Multiple pregnancy: legal and ethical issues

Multiple pregnancy is increasingly considered a complication of in vitro fertilization (IVF) and ovarian stimulation for natural fertilization. Harms to fetuses, newborn and older children, mothers, families, and healthcare systems are encouraging single embryo transfer. When patients knowingly accept multiple pregnancy risks from IVF or ovarian stimulation, they are unlikely to succeed in litigation against healthcare providers for wrongful pregnancy or wrongful birth. More challenging are impaired children's claims for "wrongful life." These are unlikely to succeed against parents, but courts are ambivalent to claims against healthcare providers. Historically, courts rejected these claims, under the principle that live birth is not a legal injury. European and other courts, however, have been more sympathetic to these claims. Multiple pregnancy treated by fetal reduction is not usually found to offend abortion laws. This poses ethical concerns, however, of "lifeboat ethics," involving how fetal reduction choices are made.     

Ectopic pregnancy and emergency care: ethical and legal issues.

Ectopic or tubal pregnancy presents a medical emergency that requires prompt treatment in order to contain risks of maternal death and morbidity, including loss of future fertility. Medical circumstances involving individual patients and resources of the prevailing health care system will determine the options and means of treatment. Termination of ectopic pregnancy does not constitute or directly implicate abortion. Any practice of deliberately delaying treatment of reliably diagnosed ectopic pregnancy, on non-clinical grounds, until rupture of the fallopian tube has occurred or is imminent, in order to justify termination of the ectopic pregnancy on grounds of saving the patient's life, is unethical and illegal. Those who undertake or counsel deliberate delay of medically-indicated treatment can be charged with criminal offences and civil (non-criminal) liability, and medical professional misconduct. On reliable diagnosis, prompt treatment to remove ectopic pregnancy is legally justified, and ethically and legally required.     

The use of pornographic materials by adolescent male cancer patients when banking sperm in the UK: legal and ethical dilemmas

Increased awareness of the importance of fertility concerns to teenage cancer survivors is leading to growing numbers of male teenagers being offered sperm banking at the time of diagnosis. This is now extending to males diagnosed with other conditions where gonadotoxic agents are used in treatment. The storage of sperm in these circumstances is a challenging aspect of health care, given the complex issues and timescale involved. UK law has been enacted to protect legal minors from the potentially harmful effects of exposure to pornographic materials, yet there is reason to suppose that their use in this context could have therapeutic benefit in aiding successful masturbation. This paper uses material gained through consultation with the eleven largest UK sperm banks and 94 male teenage cancer survivors, to discuss the associated legal and ethical dilemmas, including those around the role of parents/carers. Findings suggest that there is variable practice in sperm banks, that almost a quarter of teenage males wanted access to soft porn when banking sperm, and half wanted to bring in their own materials. It concludes that there is an urgent need for any legal barriers to the therapeutic use of pornographic materials to be understood and examined.     

Medical errors: legal and ethical responses.

Liability to err is a human, often unavoidable, characteristic. Errors can be classified as skill-based, rule-based, knowledge-based and other errors, such as of judgment. In law, a key distinction is between negligent and non-negligent errors. To describe a mistake as an error of clinical judgment is legally ambiguous, since an error that a physician might have made when acting with ordinary care and the professional skill the physician claims, is not deemed negligent in law. If errors prejudice patients' recovery from treatment and/or future care, in physical or psychological ways, it is legally and ethically required that they be informed of them in appropriate time. Senior colleagues, facility administrators and others such as medical licensing authorities should be informed of serious forms of error, so that preventive education and strategies can be designed. Errors for which clinicians may be legally liable may originate in systemically defective institutional administration.     

Conflict of interest: legal and ethical aspects.

Conflicts of interest arise when those who owe conscientious duties to others appear to have personal interests that might tempt them to subordinate those duties to their self-interest. Conflicts of interest are distinguishable from conflicts of commitment, which arise when individuals bear two or more mutually exclusive duties to others. If persons in conflicts of interest favor their self-interest, they may violate binding legal duties such as fiduciary duties. Conflicts arise when, for instance, medical practitioners refer their patients to other practitioners in exchange for payments (fee splitting), and when they gain secondary incomes such as from testing patients' samples in laboratories in which they hold ownership or investment interests. Financial dealings with commercial sponsors may place researchers in apparent conflicts of interest with research subjects. When conflicts of interest are unavoidable, they may be resolved by appropriate disclosure.     

Anti-E alloimmunization in pregnancy: management dilemmas

Compared to anti-D alloimmunization, anti-E alloimmunization is a less common cause of hemolytic diseases of the newborn. Being a less potent immunogen, clinical manifestations of anti-E alloimmunization are more variable and usually of less severity. However, the clinical obstetric management of these cases of anti-E alloimmunization is just as challenging. We report here the management of a patient with anti-E alloimmunization to illustrate the controversies of invasive and non-invasive monitoring in the management of such cases.     

Obstetrical delivery of the HIV-positive woman: legal and ethical considerations

Every year, thousands of perinatally HIV-infected children are born, resulting in debate about appropriate HIV treatment and interventions for pregnant women. Recent medical studies endorse the use of the cesarean delivery to reduce vertical (mother to infant) transmission of HIV. In addition to medical questions, this practice raises legal and ethical considerations for the attending physician. In the context of AIDS prevention, the potential exists for reasoned and well-informed decision making to give way to encouragement, and even duress, in cases where a woman refuses recommended surgical delivery. However, in such cases, the role of the physician should remain as that of an informed educator and counselor, enabling the patient to exercise her autonomy and personal choice within her social and cultural context.     

Crossing the line: the legal and ethical problems of foreign surrogacy

UK law has for many years taken a careful approach to surrogacy, neither banning it nor allowing it to develop unrestrictedly. This careful middle approach seeks to balance permitting what may be a last hope for infertile couples against a wider public policy that bars commercialized reproduction: surrogacy is allowed in the UK, provided it is consensual and involves the payment of no more than reasonable expenses. But in an increasingly globalized world, patients are crossing borders for treatment, often to places where such restrictions on the commerciality or enforceability of surrogacy arrangements do not apply. The resulting conflicts of law can be a minefield, and this makes the maintenance of the UK's careful legal balance increasingly untenable.     

The quality of dying: financial, psychological, and ethical dilemmas

The quality of life of terminally ill patients depends on the information base and psychosocial skills of their health care team. Patients have the right to choose to forego medical care, and it is important to learn the who, what, when, and where of informing a patient and supporting their decisions. Planning for care outside the hospital must include psychological support for the patient and family during the initial transition to issues involving the terminal phase of an illness. Although there is a remarkable array of potential care choices--home hospice, hospital-based hospice, and varying nursing home coverage--the access of an individual patient to these may vary widely. The impoverishment of the family, monetarily and physically; the denial of alternatives, even though potentially more cost-effective; and lack of coverage for a significant portion of the patient population can make humane care at the end of life impossible. Physicians have an ethical responsibility to inform themselves about terminal care and to advocate improved coverage at the end of life.     

Maternal confidentiality: an ethical,professional and legal duty

This paper will briefly discuss the duty of confidentiality from an ethical, legal, and professional perspective, especially maternal confidentiality where any analysis should consider the consequences for the patient, the fetus and the father. We will explain why patient confidentiality is considered vital and delineate the ways in which the General Medical Council and the laws of England and Wales protect the rights of patients to privacy. We will also discuss situations where breaches are permissible or mandatory and remind clinicians of traditional challenges that exist in trying to maintain patient privacy. We will consider the issue of confidentiality in the age of the internet.     

Removing organs from anencephalic infants: ethical and legal considerations

Removing organs from anencephalic infants for transplantation into other infants offers benefits to the recipients, the family of the anencephalic infant, and to society. No interest of the anencephalic infant appears to be violated. Nonetheless, there are serious ethical and legal barriers to such proposals, primarily owing to risks for other patients whose interests might be at risk if barriers against killing were weakened. Five proposals for avoiding these pitfalls are analyzed. There should be consensus on the justifications for such transplants before the practice becomes accepted.     

Early pregnancy wastage: ethical considerations

Information on early embryo wastage is relevant for debating the status of human embryos. Two main points of view confront each other. Theists hold that human embryos should be treated as human persons from the moment of conception because, even accepting that human beings are the fruit of evolution, they are part of a divine project. Without a developmental event prior to which the human embryo could not be considered a human being, embryos should be regarded as if they were human subjects. After all, if one believes in the resurrection of the dead, it makes no difference at what stage one's life ends. Secularists oppose the idea of granting absolute value to human life from its beginning because early human embryos lack individuality and sentience. Personifying embryos is morally absurd because it would mean that countless human beings never had even the slightest chance to express their potential and, in the light of this catastrophic loss, one would expect early pregnancy wastage to have become an important research priority; this is not the case. In practical terms, most Western countries have legalized first-trimester abortion, de facto giving embryos a lower status than that of full person.     

Assisted reproduction project: legal constraints, ethical considerations

The ART law on that governs the IVF assisted reproduction project in many ways seems more or less contestable from an ethical point of view, even casting doubt on the justice of the legislative measures in the hope that ethical reflection would be pursued at the institutional level as well as in clinical ethical centers, so that more human solutions can be found.     

Cryopreservation of embryos: Medical,ethical, and legal issues

Conclusion The option of cryopreservation has proven to be an extraordinarily useful procedure in assisted reproductive technology. At present, the best programs report an 90% survival rate of cryopreserved material. Furthermore, the pregnancy rate per thawed embryo transfer approximates the pregnancy rate of fresh embryo transfer. It is obviously of the utmost importance that these excellent results not be overshadowed by neglect of the problems of cryopreservation. IVF programs should put emphasis on ethical and legal issues: otherwise there is a danger that the advantages of cryopreservation will be lost.