Imogen Goold

In favour of freezing eggs for non-medical reasons.

This article explores the social benefits and moral arguments in favour of women and couples freezing eggs and embryos for social reasons. Social IVF promotes equal participation by women in employment; it offers women more time to choose a partner; it provides better opportunities for the child as it allows couples more time to become financially stable; it may reduce the risk of genetic and chromosomal abnormality; it allows women and couples to have another child if circumstances change; it offers an option to women and children at risk of ovarian failure; it may increase the egg and embryo pool. There are strong arguments based on equal concern and respect for women which require that women have access to this new technology. Freezing eggs also avoids some of the moral objections associated with freezing embryos.

Must the Surgeon Take the Pill? Negligence Duty in the Context of Cognitive Enhancement

Recently, attention has turned to the possibility of enhancing human cognitive abilities via pharmacological interventions. Known as ‘cognitive enhancers’, these drugs can alter human mental capacities, and in some cases can effect significant improvements. One prime example is modafinil, a drug used to treat narcolepsy, which can help combat decreases in wakefulness and cognitive capacity that arise due to fatigue in otherwise healthy individuals. In this paper, we respond to calls in the philosophical and ethical literature that surgeons and other medical professionals should be morally obliged to take cognitively enhancing drugs. We examine whether surgeons who make fatigue‐related errors during patient care might be considered legally obliged to enhance themselves. We focus on liability for a failure to medicate, and conclude that it is highly unlikely that surgeons will be legally obliged to address their fatigue through the use of cognitive enhancing drugs.

Freezing Eggs for Lifestyle Reasons

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Should older and postmenopausal women have access to assisted reproductive technology

In vitro fertilisation and other assisted reproductive technologies (ART) now enable many women to have children, who would otherwise have remained childless. The most obvious application for these technologies is to help physically infertile, but otherwise healthy young women to have children. However, increasingly, other groups are seeking access to ART to conceive, raising ethical questions about who should be allowed to use these technologies to bear children. In particular, the question of access to ART by lesbian couples and single women has roused considerable ethical, legal and public debate.This paper examines the perhaps less often considered issue of older and postmenopausal women, who are infertile due to age, using ART to conceive. A range of objections have been made to allowing these women access to ART, including concerns about their ability to care for the child, the risk of birth defects and the ‘unnaturalness’ of extending childbearing capacity beyond the menopause. This paper examines these objections and provides some responses.

Why does it matter how we regulate the use of human body parts

Human tissue and body parts have been used in one way or another for millennia. They have been preserved and displayed, both in museums and public shows. Real human hair is used for wigs, while some artists even use human tissue in their works. Blood, bone marrow, whole organs and a host of other structures and human substances are all transplanted into living persons to treat illness. New life can be created from gametes through in vitro fertilisation (IVF), while the creation of cell lines keeps tissue alive indefinitely. These uses create significant challenges for the legal system in the UK. The major challenge for the law is to balance the competing demands of those groups who have vested interests in human tissue—researchers, medical practitioners, patients, families, the community and the police, among many others. It must provide sufficient control to users of tissue, but also take account of the fact that our bodies hold psychological importance for us while we live and, after we die, for those we leave behind. To some degree the law has been successful, but we still lack a comprehensive, coherent approach to the regulation of human tissue. Partially as a reaction to this lack of a comprehensive approach, some commentators have turned to applying the concept of property to human tissue means to achieve regulatory outcomes they support.

Quality and safety of genetic testing in Australia and New Zealand: a review of the current regulatory framework

This paper provides an overview of the regulation of quality assurance for genetic testing in Australia and New Zealand and outlines the steps currently being taken to critically appraise and improve the regulatory framework in each country. It aims to contextualize this framework within the broader context of quality and patient safety concerns; and to draw together the concerns and recommendations of the various organizations that have been working to improve quality assurance in this area.

The human body as property? Possession, control and commodification

In the wake of three high-profile judicial decisions concerning the use of human biological materials, the editors of this collection felt in 2011 that there was a need for detailed scholarly exploration of the ethical and legal implications of these decisions. For centuries, it seemed that in Australia and England and Wales, individuals did not have any proprietary interests in their excised tissue. Others might acquire such interests, but there had been no clear decision on the rights or otherwise of the persons from whom the tissue was obtained. In 2009, however, the Court of Appeal of England and Wales recognised a limited exception to this position in Jonathan Yearworth and others v North Bristol NHS Trust (2009). In that case, the Court held that the appellants, who had deposited semen samples for freezing before they undertook treatment for cancer, had “for the purposes of a claim in negligence … ownership of the sperm which they had ejaculated”. One year later, the Supreme Court of Queensland, Australia, took a similarly property-based approach to determining how a semen sample stored shortly before death should be dealt in Bazley v Wesley Monash IVF (2010). According to that court, the co-executors of the estate had sufficient proprietary interests in the semen to legally demand its return from the laboratory where it was held. In 2011, the New South Wales Supreme Court similarly found that the widow of a recently deceased man had a right to possession of his semen in Joceyln Edwards; Re the estate of the late Mark Edwards (2011). In the editors’ view, these decisions signalled a turning point in the Anglo-Australian jurisprudence in this area, taking the law a step beyond the decisions of the late 20th century such as R v Kelly (1998), in which possessory rights were found …

OBLIGING SURGEONS TO ENHANCE: NEGLIGENCE LIABILITY FOR UNCORRECTED FATIGUE AND PROBLEMS WITH PROVING CAUSATION

Increasing interest in the use of cognitive enhancing pharmaceuticals, such as modafinil, has led to considerable ethical debate about issues around authenticity, fairness and even whether there is a moral obligation to enhance. This latter question has raised questions as to whether there might be a legal obligation to enhance. We have argued elsewhere that the law will not oblige a professional to self-enhance. In this article, we explore a second reason why a claim of negligence for a failure to enhance would be unlikely to succeed: the problem of establishing causation. As the science on enhancers and what they are capable of currently stands, it would be almost invariably impossible to establish a causal link between failure to enhance to redress fatigue, and the harm that allegedly resulted. Even where a link between fatigue and harm can be established, it will be extremely difficult to show that taking an enhancer would have averted the harm. We focus on the most likely context in which such claims might arise--clinical negligence--and on the most efficacious enhancing drug currently available-modafinil.

Withholding artificial nutrition and hydration

This special issue, Withholding artificial nutrition and hydration , comprises several papers, commentaries and responses centred largely around the issues raised by the 2011 decision of the English Court of Protection in W v M .i In that case, the mother of an adult patient applied for the withdrawal of life-sustaining treatment (specifically, artificial nutrition and hydration). In 2003, the patient, M, had contracted viral encephalitis and suffered irreparable brain damage as a result. She fell into a coma, and when she emerged appeared to be in a vegetative state and for 8 years was entirely dependent on life-sustaining care. Following her mothers application, M was held to lack capacity and hence in accordance with section 4 of the Mental Capacity Act 2005 (MCA), the matter turned on whether it was in her best interests for the treatment to be withdrawn. It was made clear in the 1993 decision of Airedale NHS Trust v Bland that life-sustaining treatment could be withdrawn from a patient in a permanent vegetative state (PVS) if, on balance, it was not in his or her interest to continue treatment.ii The MCA also allows for withdrawal of treatment, although the approach to best interests is slightly different. However, the case of W v M is importantly different from the Bland case, because M was found not to be in a PVS, but instead was minimally conscious (MC). Much evidence was presented of her capacity to respond to stimuli, seemingly express emotion and occasionally speak. In the first of his papers in this issue ( see page 543, Editors choice), Julian Sheather provides an overview of the case, particularly illuminating the discussions of Ms interests and the views of her …

Trust women to choose: a response to John a Robertson's ‘Egg freezing and Egg banking: empowerment and alienation in assisted reproduction’

Abstract In ‘Egg Freezing and Egg Banking: Empowerment and Alienation in Assisted Reproduction’, John A Robertson responds to the American Society of Reproductive Medicines statement that oocyte preservation should no longer be considered an experimental treatment. He explores the implications of this development, focusing on the potentially empowering impact of oocyte preservation as a means for women to preserve their fertility. He also engages with concerns about the possibility that such a development may raise issues of alienation. He highlights some of the potential problems that may emerge as women gain the capacity to store and either donate or sell any eggs they do not need for their own reproductive purposes. Much of his paper is valuable and considered, but in places, his views rest on assumptions about womens attitudes to their fertility, understanding of the technology, and relationship with their gametes that are open to dispute. This paper teases out some of these assumptions and puts pressure on them by drawing on the growing body of data about what women actually do think and feel about fertility issues. It focuses on two of his main concerns—that social egg freezing may give women a false sense of security and that women may be harmed if a market in eggs leads to their alienation from their gametes. Via this response to Robertson, I aim to redress the tendency often seen in discussions around women, infertility, aging, and empowerment to unquestioningly accept what I argue are stereotypes and assumptions about womens views and capacity to reason.