Daniela Cutas

Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

Postmenopausal motherhood: immoral, illegal? A case study

The paper explores the ethics of post-menopausal motherhood by looking at the case of Adriana Iliescu, the oldest woman ever to have given birth (so far). To this end, I will approach the three most common objections brought against the mother and/or against the team of healthcare professionals who made it happen: the age of the mother, the fact that she is single, the appropriateness of her motivation and of that of the medical team.

Artificial gametes: perspectives of geneticists, ethicists and representatives of potential users.

Abstract Several threads of research towards developing artificial gametes are ongoing in a number of research labs worldwide. The development of a technology that could generate gametes in vitro has significant potential for human reproduction, and raises a lot of interest, as evidenced by the frequent and extensive media coverage of research in this area. We have asked researchers involved in work with artificial gametes, ethicists, and representatives of potential user groups, how they envisioned the use of artificial gametes in human reproduction. In the course of three focus groups, the participants commented on the various aspects involved. The two recurring themes were the strength of the claim of becoming a parent genetically, and the importance of responsible communication of science. The participants concurred that (a) the desire or need to have genetic offspring of one’s own does not warrant the investment of research resources into these technologies, and that (b) given the minefield in terms of moral controversy and sensitivity that characterises the issues involved, how information is communicated and handled is of great importance.

Preserving children’s fertility: two tales about children’s right to an open future and the margins of parental obligations

Abstract The sources, extent and margins of parental obligations in taking decisions regarding their children’s medical care are subjects of ongoing debates. Balancing children’s immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children—and indeed in some cases taking such actions is problematic.

Postmenopausal Motherhood Reloaded: Advanced Age and In Vitro Derived Gametes

In this paper we look at the implications of an emerging technology for the case in favor of, or against, postmenopausal motherhood. Technologies such as in vitro derived gametes (sperm and eggs derived from nonreproductive cells) have the potential to influence the ways in which reproductive medicine is practiced, and are already bringing new dimensions to debates in this area. We explain what in vitro derived gametes are and how their development may impact on the case of postmenopausal motherhood. We briefly review some of the concerns that postmenopausal motherhood has raised—and the implications that the successful development, and use in reproduction, of artificial gametes might have for such concerns. The concerns addressed include arguments from nature, risks and efficacy, reduced energy of the mother, and maternal life expectancy. We also consider whether the use of in vitro derived gametes to facilitate postmenopausal motherhood would contribute to reinforcing a narrow, geneticized account of reproduction and a pro-reproductive culture that encourages women to produce genetically related offspring at all costs.

On triparenting. Is having three committed parents better than having only two

Although research indicates that single parenting is not by itself worse for children than their being brought up by both their parents, there are reasons why it is better for children to have more than one committed parent. If having two committed parents is better, everything else being equal, than having just one, I argue that it might be even better for children to have three committed parents. There might, in addition, be further reasons why allowing triparenting would benefit children and adults, at least in some cases. Whether or not triparenting is on the whole preferable to bi- or monoparenting, it does have certain advantages (as well as shortcomings) which, at the very least, warrant its inclusion in debates over the sorts of family structures we should allow in our societies, and how many people should be accepted in them. This paper has the modest aim of scratching the surface of this wider topic by challenging the necessity of the max-two-parents framework.

Life extension, overpopulation and the right to life: against lethal ethics

Some of the objections to life-extension stem from a concern with overpopulation. I will show that whether or not the overpopulation threat is realistic, arguments from overpopulation cannot ethically demand halting the quest for, nor access to, life-extension. The reason for this is that we have a right to life, which entitles us not to have meaningful life denied to us against our will and which does not allow discrimination solely on the grounds of age. If the threat of overpopulation creates a rights conflict between the right to come into existence, the right to reproduce, the right to more opportunities and space (if, indeed, these rights can be successfully defended), and the right to life, the latter ought to be given precedence.

Writers Blocked: On the Wrongs of Research Co-authorship and Some Possible Strategies for Improvement

AbstractThe various problems associated with co-authorship of research articles have attracted much attention in recent years. We believe that this (hopefully) growing awareness is a very welcome development. However, we will argue that the particular and increasing importance of authorship and the harmful implications of current practices of research authorship for junior researchers have not been emphasised enough. We will use the case of our own research area (bioethics) to illustrate some of the pitfalls of current publishing practices—in particular, the impact on the evaluation of one’s work in the area of employment or funding. Even where there are explicit guidelines, they are often disregarded. This disregard, which is often exemplified through the inflation of co-authorship in some research areas, may seem benign to some of us; but it is not. Attribution of co-authorship for reasons other than merit in relation to the publication misrepresents the work towards that publication, and generates unfair competition. We make a case for increasing awareness, for transparency and for more explicit guidelines and regulation of research co-authorship within and across research areas. We examine some of the most sensitive areas of concern and their implications for researchers, particularly junior ones, and we suggest several strategies for future action.

Families - Beyond the Nuclear Ideal

This book examines, through a multi-disciplinary lens, the possibilities offered by relationships and family forms that challenge the nuclear family ideal, and some of the arguments that recommend ...

Sex is over-rated: On the right to reproduce

In this article, I will show what is respected most in human reproduction and parenting is not a right to reproduce in the way in which this right is explicitly proposed. The only way in which people can become, and function as, parents without having to submit themselves to anyone elses judgements and decisions, is by having reproductive sex. Whatever ones intentions, social status, standard of living, income, etc., so long as assistance is not required, that persons reproductive decisions will not be interfered with in any way, at least not until neglect or abuse of their offspring becomes known. Moreover, none of the features that are said to back the right to reproduce (such as bodily integrity or personal autonomy) can justify ones unquestioned access to the relationship with another unable to consent (the child). This indicates that the discourse in terms of the right to reproduce as is currently used so as to justify non-interference with natural reproduction and parenting coupled with the regulation of assisted forms of reproduction and parenting, is at best self-deluding and that all it protects is peoples freedom to have reproductive sex and handle the consequences.