future genetic identities. Through weighing risks and benefits, adults also have the power to consent to—and assume the risks of—genetic modifications for themselves in a way not possible in prenatal genetic interventions.
    Keywords: Enhancement ; Genethics ; Children
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 2
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 18 August 2013, Vol.39(8), p.529
    Description: Some commentators argue that conception signals the onset of human personhood and that moral responsibilities toward zygotic or embryonic persons begin at this point, not the least of which is to protect them from exposure to death. Critics of the conception threshold of personhood ask how it can be morally consistent to object to the embryo loss that occurs in fertility medicine and research but not object to the significant embryo loss that occurs through conception in vivo. Using that apparent inconsistency as a starting point, they argue that if that embryo loss is tolerable as a way of conceiving children, it should be tolerable in fertility medicine and human embryonic research. Double-effect reasoning shows, by contrast, that conception in vivo is justified even if it involves the death of persons because the motives for wanting children are not inherently objectionable, because the embryo loss that occurs in unassisted conception is not the means by which successful conception occurs, and because the effect of having children is proportionate to the loss involved. A similar outcome holds true for in vitro fertilisation in fertility medicine but not for in vitro fertilisation for research involving human embryos.
    Keywords: Reproductive Medicine ; Research Ethics ; Embryos and Fetuses
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 3
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 20 February 2011, Vol.37(2), p.105
    Description: Some commentators object to the use of embryonic and fetal diagnostic technologies by parents who wish to avoid disabilities in their children. In particular, they say this use is hurtful in the meaning it expresses, namely that the lives of people with disabilities are not valuable or are less valuable than the lives of others. Other commentators have tried to show that this meaning does not necessarily belong to parents' choices and is not therefore credible as a general moral objection. However, this analysis overlooks the way in which the use of these technologies can be legitimately interpreted as hurtful. Once we admit to these hurtful effects felt by people with disabilities and those who hold them dear, it becomes important to ask whether that hurt can justify limits on parents' choices. Because the use of these technologies does not hurt people with disabilities directly and because there is no requirement that people having children work to ensure the continued existence of people with disabilities, no justification for limiting parents' choices is to be found in the hurt some people experience in steps taken to avoid disabilities in children.
    Keywords: Assisted Reproductive Technologies ; Children ; Disabilities ; Ethics ; Enhancement ; in Vitro Fertilization and Embryo Transfer ; Eugenics ; Genetic Screening/Testing
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 4
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 27 December 2018, Vol.44(12), p.823
    Description: Researchers are pursuing various ways to synthesise human male and female gametes, which would be useful for people facing infertility. Some people are unable to conceive children with their partner because one of them is infertile in the sense of having an anatomical or physiological deficit. Other people—in same sex couples—may not be individually infertile but situationally infertile in relation to one another. Segers have described a pathway towards synthetic gametes that would rely on embryonic stem cells, rather than somatic cells. This pathway would be advantageous, they say, for same-sex couples even though it would not offer those couples 50%–50% shared genetics in their children but only 50%–25%. It is unclear, however, why this approach should be preferred morally speaking since it represents a falling off from the kind of shared genetics in children that are functionally a gold standard in parents' expectations generally. Despite raising concerns about whether genetic relatedness is necessary or sufficient as a condition of parental interest in children, Segers cede the sociocultural importance of that standard. If so, same-sex couples seem entitled to press a case for some measure of research priority that would offer the same level of access to that social good as everyone else.
    Keywords: Genethics ; Reproductive Medicine ; Ethics
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 5
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 31 November 2014, Vol.40(11), p.762
    Description: Some commentators indirectly challenge the ethics of using synthetic gametes as a way for same-sex couples to have children with shared genetics. These commentators typically impose a moral burden of proof on same-sex couples they do not impose on opposite-sex couples in terms of their eligibility to have children. Other commentators directly raise objections to parenthood by same-sex couples on the grounds that it compromises the rights and/or welfare of children. Ironically, the prospect of synthetic gametes neutralises certain of these objections, insofar as they would ensure that children have parents whom they can know as their genetic parents, which outcome is not always possible when same-sex couples involve third parties as the source of gametes or embryos. Not all commentators in bioethics throw the use of synthetic gametes into doubt as far as same-sex couples are concerned, but even these commentators put parenting by gay men and lesbians at the conclusion of an argument rather than presupposing parental legitimacy from the outset. Synthetic gametes do raise questions of ethics in regard to parenthood for gay men and lesbians, but these are largely questions of access and equity, not questions of parental fitness and/or child welfare.
    Keywords: Children ; Embryonic Stem Cells ; Ethics ; Reproductive Medicine ; Sexuality/Gender
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 6
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 21 November 2014, Vol.40(11), p.739
    Description: Certain interventions now permit the derivation of mammalian gametes from stem cells cultivated from either somatic cells or embryos. These gametes can be used in an indefinite cycle of conception in vitro, gamete derivation, conception in vitro, and so on, producing genetic generations that live only in vitro. One commentator has described this prospect for human beings as eugenics, insofar as it would allow for the selection and development of certain traits in human beings. This commentary not only offers this topic for discussion, it also wades into the ethical fray over the practice. Several possible lines of objection can be raised against this practice, but these accounts are by and large insufficient as an ethical analysis of this possible, future way of conceiving human children.
    Keywords: Embryonic Stem Cells ; Gene Therapy/Transfer ; Genethics ; In Vitro Fertilization and Embryo Transfer ; Genetic Selection
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 7
    Language: English
    In: Journal of Medical Ethics, 5 May 2015, Vol.41(5), p.388
    Description: One way to help ensure the future of human life on the planet is to reduce the total number of people alive as a hedge against dangers to the environment. One commentator has proposed withdrawing government and insurance subsidies from all fertile people to help reduce the number of births. Any proposal of this kind does not, however, offer a solution commensurate with current problems of resource use and carbon emissions. Closing off fertility medicine to some people—or even to all—would have only negligible effects on environmental protection. Moreover, the proposal to withdraw financial subsidies from fertile individuals would have prejudicial effects on lesbian and gay people, who must always reach beyond their same-sex relationships for help in having children. It is, moreover, entirely unclear why some people turning to fertility medicine for help in having children should have to pay their own way even though they contribute to the pool of money available for government and insurance subsidies. Entitlements based on an alleged moral difference between the ‘fertile’ and the ‘infertile’ cannot support such a conclusion.
    Keywords: Reproductive Medicine ; Environmental Ethics
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 8
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 11 June 2014, Vol.40(6), p.392
    Description: Anja Karnein has suggested that because of the importance of respect for persons, law and policy should require some human embryos created in vitro to be available for adoption for a period of time. If no one comes forward to adopt the embryos during that time, they may be destroyed (in the case of embryos left over from fertility medicine) or used in research (in the case of embryos created for that purpose or left over from fertility medicine). This adoption option would increase the number of embryos available for couples looking for help in having children, but that effect is less important—Karnein argues—than the observance of respect for human persons. As possible persons, she holds that embryos ought to be treated, as if they will become children, if only for a while. If enacted as a matter of law and policy, an ‘adoption option’ would wrongly interfere with the dispositional rights women and men ought to have over embryos they create in the course of trying to have children. Karnein's proposal would also deprive researchers of certainty that the embryos they create for research would actually be available that way, leading to increased burdens of time and money and maybe even to more embryos than would otherwise be produced. Karnein's analysis does not show, moreover, that any duty of rescue applies to embryos. No woman is required to adopt any embryo, which significantly undercuts the justification for an obligatory adoption period.
    Keywords: Adoption -- Legislation & Jurisprudence ; Beginning of Human Life -- Ethics ; Embryo Transfer -- Ethics ; Fertilization in Vitro -- Ethics;
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 9
    Article
    Article
    BMJ Publishing Group Ltd and Institute of Medical Ethics
    Language: English
    In: Journal of Medical Ethics, 26 December 2010, Vol.36(12), p.806
    Description: Researchers are working to derive sperm from banked testicular tissue taken from pre-pubertal boys who face therapies or injuries that destroy sperm production. Success in deriving sperm from this tissue will help to preserve the option for these boys to have genetically related children later in life. For the twin moral reasons of preserving access and equity in regard to having such children, clinicians and researchers are justified in offering the option to the parents of all affected boys. However, some parents may wish to decline the option to bank tissue from their boys because the technique may seem too unfamiliar or unusual, but over time people may become more comfortable with the technique as they have done with other novel assisted reproductive treatments (ARTs). Other parents may wish to decline the option because of moral or religious reasons. A prominent natural law theory holds, for example, that the ARTs that would be involved in using sperm derived from banked tissue to produce a child are morally objectionable. Some parents might not want to bank tissue in order to shield their son from using ARTs they see as objectionable. Clinicians and researchers should respect parents who wish to decline banking tissue, but parents should ordinarily embrace choices that protect the possible interests their sons may have as adult men, including the wish to have genetically related children.
    Keywords: Ethics ; Fertility ; Informed Consent ; Tissue Banking ; Minors/Parental Consent ; Cryobanking of Sperm ; Ova or Embryos
    ISSN: 0306-6800
    ISSN: 03066800
    E-ISSN: 1473-4257
    E-ISSN: 14734257
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  • 10
    Language: English
    In: Chest, September 2011, Vol.140(3), pp.611-617
    Description: Pathogenic bacteria colonize the airways of 30% to 40% of patients with COPD and cause approximately 50% of exacerbations. New strains of nontypeable (NTHI) and are associated with exacerbations. Antimicrobial protein/peptides (AMPs) play important roles in innate lung defense against pathogens. To our knowledge, the changes in AMP baseline levels in respiratory secretions during bacterial colonization and exacerbation have not been described. The objective of this study was to elucidate the effects of the acquisition of a new strain of pathogenic bacteria on the airway levels of AMPs in patients with COPD. One hundred fifty-three samples from 11 patients were selected from COPD sputum samples collected prospectively over 6 years. Samples were grouped as culture-negative (no pathogenic bacteria), colonization, and exacerbation due to new strains of NTHI and Levels of lysozyme, lactoferrin, LL-37, and secretory leukocyte protease inhibitor (SLPI) were measured by enzyme-linked immunosorbent assay and compared among groups by paired analysis. Compared with baseline, sputum lysozyme levels were significantly lower during colonization and exacerbation by NTHI ( = .001 and = .013, respectively) and ( = .007 and = .018, respectively); SLPI levels were lower with exacerbation due to NTHI and ( = .002 and = .004, respectively), and during colonization by ( = 032). Lactoferrin levels did not change significantly; LL-37 levels were higher during exacerbation by NTHI and ( = .001 and = .018, respectively). Acquisition of NTHI and is associated with significant changes in airway levels of AMPs, with larger changes in exacerbation. Airway AMP levels are likely to be important in pathogen clearance and clinical outcomes of infection in COPD.
    Keywords: Medicine
    ISSN: 0012-3692
    E-ISSN: 1931-3543
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