Legal and ethical issues regarding-the autonomy of the pregnant woman with special reference to foetal surgery and treatment

Though the pregnant woman usually wants her foetus to be born a healthy child, and though she usually concurs with the physician as to the best method by which to attain this goal, there are circumstances when their goals and wishes will not concur. Due to the recent 'reproduction revolution', the foetus is now treatable in a multitude of circumstances and is no longer a mysterious entity whose protection lies solely in the hands of God or chance. Therefore, a possible conflict of interests arises between the physician or the government, who may have the interest of the foetus at heart (due to their interest in the sanctity of life) and the pregnant woman, who may have her interest in freedom from unwanted bodily intrusion at heart. Gerald Dworkin's theory of autonomy is compared to other theories of liberty and autonomy, and is favoured for its legal applicability and then applied to the scenario of the pregnant woman. The thesis aims to legally regulate the conflict of interests recommending that out of a concern for her individual autonomy, the pregnant woman should at no point be forced into unwanted bodily intervention. On the other hand, it is recommended that her right to demand treatment on her own behalf, or on behalf of the foetus should be made subject to governmental control due to the potential of the foetus to become human, and due to its human origins. However, the pregnant woman will still retain some protection due to the inequality with other woman that would otherwise arise. It is with the most recent technologies that this thesis proves most important, for the possibilities of genetically or cosmetically altering the foetus are increasing, and it is important that the law controls such treatments to prevent the trampling of rights

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo