The beginning of human life and embryos: a philosophical and theological perspective

Life is a process that has a beginning and an end. Every health care professional, especially the one who works more at these edges, should have a very clear position on when a human life begins and ends. This is very important, since the moral acceptability of some medical applications depends on the definition of these times. There are different views from the scholars in different academic fields on the time of the beginning of human life. Although there is not much debate on the ‘humanity’ of a newborn, except some marginal philosophers, the moral status of the embryos and fetuses are still debated. Since determining the beginning and the end of life is a matter of moral decisions, the concept of human life shall be defined from a social sciences perspective, so the time of its beginning can be explored. The paper refers some bioethical concepts, like ‘human being’, ‘human person’ and ‘moral being’. By examining the issue from philosophical and different religious perspectives, it is argued that human life begins, therefore morally matters, in the womb at the beginning of the eighth week after conception.     

Assisted reproductive technology: perspectives in Halakha (Jewish religious law)

The Jewish religion is characterized by a strict association between faith and practical precepts. In principle, Jewish law has two divisions, the Written and the Oral traditions. The foundation of the Written Law and the origin of authority is the Torah, the first five books of the Scripture. This paper presents the attitude of Jewish religion to assisted reproductive therapeutic procedures such as IVF-embryo transfer, spermatozoa, oocytes, embryo donation, cryopreservation of genetic material, surrogacy, posthumous reproduction, gender preselection and reproductive and therapeutic cloning.     

JEWISH RELIGIOUS PRACTICES RELATED TO CHILDBEARING*

Practices related to childbearing and the postpartum period are influenced by religious beliefs and traditional customs. Among the Jewish people, these practices vary in accordance with the identification of the Jew with either an Orthodox, Conservative, or Reform group. The nurse-midwife must be familiar with the practices of her clients. The Jewish religion has a profound influence on the total life of the individual Jew. Specific laws govern the dietary habits, the important days of the calendar, marriage, and childbearing. Most of these religious laws are derived from statements in the Bible and the commentaries of the rabbis of old. Circumcision, one of the fundamental religious rites and ceremonies of Judaism, must be observed in a ritual manner on the eighth day after birth. At this time a Hebrew name is bestowed on the male child. A female child is named in the synagogue soon after birth. Members of the Jewish faith adhere to many different customs. It behooves the nurse-midwife to be familiar with some of the major concepts of the Jewish religion in order to better care for her Jewish clients and their families.     

The beginning of human life and its modern scientific assessment

One of the most controversial topics in modern bioethics, science, and philosophy is the beginning of individual human life. In the seemingly endless debate, strongly stimulated, by recent technologic advances in human reproduction, a synthesis between scientific data and hypothesis, philosophical thought, and issues of humanities has become a necessity to deal with ethical, juridical, and social problems. Furthermore, in this field there is a temptation to ask science to choose between opinions and beliefs, which neutralize one another. The question of when human life begins requires the essential aid of different forms of knowledge. Here we become involved in the juncture between science and religion, which needs to be carefully explored.     

Contraceptive counseling for orthodox Jewish women.

OBJECTIVES: The evaluation of birth control issues among orthodox Jews who strictly follow the Halachah (the Jewish codes of conduct). METHODS: We examine traditional Jewish concepts and practices of reproduction, review various contraceptive methods, and define problems that may arise with their use in the Jewish orthodox society. We focus on the orthodox and ultra-orthodox (Haredi) elements of the Jewish community. RESULTS: The choices of orthodox religious women are limited and determined largely by considerations related to religious doctrine. CONCLUSIONS: Understanding the religious, social and cultural background of patients, religious orthodox women in particular, enables to appropriately counsel them.     

The beginning of human life

The beginning of human life is seen differently by different individuals, groups, cultures, and religions. Embryonic and fetal life are a continuum, within which are time sequences and points—birth of a newborn, viability, neuromaturation, implantation, and conception—that may be declared as the beginning of human life. For each of these there are ethical and legal implications and considerations. Abortion laws reflect the interests of a given society at a given time. Although we have witnessed a change in the United States from virtual denial of the right to abortion to acceptance for certain reasons, abortion laws remain ambiguous. With the recent introduction of the antiprogesterones, it is conceivable that we will soon witness yet another procreation revolution with consequent increased controversy. Fundamental to productive debate and reconciliation between minority and majority groups is an understanding of the ill-defined concept of the beginning of human life.Unaffiliated     

Assisted reproductive practice: religious perspectives

It is important to those who practise reproductive techniques to learn about different religious perspectives related to reproductive health problems. Religious groups are active in influencing the public regarding bioethical positions, and this is particularly evident with issues concerning procreation, abortion and infertility therapy. The Jewish attitude towards procreation is derived from the first commandment of God to Adam to 'Be fruitful and multiply'. Judaism allows the practice of all techniques of assisted reproduction when the oocyte and spermatozoon originate from the wife and husband respectively. The attitude toward reproductive practice varies among Christian groups. While assisted reproduction is not accepted by the Vatican, it may be practised by Protestant, Anglican and other denominations. According to traditional Christian views, beginning at conception, the embryo has moral status as a human being, and thus most assisted reproductive technologies are forbidden. According to Islam, the procedures of IVF and embryo transfer are acceptable, although they can be performed only for husband and wife. Developments in science and technology and corresponding clinical applications raise new religious questions, often without clear answers. The role of theology in bioethics is integral to clarify perceived attitudes toward these developments for different religious communities. This paper presents the attitude of monotheistic religions to therapeutic procedures, such as IVF-embryo transfer, spermatozoa, oocytes, embryo donation, cryopreservation of genetic material, surrogacy, posthumous reproduction, gender preselection, reproductive and therapeutic cloning.     

What is the biblical attitude towards personal hygiene during vaginal bleeding?

OBJECTIVE: To analyze biblical passages associated with personal hygiene during vaginal bleeding. According to the Bible, a woman who is menstruating or who has pathological vaginal bleeding is unclean. Anybody who touches such a woman's bed or her personal things is also regarded as unclean and should therefore, wash carefully. Sexual relations are forbidden within 7 days from the beginning of menstruation and during pathological vaginal bleeding. Seven days after the cessation of vaginal bleeding, a woman is considered as clean, and therefore, sexual contacts are permitted. From a modern perspective sexual contacts during menses are associated with the development of chlamydial and gonococcal diseases, the risk of transmission of the human immunodeficiency virus infection, endometriosis and subsequent infertility.This report indicates that the roots of contemporary obstetric preventive medicine can be traced to Biblical times.     

A comparison of Israeli Jewish and Arab women's birth perceptions

Background

birth is a normal physiological process, but can also be experienced as a traumatic event. Israeli Jewish and Arab women share Israeli residency, citizenship, and universal access to the Israeli medical system. However, language, religion, values, customs, symbols, and lifestyle differ between the groups.

Objectives

to examine Israeli Arab and Jewish women's perceptions of their birth experience, and to assess the extent to which childbirth details and perceptions predict satisfaction with the birth experience and the extent of assessing the childbirth as traumatic.

Methods

this study was conducted in two post partum units of two major public hospitals in the northern part of Israel. The sample included 171 respondents, including 115 Jewish Israeli and 56 Arab Israeli women who gave birth to their first (33%) or second (67%) child. Respondents described their childbirth experiences using a self-report questionnaire 24–48 hours after childbirth.

Findings

the Arab women were much less likely to attend childbirth preparation classes than the Jewish women (5% versus 24%). Forty-three per cent of the respondents reported feeling helpless, and 68% reported feeling lack of control during childbirth. Twenty per cent of the women rated their childbirth experience as traumatic, a rate much lower than the rate of medical indicators of traumatic birth (39%). The rate of self-reported traumatic birth was significantly higher among the Arab women than among the Jewish women (32% versus 14%). A higher percentage of the Arab women reported being afraid during labour (χ²=4.97, p<.05), expressed fear for their newborn's safety (χ²=12.44, p<.001), and reported that the level of medical intervention was excessive in their opinion, as compared to the Jewish women (χ²=5.09, p<.05; χ²=7.33, p<.01). However, both the Arab and Jewish women reported similar numbers of medical interventions and levels of satisfaction with their medical treatment.

Conclusions

despite universal access to the Israeli health care system, Arab Israeli women use fewer perinatal medical resources and subjectively report more birth trauma than Jewish Israeli women. Yet, they give birth in the same hospitals with the same practitioners and report similarly high levels of satisfaction with the medical services. Taking into account the fact that perceptions of the birth experience differ between ethno-cultural groups will enable professionals to better tailor intervention and support throughout childbirth in order to increase satisfaction and minimise trauma from the experience.     

Patient satisfaction and the impact of written material about postpartum contraceptive decisions

OBJECTIVE: The purpose of this study was to evaluate the impact of written educational material about patient satisfaction and decision-making regarding postpartum contraception. STUDY DESIGN: Baseline patient satisfaction and effectiveness of contraceptive counseling on a postpartum unit was evaluated with the use of a self-administered questionnaire. Data were compared with patients who received additional comprehensive written educational material during their postpartum hospitalization. RESULTS: A total of 109 women participated in the study (control subjects, 53; intervention group, 56). Demographics and patient satisfaction with contraceptive counseling were similar between groups. Thirty-four percent of the control subjects reported having received some sort of written information; all women in the intervention group received a standardized comprehensive booklet of information during their postpartum stay (P <.01). Among the women who received written information, the intervention group was more likely to state that written material contributed to their ultimate choice in birth control (P <.01). CONCLUSION: The postpartum distribution of written material about contraceptive options increases a woman's ability to make an informed decision regarding birth control.     

Giving birth: the voices of Orthodox Jewish women living in Canada

OBJECTIVE: To describe the meaning of the childbirth experience to Orthodox Jewish women living in Canada. DESIGN: In this phenomenologic study, audiotaped interviews were conducted. Tapes were transcribed verbatim and analyzed for emergent themes. Demographic data also were collected. SETTING AND PARTICIPANTS: Thirty Orthodox Jewish women who had given birth to healthy full-term newborns at a university-affiliated Jewish hospital in Montreal, Canada, participated in the study. Data were collected within 2 weeks after childbirth, either in the mother's postpartum hospital room or in her home. RESULTS: The following themes reflecting spiritual/cultural dimensions of the childbirth experience were identified: (a) birth as a significant life event, (b) birth as a bittersweet paradox, (c) the spiritual dimensions of giving birth, (d) the importance of obedience to rabbinical law, and (e) a sense of support and affirmation. CONCLUSION: This study documents cultural, religious, and spiritual dimensions of the childbirth experience of Orthodox Jewish women living in Canada. Knowledge and appreciation of the multiple dimensions of childbirth reflected by this study's findings can contribute to holistic and culturally competent nursing care of women and newborns.     

Racial discrimination and the black-white gap in adverse birth outcomes: a review

Introduction: The purpose of this integrative review was to evaluate what is known about the relationship between racial discrimination and adverse birth outcomes. Methods: A search of the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PsycINFO was conducted. The keywords used were: preterm birth, premature birth, preterm delivery, preterm labor, low birth weight, very low birth weight, racism, racial discrimination, and prejudice. Ten research studies were reviewed. All of the studies included African American women in their samples, were conducted in the United States, and were written in English. We did not limit the year of publication for the studies. Data were extracted based on the birth outcomes of preterm birth, low birth weight, or very low birth weight. Results: A consistent positive relationship existed between perceptions of racial discrimination and preterm birth, low birth weight, and very low birth weight. No relationship was found between racial discrimination and gestational age at birth. Discussion: Future research should explore the effects of racial discrimination as a chronic stressor contributing to the persistent gap in birth outcomes between racial groups.     

The Greek Orthodox position on the ethics of assisted reproduction

In dealing with reproduction, the Church believes that every human being has a beginning but has no end; this is why conception constitutes an event of unique importance. The exact moment of the beginning of life is unknown to man, but the logic of sexual intercourse without reproduction and of reproduction without sexual intercourse must be seen with concern. Irrespective of the way it is conceived, the embryo has both a human beginning and a human perspective and in it, along with cellular multiplication, another process takes place, the beginning and development of its soul. Although modern technology has greatly contributed to health research, its irrational use threatens to desacralize man and to treat him as a machine. For this reason, all modern techniques of artificial fertilization have ethical and spiritual parameters that compel the Church to state Her reservations. The Church cannot recommend assisted reproduction as the solution to infertility; instead, She proposes a non-secularized perception on life that guarantees simplicity, peace, abstinence and mutual trust between spouses. She does not oppose resorting to medical help, but, at the same time, suggests that men and women render their life into the hands of God.     

Chirurgische Behandlung weiblicher genitaler Fehlbildungen im Kindesalter

Disorders of sexual differentiation (DSD) is an umbrella term for atypical development of chromosomal, gonadal or phenotypic sex. Resulting anatomic conditions and biological mechanisms vary widely. During the past few decades, an intense discussion among physicians, ethicists and concerned persons led to a paradigm shift regarding recommendations of therapy. This article provides a summary of the surgical management of 46,XX DSD girls with congenital adrenal hyperplasia, urogenital sinus, persistent cloaca, and bladder or cloacal exstrophy. The focus lies on surgical reconstruction including the contentious issues of indications for surgery, ideal time point of surgery, different surgical procedures and long-term complications. However, the paradigm of early gender assignment has been challenged by the results of clinical and basic science research, which show that gender identity development likely begins in utero.     

Oral contraceptives for inducing ovulation delay in orthodox Jewish women: a report of 2 cases

BACKGROUND: Orthodox Jewish women are prohibited from participating in sexual intercourse from the start of menstruation to 7 days after the end of flow, when they participate in a ritual bath. CASE: Two orthodox Jews with ovulation prior to initiating sexual intercourse were treated with oral contraceptives to delay ovulation. CONCLUSION: Oral contraceptive treatment strategies are effective at delaying ovulation until after the ritual cleansing for orthodox Jewish women with short follicular phases.     

Abigail's story

Child death before term affects many parents. This article is the story of one of those circumstances, but quite a rare one. Revd. Daniel Richards talks of how his daughter Abigail grew to five months before it was discovered she had anencephaly. The article will discuss: Narrative of the situation: events and feelings. The excellent standard of care received by those present: despite difficult circumstances, the behaviour of the health professionals dealing with the situation was sensitive and compassionate The helpful/unhelpful things that are said and done--not simply by those working there, but that people everywhere need to know about how to approach situations with the sensitivity and care required. The holistic value of what it means to be empathetic. Basic encouragement to those seeking midwifery/healthcare that what they do is intrinsic to life and the gift of life.     

Racial and ethnic disparities in preterm birth: the role of stressful life events

OBJECTIVE: The purpose of this study was to examine racial-ethnic disparities in stressful life events before and during pregnancy and to assess the relationship between stressful life events and racial-ethnic disparities in preterm birth. STUDY DESIGN: Using data from the Pregnancy Risk Assessment Monitoring System, we conducted a retrospective cohort analysis of a sample of 33,542 women from 19 states who were delivered of a live-born infant in 2000. Principal component analysis was used to group 13 stressful life events into 4 stress constructs: emotional, financial, partner-related, and traumatic. Racial-ethnic disparities in stressful life events were assessed with the use of bivariate and multivariate regression analyses. The contribution of stressful life events to racial-ethnic disparities in preterm birth was evaluated with the use of stepwise regression model and interaction terms. RESULTS: Black women and American Indian/Alaska Native women reported the highest number of stressful life events in the 12 months before delivery. Compared with non-Hispanic white women, black women were 24% more likely to report emotional stressors, 35% more likely to report financial stressors, 163% more likely to report partner-related stressors, and 83% more likely to report traumatic stressors. The addition of stress constructs to the stepwise regression model minimally affected the association between race-ethnicity and preterm birth, and none of the stress constructs were significantly associated with preterm birth. There were no significant interaction effects between race-ethnicity and stress on preterm birth, except for a modest effect between black race and traumatic stressors. CONCLUSION: There are significant racial-ethnic disparities in the experience of stressful life events before and during pregnancy. Stressful life events do not appear to contribute significantly to racial-ethnic disparities in preterm birth.     

Term delivery in twin pregnancy

We analyzed the data on 55,839 births that taken place in 1998 year in the southeast region of Poland. The incidence of twin pregnancy was about 1%. A half of them delivered before 259 day of gestational age, the beginning of birth occurring norm for human. This means that onset of this norm for singleton pregnancies is the mean of 12 weeks births occurring norm (215-303 days of gestational age) for multifetal pregnancies simultaneously. The particular meaning has prevention of preterm delivery and in this case the computer-aided monitoring of pregnancy and prediction of birth date is a very useful invention.     

Just Another Day in a Woman's Life? Women's Long-Term Perceptions of Their First Birth Experience. Part I

ABSTRACT: This study explored and analyzed the long-term impact of the birth experience on a group of 20 women from the natural childbirth culture of the late 1960s and early 1970s. The data consisted of 1) a structured labor and birth questionnaire and an unstructured account of their experiences written shortly after their babies were born; 2) a similar questionnaire and account written 15 to 20 years later; and 3) a transcribed one- to one-and-a-half-hour interview during which each woman's memories and perceptions were discussed. Women reported that their memories were vivid and deeply felt. Those with highest long-term satisfaction ratings thought that they accomplished something important, that they were in control, and that the birth experience contributed to their self-confidence and self-esteem. They had positive memories of their doctors' and nurses' words and actions. These positive associations were not reported among women with lower satisfaction ratings.