Robert H. Blank

Assisted reproduction and reproductive rights: the case of in vitro fertilization.

In vitro fertilization (IVF) and other assisted reproduction technologies (ARTs) have become widely accepted as therapy for a wide array of fertility problems and accompanied by the rapid expansion of clinics that provide full range of ARTs. Although these technologies undoubtedly offer benefits for some individuals, they raise important questions over reproductive rights to safe and effective treatment as well as access. This article analyzes current data concerning the safety, effectiveness, and cost of IVF. It concludes that IVF and related techniques have been transformed too rapidly and easily from experimental to therapy status, despite evidence that suggests considerable caution is warranted. Unfortunately, the widespread diffusion of IVF has preceded rather than followed firm evidence of its value in extending the reproductive rights of women and couples. Resources might better be directed toward prevention of fertility problems and discovering the causes of infertility.

Biopolicy: A Restatement of Its Role in Politics and the Life Sciences

There is nothing unique in a call for increased attention to the policy dimensions of biological developments. Almost two decades ago, Caldwell (1964:2) urged a policy synthesis of scientific knowledge and ethical values in response to the public policy questions raised try the explosion of biomedicai knowledge and technology. Despite similar exhortations intermittently since that time, Somit and Peterson (1979) conclude that political scientists have yet to give adequate attention to the public policy implications of biological issues. Wiegele, too, (1979:151) sees the need for some students of biopolitics to become interested in the political policy relevance of certain aspects of the life sciences but sees only a few scholars interested in pursuing such an endeavor at this time.

The Palgrave international handbook of healthcare policy and governance

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The brain, aggression, and public policy.

Abstract Investigational, conceptual, and interventional advances in the neurosciences strain consensus in research ethics, clinical ethics, legal ethics, and jurisprudence and demand innovative adaptation in public policy. I review these advances, ask how they might change a range of policies, and conclude that their implications — particularly relating to aggression — are likely to have been underestimated.

Policy Implications of the New Neuroscience

The 1990s “Decade of the Brain” stimulated research on many fronts and resulted in considerable advancement in neuroscience. Unfortunately, we have been slow to develop a policy dialogue to anticipate and deal with vast implications. Simply put, our political and social institutions have not kept pace with these advances. At the base, policy issues center on how we interpret the implications of these developments, especially given the complexity of the subject and the speculative nature of much of the evidence to date. The issues discussed here go to the heart of the major problems facing the world today and challenge basic assumptions on both the right and the left of the political/ ideological spectrum as well as the standard social science model of behavior. As a result, the findings of neuroscience are open to ideological maneuvering designed to put the most expedient spin on their meaning. Although we know considerably more about the brain than we did even several years ago, in many ways it is still rudimentary. There are a lot of theories and suppositions, as well as a proliferation of information and findings, as scientists work to identify the anatomical connections and to understand the biochemical, molecular, and genetic mechanisms of the brain. There is a synergism and convergence of many types of research coming together in the neuroscience research area.1 The growing potential for evermore precise and effective means to predict, modify, and potentially control behavior raises many political issues. Now is the time to broaden the dialogue over how to use these new tools appropriately for understanding human behavior. After briefly describing the range of innovations in neuroscience and discussing generic policy issues, this article focuses on the policy implications of cognitive neuroscience and imaging technologies for our understanding of human behavior with special attention to violent behavior. It then speculates on what this all means in terms of policy.

Biopolicy after three decades

T hirty years ago there were at most only a handful of political scientists who were interested in or publishing about policy issues in the life sciences, concentrated primarily in the health or environmental policy areas. As a result, political science was notably absent as a discipline either in the literature, at conferences, or as members of state or national commissions, advisory bodies, or institutional review boards involving the life sciences. Although most of the early activity in biopolitics understandably was focused on the evolutionary and behavioral aspects, from the beginning Thomas Wiegele and others believed it was vital to ensure that biopolitics coverage was inclusive and that the policy dimension be a critical component. For that reason, when building the graduate program in biopolitics at Northern Illinois University, Wiegele’s first faculty hire was a policy person. This is also why one of the two articles in the premier issue of the journal was ‘‘Biopolicy: A Restatement of Its Role in Politics and the Life Sciences.’’ In that article, I argued that scholars in all areas of politics and the life sciences had significant contributions to make to biopolicy because they possessed an awareness and appreciation of biological fact and a grasp of the relevant biological issues. Until that time, the enunciation and shaping of issues in the life sciences had come from biological scientists themselves and from the then-emerging bioethics movement. I outlined a range of biopolicy issues at the individual, societal and global levels (see Table 1) and stated that these areas represented but the surface of an extensive array of biopolicy concerns that should be of interest to scholars in biopolitics. In each case, the political ramifications were widespread and complicated and I asserted that a biopolitical perspective would be helpful. I contended then that if we as political scientists were to transcend disciplinary boundaries, it was imperative that our discipline be able to offer life scientists, policy makers, and the interested broader public tangible guidance regarding the policy ramifications of the rapid advances across the life sciences. I also argued that political scientists had a useful perspective as well as substantive knowledge about the political process to offer those in the life sciences. More importantly, fundamental policy questions needed to be addressed on the basis of the unfolding knowledge of the evolutionary foundations of political systems and political behavior, such as whether the current political institutions were capable of dealing with new issues produced by biology. To that end, I argued that we must make clear the policy implications of knowledge gained through biobehavioral research, including a need for expanded time frames for public policy and for more comprehensive, anticipatory assessment of a policy on future generations. Thus, we needed to influence the very framework of policy decision making by infusing biobehavioral knowledge into research on the policy process itself. For good examples of potentially valuable contributions to this new policy framework, see Corning on synergism, Somit and Peterson on democracy, Caldwell on biocracy, and Masters, Flohr, and Losco on bureaucracy, just to cite a few. In summary, I argued for the need for a systematic effort to coordinate and integrate the then-divergent areas of biopolicy research if we were to have any input doi: 10.2990/30_1_52

Fetal protection policies in the workplace: continuing controversy in light of Johnson Controls.

Despite the Supreme Court ruling in the Johnson Controls case that fetal protection policies that exclude women from workplaces deemed hazardous to the fetus are in clear violation of the 1978 Pregnancy Discrimination Amendment, the issue of fetal health remains on the policy agenda. This article summarizes the rationale behind fetal protection policies and the current scientific evidence over workplace hazards. It also discusses the disparate court response to these policies before Johnson Controls and the confusing regulatory framework. Finally, it makes a case for including consideration of the paternal contribution to fetal injury in the workplace and calls for a balanced approach to accommodate both womens rights to employment and societys interest in healthy children.

Politics and genetic engineering.

THE PURPOSE OF THIS short note is to update readers on recent developments in, and political implications of, genetic engineering, a critical tool in the expanding field of biotechnology. Based on new understanding of the mechanisms of DNA, molecular biologists are now able to chemically cut genes or sets of genes from one organism and splice them into the DNA of another. This is called recombinant DNA (rDNA) technology. Although these techniques were first applied to bacteria and yeasts, in the last decade researchers have made remarkable strides in putting foreign genes into more complex plants and animals.

Teaching biomedical policy to undergraduates.

Biomedical choices are emerging as critical policy issues of the 1980s. Political pressures for cost containment, trends toward corporate medicine, and continuing problems of access and equity ensure biomedical issues a prominent place on the policy agenda. Students of political science should be familiar with the array of biomedical technologies that currently are challenging the tenets of medicine as well as the capacity of political institutions to resolve the resulting policy dilemmas. Based on this, a course in biomedical policy is overdue. This article outlines a course which is designed to clarify the public policy dimensions of biomedicine and develop analytical skills in the students so that they can better cope with these issues of public and personal importance. It describes some of the approaches and methods that I have found useful and summarizes a few of the problems one might expect to encounter in teaching biomedical policy.

Embryos, stem cell research, and the promise of health: comment on Gurmankin, Sisti, and Caplan.

In this issue of Politics and the Life Sciences, Gurmankin, Sisti, and Caplan report useful original data on the embryo-disposal practices of a good sample of in vitro fertilization (IVF) clinics in the United States. Their paper has important implications for the broadening debate about potential uses of cryopreserved embryos. Since a large proportion of these embryos will never be used for reproductive purposes, the primary choice becomes one of disposal as biological waste material or use in medical, primarily stem-cell, research. Although the authors rightly do not discuss these issues in this short research article, the question of the advisability and acceptability of such directed uses is most timely. Another set of issues raised by the authors relates to consent for disposal and, indirectly, to ownership of extra embryos. Clearly, the authors suggestion for full disclosure of disposal options at time of enrollment is long-since overdue. However, while the majority of clinics include donation-to-research as an option, these data do not clarify the context within which this and other options are presented to patients. What information, if any, is given to patients to help or influence their decisions? I imagine that most patients would choose to donate their embryos to research rather than having them destroyed as biological waste after a certain period, if presented with such a choice clearly expressed. Not addressed is why we have so many spare embryos in the first place, given the risks now associated with hyper-stimulating ovaries to increase egg production prior to laparoscopie harvest. This question takes us to another: should American IVF clinics adopt standards and accept regulations similar to those developed by the Human Fertilisation and Embryology Authority in the United Kingdom? Although the advantages would likely be many, as the HFEA appears to be a success in the UK,1 American professional practices will undoubtedly remain disparate and patient experiences inconsistent, making studies of the type published in this issue ever more critical. The authors contribution ? published onlinebefore-print 9 August 2004 for the third anniversary of George W. Bushs announcement of a federal stemcell research policy ? is especially timely in light of a front-burner debate now heating up American electoral politics. Despite little public understanding of terms or underlying science, distinctions among embryonic and other types of stem cells (i.e., adultderived and umbilical-cord stem cells), differences between therapeutic and reproductive cloning, and distortions of the reality (if not the promise) of stemcell research have become startlingly emotive fixtures of the 2004 presidential campaign, widely referenced by John Kerry, Ron Reagan, and others at the Democratic Convention. As usual when an issue becomes political, rhetoric on all sides tends to blur the facts. While I believe they are mistaken regarding the use of spare embryos, opponents of embryonic stem-cell use are wise to fear the creation of embryos expressly for research purposes, particularly if the more optimistic forecasts of proponents do in fact eventuate. Demand for stem cell sources would then expand rapidly because of huge commercial stakes in research and an ineluctable drive for rapid diffusion of clinical applications. Of two options to meet a burgeoning demand for cell lines, the first, permitting production of human embryos specifically for research, remains highly improbable in the current US political climate. Thus,