Ethics and Uncertainty: In Vitro Fertilization and Risks to Women\u27s Health

Dr. de Melo-Martin examines the risks, uncertainties and public policies surrounding in vitro fertilization and women\u27s health issues

Concerns about Contextual Values in Science and the Legitimate/Illegitimate Distinction

Philosophers of science have come to accept that contextual values can play unavoidable and desirable roles in science. This has raised concerns about the need to distinguish legitimate and illegitimate value influences in scientific inquiry. I discuss here four such concerns: epistemic distortion, value imposition, undermining of public trust in science, and the use of objectionable values. I contend that preserving epistemic integrity and avoiding value imposition provide good reasons to attempt to distinguish between legitimate and illegitimate influences of values in science. However, the trust and the objectionable values concerns constitute no good reason for demarcation criteria

Reproductive Embryo Editing: Attending to Justice

The use of genome embryo editing tools in reproduction is often touted as a way to ensure the birth of healthy and genetically related children. Many would agree that this is a worthy goal. The purpose of this paper is to argue that, if we are concerned with justice, accepting such goal as morally appropriate commits one to rejecting the development of embryo editing for reproductive purposes. This is so because safer and more effective means exist that can allow many more prospective parents to achieve the same valued goal and that offer additional benefits

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

When is Biology Destiny? Biological Determinism and Social Responsibility

When is Biology Destiny? Biological Determinism and Social Responsibility Abstract I argue here that critics of biological explanations of human nature are mistaken when they maintain that the truth of genetic determinism implies the end of critical evaluation and reform of our social institutions. Such claim erroneously presupposes that our social values, practices, and institutions have nothing to do with what makes biological explanations troublesome. What constitutes a problem for those who are concerned with social justice is not the fact that particular behaviors might be genetically determined, but the fact that our value system and social institutions create the conditions that make such behaviors problematic

The home birth debate: Why scientists need to pay attention to values

This presentation is part of the The Role(s) of Values in Science track. A growing number of scientific studies show that, among low-risk women, there is no increased maternal or neonatal risk for planned home births compared to planned hospital births (Janssen et al, 2002; Fullerton et al, 2007; de Jonge et al. 2009). Nonetheless, the American Medical Association (AMA) and the American College of Obstetricians and Gyneocologists (ACOG) have both recently adopted resolutions strongly opposing home births for any woman because they believe that the safest setting for labor and delivery is in the hospital or a birthing center within a hospital complex (ACOG 2008; AMA 2008). In fact, the AMA is currently supporting legislation that would make it illegal to give birth or assist a birth out of a hospital setting (AMA 2008). Interestingly, the ACOG and AMA resolutions provide no references supporting their claim that a hospital setting is the place for labor delivery. The ACOG statement does claim, however that the studies comparing the safety and outcomes of hospital and home births are “limited and have not been scientifically rigorous.” At the same time, organizations such as the American College of Nurse-Midwives, the American Public Health Association, the Midwives of North America, and proponents of home birth have argued that the ACOG is simply disregarding the scientific evidence on the relative safety of planned homebirths and that it is applying to out-of-hospital birth scientific evidence a standard that other ACOG obstetric recommendations do not meet (Cohain 2008; Young 2008; Lowe 2009). It is true that there are several obstacles to conducting empirical studies on the relative safety of home births for low-risk women. First, because in some countries like the US a very small umber of women have planned homebirths, it is often difficult to conduct a study with a sufficiently large sample size. Second, because pregnant women cannot be assigned a place of birth regardless of their preferences, ethical and practical reasons make it impossible to conduct randomized clinical trials. Third, there are limitations related to a variety of confounding variables such as how to determine the skill of the birth attendant, when birthing location counts as planned or unplanned, and how to determine when women are low-risk. Given this state of affairs, one might be tempted to conclude that the conflict between opponents and proponents of home birth is solely the result of empirical or methodological disagreements about how to conduct home birth safety studies. Hence, where the opponents of out-of-hospital births are skeptical about the possibility of performing well-designed research studies of sufficient size, the proponents simply point to the existence of such studies. The purpose of this presentation is to argue that the dispute between opponents and proponents of the safety of home birth is not solely a product of empirical or methodological disagreements. Rather, disagreement about the evidence for the safety of homebirths is grounded on disagreements over particular epistemological and ethical values that are often implicit, as well as over the weight that those values should be given. Specifically, we show that disputes about the relative safety of home births depend on value judgments about 1) what counts as good evidence in medical science (including what sort of data should be collected, how outcomes should be measured, and whether the precautionary principle should be employed), 2) what counts as maternal and neonatal risks, 3) how risks ought to be weighed, and 4) which background assumptions are most appropriate in interpreting data. If our claims are correct, continuing this debate by focusing exclusively on methodological issues is unlikely to solve the impasse between those who reject the safety of out-of-hospital births and those who support the availability of home birth as a safe option for low risk women. What is needed, in order to move the debate about home birth forward, is to ensure that the value judgments underlying the choice of particular methodologies, the interpretation of evidence, and the design of clinical trials are made explicit and are critically evaluated by a diverse group of stakeholders. We take this case to be illustrative of a larger problem. Regardless of a growing body of literature, scientists still work under the assumption that they need not (and should not) endorse any particular social or ethical values. There is fear that doing so is likely to lead to bias. This case shows that failures to be attentive to the values at stake in research can cause scientists to talk past each other and may lead to public policy that is not really supported by the best evidence available. Good science requires careful attention to the evidence, adequate research methodologies, and suitable questions. But as necessary as all these factors are, they are not always sufficient. For some type of research at least, attention to the value judgments that underlie such research is also essential