Insurance Coverage Post-Class Reflections

I think that our group had a pretty stable (mock) health insurance company! Other than denying payment for all ART, we generally chose to cover doctor approved treatments up to a set amount of money or a percentage of the treatment cost.
This decision was disputed by another group who questioned why our insurance company had the right to deny payment for ART but still allow coverage for PGD (pre embryo diagnosis). Our decision was made in a more economical sense rather than an emotional one: if the couple could not afford a full reproductive treatment, there is much less chance that they will be able to take on all the expenses that will come with those treatments in the future. However, if you can pay for your full treatment initially, then our insurance company would pay for you to have your embryos diagnosed to see which one would be the most viable, producing the healthiest baby, lowering the cost to our insurance company in the long run. Is it okay for us to assume that if you cannot pay for the initial treatments then we don't think you should have them? This is correct. Some other groups had our same stipulations and views on insuring for ART, but they also provided insurance over less expensive infertility drugs, meeting patients half-way. I can see how this could be a valid option, but where do you draw the line on where the infertility drugs will get as expensive as ART, basically nullifying the reasons that we discarded the idea of insuring ART in the first place?
Our idea behind setting up a sort of financial 'barrier' to the assisted reproductive treatments is that in the long run this will ensure that our clients who decide to enter onto this long road of the new technologies is well prepared, (financially, and thereby emotionally) to endure the trials that may come with using these technologies. If someone has prioritized getting pregnant to the extent of paying for IVF, then they are well prepared to face dealing with the decisions that come later in the journey of testing and cycles.
But does this frame of mind discriminate against the people who cannot pay for ART? Is it fair to deny them the chance to have a child because they cannot pay for the treatment? The people who would get the treatment would be the people who could pay, inevitably prioritizing the upper class, and insurance companies have never been able to regulate who becomes pregnant or is financially equipped to become pregnant in the past. However, this is exactly how everything else in life works. If I wanted a BMW but was making the wages of a cashier, I would have to REALLY want that BMW and therefore have to save for many years to afford it. Just because it may be painful and seem unfair not to have the amount of money for these reproductive treatments, it is always possible to save. And it may help you in the long run that these treatments are so expensive -- you realize how much money a baby can be, and may decide that you are not ready yet. Studies have shown that a baby costs around 11-14 K in their first year, so realizing the costs early is actually a good thing!
I guess talking about it in class brought up the more 'is this a humane way of thinking' more than actually thinking of insurance companies like they are- companies. For profit companies. They want money to pay off their stockholders and in general are comprised of businessmen and women who are primarily thinking about the financial aspect of the business when describing the rules rather than focusing on if they are offering equality across social classes in their coverage. So in this respect, our mock insurance company did a good job at focusing on the profit side of the insurance business, and some other groups did a good job of focusing on how patients would respond.

Technology Update

After class one day last week a small discussion occurred talking about the technologies we are using in this class. Many students were saying how they didn't sign up for a technology-heavy class, and they thought that the portfolios were just going to be something on the side, and not the main focus of the course. They said " I would have signed up for a web design class if I had wanted to do this much technological work". I do agree that it has been more tech-savvy than I am used to, but unlike some of my peers, I have definitely gotten a lot out of having to make a website. Even though it was tough navigating my way around Wordpress, I feel like I now have a grip on how the site is run, and I can easily make more websites like it in my future. This skill is something that a course taught purely for the purpose of web-design may not have given me, so I am grateful. However, I think that many of us are feeling lost in what Dr. Case would like on our websites, and we feel terrible with how busy she is, but we would like some more direction on how we are being graded and what we should prioritize in terms of references vs. web design vs. content vs. citations vs. class discussion research vs. blogging etc. In the end, I am trusting that Dr. Case will see the effort and grade accordingly, but I think that the layout of the grading should be defined more so that we can figure out how to allocate our time.

Born to American mom, in-vitro twins denied citizenship

Born to American mom, in-vitro twins denied citizenship
Should the in-vitro twins be given American citizenship? They do not have biological ties to America whatsoever, except that the woman was the gestational mother. So, the real question lies, does being a gestational citizen give the children that citizenship, even though they have never been to that country?
The woman is claiming that the laws are not keeping up with the technology. I would claim that if there is no biological connection to the citizen, then there should be no citizenship granted to the children. However, since in this case the children were the gestational children of the woman, they have a more legitimate case to be citizens. If by law we recognize that the gestational mother, the one that gives birth to the children, is the lawful mother, then isn't it logical that they receive the same priorities as children born from an American mother but are not from IVF?
For my media section of the website, I wanted to highlight how it describes the humiliation of IVF described in the news story;

“I have been embarrassed, humiliated, horrified, ashamed,’’ Lavi told NBC News.
When Lavi went to the U.S. Embassy in Israel to register her children, she said she was asked over a loudspeaker in a crowded room by an embassy official how she conceived the children.
“It’s an outrageous question,’’ she said, recalling the experience. She later left the embassy in tears after more questioning.

This sense of embarrassment felt by a satisfied user of IVF brings to light how women are still not comfortable with the knowledge that they have had to use ART. Clearly, they do not think that it is socially acceptable yet. Women reading this article contemplating undergoing IVF treatment may be more hesitant because they feel like they may be seen differently, and they have a reason to feel humiliated.
Along with this humiliation, new IVF users may shy away because they are afraid that the laws are indeed not keeping up with the technology. Not knowing how the law has adapted to new ART's can be scary for some, causing hesitation with having the treatments.
Soon we shall see if this situation gets figured out--whether children who are products of IVF in the future will receive citizenship of their gestational mothers.

Reporting Mistakes in ART-- Post-Class discussion

From the twitter class discussion it seemed as though a lot of people agreed that ART physicians have an obligation to tell the parents when there has been some sort of mix up or mistake in their treatment. There is really no completely good reason not to tell a couple. The only thing that comes close would be if the physician discovers late in the child's life that there was a mix up. Therefore, the family bonds would have already been deeply set, and telling the parties involved may end up being more harmful than anything, but doesn't delay the fact that the correct information should be put out into the open. I think that there should be some sort of society that all the ART physicians should join (run by physicians) that would have rules and regulations that are required to be followed by all physicians in the society. This would include a stipulation about being upfront to the patients about all treatments and mistakes, as well as safety and ethics information as well. The 'teeth' that the societies would use for enforcement could be a combination of a couple things if the misdemeanor is detected: suspension of license, permanent suspension of license, bad marks on overall report, or even the shut down of their clinic. Because this would be assigned by the peer-run society, they would have a better insight into how bad an infraction was, and they would understand the circumstances to a better degree than any state or federal mandate for ART. Right now, reporting to the CDC is voluntary, meaning a lot of information that clinics would not like the report is able to be swept under the rug. In these societies, reporting clinic information would be mandatory, and there would be more information required than was required for the CDC.
Another reason against state and federal mandates would be that it would most likely stunt the growth of these technologies. If more and more bars are put up against expanding the horizons, there will be less discoveries of new techniques and services that may have proven very helpful to the medical society of the future.
One thing that the state should have enforcement over would be patient well being, access to services and consumer protection (i.e. drug safety).

Kate mentioned something in class in terms of how physicians would handle telling the couple the truth if there was a mix up in the IVF treatments-- using a M&M Committee to be able to explain the situation and allow them to help the physician know how to go about the next steps. This would give the physician an outlet where he/she is not judged/accused, but allow him/her to get further insight into the best manner to inform the couple of the truth.

Post-Case 4 and 5 Discussion

Though we had to rush through Cases 4 and 5, the discussion in class was very tough, as these two cases were definitely the hardest for me of the 5.
Can parents be more clinical about their decisions concerning their own children's life?
I believe that the parent goes through multiple stages of teeter-tottering between being more medically minded to more emotionally minded when their child is going through life-altering treatments. First, they are solely emotional: they have little idea what is going on medically and keep that clinical decision making in the hands of the doctors. They deal with the emotional consequences and do whatever they can to save their child. Then, when things get worse, treatments get more risky, the parents begin to weigh in more of what the actual procedures are doing, and want to see how they can alleviate those treatments to make sure their child is in the best care possible. Then in terminal situations, the hardest cases, parents must use both clinical outlooks on the situation and block the emotional side, but this is the hardest stage to do. The pain and uncertainty of the child's wellbeing takes over, and many times parents can go into overdrive making sure that their child survives. In our case, case 5, the parents have employed their idea of the clinical side a little too late, and figure that it's okay to pull the plug after the physicians have said that that decision was warranted.  I hate to put this much pressure on the physicians, but when more professional medial experience says to do something, that should be the method followed, and parent autonomy should be halted. What the parents in case 5 need to understand is that they have already driven the situation so far into a painful situation for the child that they cannot turn back. They need to do everything in their power to save their child.
In the twitter discussions, parent autonomy was a popular topic, seeming to range from where on the spectrum the parents lose the ability to make decisions concerning the time of death of their child. I would question whether or not along that scale does the parent lose control of recognizing the clinical thoughts concerning their child and their decision on the overall well-being of the child: if the child is already in so much pain, why stop treatment now?
But that brings us back to the idea of when does the hospital stop paying for treatment. I would argue in that case when the doctors decide that further treatment would do nothing to further alleviate the pain of the patient, treatment should be halted.
This is obviously another case where you could go around in circles with spectrums of opinions.

Cases 1,2,3 Post-Class

Today's twitter was especially interesting, I think because we covered so many different topics in one class period. The most pertinent and interesting conversations were on the use of contracts and the use of foetal tissue for a preacher's child. In case 1, where the couple had signed 7 contracts saying the wife would have the right to use the frozen embryos was especially interesting because the contracts were thrown out of the picture in comparison to the husband's right not to reproduce. Contracts should be enforced at the embryo freezing clinics, but there should be a preface to the clients that tells them how the contracts cannot defy one's rights to reproduce/not to reproduce, as seen by all the case laws that have considered them null. After all, the contract cannot replace the possibility that the client may change his/her mind of deciding to/not to reproduce at a later time in their future. If these more complicated cases come up, it is fair that their rights be reviewed as higher in priority than the contracts signed x number of years before. But why make contracts then? As we said in class, if extraneous circumstances arise, like the death of a parent or a major court dispute, the contract can stand in as a benchmark of the client's intent at that point in time, either validating or invalidating their court case. Because of this, the more detailed the contract, the better, but the client's overall basic rights will trump if the debacle is between those who signed the contract.
The other interesting aspect of the class involved more religious undertones, so it ended up coming out more in the twitter conversations. In general it appeared as if the class was torn on the fact that the preacher and his wife decided to take the foetal tissue instead of regarding the thoughts of their parish in higher degree than their own desires. Does using foetal tissue to save your child mean that you are indirectly supporting abortion? This is the line that most of the class disagreed on. I believe that by using the tissues, you are not supporting abortion, but rather saving a life by using another's life. This is walking on a very thin line though-- if women choosing abortion knew that their actions may be used to save another's child, I bet you these women would be so happy and relieved, and their emotional pain and guilt would be alleviated to some extent. This indirectly may be helping the case for abortion, as it does not make the women feel the full extent of the guilt if their actions were merely murdur. In somewhat teh same way, a person's death is not as bad if their organs were able to save others. The death was seen as a donation, sort of, and on the surface that is what this case was dealing with.
My cases were 4+5, so we'll see how those go on Thursday!

Reflection on NICU issues

Regarding this issue, I have been having a tough time coming to terms with how my faith merges with the issues of the NICU. I know that all life is sacred, and that we were given these life saving technologies, so why not use them to save human lives? But I also know that some infant lives would not be lives unless they were constantly fixed to a machine, so does that mean we should have the right to prolong their life, even when they are painfully degenerating while on machines? I have asked my bible study leader these same questions but unfortunately I have not come to terms with how the church would feel with these issues.

I want to try to go deeper into the economics of it all. On the twitter feed, one student commented that the issue of NICU expense should have no factor into how we address these cases. While it is noble to think that we can just set economics aside and be purely moral creatures, life still goes on while the infant is being treated in the NICU, whether he/she dies or lives. If a couple is using their own money for the procedures of keeping their child alive, they should be able to go as long and far as they want with their child's treatment because they are still somewhat weighing the cost/benefits in their own minds: use up savings because my child has a 60% chance of living, or use up savings because there is a 20% chance of living, the choice is theirs and they can weigh those costs. However, when the parents are having the hospital take up the bill, a parent is solely focused on ensuring their child will live, now that finances is out of the way. Again, though this is ideal, a parent is most likely to say 'yes' to every procedure that will save the infants life, and the hospital in turn must dive into its funds, or be ridiculed for denying life saving services to a patient. This is the dilemma a hospital runs into--where do they draw the line on not allowing a parent to tell them what to use their money on? 

In these situations, I have to think about one of my friend's cousin, who was born at 24 weeks, very unstable at birth, and now miraculously is a healthy baby boy. She told me that the care for her cousin was extremely expensive, and the hospital was going to help out her aunt and uncle with the costs of treatment. I was happy about it. I think this happiness stems from the fact that a child was being saved by our recent technologies, which allow us to rescue a child who would probably have died. I was also thankful for the expertise of the physicians who were caring for him. However, now I have no doubt in my mind that these physicians probably went through a tough time deciding whether to carry on treatment or stop it all-together because the cause was futile. I hope to believe that the doctors weighed the costs in their minds, taking in the financial burden it would cost the hospital, and continued to move forward because they saw that there was still hope that the baby boy would make it out of the hospital with little to no future pain after he left-- the treatment would end at one point. 

I think that is where I would draw some form of a line in determining whether or not treatment in the NICU should be continued. If a child has a chance to live a life that is not hindered by sickness and continued treatments, physicians should use every resource they are given in order to save the child's life. Where that "chance" mathematically lies, and how to calculate that, I am ill-equipped to tell. 

I am glad that there are hospital ethics committees that can be called upon in when dealing with decisions on NICU cases, and the doctor is not the only one deciding these life changing choices.

Working with the Class Technology

Wordpress: Overall, using Wordpress has been a major learning experience for me, most of which I have enjoyed very much! Getting together with our group at the beginning I had the most interest in the website, and so I told the group that I would start looking into making the logo. Unfortunately, I have spent it seems like a fair amount more time working on the website than any of my partners, as can be seen in the tracked revisions on Wordpress. I have also had 3 private (open to the rest of my group, but no one can make it) sessions with Kristen and her Fellow to go over how to make the website more like how we would like it. I believe that it would be more profitable if the rest of my group would learn how to use the technology of Wordpress better than having to rely on me to change the structure and makeup of the website. I have also had success in meeting with Dr. Case to discuss the specific pages that I will be doing, which gave me more concrete ideas to move forward with. I have encouraged my group members to do the same, however some are not taking the initiative as much as others, and I am afraid that this will hold back the website.
I hope that we will be able to get the Resources section together so that it will not be any copyright issues... as I am very unfamiliar with that kind of stuff, and our session on copyright only helped a little.

Twitter: I love this! I like the new idea that Dr. Case had about only periodically having specific times to Tweet, and it is fun seeing the train of thoughts of other students in the class. I really want to know who some students are! Davidson Biokid has some very interesting comments that I would like to discuss further with him/her!

Blog: This certainly tops my charts on the most beneficial technology for the class. On the web now, it seems like everyone has some type of blog where they can just spew everything about crafts, fitness, food, design, diy-- whatever they are interested in; and this certainly allows me to see how awesome blogging can be! I also appreciate Dr. Case's comments on my posts, I really have something to think about after I write them, and I can improve next time! It's somewhere between a diary and a paper, you can be private, but you want to be valid in your posts, both at the same time.

Post-Class Addicted Mothers

Through all the tweets during class, it seems as if we all came back to the centering question of 'what defines whether a fetus is a person or not?' This seems to be the centering question in the class; almost all the cases deal in some way with whether the unborn is considered to have rights as a person. Basically, what defines life? This question is too controversial for the court system to address concretely, so it seems to me like every case tries to skirt around this question by addressing each persons rights separately in each situation. Though it may only solve tiny pieces of the ethics problems involving reproductive technology, it is probably the only peaceful way to address these complex and controversial issues.
Over the discussion, I was running into the mental barriers of how to decide if there should be punishments for these women, or just a standard of helping these women through treatment. I am still baffled that even though our technology has soared in reproductive technology, we still are not able to discern whether or not a child's illness is due to a mother's bad decisions. Would this have to be determined by a mother's intentions? How in the heck would you be able to judge this?
If we were only able to know the correlation between defects to mother's choices, then the government and social services would have more of an ability to enforce punishments relating to the mother's decisions. If it were related, I believe there should be some punishment. In a woman's pre-natal care, she is informed by her doctor that smoking, alcohol and drugs have a negative effect on her child. Since this is  known information to the mother, she is taking a direct choice to negatively impact her child. There is no way around it if she has been informed of possible consequences of her actions. However, in the situation we are in now, where there can be no true connection drawn between a mothers decision and the effects on her child, it is not fair to accuse a mother of child abuse with no conclusive evidence.
If there was a limit to the time period drinking/smoking/drugs was 'allowed' in a pregnancy without the threat of being charged with child abuse, it would almost be as though the government is condoning these acts during pregnancy. There should either be no regulation, or a complete regulation. The way the system is running as of now, with some cases handcuffing a woman to her birthing bed, and some cases allowing women to go about her regular addictive tendencies of drinking and smoking, these inconsistencies are confusing and put a judge's decision up in the air, different for each state.
One decisive decision should be made addressing the large questions, thus tackling smaller questions and cases.

Embryo freezing Post-Class Reflection

I thought it was very interesting how each of our mini-groups came up with different ideas of what the main issues were on regulation of these frozen embryos. Elizabeth and Kate both brought up the fact that in other issues of reproductive technology like we saw in surrogacy, contracts were almost never followed. So when discussion of contracts with frozen embryos of parents who have died or were divorced, I started to rethink my impulsive decision to write a contract like it would solve all legal problems. So since these contracts are not holding up in court, what sort of enforcement could help a couple in legal disputes? It seems to me as though because contracts are not always being enforced, couples are losing more and more of autonomous decisions.
It is coming down to pure state-law. Which should definitely be in place, I think, though the contracts an individual couple makes should still hold some value. Florida holds one of the most stringent policies on when to discard a frozen embryo: death, divorce, or an extraneous situation regarding the parties that donated the egg and sperm of the embryo. This brings up an interesting point about property though-- in the Bill of Rights, every American is entitled to their private property. The Federal court has agreed that the embryo is determined to be property, and should be legally given and adopted (if so chosen) as property. But is it "private" property? If it were, there would be a huge debacle in Florida whether or not the state is taking away your property if in a divorce you get your embryos taken away. In this sense, I would argue that an embryo is not considered 'private' any longer. The embryo belongs to the state, as it is now their decision to take the destroying of an embryo into their own hands. Where does this transfer of ownership happen then--when you decide to give your embryo to the clinic to store? When you have any form of ART? For this defense, one could argue that because an embryo could be called human life, the state has a right to decide the best interest of that embryo in relation to their capacity to store the embryos. It almost sounds to me like Florida would lean on the side of having these embryos hold some form of life in a way, in that the state feels like it holds responsibility for them.
I look forward to tomorrow's Twitter discussion in class, and I hope that I can master the ability to stay in class discussion as well as be involved in Tweeting!

Post-Class Reflection on Traditional and Gestational Surrogacy

Reasons for wanting to be a surrogate probably stem from a biological connection to the intended parents, desires to be pregnant, and monetary incentive. Each one of these can be used against a surrogate and can be used as blinders to the logistical and legal act of surrogacy. Whether a woman's decisive and impulsive desire to help her homosexual brother and his partner through surrogacy, to want to be pregnant, or to have a little extra cash, these incentives may lead her to overlook some of the important issues that come up during surrogacy. What will happen if she becomes attached to the child? How does she get paid 'fairly' for her services? What if she enters into unhealthy habits during pregnancy? How can she be reprimanded for a breach in the contract?
Contracts should be as thorough as possible to avoid as many legal mishaps during/after the pregnancy as can be. But what about verbal contracts that happen to protect the surrogate's ethical standing, as in the Beasley case? Whose decision is it during the pregnancy whether or not to end the pregnancy? The surrogate is being paid for her 'services', not her eggs, or any other form of nurturing. Thus, the intended parents should have full rights to determine PNI, and all abortion/reduction decisions, but only to the extent to which it does not harm the surrogate mother. After all, they do not have control over her body, only what can be done to their child. This is intact with the California law which gives parental rights to the intended parents, not the surrogate. However, I do think that it should be left up to the states to determine which rights the surrogate is allowed. This would allow surrogates who disagree with certain issues (reductions, PNI, decision making) to still be able to be a surrogate without disregarding the idea because of the regulations of a clinic.
Dealing with the price of surrogacy, women should be paid equally for their services of surrogacy. I do think that 'bonus's' will most definitely be given to women under the table if they agree to live to a certain lifestyle or agree to the intended parents desires, but logistically, the government will never be able to regulate that risk. It is more important to hold the standard of equality initially, then not condone, but not punish those who would like to go beyond the cost to ensure their surrogate's pregnancy plays out like they want.

Gestational and Traditional Surrogacies

With all the drama and ethical issues surrounding surrogacy, I definitely had to do some research to determine my position on it. But first, the two issues at hand.
Baby "M" case: The interesting thing about this that struck me was how a traditional surrogacy brings such a stronger case to how the genetic mother might be seen to have legal rights. In this instance, Mary Beth was the traditional surrogate for the Stern family, and signed a contract with them to 'be inseminated with Mr. Stern's sperm, to carry the baby, and the give the baby up.' Because this was only 4 years after the first paid traditional surrogate case, the contract situation was still in the early stages of having a set foundation, thus was shaky compared to the contracts used today. Likewise, Mary Beth was easily written off as psychologically 'ok' to commit to this surrogacy, even though after the fact, her mindset seemed quite unfit to have entered into the situation with the Stern family.
Basically, this was one whole tug of war story, intermittently spattered with drastic actions taken on both sides. Mary Beth takes the child, the Sterns get Judge Sorkow to issue an ex parte order and seize the baby from Mary Beth, Mary Beth threatens the Sterns over the phone, takes baby with husband and flee, I was at the library, literally laughing out loud when I read more and more of the story.
I believe that the Sterns were in the right in this situation, even though Mary Beth would argue that she was misinformed about the procedure, not knowing whose egg and sperm were being used. This is pure idiocy. Pregnancy is a major thing, something that I think a lot of people take too lightly. She may have thought she was ready to enter into this surrogacy, but if she seriously didn't understand how the baby would be her biological child and that in signing the contract she would essentially be giving away her daughter, then her own ill-informed self is to blame. I am glad that now in certain states, these contracts are entered into after complete understanding between the parties involved. These contracts are very lengthy, but cover all bases in terms of medical care, intent, and plans during and post-pregnancy.
After the "Baby M" case, NJ and Michigan passed laws banning commercial surrogacy, and now traditional surrogates are not compensated for delivering a live child, but for being pregnant, and now the baby is the legal child of the intended parents prior to birth. These new laws definitely cover the problems that were addressed in the 1984 case.

Similarly, the case of Beasley vs. Wheeler poses questions about abortions and contact with the intended parents. My big concern with this situation is how the parties agreed any abortion would occur before 12 weeks, and at 24 weeks (after the intended parents were finally reachable from being abroad) they decided to reduce the pregnancy. Unfortunately, this agreement was only verbal, holding no court value. I am completely morally against reductions, and I hate it when people are hard to get in touch with, thus, I have to side with Beasley in this case. However, since the Wheelers had only verbally confirmed this 'reduction before 12 weeks' commitment, they are technically in the right. What can I say, more than THESE CONTRACTS NEED TO BE THOROUGH FOR GOODNESS SAKES!!!! Life throws you some pretty crazy situations that may change your mind over 9 months, and without these detailed contracts signed before the pregnancy, these types of cases become main stream media, causing dread to all families involved, making the child a major news story at birth.

When should traditional and gestational surrogacy happen? In my opinion-- never. I am religiously and ethically against any form of surrogacy because I think that it is disrespectful of a child's dignity, having the child question their identity as they grow up because surrogacy can get so darn confusing and emotionally involved. "Who is my mother?" "Did my parents love each other when I was conceived?" "If my mom is my aunt, should I think of her in a different light?" "Are my cousins my half brothers/sisters?" I believe that I will be repeating my self a fair amount in this blog when I say that a child should be conceived with the intention of conceiving, between a man and a woman who are sexually involved though marriage as an act of love for one another. Surrogacy undermines both those constants for me.
However, if I were to remove those ideas from my decision making, I would argue that traditional surrogacy should happen if the couple is LGBTQ and the surrogate is genetically bonded to the intended parents.

Post-Humous Reproduction Debate: Social Security Commissioner

Things that I am now sure of after this debate: More information and more points of view only make these topics more confusing.
In this simulation, I played the part of a Social Security Commissioner, on the pro-limitations side to post-humous reproduction. From the governmental/economical aspect, post-humous reproduction only poses financial problems when discerning whether or not a woman is getting pregnant with the sperm of a dead man. Does she really feel like he would want her to be using her sperm? If so, does that mean that the child is 'dependant' on the man, thus receiving benefits from his side? How long can one be allowed to wait before the frozen sperm is used?
Being part of the government, I obviously leaned on the side of strict consent and regulations before one would undergo post-humous reproduction. What if the man did not want his sperm to be used? Problems that arise from this type of reproduction can be limited if there is layers and layers of consent, a notion that the couple was trying to have a child before a partner's death (trying for IVF), and a time limit on the usage of the sperm. In my position, I am just trying to make sure that every one's rights are recognized.
In the 'pro-restriction' group, it was difficult to come up with a generalized regulatory standard that we all agreed on since we had a couple religious leaders on our side (Catholic priest and a Presbyterian priest). The legal characters, like myself, could not be influenced by moral or religious sways, because we could only represent justice and humane rights, including autonomy.
This exercise was helpful because I had to delineate the different roles in my head, taking each person as one mindset, focusing on certain issues and completely disregarding others. I will have to be able to turn off some parts of my brain for some parts of analysis, but still keep my personal views intact.

A Recent Podcast

 



I recently was listening to a Catholic podcast "Catholic Underground" and came across one 'Life is Still Worth Living' on 2/2/12 about contraceptives and the religious views on them. I thought that the speaker was incredibly effective in his delivery and evidence against using any form of contraception. I even forwarded this to a few of my Protestant friends to listen to!

Age Limits To Motherhood?

In 2005 a 66 year old Romanian professor Adriana Iliescu chose to have IVF and gave birth to a child via emergency Cesarian section. Ever since this case, age limits to ART have been popular debate, causing individual clinics to differ on the way they regulate and enforce limitations. Arthur Caplan addresses this particular case in his MSNBC article 'How Old is Too Old to Have a Baby?' from 2005. Taking a strong stance against these 'granny-moms', he reports "there was a terrible price to pay for using reproductive technology to make a 66-year-old woman pregnant". Statistically any pregnancy for a woman over 40 is considered 'high risk', and in Adriana's case, caused her to have a premature baby. Caplan brings up the problems that result from these unrestricted age treatments: the mother will not be able to physically take care of the child, as she will need looking after soon; the baby has intensified risks during the pregnancy, and the pregnancy is very stressful on such an old body. He proposes state regulation should enforce an age restriction of  65 years old for single women to have a baby through ART, and if in a relationship the total years should not exceed 130. Anyone near 55 years of age must pass a physical examination. 

 The chapter "From Legalization to legislation: Race and Age as Determining Factors" taken from Jose Van Dyck's book Manufacturing Babies and Public Consent  covers a couple topics relating to social restrictions: post menopausal pregnancies, transracial impregnation, and foetal pregnancies. He gives an interesting statistical approach to age restrictions for ART. Technologies now make it possible for ages to have the capacity to gestate and deliver babies using egg donation and oocyte transplantation, causing increased success rates in older women. So now, clinics which were once holding back from fear of decreasing overall success rate are now more inclined to provide assistance to these older women. Who wouldn't want that extra income from an older, wealthier couple, desperate for a child? Grandmothers have always had a role in childrearing, and provide as much love as any young mother, right? Van Dyck doesn't give an answer to the question of age-regulation, but ends the chapter commenting on the difficulty on clinic enforcement especially since denying access would decrease revenues. 

Our technology is getting so advanced that not even the idea of decreased success rates can scare a clinic into creating an age policy, it now relies on the initiative of a clinic's individual preference to set the standards of regulation. I believe that if a woman has hit menopause, they should not be given any form of ART. because at that point, God is indirectly telling them that they are not naturally meant to reproduce any longer. This should be a federally mandated restriction, as it would be their responsibility to pay for the child and/or mother who may suffer any consequences of such a late pregnancy. 

I believe that I have formed these opinions due to my brother having been born so late in my mom's life. In her situation, there was nothing wrong with her becoming a mother again because it happened naturally. However, when a woman has had menopause for over 15 or 20 years, her biological clock has told her she is not physically able to carry out the pregnancy and become a mother. If under some unusual circumstances an age of menopause is in question, the default should be the average age of 51 years. 


Post-Class Discussion
I found our class discussion on the different topics very held back and reserved. I would love to have an intense debate with one another in an anonymous setting, as I felt like I had to hold back a few things because of what I believed religiously. Especially in my group discussion on age, I could not see how it would be possible to have a non-mandated policy on age if you had any thought that age in fact posed a problem in ART treatment. I briefly touched on my religious beliefs, but when our group tried to combine our views to create a unified decision on regulation, we could not mix. I hope that my religious views will not offend anyone, because I definitely will not be cutting down on what I want to convey about what I think is right and wrong. 
Everyone's various scholarly articles were very helpful when we needed to back up our position with evidence and statistics. I think that having the RefWorks account with the various articles posted on it will be very helpful in the future for our websites. I just hope that people remember to put up the article summary for their source! 

Infertility and Ethnicity

The notion of 'access' implies that there is a certain need, demand and supply of a product or service. A more appropriate term when discussing ART's is an 'equitable service'(Culley). This is defined as a service that provides equal access for an equal need. When looking at the 'needs' of individuals seeking reproductive technology services, a discerning factor is the race of the individual. Data from a national survey found that 10.5% of Blacks, 13.6% of Hispanics, and 6.4% of Caucasians reported infertility out of 10,847 women (Jain, 2006). But does this match the social stereotypes of family sizes? In the media, black and hispanic families consist of multiple generations with multiple children, which most definitely play a part in the common notion that black and hispanic females may be more fertile than whites. Because of this stereotype of fertility, many would argue that blacks and hispanics have this limited cultural access to ART due to the stigma of being infertile. 

I don't think that this is something that we can deliberately change, but it is interesting to see how jokes, pictures, tv shows and the news can portray one set of racial ideals that may be making it taboo for women of some races feel comfortable to use ART. 

Minutes in the mind of a Fertility Doctor

I have recently been studying the various barriers that can block the way for women and men in our society to receive assistance on becoming pregnant. Throughout the US and the world, people are being denied fertility treatment based on marital status, sexual orientation, ability to pay, and other discriminatory factors. In late 2005 and early 2006, legislation in Indiana and Virginia prohibited providers from offering any conception procedure to an unmarried woman (Schneider, Assisted Reproduction Bill Dropped, Indianapolis Star, Oct. 6, 2005). The politically correct knee jerk reaction is to be offended by these realities: how is this happening in our society-- we are all supposed to be treated equally! Even though I know I should be whole-heartedly behind that train of thought, I am not. Truthfully, I am slightly against the thought of an unmarried couple wanting to have fertility treatment. If I were the fertility doctor posed with the case, you bet that in the back of my mind I would be saying, "Most likely, this relationship is not going to last. Especially after the emotionally trying times of fertility treatment. If this woman gets pregnant with my help, I will aided bringing a child into a most likely single-parent home."THAT would be the first knee jerk reaction for me; the 'equal rights for all'/'don't judge' notion would follow.
But then it dawned on me to compare this to natural conception. There are children born every second to homes that many would not approve of, or think that it is an 'optimal' setting. Yet, no one has the right to tell them that they cannot procreate, or dare to think that they shouldn't have been born. Heck, we can believe all we want that it's not great that kids are born to families of criminals, prostitutes, drug dealers, or even to 16-year-olds-- yet it happens and the public doesn't think its morally wrong not to have any say. Why in the situation of fertility treatments I would mentally determine the couple's 'eligibility' to have children? Talk about double standards.

Dr. McIntosh 1/26/12

The science behind reproductive technologies continues to astound me. Recently I have been focusing on the more social and ethical aspects of reproductive medicine, without fully understanding the science techniques that are making it all possible. Though some of it was still a little above my head, I understood how many different variations there could be on a procedure to become pregnant. Clomiphene citrate, Gonadotropins, GnRH Pumps, Interuterine Insemination IUI, and many more-- all give a viable way for reproduction.  

One technique started making me think of the ethical aspects that I have been researching. The ICSI (Intra Cytoplasmic Sperm Injection) technique literally forces the sperm into the egg via a needle. Is this crossing an ethical line? Instead of allowing the most able sperm to "win" entrance into the egg for fertilization, a possible sign of sperm strength, there is a deliberate join. Would a couple trying for pregnancy even think of what the procedure actually is, or would they just see it as a successful option for becoming pregnant? I would hope that many couples would think of the ethical implications each option gives, but then again, if I was in their place I would probably view the prospect of a successful pregnancy much higher in importance than chancing it on other less successful reproductive techniques. 

Anticipating Dr. McIntosh's Talk

I believe that I have heard Dr. Robert McIntosh talk once before in an event held last semester. It was actually a discussion hosted by the pre-medical society of Davidson, interestingly named almost exactly after this class. He brought of a multitude of questions that I am continuing to delve into concerning reproductive medicine. His knowledge of the laws and practices of these technologies astound me, and encouraged me to learn as much as I can on this subject that is very touchy, yet pivotal to our existence as human beings.
In his past talk, he mentioned facts about surrogate motherhood, the laws behind IVF, stories of abortions and treatments, unbelievable ethical situations, and much more talk that had me questioning what I believed. I guess that is why I have already probably been the only one to have a few posts on subjects that I have found interesting. Why am I so interested in this? The only connections I can clearly draw are a) my brother was basically a miracle child, and b) my mom works at Birthchoice as an ultrasound technician.

Now about the class in general-- I am so thrilled that I can't even explain myself. This is the first time BY FAR that I have gone out of my way to do (quite intense) research outside of class, have hour-long conversations with my friends about the articles and books that I have read, and been reading online journals about reproductive medicine while eating my oatmeal in the morning. It's really awesome how I can email and call my mom to discuss the topics I find astounding and ridiculous, and hear her perspective on them, religiously and medically.

I'm excited to find out what semester holds!!

"Reducing" Twins

Since Group 3 is to study how societal pressures impact our use of reproductive technology, I found it very interesting to learn more about twin 'reduction', and even more fascinating to understand the viewpoint of those who are pro-choice on this subject. In Jennifer Fulwiler's August article What Pro-Choice Intellectual Honesty Looks Like, there are opinions on twin reductions from pro-choice individuals who are struggling to determine whether or not they believe this is moral or not. It is unusual how they have no trouble with killing one fetus, but they don't necessarily agree with twin reduction. The way I see it, killing is killing. Is not creating a child a miracle in itself, regardless of whether it was done artificially or naturally?
Apparently, parents choose this option largely based on economical reasons of supporting two children instead of the anticipated one. They thought that they could afford one child, but two would be way too much stress on them and their pocketbooks. My question is: if they were willing to spend between $12,000-$15,000 for one session of IVF, shouldn't they have been so incredibly dedicated to having the chance to have a child that they would be even more overjoyed to be blessed with two, regardless the financial cost?

"Good" and "Bad" Websites

For a well formatted website, I would choose Comixed.com. Though commonly used by high-schoolers and those looking for a quick joke, it exemplifies aspects of a "good" website. Because it covers such a wide area of comics, the key to this website is organization. Along the top navigation bar lies many tabs and toolbars, which prove very useful when browsing the various comics on the site. For those who know what they are looking for, the right hand navigation bar provides particular content areas that narrow the user's search even more. The search bar and the log-in area are easily accessible, the ladder making it more likely for users to become members. My only complaint would be the placement of advertisements on the web page. They significantly hinder the usability of the page, making navigation a hassle.
An unformatted website, though addictive, is Pinterest. This site has become my latest obsession, and is quickly spreading to women all over the US. The idea of the website is simple, thus the page is simple: pictures that lead to links-- little to no format required. It is equipped with 4 drop down menus and a search bar. Because this page is so simple, it leaves the focus on the endless stream of pictures flowing down the page. Although this is not technically "unformatted", it is surely very minimally formatted, thus may seem to be hard to navigate for some. I end up using the search bar for almost everything I am looking for. But BEWARE: if you are a female about to enter Pinterest for the first time, make sure you are prepared to be hooked!!!

New York Times article regarding the LGBTQ community
Another question about access to reproductive medicine-- to people of all sexual orientation? Should one couple be chosen to have IVF over another same-sex couple?

Jose van Dyck's "Manufacturing Babies and Public Consent"

Yes, I became a little over-ambitious with this class and decided to look up all E.H. Little had to offer concerning reproductive medicine. Foraging through the stacks in the library I finally discovered the nook of books that pertained to our particular field of study: the ethics behind it all. I checked out three of the books, but have only looked at a chapter in Manufacturing Babies and Public Consent by Jose van Dyck. A chapter labeled "From Legalization to Legislation: Race and Age as Determining Factors" caught my eye particularly for information for the next in-class discussion.

It described three instances in the mid 1990's that sparked new thought on who has the right to IVF. Firstly, a 63 year old woman who was denied in Britain, but underwent IVF in Italy and later had a set of twins. Secondly, a black woman in Britain who underwent IVF with a white fetus because the bank was very low on eggs. Thirdly, in extenuating circumstances, eggs from aborted feotuses that are extracted and used to help infertile women become pregnant. 

Holy Cow!!! I was so flabbergasted by these conundrums that I finished off another two chapters in this book, later overflowing in conversation to my roommate. 

Using eggs from aborted fetus'? Isn't that kinda gross? Well, it is a baby after all; a human being... but still, who would want that? Someone who is desperate? Isn't everyone who has IVF desperate? But how desperate to be willing to take eggs from an aborted fetus? 

Wow. This will be one great book.