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.