Mary B. Mahowald

Maternal-fetal surgery for treatment of myelomeningocele

Maternal-fetal surgery for repair of fetal MMC is experimental treatment for which ethically justified clinical trials are not yet possible because equipoise is not established on medical or nonmedical grounds. We have focused here on only two of the important questions raised by this surgery. At least three others might have been considered. First is the question of access to the surgery. MMC is available only to those who can afford it. Given its poor results, that may be a good thing. However, if it were ever proved successful, it should be covered for the poor and affluent women who desire it. Second is the question of the autonomy of the women who seek the procedure. Although the women who undergo the surgery at Vanderbilt are counseled extensively by bioethicists, the autonomy of their decisions may be compromised by pressures from partners or others who think that any risk for the sake of a potential child is fully warranted. Third is the issue of potential discrimination against people with disabilities. Seeking or providing surgery that introduces the risk of fetal demise, a risk that could be avoided by postponing the surgery until after birth, suggests that life with disability is regarded as worse than death. Each of these questions deserves careful, critical analysis in its own right. Along with those addressed in this article, these issues are applicable to other ethical issues in perinatology, including those examined by other contributors to this issue.

Gender justice in genetics.

The focus of this issue of Women’s Health Issues is on women. We have attempted to identify aspects of the new genetics that particularly affect the majority of the human community who are phenotypically female and to examine whether the impact of the Human Genome Project (HGP) on them is likely to promote justice in general and gender justice in particular.

An overview of the human Genome project and its implications for women

The Human Genome Project (HGP) is a worldwide effort to map and sequence the genetic make-up of human beings. A genome is a complete copy of the genetic material of a specific organism. To map the human genome means to locate each of approximately 100,000 genes on our 24 different chromosomes. Sequencing refers to the determination of how four nucleosides (adenosine, guanosine, cytodine, and thymidine) are arranged within our strands of DNA (deoxyribonucleic acid) to direct the production of RNA (ribonucleic acid) and proteins for specific functions. The study of model organisms is included in the HGP as a means of facilitating the

The President's Council on Bioethics , 2002-2004 an overview

The Presidents Council on Bioethics, headed by Leon Kass, was created by President George W. Bush to advise the President on issues of ethical import raised by advances in biomedical science. Between 2002 and 2004, members of the Council from diverse disciplines addressed topics such as human cloning, stem cell research, assisted reproduction, and medical interventions intended to enhance human capability or appearance. This article provides background on the Council and reviews its published reports. It also considers key definitions and distinctions, specific recommendations of the Council, and positions articulated by members who contributed to the development of its reports.

On helping people to die: a pragmatic account.

Here is the doubt that triggers my inquiry: I have two beliefs that are apparently at odds. The first is that we should never kill; the second, that we should always attempt to alleviate pain. The apparent conflict between these beliefs arises from the fact that death may constitute the ultimate pain relief.

Babies by (Intelligent) Design

Advances in reproductive technology and genetic interventions raise questions about the possibility of using these procedures to promote the birth of children with socially advantageous conditions. In Babies by Design, Ronald M. Green supports this goal and accuses its opponents of a “status quo bias.” Unfortunately, some of Green’s own arguments also show a status quo bias. Moreover, although he attempts to avoid the thorny issue of the moral status of human embryos, he implicitly takes a stand on it by endorsing prenatal interventions that inevitably entail the creation and loss of some human embryos. This essay identifies these and other flaws in Green’s account.

Choosing Children: The Ethical Dilemmas of Genetic Intervention (review)

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Designing Our Descendants: The Promises and Perils of Genetic Modifications (review)

and the simultaneous, independent, and virtually identical analysis of Alfred Russel Wallace that forced Darwin to publish so as to secure priority—these and other well-known points constitute the elements of the standard historiographical view that the sources of Darwin’s Origin of Species (1859) lay in the common context of a set of intellectual and social values and political economic interests. It is this standard interpretation that Richards rejects. Instead, he argues that Darwin was enamored of Humboldt’s organic, nonmechanistic view of nature, of a cosmos bubbling over with life; that he favored the theory of archetypes so dear to German romantics; that he endowed nature with teleological structure; and that he considered aesthetic and moral values as inherent to organic nature. This learned, well-written, and well-illustrated analysis of the romantic conception of life weaves together philosophy, science, and art. It presents a penetrating account of German Romantic science and of its implications for Darwin and other naturalists later in the century. All serious scholars of the history of biology and of 19th-century culture in general will want to avail themselves of this intellectual tour de force.